OBJECTIVE: Many evidences raise the possibility that the panic disorder (PD) patients with respiratory subtype (RS) may have characteristic structural abnormalities. We aimed to explore the structural differences between PD patients with and without the respiratory symptoms. METHODS: Patients with PD were recruited from the Department of Psychiatry at Korea University Anam Hospital. Respiratory subtype (RS) was diagnosed when at least 4 out of 5 of the following respiratory symptoms were present during the panic attack: fear of dying, chest pain/discomfort, shortness of breath, paresthesias, and a choking sensation. We acquired high-resolution MRI scans and used FreeSurfer to obtain a measure of cortical thickness for each patient. RESULTS: Cluster based analysis revealed significantly decreased cortical thickness in the left hemisphere in the caudal-middle-frontal, superior frontal, and posterior parietal areas in the RS group. No significant difference was observed in any of the limbic areas. CONCLUSION: Respiratory symptoms of panic disorder were associated with a reduction in cortical thickness in the left frontal and parietal areas. This finding leads to the assumption that the frontoparietal network is the crucial component in a larger cortical network underlying the perception of dyspnea in RS.
Airway Obstruction ; Dyspnea ; Humans ; Korea ; Magnetic Resonance Imaging ; Panic Disorder* ; Panic* ; Paresthesia ; Rabeprazole ; Sensation ; Thorax

BACKGROUND/AIMS: The causes of gastric outlet obstruction (GOO) have changed from peptic ulcer disease (PUD) to malignant diseases in recent years. The aims of this study are to determine the relative incidence of malignany and other causative diseases, and to consider therapeutic and diagnostic usefulness of endoscopy. METHODS: 95 patients with GOO who diagnosed by radiologic and endoscopic examination or surgery were reviewed by causative diseases, clinical features, endoscopic findings and outcome of treatment. RESULTS: 1) The mean age was 57.5 years (M:F=2.4:1). 2) The causative diseases were gastric or duodenal malignancy (56.8%), complication of PUD (39.2%), and biliary and pancreatic disease (4.2%). 3) Malignancy was diagnosed by upper gastrointestinal (UGI) endoscopy in 95.8%; obstruction by complication of PUD was detected by endoscopy in 100%. 4) The most common endoscopic type of malignancy was Borrman type 3 (84.8%) and the most common benign lesions were duodenal or pyloric ulcer (94.5%). 5) The managements of malignancy were operation (53.5%), endoscopic stenting (18.5%), and conservative treatment (38.8%). The complications of PUD were treated by anti-ulcer medication (85.3%), endoscopic dilatation (4.8%) and operation (13.6%). CONCLUSIONS: The main causes of GOO are changed to malignancy in recent 5 years. Endoscopy is useful to detect the various causes of GOO, and necessary procedure to decide the method of their management.
Dilatation ; Endoscopy* ; Gastric Outlet Obstruction* ; Humans ; Incidence ; Pancreatic Diseases ; Peptic Ulcer ; Stents ; Ulcer

BACKGROUND/AIMS: The causes of gastric outlet obstruction (GOO) have changed from peptic ulcer disease (PUD) to malignant diseases in recent years. The aims of this study are to determine the relative incidence of malignany and other causative diseases, and to consider therapeutic and diagnostic usefulness of endoscopy. METHODS: 95 patients with GOO who diagnosed by radiologic and endoscopic examination or surgery were reviewed by causative diseases, clinical features, endoscopic findings and outcome of treatment. RESULTS: 1) The mean age was 57.5 years (M:F=2.4:1). 2) The causative diseases were gastric or duodenal malignancy (56.8%), complication of PUD (39.2%), and biliary and pancreatic disease (4.2%). 3) Malignancy was diagnosed by upper gastrointestinal (UGI) endoscopy in 95.8%; obstruction by complication of PUD was detected by endoscopy in 100%. 4) The most common endoscopic type of malignancy was Borrman type 3 (84.8%) and the most common benign lesions were duodenal or pyloric ulcer (94.5%). 5) The managements of malignancy were operation (53.5%), endoscopic stenting (18.5%), and conservative treatment (38.8%). The complications of PUD were treated by anti-ulcer medication (85.3%), endoscopic dilatation (4.8%) and operation (13.6%). CONCLUSIONS: The main causes of GOO are changed to malignancy in recent 5 years. Endoscopy is useful to detect the various causes of GOO, and necessary procedure to decide the method of their management.
Dilatation ; Endoscopy* ; Gastric Outlet Obstruction* ; Humans ; Incidence ; Pancreatic Diseases ; Peptic Ulcer ; Stents ; Ulcer

