The concept of bipolar disorder is an ongoing process, still in evolution, although its roots can be found from ancient Greek. Until recently, it was believed that no more than 1% of the general population has bipolar disorder. But literature on the lifetime prevalence of the bipolar spectrum disorder suggests rates of 4-5%. Bipolar spectrum disorder is a longitudinal diagnosis characterized by abnormal mood swings comprising some of the following cross-sectional clinical states: mania, hypomania, mixed states, hyperthymic temperament, major depressive episode, and depressive mixed state. Failure to recognize subthreshold expressions of mania, such as hypomania, cyclothymia, and hyperthymia, contributes to the frequent under-diagnosis of bipolar disorder. There are several reasons for the lower rate of recognition of subthreshold manic symptoms, when compared to the analogous pure depressive one. These include the lack of subjective suffering, enhanced productivity, egosyntonicity, diurnal and seasonal rhythmicity associated with many of the manic and hypomanic symptoms, and the psychiatrists' difficulty in differentiating with personality disorders. In addition, most patients with bipolar spectrum disorder seek treatment for depression, rather than mania or hypomania. Therefore clinicians often miss the diagnosis of bipolar spectrum disorder. The recent 10 years of researches have suggested that 30-55% of patients with major depressive disorder are actually identified with broader spectrum of bipolar disorders. However, 48% of patients of bipolar disorder consulted 3 or more professionals before receiving a correct diagnosis, and 10% consulted 7 or more for their first diagnosis of bipolar disorder. Several studies have documented that patients often wait as long as 10 years for the correct diagnosis of bipolar spectrum disorder. This delay in diagnosis often has substantial adverse results. Patients do not get the appropriate treatment to alleviate their symptoms. They may even get treatments that exacerbate their symptoms, such as prescription of antidepressants precipitating mania and producing rapid cycling. The concepts of hypomania, cyclothymia, mixed state, depressive mixed states, hyperthymic temperament are the new areas of studying mood disorders in recent 20 years. The authors will review the studies on various subtypes of bipolar spectrum disorder with their historic aspects, and introduce the suggested screening tests for bipolar spectrum disorder in clinical practice.
Antidepressive Agents ; Bipolar Disorder ; Classification ; Depression ; Depressive Disorder, Major ; Diagnosis ; Efficiency ; Humans ; Mass Screening ; Mood Disorders ; Periodicity ; Personality Disorders ; Prescriptions ; Prevalence ; Seasons ; Temperament

No abstract available.
Humans ; Male ; Nursing* ; Urinary Incontinence*

Extramammary Pagets disease of the vulva is an uncommon vulvar neoplasm with a high rate of recurrence. We report a young woman in whom vulval Paget's disease occurred in association with local adenocarcinoma. The patient presented at the age of 28 years with slowly growing vulval mass which had some mucoid discharge. Biopsy of the mass showed Paget's disease with associated local adenocarcinoma. This patient received modified radical vulvectomy with unilateral inguinofemoral lymphadenectomy. Until now she is under follow up without evidence of recurrence for 24 months. According to our medline research from 1980 to 2000, this case is the youngest asian patient yet recorded. We recommend that abnormally growing vulvar mass need to be biopsied eventhough she is young.
Adenocarcinoma* ; Asian Continental Ancestry Group ; Biopsy ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Paget Disease, Extramammary ; Recurrence ; Vulva ; Vulvar Neoplasms

