OBJECTIVE: Panic disorder has been suggested to be divided into the respiratory and non-respiratory subtypes in terms of its clinical presentations. The present study aimed to investigate whether there are any differences in treatment response and clinical characteristics between the respiratory and non-respiratory subtypes of panic disorder patients. METHODS: Among the 48 patients those who completed the study, 25 panic disorder patients were classified as the respiratory subtype, whereas 23 panic disorder patients were classified as the non-respiratory subtype. All patients were treated with escitalopram or paroxetine for 12 weeks. We measured clinical and psychological characteristics before and after pharmacotherapy using the Panic Disorder Severity Scale (PDSS), Albany Panic and Phobic Questionnaire (APPQ), Anxiety Sensitivity Index-Revised (ASI-R), State-Trait Anxiety Inventory (STAI-T, STAI-S), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D). RESULTS: The prevalence of the agoraphobia was significantly higher in the respiratory group than the non-respiratory group although there were no differences in gender and medication between the two groups. The respiratory group showed higher scores on the fear of respiratory symptoms of the ASI-R. In addition, after pharmacotherapy, the respiratory group showed more improvement in panic symptoms than the non-respiratory group. CONCLUSION: Panic disorder patients with the respiratory subtype showed more severe clinical presentations, but a greater treatment response to SSRIs than those with non-respiratory subtype. Thus, classification of panic disorder patients as respiratory and non-respiratory subtypes may be useful to predict clinical course and treatment response to SSRIs.
Agoraphobia ; Anxiety ; Citalopram ; Classification ; Depression ; Drug Therapy ; Humans ; Panic ; Panic Disorder* ; Paroxetine ; Prevalence ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Treatment Outcome

PURPOSE: Laparoscopic totally extraperitoneal (TEP) hernia repair is known to be relatively difficult in cases with a history of lower abdominal surgery. We assess the feasibility of laparoscopic TEP hernia repair in those patients. METHODS: Thirty five patients with a previous history of radical prostatectomy or lower abdominal surgery who underwent laparoscopic TEP hernia repair for inguinal hernia were reviewed retrospectively. All operations were performed by a single experienced surgeon. RESULTS: Thirty three out of the 35 patients (94%) were men. Laparoscopic TEP hernia repair was performed successfully in 30 out of 35 cases. Twenty five cases (71%) were right inguinal hernia, 6 cases (17%) were left hernias, and 4 cases (11%) had an inguinal hernia on both sides. Five cases were converted to transabdominal preperitoneal (TAPP) (n=3) or open methods (n=2). Mean operation time was 111 minutes. The patient group with previous radical prostatectomy was the largest (n=22, 63%) and required a longer operation time (124 minutes). Blood loss was less than 50 cc in all cases. Average hospital stay was 1.2 days after surgery. Voiding difficulties requiring catheterization were observed in 13 cases (37%). CONCLUSION: Laparoscopic TEP hernia repair for a patient with previous history of radical prostatectomy or lower abdominal surgery except for appendectomy can be safely performed by an experienced surgeon, but is not recommended as a standard choice because of a longer operation time and higher conversion rate.
Appendectomy* ; Catheterization ; Catheters ; Hernia* ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy ; Length of Stay ; Male ; Prostatectomy* ; Retrospective Studies

This study aimed to investigate the concentrations of nonpersistent endocrine-disrupting chemicals (EDCs) and per- and polyfluoroalkyl substances (PFAS) in human milk through a literature review and to affirm the association between EDCs and lifestyle factors based on the reviewed literature. We analyzed studies reporting EDC concentrations in breast milk from literature published on Google Scholar and PubMed between 2000 and 2022. In Korea, most EDC concentrations in breast milk were comparable to or lower than those in other countries. However, the concentrations of PFAS in breast milk, especially perfluorooctanoic acid, have shown an increasing trend compared to the past in Korea. Considering the potential risks of EDCs, breastfeeding mothers should take measures to minimize their exposure to these chemicals.

