OBJECTIVES: Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function. METHODS: For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-IV classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT inerval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGE), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration. RESULTS: 1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone adminisration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(p<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers). CONCLUSIONS: Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.
Agranulocytosis ; Antipsychotic Agents ; Blood Platelets ; Blood Pressure ; Body Weight ; Cholesterol ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Heart Rate ; Humans ; Male ; Partial Thromboplastin Time ; Prothrombin Time ; Psychotic Disorders ; Risperidone* ; Schizophrenia ; Seizures ; Smoke ; Smoking ; Triglycerides

Paraneoplastic limbic encephalitis associated with ovarian teratoma has variable clinical manifestations, including hallucination, abnormal behavior, amnesia, mental change, fever, chorea and dystonia, and often has antibodies to N-methyl-D-aspartate receptor (NMDAR), however cases without tumor or antibodies to NMDAR have also been reported. Here, we describe a 35-year-old female who was initially misdiagnosed as schizophrenia because she presented with acute onset of psychiatric symptoms, including visual hallucination, abnormal behavior, confusion, and memory impairment. Three days after admission, she developed high fever refractory to antibiotics. Brain MRI and examination of cerebrospinal fluid were normal. Computerized tomography of the pelvis showed an ovarian teratoma. The patient showed complete improvement after surgical removal of the ovarian teratoma and steroid therapy. We suggest that physicians should consider the possibility of paraneoplastic limbic encephalitis in patients who present with acute onset of psychiatric symptoms with high fever or movement disorder.
Adult ; Amnesia ; Anti-Bacterial Agents ; Antibodies ; Brain ; Cerebrospinal Fluid ; Chorea ; Dystonia ; Female ; Fever ; Hallucinations ; Humans ; Limbic Encephalitis* ; Magnetic Resonance Imaging ; Memory ; Movement Disorders ; N-Methylaspartate ; Pelvis ; Schizophrenia ; Teratoma

Takayasu's disease is characterized by absent upper extremity pulses and ophthalmological finding of secreased visions and catract formation. Clinical features of Takayasu's disease are attributed to an obstructive arteritis of the large vessels criginating from aortic arch and other aortic segments. This dissease most frequently has been reported from Orient, and has affected primarily young females. This is a report of a 10 years old girl who developed the typical clinical and pathophysiological manifestation of Takayasu's disease and we also made brief review of literature.
Aorta, Thoracic ; Arteritis ; Child ; Female ; Humans ; Upper Extremity

Veratrum patulum is a perennial plant with toxicity, which grows wild in the high mountain areas of Korea. Various types of steroidal alkaloids contained in Veratrum patulum are known to cause symptoms such as nausea, vomiting, bradycardia and hypotension. Twenty-three patients were admitted to our center with chief complaints of nausea and vomiting after ingesting leaves of Veratrum patulum. The mean age of the group was 44 years old and was comprised of 19 males and 4 females. Some patients showed hypotension and bradycardia with symptoms such as dizziness. Ten patients with severe bradycardia coupled with other symptoms received atropine administration. Nausea and vomiting were improved after the administration of anti-emetics. Blood pressure and the pulse rate were all normalized on the day after admission, and all of the patients were discharged without any symptoms.
Alkaloids ; Antiemetics ; Atropine ; Blood Pressure ; Bradycardia ; Dizziness ; Female ; Heart Rate ; Humans ; Hypotension ; Korea ; Male ; Nausea ; Plants ; Veratrum ; Vomiting

