The serotonin transporter (SERT) is the target site for serotonin reuptake inhibitors, which are the most widely used agents for treating various psychiatric diseases including depression. The SERT is a member of a large family of homologous integral membrane proteins. This transporter takes up 5-HT in a process that is coupled to the transmembrane movement of Na+, Cl-, and K+. The SERT may operate in at least two modes, an alternating access carrier or a channel. The function of SERT is acutely regulated by various protein kinases and phosphatases. The SERT gene is located on chromosome 17 and has several polymorphisms including 5-HTTLPR and intron 2 VNTR. Most studies involving the association between 5-HTTLPR and the response to SSRI in depression reported that l/l genotype showed better response and fewer side effects. But, it is too early to draw definite conclusion of the effects of 5-HTTLPR on anti-depressant treatment. Therefore, it is necessary to perform further studies reflecting various ethnicities and genetics of subjects as well as the environmental interactions. This review discusses recent advances in defining the structure, the action mechanism, the location, and the regulation of SERT. Furthermore, it discusses the function of SERT polymorphisms and its implications on the anti-depressant therapies.
Chromosomes, Human, Pair 17 ; Depression ; Drug Therapy* ; Genetics ; Genotype ; Humans ; Introns ; Membrane Proteins ; Phosphoric Monoester Hydrolases ; Protein Kinases ; Serotonin Plasma Membrane Transport Proteins* ; Serotonin Uptake Inhibitors ; Serotonin*

PURPOSE: To report the clinical manifestations of patients with ocular tilt reaction (OTR) and the differential point from other disorders with abnormal head posture. METHODS: The clinical manifestations of four patients who complained of abnormal head posture and diplopia and who were diagnosed to have OTR from January, 2001 to January, 2002 were investigated. The diagnoses were made with alternate cover test, duction and version test, Lancaster test, Bielschowsky head tilt test, fundus photography, and brain MRI. RESULTS: All the four patients showed ipsilateral head tilt, ocular torsion, and vertical deviation. Type of their OTR was tonic OTR. Subjective tilting of visual vertical was observed in one patient. Only with the 3-step test, OTR could be misdiagnosed as an extraocular muscle palsy. The most important sign in differentiation from other disorders of abnormal head posture was ocular torsion. Duction and version examination and tilt of subjective visual vertical were also helpful for the differentiation. CONCLUSIONS: OTR should be considered in patients with ocular torsion, vertical deviation and ipsilateral head tilt. In patients with diplopia and head tilt, examination of ocular torsion should be performed with the 3-step test in order not to make a misdiagnosis of extraocular muscle palsy.
Brain ; Diagnosis ; Diagnostic Errors ; Diplopia ; Head ; Humans ; Magnetic Resonance Imaging ; Paralysis ; Photography ; Posture

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

No abstract availble
Adenocarcinoma/*diagnosis/radiography ; Aged ; Anus Diseases/complications ; Colon, Ascending ; Colonic Neoplasms/*diagnosis/radiography ; *Colonography, Computed Tomographic ; *Colonoscopy ; Constriction, Pathologic ; Humans ; Male ; Tomography, X-Ray Computed

Recently there has been a progressive increase of thoracolumbar fractures with neurologic symptoms. It has been thought that laminectomy increased instability and was therefore considered a contraindication. Currently, with the development of instrument for posterior stabilization, it is possible to perform posterior fusion and instrumentation, both with and without laminectomy. To compare the effect of neurologic recovery with and without laminectomy, we analyzed the clinical records of 38 patients with neurologic symptoms who were evaluated with plain radiographs and CT before and after surgery from 1989 to 1996 in Gyeong-Sang National University Hospital. We divided our cases into two groups, one group consisted open reduction with laminectomy and instrumentation with posterior fusion. The other group consisted of open reduction without laminectomy and instrumentation with posterior fusion. Twenty three of 38 were operated with open reduction and internal fixation with laminectomy and others were operated without laminectomy. The results were that both groups had improvement of neurologic symptoms after surgery and at follow-up. There was no significant statistical difference between the two groups. Depending on the time interval between injury and surgery, patients who were underwent emergency surgery had an marked improvement of neurologic symptoms. Except cases of complete paraplegia, incomplete paraplegic patients who were operated within 24 hours with laminectomy group had greater improvement than those without laminectomy. The improvement was statistically significant(P<0.05).
Emergencies ; Follow-Up Studies ; Humans ; Laminectomy* ; Neurologic Manifestations* ; Paraplegia