The subacute necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a benign, self-limited disorder of unknown cause. This rare disease is characterized by fever, lymphadenopathy, leukopenia, and elevated sedimentation rate. This disease preferentially affects young women. The diagnosis of this disease is confirmed by involved lymphnodes biopsy. Evidence for autoimmune dysfunction has been reported, but is usually lacking. According to the review of the literatures, a total of 192 cases of subacute necrotizing lymphadenitis were reported in Korea since 1983 mostly in literatures of pathology or internal medicine and only 7 cases in pediatrics. There was female predominance in a 141:51 ratio. However, among 25 cases of under 20 years of age, there was male predominance in a 16:9 ratio. The patients of under and over 20 years of age were 29 and 82, respectively among the age-known 111 cases of 192 reported. We experienced a 13-year-old boy, who had right cervical lymphadenitis with persisting high temperature and pain on lymph nodes for more than 10 days. An excisional cervical lymph node biopsy was performed and pathologic diagnosis was compatible with subacute necrotizing lymphadenitis. Most antibiotics were not effective, but fever subsided with one day of oral prednisolone therapy. Various laboratory studies for prolonged fever were negative except leukopenia and increased sedimentation rates. The CD4/CD8 ratios in acute and recovery stages were 1.1 and 1.5 respectively, showing mild decrease of CD4/CD8 ratio in the acute stage. Decreased T cell proportions in the acute stage were also noted.
Adolescent ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Internal Medicine ; Korea ; Leukopenia ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Lymphocyte Subsets* ; Lymphocytes* ; Male ; Pathology ; Pediatrics ; Prednisolone ; Rare Diseases

The subacute necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a benign, self-limited disorder of unknown cause. This rare disease is characterized by fever, lymphadenopathy, leukopenia, and elevated sedimentation rate. This disease preferentially affects young women. The diagnosis of this disease is confirmed by involved lymphnodes biopsy. Evidence for autoimmune dysfunction has been reported, but is usually lacking. According to the review of the literatures, a total of 192 cases of subacute necrotizing lymphadenitis were reported in Korea since 1983 mostly in literatures of pathology or internal medicine and only 7 cases in pediatrics. There was female predominance in a 141:51 ratio. However, among 25 cases of under 20 years of age, there was male predominance in a 16:9 ratio. The patients of under and over 20 years of age were 29 and 82, respectively among the age-known 111 cases of 192 reported. We experienced a 13-year-old boy, who had right cervical lymphadenitis with persisting high temperature and pain on lymph nodes for more than 10 days. An excisional cervical lymph node biopsy was performed and pathologic diagnosis was compatible with subacute necrotizing lymphadenitis. Most antibiotics were not effective, but fever subsided with one day of oral prednisolone therapy. Various laboratory studies for prolonged fever were negative except leukopenia and increased sedimentation rates. The CD4/CD8 ratios in acute and recovery stages were 1.1 and 1.5 respectively, showing mild decrease of CD4/CD8 ratio in the acute stage. Decreased T cell proportions in the acute stage were also noted.
Adolescent ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Internal Medicine ; Korea ; Leukopenia ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Lymphocyte Subsets* ; Lymphocytes* ; Male ; Pathology ; Pediatrics ; Prednisolone ; Rare Diseases

Fumarase catalyzes the conversion of fumarate to malate in the Krebs cycle. Fumarase deficiency is a rare inborn error of metabolism and is inherited in an autosomal recessive manner. It causes mitochondrial encephalomyopathy. The symptom is characterized by developmental delay and hypotonia. We report here a case of a 32-month-old child who was initially refered because of spastic quadriplegia, delayed development and poor feeding.
Child ; Child, Preschool ; Citric Acid Cycle ; Fumarate Hydratase* ; Humans ; Metabolism ; Mitochondrial Encephalomyopathies ; Muscle Hypotonia ; Muscle Spasticity* ; Quadriplegia*