PURPOSE: Cyclin D1, cytokeratin(CK)7, CK20 and vimentin play an important role in tumorigenesis and tumor progression. Our aim was to investigate the expression of cyclin D1, CK7, CK20 and vimentin in 138 papillary thyroid cancer and relationship with clinicobiological factors. We also tried to evaluate the value of those as prognostic factors. METHODS: We performed an immunohistochemical assay for cyclin D1, CK7, CK20, and vimentin in 138 papillary thyroid cancer tissue specimens. The correlation between these factors and the clinicobiological parameters was analyzed. RESULTS: In 138 papillary thyroid carcinoma specimens, the expression of cyclin D1, CK7, CK20 and vimentin was seen in 118 cases (85.5%), 133 cases (96.4%), 2 cases (1.4%) and 119 cases (86.2%), respectively. In our cases, there was a significant association among the expressions of cyclin D1, gender and lymph node metastasis. However, no obvious correlation was found between those proteins, age, tumor size, tumor amount, lymph node status and the TNM stage. CONCLUSION: Our results suggested increased cyclin D1 expression was seen in female gender and it may be a useful marker for evaluating lymph node metastasis. However, the clinical utility of cyclin D1, CK7, CK20 and vimentin in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.
Carcinogenesis ; Cyclin D1* ; Cyclins* ; Female ; Humans ; Keratin-20* ; Keratin-7* ; Keratins* ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies ; Sample Size ; Thyroid Gland* ; Thyroid Neoplasms* ; Vimentin*

BACKGROUND/AIMS: Ghrelin has recently been reported as exerting a protective effect in the damaged pancreas in rats. We investigated the correlation between severity of acute pancreatitis and serum ghrelin concentrations. METHODS: Blood samples were collected three times (at admission, after 48 hours, and at discharge) from patients admitted with acute pancreatitis. We divided the patients into nonrisk and risk groups. The risk group was defined as the presence of at least one of following risk factors for severe acute pancreatitis: Ranson's score > or =3, acute physiology and chronic health evaluation (APACHE) II score > or =8, C-reactive protein (CRP) > or =150 mg/L, and CT severity index (CTSI) > or =4. Serum ghrelin concentrations were measured with RIA kit and analyzed based on clinical and biochemical parameters. RESULTS: A total of 53 patients was enrolled in this study: 28 in the nonrisk group and 25 in the risk group. At admission, the ghrelin concentration was significantly higher in the risk group (286.39+/-272.19 vs 175.96+/-138.87 pg/mL [mean+/-SD], p=0.049). However, the ghrelin concentration did not differ significantly between the two groups after 48 hours (p=0.450) and at discharge (p=0.678). The overall ghrelin concentration was significantly lower at admission than at discharge (240.65+/-247.96 vs 369.41+/-254.27 pg/mL, p=0.001). CONCLUSIONS: Patients with risk factors for severe acute pancreatitis have higher serum ghrelin concentrations.
Animals ; APACHE ; C-Reactive Protein ; Ghrelin ; Humans ; Pancreas ; Pancreatitis ; Rats ; Risk Factors

PURPOSE: The concentration of capecitabine peaks at 1–2 hours after administration. We therefore assumed that proper timing of capecitabine administration and radiotherapy would maximize radiosensitization and influence survival among patients with locally advanced rectal cancer. MATERIALS AND METHODS: We retrospectively reviewed 223 patients with locally advanced rectal cancer who underwent preoperative chemoradiation, followed by surgery from January 2002 to May 2006. All patients underwent pelvic radiotherapy (50 Gy/25 fractions) and received capecitabine twice daily at 12-hour intervals (1,650 mg/m²/day). Patients were divided into two groups according to the time interval between capecitabine intake and radiotherapy. Patients who took capecitabine 1 hour before radiotherapy were classified as Group A (n = 109); all others were classified as Group B (n = 114). RESULTS: The median follow-up period was 72 months (range, 7 to 149 months). Although Group A had a significantly higher rate of good responses (44% vs. 25%; p = 0.005), the 5-year local recurrence-free survival rates of 93% in Group A and 97% in Group B did not differ significantly (p = 0.519). The 5-year disease-free survival and overall survival rates were also comparable between the groups. CONCLUSIONS: Despite the better pathological response in Group A, the time interval between capecitabine and radiotherapy administration did not have a significant effect on survivals. Further evaluations are needed to clarify the interaction of these treatment modalities.
Capecitabine* ; Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Radiotherapy* ; Rectal Neoplasms* ; Retrospective Studies ; Survival Analysis ; Survival Rate

