Whenever a clinician manages the patients with depression, he may meet various prolems that make it difficult to treat them. Even though he has good skills and knowledge abut depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather tnan the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used durig pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms durig pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes folowing prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.
Antidepressive Agents ; Compliance ; Depression* ; Depressive Disorder, Treatment-Resistant ; Female ; Fetus ; Humans ; Polypharmacy ; Pregnancy ; Treatment Failure

No abstract available.
Adolescent ; Adolescent, Hospitalized* ; Humans ; Mental Disorders*

No abstract available.
Aged* ; Gallstones* ; Humans

No abstract available.
Gonadal Dysgenesis, Mixed*

The ulcerative colitis is a relatively common disease in the European and North American countries aince Dr. Wilks has first reported the cases in 1895, But in Korea, this disease is a rare entity and only a few case have been reported. However, rescently the diagnoetic methods for ulcerative colitis are much developed we have experienced 28 cases of ulcerative colitis which were diagnosed by endoscopy, barium enema exam and biopsy. Therefore a total of 28 patient with ulcerative colitis diagnosed and treated at the department of internal medicine of HYUH from June 1979 to June 1986 was reviewed. We obtained the results as follows; 1) The sex distribution assumed a ratio of 1 to 1.33 with 12 males and 16 females. 2) The age dietribution was relatively even but the majority of cases were between 5th and 6th decade (32.1%), 3) The most prominent clinical symptoms were rectal bleeding, abdominal pain, diarrhea, fever, wight loss and vomiting. 4) Significant laboratory findins were anemia, eleveited ESR, leukocytosis, positive stool OB, electrolyte imbalance and decreased serum albumin level. 5) As to the extent of disease determined by the barium enema examination and endoscopic exam., rectum or rectosigmoid colon is involved in majority of the cases (92.8%). 6) The endoscopic examination was performed in all 28 cases and showed significant findings such as ulceration, hyperemia, mucosal friability, bleeding etcs. 7) The barium enema examination was performed in 19 cases and showed positive findings such as ulceration, luminal narrowing, bowel shortening and rigidity in 17 cases. 8) 21 of 28 patients treated by medical therapy showed relatively improved but 4 of 28 patients was exacerbated or relapsed and one has expired.
Abdominal Pain ; Anemia ; Barium ; Biopsy ; Colitis, Ulcerative* ; Colon ; Diarrhea ; Endoscopy ; Enema ; Female ; Fever ; Hemorrhage ; Humans ; Hyperemia ; Internal Medicine ; Korea ; Leukocytosis ; Male ; Phenobarbital ; Rectum ; Serum Albumin ; Sex Distribution ; Ulcer* ; Vomiting

No abstract available.

Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.
Carcinoma, Hepatocellular ; Deglutition Disorders ; Emergencies ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation* ; Thrombosis ; Varicose Veins

No abstract available.
Urinary Tract*

Three hundred and ninety patients with benign prostatic hyperplasia managed at Seoul National University Hospital during a 5 year period from 1981 to 1985 were analyzed retrospectively. Most patients experienced urinary retention(60.3%) or had significant residual urine(l2.O %). Azotemia was found in 41 patients(10.5%) and bacteriuria in 67 patients(l7.2%). Intravenous pyelography was performed routinely in most of patients but it did not contribute significantly for the management. 217 transurethral(55.6%), 124 suprapubic(31.8%), and retropubic resections(12.6%) were done according to size of prostate, patient`s general condition and surgeon`s preference by 27 operators including 20 senior residents. The mean weight of resected tissue was 14.5gm in TUR and 36.1gm in open resection. The mean perioperative transfusion was l.2 pints in TUR and 2.2 pints in open resection. Overall morbidity of prostatectomy was l7.4% and there was no difference between TUR and open resection. Excessive bleeding was the major complication which developed in 6.9% of TUR and 6.4% of open resection. Initial azotemia, bacteriuria and old age over 80 years did not increase the operative morbidity. In TUR, 30gm or more of resceted adenoma and/or 90min or more of resection time increased the morbidity significantly. Prophylactic antibiotics decreased the postoperative urinary tract infection. The antibiotics were continued until 5~7 days after removal of catheter, and an additional antibiotics were not necessary even in the presence of microscopic pyuria which persistence for longer time. In 351 patients(90.9%), voiding problem was improved but in 39 patients(10%), it was persisted. Uroflowmetry was useful to evaluated the outcome of the resection. Maximum improvement in the flowrate was found 3 month postoperatively and the result was same in the patients with TUR and open resection.
Adenoma ; Anti-Bacterial Agents ; Azotemia ; Bacteriuria ; Catheters ; Hemorrhage ; Humans ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Pyuria ; Retrospective Studies ; Seoul ; Urinary Tract Infections ; Urography

No abstract available.
Kidney Transplantation*