OBJECTIVES: Risperidone, an atypical antipsychitics which blocks both dopaminergic and serotonergic receptors, have a good response to the negative symptoms as well as positive symptoms, and improve cognitive dysfunction of schizophrenic patients. Furthermore, it has few extrapyramidal side effects and tardive dyskinesia. Although it had been reported that the atypical antipsychotics have less effect on prolactin(PRL) than the classical antipsychotics, we could experience PRL-associated symptoms such as amenorrhea, galactorrhea and hyperprolactinemia in practice. Therefore we tried to identify the sex differences of risperidone-induced hyperprolactinemia, to evaluate factors affecting PRL levels, and to know the association between cognitive disorders and PRL. METHODS: The baseline levels of PRL and TSH prior th risperidone administration were measured by enzyme immunoassay method for 50 patients (25 males and 25 females) admitted with schizophrenia, schizoaffective disorder or schizophreniform disorder according to the DSM-IV classification, and the measurements of PRL were repeated on the 2nd and the 4th wks of risperidone administration. Concomitantly, the severity of psychotic symptoms using CGI, BPRS and PANSS, and the cognitive dysfunction using PANSS-CF were assessed prior to, on the 2nd and the 4th wks of risperidone administration. The PRL and TSH levels of 54 healthy controls(29 males and 25 females) who had no medical, neurological and psychiatric illnesses were also evaluated. Furthermore, the correlation with the psychiatric diagnosis, education, age, sex, duration of illnesses, risperidone dosage, duration of risperdone administration, TSH concentration, cognitive function, severity of psychotic symptoms were also identified. RESULTS: 1) The baseline PRL levels of female schizophrenics(74.3+/-49.6ng/ml) were significantly(p<0.005) higher than those of males(36.3+/-24.6ng/ml), which wee significantly(p<0.0001 respectively) higher than those of controls(females 16.9+/-6.1ng/ml, males 13.3+/-4.9ng/ml). The PRL levels measured on the 2nd wks(females 133.7+/-47.8ng/ml, males 56.9+/-23.6ng/ml) and on the 4th wks(females 146.1+/-45.9ng/ml, males 70.0+/-31.5ng/ml) after risperidone administration were significantly(p<0.0001 respectively) higher in females. The mean dosages of risperidone on the 2nd wks were 3.8+/-1.7mg(2-6mg) for the females and 4.0+/-1.6mg(2-6mg) fore the males, and on the 4th wks were 4.5+/-2.1mg(2-8mg) fore the females and 5.4+/-2.2mg(2-8mg) for the males. 2) The rise of PRL levels were positively correlated with increased risperidone dosage in males(y=0.307 on the 2nd wks and y=0.280 on the 4th wks), while they were not correlated with dosages in females. For the females, the PRL levels were negatively correlated(y=-0.320) with decrease of TSH concentration. The baseline PRL levels were not correlated with age, education, duration of illnesses, psychopathology, cognitive disorders in both males and females, while it was negatively correlated with TSH levels only in females(y=-0.320). 3) The cognitive dysfunction was correlated with PRL levels in males, while PANSS-CF scores were negatively correlated with PRL levels(y=-0.220 on the 2nd wks and y=-0.366 on the 4th wks) in females. The psychopathology was positively correlated with cognitive dysfunction in both males and females. Therefore, the risperdone-induced cognitive improvement seemed to be correlated with improvement of psychopathology in both males and females, and with increase in PRL levels only in females. CONCLUSIONS: The fact that the serum PRL levels of schizophrenics were higher than those of controls, especially in females suggested that it could be related with risperidone dosage in males and with primary pathological process in females. The risperidone-associated cognitive improvement seemed to be related with general improvement of psychopathology as well as the rise of PRL levels especially in females. The facts that the effect of risperidone-induced hyperprolactinemia and the cognitive function were more in females suggested that somewhat different mechanisms could be exerted on them.
Amenorrhea ; Antipsychotic Agents ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Female ; Galactorrhea ; Humans ; Hyperprolactinemia ; Immunoenzyme Techniques ; Male ; Mental Disorders ; Movement Disorders ; Pregnancy ; Prolactin* ; Psychopathology ; Psychotic Disorders ; Risperidone* ; Schizophrenia ; Sex Characteristics

BACKGROUND: It is important to evaluate the patient presenting with non-traumatic chest pain in emergency department, and it is also difficult to classify appropriately. The purpose of this study is to predict probability of acute myocardial infarction(AMI) and assess the group for low probability of AMI that is target for observation-unit of chest pain in emergency department. METHODS: A prospective, clinical study was performed from March 1998 to August 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. We classified high-probability group and low-probability group of AMI according to Goldman's algorithm and then compared with the final diagnosis. RESULTS: The study included 218 patients. 84 patients(39%) was the high-probability group and 134 patients(61%) was the low-probability group of AMI. As compared with final diagnosis, AMI was 47 patients(56%) among the high-probability group and 1 patient(0.7%) among the low-probability group. We observed sensitivity of 98%, specificity of 78% in predicting AMI. CONCLUSION: The classification according to Goldman's algorithm may be useful predictor of AMI and improve triage for emergency department patient with chest pain. It is also helpful for management of observation-unit of chest pain in emergency department.
Chest Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thorax* ; Triage

