The dysfunction of either or both noradrenaline and serotonin system are important in the pathophysiology of depression. Previous reports have suggested that there may be an important interaction between these two systems. Recently, some investigators have suggested that the combination of tricyclic antidepressants(TCAs and selective serotonin reuptake inhibitors(SSRIs would produce a rapid synergistic effect on down-regulation of either or both of these two systems and that this combination may produce a more rapid and absolute antidepressant effect. We compared the treatment efficacy, treatment associated side effects, treatment satisfaction, and the quality of life between the combination therapy of dothiepin-sertraline as well as the therapy of dothiepin alone in the treatment of major depressive disorder and dysthymic disorder. In our study, the combination therapy of dothiepin and sertraline produced a more rapid and absolute antidepressant effect than dothiepin alone. And the patients with combination therapy experienced relatively high treatment satisfaction than the patients with dothiepin therapy. The patients quality of life improved more rapidly in the combination therapy, especially, in the health perception, social behavior, and life satisfaction, that dothiepin alone. These results support the hypothesis that the combination of TCA an SSRI may produce a rapid synergistic effect on either or both norepinephrine and serotonin system, and more rapid antidepressant effect and high treatment satisfaction.
Depression ; Depressive Disorder* ; Depressive Disorder, Major ; Dothiepin* ; Down-Regulation ; Dysthymic Disorder ; Humans ; Norepinephrine ; Quality of Life ; Research Personnel ; Serotonin ; Sertraline ; Social Perception ; Treatment Outcome

Noninvasive prenatal test (NIPT) is a novel screening method for the diagnosis of fetal chromosomal aneuploidies. NIPT is based on technology that detects cell-free fetal DNA in maternal plasma and analyzes it with massively parallel sequencing technology to determine whether the fetus is at risk of trisomy 21, trisomy 18, trisomy 13 or sex chromosome abnormalities (SCAs). NIPT has been reported to have sensitivity of 99% and a false positive rate of less than 1% for detecting trisomy 21 and trisomy 18. Although extension of the application of NIPT to other SCAs has been attempted, there are concerns in extending NIPT to SCAs because of maternal or fetal mosaicism, undetected maternal SCAs, and multiple pregnancies. Recently, we assessed a pregnancy with the rare Turner syndrome mosaicism 45, X/47, XXX, which was reported as 45, X with NIPT. We present the case here and briefly review the current literatures on NIPT in testing for fetal monosomy X. To the best of our knowledge, this is the first report of the 45, X/47, XXX mosaicism in Korea to be reported as 45, X by NIPT with whole genome sequencing. This case report will provide valuable information for counseling women who want to undergo NIPT.
Aneuploidy ; Counseling ; Diagnosis ; DNA ; Down Syndrome ; Female ; Fetus ; Genome ; High-Throughput Nucleotide Sequencing ; Humans ; Korea ; Mass Screening ; Mosaicism* ; Plasma ; Pregnancy* ; Pregnancy, Multiple ; Prenatal Diagnosis ; Sex Chromosome Aberrations ; Trisomy ; Turner Syndrome*

BACKGROUND: Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. METHOD AND MATERIALS: The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale(MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index-Side Effect Scale(EISE). RESULTS: A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demographic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group 1.39+/-0.61 ; amitriptyline group 2.00+/-0.85, p<.001). At the 4-PISE. There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. CONCLUSIONS: In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.
Adolescent ; Amitriptyline* ; Depression ; Double-Blind Method ; Drug Therapy ; Dysthymic Disorder* ; Follow-Up Studies ; Humans ; Moclobemide*

Bariatric surgery is the best known procedure for treating severe obesity and the majority of patients who received surgical weight loss procedure were at childbearing age. Female patients who successfully lost weight following bariatric procedure, become pregnant and those are need to be evaluated carefully due to various operative procedures and to ensure intake of quality nutrition. A 35-year-old female, gravida 4, para 2, treated for morbid obesity with vertical sleeve gastrectomy performed 14 months earlier, presented 7 weeks of gestation. Before surgery, she had weighed 92.4 kg (body mass index (BMI); 32.9 kg/m(2)); she had gradually reduced her weight to 65.5 kg (BMI; 23.5 kg/m(2)) postoperatively at 14 months. For the first trimester of pregnancy, her average intake was 698.6 kcal/day from food, and 840~1352.8 kcal/day in second and third trimester. During pregnancy, significant iron, cobalamin and vitamin B12 deficiencies were not founded. She has gained a total of 8 kg. She delivered a healthy female infant at full term. Nutritional supplementation following bariatric surgery and close supervision during pregnancy can prevent nutrition-related complications and improve maternal and fetal health.
Adult ; Bariatric Surgery ; Female ; Gastrectomy* ; Humans ; Infant ; Iron ; Obesity, Morbid ; Organization and Administration ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Pregnancy* ; Surgical Procedures, Operative ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Weight Loss

