Depressive disorder is one of the very serious mental diseases in terms of personal, social, economical losses. It is not clear for the pathogenesis of the depression, however, even though decreased 5-HT and NE may be the biological causing factors in the neuronal synapses. Moreover, there are many depressive patients who are treatment resistant or partial responders. Thus, we have been needed the other therapeutic methods for those cases. Repeated transcranial magnetic stimulation (rTMS) & VNS are the newly introduced methods for the treatment of refractory or partial responders with depression, which nature of therapeutic effect is the stimulation of the CNS. VNS has been used to treat the refractory epilepsy patients. Despite of numerous empirical and preclinical data, although VNS may be effective for the treatment of depression, the parameters for the treatment of depression using the VNS device have not been confirmed yet. However, from the several reports clinical effectiveness were described about 40%, thus, it is interested that VNS will be able to use for the treatment of depression in a future.
Depression* ; Depressive Disorder ; Depressive Disorder, Treatment-Resistant ; Epilepsy ; Humans ; Neurons ; Serotonin ; Synapses ; Transcranial Magnetic Stimulation ; Vagus Nerve Stimulation* ; Vagus Nerve*

BACKGROUND/AIMS: The optimal time point for initiating renal replacement therapy in patients with end-stage renal disease remains controversial. The primary objective of our study was to determine the effects of residual renal function at the beginning of renal replacement therapy on the mortality of patients with end-stage renal disease. METHODS: We retrospectively studied the clinical outcomes in patients (n=210) with end-stage renal disease who underwent renal replacement therapy at our hospital between 2000 and 2005; all patients were followed for more than 1 year. We used the Modification of Diet in Renal Disease equation to estimate residual renal function. RESULTS: Of the 210 patients who received renal replacement therapy, 108 were treated with hemodialysis and 102 were treated with peritoneal dialysis. Thirty-three patients died, and the mean survival period was 37.3+/-17.7 months. The survival rates were compared based on the estimated glomerular filtration rate; no difference in survival rates was observed (p=0.27). Subgroup analysis in the hemodialysis group showed that patients who began chronic dialysis at a lower estimated glomerular filtration rate had higher mortality rates (p<0.05); patients treated with peritoneal dialysis showed no significant difference in mortality rate (p=0.50). CONCLUSIONS: Although there was no difference in the mortality rate based on residual renal function, hemodialysis patients with a lower estimated glomerular filtration rate showed a higher mortality rate than those with a higher estimated glomerular filtration rate.
Female ; Follow-Up Studies ; Glomerular Filtration Rate/*physiology ; Humans ; Kidney Failure, Chronic/*mortality/physiopathology/therapy ; Korea/epidemiology ; Male ; Middle Aged ; Prognosis ; Renal Dialysis/*methods ; Retrospective Studies ; Survival Rate/trends ; Time Factors

PURPOSE: Gastric cancer is the most common cancer in Korea. The principal therapy for this type of cancer is surgical operation along with neoadjuvant or adjuvant therapy. Gastric cancer patients develop disorders such as poor oral intake and indigestion after receiving a gastrectomy. Such patients gradually fall into nutritional disorders. The selection of gastrectomy procedures and anastomosis methods applied differentiate the presence of post-operative complications; and furthermore, whether the application adjuvant chemotherapy causes a difference in the grade of the nutritional disorder. In the past, the survival length was too short after the gastric cancer operation for interest to arise in the post-operative nutritional failure problems. However, current early screening tests have increased the detection rate of early gastric cancers, and the advancements in surgical techniques and immunochemical therapy have lengthened the expected life span long enough to raise the nutritional problems. This aim of this research was to study the changes in the mineral contents before and after a gastrectomy using hair tissues. METHODS: Twenty gastric cancer patients who received operation in Severance Hospital Yonsei University between January and March, 2002, were selected. Hair tissues with a length of 3 cm were collected from the posterior cephalic region before and 3 months after the operation. The collected hair tissues were sent to Tei KOREA CO., LTD. for the levels of 23 different minerals before and after the operation to be examined and measured. RESULTS: The average age was 53.55+/-11.74 years old, and the male and female ratio was 14: 6. Five cases received a total gastrectomy, while the other 15 received a subtotal gastrectomy. Six out of the 20 received post-operative adjuvant chemotherapy. The levels of almost all the minerals were marginally decreased, with the exception of two. The level of sodium had meaningfully decreased while that of molybdenum had increased. CONCLUSION: The mineral contents gradually decreased three month after the gastrectomy has been carried out. The level of sodium significantly decreased, while that of molybdenum increased. Further study and prolonged follow-up observations are essential to detect minerals changes in the evaluation of nutritional changes in those patients having received a gastrectomy.
Chemotherapy, Adjuvant ; Child ; Dyspepsia ; Female ; Follow-Up Studies ; Gastrectomy* ; Hair* ; Humans ; Korea ; Male ; Mass Screening ; Minerals* ; Molybdenum ; Nutrition Disorders ; Sodium ; Stomach Neoplasms* ; Stomach*

