Although the scientific evidence is not entirely supportive, atypical antipsychotics have been used widely for the treatment of children and adolescents with mental illnesses as alternatives to typical antipsychotics which have more serious unwanted adverse effects than atypical neuroleptics. On the basis of clinical experiences and research data, atypical antipsychotics have been prescribed for adolescents with schizophrenia, manic or mixed episodes of bipolar disorders, tic disorders, aberrant behaviors in pervasive developmental disorders, and impulsive or violent behaviors in disruptive behavior disorders. Due to their efficacy and relatively more tolerable side effects, the use of atypical antipsychotics has become increasingly popular in child and adolescent psychiatry. However, we should pay attention to the limitations associated with short-term clinical experiences and the lack of well-designed controlled studies, especially in terms of adverse effects including those involving metabolic processes.
Adolescent ; Adolescent Psychiatry ; Antipsychotic Agents ; Bipolar Disorder ; Child ; Humans ; Mental Disorders ; Schizophrenia ; Tic Disorders

Title change to "Factors Relating with the Resolution of Primary Vesicoureteral Reflux in Infants with Urinary Tract Infection"

BACKGROUND: Squamous cell carcinoma(SCC) may occur anywhere on the skin and on mucous membranes with squamous epithelium. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of SCC. METHODS: A total of 62 patients with SCC were enrolled in this study. Six cases with metastatic SCC were included. The hospital charts and histopathological slides of the patients with SCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. The male and female ratio was 1.8:1. The mean age at diagnosis was 61.5 years in male patients and 71.8 years in female patients. 2. Most commonly involved sites were the face(41.8%). Upper extremities, trunk, lower extremities, genitalia and scalp were followed in decreasing order. The proximal nail fold was involved in 3 case of primary cutaneous SCC and 1 cases of metastatic SCC. 3. Six cases(9.7%) of metastatic SCC were included. Lung cancer(83.3%) was the most common cause of metastatic SCC in this study. Interestingly, one case presented with SCC of the proximal nail fold revealed metastatic SCC from the lung. 4. The possible causative diseases of primary cutaneous SCC were actinic keratosis(12.5%), burn scar(8.9%), immune suppression(8.9%) owing to kidney transplantation and chemotherapy, arsenical keratosis(7.1%), Bowen's disease(5.4%), trauma(5.4%), osteomyelitis(3.6%), and porokeratosis(1.8%). The causes of 25 cases(44.6%) were undetermined. 5. Histopathological differentiation of the primary cutaneous SCC was performed as follows: 29 cases(51.8%) of well-differentiated, 11 cases(19.6%) of moderately-differentiated, 8 cases(14.3%) of poorly-differentiated, 6 cases(10.7%) of acantholytic, and 2 cases(3.6%) of verrucous SCC. 6. Metastatic rate of primary cutaneous SCC was 16.1%. Metastasis of SCC from osteomyelitis (100%) and burn scar(40%) or trauma(33.3%) and that of poorly differentiated SCC(37.5%) were more common. Regional lymph nodes(55.6%), skin(44.4%), and lung(33.3%) were common metastatic organs.
Actins ; Burns ; Carcinoma, Squamous Cell* ; Chungcheongnam-do ; Diagnosis ; Drug Therapy ; Epithelium ; Female ; Genitalia ; Humans ; Kidney Transplantation ; Lower Extremity ; Lung ; Male ; Mucous Membrane ; Neoplasm Metastasis ; Osteomyelitis ; Scalp ; Skin ; Upper Extremity

Gastrointestinal (GI) symptoms in children and adolescents are influenced by diverse psychiatric components such as psychosocial stresses, familial environment, school-related situations, and comorbid psychiatric conditions. Absolutely psychiatric symptoms of pediatric patients are also affected by problems of GI system. Lots of symptoms including anorexia, dyspepsia, nausea and so on are commonly originated from either GI or psychiatric causes or both. Sometimes the negative interactions between GI and psychiatric problems aggravate the severity and eventually decline the functions of children and adolescents with GI symptoms. We summarized the common GI and psychiatric conditions which have GI and psychiatric associations. To a clinician who manages pediatric GI disorders, psychiatric considerations can be beneficial to understand the clinical manifestations of patients and to find the way to relieve them. This short and somewhat superficial review may help to have a bird's-eye view on this topic.
Adolescent ; Anorexia ; Child ; Dyspepsia ; Humans ; Nausea ; Psychophysiologic Disorders

