The concept of bipolar disorder is an ongoing process, still in evolution, although its roots can be found from ancient Greek. Until recently, it was believed that no more than 1% of the general population has bipolar disorder. But literature on the lifetime prevalence of the bipolar spectrum disorder suggests rates of 4-5%. Bipolar spectrum disorder is a longitudinal diagnosis characterized by abnormal mood swings comprising some of the following cross-sectional clinical states: mania, hypomania, mixed states, hyperthymic temperament, major depressive episode, and depressive mixed state. Failure to recognize subthreshold expressions of mania, such as hypomania, cyclothymia, and hyperthymia, contributes to the frequent under-diagnosis of bipolar disorder. There are several reasons for the lower rate of recognition of subthreshold manic symptoms, when compared to the analogous pure depressive one. These include the lack of subjective suffering, enhanced productivity, egosyntonicity, diurnal and seasonal rhythmicity associated with many of the manic and hypomanic symptoms, and the psychiatrists' difficulty in differentiating with personality disorders. In addition, most patients with bipolar spectrum disorder seek treatment for depression, rather than mania or hypomania. Therefore clinicians often miss the diagnosis of bipolar spectrum disorder. The recent 10 years of researches have suggested that 30-55% of patients with major depressive disorder are actually identified with broader spectrum of bipolar disorders. However, 48% of patients of bipolar disorder consulted 3 or more professionals before receiving a correct diagnosis, and 10% consulted 7 or more for their first diagnosis of bipolar disorder. Several studies have documented that patients often wait as long as 10 years for the correct diagnosis of bipolar spectrum disorder. This delay in diagnosis often has substantial adverse results. Patients do not get the appropriate treatment to alleviate their symptoms. They may even get treatments that exacerbate their symptoms, such as prescription of antidepressants precipitating mania and producing rapid cycling. The concepts of hypomania, cyclothymia, mixed state, depressive mixed states, hyperthymic temperament are the new areas of studying mood disorders in recent 20 years. The authors will review the studies on various subtypes of bipolar spectrum disorder with their historic aspects, and introduce the suggested screening tests for bipolar spectrum disorder in clinical practice.
Antidepressive Agents ; Bipolar Disorder ; Classification ; Depression ; Depressive Disorder, Major ; Diagnosis ; Efficiency ; Humans ; Mass Screening ; Mood Disorders ; Periodicity ; Personality Disorders ; Prescriptions ; Prevalence ; Seasons ; Temperament

No abstract available.

It has been widely accepted that complete surgical resection of hepatoblastoma is essential for long-term survival. But unfortunately less that 50% of hepatic tumors in children can be totally removed at the time of diagnosis. This report is to present the experience of successful resection of hepatoblastoma after concurrent radiotherapy with transarterial chemoinfusion in a child. We believe this modality of treatment enables complete resection of unresectable hepatoblastoma, which is resistant to the systemic chemotherapy.
Child ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Radiotherapy*

PURPOSE: This study was conducted to compare the postural habits, body image, and peer attachment of adolescents with idiopathic scoliosis and healthy adolescents, and to examine the correlation between body image and peer attachment in each group. METHODS: Eighty-three adolescents with idiopathic scoliosis and 83 healthy adolescents were recruited from 4 middle schools located in W city. Data were collected from November 22 to December 6 2010 using a structured questionnaire including items about postural habits, body image, and peer attachment. Data were analyzed using descriptive statistics, chi2-test, independent t-test and Pearson Correlation Coefficient. RESULTS: Compared to healthy adolescents, adolescents with idiopathic scoliosis were more likely to use one hand, to lean back while seated, and to put weight on one leg while standing. The score for body image was significantly lower for adolescents with idiopathic scoliosis compared to healthy adolescents, but peer attachment was not significantly different between the two groups. Body image was significantly correlated with peer attachment only for the adolescents with idiopathic scoliosis. CONCLUSION: Interventions to promote balanced postural habits in adolescents with idiopathic scoliosis are needed. Information on body image and peer attachment for these adolescents should also be considered when developing interventions.
Adolescent ; Body Image ; Hand ; Humans ; Leg ; Posture ; Scoliosis ; Child Health ; Surveys and Questionnaires

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood illness, which frequently presents with various comorbid emotional, social, and behavioral problems. Yet, children with epilepsy also experience significant behavioral problems. In this study, we compared behavioral problems of 124 children and adolescents with newly diagnosed ADHD and 40 youths with epilepsy, aged 6~17 years. METHODS: Among 1,576 urban community children and adolescents, the ADHD rating scale, the Comprehensive Attention Test, and a psychiatric interview were used to diagnose ADHD. In addition, we used the mother's rating on the Korean Child Behavior Checklist (K-CBCL) to assess the presence of behavioral problems. RESULTS: Compared to the epilepsy group, the ADHD group had lower IQ scores (100.29±13.47 vs. 108.61±15.04, p=0.007). In addition, the ADHD group had higher total K-CBCL scores (66.44±10.32 vs. 50.68±8.97, p<0.001) as well as higher scores on all eight subscales of the K-CBCL than the epilepsy group. Sixty-five participants (52.4%) in the ADHD group showed significant behavioral problems (t score ≥64) compared to 7.5% of epilepsy group. After controlling for IQ, using an analysis of covariance, the ADHD group showed significantly higher total scores on the K-CBCL and all its subscales (p<0.001) than the epilepsy group, except on the somatic complaints subscale (p=0.275). CONCLUSION: Children with newly diagnosed ADHD suffer from various behavioral problems; therefore, the early assessment of and interventions for comorbid behavioral problems should be conducted for optimal management of childhood ADHD.
Adolescent* ; Checklist ; Child Behavior ; Child* ; Epilepsy* ; Humans ; Problem Behavior*

