Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A and alpha1 adrenergic receptors. Compared with SSRIs nefazodone caused the fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia) and adverse effects of sexual function, but is associated with the more dizziness, dry mouth, constipation, visual disturbances and confusion. We report on 4 cases of visual disturbances and hallucinations in patients taking nefazodone. 1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances. 2) mCPP, metabolite of nefazodone might contribute to the hallucination through action on 5-HT receptor. 3) Dopaminergic enhancing activity of nefazodone might cause hallucination. The case report raises the possibility that dose-related perceptual disturbances may exist with nefazodone. The fact emphasizes the need to pay close attention to all possible drug interactions, particularly in patients treated with multiple psychoactive agents, older patients, and patients with decreased hepatic function.
Constipation ; Diarrhea ; Dizziness ; Drug Interactions ; Hallucinations ; Humans ; Mouth ; Norepinephrine ; Psychotropic Drugs ; Receptors, Adrenergic ; Serotonin ; Serotonin 5-HT2 Receptor Antagonists

OBJECTIVES: It has been known that the contents of dreams change according to neuro-developmental differences in sex, progression of age and various environments, unlike the established psychoanalytic theory. To investigate the changes, we collected "most recent dream report" and analyzed the contents of dreams by using Hall/Van de Castle System. METHOD: Most recent dream reports were gathered from age 12-14 years old, 2,673 middle school students (1,544 male 1,129 female) and analyzed those reports using Hall/Van de Castle System. The data were sorted in SAS and dream SAT. RESULT: There were prominent differences between male and female middle school students in Male/Female Percentage (male/female; 56%/35%), Familiarity Percentage (57%/69%), Aggression/Friendliness Percentage (79%/65%), Befriender Percentage (50%/33%), Physical Aggression Percentage (90%/70%), Indoor Setting Percentage (40%/55%), Negative Emotion Percentage (56%/68%) and Torso/Anatomy Percentage (51%/36%). There were significant differences in Male/Female Percentage (65%/44%), Friendliness, Physical Aggression and Self Negativity Percentage in male and there were significant differences in Friendliness, Familiarity and Friends Percent in female between 1st and 2nd grade. But, it showed much similar dream patterns between 2nd and 3rd grade in both gender. In male, Aggression/Character Index with male character is significantly increased by 2nd grade (1st/ 2nd/ 3rd; 0.48/1.04/0.98), In female, Friendliness/Character Index with male character had significantly decreased by 2nd grade (0.38/0.19/0.20). CONCLUSION: There were apparent differences between age 12-14 years old male and female. Male adolescents have differences mostly in categories related with aggression, but female adolescents have differences in categories related with environment or character. It shows that developmental level of male are slower than female as of yet and male needs more active interpersonal relationship to find identity. Otherwise, the influences of passive attitude and actual circumferential environment are reflected in female's dream. There are no prominent differences among ages, but age 12-13 years old adolescents shows significant differences in interacting with the other gender. It means that circumferential environment and interpersonal relationship affect the contents of dreams and also the cognitive development related to age and sex. Afterwards, the development of dreams could be better understood through the neurocognitive study and dream analysis between other ages and nations.
Adolescent* ; Aggression ; Dreams* ; Female ; Friends ; Humans ; Male ; Psychoanalytic Theory ; Recognition (Psychology)

BACKGROUND AND OBJECTIVES: Sound localization in subjects with normal hearing is done by recognition of interaural difference of time, intensity and phase of sound source. Individuals with unilateral hearing losses, deprived of the binaural cues, are expected to have difficulty in localizing sound. The purpose of the research is to investigate the sound localizing ability in subjects with unilateral hearing losses to localize sound in horizontal plane by comparing with normal control group, and to know the effects of age, gender, stimulus type and hearing level. MATERIALS: Two groups of subjects participated in this study. The first group consisted of 60 normal hearing adults, in each age groups of 10 subjects, ranging from teens to sixties. The second group consisted of 50 subjects with unilateral hearing losses. METHODS: Sound localization ability was assessed by means of an array of eight loudspeakers positioned at the azimuth of 45 degrees each in the horizontal plane at a distance of 100 cm from the subject. The stimuli consisted of speech noise, narrow band noise centered at 500 Hz and 4000 Hz, pure tone of 500 Hz and 4000 Hz at the level of 45 dB HL for 5 seconds. RESULTS: 1) Speech noise was the most easily detected stimulus (p<0.001). 2) The age and gender did not affect significantly to the ability to localize sound (p>0.05). 3) The localization errors for speech noise increased significantly as hearing threshold increased in patients with unilateral hearing losses (p<0.001). CONCLUSION: The results suggest that speech noise is the most easily detected stimulus in directional discrimination test and that the ability of sound localization is degraded as hearing threshold is increased for patients with unilateral hearing losses.
Adolescent ; Adult ; Cues ; Discrimination (Psychology) ; Hearing Loss* ; Hearing Loss, Unilateral* ; Hearing* ; Humans ; Noise ; Sound Localization*

