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

Isovaleric acidemia is an inborn error in metabolism due to a defect in isovaleryl-CoA dehydrogenase. Accumulation of serum isovaleric acid causes poor feeding, vomiting, lethargy, hypothermia, convulsion, mental retardation, etc. It is inherited as an autosomal recessive trait. Since the first reports of isovaleric acidemia by Tanaka et al in 1966, more than 60 cases have been reported. There are two clinically different presentations of isovaleric acidemia, with about half the patients presenting with an acute severe neonatal form and about half with a chronic intermittent forrn. The difference in clinical presentation may not be a consequence of differing severities of the causative mutation, but a result of the timing of application of catabolic stress or the ability to form isovalerylglycine. We described here clinical and organic acid analytical findings of brothers with chronic intermittent form of isovaleric acidemia. (J Korean Pediatr Soc 2000;43:828-831)
Humans ; Hypothermia ; Intellectual Disability ; Isovaleryl-CoA Dehydrogenase ; Lethargy ; Metabolism ; Seizures ; Siblings* ; Vomiting

Bleoxycin is known to have good therapeutic effect on verrucae, which has been used for varioua malignant turnors for its antimitatic effect RecentIy Kim & Kim, reported an exceIIent treatment method. of verrucae with Bleomycin using needle free. They poetulated that the excellent effcts were achievei thraugh infiltration of the ekin, in.cluding the affected epidermis, with Bleomycin which is not possible with other rnethods, It is therefore interesting to know the effects of Dermajet instilled Bleomycin an normal ekin. We selected guinea pigs for thia experirnent. Five albino guixim pigs, weighting about 500 Gm, were ueed. Bleomycin water ohxtion, 0.25mg/ml, 0.06ml for each chet was injected utilizing Dermojet on the back of a guinea pig after clipping. The injected sites and the contralateral sites were tiopsied a,fter vaxying length of time and histologia examinationa were made. The experiment was eoarranged that the biopsies for different experiment aitea celd be done on oxeittirnig. Fix hours after the bleomycin injection, the epidermis becase shrunk and t@4e upper dermie showed aligbt inflammatory infiltration. After 10 hours. and also after 24 houra, a auperficial ulceration and necrosis were noted and the dermal infiltration became progressively severer. After 2 days epithelization, had started and. the necrotic debris began to drop off. After 4 daya the epithelization was camplete. These findings were in sorne part similar to the findings observed in humans by Kirn and Kim in the treatment af verruca but th time sequenc was far faster in guinea pigs.
Animals ; Biopsy ; Bleomycin* ; Epidermis ; Guinea Pigs* ; Guinea* ; Humans ; Necrosis ; Needles ; Skin* ; Swine ; Ulcer ; Warts ; Water

The association of colonic atresia in patients with Down syndrome is a rare anomaly. The incidence of congenital atresia of the gastrointestinal tract has been estimated to be about one in 1500 births. Colonic atresia is rarer still, and is throut to comprise about 5% to 10% of this group. This intestinal atresia occurs in about 30% to 50% of patient with Down syndrome. We experienced a case of Down syndrome associated with colonic atresia in a 1 day old male. His initial chief complaints at the admission were severe abdominal distension and Down appearance. Diagnosis was confirmed by chromosomal study and operative laparotomy with end-to-end ileodescending colostomy. We report the case with brief review of related literatures.
Colon* ; Colostomy ; Diagnosis ; Down Syndrome* ; Gastrointestinal Tract ; Humans ; Incidence ; Intestinal Atresia ; Laparotomy ; Male ; Parturition

No abstract available.
Humans ; Twins*

We report two cases of recurrent BCC in a 51- year-old woman and a 39-year-old woman which had been misdiagnosed aind treated as pigrnented nevi. Complete surgical resections were done followed by reconstruction using local rhombic transposition flaps. Final cosmetic results were excellent and no local recurrence was noticed during one year follow-up.
Adult ; Carcinoma, Basal Cell* ; Female ; Follow-Up Studies ; Humans ; Nevus ; Recurrence

