There has been increasing recognition of pediatric bipolar disorder in the psychiatric field during the past 10 years. The clinical presentation of this disorder in preadolescent is greatly debated and few studies have been conducted in Korea. The authors report 3 cases of children with bipolar I disorder whose clinical symptoms were improved after pharmacotherapy. The authors also review current concepts, debates and treatment of pediatric bipolar disorder.
Bipolar Disorder ; Child ; Drug Therapy* ; Humans ; Korea

Adenomyomatosis of the gallbladder is Characterized by hyperplastic changes including overgrowth of the mucosa, thickening of the muscle wall, and intramural diverticula, crypts, or sinus tracts(Rokitaasky-Aschoff sinuses). The main diagnostic test for the detection of this disease is oral cholecystography but it's use is being decreased. Recently, Ultrasound, ERCP, and CT have been used for diagnosis. We present a report of case in whom ademomyomatosis of gallbladder was disgnosed on ultrasound and ERCP and confirmed by surgery. The essential feactures of ultrasound and ERCP diagnosis are discussed.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystography ; Diagnosis ; Diagnostic Tests, Routine ; Diverticulum ; Gallbladder* ; Mucous Membrane ; Ultrasonography

OBJECTIVE: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of I-ILA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. METHODS: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University iHospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. RESULTS: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk(RR) and etiologic fraction(EF) of HLA-B27 were 5.99 and 0. 1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR, C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. CONCLUSIONS: An increased freuency of HLA-B27 in RA patients was significantly found in Korea(RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLA-B27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.
Arthritis, Rheumatoid* ; Atlanto-Axial Joint ; C-Reactive Protein ; HLA-B27 Antigen* ; Humans ; Joints ; Rheumatic Diseases ; Rheumatoid Factor ; Spine ; Sweden ; Zygapophyseal Joint

BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.
Acrocephalosyndactylia ; Adult ; Child ; Exophthalmos ; Forehead ; Hand ; Humans ; Hypertelorism ; Male ; Maxilla ; Nasal Septum ; Nose ; Osteotomy ; Palate ; Prognathism ; Prosencephalon ; Skull ; Skull Base ; Sutures ; Syndactyly

Herniation of the synovium from the joint space into perioarticular soft tissues is a relatively common complication of adult rheumatoid arthritis, but rare in juvenile rheumatoid arthritis. The most completely described is the popliteal cysts. However, cysts have rarely been reported in the arm. Authors experienced a case of a boy with systemic form of juvenile rheumatoid arthritis who have bicipital synovial cysts in both arm and report this with a review of literature.
Adult ; Arm ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Humans ; Joints ; Male ; Popliteal Cyst ; Synovial Cyst ; Synovial Membrane

OBJECTIVES: To isolate and culture of human muscle cells by manipulating culture conditions. METHODS: Muscle samples were obtained during total hip replacement or bedside muscle biopsy. We isolated myoblasts from freshly obtained human muscle tissue by trypsin and collagenase digesion. RESULTS: Selective isolation of myoblasts was identified through histologic examination by light-microscope. We identified monoc]onal antibodies(Leu-19) as molecular markers in human skeletal muscle were expressed. CONCLUSIONS: This study demonstrated that it had been possible to culture morphologically and immunelogically identifiable myoblasts isolated from human skeletal muscle tissue.
Arthroplasty, Replacement, Hip ; Biopsy ; Collagenases ; Humans* ; Muscle Cells* ; Muscle, Skeletal ; Myoblasts ; Trypsin

OBJECTIVES: To document the clinical characteristics of Korean male patients with rheumatoid arthritis that are different from those of female counterparts. METHODS: Six hundred and seventy-five patients who had met the ACR criteria for rheumatoid arthritis were included in the study. Clinical and laboratory data were retrospectively reviewed and radiologic features of hands and feet were graded by Steinbroker's method. RESULTS: The female : male ratio in the total patients studied is 567 : 108 (5.25). The symptom onset age was 39.5 +/- 11.8 in woman and 44.0 +/- 11.3 in men. The functional class at the time of diagnosis and the incidence of anemia showed little significant difference. Among the extraarticular manifestations, only interstitial lung disease was more common in males. There were significant differences between both sexes on positivity of antiperinuclear factor, C-reactive protein, and titer of rheumatoid factor in the seropositive groups, but not on rheumatoid factor positivity. Radiologically there was no significant difference in the hands and feet joints between males and females. Higher dosage of steroid was initially prescribed for male patients. CONCLUSIONS: The males seem to have slightly more active disease and to show significant differences in antiperinuclear factor positivity, the titer of rheumatoid factor and C-reactive protein, and lung involvement. However, we failed to demonstrate that the disease in males was more severe than compared to that of their female counterparts.
Age of Onset ; Anemia ; Arthritis, Rheumatoid* ; C-Reactive Protein ; Diagnosis ; Female ; Foot ; Hand ; Humans ; Incidence ; Joints ; Lung ; Lung Diseases, Interstitial ; Male* ; Retrospective Studies ; Rheumatoid Factor

