Thrombosed capillary or vein is a dome-shaped or slightly lobulated moderately firm, blue black nodule arising either abruptly or gradually. There may be a rim of erythema or brownish pigmentation around it. Its clinical features are similar to a malignant melanoma. We report a case of thrombosed capillary or vein associated with angiokeratoma in 44-year old male patient who has a bean sized, dome-shaped, blue-black nodule and multiple hyperkeratotic pinhead sized dark red papules un scrotum.
Adult ; Angiokeratoma* ; Capillaries* ; Erythema ; Humans ; Male ; Melanoma ; Pigmentation ; Scrotum ; United Nations ; Veins*

PURPOSE: Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. MATERIALS AND METHODS: A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. RESULTS: The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. CONCLUSION: Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.
Adult ; Asian Continental Ancestry Group ; Bipolar Disorder/*complications/*psychology ; Depressive Disorder/complications/*psychology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Suicide, Attempted/*psychology/statistics & numerical data ; Young Adult

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) plays an important role in cell survival, differentiation, and cell death as well as in neural plasticity. Recent studies have suggested that BDNF is involved in the pathogenesis of bipolar disorder. The aim of this study was to investigate the association of the genetic variations of the BDNF gene with bipolar disorder in Korea. We also studied the possible association of these genetic variants with clinical features. METHODS: The allelic and genotypic distributions of Val66Met polymorphism of the BDNF gene were analyzed using a polymerase chain reaction-based method in 184 bipolar patients and 214 controls. Analysis was performed to investigate an association of the Val66Met polymorphism of the BDNF gene and the clinical features in bipolar patients. RESULTS: No significant difference was found between bipolar patients and controls in the genotype and allele frequencies for the investigated BDNF polymorphism. However, the age of onset of bipolar disorder among the Val/Val (25.57), Val/Met (30.42) and Met/Met (32.45) genotype groups were significantly different (p=0.037). CONCLUSION: This study suggests that Val66Met polymorphisms are unlikely to contribution to the genetic predisposition to bipolar disorder as a whole. But Val66Met polymorphism may be associated with age of onset of the disorder, further studies designed to investigate the relationship in a larger population may be warranted.
Age of Onset ; Bipolar Disorder ; Brain-Derived Neurotrophic Factor ; Cell Death ; Cell Survival ; Gene Frequency ; Genetic Predisposition to Disease ; Genetic Variation ; Genotype ; Humans ; Korea

OBJECTIVES: It has been reported that first episode polarity affected the course and the prognosis of bipolar disorder. However, there is remarkable paucity of information regarding first episode polarity in bipolar disorder. We investigated the clinical characteristics related to the first episode polarity of bipolar patients who had been hospitalized. METHODS: Analyses were based on the medical documents of 520 bipolar patients who had been hospitalized in 4 hospitals. We examined clinical features of the current episode, demographics, past treatment history, suicidal attempt history, family history and comorbidity. Clinical characteristics were compared between manic onset and depressive onset patients. RESULTS: The mean age of the patients was 36.7 years old; they had 2.1 number of admission history and 6.6 years of illness duration. The patients beginning with depressive onset was 39.4%, and they had more diagnosis of bipolar II disorder, more number of suicidal attempts and reported more depressive mood during index admission than manic onset patients. CONCLUSION: Depressive onset is a common presentation in bipolar disorder. It is necessary to give more attention to depressive episode in bipolar disorder. Prospective study needs to explore the correlation of first-episode of polarity and course of the illness in the future.
Bipolar Disorder* ; Comorbidity ; Demography ; Diagnosis ; Humans ; Prognosis