PURPOSE: Long time total parenteral nutrition (TPN) can induce irreversible liver damage. In this study, we investigated the associated factors of parenteral nutrition associated cholestasis (PNAC) in neonates. METHODS: We retrospectively reviewed 227 neonates (male:female=110:117) those who had received TPN over 2 weeks from March 2010 to February 2014. PNAC was defined as direct bilirubin was higher than 2.0 mg/dL without any cause except TPN. RESULTS: Overall incidence was 28.6%. PNAC was frequently developed in younger gestational age with lower birth weight. Episodes of sepsis, underlying bronchopulmonary dysplasia, history of necrotizing enterocolitis, and experience of gastrointestinal surgery increase the incidence of PNAC. PNAC was directly associated the duration of TPN and long period to full enteral feeding, reaching 60 and 150 mL/kg/day. Overall mortality rate was 9.7%. It was higher in PNAC group despite PNAC was not the primary cause of death. All survivors were recovered from cholestasis with encourage of enteral nutrition. CONCLUSION: PNAC in neonate was associated with younger gestational ages and lower birth weights, duration of TPN, or who experienced sepsis, necrotizing enterocolitis, gastrointestinal surgery or bronchopulmonary dysplasia.
Bilirubin ; Birth Weight ; Bronchopulmonary Dysplasia ; Cause of Death ; Cholestasis* ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Incidence ; Infant, Newborn* ; Liver ; Mortality ; Parenteral Nutrition* ; Parenteral Nutrition, Total ; Retrospective Studies ; Sepsis ; Survivors

BACKGROUND: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. METHODS: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arrangement (with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. RESULTS: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. CONCLUSION: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female participants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls.
Aged ; Arthritis ; Female ; Foot ; Hearing ; Humans ; Hypogonadism ; Incidence ; Lower Extremity ; Memory ; Mitochondrial Diseases ; Ophthalmoplegia ; Proprioception ; Surveys and Questionnaires ; Residence Characteristics ; Risk Factors ; Sensation ; Telephone

PURPOSE: Cox-2 expression in breast carcinoma has been reported to be related to angiogenesis, lymph node metastasis and Her-2 expression. The aim of this study is to evaluate the clinicopathologic significance of Cox-2 expression in the invasive ductal carcinomas (IDC) and intraductal carcinomas (DCIS) of the breast. METHODS: The materials were 353 IDC cases and 82 DCIS cases. Immunohistochemical stain for Cox-2 was interpreted as 1+ (weak & focal) and 2+ (diffuse), and the relationships between Cox-2 and ER, PR, Her-2, p53, Ki-67 and bcl-2 expressions were analyzed. RESULTS: There was no significant difference of Cox-2 expression between IDC (148/353, 41.9%) and DCIS (38/82, 46.3%). Cox-2 (2+) expression was more frequent in low grade than intermediate and high grade IDC, but the difference was not significant statistically (P=0.0833), and there were no significant differences of Cox-2 expression according to age, tumor size, nuclear grade, lymph node metastasis in IDC and DCIS cases. In IDC cases, Cox-2 (1+ and 2+) expression showed positive relationships with p53 (+) and more than 10% of Ki-67 labeling index (P=0.0029, P=0.0015), and revealed tendencies of positive relationships with ER (+) and bcl-2 (+) (P=0.0750, P=0.0776). However, no significant relationship between Cox-2 and Her-2 expressions was recognized. In DCIS cases, Cox-2 (2+) expression rate was increased in cases showing negative for Her-2 (P=0.0092) and positive for bcl-2 (P=0.0486). CONCLUSION: Cox-2 expression seems to be involved in the development of breast carcinomas, but not related to the invasiveness. Cox-2 expression, especially 2+, in the DCIS cases suggest a possibility of less aggressive biological behavior.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Lymph Nodes ; Neoplasm Metastasis