We report here on our technique and outcomes of the first two cases of robot-assisted laparoscopic nephroureterectomy with a bladder cuff excision(RLNU). RLNU was performed on two female patients who both had a muscle invasive lower ureter tumor. For the first step, nephroureterectomy was performed in the lateral flank position. For the second step, bladder cuff excision and bladder repair were performed in a steep Trendelenburg position. The specimen was extracted through a 6 cm sized incision in the umbilical trocar site. Both procedures were successfully completed with using the robot without conversion to open surgery. The total operative time, including the lymphadenectomy and the robot docking times, was 320 and 241 minutes, respectively, for the 2 patients. The estimated blood loss was 40 and 200 ml, respectively. The pathological examinations showed stage T3 and T2 invasive transitional cell carcinoma of the ureter. The patients' postoperative recoveries were uneventful and the bladder cuff was free of tumor. RLNU may have potential advantages over open and laparosopic surgery due to its minimal invasiveness. This approach can be an alternative to open surgery or laparoscopic technique.
Carcinoma, Transitional Cell ; Conversion to Open Surgery ; Female ; Head-Down Tilt ; Humans ; Laparoscopy ; Lymph Node Excision ; Muscles ; Operative Time ; Resin Cements ; Robotics ; Surgical Instruments ; Ureter ; Ureteral Neoplasms ; Urinary Bladder

OBJECTIVES: There are many studies that assessed the relationship between Cloninger's Temperament and Character Inventory (TCI) on depression, and the relationship between depression and personality trait has been debated for many years. In this study, the relationship between the TCI and remission state of depression in respect to personality trait was examined. METHODS: The subjects were composed of 50 patients who have been diagnosed as major depressive disorder by DSM-IV. Depressed patients' Hamilton Depression Scale (HAM-D) scores were over 18 and those in remission were HAM-D score lower than 8. The 50 depressed subjects and 50 healthy controls were asked to complete the TCI. RESULTS: The depressed patients in remission exhibited higher harm avoidance and lower persistence scores compared to healthy controls. CONCLUSION: This study confirms the trait dependence of the harm avoidance dimension.
Depression* ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Temperament*

PURPOSE: The prognosis of bladder cancer is related to tumor grade and stage. Because these pathological changes are preceded by molecular alterations, new molecular markers are needed in early diagnosis. New target molecular biomarkers can be differentially expressed genes(DEGs) between normal and cancer tissues. We tried to find a new DEG and demonstrated that it may be related to the development of the bladder cancer. MATERIALS AND METHODS: Cancer tissues were obtained from 39 patients with urothelial cell carcinoma, treated by transurethral resection of tumor (TURB) since 2002. Normal bladder tissues were obtained from the same patients during TURB. We compared the mRNA profiles between normal and cancer tissues using annealing control primer(ACP)-based Genefishing(TM) PCR to identify the DEGs in normal and cancer tissues of one same patient. To validate the result of ACP-based GeneFishing(TM) PCR, reverse transcription-polymerase chain reaction(RT-PCR) was performed on those of 39 patients. RESULTS: According to the result of ACP-based Genefishing(TM) PCR, EAR-3 gene was only present or markedly upregulated in normal tissue, compared with cancer tissues. The expression pattern that EAR-3 gene was downregulated in cancer tissues, irrespective of the clinicopathologic parameters was confirmed by RT-PCR in 39 patients. CONCLUSIONS: EAR-3 gene was downregulated in cancer tissues, irrespective of clinicopathologic parameters, compared with normal tissues in the bladder of the same patient. Therefore, we suggested that EAR-3 gene may be also play a role in bladder cancer development.
Biological Markers ; Carcinoma, Transitional Cell* ; Early Diagnosis ; Gene Expression* ; Humans* ; Polymerase Chain Reaction ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Gynecologic malignancies may have similar histological characteristics. This may lead to difficulties in determining the origin of the cancer and to distinguish a synchronous neoplasm from a metastatic cancer in advanced cases. Recently, we treated a 59-year-old patient with adenocarcinoma of the uterine cervix, endometrium, fallopian tubes, and ovaries. It was difficult to determine whether the cancer was a single origin metastatic cancer or a synchronous neoplasm. The patient was finally diagnosed with metastatic cancer that originated from the uterine cervix by human papillomavirus (HPV) test. Here we report the case and briefly review of the medical literature.
Adenocarcinoma ; Cervix Uteri ; Endometrium ; Fallopian Tubes ; Female ; Humans ; Middle Aged ; Neoplasms, Multiple Primary ; Ovary

