The debate about whether depressive disorders should be divided into categories or arrayed along a continuum has gone for decade, without resolution. In our review, there is more evidence consistent with the spectrum concept than there is with the idea that depressive disorders constitute discrete clusters marked by relatively discontinuous boundaries. First, "depression spectrum", "is there a common genetic factors in bipolar and unipolar affective disorder", "threshold model of depression" and "bipolar spectrum disorder" are reviewed. And, a new subtype of depression is so called SeCA depression that is a stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression. SeCA depression is discussed. But, there is with the idea that depressive disorders constitute discrete subtypes marked by relatively discontinuous boundaries. This subtypes of depressive disorder were reviewed from a variety of theoretical frames of reference. The following issues are discussed ; Dexamethasone suppression test(DST), TRH stimulation test, MHPG, Temperament Character Inventory(TCI), and heart rate variability(HRV).
Depression* ; Depressive Disorder ; Dexamethasone ; Heart Rate ; Methoxyhydroxyphenylglycol ; Temperament

If peptic ulcer perforates in the presence of shock or concurrent medical disease or delay of operation, the postoperative morbidity and mortality are high. Years ago most discussion was on whether urgent definite surgery was the most effect therapy, nowadays there is a tendency to less invasive measures in risk situation. Although the simple closure or omental patching has its weak point of high frequency of symptomatic relapse, it is a simple and safe method with the advantage of having a low complication rate than other definite operations. So many surgeons frequently use this simple method in high risk situation. But in the rare instance of large perforation of prepyloric ulcer, this simple closure method is not safe to apply. The authors experienced an unusual case of large prepyloric ulcer perforation in an 80 year old female who had undergone a previous operation(choledocho-duodenostomy). Moreover she had suffered from several concurrent medical diseases and the operation was delayed. We succeeded in repairing the perforation using controlled gastrostomy and omental patching method, and present this case with a review of the literature.
Aged, 80 and over ; Female ; Gastrostomy* ; Humans ; Mortality ; Peptic Ulcer Perforation* ; Peptic Ulcer* ; Recurrence ; Shock ; Ulcer

One author's name is misspelled. Correct Seungho Rhu into Seungho Ryu.

This study was designed to evaluated the effects of opioid receptor agonists on the spontaneous alternation behaviour in an animal model of obsessive-compulsive disorder in rats. According to the theory that dopamine is related to the biological etiology of obsessive-compulsive disorder, the effect of the nalbuphine(opioid kappa agonist) and the tramadol(opioid mu agonist), which act as manipulating agents on the inhibition or stimulation of dopamine release, in the spontaneous alternation behaviour were evaluated. 24 hours prior to the experiment, rats were food-deprived. These rats were put into the T-maze, in which white and black goal boxes were baited with small amounts of chocolate milk. Each rat was given 2 set of 7 trials during which it was placed in the start box and allowed to choose the one of the goal boxes for each time. After identifying the stable baseline of spontaneous alternation behaviour, nonselective 5-HT agonist 5-MeODMT(1.25mg/kg/IP) disrupted spontaneous alternation. Rats were stratified into fluoxetine(10mg/kg/IP), nalbuphine(10mg/kg/IP), tramadol(46.4mg/kg/IP), and saline(0.5cc/IP) injection group with experimental drug treatment for 21 days. The effects on the 5-M?DMT(1.25mg/kg/IP) induced disruption of spontaneous alternation behaviour were checked at the next day of discontinuation of drug treatment. The results were as follows : 1) At the day after 21 days of the drug treatment, the nalbuphine treated group and the fluoxetine treated group showed significant difference from the tramadol treated group and the saline treated group in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. 2) Within each drug treatment group, the fluoxetine treated group showed significant difference between before and after the treatment of fluoxetine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. And also, the nalbuphine treated group showed significant difference between before and after the treatment of nalbuphine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. There was no difference between the baseline and after the treatment of nalbuphine in the 5-MeODMT(1.25mg/kg/IP) induced suppression of spontaneous alternation behaviour. We indentified that the opioid kappa agonist that act as dopamine release inhibitor affect the spontaneous alternation behaviour which is an animal model of obsessive-compulsive disorder in rat.
Animals ; Cacao ; Dopamine ; Fluoxetine ; Milk ; Models, Animal ; Nalbuphine ; Obsessive-Compulsive Disorder ; Rats* ; Receptors, Opioid ; Serotonin Receptor Agonists ; Tramadol

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.
Anesthesia, General* ; Deglutition Disorders ; Dysarthria ; Female ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Intubation, Intratracheal* ; Mastectomy, Modified Radical ; Middle Aged ; Paralysis ; Physical Examination ; Tongue