No abstract available.
Urinary Tract Infections* ; Urinary Tract*

No abstract available.
Odontoma*

Endosonography (EUS) enables the acquisition of clear images of the gastrointestinal tract wall and the surrounding structures. EUS enables much greater accuracy for staging decisions compared to computed tomography. Surgery for esophageal cancer has a high rate of morbidity and mortality, and it is important to decide on an appropriate treatment method through pre-surgical evaluation. Minimal invasive surgery is widely used for the treatment of gastrointestinal cancer, and endoscopic submucosal dissection is a safe treatment method for early cancer of the gastrointestinal tract that does not result in lymph node metastasis. EUS is essential for pre-surgical evaluation for all esophageal cancers. The use of EUS can effectively reduce unnecessary surgeries and thereby allow for appropriate treatment planning for patients. A number of different diagnostic modalities are available, but EUS is still the mainstay for pre-surgical evaluation of esophageal cancer. The role of EUS for early stomach cancer treatment as a tool for determining the need for endoscopic resection and for pre-surgical assessment is increasing.
Endosonography* ; Esophageal Neoplasms ; Gastrointestinal Neoplasms* ; Gastrointestinal Tract ; Humans ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Rectal Neoplasms ; Stomach Neoplasms

Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.
Adenocarcinoma ; Anisakis ; Carcinoid Tumor ; Diagnosis ; Duodenum ; Early Detection of Cancer ; Endoscopy ; Endosonography ; Esophagus ; Gastrointestinal Stromal Tumors ; Glomus Tumor ; Humans ; Inflammation ; Japan ; Korea ; Lymphoma ; Neoplasm Metastasis ; Prognosis ; Stomach ; Stomach Neoplasms

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

While a number of diagnostic methods have been developed, endoscopic ultrasound (EUS) still takes the most important role in the preoperative evaluation of esophageal cancer. EUS can detect lesions of all esophageal cancer and can accurately perform T staging. In a recent meta-analysis of EUS in esophageal cancer, the sensitivity and specificity of EUS on esophageal cancer were 81.6% and 99.4% in T1, 81.4% and 96.3% in T2, 91.4% and 94.4% in T3, and 92.4% and 97.4% in T4, respectively. The use of EUS can reduce unnecessary surgeries and lead to apply proper treatments to patients. The advance of endoscopic submucosal dissection have necessitated the presurgical detection of early cancer lesions without lymph node metastasis. Understanding the practical meanings of images shown by EUS is important to decide patients for whom endoscopic treatments can be effective. In early gastric cancer, EUS can accurately predict mucosal and SM1 (invasion into the submucosal layer of less than 500 microm from muscularis mucosa) lesions, which are considered as good indications for endoscopic treatments.
Endosonography ; Esophageal Neoplasms ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Sensitivity and Specificity ; Stomach Neoplasms

BACKGROUND: We studied the antibiotic sensitivities to the causative microorganisms of acute simple urinary tract infection for recent 3 years. METHODS: We analyzed 112 microorganisms and their antibiotic sensitivities of the 104 patients who were admitted to or visited the Department of Urology, Catholic University St. Marys Hospital and had more than 10cfu/mL on urine culture from June 1996 to January 1999 retrospectively. RESULTS: The chance of gram negative and positive as causative microorganisms was 72.3% and 27.7% respectively. The most common pathogenic microorganisms were Escherichia coli (67.0%) followed by a-hemolytic streptococci, Entercoccus. In gram negative acute UTI, imipenem, sulperanzone showed relatively higher sensitivity, while cotrimoxazole, ampicillin showed relatively lower sensitivity. In gram positive, vancomycin, penicillin showed relatively higher sensitivity, while ampicillin, imipenem showed relatively lower sensitivity. CONCLUSIONS: We consider that gram negative microorganisms, especially E. coli, is the main cause of acute simple UTI. But, we should be concerned about the increase of gram positive organisms and other gram negative organisms besides E. coli. Regarding to the choice of adequate drug in the treatment of UTI, it is necessary to consider the change of pathologic microorganisms.
Ampicillin ; Escherichia coli ; Humans ; Imipenem ; Penicillins ; Retrospective Studies ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections* ; Urinary Tract* ; Urology ; Vancomycin

No abstract available.
Animals ; Dental Cementum* ; Dentin* ; Dogs*