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.
Age of Onset ; Ambulatory Care Facilities ; Caregivers* ; Education ; Employment ; Humans ; Marital Status ; Outpatients* ; Parents ; Schizophrenia

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.
Age of Onset ; Ambulatory Care Facilities ; Caregivers* ; Education ; Employment ; Humans ; Marital Status ; Outpatients* ; Parents ; Schizophrenia

A myolipoma is an extremely rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum. We experienced a case of an anal myolipoma occurring in a 30-year-old woman, and it was surgically resected. To our knowledge, this is the first reported case of a myolipoma arising from the anus, so such a possibility needs to be considered in the differential diagnosis.
Abdomen ; Adult ; Anal Canal ; Angiomyolipoma ; Diagnosis, Differential ; Female ; Humans

Dermatomyositis (DM) is an idiopathic autoimmune connective disease characterized by muscles and skin inflammation of and a well-recognized association with several human malignancies, especially breast cancer. Paclitaxel is a taxane antineoplastic agent with therapeutic effects against a wide range of cancers including breast cancer. This drug is well known for neurotoxicity and hypersensitivity reactions. However, cutaneous drug eruptions, especially those of grade III or higher, are not frequent. Here, we describe the case of a 55-year-old woman with metastatic breast cancer who developed paraneoplastic DM and a paclitaxel-induced exanthematous drug eruption. This case report emphasizes the importance of evaluating internal malignancies, such as advanced breast cancer, in newly developed DM patients. In addition, it presents a rare case of paclitaxel-induced exanthematous drug eruption. The purpose of this case report highlights the immunological pathogenic mechanism of DM and drug eruption in underlying advanced breast cancer.
Breast Neoplasms* ; Dermatomyositis* ; Drug Eruptions* ; Female ; Humans ; Hypersensitivity ; Inflammation ; Middle Aged ; Muscles ; Paclitaxel ; Skin

PURPOSE: The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. RESULTS: The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. CONCLUSION: Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up.
Arthroplasty, Replacement, Hip* ; Bone Resorption ; Female ; Femur ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Retrospective Studies

Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare even in the elderly. Most are associated with major trauma, previous spine surgery, or stress-related activity. Here, the authors describe an unique case of unilateral pedicle fracture associated with spondylolytic spondylolisthesis at the L5 level, which was successfully treated by posterior lumbar interbody fusion with screw fixation at the L5-S1 level. As far as the authors' knowledge, no such case has been previously reported in the literature. The pathophysiological mechanism of this uncommon entity is discussed and a review of relevant literature is included.
Aged ; Fractures, Stress ; Humans ; Spine ; Spondylolisthesis* ; Spondylolysis

Juxtafacet cysts are implicated in neural compression. Thus far, it is known that surgical removal is the definitive treatment for symptomatic juxtafacet cyst because spontaneous regression is rare, and the failure rate of conservative treatment is high. We have reported a rare case of right-sided juxtafacet cyst development after the spontaneous resolution of contralateral left-sided facet cyst. The left-sided facet cyst resolved spontaneously without surgical treatment, but a juxtacyst developed on the contralateral facet on the right side, as illustrated on 4-year follow-up magnetic resonance images. To the best of our knowledge, this is the first report of newly developed contralateral juxtafacet cyst after spontaneous regression. Herein, we have discussed the natural history and the management of this rare case.
Follow-Up Studies ; Natural History