Switch to another newer antipsychotic is indicated when current treatment is insufficiently effective or is associated with drug related adverse events that impair quality of life. There are two main switching strategies. The first `clean method' is to discontinue the previous treatment and then to start the new one. The second, more preferable method is cross-tapering where the previous and the new antipsychotic treatment are overlapped. Abrupt switching is usually indicated when severe side effects are present, but it may produce withdrawal problems or higher risk of relapse. When overlapping the previous and new treatments in cross-tapering, the daily dose of the former is tapered down progressively (by approximately 30-50% every 3 to 7 days) and the latter is started and titrated up progressively to achieve a therapeutic response. In relation to the speed of cross-tapering, it is important to maintain adequate therapeutic level of overlapping drugs to avoid relapse or adverse events associated with subtherapeutic or too high level of overlapping drugs. Caution is advised in patients who have suffered recent relapse, a severe psychotic episode or who are being treated as outpatients. Anticholinergic medication, if needed, should be continued for 2-4 weeks after the switch has been made. Treatment should be individualized. At least three months of full-dose treatment is required for the decision of successful drug switch. Patient education and frequent monitoring is essential in switching medications. Switch from clozapine need more caution and clozapine should be tapered slowly for 2-6 weeks except in inevitable cases. In this review, the advantages of switching to a newer antipsychotic drug in the management of patients with schizophrenia have been demonstrated while successful switching strategies being presented.
Clozapine ; Humans ; Outpatients ; Patient Education as Topic ; Quality of Life ; Recurrence ; Schizophrenia

Most informations on the efficacy and safety of new antipsychotic durgs are based on short-term clinical trials. Short-term studies are usually conducted as well-controlled, randomized, comparative studies. However, they do not provide any informations about delayed efficacy or late-onset adverse events such as tardive dyskinesia, functional recovery, relapse or recur rates and maintenance treatment. This is why there is growing interest in long-term clinical studies of antipsychotic drugs. The number of well designed long-term studies, however, are limited compared to that of short-term studies because of practical reasons as well as some methodological issues. In this article, the authors reviewed original research papers on the long-term treatment outcomes of risperidone while discussing the methodological considerations.
Antipsychotic Agents ; Humans ; Movement Disorders ; Recurrence ; Risperidone* ; Schizophrenia*

Total abdominal hystrectomy is the most common surgery of Gynecology. It's complication are taken very important. Although neuropathy, especially femoral nerve injury, is rare, recently we have experienced a case of femoral neuropathy after total abdominal hystrectomy. We present this case with a brief review of literature.
Femoral Nerve* ; Femoral Neuropathy ; Gynecology

Congenital bronchoesophageal fistula in the adult is rare, especially Braimbridge type III is very rare. We experienced congenital bronchoesophageal fistula associated intrapulmonary bronchogenic cyst. The patient was a 38-year-old male with chief complaints of coughing and abdominal pain 3 days before admission. Esophagogram revealed a fistulous tract between esophagus and cystic lesion in RLL. Fistulectomy and right lower and middle bilobectomy was performed. The postoperative course was uneventful.
Abdominal Pain ; Adult ; Bronchogenic Cyst* ; Cough ; Esophagus ; Fistula* ; Humans ; Male

It suggested that localized fibrous tumor of the pleura originated from a primitive submesothelial mesenchymal cell. The criteria used for a judgment of malignancy were high cellularity and mitotic activity(more than four mitotic figures per 10 high-power fields), pleomorphism, hemorrhage, and necrosis. This 62 years female was admitted with dyspnea and cough. Chest X-ray and CT scan showed a huge mass in right thorax. A 23X18X12 cm, 2 Kg sized mass was excised, and it was collase the right lower lobe and right middle lobe and was adhered to the diaphragm. Pathologically, the tumor was composed high cellularity, fascicle of the spindle cells, and high mitotic numbers(27 mitosis/10HPF). Immunohistochemically, it was positive for vimentin and CD34. This tumor was diagnosised to the malignancy localized fibrous tumor. We experience a case of pleural malignant fibrous tumor and report this case with the review of literature.
Cough ; Diagnosis ; Diaphragm ; Dyspnea ; Female ; Hemorrhage ; Humans ; Judgment ; Necrosis ; Pleura ; Pleural Neoplasms ; Solitary Fibrous Tumor, Pleural* ; Solitary Fibrous Tumors* ; Thorax ; Tomography, X-Ray Computed ; Vimentin