OBJECTIVE: There is a rich literature confirming the default mode network found compatible with task-induced deactivation regions in normal subjects, but few investigations of alterations of the motor deactivation in patients with intracranial lesions. Therefore, we hypothesized that an intracranial lesion results in abnormal changes in a task-induced deactivation region compared with default mode network, and these changes are associated with specific attributes of allocated regions. METHODS: Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) during a motor task were obtained from 27 intracranial lesion patients (mean age, 57.3 years; range 15-78 years) who had various kinds of brain tumors. The BOLD fMRI data for each patient were evaluated to obtain activation or deactivation regions. The distinctive deactivation regions from intracranial lesion patients were evaluated by comparing to the literature reports. RESULTS: There were additive deactivated regions according to intracranial lesions: fusiform gyrus in cavernous hemangioma; lateral occipital gyrus in meningioma; crus cerebri in hemangiopericytoma; globus pallidus, lateral occipital gyrus, caudate nucleus, fusiform gyrus, lingual gyrus, claustrum, substantia nigra, subthalamic nucleus in GBM; fusiform gyrus in metastatic brain tumors. CONCLUSION: There is increasing interest in human brain function using fMRI. The authors report the brain function migrations and changes that occur in patients with intracranial lesions.
Basal Ganglia ; Brain ; Brain Neoplasms ; Caudate Nucleus ; Globus Pallidus ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Magnetic Resonance Imaging ; Meningioma ; Oxygen ; Substantia Nigra ; Subthalamic Nucleus

A 70-year-old woman underwent cardiopulmonary bypass surgery for aorta dissection. After 10 days she developed a vertical gaze palsy, and 2 months later she presented with dysarthria, bradykinesia, postural instability, blepharospasm, and truncal tilt to the left. Brain imaging indicated old lacunes in the bilateral thalamus. Her symptoms remained unchanged during a 4-year follow-up, which seems to be incompatible with progressive supranuclear palsy (PSP). However, the clinical features of this case were suggestive of PSP-like syndrome after cardiopulmonary bypass surgery.
Aged ; Aorta* ; Blepharospasm ; Cardiopulmonary Bypass ; Dysarthria ; Female ; Follow-Up Studies ; Humans ; Hypokinesia ; Neuroimaging ; Paralysis ; Parkinsonian Disorders ; Supranuclear Palsy, Progressive ; Thalamus

PURPOSE: To analyze the clinical and radiological outcomes of total hip replacement arthroplasty (THRA) for the treatment of femur neck fractures in the elderly. MATERIALS AND METHODS: Femur neck fracture patients older than70 years of age, who showed good preoperative walking ability without dementia,and underwent THRA between February, 2008 and March, 2010 were reviewed retrospectively. Twelve patients(13 hips) were enrolled and the mean ages of the patients were 79.4(70-91). The mean follow-up period was 31(20-49) months. The modified Koval index was used to determine the clinical outcome. Inclination and anteversion of acetabular cup, loosening, osteolysis, periprosthetic fractures and dislocations were evaluated using the radiographs. RESULTS: The modified Koval index decreased from 4.92 to 4.84 at the final follow-up, but the decrease was not significant (P=0.339). Dislocations occurred in 2 cases postoperatively(2/13, 15.4%). No other complications were encountered. CONCLUSION: The THRA for the treatment of femur neck fractures in elderly patients over 70 years of age showed satisfactory clinical and radiological outcomes. Nevertheless, caution should be taken regarding the relatively high incidence of postoperative dislocations.
Aged* ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Dislocations ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Follow-Up Studies ; Humans ; Incidence ; Osteolysis ; Periprosthetic Fractures ; Retrospective Studies ; Walking

BACKGROUND AND OBJECTIVES: The objectives of the study are to investigate the incidence and characteristics of nasal obstruction and their association with the types and direction of external deviation among patients with a deviated nose. MATERIALS AND METHODS: Eighty-eight patients with a deviated nose without mucosal diseases in the nose from January 2004 to July 2005 were retrospectively reviewed. The overall incidences of nasal obstruction were assessed. Incidences of nasal obstruction by the types and direction of deviation in the external nose and by the direction of the septal deviation were also assessed. RESULTS: Seventy-two patients (81.8%) were found to suffer from various degrees of nasal obstruction. Left sided obstruction was more dominant irrespective of the direction of external nose. There was no relationship between the dominant sides of nasal obstruction and the type and the direction of the deviation of external nose. Among patients with a linear shaped deviated nose, the septum tends to deviate to the opposite side of the direction of the external nose. CONCLUSION: Nasal obstruction is commonly found among patients with a deviated nose. But not all patients suffer from nasal obstruction. To attain good aesthetic and functional results, a rhinoplastic surgeon should pay particular attention to this common findings among patients with deviated nose.
Humans ; Incidence ; Nasal Obstruction* ; Nose* ; Retrospective Studies

Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation.
Anesthesia, General ; Arytenoid Cartilage ; Dislocations* ; Early Diagnosis ; Female ; Gynecologic Surgical Procedures ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal* ; Middle Aged ; Prognosis ; Vocal Cords