The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
Adrenal Insufficiency ; Anxiety ; Appetite ; Axis ; Depression ; Diagnosis, Differential ; Endocrine System Diseases ; Fatigue ; Fever ; Growth Hormone ; Headache ; Humans ; Hypopituitarism ; Hypothyroidism ; Sleep Initiation and Maintenance Disorders ; Weight Loss

Low back pain is the most costly occupational health problem and is in steadily increasing trend. Some occupational back problems often lead to persistent pain with medical, psychologic and occupational implications. Treatment is uncertain these chronic low back pain patients are responsible for most of medical expenses spent on occupational back pain. So, chronic low back pain prevention seems very important and is accomplished by a combination of measures. The authors experienced a case of chronic low back pain in compensation without definite evidence of organic causes and report the case with clinical reviews and measurements of the pain and pain behaviors using psychological tests and pain questionnaire.
Back Pain ; Chronic Pain ; Compensation and Redress ; Humans ; Low Back Pain ; Occupational Health ; Occupations ; Psychological Tests ; Questionnaires

It is generally accepted that a vascular accident in utero during the fetal period plays an important role in the occurrence of intestinal atresia. An experimental study, making use of chick embryos was made to induce intestinal atresia by vascular occlusion or ligation of a loop of intestine. A study using the chick embryos made it relatively easy to obtain the experimental group. Its advantages are a short incubation period(21 days) and many operations can be performed with only a limited supply of surgical instruments. Physiologic umbilical hernia of the chick embryo is present from the 9th to the 18th day of development. We used chick embryos between 9th to 15th day of development to perform experiments. In group I, as a control group, round shaped opening was made in the eggshell, shell membrane and chorioallantoic membrane with diameter of 1 cm, and then closed with transparent tape. In group II, the mesenteric artery was ligated with prolene 7-0. In the group III, a loop of intestine was ligated with prolene 7-0. The survival rate of group I was 35.7%(50/140), group II, 5.1%(36/700) and group III was 7.6%(53/700)(p<0.001). The intestinal atresia in hatched embryos showed no case in group I, 14cases out of 36cases in Group II(type II 5cases, type III 9cases), and all cases in Group III(type I 3cases, type II 29cases, type III 21cases). There was no significant relation between experimental group and type of intestinal atresia(p=0.09). In this experiments, the survival rate and incidence of intestinal atresia of group III were higher than group II. We concluded that vascular accident of intestine during fetal period was a factor in development of intestinal atresia, but, mechanical obstruction of intestinal loop was more important.
Animals ; Chick Embryo* ; Chorioallantoic Membrane ; Embryonic Structures ; Hernia, Umbilical ; Incidence ; Intestinal Atresia* ; Intestines ; Ligation ; Membranes ; Mesenteric Arteries ; Polypropylenes ; Surgical Instruments ; Survival Rate

The prevalence of allergic diseases has increased worldwide, a phenomenon that can be largely attributed to environmental effects. Among environmental factors, air pollution due to traffic is thought to be a major threat to childhood health. Residing near busy roadways is associated with increased asthma hospitalization, decreased lung function, and increased prevalence and severity of wheezing and allergic rhinitis. Recently, prospective cohort studies using more accurate measurements of individual exposure to air pollution have been conducted and have provided definitive evidence of the impact of air pollution on allergic diseases. Particulate matter and ground-level ozone are the most frequent air pollutants that cause harmful effects, and the mechanisms underlying these effects may be related to oxidative stress. The reactive oxidative species produced in response to air pollutants can overwhelm the redox system and damage the cell wall, lipids, proteins, and DNA, leading to airway inflammation and hyper-reactivity. Pollutants may also cause harmful effects via epigenetic mechanisms, which control the expression of genes without changing the DNA sequence itself. These mechanisms are likely to be a target for the prevention of allergies. Further studies are necessary to identify children at risk and understand how these mechanisms regulate gene-environment interactions. This review provides an update of the current understanding on the impact of air pollution on allergic diseases in children and facilitates the integration of issues regarding air pollution and allergies into pediatric practices, with the goal of improving pediatric health.
Air Pollutants ; Air Pollution ; Asthma ; Base Sequence ; Cell Wall ; Child ; Cohort Studies ; DNA ; Epigenomics ; Gene-Environment Interaction ; Hospitalization ; Humans ; Hypersensitivity ; Inflammation ; Lung ; Oxidation-Reduction ; Oxidative Stress ; Ozone ; Particulate Matter ; Prevalence ; Proteins ; Respiratory Sounds ; Rhinitis ; Rhinitis, Allergic, Perennial

