The debate about whether depressive disorders should be divided into categories or arrayed along a continuum has gone for decade, without resolution. In our review, there is more evidence consistent with the spectrum concept than there is with the idea that depressive disorders constitute discrete clusters marked by relatively discontinuous boundaries. First, "depression spectrum", "is there a common genetic factors in bipolar and unipolar affective disorder", "threshold model of depression" and "bipolar spectrum disorder" are reviewed. And, a new subtype of depression is so called SeCA depression that is a stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression. SeCA depression is discussed. But, there is with the idea that depressive disorders constitute discrete subtypes marked by relatively discontinuous boundaries. This subtypes of depressive disorder were reviewed from a variety of theoretical frames of reference. The following issues are discussed ; Dexamethasone suppression test(DST), TRH stimulation test, MHPG, Temperament Character Inventory(TCI), and heart rate variability(HRV).
Depression* ; Depressive Disorder ; Dexamethasone ; Heart Rate ; Methoxyhydroxyphenylglycol ; Temperament

PURPOSE: We evaluated the correlation between the carcinogenesis of gallbladder and the expression of lysozyme, p53, c-erbB2 and CEA in gallbladder lesions. MATERIALS AND METHODS: Thirty cases of gallbladder lesions (containing 17 cases of GB carcinoma) were examined. We analyzed the clinicopathologic findings of the early (stage I & II) and advanced carcinoma (stage III, IV & V) and those of carcinoma with or without metaplasia in the tumor. We performed p53, c-erbB2 and CEA immunohistochemical staining and compared their findings with those of normal mucosa and preneoplastic lesions. We also performed lysozyme immunohistochemical staining and compared its finding with metaplastic and non-metaplastic lesions. RESULTS: There are two distinct genetic pathways in gallbladder cacinogenesis and metaplastic carcinoma was more frequent than non-metaplastic carcinoma. Metaplasia of gallbladder did not reveal any difference of the clinicopathologic findings and depth of invasion (Nevin stage). Lysozyme expression was found in all metaplastic lesions but non-expression did not indicate non-metaplastic lesions. p53 mutations and c-erbB2 alterations may have a role in the carcinogenesis of gallbladder carcinomas, especially, in a late event, and in an early and late events, respectively. The correlation of p53 and c-erbB2 expressions was found but which did not indicate that the co-expression was needed in the carcinogenesis. CEA immunohistochemical staining may be helpful in the differential diagnosis of benign lesions and precancerous and cancerous lesions of the gallbladder. CONCLUSION: These results suggest that p53 mutations and c-erbB2 alterations may have a role in the carcinogenesis of gallbladder carcinomas, especially, in a late event, and in an early and late events, respectively.
Carcinogenesis ; Diagnosis, Differential ; Gallbladder* ; Metaplasia* ; Mucous Membrane ; Muramidase

No abstract available.
Lymphoma, T-Cell, Cutaneous*

The courses of the progression in the fibrous dysplasia are characterized by asymptomatic progression or spontaneous regression in some cases after the growth has ceased and the aims of treatment for a fibrous dysplasia are prevention of the pathologic fractures and correction of the deformities. The osteogenic potentiality of the cambium layer in the periosteum and the beneficial effect on the osteogenesis of the impregnating bone graft with autologous red marrow are well documented. We experienced an extensive fibrous dysplasia with cortical thinning and pathologic fracture and it was managed with subperiosteal combined xenograft of Kiel bone with autologous red marrow for the induction of cortical thickening and prevention of the pathologic fractures because of the inoperability of curettage due to extensive lesion over the entire femur, limitations in obtaining large amount of autogenous cancellous bone for the graft and lack of the facilities of the bone bank. This subperiosteal composite xenograft with autologous red marrow for a fibrous dysplasia gave an excellent result of a remarkable cortical thickening and we think this can be a type of management for a entensive fibrous dysplasia. So we are reporting this case with bibliographic reviews.
Bone Banks ; Bone Marrow ; Cambium ; Congenital Abnormalities ; Curettage ; Femur ; Fractures, Spontaneous ; Heterografts ; Osteogenesis ; Periosteum ; Transplants