PURPOSE: This study was performed to identify factors related to the resolution of primary vesicoureteral reflux (VUR) in infants. METHODS: We reviewed 183 infants (M : F=149 : 34) diagnosed as urinary tract infection (UTI) between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture (n=97), catheterization (n=83), or collection bag method (n=3, twice positive culture of same organism). All of the infants were performed renal ultrasonography, DMSA scan and voiding cystourethrography (VCUG) study. Follow-up imaging consisted of contrast VCUG or direct isotope VCUG at interval of 1 year. We evaluated the relationship of clinical and laboratory finding, radiologic finding in infants with VUR. RESULTS: Among 51 VUR patients, 18 infants had grade I-II, 12 infants had grade III and the other 21 patients had grade IV-V. Abnormal findings including hydronephrosis on renal ultrasonography were not correlated with severity of VUR. However, the incidence of renal defect in the first DMSA scan showed a tendency of direct correlation with severity of VUR in female patients only (P<0.001). There was significant difference of resolution rate in three VUR groups (grade I-II, III, IV-V) in male patients only (P=0.025). Resolution rate was higher for male patients with unilateral VUR than bilateral (P<0.001). But unilaterality had not any affect on VUR resolution in female VUR patients (P=0.786). Resolution rate was higher for VUR patients without renal scar than VUR patients with renal scar (P<0.001). CONCLUSION: According to our findings, grade of VUR, laterality and renal scar are the factors that contribute to resolution of primary VUR in male and female infants differently.
Catheterization ; Catheters ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Incidence ; Infant ; Male ; Punctures ; Succimer ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Diffuse neonatal hemangiomatosis (DNH) is characterized by multiple capillary or cavernous hemangiomas on the skin and internal organs occurring during the neonatal period. It is a life-threatening condition due to high-output heart failure with a mortality rate of 60-85% without proper treatment. The areas that are most commonly involved include the skin (100%), liver (64-100%), and central nervous system (52%). Corticosteroids are the drugs of choice as an initial treatment and have a response rate of 30-60%. We present here a case of a newborn baby with multiple hemangiomas on her skin (scalp, lips, neck, back, shoulder, arm, buttock, and leg), brain (right cerebellum, pons, and medulla oblongata), lungs, liver, kidney, and bones. She suffered from 6th, 7th, 9th, 10th, and 12th cranial nerve palsy resulting from hemorrhage of the hemangiomas in the brain. The first-line treatment of prednisolone (4 mg/kg/day) was not effective and propranolol (2 mg/kg/day) was administered as a second-line treatment. After 2 weeks of treatment, the hemangiomas had decreased in size with no associated acute hemorrhage. The infant is now 10 months old and both the multiple hemangiomas and cranial nerve palsy have improved. Propranolol was effective without significant adverse effects in treating DNH resistant to corticosteroids.
Abducens Nerve Diseases ; Adrenal Cortex Hormones ; Arm ; Brain ; Buttocks ; Capillaries ; Central Nervous System ; Cerebellum ; Cranial Nerve Diseases* ; Cranial Nerves* ; Facial Paralysis ; Heart Failure ; Hemangioma ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Kidney ; Lip ; Liver ; Lung ; Mortality ; Neck ; Pons ; Prednisolone ; Propranolol* ; Shoulder ; Skin

OBJECTIVE: The authors would like to fine the relationship between zolpidem and nocturnal eating episodes in diverse psychiatric patients. METHOD: We evaluated case series of 6 patients who showed nocturnal eating episodes after takine zolpidem. RESULTS: We have experienced 6 cases who showed nocturnal eating behavior after taking zolpidem. They included 3 patients with schizoprenia, a patient with major depressive disorder, a patient with PTSD and a patient with bipolra I disorder. With reducing or discontiuation of of zolpidem, their nocturnal eating resolved. CONCLUSION: This finding strongly suggests the relationship between zolpidem and the nocturnal eating episode. Physicians should be aware that zolpidem might induce nocturnal eating behaviors.
Depressive Disorder, Major ; Eating* ; Feeding Behavior* ; Humans ; Stress Disorders, Post-Traumatic