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

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*

OBJECTIVE: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. METHODS: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n=16), olanzapine (n=26), quetiapine (n=9), or haloperidol (n=10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. RESULTS: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. CONCLUSION: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance.
Antipsychotic Agents ; Follow-Up Studies ; Haloperidol ; Humans ; Inpatients* ; Risk Factors ; Risperidone ; Schizophrenia

OBJECTIVES: To investigate the clinical, laboratory and radiological features of psoriatic arthritis. METHODS: Seventeen patients with psoriatic arthritis were studied. The diagnosis of psoriatic arthritis was based on the presence of an inflammatory arthritis associated with psoriasis, usually seronegative. Other rheumatic conditions were excluded. RESULTS: 1) There were 8 men and 9 women(male to female ratio of 1:1.13) and mean age was 41 years old. 2) Thirteen patients developed arthritis an average of 7. 3 years after the onset of psoriasis ; Three had a simultaneous onset of skin and joint disease(within 6 months), while in one patient the arthritis preceded psoriasis by a 10 years. 3) Ten patients had nail lesions, and dactyliris was presented in 6 patients. 4) The frequency of positive rheumatoid factor was 18 percent of the patients, and HLA-B27 was detected in 24 percent. 5) The prevalences of clinical patterns were as follows : oligoarthritis(41.2%), polyarthritis(29.4%), spondyloarthritis(23.5%) and arthritis in distal joint (5.9%). CONCLUSIONS: In contrast to rheumatoid arthritis, psoriatic arthritis occured frequently in males as in females and oligoarthritis was the most common joint pattern.
Adult ; Arthritis ; Arthritis, Psoriatic* ; Arthritis, Rheumatoid ; Diagnosis ; Female ; HLA-B27 Antigen ; Humans ; Joints ; Male ; Prevalence ; Psoriasis ; Rheumatoid Factor ; Skin

Gastric carcinoid tumor is a rare neoplasm and it accounts for only 0.3% of all the gastric neoplasms. Gastric carcinoid tumor has high incidence in patients who are aged between 50 and 70 years, and it usually develops over a long period of time. Type I gastric carcinoid tumors are associated with autoimmune atrophic gastritis and pernicious anemia, and there are a few cases of gastric carcinoids in patients with other autoimmune diseases like Sjogren's syndrome and autoimmune thyroiditis. Here, we report on a case of recurrent type I gastric carcinoid tumors in a 42-years old woman who suffered with systemic lupus erythematosus.
Aged ; Anemia, Pernicious ; Autoimmune Diseases ; Carcinoid Tumor ; Female ; Gastritis, Atrophic ; Humans ; Incidence ; Lupus Erythematosus, Systemic ; Sjogren's Syndrome ; Stomach Neoplasms ; Thyroiditis, Autoimmune

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

It's now well recognized that the cervical spine is commonly affected in rheumatoid arthritis(RA) and that subluxation of the atlas is frequently present and may occasionally be fatal. It is not widely appreciated, however, that some rheumatoid patients may develop fractures of the odontoid process in association with relatively minimal trauma or no trauma at all. This is a fracture caused by erosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subluxation working on the odontoid in cervical extension. We evaluated a patient with RA who had a fracture of the odontoid process. Following diagnosis she underwent surgery for which the prognosis was excellent.
Aging ; Arthritis, Rheumatoid* ; Diagnosis ; Humans ; Odontoid Process ; Osteoporosis ; Prognosis ; Spine ; Synovitis

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