PURPOSE: Cycloporine A (CsA) is a immunosuppressive agent most widely used in organ transplanted patients for preventing immunorejection, but it has some side effects, including hypertension, nephrotoxicity, hepatotoxicity and diabetes. The mechanism of toxicity of CsA was not completely understood, but the reactive oxygen species has been proposed to be involved in the reaction of toxicity of CsA. The purpose of this study is to determine the effects of glutathione, as a physiological antioxidant on CsA induced cytotoxicity in rat insulinoma (RINm5F) cells. METHODS: RINm5F cells were incubated in the presence of CsA (105~108 M) and buthionine sulfoximine (BSO), as a inhibitor of r-glutamyl cysteine synthetase, was added to cultured media (RPMI1640). Twenty four hours of incubation with CsA and BSO, viable cells were determined by MTT method. RESULTS: CsA decreased cell viability in dose response in cultured RINm5F cells and significantly decreased according to redusing glutathione. CONCLUSION: These results suggested that CsA may induce the diabetes and glutathione have some roles in the pathogenesis of CsA-induced diabetes.
Animals ; Buthionine Sulfoximine ; Cell Survival ; Cyclosporine* ; Cysteine ; Glutathione* ; Humans ; Hypertension ; Insulinoma* ; Ligases ; Rats ; Reactive Oxygen Species

PURPOSE: Endovenous laser treatment for incompetent great saphenous vein (GSV) has been recently proposed as an effective means of treatment. The aim of this study is to identify the complications and safety of EVLT as the main treatment for primary varicose vein incompetence when used concomitantly with miniphlebectomy and sclerotherapy. METHODS: We reviewed the records of 153 patients who underwent EVLT. Venous duplex scanning was performed 3 months after surgery in all the patients. The clinical outcomes were evaluated using questionnaires at the outpatient clinic or through phone calls. RESULTS: Considering the 97% satisfaction rate of EVLT, EVLT was an effective treatment for primary varicose vein. We observed complications such as paresthesia (20.9%), pain lasting more than 2 weeks (11.8%), ecchymosis or bruising (7.2%) that subsided spontaneously, superficial burn (5.2%) and phlebitis (2%) that was controlled by conservative treatment. The GSV recanalization rate 3 months after the procedure was 3.3%, resulting in a 96.7% success rate. CONCLUSION: The early results indicate that EVLT is an effective and safe procedure to eliminate the SFJ (sapheno-femoral junction) and obliteration of the GSV. However, long-term follow-up is necessary in our study. Better treatment outcomes are possible with accumulated experience and the establishment of strict indications for EVLT.
Ambulatory Care Facilities ; Burns ; Ecchymosis ; Follow-Up Studies ; Humans ; Paresthesia ; Phlebitis ; Surveys and Questionnaires ; Saphenous Vein ; Sclerotherapy ; Varicose Veins*

CT findings and comparison between clinical and CT staging were reviewed in 45 consecutive patients withbiopsy proven carcinoma of the cervix. CT was done for staging of primary untreted cercial cancer in 36 patientsand for diagnosis of recurrent cervical cancer or follow-up study 14 times in 9 patients . The results are asfollows; 1. As comparing with clinical staging in 36 cases, CT agreed with clinical stage in 19 cases (52.8%),upstaged in 10 cases(27.8%) and downstaged inn 7 cases (19.4%). 2. The main upstaged CT findings are detection ofunsuspected bladder or rectal invasion and paraaortic lymph node metastasis. Inadequate delineation ofintravaginal tumor was the leading causes of understage of CT than clinical one. 3. CT detected all 10 cases ofthe hydronephrosis shown by IVP and detected unsuspected bladder invasion in 3 cases. 4. CT was valuable in thediagnosis of recurrent tumor and follow-up study after treatment. 5. CT offeres distinct advantages over clinicalstaging and can be integrated into the present FIGO classification of uterine cervix carcinoma. CT can served asan initial radiological staging work-up of primary of recurrent cervical carcinoma.
Cervix Uteri ; Chungcheongnam-do ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Lymph Nodes ; Neoplasm Metastasis ; Urinary Bladder ; Uterine Cervical Neoplasms

