BACKGROUND: In spite of relative high risk of extrapyramidal side effect and tardive dyskinesia, it is common clinical practice to use antipyschotics in treatment of bipolar I disorder. But in Korea, there has been few study about clinical factors related with antipsychotics treatment in bipolar disorder patients. So the author studied about the clinical factors related with antipsychotics treatment in bipolar inpatients focusing on the comparison of risperidone and classical antipsychotics. METHOD: By reviewing medical record retrospectively, datas about patient-related, illness-related, and treatment-related clinical factors on antipsychotics use were collected. Association between antipsychotics dose and duration and clinical factors were analysed by statistical method. RESULTS: Aggressive behavior was only statistically significant factor associated with antipsychotics use. And in the case of aggression, maintenance dose of risperidone was not changed(p=0.84), but dose of classical antipsychotics was increased significantly(p=0.005). Total hospital days and antipsychotics treatment duration showed no difference between risperidone and classical antipsychotics treatment groups. CONCLUSION: Clinical factors associated with antipsychotics use was aggressive behavior. In the case of aggression, risperidone required lesser dose increment compared with classical antipsychotics.
Aggression ; Antipsychotic Agents* ; Bipolar Disorder ; Humans ; Inpatients* ; Korea ; Medical Records ; Movement Disorders ; Retrospective Studies ; Risperidone*

OBJECTIVE: The implantation failure after embryo-transfer (ET) is a major continuing problem in in vitro fertilization (IVF). This study was undertaken to determine the effectiveness of intravenous immunoglobulin for treatment of individuals experiencing repeated unexplained in vitro fertilization-embryo transfer (IVF-ET) failure. METHODS: A total of nine consecutive infertile patients who failed to become pregnant after previous IVF-ET replacing at least three or more normal developed embryos each were included in our study. During the subsequent new IVF-ET cycle, each women received intravenous immunoglobulin 500mg/kg before the embryo transfer. RESULTS: Only one implantation occurred. There were no remarkable side effects. A specific effect of intravenous immunoglobulin for patients with repeated IVF-ET failure could not be demonstrated. CONCLUSION: High-dose intravenous immunoglobulin may not be useful for patients with repeated failure of embryo transfer.
Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Immunoglobulins*

Intersphincteric resection (ISR) is the ultimate sphincter saving procedure for low rectal cancer. Hemorrhoids are a common benign condition. We present and discuss a case of ISR which developed painful edematous hemorrhoids after ISR. A 62-year-old female with low rectal cancer received neoadjuvant chemoradiotherapy with successful down staging of tumor before undergoing robot assisted ISR with coloanal hand-sewn anastomosis. She had pre-existing external hemorrhoids which were not excised. She developed painful and edematous external hemorrhoids 4 days after surgery. These were treated conservatively before discharge. Many colorectal surgeons performing ISR have experienced similar situations in their patients, but none have reported on this phenomenon. We discuss the possible factors that may contribute to this situation. A possible solution is prophylactic excision of the hemorrhoids during coloanal anastomosis. Painful hemorrhoids may occur after ISR and if managed conservatively, the outcome is skin tags.
Chemoradiotherapy ; Female ; Hemorrhoids ; Humans ; Middle Aged ; Rectal Neoplasms ; Skin

There are many studies of the spousal bereavement as an important etiologic factor of depression in elders. But there are some differernt natures of spousal bereavement between the Korean and the western elderly. The problems of spousal bereavement in Korean would be more persistent than that in western. And the depressive symptoms of Korean elders are different with that of western elders due to the differences of sociocultural background. The authors studied the effect of the spousal bereavement to the depressive symptoms of elders by using KGDS (Korean Form of Geriatric Depression Scale), which already has been standardized in Korea. The subjects were consist of one hundred seventy-five, 60 years and older. The authors compared KGDS and its 5 factors in the spousal bereaved subjects group (SBG) with those in the spousal non-bereaved subjects group (SNG), and also investigated the differences according to sex and children living with the subject in the SBG. And the authors analysed the correlations between ages at spousal death, durations after spousal death and KGDS in the SBG. The mean KGDS scores in the SBG were significantly higher than that of the SNG, and especially Factor 1, Factor 2 and Factor 4 were significant. In the SBG, the mean KGDS scores of the female were significantly higher than that of the male, and especially Factor 2, Factor 3, and Factor 5 were significant. And in the SBG, the mean KGDS scores of the subjects living with children were slightly higher than those of the subjects living without children. And also in the SBG, there were negative correlations between KGDS scores and ages at spousal death, and positive correlations between KGDS scores and durations after spousal death. The authors found that the spousal bearevement could be an important etiologic factor of geriatric depression, and the risk factors of depression were female, younger at spousal death and longer duration after spousal death in bereaved elders, as the earlier studies in the western. However, the authors found that, in Korea, there were some different results from the western, such as the longer duration after spousal death and higher ratio of the widower to the widow than that in the western, the spousal bereaved elders living with children were rather depressive than who living without children.
Aged ; Bereavement ; Child ; Depression* ; Female ; Humans ; Korea ; Male ; Risk Factors ; Widowhood

