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

PURPOSE: Juvenile dermatomyositis (JDM) is the most common of the idiopathic inflammatory myopathies in children. The purpose of this study is to observe demographic, initial presentations, duration of time between disease onset and diagnosis, clinical manifestations and laboratory findings at diagnosis of patients with JDM. METHODS: Forty seven patients identified at Seoul National University Children's Hospital from January 1986 to May 2007. Medical records were reviewed retrospectively focusing on initial presentations, clinical manifestations and laboratory findings at the time of diagnosis of patients with JDM. RESULTS: Male and female patients were 25 and 22, respectively and sex ratio was 1.14:1. The average age at the time of diagnosis was 6.51 years. Skin rash (94%) was the most common symptom, followed by the proximal muscle weakness (89%). The disease activity score was 10.8. The duration between the onset of the skin rash and the muscle weakness and diagnosis was 7.18 and 4.70 months, respectively. The serum muscle enzymes, LDH, AST, CK and aldolase, were elevated in the patient with JDM. Autoimmune antibodies, antinuclear antibody, anti SSA antibody and anti SSB antibody, were negative findings. Electromyography findings were consistent with JDM in 88% of the patients, the muscle biopsy was in 91% and all MRI findings were compatible with those of patients with JDM. The most common symptom besides musculocutaneous lesions was the calcinosis (62.5%). The most common site of calcinosis was the pelvic area and buttocks. CONCLUSION: This study shows that the major symptoms are proximal muscle weakness and cutaneous lesion, and they are important to diagnose JDM.
Antibodies, Antinuclear ; Biopsy ; Buttocks ; Calcinosis ; Child ; Dermatomyositis* ; Diagnosis* ; Electromyography ; Exanthema ; Female ; Fructose-Bisphosphate Aldolase ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Muscle Weakness ; Myositis ; Retrospective Studies ; Seoul ; Sex Ratio

Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin’s lymphoma arising from a B-cell lineage characterized by the formation of malignant effusion in body cavities without evidence of a detectable tumor. The effusion contains tumor cells universally infected with human herpesvirus 8 (HHV8), which is the critical factor differentiating PEL from HHV8-unrelated PEL-like lymphoma (PEL-LL). This report describes a 77-year-old male patient with pleural effusion and ascites, containing lymphoma cells expressing a B-cell phenotype, but without markers of HHV8 in immunocytochemical analysis. The patient was diagnosed with PEL-LL and treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), which resulted in a complete remission. The patient is currently disease-free 15 months post-treatment. To the best of our knowledge, this is the first report on administration of R-CHOP in a PEL-LL patient in South Korea.
Aged* ; Ascites ; B-Lymphocytes ; Cyclophosphamide* ; Doxorubicin* ; Herpesvirus 8, Human ; Humans* ; Korea ; Lymphoma* ; Lymphoma, Primary Effusion ; Male ; Phenotype ; Pleural Effusion ; Prednisolone* ; Rituximab* ; Vincristine*

Lymphomatoid papulosis (LyP) is a relatively uncommon CD30＋ lymphoproliferative disorder with a good prognosis. However, it is important to be cautious because 4%∼25% of the cases are accompanied by secondary lymphoma. LyP is divided into subtypes of infiltrate-descriptive categories based on the histological findings. Classically, LyP shows a patchy, wedge-shaped, dermal infiltrate of small to intermediate-sized lymphocytes, with atypical lymphoid cells and a variable mixture of neutrophils, histiocytes, and eosinophils. Follicular LyP (type F LyP), which was recently described and is not yet included as an official subtype in the World Health Organization classification, shares these characteristics, although its infiltrate is folliculocentric. Variable folliculotropism, follicular dilation, rupture, and mucinosis can occur. This entity is commonly misdiagnosed and is possibly underreported because its histopathologic features can masquerade as more common follicular-based entities. Herein, we report the case of follicular type LyP, which has not been reported in in Korean dermatology literature.