Carcinoma of the thyroid usually presents as a palpable thyroid mass. However, in rare cases patients with thyroid cancer present with metastases of the cervical lymph node as the initial manifestation. The metastatic papillary tumor in cervical lymph nodes stained positive for thyroglobulin indicates the presence of a thyroid carcinoma, usually in the ipsilateral lobe. We herein report a case of multiple metastases in papillary thyroid carcinoma arising in the lateral aberrant thyroid with no evidence of thyroid carcinoma in the thyroid lobe.
Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

Zollinger-Ellison syndrome (ZES) is a clinical syndrome caused by excessive gastric acid secretion by gastrinoma, characteristically causing peptic disease and/or gastroesophageal reflux disease. Approximately one third of patients with gastrinoma have multiple endocrine neoplasia type 1 (MEN-1). A 56-year-old man was admitted for abdominal pain and diarrhea lasting for 2 weeks. The endoscopic findings revealed severe reflux esophagitis and multiple ulcers at the bulb and second portion of the duodenum. He was diagnosed as ZES based on typical clinical features such as markedly elevated fasting gastrin level (> or =1,263 pg/mL) and findings from a CT scan and somatostatin receptor scan. Pathologic findings after the operation revealed malignant gastrinoma. He was confirmed to have parathyroid adenoma and MEN-1. Despite antisecretory therapy with proton pump inhibitors, an esophageal stricture developed, and we performed esophageal balloon dilatation and stent insertion.
Abdominal Pain ; Diarrhea ; Dilatation ; Duodenum ; Esophageal Stenosis ; Esophagitis, Peptic ; Fasting ; Gastric Acid ; Gastrinoma ; Gastrins ; Gastroesophageal Reflux ; Humans ; Middle Aged ; Multiple Endocrine Neoplasia Type 1 ; Parathyroid Neoplasms ; Proton Pump Inhibitors ; Receptors, Somatostatin ; Stents ; Ulcer ; Zollinger-Ellison Syndrome

To determine whether family history of cancer may be a risk factor for the mutator phenotype in colorectal cancer, we recruited 143 consecutive colorectal cancer patients with a family history of accompanying cancers not meeting the Amsterdam criteria. Microsatellite instability (MSI) at 5 markers, hMLH1-promoter methylation, and expression of mismatch repair (MMR) proteins (hMLH1, hMSH2, hMSH6, hMPS1, and hPMS2) were determined. Among the relatives of familial colorectal cancer patients, colorectal cancer was the most common tumor type. Of the proband colorectal cancers, 26 (18.2%) showed high-level MSI (MSI-H); 47 additional tumors with mutator phenotype (32.9%) were identified by hMLH1-promoter methylation and/or loss of MMR protein expression. Mutator phenotype was associated with right-sided colon cancer and the type of accompanying cancer. Family history, which was differentially quantified according to the degree of relatives and the type of accompanying cancers, effectively discriminated MSI-H from microsatellite stable (MSS) and low-level microsatellite instability (MSI-L) and mutator phenotypes. Our findings indicate that familial colorectal cancer may be associated with multiple occurrences of colorectal or accompanying cancers and that family history could be correlated with microsatellite instability.
Adaptor Proteins, Signal Transducing/genetics/metabolism ; Adenosine Triphosphatases/metabolism ; Adult ; Aged ; Aged, 80 and over ; Base Sequence ; Colorectal Neoplasms/*genetics/metabolism/pathology ; DNA Methylation ; DNA Mismatch Repair ; DNA Repair Enzymes/metabolism ; DNA, Neoplasm/genetics ; DNA-Binding Proteins/metabolism ; Female ; Humans ; Male ; *Microsatellite Instability ; Middle Aged ; MutS Homolog 2 Protein/metabolism ; Neoplasm Proteins/metabolism ; Nuclear Proteins/genetics/metabolism ; Phenotype ; Promoter Regions, Genetic ; Risk Factors