OBJECTIVE: GnRH agonist used in the medical treatment of endometriosis, induces accelerated bone loss, which leads to osteoporosis. This study was performed to investigate the possibilities of prevention of bone loss by progestogen add-back therapy in GnRH agonist treatment. METHODS: Thirty patients, who were diagnosed as endometriosis from Apr 1996 to Jun 2001, were divided into GnRH agonist treatment group and progestogen add-back therapy group. The changes of lumbar spine and femur BMD were checked from the onset of treatment to 6 months later, and the changes of bone markers (serum osteocalcin, urine deoxypyridinoline) from the onset of treatment, to 3 months later, to 6 months later, respectively. RESULTS: In GnRH agonist group, the BMDs were decreased by 5.56%, 3.85%, 6.10% and 5.19% in lumbar spine, femur neck, ward triangle, and femur trochanter respectively. All of these changes were significant compared with basal BMDs at each sites. Basal serum osteocalcin level of 5.34+/-2.37 ng/ml was significantly and continuously increased to 8.87+/-3.06 ng/ml and 11.87+/-3.15 ng/ml at 3rd and 6th month of treatment respectively. Urinary deoxypyridinoline level was increased from basal 7.07+/-2.48 ng/ml to 9.56+/-3.13 ng/ml at 3rd month and 9.87+/-2.18 ng/ml respectively. The significant change was noted from 3rd month of treatment with no change between 3rd and 6th month of treatment. In MPA add-back therapy group, the BMDs after treatment were significantly decreased by 5.39% and 4.30% only in lumbar spine and ward triangle of femur compared with pretreatment basal BMD levels. But there was no significant change at femur neck and trochanter. Serum osteocalcin level was significantly increased from basal 8.02+/-3.25 ng/ml to 11.05+/-4.02 ng/ml at 6th month of treatment, while there was no change at 3rd month of treatment. Meanwhile urinary deoxypyridinoline level was not changed during treatment. CONCLUSION: Although the decrease of BMD and the increase of bone turnover rate are induced during GnRH agonist therapy for endometriosis, progestogen add-back therapy could prevent these changes to some degree.
Endometriosis* ; Female ; Femur ; Femur Neck ; Gonadotropin-Releasing Hormone* ; Humans ; Osteocalcin ; Osteoporosis ; Spine

BACKGROUND: Bronchial asthma is characterized by chronic eosinophilic inflammatory airway disease associated with bronchial hyperresponsiveness and reversible airway obstruction. Bronchial inflammation in asthma may depend in part on the activation of T helper lymphocytes that elaborate proinflammatory cytokines. T helper (Th) lymphocytes can be divided into two categories ; Th1 lymphocytes, which secrete IL-2, IL-12 and IFN-, and Th2 lymphocytes, which secrete IL-4, IL-5, IL-6 and IL-10. Th2 lymphocytes appear to induce allergic responses, whereas Th1 lymphocytes induce delayed-type hypersensitivity response. Some infections, such as tuberculosis, cultivate a Th1 immunological environment and inhibit Th2 lymphocytes function. The presence of such infections might inhibit Th2 immune responses and thus protect development of atopic diseases. METHOD: 15 patients with allergic bronchial asthma, 10 patients with intrinsic bronchial asthma, and 10 healthy volunteers were studied. The serum concentrations of IFN-, IL-12, IL-4, IL-5, and IL-10 were measured by ELISA method and tuberculin skin test was estimated in different groups. RESULTS: The positive response rates of tuberculin test were 46.7% in patients with allergic asthma , 100% in patients with intrinsic asthma and 60% in normal controls. The positive response rates were significantly lower in patients with allergic asthma than those of in patients with intrinsic asthma (p<0.05). Degree of responses to tuberculin test were 12.09.6mm in patients with allergic asthma, 18.44.5mm in patients with intrinsic asthma and 10.98.8mm in normal controls. The degree of responses were significantly reduced in patients with allergic asthma than those of patients with intrinsic asthma (p<0.05). The serum levels of IL-5 in patients with allergic asthma were significantly higher than in patients with intrinsic asthma and normal controls (p<0.05), although it was insignificant, the serum levels of IL-4 and IL-10 in patients with allergic asthma were higher than that of intrinsic asthma and normal controls. The serum levels of IL-12 and IFN- in patients with allergic asthma and intrinsic asthma were significantly lower than those in normal controls(P<0.05). The serum levels of total immunoglobulin E (IgE) and peripheral blood eosinophile counts in patients with allergic asthma were significantly higher than those in normal controls. Peripheral blood esinophil counts had a significant correlation with the serum levels of total IgE, IL-5 and IL-10 in patients with allergic asthma (p<0.05). CONCLUSION: These results have showed that Th1 lymphocyte functions were lowered and Th2 lymphocyte functions were elevated in patients with allergic asthma than those in normal controls. Suppression of Th1 lymphocyte functions by activation of Th2 lymphocyte might be one of the important aspects of pathogenesis in allergic bronchial asthma.
Airway Obstruction ; Asthma* ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Healthy Volunteers ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Inflammation ; Interleukin-10 ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Interleukin-6 ; Lymphocytes ; Skin Tests* ; Skin* ; Tuberculin Test ; Tuberculin* ; Tuberculosis