OBJECTIVE: The aim of this study was to monitor changes of prescription patterns for bipolar disorder in clinical settings during the last five years in four psychiatric treatment centers. METHODS: A retrospective chart review of data of 601 patients with bipolar disorder was performed between January 2001 and December 2005 from four psychiatric centers in Seoul and GyeongGi-Do. Data on demograpnic variables, clinical characteristics, and the types and dosages of mood stabilizers and antipsychotics, and the patterns of prescriptions over the five-year period were analyzed. RESULTS: The use of valproate has increased, whereas the percentage of lithium use has decreased. The combined prescription of valproate and lithium remained constant at 12% over the five-year period. The prescription of newer-class of mood stabilizers such as lamotrigine and topiramate was few. Most of the patients in our study were on more than two psychotropic agents, with the most common discharge medication being a combination of a mood stabilizer and an antipsychotic (81.9%). The use of atypical antipsychotics has increased its share from 71.4% in 2001 to 92.3% in 2005. Among the atypical antipsychotics, Quetiapine use showed the most rapid increase since year 2001 and ranked as the most frequenctly used antipsychotics for bipolar disorder in 2005 (38.5% of antipsychotics). Especially, in those without psychotic features, quetiapine was the most frequently used antipsychotics (51.2% in 2005). In those with psychotic features, risperidone (39.1%) was more frequently used than quetiapine (28.3%). CONCLUSION: The present study showed that significant changes have occurred in the prescription patterns of mood stabilizers and antipsychotics and the rate of combination therapy for patients with bipolar disorder in the last five years. These results seem to reflect the introduction of new agents and the accumulating evidencebased data for the treatment of bipolar disorder, and will provide the useful information to clinicians for the establishment of better treatment guidelines for patients with bipolar disorder.
Antipsychotic Agents ; Bipolar Disorder* ; Gyeonggi-do ; Humans ; Inpatients* ; Lithium ; Prescriptions* ; Retrospective Studies ; Risperidone ; Seoul ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVES: The aim of this study was to exam whether personality, i.e. temperament and character, has an association with a previous presence of psychotic features in euthymic bipolar I disorder. METHODS: We recruited 25 psychotic patients with bipolar I disorder, 23 non-psychotic bipolar I patients and 48 normal controls. All subjects were asked to perform Temperament and Character Inventory (TCI). Euthymic state was defined in bipolar patients by scores of below 10 on the Hamilton Depression Rating Scale (HDRS) and on the Young Manic Rating Scale (YMRS). RESULTS: Psychotic bipolar patients, compared to normal controls, showed higher harm avoidance (HA) and self-transcendence (ST). In addition, HA in psychotic bipolar patients was higher than that in non-psychotic bipolar patients. However, no significant differences on TCI were demonstrated between non-psychotic patients and normal controls. CONCLUSION: There are significant discrepancies in personality between psychotic and non-psychotic bipolar patients on HA and ST. These findings are consistent with the hypothesis of a continuum between bipolar disorder with psychotic features and psychotic disorders.
Bipolar Disorder ; Depression ; Humans ; Psychotic Disorders ; Temperament*

BACKGROUND: The standard operative treatment of primary spontaneous pneumothorax (PSP) is thoracoscopic wedge resection, but necessity of pleurodesis still remains controversial. Nevertheless, pleural procedure after wedge resection such as pleurodesis has been performed in some patients who need an extremely low recurrence rate. MATERIALS AND METHODS: From January 2000 to July 2010, 207 patients who had undergone thoracoscopic wedge resection and pleurodesis were enrolled in this study. All patients were divided into two groups according to the methods of pleurodesis; apical parietal pleurectomy (group A) and pleural abrasion (group B). The recurrence after surgery had been checked by reviewing medical record through follow-up in ambulatory care clinic or calling to the patients, directly until January 2011. RESULTS: Of the 207 patients, the recurrence rate of group A and B was 9.1% and 12.8%, respectively and there was a significant difference (p=0.01, Cox's proportional hazard model). There was no significant difference in age, gender, smoking status, and body mass index between two groups. CONCLUSION: This study suggests that the risk of recurrence after surgery in PSP is significantly low in patients who underwent thoracoscopic wedge resection with parietal pleurectomy than pleural abrasion.
Ambulatory Care ; Body Mass Index ; Follow-Up Studies ; Humans ; Medical Records ; Pleurodesis ; Pneumothorax ; Recurrence ; Smoke ; Smoking ; Thoracoscopy