BACKGROUND: To evaluate the efficacy and safety of gemcitabine and cisplatin chemotherapy in advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Forty patients (21 men, 19 women ; age range, 37 to 73 years; median, 63 years) with unresectable stage IIIB to IV NSCLC were evaluated. Patients received cisplatin 60mg/m2 (Day 1), gemcitabine 1200mg/m2 (Day 1 and 8) every 21 days. Eighteen patients had stage IIIB disease and 22 had stage IV. There were 28 patients of adenocarcinoma (70.0%), 11 of squamous cell carcinoma (27.5%), and one of large cell carcinoma (2.5%). RESULTS: Of 40 patients, no patients showed complete response while 15(37.5%) showed partial response, 7(17.5%) had stable diseases, 18(45%) had progressive diseases. During a total of 195 courses of chemotherapy, grade 3 or more granulocytopenia and thrombocytopenia occured in 12.5% and 2.5% of patients respectively. Non-hematologic toxicity was mild and easily controlled. There was one case of treatment-related death by pneumomia. The median survival was 55 weeks (95% CI, 34~75weeks), and the time to progression was 19 weeks (95% CI, 16~23weeks). One year survival rate was 55% and 2 year survival rate was 10%. CONCLUSION: The efficacy of cisplatin and gemcitabine combination chemotherapy was acceptable in the treatment of advanced NSCLC.
Adenocarcinoma ; Agranulocytosis ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Humans ; Male ; Survival Rate ; Thrombocytopenia

OBJECTIVES:Nitric Oxide(NO) is a toxic, inorganic, gaseous free radical produced during the metabolism of L-Arginine by NO synthase(NOS). It has been implicated in a rapidly growing number of physiological and pathophysiological processes such as cytotoxic effects against microbes and tumor cells, blood vessel dilation and neurotransmitter. Recently there is growing evidence implicating NO in immune regulation, inflammation, autoimmunity, and arthritis. We performed this study to determine a role for nitric oxide in inflammatory arthritis especially rheumatoid arthritis(RA). METHODS: We measured (1) the concentrations of nitrite, a breakdown product of nitric oxide, in serum and synovial fluid from patients with RA and osteoarthritis(OA) and in the serum of controls (2) the concentrations of nitrite in the supernatant of cultured synovial tissue with RA and OA and (3) determined whether human chondrocytes and synoviocytes can synthesize nitric oxide and if so, how production is regulated by cytokines and antirheumatic drugs. RESULTS: 1) Serum nitrite concentrations in patients with RA and OA were higher than in controls. In both disease groups synovial fluid nitrite was higher than serum nitrite. Serum and synovial fluid nitrite concenrations in RA were higher than those in OA. However, those findings are not statistically significant. 2) Although these findings are not statistically significant, the concentration of nitrite in the supernatant of cultured synavial tissue with RA was higher than that in OA. 3) IL-1beta and TNF-alpah induced the biosynthesis of NO by chondrocytes and synoviocytes. IGF-1 and TGF-beta failed to provoke the production of NO. The biosynthesis of NO required an induction period of approximately 6 hours and was inhibited by L-NMMA and cycloheximide. Dexamethasone, indomethacin, gold sodium thiomalate and methotrexate had no effect on the induction of NO biosynthesis. CONCLUSION: These results suggest a role for nitric oxide as an inflommatory mediator in inflammatory arthritis.
Antirheumatic Agents ; Arginine ; Arthritis* ; Arthritis, Rheumatoid ; Autoimmunity ; Blood Cells ; Chondrocytes ; Cycloheximide ; Cytokines ; Dexamethasone ; Gold Sodium Thiomalate ; Humans ; Indomethacin ; Inflammation ; Insulin-Like Growth Factor I ; Metabolism ; Methotrexate ; Neurotransmitter Agents ; Nitric Oxide ; omega-N-Methylarginine ; Synovial Fluid ; Transforming Growth Factor beta

PURPOSE: We assumed that an obese patient has a high rate of postoperative wounds, but there is no objective data showing the relationship between the body mass index (BMI) and the rate of postoperative wounds in Korea. We describe the relationship of BMI and rates of postoperative wound complications. MATERIALS AND METHODS: From September 2005 to February 2006, 772 patients undergoing elective gastrectomy surgery due to gastric cancer were enrolled in a retrospective study to measure postoperative wound complications. A preoperative history, physical examination and daily progress notes were reviewed retrospectively from the medical records. Postoperative wound complications were detected from the elective medical record and from a doctor in charge statement. RESULTS: The total number of patients was 772, the mean age of the patients was 57+/-11.2 years and the sex ratio (male/female) was 1.82:1. Postoperative wound complication rates were different among the BMI groups (BMI<20 kg/m2 vs 20< or =BMI< or =25 kg/m2 vs >25 kg/m2), and patients with a BMI>25 kg/m2 that underwent gastrectomy had a significantly higher wound complication rate (4.6%) than underweight and normal weight patients (0.9% and 1.6%, respectively) (P=0.038). CONCLUSION: Overall, there was a statistical correlation between BMI and the postoperative wound complication rate. Overweight (BMI>25 kg/m2) patients that underwent gastrectomy had a higher wound complication rate than normal body weight (BMI< or =25 kg/m2) patients. Further studies will be required with a larger population and prospectively designed study considering other factors that affect the wound complication rate.
Body Mass Index* ; Gastrectomy ; Humans ; Ideal Body Weight ; Korea ; Medical Records ; Overweight ; Physical Examination ; Retrospective Studies ; Sex Ratio ; Stomach Neoplasms* ; Thinness ; Wounds and Injuries*