Primary pulmonary hypertension (PPH) is a rare, progressive and incurable disease, which is characterized by an increase in the pulmonary artery pressure without a demonstrable cause. The most common presenting symptom is dyspnea on exertion, with other symptoms comprising of chest pain, syncope and hemoptysis. The diagnosis is one of exclusion of any of the known causes of pulmonary hypertension. When associated with pregnancy, the maternal mortality ranges from 30 to 50%. Because pregnancy and labor are very serious problems for patients with PPH, the available evidence suggests that pregnancy when afflicted with PPH should be avoided. In account the case of a 33-year old patient, reporting with massive hemoptysis, and diagnosed with PPH during her twenty seventh week of gestation, is presented. She was treated with conservative management, including oxygen and a vasodilator, and underwent a pregnancy termination. However, due to aggravation of right heart failure, she presented with severe systemic hypotension and hypoxemia, and eventually died. This case is reported, with brief review of the literature.
Adult ; Anoxia ; Chest Pain ; Diagnosis ; Dyspnea ; Heart Failure ; Hemoptysis* ; Humans ; Hypertension, Pulmonary* ; Hypotension ; Maternal Mortality ; Oxygen ; Pregnancy* ; Pulmonary Artery ; Syncope

BACKGROUND: Cysteinyl leukotrienes are important inflammatory mediators in bronchial asthma because they enhance microvascular permeability, increase nonspecific bronchial hyperresponsiveness, and are potent bronchoconstrictor agents. Leukotriene E4 is a major metabolite of cysteinyl leukotriene excreted in urine and its concentration of urine can be a reliable marker of the overall leukotriene production in the body. OBJECTIVE: To determine whether clinical parameters of bronchial asthma are associated with production of cysteinyl leukotrienes, expressed by urinary leukotriene E4. METHOD: We measured the urinary concentration of leukotriene E4 in bronchial asthma(127 patients) and normal control(15 persons) group by ELISA method. Pulmonary function test, allergic skin test, measurement of peripheral eosinophil count and eosinophil cationic protein were undertaken in bronchial asthma patients. RESULTS: The concentrations of urinary leukotriene E4 were significantly higher in bronchial asthma patients than normal controls (p<0.05). The increased concentrations of leukotriene E4 had a significant correlation with FEV1/FVC or methacholine PC20(p<0.05). However, the concentration of leukotriene E4 did not have any correlation with the presence of atopy, peripheral blood eosinophil count, and eosinophil cationic protein level. CONCLUSION: The concentration of urinary leukotriene E4 that represents the overall leukotriene production in the body is correlated with the degree of airway obstruction and airway hyperresponsiveness. So, the concentration of urinary leukotriene E4 may be used as an adjunctive parameter of airway obstruction and hyperresponsiveness in bronchial asthma.
Airway Obstruction ; Asthma* ; Bronchoconstrictor Agents ; Capillary Permeability ; Enzyme-Linked Immunosorbent Assay ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Leukotriene E4* ; Leukotrienes ; Methacholine Chloride ; Respiratory Function Tests ; Skin Tests

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.
Corneal Transplantation ; Humans ; Keratoplasty, Penetrating ; Microscopy ; Prospective Studies ; Ultrasonography