No abstract available.
Fetal Blood* ; Humans ; Infant, Newborn* ; Phenotype

BACKGROUND: Dopamine receptors have been regarded as a strong candidate involved in etiology of schizophrenia and a target for various antipsychotic drugs. The purpose of our study was to investigate whether dopamine D1 receptor(DRD1) gene polymorphisms would predict the treatment response to antipsychotics in schizophrenia. METHOD: One hundred thirty-four schizophrenic patients, who met DSM-IV criteria for schizophrenia were entered into a 48-week study. The psychopathology of the patients was assessed at baseline, 12th, 24th, 48th weeks of treatment by PANSS. Responders were defined by a 20% of the reduction in total PAnSS score at end point. The genomic DNA fragment corresponding to nucleotides of dopamine D1 receptor gene was amplified by polymerase chain reaction(PCR). RESULT: Neither allelic frequencies nor genotypes for dopamine D1 receptor differed significantly between responders and non-responders. Also, there was no difference of changes of PANSS scores among three genotype groups of the dopamine D1 receptor. CONCLUSION: Allelic variation in the dopamine D1 gene is not associated with individual differences in antipsychotic response.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Dopamine* ; Genotype* ; Humans ; Individuality ; Nucleotides ; Psychopathology ; Receptors, Dopamine ; Receptors, Dopamine D1* ; Schizophrenia

PURPOSE: beta-catenin is a key regulator of the cadherin-mediated cell adhesion system and also plays a role as a transcription regulating factor. Nuclear expression and mutation of beta-catenin have been identified in some benign and malignant tumors, and over expression of beta-catenin indicates an oncogenic potential. This study was designed to clarify the role of beta-catenin in the histogenesis of gallbladder carcinoma. METHODS: In benign hyperplastic lesions, adenomas, and carcinomas of the gallbladder, intracellular expression of beta-catenin was investigated by immunohistochemical stainings. Cyclin D1 and Ki-67 were also examined. RESULTS: All of the hyperplastic lesions showed membranous expression of beta-catenin. Adenomas and polypoid carcinomas showed significantly higher incidence of cytoplasmic and nuclear expression of beta-catenin than hyperplastic lesions and infiltrative carcinomas (P<0.01). Loss of beta-catenin expression was frequently noticed in infiltrative and poorly differentiated carcinomas. Nuclear expression of beta-catenin in carcinomas had unique pathologic characteristics, including polypoid growing, well differentiated tubular type, and early stage. Cytoplasmic and nuclear expression of beta-catenin showed good correlations with cyclin-D1 expression (P<0.05). The Ki-67 index was significantly higher in infiltrative carcinomas than in adenomas or polypoid carcinomas (P<0.05). CONCLUSION: Our results suggest that beta-catenin as a molecular marker may play a role in the carcinogenesis of the adenoma-carcinoma sequence of polypoid carcinomas. Infiltrative carcinomas, however, may have different mechanisms.
Adenoma* ; beta Catenin* ; Carcinogenesis ; Cell Adhesion ; Cyclin D1 ; Cytoplasm ; Gallbladder* ; Incidence