PURPOSE: The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula. RESULTS: The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula. CONCLUSION: We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.
Cutaneous Fistula ; Drainage ; Empyema ; Fistula ; Free Tissue Flaps ; Humans ; Lung ; Muscles ; Postoperative Complications ; Rectus Abdominis ; Thoracic Wall ; Thorax

Lynch syndrome is a genetic malignancy syndrome affecting the colon, endometrium, and other organs. It is difficult to find a Lynch syndrome patient without any family history of cancer. We have recently examined an endometrial cancer patient with a MSH2 gene mutation without a family history of cancer. A 55-year old Korean woman was admitted to a local clinic for vaginal bleeding. An endometrial biopsy revealed the presence of adenocarcinoma (endometrioid type, grade 1). After surgical staging, no further adjuvant therapy was required. Analysis of the tissue using immunohistochemistry (IHC) showed the endometrium stained negatively for MSH2. Microsatellite instability (MSI) was analyzed for five markers. The patient was scored as unstable. Further, additional gene sequencing revealed one missense mutation in c.23C > T (p.Thr8Met). This is the first case of Lynch syndrome endometrial cancer in Korea in which the patient does not have any family history of cancer.
Adenocarcinoma ; Biopsy ; Colon ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Endometrial Neoplasms* ; Endometrium ; Female ; Germ-Line Mutation* ; Humans ; Immunohistochemistry ; Korea ; Microsatellite Instability ; Middle Aged ; Mutation, Missense ; Uterine Hemorrhage

PURPOSE: Estrogen, various polypeptide hormones and growth factors are associated with the development and progression of breast cancer. Coregulatory proteins are also associated with estrogen receptor (ER) transcriptional activity and tamoxifen resistance. Therefore, it is necessary to investigate the change of coregulator mRNAs and various cell proliferation proteins and cell cycle-related proteins after treatment with estrogen or antiestrogen. METHODS: MCF-7 cells were maintained in dextran-coated charcoal stripped 10% Dulbecco's Modified Eagle Medium (DMEM). To measure the change of the coactivators' (src-1, P/CAF, CBP, AIB1) mRNAs and corepressors' (SMRT, N-coR) mRNAs, multiple PCR was carried out using specific primers. In addition, intracellular proteins related to cell proliferation and cell cycle regulation were measured by performing Western blotting after treatment with estrogen or tamoxifen. The change of mitogen activated protein kinases was also measured by performing Western after tamoxifen treatment for 4 weeks. RESULTS: Coactivator mRNAs expression rapidly decreased in 15 min after estrogen treatment but this recovered to the initial level in 3 hr. The pattern was similar for the case of tamoxifen treatment. Corepressor mRNAs expression rapidly decreased in 15 min after estrogen treatment and it remained at a lower level until 24 hr after estrogen treatment. With tamoxifen treatment, the initial response was similar to the cases of estrogen treatment, but the xpression gradually increased 3 hr after tamoxifen treatment. Treatment of estrogen induced intracellular concentrations of c-myc and Ki-67 and it increased nuclear translocation of NF-kappaB and phosphor-ERK and it decreased the intracellular cell cycle suppressor p27/kip1. Tamoxifen treatment increased nuclear p27/kip1 but it decreased c-myc, NF-kappaB and phosphor-ERK. Long-term (4 weeks) treatment of tamoxifen was associated with decrease of activated ERK and p38 but there was no change in phospho-Akt level. CONCLUSION: Estrogen induced cell proliferation and the survival pathway-related factors, but it decreased the cell cycle suppressor p27/kip1. Long-term treatment with antiestrogen tamoxifen might decrease the MAPK activities in ERalpha-expressing tumor cells.
Blotting, Western ; Breast ; Breast Neoplasms ; Cell Cycle ; Cell Line ; Cell Proliferation ; Charcoal ; Eagles ; Estrogen Receptor Modulators ; Estrogens ; Intercellular Signaling Peptides and Proteins ; MCF-7 Cells ; Mitogen-Activated Protein Kinases ; NF-kappa B ; Peptide Hormones ; Phosphotransferases ; Polymerase Chain Reaction ; Proteins ; RNA, Messenger ; Tamoxifen