Cardiac myxoma is rare and has protean clinical manifestations mimicking various disease. Unless clinician has a high index of suspicion, the diagnosis can be easil missed. However diagnosis is all the more important since surgery can be dramatically successful, where as untreated myxoma invariably leads to death. Cardiac myxoma accounts for 50% of primary cardiac tumor and mainly originates in left atrium.(75%). The features of myxoma can be described under the three headings : Constitutional, obstructive, and embolic. From 1977 to 1985, the authors have experienced 30 cases of cardiac myxoma, one of which recurred. Of 29 patients, 8 were male and 21 were female. Their ages ranged from 11 to 55 years with average of 39.8 years. Constitutional manifestation was found in 25 of the 27 patients, obstructive manifestation in 27, and embolic phenomenon in 5. The diagnosis of myxoma was made on the basis of 2-D echocardiography. The sensitivity was 100%. Except 1 case who refused operation, all received surgical treatment. Immediate postoperative complication occurred in 6 patients(23%). Among them serious complication could be found only in 2 cases(7.7%). During long term follow up there was one recurrence and one patient with right ventricular myxoma has tricuspid regurgitation. In other cases, we could not found any problems.
Diagnosis ; Echocardiography ; Female ; Follow-Up Studies ; Head ; Heart Neoplasms ; Humans ; Male ; Myxoma* ; Postoperative Complications ; Recurrence ; Tricuspid Valve Insufficiency

Amenorrhea is one of the well-known side effects of antipsychotics in women. It is associated with hyperprolactinemia induced by dopamine blocking effect of antipsychotics. Administration of bromocriptine which belongs to dopamine agonist may reverse amenorrhea and hyperprolactinemia. However dopamine agonist has been reserved in the treatment of antipsychotics-induced amenorrhea because of concern about exacerbation of psychotic symptoms. This case series study was designed to determine whether bromocriptine can be used safely in schizophrenic patients with amenorrhea. We administered bromocriptine to 5 stable schizophrenic outpatients who experienced amenorrhea over 6 months. Bromocrptine dosage was titrated upward from 2.5 mg/day to 7.5 mg/day until menstrual recovery. Patients' menstrual state and side effects of bromocriptine was monitored prospectively for 22 weeks, and clinical symptom were assessed using brief psychiatric rating scale (BPRS) and clinical global impression scale-severity (CGI-S). These were assessed biweekly until 12th week and then every 4weeks thereafter. All five patients resumed menstruation without deterioration of clinical symptoms measured by BPRS and CGI-S. No serious side effect of bromocriptine was reported. Patients with lower baseline prolactin level showed faster recovery and needed lower dose of bromocriptine. These findings suggest bromocriptine may be used safely in the treatment of antipsychotics-induced amenorrhea.
Amenorrhea* ; Antipsychotic Agents ; Brief Psychiatric Rating Scale ; Bromocriptine* ; Dopamine ; Dopamine Agonists ; Female ; Humans ; Hyperprolactinemia ; Menstruation ; Outpatients ; Prolactin ; Prospective Studies

BACKGROUND: Increasing interest in the use of arterial conduits is based on the better patency of left internal thoracic artery (LITA) than that of saphenous vein (SV) graft and radial artery (RA) is emerging as one of them. We compared the early result of coronary artery bypass grafting (CABG) using LITA and RA (RA group) with CABG using LITA and SV only (SV group). MATERIAL AND METHOD: We compared the early operative results of 45 cases in RA group with 45 cases in SV group selected from 165 cases who had CABG between January 2000 and December 2002. The two groups had similar profiles of age, sex, NYHA functional class, left ventricular ejection fraction and coronary angiographic anatomy. We analysed each group on the preoperative risk factors and operative results. RESULT: There were no statically signigicant difference between groups in operative mortality and each morbidities (stroke, IABP insertion, perioperative MI), respectively. However, the overall incidence of mortality and morbidities was lower in RA group compared to SV group (p<0.05). RA group (2.93+/-0.62 days) had shorter duration of ICU stay than SV group (3.55+/-0.95 days) (p<0.001). The patency on postoperative coronary angiography at 7~14 days after operation in RA group patients were 100% of LITA and RA and 94.9% of SV. CONCLUSION: We had better early operative results in RA group compared with SV group.
Arteries* ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Incidence ; Mammary Arteries ; Mortality ; Radial Artery ; Risk Factors ; Saphenous Vein ; Stroke Volume ; Transplants

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as 'Moyamoya vessels'. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.
Brain ; Brain Ischemia ; Cardiopulmonary Bypass ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebrovascular Disorders ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Humans ; Moyamoya Disease* ; Thoracic Surgery* ; Transplants

A case with carcinoid tumor of the appendix was encountered incidentally during an elective abdominal surgery for borderline mucinous ovarian tumor in a 16-year old female. Carcinoid tumor of appendix is the most common neoplasm of the gastrointestinal tract in childhood and adolesence. They are usually regarded as a benign neoplasm and an uncommon source of metastasis and recurrence. We report this case with reference to the value of grosss examination of the appendix and incidental appendectomy during gynecologic abdominal operations.
Adolescent ; Appendectomy ; Appendix* ; Carcinoid Tumor* ; Female ; Gastrointestinal Tract ; Humans ; Mucins* ; Neoplasm Metastasis ; Recurrence