The fluoxetine is one of the most frequently prescribed drugs for the treatment of depression and obsessive-compulsive disorder(OCD). This has been know as one of the most safest medication. But since the advent of this drug, there have been several reports of side effects-the mania and suicidal ideation-encountered during coadministration of fluoxetine with or without other psychotropic drugs. We experienced a case of 20 years old male OCD patient who developed into abrupt manic state and also was preoccupied with intense suicidal ideation following fluoxetine use. He was a only child in his family and his father had a history of alcoholism about 15 years ago. Our patient's obsessive-compulsive symptoms have been occured since puberty. His OCD symptoms and anxiety were aggravated since joining the army. Beside these facts, we could not find any other psychiatric history such as depressive disoder and bipolar disorder. We used the fluoxetine starting dosage of 20mg and increased to 40mg at second week. About 3 weeks after the treatment, he developed sudden manic symptom and more aggravated suicidal ideation without any OCD symptoms. He felt vitalized and energetic without having enough sleep and food. These symptoms were ceased over two weeks by stopping medication. Up to this point, the reason why fluoxetine induces mania and suicidal preoccupation is unclear. But somehow the fluoxetine has effects on serotonin receptor and serotonin-dopamine regulations, thus we could make an assumption that fluoxetine can induce mania, extrapyramidal symptoms(EPS) and suicidal ideation in some part of the serotonin unbalanced patients. We think this would be the first report to remark on fluoxetine's suicidal and manic side effects in Korea. So here we present the case with the summary of reviewed articles.
Adolescent ; Alcoholism ; Anxiety ; Bipolar Disorder* ; Depression ; Fathers ; Fluoxetine ; Humans ; Korea ; Male ; Obsessive-Compulsive Disorder* ; Only Child ; Psychotropic Drugs ; Puberty ; Serotonin ; Social Control, Formal ; Suicidal Ideation* ; Suicide ; Young Adult

No abstract available.
Signal Transduction*

The dopamine D4 receptor gene has a hypervariable segment in the coding region charcterized by a varying number of 48bp repeats in exon III of the gene. Varying the numbers of repeated segments may change the length, structure, and function of the receptor, which makes this gene a possible candidate for variations in dopamine-related behaviors. such as alcoholism and drug abuse. We evaluated the dopamine D4 receptor genotype in male alcoholics and normal controls. All alcoholics and controls were unrelated and from the Korean population. Genotype and allele frequencies in 67 alcoholics were compared to 67 controls who were free of alcohol abuse. substance abuse. and major mental illness. No association was found between the dopamin D4 recepto allele and alcoholism. This result indicate that there is no association of the dopamine D4 receptor with alcoholism in Korean. Further systemized investigation to determine the role of dopamine D4 receptor gene in alcoholism with a larger sample size will be required.
Alcoholics ; Alcoholism* ; Alleles ; Clinical Coding ; Dopamine* ; Exons ; Gene Frequency ; Genotype ; Humans ; Male ; Receptors, Dopamine D4* ; Sample Size ; Substance-Related Disorders

No abstract available in English.
Clinical Study ; Humans ; Upper Extremity

BACKGROUND: Nevus depigmentosus was first reported in 1884 by Lesser. It is defined as a congenital non-progressive hypopigmented macule or patch that is stable in its relative size and distribution throughout the life of the individual. The etiopathogenesis and histopathological characteristics of nevus depigmentosus are not fully established. OBJECT: The purpose of this study is to investigate the clinical and histopathological characteristics and pathogenesis of nevus depigmentosus. METHODS: Clinieal survey was carried out on forty-nine patients with nevus depigmentosus and two skin biopsies were taken from eighteen patients; from the central part of the depigmented lesion and the border of the lesion including the perilesional normal skin. The sections were stained with hematoxylin-eosin, Fontana-Masson and S-100 protein. The ultrastructural evaluation were also done to detect alternation of melanocytes. RESULTS: The results are as follows ; 1. The lesions were mostly (91.8%) present before the age of three, but some lesions appeared in childhood (8.2%). 2. The lesions were most frequently found on the trunk (42.9%), followed by the face and scalp (20.4%). 3. There were 33 patients (67.3%) with the isolated type, 15 patients (30.6%) with the dermatomal type and one patient with the whorled type. 4. Histopathological studies have shown that the stainability of Fontana-Masson in the lesions of nevus depigmentosus was decreased compared with perilesional nomal skin, but there were no changes in the number of melanocytes. 5. There was a great reduction in the number of melanosomes in melanocytes and keratinocytes of nevus depigmentosus. In keratinocytes, there was some aggregations of melanosomes and some of them showed membrane bound architecture. CONCLUSION: The results of this study support the fact that nevus depigmentosus is caused by functional defects of melanocytes and morphological abnonnalities of melanosomes.
Biopsy ; Humans ; Keratinocytes ; Melanocytes ; Melanosomes ; Membranes ; Nevus* ; S100 Proteins ; Scalp ; Skin