Gastric adenocarcinoma is among the top causes of cancer-related death and is one of the most commonly diagnosed carcinomas worldwide. Benzyl isothiocyanate (BITC) has been reported to inhibit the gastric cancer metastasis. In our previous study, BITC induced apoptosis in AGS cells. The purpose of the present study was to investigate the effect of BITC on autophagy mechanism in AGS cells. First, the AGS cells were treated with 5, 10, or 15 μM BITC for 24 h, followed by an analysis of the autophagy mechanism. The expression level of autophagy proteins involved in different steps of autophagy, such as LC3B, p62/SQSTM1, Atg5-Atg12, Beclin1, p-mTOR/mTOR ratio, and class III PI3K was measured in the BITC-treated cells. Lysosomal function was investigated using cathepsin activity and Bafilomycin A1, an autophagy degradation stage inhibitor. Methods including qPCR, western blotting, and immunocytochemistry were employed to detect the protein expression levels. Acridine orange staining and omnicathepsin assay were conducted to analyze the lysosomal function. siRNA transfection was performed to knock down the LC3B gene. BITC reduced the level of autophagy protein such as Beclin 1, class III PI3K, and Atg5-Atg12. BITC also induced lysosomal dysfunction which was shown as reducing cathepsin activity, protein level of cathepsin, and enlargement of acidic vesicle. Overall, the results showed that the BITC-induced AGS cell death mechanism also comprises the inhibition of the cytoprotective autophagy at both initiation and degradation steps.

Arcanobacterium haemolyticum is a cause of chronic skin ulcers in diabetic patients and respiratory infection, especially pharyngitis in healthy person. Less frequently, it is a cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. We isolated A. haemolyticum from 5 patients including foot or back ulceration in 3 diabetic patients, wound on calcaneus in a chronic osteomyelitis patient and peritonsillar abscess in a pharyngitis patient. A. haemolyticum is usually isolated with other microorganisms and coryneform bacilli which are often considered to be nonpathogenic normal flora or contaminants in wound infections. The correct diagnosis of this microorganism is important for proper treatment and prevention of serious infections.
Abscess ; Arcanobacterium* ; Calcaneus ; Diagnosis ; Endocarditis ; Foot ; Humans ; Meningitis ; Osteomyelitis ; Peritonsillar Abscess* ; Pharyngitis ; Pneumonia ; Sepsis ; Skin Ulcer* ; Ulcer ; Wound Infection ; Wounds and Injuries

The authors describe the case of a 71-year-old patient with acute megakaryocytic leukemia (AML-M7) who was successfully treated with low-dose cytarabine induction followed by intermediate-dose cytarabine consolidation therapy. The patient presented with infection and rapidly increasing blood blasts. The diagnosis was consistent with AML-M7 with a normal karyotype. Peripheral blood blasts decreased rapidly upon low-dose cytarabine administration, and the patient achieved complete remission after two courses of low-dose cytarabine (10 mg/m2 bid for 12 days). Consolidation therapy with intermediate-dose cytarabine (1.0 g/m2 bid on day 1, 3 and 5) was then instituted without serious complication. He remained in complete remission at the time of writing 47 month after diagnosis. In spite of multiple poor prognostic factors, this patient showed excellent treatment outcome through low-dose cytarabine induction and intermediate- dose cytarabine consolidation. It needs to be validated whether acute leukemia with a megakaryocytic morphology is exceptionally sensitive to cytarabine.
Aged ; Cytarabine ; Humans ; Karyotype ; Leukemia ; Leukemia, Megakaryoblastic, Acute ; Leukemia, Myeloid, Acute ; Treatment Outcome ; Writing