Speckled lentiginous nevus is circumscribed patch of hyperpigmentation with smaller, darker pigmented macules or papules within the patch. The background shows histologic features of lentigo simplex. The speckled areas show junctional or compound nevus. Association of speckled lentiginous nevus with multiple spitz nevi was rarely reported. We report a case of multiple spitz nevi arising in a giant speckled lentiginous nevus.
Hyperpigmentation ; Lentigo ; Nevus* ; Nevus, Epithelioid and Spindle Cell*

We report the case of a 42-year-old male who was admitted to the hospital with progressive dyspnea. Cardiomegaly and diffuse pulmonary edema were visible on chest X-ray and multiple oral and genital ulcers on physical examination. On admission, echocardiography revealed mitral valve prolapse (MVP) predominantly involving a basal portion of the posterior leaflet, with severe mitral regurgitation. A successful mitral valve replacement with St. Jude #29 was performed, after pre-treatment with prednisolone for 2 weeks. Fifteen months following the operation, the patient expired from severe pulmonary edema and secondary pneumonia. This case demonstrates, for the first time in the literature, an unusual feature of mitral prolapse in the basal portion with severe mitral regurgitation in a patient with Behcet's disease. As suggested by this case, we should consider an atypical type of MVP as a possible inflammatory involvement of the heart in patients with Behcet's disease.
Adult ; Behcet Syndrome ; Cardiomegaly ; Dyspnea ; Echocardiography ; Heart ; Heart Valve Prolapse ; Humans ; Inflammation ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Physical Examination ; Pneumonia ; Prednisolone ; Prolapse ; Pulmonary Edema ; Thorax ; Ulcer

OBJECTIVES: To determine differences of common personality profiles and coping mechanisms of medical students who prefer specific specialties (medicine and surgery), the authors evaluated the defense mechanisms of the medical students by using Ewha Defense Mechanisms Test. METHODS: The authors compared the defense mechanisms between two groups (medicine selection group and surgery selection group) who are in the senior year of the Soonchunhyang University School of Medicine. RESULTS: There were no significant differences in mean scores of the each defense mechanism and 4 groups of defense mechanisms divided by maturity level between the groups of students who selected medicine and surgery. But, frequency of major defense mechanisms were as follows; For the surgery selection group, the passive-aggression in the Immature defense mechanism and show-off in the Neurotic defense mechanism were significantly higher than in the medicine selection group. Contrarily, in the medicine selection group, humor in the mature defense mechanism as the major defense mechanism was significantly higher than in the surgery selection group. CONCLUSION: After analysis of the differences of frequency of major defense mechanisms between the two groups, there were no significant differences between the two groups in personality. However, the students of the medicine selection group used humor of the mature defense mechanism as a major defense mechanism in higher frequency than the surgery selection group. In situations of complications, anxiety and suffering, the use of the humor defense mechanism gave the students strength to endure these situations. Among these students, there is a high probability that many of them possess strong ego strength. Contrarily, the students of the surgery selection group did not express aggression directly, rather, they expressed these feelings indirectly through passive opposition. There was a high frequency of passive-aggression defense mechanism in dealing with feelings of aggression. Also, in the neurotic defense mechanism, compared to ability, excessive goals were set as was the resulting behavior. Especially, behavior was extremely sensitive to how others would evaluate those actions resulting in using show-off mechanism as a major defense mechanism in higher frequency by the surgery selection group. The results seem to be useful in understanding the student's optimal character for specific specialities that were selected by evaluating the differences of the common characteristics and coping mechanisms of each specialty group.
Aggression ; Anxiety ; Defense Mechanisms* ; Ego ; Humans ; Students, Medical*

To evaluate the differences between current and past surgical treatment of intussusception, the medical records of 48 intussusception patients who underwent surgical treatment over 4 years (1975-1978, Group A) were reviewed and compared to the medical records of 75 intussusception patients who underwent surgical treatment over 4 years (1995-1998, Group B). Sex ratio is male predominant in both group (2.7:1 vs 1.6:1) and mean age of operation is 6.7+/-5.0 month (Group A) and 8.1+/-7.0 month (Group B). Major symptoms and signs of both groups are vomiting, hematochezia and irritability. White blood cell count of peripheral blood in both groups had no significant difference (12,417+/-4,446/mm3 vs 12,297+/-4,531/mm3). In operation methods, group A had significantly higher bowel resection rate over group B (31.3% vs 14.7%, p<0.05). In group A, 2 patients were died after operation, but group B have no operative mortality. Admission period after operation is significantly short in Group B (7.5+/-2.7 day vs 5.4+/-2.1 day, p<0.01). These results suggest there were no significant difference in characters of patients between Group A and B. But surgical treatment of intussusception in 1990s was more conservative than that in 1970s. We expect that recent surgical treatment lead early recovery from operation and early discharge from hospital.
Gastrointestinal Hemorrhage ; Humans ; Intussusception* ; Leukocyte Count ; Male ; Medical Records ; Mortality ; Sex Ratio ; Vomiting

No abstract available.
Hospitals, General* ; Humans