OBJECTIVE: Bipolar depression has a disabling course and its treatment represents a major challenge. Recently, a randomized, controlled trial of quetiapine monotherapy in patients with bipolar depression showed significant reductions in depressive symptomatology. The purpose of this study was to evaluate the efficacy of quetiapine in bipolar depression in the clinical setting. METHODS: This study was a multi-center, prospective, open-label, observational, 8-week evaluation of the efficacy of quetiapine in patients with bipolar depression. Patients with a DSM-IV-TR diagnosis of bipolar depression (bipolar I disorder, most recent episode depressed and bipolar II disorder, most recent episode depressed) were included and treated with quetiapine. The dose of quetiapine was flexible and concomitant mediations were permitted, by clinical judgment. Clinical improvements were rated with the Clinical Global Impression-Bipolar version (CGI-BP) and Montgomery-Asberg Depression Rating Scale (MADRS) at baseline, week 4, and week 8. RESULTS: A total of 1,193 patients were recruited and 46 (3.9%) patients were dropped from the study. The mean initial dose of quetiapine was 192.3+/-181.9 mg/day and the mean doses at weeks 4 and 8 were 315.2+/-229.7 mg/day and 337.1+/-229.9 mg/day, respectively. CGI-BP and MADRS were significantly improved at weeks 4 and 8, compared with baseline. In addition, improvements at week 8 were greater than at week 4. Subjectively, about 75% of the patients reported therapeutic compliance above 75% at weeks 4 and 8. Seven (0.6%) and four (0.3%) patients showed manic/hypomanic episodes at weeks 4 and 8, respectively. CONCLUSION: This study suggests that quetiapine improves depressive symptoms in bipolar depression, with minimal incidence of manic switching. We suggest that quetiapine could be an effective and safe option in treating bipolar depression.
Bipolar Disorder ; Compliance ; Depression ; Dibenzothiazepines ; Humans ; Incidence ; Judgment ; Prospective Studies ; Quetiapine Fumarate

A congenital coronary arteriovenous fistula is a rare condition, which is an abnormal communication of the coronary artery with the right or left ventricle, the right or left atrium or the pulmonary artery. A coronary arteriovenous fistula, complicated with a pulmonary aneurysm, is quite uncommon. A case of 68-year-old woman, complaining of resting chest pain for 1 week, is reported. The coronary arteriovenous fistula associated, with a pulmonary aneurysm, was confirmed by coronary angiography and multidetector-row helical CT (MDCT), and was surgically ligated.
Aged ; Aneurysm* ; Arteriovenous Fistula* ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Pulmonary Artery* ; Tomography, Spiral Computed*

OBJECTIVES: The purpose of this study was to evaluate the efficacy and tolerability of osmotic release oral systemmethylphenidate (OROS-MPH) in children with attention-deficit hyperactivity disorder (ADHD) and comorbid psychiatric disorders. METHODS: This was an 8-week open label study of OROS-MPH monotherapy. The subjects were 113 children with ADHD aged 6-12 years. Outcome measures were the Korean version of the parent ADHD Rating Scale (K-ARS), Korean version of the Conners Parent Rating Scale (K-CPRS), Clinical Global Impression-Severity and Clinical Global Impression-Improvement. Side effects were monitored using Barkley's Side Effect Rating Scale. We compared the change-over-time in the mean scores of the outcome measure according to the comorbidity of disruptive behavior disorder, depressive disorder, anxiety disorder, and tic disorder. RESULTS: The mean K-ARS and K-CPRS scores were significantly decreased, regardless of the comorbidity. The mean doses of OROS-MPH and dropout rate did not differ significantly according to comorbidity. The OROS-MPH was well tolerated, regardless of the comorbidity. However, children with tic disorder reported a higher frequency of tics or nervous movements between the 2nd and 8th week than those without tic disorder. CONCLUSION: The OROS-MPH is effective for decreasing the symptoms of ADHD, and it is well tolerated, even by patients with comorbid psychiatric disorders.
Aged ; Anxiety Disorders ; Attention Deficit and Disruptive Behavior Disorders ; Child ; Comorbidity ; Depressive Disorder ; Humans ; Outcome Assessment (Health Care) ; Parents ; Patient Dropouts ; Tic Disorders ; Tics