OBJECTIVE: To determine whether the rehabilitation desire of patients with spinal cord injury (SCI) in post-acute rehabilitation hospitals be suitable to objective parameters, and to figure out the discharge plan after post-acute rehabilitation hospitals. METHOD: 98 patients with SCI in post-acute rehabilitation hospitals were included. In order to identify rehabilitation desire, interviews were conducted among patients or their family members in a direct line. Discharge plans of patients after post-acute rehabilitation hospitals were surveyed. All participants completed demographic measures, Korean Modified Barthel Index (K-MBI) and International Classification of Functioning, Disability and Health (ICF) core-set for patients with neurological problems in post-acute rehabilitation facilities to determine the influences on rehabilitation desire. RESULTS: Most (80.6%) of patients desired more intensive rehabilitation services and 47 patients (48.0%) purposed to get physical therapy focused on motor recovery. Only 15 patients (15.3%) planned to discharge to home. Patients who planned to discharge to home had higher K-MBI score and lower numbers of decreased body functioning, activities and participation in ICF core-set than patients who would admit to another rehabilitation hospitals after discharge. CONCLUSION: Appropriate and intensive educations after spinal cord injury on the recovery process and goal of rehabilitation are required to supply adequate rehabilitation services and to avoid unnecessary admission to rehabilitation hospitals. And the rehabilitation program focusing on functional recovery should be emphasized in patients with SCI.
Humans ; Spinal Cord ; Spinal Cord Injuries

Takayasu arteritis is a chronic inflammatory disease of unknown etiology primarily affecting the aorta and its major branches and usually occurring in the second or third decade of life. Here, we report a case of Takayasu arteritis in a 10-month-old patient. The infant presented with signs of congestive heart failure and severe aortic regurgitation. Echocardiography and computed tomography angiography showed an abnormally dilated thoracic and abdominal aorta. The infant was initially treated with prednisolone, followed by commissuroplasty of the aortic valve but neither approach ameliorated the heart failure. The patient was eventually treated with a mechanical aortic valve replacement surgery at the age of 12 months, and her condition stabilized. Although unusual, this case indicates that the diagnosis of Takayasu arteritis should be considered in children with unexplained systemic symptoms, aortic valve regurgitation, and heart failure. Because severe aortic regurgitation may be a fatal complication of Takayasu arteritis, early aortic valve replacement surgery should be considered, even in very young children.
Angiography ; Aorta ; Aorta, Abdominal ; Aortic Valve ; Aortic Valve Insufficiency ; Child ; Echocardiography ; Heart Failure ; Humans ; Infant ; Prednisolone ; Takayasu Arteritis

BACKGROUND AND OBJECTIVES: Based on our previous studies on pulmonary atresia with ventricular septal defect (VSD) and major aorto-pulmonary collateral arteries (MAPCAs), a management strategy for this disease was formulated at our hospital in 1999. To evaluate this strategy, it was applied to the new patients and their outcomes were measured. SUBJECTS AND METHODS: The subjects were a cohort of newly diagnosed patients who were without any prior interventions and these patients were treated at our hospital from January 2000 to December 2003. The management strategy focused on promoting the growth of the pulmonary arterial confluence (PAC), if present, by performing a right ventricle-pulmonary artery conduit operation (RV-PA conduit). If the PAC was large or absent, then the management plan was discussed among the surgeons after performing an exhaustive work-up. RESULTS: Seventeen patients were enrolled and their age at the time of diagnosis ranged from 8 days to 34 months with a median age of 3 months. The initial surgical method varied from one-stage total correction (4 cases) to a conduit operation with or without additional MAPCAs procedures (13 cases). All but three of the patients survived their initial surgery. There were two late deaths. In addition to the 3 survivors from one-stage total correction, 4 patients underwent a staged total corrective operation. The 5 remaining patients are still a subtotal correction state or a palliated state. CONCLUSION: When a large PAC is present, one-stage total correction is the best surgical option. However, when the PAC is small, then RV-PA conduit without any vascular procedures may be a good alternative. This staged approach makes a larger PAC, which enables surgeons to create a much easier vascular anastomosis later on.
Arteries* ; Cohort Studies ; Diagnosis ; Heart Septal Defects, Ventricular* ; Humans ; Pulmonary Atresia* ; Survivors