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and neurocognitive functions in schizophrenia patients with treatment-resistant auditory hallucination. METHODS: The 30 patients with treatment-resistant hallucination (hallucinating patients) were compared with 31 patients without hallucination (non-hallucinating patients) and 30 normal controls. The hallucinating patients included the schizophrenic patients who reported not-remitting hallucinations for 2 years in spite of appropriate treatments. The non-hallucinating patients included schizophrenic patients who had chronic illness course, and not reporting hallucination within 2 years. The hallucination characteristics and neurocognitive were measured by self report questionnaires on hallucination: functions Wisconsin card sorting test (WCST), Continuous performance test (CPT) and Sentence repetition test (SRT) among three groups. Psychopathology, depressive symptomps and extrapyramidal symtomps were measured by Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Beck depression Inventory (BDI) and Extrapyramidal Symptom Rating Scale (ESRS), separately. RESULTS: The auditory hallucinations 1 or 2 times a day (33%), with the contents of criticising and cursing (26%) were most frequent. Hallucinating patients did not feel uncomfortable with their hallucinations. WCST performances were significantly decreased in hallucinating patients than non-hallucinating patients, especially on total error (35.2+/-7.6 vs 25.3+/-10.0), perseverative error (54.8+/-14.9 vs 38.5+/-13.0). In CPT, hallucinating patients showed more error response (11.9+/-8.1 vs 8.9+/-7.5) and more prolonged reaction time to incorrect answers (552.4+/-433.2 ms vs 492.7+/-358.5 ms). CONCLUSION: Integrating these observations, it can be said that schizophrenic patients with treatment-resistant auditory hallucination have more neurocogntive functional deficits implying frontal lobe dysfunction than non-hallucinating schizophrenic patients.
Chronic Disease ; Depression ; Frontal Lobe ; Hallucinations* ; Humans ; Psychopathology ; Surveys and Questionnaires ; Reaction Time ; Schizophrenia* ; Self Report ; Wisconsin

BACKGROUND: Acute lung injury (ALI) is a commonly encountered respiratory disease and its prognosis is poor when the treatment is not provided promptly and properly. However no specific pharmacologic treatment is currently available for ALI, although recently several supportive drugs have been under scrutiny. We studied anti-inflammatory effects of pentoxifylline (PF), a methylated xanthine, and ONO-5046, a synthetic neutrophil elastase inhibitor on lipopolysaccharide (LPS)-induced ALI in vitro. METHODS: To establish an in vitro model of LPS-induced ALI, primary rat alveolar macrophages and peripheral neutrophils in various ratios (1:0, 5:1,1:1,1:5,0:1) were co-cultured with transformed rat alveolar epithelial cells (L2 cell line) or vascular endothelial cells (IP2-E4 cell line) under LPS stimulation. Each experiment was divided into five groups-control, LPS, LPS+PF, LPS+ONO, and LPS+PF+ONO. We compared LPS-induced superoxide anion productions from primary rat alveolar macrophages and peripheral neutrophils in various ratios, and the resultant cytotoxxicity on L2 cells or IP2-E4 cells between groups. In addition we also compared the productions of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, monocyte chemotactic protein(MCP)-1, IL-6, and IL-10 as will as mRNA expressions of TNF-α, inducible nitric oxide synthetase(iNOS), and MCP-1 from LPS-stimulated primary rat alveolar macrophages between groups. RESULTS: (1) PF and ONO-5046 in each or both showed a trend to suppress LPS-induced superoxide anion productions from primary rat alveolar macrophages and peripheral neutrophils regardless of their ratio, except for the LPS+PF+ONO group with the 1:5 ratio, although statistical significance was limited to a few selected experimental conditions. (2) PF and ONO-5046 in each or both showed a trend to prevent IP2-E4 cells from LPS-induced cytotoxicity by primary rat alveolar macrophages and peripheral neutrophils regardless their ratio, although statistical significance was limited to a few selected experimental conditions. The effects of PF and/or ONO-5046 on LPS-induced L2 cell cytotoxicity varied according to expaerimental conditions. (3) PF showed a trend to inhibit LPS-induced productions of TNF-α, MCP-1, and IL-10 from primary rat alveolar macrophages. ONO-5046 alone didnot affect the LPS-induced productions of proinflammatory cytokines from primary rat alveolar macrophages but the combination of PF and ONO-5046 showed a trend to suppress LPS-induced productions of TNF-αand IL-10 PF and ONO-5046 in each or both showed a trend to increase LPS-induced IL-β and IL-6 productions from primary rat alveolar macrophages. (4) PF and ONO-5046 in each or both showed atrend to attenuate LPS-induced mRNA expressions of TNF-α and MCP-1 from primary rat alveolar macrophages but at the same time showed a trend increase iNOS mRNA expression. CONCLUSION: These results suggest that PF and ONO-5046 may play a role in attenuating inflammation in LPS-induced ALI and that further study is needed to use these drugs as a new supportive therapeutic strategy for ALI.
Acute Lung Injury* ; Animals ; Cytokines ; Endothelial Cells ; Epithelial Cells ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Leukocyte Elastase* ; Macrophages, Alveolar ; Monocytes ; Neutrophils* ; Nitric Oxide ; Pentoxifylline* ; Prognosis ; Rats ; RNA, Messenger ; Superoxides ; Tumor Necrosis Factor-alpha ; Xanthine