OBJECTIVES: Posttraumatic stress disorder(PTSD) has been primarily associated with emotional problems. Recently, however, the impact of PTSD on cognitive processes has interested a growing number of researchers. The current study is aimed at investigating the cognitive aspects of PTSD at both behavioral and neurological levels. METHODS: We recruited individuals with PTSD who survived the Daegu subway explosion in 2003 as well as non-PTSD individuals as a control group. To evaluate the inhibitory processes and the neural mechanisms, we had these individuals perform the negative priming task simultaneously with functional MRI scanning. RESULTS: Behaviorally, the negative priming effect was intact in the control group but was not evident in the PTSD group. In the imaging results, only the PTSD group showed the negative priming effect (i.e., increased activation of the negative priming condition as opposed to the neutral condition) in the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior temporal gyrus. The PTSD group also showed increased activity for the positive priming condition as opposed to the neutral condition in the claustrum. These results confirm and extend the previous findings that the integrity of the ACC is compromised in the trauma survivors due to disrupted white matter tract. CONCLUSIONS: The current results suggest that deteriorated performance of the PTSD group may be due to the functional problem as well as the structural abnormalities.
Basal Ganglia ; European Continental Ancestry Group ; Explosions ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prefrontal Cortex ; Railroads ; Stress Disorders, Post-Traumatic ; Survivors

Forensic autopsy is performed to investigate a death. However, this is difficult in some cases, particularly in putrefied bodies. Pulmonary ossification is a rare pathological process, characterized by progressive and metaplastic ossification, which leads to the formation of small bony fragments in the pulmonary tissue. This condition can develop within the pulmonary tissues that are injured due to various causes. Metastatic and dystrophic calcification occur in normal tissues in conditions of deranged calcium metabolism and dead or degenerative tissue, respectively. Here, we describe the case of a 54-year-old man who lived alone and whose putrefied body was discovered by his landlord. A forensic pathologist identified needle-like sharp materials in both the lower lobes of the lungs during autopsy. Microscopic examination revealed dendriform pulmonary ossification with calcification. After autopsy, his medical history, including chronic kidney disease, was recorded by forensic pathologist. A review of his past medical history and comprehensive postmortem examination findings of the gross dissection, microscopic examination, and postmortem laboratory tests led to the determination of the cause of death as renal problems.

Antibiotics related colitis is a well recognized disease entity which in its severest form may result in pseudomembranous colitis, whereas in another form, acute hemorrhagic colitis without pseudomembrane, related to the use of penicillin-type antibiotics is rarely reported. The clinical features of hemorrhagic colitis associated with antibiotics was characterized that the bloody diarrhea, often with abdominal cramping pain begins 2~7 days after starting the antibiotics and rapidly recovered after its withdrawal. Pathogenesis of this disease is not entirely clear. It has been believed that right-sided hemorrhagic colitis is one of the main forms of colitis associated with antibiotics, especially ampicillin derivatives or cephalosporin, but recent reports presented left-sided colitis. We experienced 2 cases of hemorrhagic colitis developed on the left colon after the introduction of quinolone.
Ampicillin ; Anti-Bacterial Agents* ; Colic ; Colitis* ; Colon ; Diarrhea ; Enterocolitis, Pseudomembranous