OBJECTIVES: The purpose of this study was to examine psychological characteristics of patients who visited psychiatric clinic for medical certificate for military service using MMPI-2-RF. We compared target group with general psychiatric patients with same age range. METHODS: A total of 165 male patients for medical certificate and 154 general psychiatric patients were collected from the Department of Psychiatry of three university hospitals. There were significant differences of age and educational level between two groups. We used independent t-test, ANCOVA, χ² test to examine differences between two groups. RESULTS: Medical certificate group scored higher on the validity scales, the Higher-Order(H-O) scales, the Restructured Clinical(RC) Scales, the Specific Problems(SP) Scales, and the Personality Psychopathology Five (PSY-5) Scales. Especially, EID, RC7, HLP, SFD, SAV, SHY, DSF, and INTR-r showed significant differences between two groups on all three statistical tests. CONCLUSIONS: The present study showed that psychiatric patients who received psychological evaluation for military service have significantly higher emotional distress, helplessness, lower self-confidence, and lower quality of interpersonal relationships. And the difference of validity scales between two groups could be related with psychological burden of compulsory military service in the study sample which causes elevation on scales of infrequent responses. MMPI-2-RF would be helpful instrument to assess these emotional and psychological characteristics.
Affective Symptoms ; Hospitals, University ; Humans ; Male ; Military Personnel* ; Psychopathology ; Social Isolation ; Weights and Measures

Despite the improved accuracy and increasing use of prenatal ultrasonography, fetal cholelithiasis is a rarely detected disease, and its natural history and clinical significance are not yet well defined. Many maternal and neonatal risk factors are associated with fetal cholelithiasis. Intrahepatic cholestasis of pregnancy could be a risk factor for fetal cholelithiasis, but no case reports in previous literatures have demonstrated this relationship. We present a case of fetal cholelithiasis in the late third trimester of pregnancy that was related to intrahepatic cholestasis of pregnancy, along with a brief review of associated literatures.
Cholelithiasis* ; Cholestasis, Intrahepatic* ; Female ; Humans ; Natural History ; Pregnancy Trimester, Third ; Pregnancy* ; Risk Factors ; Ultrasonography ; Ultrasonography, Prenatal

Uterine serosal pregnancy is an extremely rare form of ectopic pregnancy. This is a report of a 35-year-old primigravida woman who was diagnosed with uterine serosal pregnancy via laparoscopic intervention. A 35-year-old woman (gravida 1, para 0) was referred from a local clinic for a ruptured left tubal pregnancy at amenorrhea 5+0 weeks with elevated serum beta human chorionic gonadotropin (16,618 mIU/mL). A pregnancy on the left posterior wall of the uterine serosa was diagnosed during the operation and successfully treated with laparoscopic surgery as a conservative management strategy to enable fertility preservation. With the advantages of ultrasonography and laparoscopy, an early diagnosis of a primary abdominal pregnancy located on the left posterior wall of the uterine serosa was made, prior to the occurrence of severe intra-abdominal massive hemorrhage, which was then treated laparoscopically as a conservative management strategy enabling the preservation of fertility.
Adult ; Amenorrhea ; Chorionic Gonadotropin ; Early Diagnosis ; Female ; Fertility ; Fertility Preservation ; Hemorrhage ; Humans ; Laparoscopy ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Serous Membrane ; Ultrasonography

A complete septate uterus with cervical duplication and a longitudinal vaginal septum is a rare uterine malformation. The dissection of the septum can be difficult because it is difficult for hysteroscopists to find out initial point, direction and final point of a complete septum. This study aimed the introduction of more efficient surgical procedure using a balloon with methylene blue. We have experienced three cases with a complete septate uterus. We performed hysteroscopic dissection of a complete uterine septum using a balloon with methylene blue and obtained good reproductive outcomes. So we report three cases with a brief review of literatures.
Methylene Blue ; Uterus

Purpose: The objective of this study was to analyze the results of several noninvasive prenatal tests (NIPTs) from a single center and confirm their efficacy and reliability. In addition, we aimed to confirm the changes in the number of invasive tests performed after introducing NIPT. Materials and Methods: NIPT data from a large single center from March 2014 to November 2018 were analyzed. Karyotyping was confirmed based on chorionic villus sampling, amniocentesis, or postnatal cord/peripheral blood sampling. Data on maternal age, gestational age, fetal fraction, and ultrasonographic results were analyzed. As the secondary outcome, the number of amniocentesis cases before and after the introduction of NIPT was compared. Results: Overall, 1,591 single pregnancy cases that underwent NIPT were enrolled. The mean maternal age was 36.05 (22-45) years. The average gestational age and fetal fraction were 12+1 (9+3 to 27+1) weeks and 10.95% (3.6% to 31.3%), respectively. A total of 1,544 cases (97.0%) were reported to have negative NIPT results and 40 (2.5%) had positive NIPT results. The sensitivity and specificity of the overall abnormalities in NIPT were 96.29% and 99.36%, respectively. The positive predictive value (PPV) and negative predictive value were 72.22% and 99.93% respectively. The mean number of amniocentesis cases were 21.7 per month (21.7±3.9), which significantly decreased from 31.5 per month (31.5±4.8) before conducting NIPT as a screening test. Conclusion NIPT is currently a useful, powerful, and safe screening test. In particular, trisomy 21 is highly specific due to its high PPV. NIPT can reduce the potential risks of procedure-related miscarriages during invasive testing.

Most patients with nephrotic syndrome visit the hospital because of edema due to hypoalbuminemia induced by severe proteinuria. However, rare cases have reported arterial thrombosis as the main problem complicating nephrotic syndrome. Arterial thrombosis combined with nephrotic syndrome is rarer than venous thrombosis, and it usually develops during treatment with steroids or diuretics. Arterial thrombosis is rarely diagnosed as the initial sign of nephrotic syndrome. We report the case of a 38-year-old-woman with membranous glomerulonephritis presenting with right common iliac artery thrombosis as the initial sign.
Diuretics ; Edema ; Glomerulonephritis, Membranous ; Humans ; Hypoalbuminemia ; Iliac Artery ; Nephrotic Syndrome ; Proteinuria ; Steroids ; Thrombosis ; Venous Thrombosis