The periodic sharp wave complexes are the most characteristic EEG abnormalities in sCJD. We report the serial EEG findings in a patient with probable sCJD. The initial EEG showed diffuse theta and delta slowings only. However, it changed to the typical periodic sharp wave complexes according to the worsening clinical state. These changes occurred during a short-term interval. The serial EEGs within the short-term interval will be helpful for the earlier diagnosis of sCJD.
Diagnosis ; Electroencephalography* ; Humans

The aim of this study was to evaluate the efficacy of intravenous immunoglobulin treatment for recurrent spontaneous abortion. Immunologic causes in either alloimmune or autoimmune type have been suggested for more than 80% of these patients. Various immunotherapy including paternal leukocyte transfusion has been used, but there is controversy on its efficacy and side-effects. The proposed immunomodulatory mechanism of intravenous immunoglobulin includes passive transfer of blocking or anti-idiotype antibody, blockade of Fc receptors, enhancement of supressor T-cell function, down regulation of B cell function. In this study, we used intravenous immunoglobulin for the prevention of spontaneous abortion. Five patients with a history of two or more spontaneous abortions were enrolled in this study. Other etiologic factors such as anatomical, chromosomal, hormonal factors were excluded. Three of them were positive for anti-cardiolipin antibody (ACA). When the pregnancy was diagnosed at about five weeks of gestation, 30 g intravenous immunoglobulin was administered and continued up to 28 weeks with three weeks. Ongoing pregnancy beyond 20 weeks was considered successful. Four among five patients (80%) was successful in maintaining pregnancy now ongoing 20, 31, 33, 39 weeks. One patient with ACA positive had abartion due to anembryonic pregnancy. No adverse reaction was observed during the treatment. From these preliminary data, it is suggested that intravenous immunoglobulin treatment may be effective in maintaining pregnancy in patients with unexplained recurrent spontaneous abortion, Further studies are needed to clarify the its immunomodulatory mechanism and establish a more simplified protocol limiting the use at certain critical period of time.
Abortion, Spontaneous* ; Critical Period (Psychology) ; Down-Regulation ; Female ; Humans ; Immunoglobulins* ; Immunotherapy ; Leukocyte Transfusion ; Pregnancy ; Receptors, Fc ; T-Lymphocytes

OBJECTIVE: Although clinical guidelines recommend that antidepressant treatment should be continued for at least 4 to 9 months, naturalistic studies show that the average length of treatment is shorter than 6 months and that dropout rates are high. But factors leading patients to discontinuation of therapy are not well understood yet. In this study, we investigated factors associated with adherence to antidepressant in Korean patients with depressive disorder. METHODS: Patients who were diagnosed as depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria and took prescribed antidepressants were included in this study. Medical records of 194 patients were reviewed retrospectively. To find adherence to antidepressant treatment, we calculated Medication Possession Ratio at 2 wks, 4 wks, 8 wks, 12 wks, 24 wks after their 1st visit. Patient-related factors, illness-related factors including measurement scales (Beck Depression Inventory, Patient Health Questionnare-15, Global Assessment of Recent Stress Scale scores), and treatment-related factors were compared between adherent group and non-adherent group using chi-square test or student t-test. Multivariate logistic regression was used to predict factors associated with adherence to antidepressant treatment. RESULTS: Analyzing data of 194 patients, 106 patients (54.6%), and 82 patients (42.3%) were adherent group at 12 wks and 24 wks, respectively. In patient-related factors, old age and low education periods were significantly associated with adherent group. In illness-related factors and treatment-related factors, none of the factors showed a significant difference between groups. In multivariate logistic regression, old age was significantly associated with sustained adherence at 12 wks. CONCLUSION: We found some factors associated with adherence to antidepressant treatment. Old age was associated with sustained adherence to antidepressant. To enhance adherence to antidepressant, our findings suggest that outpatient education program is needed. And social policy is also essential to reduce stigma in psychiatric department especially among young patients.
Antidepressive Agents ; Depression ; Depressive Disorder* ; Education ; Humans ; Logistic Models ; Medical Records ; Outpatients* ; Patient Dropouts ; Public Policy ; Retrospective Studies ; Weights and Measures