Adenoid cystic carcinoma (ACC) is the second most common malignancy in sinonasal tract occurring in the minor salivary gland of paranasal sinuses. It is also an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis by perineural invasion. A 67-year-old woman had developed progressive nasal obstruction and facial pain for over two years. The imaging study showed a huge polypoid mass in the paranasal sinuses bulging into the nasal cavity without any adjacent bony erosion and orbital extension. The pathology was reported as a cribriform type of ACC. The mass was removed by endonasal endoscopic surgery and "Mini" Caldwell-Luc operation. Considering local recurrence due to perineural lymphatic invasion, postoperative radiation therapy was performed. We discuss here how the combination of endonasal endoscopic surgery and radiotherapy could provide the best chance for disease control in the selected stages of ACC.
Adenoids ; Carcinoma, Adenoid Cystic ; Facial Pain ; Female ; Humans ; Incidence ; Nasal Cavity ; Nasal Obstruction ; Nasal Polyps ; Neoplasm Metastasis ; Orbit ; Paranasal Sinuses ; Recurrence ; Salivary Glands, Minor

PURPOSE: The purpose of this study was to evaluate the effect of contrast improvement of enhancing brain lesions by inherent magnetization transfer effect in turbo spin-echo (TSE) T1-weighted MR imaging. MATERIALS AND METHODS: Twenty-six enhancing lesions of 19 patients were included in this study. Using a 1.0T superconductive MR unit, contrast-enhanced SE T1-weighted images (TR=600 msec, TE=12 msec, NEX=2, acquisition time=4 min 27sec) and contrast-enhanced TSE T1-weighted images (TR=600 msec, TE=12 msec, NEX=2, acquisition time=1min 44sec) were obtained. Signal intensities at enhancing lesions and adjacent white matter were measured in the same regions of both images. Signal-to-noise ratio (SNR) of enhancing lesions and adjacent white matter, and contrast-to-noise ratio (CNR) and lesion-to-background contrast (LBC) of enhancing lesions were calculated and statistically analysed using the paired t-test. RESULTS: On contrast-enhanced TSE T1-weighted images, SNR of enhancing lesions and adjacent white matter decreased by 18%(p<0.01) and 32% (p<0.01), respectively, compared to contrast-enhanced SET1-weighted images. CNR and LBC of enhancing lesions increased by 16% (p<0.05) and 66% (p<0.01), respectively. CONCLUSION: Due to the proposed inherent magnetization transfer effects in TSE imaging, contrast-enhanced T1-weighted TSE images demonstrated a statistically significant improvement in CNR and LBC, compared to conventional contrast-enhanced T1-weighted SE images, and scan time was much shorter.
Brain ; Humans ; Magnetic Resonance Imaging ; Signal-To-Noise Ratio