Purpose: This study aimed to evaluate the cost-effectiveness of treatment with retrograde intrarenal surgery (RIRS) versus repeated shock wave lithotripsy (SWL) in patients with renal calculi. Materials and Methods: The non-retreatment rates (NRRs) and their respective real-world costs for RIRS and SWL were derived through retrospective analysis of health insurance claims data from 2015 to 2017. Decision tree modeling was performed to demonstrate the cost-effectiveness of RIRS. Furthermore, sensitivity analysis was performed to examine the robustness of the results. Results: Analysis of the obtained data showed that NRRs of single SWL ranged from 46% to 56%, whereas NRRs of single RIRS ranged from 75% to 93%. Introducing RIRS early in the treatment sequence was observed to be favorable for the reduction of overall failure (overall NRR, 0.997) compared to the results of repeated SWL (overall NRR, 0.928). The implementation of decision tree modeling revealed that the cost per retreatment-avoided increased with the introduction of RIRS at an earlier time (first line, second line, third line, fourth line: 18640 USD, 10376 USD, 4294 USD, 3377 USD, respectively). Probabilistic modeling also indicated that the introduction of RIRS as the first line of treatment was least likely to be cost-effective, when compared to other options of introducing RIRS as the second, third, or fourth line of treatment. Conclusion Performing RIRS as early as possible

No abstract available.
Cervical Ripening* ; Female ; Pregnancy

PURPOSE: The purpose of this study was to analyze the trend of research on the use of home-based pulmonary rehabilitation. METHOD: Using Medline and CINAHL search engine, experiemental research, titled as 'home-based pulmonary rehabilitation' and 'chronic lung disease', statistics were collected. The total 29 experimental studies published between 1981 to 2000 were selected and analyzed according to the ATS guidelines. RESULT: 1) The study samples in research were mostly of men, whose lung function was moderate to severe. 2) The total period of the intervention program varied from 5 to 12 week. The program included excercise intervention and educational intervention. Psychosocial intervention was minimal. 3) The outcome of the home-based pulmonary rehabilitation had been measured mostly by physical aspects. Quality of life and cost were less frequently measured. 4) In terms of effectiveness of the home based pulmonary rehabilitation program, physiologic outcome, such as lung function and hematologic markers, there was more 'no effect' than 'positive effect', whereas there was more 'positive effect' in decreasing dyspnea, improving excercise capacity, and improving quality of life. CONCLUSION: Based on these findings, future research on home-based pulmonary rehabilitation should be emphasized and provide standardized protocol, including psychosocial intervention, and analyses on cost and quality of life.
Dyspnea ; Home Care Services ; Humans ; Lung ; Male ; Quality of Life ; Rehabilitation* ; Search Engine

PURPOSE: To investigate osseointergration of titanium implants into the tibia of rabbits, which were fed a low calcium diet and irradiated. MATERIALS AND METHODS: To prepare the experimental model, control group was fed a normal diet and experimental group was fed a low calcium diet for 4 weeks. And then, titanium implants were inserted into the tibia of each rabbit. Experimental group was subdivided into two groups; low calcium diet/non-irradiation group and low calcium diet/irradiation group. The low calcium diet/irradiation group was irradiated with a single absorbed dose of 15 Gy at the 5th postoperative days. On the 12th, 19th, 33rd, 47th, and 61st days after implantation(1, 2, 4, 6, and 8 weeks after irradiation), the bone formation in the bone-implant interface area was examined by light microscopy and fluorescent microscopy. RESULTS AND CONCLUSIONS: 1. In the control group, there began to form woven bone in the bone-implant interface area on the 12th days after implantation. As the experimental time was going on, the amount of bone which was in contact with the implant was increased. 2. In the low calcium diet/non-irradiation group, there began to form woven bone in the bone-implant interface area on the 19th days after implantation. Although the amount of bone which was in contact with the implant was increased as the experimental time was going on, the extent of increased bone was slightly weak as compared with control group. 3. In the low calcium diet/irradiation group, there began to form woven bone incompletely in the bone-implant interface area on the 19th days after implantation, but there were vascular connective tissues in the bone- implant interface area over the entire experimental period. 4. In the control group and low calcium diet/non-irradiation group, bone labeling bands were observed on the 33rd days after implantation, which suggests that the bone formation and remodeling was in process, but interstitial bone remodeling was not observed in the low calcium diet/irradiation group.
Bone Remodeling ; Calcium* ; Connective Tissue ; Diet* ; Microscopy ; Models, Theoretical ; Osseointegration* ; Osteogenesis ; Osteoporosis ; Rabbits ; Tibia ; Titanium