The fluoxetine is one of the most frequently prescribed drugs for the treatment of depression and obsessive-compulsive disorder(OCD). This has been know as one of the most safest medication. But since the advent of this drug, there have been several reports of side effects-the mania and suicidal ideation-encountered during coadministration of fluoxetine with or without other psychotropic drugs. We experienced a case of 20 years old male OCD patient who developed into abrupt manic state and also was preoccupied with intense suicidal ideation following fluoxetine use. He was a only child in his family and his father had a history of alcoholism about 15 years ago. Our patient's obsessive-compulsive symptoms have been occured since puberty. His OCD symptoms and anxiety were aggravated since joining the army. Beside these facts, we could not find any other psychiatric history such as depressive disoder and bipolar disorder. We used the fluoxetine starting dosage of 20mg and increased to 40mg at second week. About 3 weeks after the treatment, he developed sudden manic symptom and more aggravated suicidal ideation without any OCD symptoms. He felt vitalized and energetic without having enough sleep and food. These symptoms were ceased over two weeks by stopping medication. Up to this point, the reason why fluoxetine induces mania and suicidal preoccupation is unclear. But somehow the fluoxetine has effects on serotonin receptor and serotonin-dopamine regulations, thus we could make an assumption that fluoxetine can induce mania, extrapyramidal symptoms(EPS) and suicidal ideation in some part of the serotonin unbalanced patients. We think this would be the first report to remark on fluoxetine's suicidal and manic side effects in Korea. So here we present the case with the summary of reviewed articles.
Adolescent ; Alcoholism ; Anxiety ; Bipolar Disorder* ; Depression ; Fathers ; Fluoxetine ; Humans ; Korea ; Male ; Obsessive-Compulsive Disorder* ; Only Child ; Psychotropic Drugs ; Puberty ; Serotonin ; Social Control, Formal ; Suicidal Ideation* ; Suicide ; Young Adult

Gliomas of the optic nerve are relatively uncommon. We have experienced one case of glioma of the optic nerve recently. The patient was 17 year old boy who had exophthalmos and visual disturbance in his left eye for three years. The vision was CF/30cm. in his left eye and the optic nerve head was extremely atrophic. The eyeball was displaced infero-temporally. The exophthalmic value was 14mm. in right and 18mm. in left eye. On July 31, 1986, the left eyeball was exposed through Kroenlein method and the tumor mass was excised totally but the eyeball remained intact. The gross appearance of the tumor was large fusiform shape(3.5 X 2.0 X 1.8cm.) with well encapsulated grayish-white surface. The cut-section of the tumor revealed grayish-white solid area and hemorrhagic cystic area. The histopathologic slides showed that the tumor was composed of multiple pilocytic astrocytic cells in the solid area and in microcystic area. The cytoplasm of the tumor cells were bipolar spindle shape and the nucleus was uniform in general and there was no sign of mitotic figure. Numerous dense and amorphous eosinophilic materials so called "Rosenthal fibers" were also seen in the microcystic areas. Finally we have diagnosed this tumor as the Optic nerve glioma.
Adolescent ; Cytoplasm ; Eosinophils ; Exophthalmos ; Glioma ; Humans ; Male ; Optic Disk ; Optic Nerve Glioma* ; Optic Nerve*

The authors evaluated the 56 patients who received the diagnosis of myopia at the department of ophthalmology in Koryo General Hospital in Seoul from May 1975 to August 1985. In this study, we reviewed the statistics of the progression of myopia with age and with the number of visits to the hospital and also the differences between male and female and left eye and right eye. The results are as follows: 1. Myopia progresses with increase of age. 2. The mean diopter of myopia over 21 years is not so remarkable compared with below 20 years. But it is not absolutely true because the number of patients are so small. 3. On the average, males are slightly higher in the degree of myopia than female, but this seems to have no statistical meaning. 4. In terms of the degree of myopia, it is higher after the age of 12 than before 12.
Diagnosis ; Female ; Hospitals, General ; Humans ; Male ; Myopia* ; Ophthalmology ; Seoul

The mirtazapine is a relatively new antidepressant that has noradrenergic and specific serotonin antagonist action(NaSSAs). This has been known as one of the most safest drugs because of its few side effects. Until now, there have been only one case report that mirtazapine causes a EPS side effect(restless leg syndrome). But the peculiar mechanism of this drug makes it impossible to explain the exact reasons why the mirtazapine could induce EPS symptoms. Authors obseved three cases of mirtazapine indeced akathisia. We could not explain the phenomenon the other way except akathisia. So here we presents the three case of mirtazapine induced akathisia and a few possible hypothesis of this phenomenon.
Leg ; Psychomotor Agitation* ; Serotonin