A case of a 21-year old female with Maffucci's syndrome is presented where the patient developed multiple cutaneous spindle-cell hemangioendotheliomas. She had multiple pea to walnut sized, non-tender, normal skin colored or slight bluish nodules and bony mass-like lesions on the left upper extremity and hand. A histological examination of the lesions showed that they were composed of irregularly dilated, thin walled cavernous blood spaces containing phleboliths and collapsed vascular spaces separated by spindled fibroblastic cells. Radiologically, the bony lesions showed radiolucent densities with calcified spots within the second proximal phalanx and metacarpal bone of the left hand, which were consistent with enchondromas.
Chondroma ; Female ; Fibroblasts ; Hand ; Hemangioendothelioma* ; Humans ; Juglans ; Peas ; Skin Pigmentation ; Upper Extremity

Tuberculosis verrucosa cutis is caused by the external inoculation of Mycobacterium tuberculosis into the skin of a person who already has a significant degree of cell mediated immunity to this organism. This form of cutaneous tuberculosis is less common. A 29-year-old male had a solitary adult palm sized, verrucous surfaced scaly plaque for about 10 years. The lesion was excised about 10 years ago but gradually increased in size. At first we suspected a deep mycosis and treated him with anti-fungal medication for 3 months. However, the skin lesion did not improve. He was then treated with anti-tuberculosis medication for 9 months under the impression of tuberculosis verrucosa cutis. The skin lesion was almost healed and no recurrence has been observed for 8 months after the treatment.
Adult ; Humans ; Immunity, Cellular ; Male ; Mycobacterium tuberculosis ; Recurrence ; Skin ; Tuberculosis* ; Tuberculosis, Cutaneous

BACKGREOUND: Acute normovolemic hemodilution (ANH) is one of the methods of autologous transfusion drawing much attention recently. It is economical and easy to apply to many surgeries requiring multiple transfusions. When used as a drug for induced hypotension, esmolol can avoid many drawbacks of sodium nitroprusside and reduce the amount of intraoperative bleeding with better operative field. Considering recent trend of combining ANH and induced hypotension to increase the success rate of autotransfusion, esmolol-induced hypotension with ANH will be used more frequently in the future. However, tissue oxygen balance may be in danger because of decreased tissue perfusion pressure by induced hypotension and reduced arterial oxygen content by ANH. Thus it is necessary to evaluate effects of induced hypotension combined with ANH on cardiovascular system and systemic oxygen balance. METHODS: In 8 mongrel dogs anesthetized with N2O-O2-enflurane and paralyzed with vecuronium, ANH was performed up to half of initial level of hemoglobin with isovolemic pentastarch infusion, and then mean arterial pressure (MAP) was lowered by 30% of the initial value by intravenous administration of esmolol. Various hemodynamic parameters were measured before and after ANH and 15, 30, 60 and 90 minutes after induction of hypotension and 30 minutes after the end of hypotension. RESULTS: Heart rate began to decrease after ANH and showed significant decrease at 60 and 90 minutes after hypotension compared with initial value. Central venous pressure increased significantly after ANH and hypotension. Pulmonary arterial pressure showed significant increase at 15 and 90 minutes after hypotension. Cardiac output was increased markedly by ANH but began to decrease after hypotension and showed significant decrease at 60 minutes after hypotension. Systemic vascular resistance showed significant decrease after ANH, 15 minutes after hypotension and 30 minutes after discontinuation ofesmolol. Pulmonary capillary wedge pressure and pulmonary vascular resistance showed no significant change. Oxygen flux was decreased markedly by esmolol but recovered after discontinuation of esmolol. Oxygen consumption was maintained throughout the study. Oxygen extraction ratio was increased dly after hypotension. There were no acidemia and hypoxemia throughout the study. CONCLUSION: In conclusion, the results of this study suggest that tissue oxygen delivery might be decreased by anemia but that systemic oxygen balance might be preserved by ANH and induced hypotension within the range used in this study.
Administration, Intravenous ; Anemia ; Animals ; Anoxia ; Arterial Pressure ; Blood Transfusion, Autologous ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Hypotension* ; Nitroprusside ; Oxygen Consumption ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Vascular Resistance ; Vecuronium Bromide