No abstract available.
Breast Neoplasms* ; Breast*

No abstract available.
Seat Belts*

Nodular pseudosarcornatous fasciitis is a benign, fibrohlastic proliferative disease. This case report is one of a hard nodule which a 35-year-old male suddenly discovered on his right forearm 10 days prior to being aeen. The nodule showed characteristic histological findings of nodular pseudosarcomatous fasciitis.
Adult ; Fasciitis* ; Forearm ; Humans ; Male

BACKGROUND: Primary targit injured from the immunologic mechanism of alopecia areata is not definitely confirmed although alopecia areata is regarded as a disease occuring from certain im munologic process. Recently, par ticular interest has been focused on the follicular keratinocytes which show morphologic and anigenic alterations in active lesions. Another important point is the subclinical state hypothesi. It is based upon the observation that the patterns of T lymphocytes infiltration and ultrastructural changes of dermal papilla cells are nearly identical in active lesions and in non-lesional areas of alopecia areata. OBJECTIVE: The purpose of this study is to determine and to compare the aberrant expression of HLA-DR, CD1 and ICAM-1 on the follicular keratinocytes from the active alopecia areata lesion, stationary lesion and non-lesional scalp. METHODS: We performed a n immunohistochemical study, using the streptavidin system to compare the patterns of HLA-DR, CD1 and ICAM-1 immunoreactivity in the follicular keratinocytes in five active alopecia lesions two stationary lesions and non-lesional scalp specimens among four active and two stationary patients, and two normal control scalp specimens. RESULTS: In the active aloecia lesions, the HLA-DR and ICAM-1 immunoreactivity was observed in some patients while CD1 immunoreactivity was observed in all the patients. In the sta tionary alopecia lesions, none of the HLA-DR or CD1 or ICAM-1 immunoreactivity was observed as was the case in the norrial control scalp specimens. In the non-lesional normal scalp specimens, the HLA-DR, CD1 and ICAM-1 immunoreactivity showed nearly the same patterns as those in the acute alopecia leions. CONCLUSION: The aberrant antigenic alterations, especially CD1 expression of follicular keratinocytes are likely to be asociated with the active progress of alopecia areata lesions. These antigenic alterations were also observed in non-lesional scalp as well as alopecia areata lesions in the very similar patterns.
Alopecia Areata* ; Alopecia* ; HLA-DR Antigens ; Humans ; Intercellular Adhesion Molecule-1 ; Keratinocytes* ; Scalp* ; Streptavidin ; T-Lymphocytes

BACKGROUND: Pustular eruptions due to drugs are uncommonly reported. We studied the characteristics of clinical and histopathologic findings of pustular drug eruption. OBJECTIVE: We observed th.e causative agents, clinical featurs and histopathologic findings of pustular drug eruption and identified differential points of generlized pustular eruption. METHODS: We evaluated t,he clinical and histopathologic findings of 8 patients with pustular drug eruption and reviewed the literatures reported cases of pustular drug eruption. RESULTS: All patients diagnosed pustular drug eruption suffered from generalized pustular eruption associated with systemic symptoms such as fever, headachened myagia one to three days after treatment with causative agents. The causative agents of putular drug eruption are antibiotics such as ceftriaxone, analgesics and antipyretics. The pustule resolved after a few days of treatment with systemic corticosteroids and antihistamines. Laboratory findings revealed leukocytosis, neutrophilia, and analevated erythrocyte sedimentation rate, On histopatologic findings, we observed subcorneal pustuls containing neutrophils, eosinophils and some lymphocytes and spongiosis, exocytosis of acute iiflammatory cells. Perivascular infiltration of lymphocyte ancl edema of papillary dermis was also bserved in the dermis. CONCLUSION: Pustular drug eruption is characterized by generalized pustular eruption associated with systemic symptoms and histopathologic findings of that are sterile subcorneal pustules. Therefore differential diagnosis of other generalized pustular erupticns are relatively easy by careful history of medication, clinical and histopathologic findings.
Adrenal Cortex Hormones ; Analgesics ; Anti-Bacterial Agents ; Antipyretics ; Blood Sedimentation ; Ceftriaxone ; Dermis ; Diagnosis, Differential ; Drug Eruptions* ; Edema ; Eosinophils ; Exocytosis ; Fever ; Histamine Antagonists ; Humans ; Leprosy ; Leukocytosis ; Lymphocytes ; Neutrophils