PURPOSE: To investigate the morphologic changes in the outer retina of patients with cone dystrophy, using spectral-domain optical coherence tomography (SD-OCT). METHODS: The medical records of 15 cone dystrophy patients examined from January 2007 to January 2012 were reviewed retrospectively. All patients underwent ophthalmic evaluation including best-corrected visual acuity (BCVA), color vision testing, fundus examination, full-field standard electroretinography (ERG), multifocal (mf) ERG, and SD-OCT. Qualitative and quantitative SD-OCT data and ERG responses were analyzed and compared among the patient categories and the normal control group. RESULTS: There were 4 major categories of SD-OCT findings, based on the status of the ellipsoid portion of the photoreceptor inner segment (ISe), outer segment (OS) contact cylinder, and retinal pigment epithelium (RPE) layer. Category 0 showed no structural abnormalities. Category 1 showed foveal ISe loss and obscurity of the border between the ISe band and the external limiting membrane (ELM). Category 2 showed foveal thinning and focal foveal ISe disruption with an intact ELM. Category 3 showed foveal thickening and perifoveal disruption of the ISe layer. Category 1 to 3 showed OS contact cylinder layer absence and RPE thickening. The patients in category 0 tended to be younger (mean, 10.0 years) than those in categories 1 to 3 (mean, 17.6 years), although this difference was not statistically significant. Category 1 to 3 patients exhibited statistically significant thinning of the central retina and outer nuclear layer and thickening of the RPE layer relative to the category 0 and normal control group. There was a significant correlation between the central foveal thickness and BCVA in the patients with cone dystrophy. ERG and mfERG responses did not differ significantly among the different cone dystrophy categories. CONCLUSIONS: The morphologic features of cone dystrophy as revealed by SD-OCT, could be categorized as either normal or 1 of 3 different types of outer retinal changes. The presence of normal retinal structures in young cone dystrophy patients with functional impairment (category 0) indicates that electrophysiologic studies are superior to current imaging modalities for the early diagnosis of cone dystrophy. The characteristic SD-OCT findings in cone dystrophy patients may aid in differential diagnosis and be useful for future research on the pathology of cone dystrophy.
Adolescent ; Adult ; Child ; Child, Preschool ; Electroretinography ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Male ; Middle Aged ; Ophthalmoscopy ; Reproducibility of Results ; Retinal Cone Photoreceptor Cells/*pathology ; Retinal Dystrophies/*pathology/physiopathology ; Retrospective Studies ; Tomography, Optical Coherence/*methods ; Visual Acuity ; Young Adult

The association of anisakiasis of the colon with colon cancer is rare and difficult to diagnose. Only one case of this type has been reported to date. In this study, we report a case of synchronous colon cancer and colonic anisakiasis. A 50-year-old woman was admitted for abdominal pain, and a volume-rendered surface-shaded image of CT colonography (CTC) revealed a concentric narrowing in the sigmoid colon and a segmental fold thickening in the ascending colon. A total colectomy was performed and the diagnosis of synchronous sigmoid colon cancer and anisakiasis of the ascending colon was confirmed. This case is the first reported visualization of synchronous colon cancer and colonic anisakiasis on a CTC.
Adenocarcinoma/*complications/*radiography/surgery ; Anisakiasis/*complications/*radiography/surgery ; Colectomy ; Colonic Diseases/*complications/*radiography/surgery ; *Colonography, Computed Tomographic ; Female ; Humans ; Middle Aged ; Sigmoid Neoplasms/*complications/*radiography/surgery

We present a rare case of a focal intrahepatic extramedullary hematopoiesis (EMH) that mimicked a hypervascular hepatic neoplasm in a 33-year-old woman with idiopathic myelofibrosis. The lesion showed homogeneous and persistent enhancement on both contrast-enhanced CT and gadolinium-enhanced dynamic MR imaging. The lesion did not demonstrate an apparent signal drop on a T2*-weighted sequence following administration of a superparamagnetic iron-oxide agent (SHU 555A). A hepatocellular adenoma was the initial radiological diagnosis. To the best of our knowledge, this is the first report of a histopathologically proven intrahepatic EMH evaluated with dynamic- and SPIO-enhanced MRI.
Adenoma/*diagnosis ; Adult ; Diagnosis, Differential ; *Hematopoiesis, Extramedullary ; Humans ; Liver/*physiology ; Liver Neoplasms/*diagnosis ; *Magnetic Resonance Imaging ; Male ; Primary Myelofibrosis/physiopathology