OBJECTIVE: Our aim was to compare the compression quality, exercise intensity, and energy expenditure in 5-minute single-rescuer cardiopulmonary resuscitation (CPR) using 15:1 or 30:2 compression-to-ventilation (C:V) ratios or chest compression only (CCO). METHODS: This was a randomized, crossover manikin study. Medical students were randomized to perform either type of CPR and do the others with intervals of at least 1 day. We measured compression quality, ratings of perceived exertion (RPE) score, heart rate, maximal oxygen uptake, and energy expenditure during CPR. RESULTS: Forty-seven students were recruited. Mean compression rates did not differ between the 3 groups. However, the mean percentage of adequate compressions in the CCO group was significantly lower than that of the 15:1 or 30:2 group (31.2±30.3% vs. 55.1±37.5% vs. 54.0±36.9%, respectively; P<0.001) and the difference occurred within the first minute. The RPE score in each minute and heart rate change in the CCO group was significantly higher than those of the C:V ratio groups. There was no significant difference in maximal oxygen uptake between the 3 groups. Energy expenditure in the CCO group was relatively lower than that of the 2 C:V ratio groups. CONCLUSION: CPR using a 15:1 C:V ratio may provide a compression quality and exercise intensity comparable to those obtained using a 30:2 C:V ratio. An earlier decrease in compression quality and increase in RPE and heart rate could be produced by CCO CPR compared with 15:1 or 30:2 C:V ratios with relatively lower oxygen uptake and energy expenditure.
Cardiopulmonary Resuscitation* ; Energy Metabolism* ; Heart Rate ; Humans ; Manikins* ; Oxygen ; Students, Medical ; Thorax* ; Ventilation

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. Methods: This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (–) and -positive (+) groups. Results: Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(–) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023).Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254–4.467; P = 0.015). Conclusion COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

BACKGROUND: Even though several oral anti-diabetic drugs (OAD) with various modes of action are replacing sulfonylurea (SU), some patients seem to be dependent on SU for adequate glycemic control. Therefore, we evaluated the clinical characteristics of such patients. METHODS: We selected the patients with type 2 diabetes who met following criteria from 2009 to 2014 at Seoul National University Hospital: glycated hemoglobin (HbA1c) was maintained below 7.5% for at least 6 months under small dose of SU (glimepiride < or =2 mg/day or equivalent dose); after discontinuation of SU, HbA1c increased > or =1.2% within 3 months or > or =1.5% within 6 months; and after resuming SU, HbA1c reduction was > or =0.8% or reduction of fasting plasma glucose was > or =40 mg/dL within 3 months. Patients with impaired hepatic or renal function, and steroid users were excluded. RESULTS: Nineteen subjects were enrolled: after averaged 4.8+/-1.5 months of SU-free period, HbA1c increased from 6.7%+/-0.4% to 8.8%+/-0.8% even though adding other OAD such as gliptins. However, HbA1c decreased to 7.4%+/-0.7% after resuming SU within 2.4+/-0.8 months. There was no sexual predominance. Despite their old age (67+/-11 years) and long duration of diabetes (18+/-10 years), fasting C-peptide was relatively well-reserved (3.9+/-2.6 ng/mL), and nephropathy was not observed (albumin-creatinine ratio 21.2+/-16.6 mg/g and estimated glomerular filtration rate 75.8+/-18.0 mL/min/1.73 m2). Strong family history was also noted (73.7%). CONCLUSION: Despite hypoglycemia risk of SU, it seemed indispensable for a subset of patients with regard to insulin secretion. Genetic influences would be evaluated.
Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Dipeptidyl-Peptidase IV Inhibitors ; Fasting ; Glomerular Filtration Rate ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Insulin ; Seoul

No abstract available.
Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Toes*

PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.
Acupuncture* ; Defecation ; Diet ; Drinking ; Flatulence ; Gastrectomy* ; Gastrointestinal Diseases ; Humans ; Ileus* ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Length of Stay ; Outcome Assessment (Health Care) ; Prospective Studies ; Stomach Neoplasms*

OBJECTIVES: There have been many investigations into the evaluation and treatment of cognitive deficits in schizophrenia, because cognitive deficits do not respond well to antipsychotics and may be a very important prognostic factor for social and occupational outcomes. And it has been known that estrogen improves cognitive functions, as proved in animal studies and studies in postmenopausal women and dementia patients. And estrogen has been unvestigated as an etiologic factor of the neuroendocrine abnormalities of schizophrenia. This preliminary study was aimed to investigate the effect of estrogen on cognitive functions of female schizophrenics, as one of the estrogen projects on our institute. METHODS: The subjects consisted of 30 females with schizophrenia. During the study, all subjects maintained the same dosage of antipsychotics as before the study. Fifteen subjects were given estrogen (EG), and the other fifteen subjects were not(CG). Trail Making Test A and B, Digit Symbol Substitution Test, Finger Tapping Test, Visual continuous Performance Test, Spatial Memory Test, and Wisconsin Card Sorting Test were taken every four weeks from the baseline to the 12th week. RESULTS: At Baseline, there were no significant differences of ages, duration of illness, antipsychotic dose, ammenorrhea, PANSS, types of schizophrenia, MADRS and CGI, and cognitive function tests between EG and CG. There were no significant improvements of Trial Making Test A & B, Finger Tapping Test, and Visual continuous Performance Test in both groups. But there were significant improvements of Digit Symbol Substitution Test, Spatial Memory Test, and Wisconsin Card Sorting Test (total errors and completed categories) in EG, but not in CG. CONCLUSION: The authors found that estrogen improved some cognitive functions, such as memory and executive function in EG. But it could not be clearly defined whether those changes are due to the direct effect of estrogen on the cognitive functions, or the improvement of psychotic symptoms, or the generalized enhancing effect of cognitive functions.
Animals ; Antipsychotic Agents ; Dementia ; Estrogens* ; Executive Function ; Female* ; Fingers ; Humans ; Memory ; Schizophrenia ; Trail Making Test ; Wisconsin