OBJECTIVE: The aim of this study is to evaluate of the significance of intraoperative electrophysiologic monitoring and follow up electrophysiologic study at seven days after microvascular decompression(MVD) for hemifacial spasm(HFS). METHODS: Thirty nine patients with hemifacial spasm were included in this study and were treated with MVD of the facial nerve from Jun 1990 to May 2001. The patients were divided into a monitoring group and a non-monitoring group. We compared the surgical outcomes, operation related complications between two groups. The abnormal muscle response(AMR) of preoperative electromyographic recording appeared on the mentalis muscle during stimulation of the zygomatic branch of the facial nerve was compared with those of changed during operation, immediately after operation and at postoperative 7th day(POD 7). The relationship between degree of AMR disappearance and surgical outcome was analyzed. RESULTS: There was no difference in surgical outcomes but significant difference in the incidence of operation-related complications between two groups. The results of electrophysiologic study at POD 7 were significantly correlated with surgical outcome in the monitoring group. CONCLUSION: The electrophysiologic study is helpful for identifying the offenders, determining the adequacy of vascular decompression and decrease of operation-related complications. The clinical and electrophysiologic status of HFS after MVD has continuously changed, and therefore the results of eletrophysiologic study at POD 7 are useful for predicting the surgical outcome.
Criminals ; Decompression ; Electromyography* ; Facial Nerve ; Follow-Up Studies* ; Hemifacial Spasm* ; Humans ; Incidence ; Microvascular Decompression Surgery*

Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism, normal blood pressure, and other clinical symptoms. As a clinical and genetical heterogeneous disorder, this syndrome can be classified into two clinical variants, antenatal Bartter syndrome and classic Bartter syndrome according to the onset age. Nephrocalcinosis is common in antenatal Bartter syndrome, but is rare in classic Bartter syndrome. It can also be classified into five genetic subtypes by the underlying mutant gene, all of which are expressed in the tubular epithelial cells of the thick ascending limb of the loop of Henle. Patients with Bartter syndrome type 1, 2 and 4 present at a younger age than classic Bartter syndrome type 3. We have experienced a case of Bartter syndrome with nephrocalcinosis in a 42-year-old woman diagnosed by biochemical and radiologic studies. We had successful response with potassium chloride and spironolactone.
Adult* ; Age of Onset ; Alkalosis ; Bartter Syndrome* ; Blood Pressure ; Epithelial Cells ; Extremities ; Female ; Humans ; Hyperaldosteronism ; Hypokalemia ; Loop of Henle ; Nephrocalcinosis* ; Potassium Chloride ; Spironolactone

Klinefelter' syndrome is a disorder of sexual differentiation in males, characterized by the presence of two or more X-chromosomes, hypogonadism, and lack of secondary sexual characteristics. The association between Klinefelter' syndrome and glomerulonephritis has been reported, while cases of glomerulonephritis associated with Klinefelter' syndrome are rare. We report the Korean case: a 31-year-old man with Klinefelter' syndrome who developed glomerulonephritis. The patient's urine analysis shows microscopic hematuria and the result of kidney biopsy was minimal change disease. The onset and course of his disease might have been influenced by the sex hormone imbalance.
Biopsy ; Glomerulonephritis ; Hematuria ; Humans ; Hypogonadism ; Kidney ; Male ; Nephrosis, Lipoid ; Sex Differentiation

PURPOSE: To evaluate the incidence and course of widening of palpebral fissure after unilateral lateral rectus muscle recession. METHODS: The palpebral fissure width (PFW) was measured in 20 patients with intermittent exotropia before unilateral rectus muscle recession and 1 week, 1 month and 6 months after the surgery. RESULTS: The amount of recession was from 7.5 to 9.0 (mean 8.37 +/- 0.51) mm. More than 0.6 mm of change in PFW after surgery was defined as the significant change. The significant change was observed in 10 patients (50%) after 1 week, 7 patients (35%) after 1 month and 7 patients (35%) after 6 months after the surgery. The amount of recession was significantly greater in the group with significant change (8.60 +/- 0.39 mm) than the group without significant change (8.15 +/- 0.53 mm) (p < 0.05). CONCLUSIONS: Thirty five percent of the patients showed palpebral fissure widening lasts at least 6 months after unilateral lateral rectus muscle recession. We think it is necessary to notice patients about the possible change in palpebral fissure width before strabismus surgery. And we believe that more cosmetically satisfactory outcome would be resulted if surgeons consider eyelid condition when they are planning strabismus surgery.
Exotropia ; Eyelids ; Humans ; Incidence ; Muscles ; Strabismus