No abstract available.
Spine*

We performed ERCP manometry of Sphincter of Oddi(SO) before and after endoscopic sphincterotomy(EST) for evaluation of the effect af EST on the SO. The subjects were postcholecystectomized common bile duct stone patients(n=l2) and EST was performed by major incision. The pressure gradient between common bile duct and duodenum before EST (8.6 + 3.9 mmHg) decreased significantly after EST(2.4 +1.7 mmHg). The length of SO before EST(8.8 + 0.8mmHg) decreased significantly after EST(2.5 + 0.8mm). But in each patient, the pressure gradient between common bile duct and duodenum remained in spite of the major incision. In conclusion, EST alters the function of the sphincter of the Oddi, but does not destroy its all protective function. The positive pressure in the bile duct is preserved in contrast to the absolute loss of pressure following surgical transduodenal sphincteroplasty.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Duodenum ; Humans ; Manometry* ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic* ; Sphincterotomy, Transhepatic

From July 1989 to August 1991, we performed 146 cases of endoscopic sphincterotomy(EST). In our series, 9 early complications occurred in 146 cases(morbidity rate: 6.2%), and no fatalities were recognized(mortality rate:0). Four cases with late complications consisted of 2 cases of acute cholecystitis, one case of chalaagitis and restenosis. There were 36 with the gallbladder with stone(11 cases) or without stone(25 cases). Two cases with chalecystitis after EST occurred in the patients with gallbladder stones. EST gives the sufficient result in diagnosis and treatment for various disease of biliary tract. Furthermore, EST was found to be a safe procedure from low rates of complications and fatalities.
Biliary Tract ; Cholecystitis, Acute ; Diagnosis ; Gallbladder ; Humans ; Sphincterotomy, Endoscopic*

The purpose of this study is to evaluate the results of the reconstruction of acetabular bone defect with morselized bone graft in revision of failed acetabular cup, used screw fixed hemispherical cup or bipolar cup as a component. Forty five revisions of an acetabular component that had been performed in 42 patients between 1988 and 1993 at SNUH, and had followed more than two years were included in this study. The revised acetabulum was evaluated by Harris hip score, in terms of osseous union and resorption of the graft, the amount of the migration of the revised components. Cup angle change and radiolucency were also evaluated in screw fixed hemispherical cup. The mean Harris hip score was improved 54 to 87 in screw fixed hemispherical cup and 56 to 78 in bipolar cup. In screw fixed hemispherical cup, osseous union showed within 6 months is 91.3% (21 cases), the graft bone resorption less than 10% of the initial graft thickness is 73.9% (17 cases). In bipolar cup, osseous union within 6 months is 52.2% (12 cases), the graft bone resorption less than 10% of the initial graft thickness is 40.9% (9 cases). The failure of revised acetabular component was five in bipolar cup cases and one in screw fixed hemispherical cup cases. In conclusion, screw fixed hemispherical cup showed better clinical results, earlier graft osseous union, less graft bone resorption and lower failure rate than bipolar cup. There was no significant difference between pure allograft mixed with autograft in clinical and radiological results. So we recommend the technique used morselized allograft with screw fixed hemispherical cup, to reconstruct the acetabular bone defect in acetabular cup revision, though bipolar cup was used in staged operation in severe acetabular bone defect with was unable to fix the acetabular cup with screws.
Acetabulum ; Allografts ; Autografts ; Bone Resorption ; Hip ; Humans ; Transplants

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the relationship between surgical outcomes and preoperative MRI findings, a retrospective review was conducted on the surgical outcomes depending on the preoperative MRI findings including type of herniation and Modic changes. SUMMARY OF LITERATURE REVIEW: In most reports, the patients that have large disc herniation were expected to have improved surgical outcomes. However, there have been controversies regarding the outcomes and Modic changes. MATERIALS AND METHODS: The retrospective review was conducted in 82 patients who underwent a discectomy for single level lumbar disc herniation. The average follow-up period was 34.2 months. Among their preoperative baseline MRI measurements, the stage of disc herniation, degree of nerve root compression, degree of dural sac compression, and Modic change of vertebral endplate were evaluated for the subsequent comparison between the preoperative and postoperative changes and ODI score. RESULTS: Patients with extrusion or sequestration type showed significant improvements compared to the patients with protrusion type disc herniation. By degree of nerve root compression, patients with root compression showed significant improvements compared to the patients who had contact type. The degree of dural sac compression revealed no correlation with changes in the ODI score. 23 of the 82 patients, the preoperative MRI showed a Modic change. Compared to the group who did not show such a Modic change, they turned out to be unrelated to the preoperative and postoperative changes in the ODI score. CONCLUSIONS: Patients who had extrusion or sequestration type disc herniation showed a better clinical improvement than protrusion type. Patients with compression type root lesion showed better clinical improvement than contact type root lesion. No correlation was noted regarding the outcomes of the surgical treatment and degree of dural sac compression or Modic changes.
Diskectomy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Radiculopathy ; Retrospective Studies

Anxiety* ; Depressive Disorder ; Depressive Disorder, Major* ; Electroencephalography ; Humans