Developmental venous anomalies are congenital anomalies of the intracranial venous drainage and clinically asymptomatic. Cavernous hemangiomas are vascular malformations composed of dilated vascular channels lined with a single layer of endothelial cells without any intervening normal neural tissue. Although, cavernous hemangioma may be clinically silent, but frequently cause variable neurologic manifestations; intracranial hemorrhage, seizures, and focal neurologic deficits. Frequent association of these two diseases has already been reported and it has been suggested that cavernous hemangiomas not the developmental venous anomalies that cause the acute clinical symptoms. A 4 year old girl with sudden onset of headache, vomiting, gait disturbance and signs of unilateral cerebellar dysfunction 2 days before admission showed a 2.5x2.5cm sized hematoma with heterogenous signal intensity both in CT and MRI in the left cerebellar hemisphere. Four-vessel cerebral angiography revealed characteristic findings of developmental venous anomalies. Pathologic findings of the surgically removed hematoma disclosed typical feature of cavernous hemangioma. Based on the findings in this case and review of the literatures, we concluded that the possibility of other diseases such as cavernous hemangiomas must be considered in patients who has intracranial hemorrhage due to the developmental venous anomalies.
Cerebellar Diseases ; Cerebral Angiography ; Child, Preschool ; Drainage ; Endothelial Cells ; Female ; Gait ; Headache ; Hemangioma, Cavernous* ; Hematoma ; Hemorrhage* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Seizures ; Vascular Malformations ; Vomiting

Authors retrospectively analyzed ultrasonographic findings of 12 cases of breast carcinomas which were proven pathologically at Yeungnam University Hospital from March 1992 to August 1992. Classically, breast carcinomas were described as irregular and lobulated hypoechoic solid masses with inhomogeneous internal echoes and frequent attenuation of the sound beam. And other additional ultrasonographic findings were echogenic rim, disruptions of superficial layer, microcalcification, skin thickening and so on. In our studies, not all of these findings of breast carcinomas were found in each case, but most of these findings were noted. However, several studies have demonstrated considerable overlap in the ultrasonographic appearance of benign lesions and carcinoma. Thus, accurate sonographic determination of the type of solid mass is not possible with current ultrasonographic imaging techniques and criteria. For more accurate diagnosis of breast lesions, sonographic and other imaging techniques are interpreted together.
Breast Neoplasms* ; Breast* ; Diagnosis ; Retrospective Studies ; Skin ; Ultrasonography

STUDY DESIGN: A retrospective study was made of patients undergoing posterolateral fusion of the lumbar spine. OBJECTIVES: To compare the clinical outcomes of the patients who underwent posterolateral fusion of the lumbar spine with commercially available allogeneic bone graft with those patients in a similar consecutive control group who underwent posterolateral fusion of the lumbar spine with autogenic bone graft and to determine whether the commercially available allogeneic bone is useful for postero-lateral fusion of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Major differences exist in the ability of an allogeneic bone graft to regenerate a viable cellular network as compared to an autogenic bone graft. This is related to the immunologic response of the host to the foreign bone. The fusion rate of deep freezing allogeneic bone graft was reported as 80-100%. MATERIALS AND METHODS: Seventy-nine patients with spondylolisthesis treated with decompression, fixation with pedicle screws and posterolateral fusion were retrospectively reviewed. Nineteen patients (group 1) were treated with commercially available allogeneic bone (Tutoplast) graft mixed with autogenic bone and the remaining 60 patients (group 2) were treated with autogenic bone graft. Operating time, amount of transfusion, duration of hospital stay, symptom improvement, fusion rate, duration of fusion, and complications were studied. RESULTS: There were no significant differences between the two groups in terms of duration of hospital stay, amount of transfusion, symptom improvement, and complications . However, there were significant differences between the allogeneic and autogenic groups in terms of operating time (212.3 versus 230.9 minutes), fusion rate (36.8% versus 98.3%), and duration of fusion (10.2 versus 6.4 months), respectively. CONCLUSIONS: Commercially available allogeneic bone is less useful for posterolateral fusion of the lumbar spine.
Decompression ; Freezing ; Humans ; Length of Stay ; Retrospective Studies ; Spine* ; Spondylolisthesis ; Transplants

We report a case of cutaneous T-cell lymphoma in a 40-year-old man. He has suffered from generalized pruritus for 10 years. Seven months ago, multiple nodules developed over the scalp, face, and thigh. The physical examination showed thickened dystrophic twenty nails with brownish discoloration and lichenified, eczematoid lesions over the trunk and extremities. The skin biopsy revealed diffuse, extensive infiltrates of atypical lymphoid cells in the dermis, which appeared as T lymphocytes by immuno-histochemistry; approximately 90% of the tumor cells were CD3-positive, 80% were CD4-positive, and 60% CD45RO-positive. Laboratory analyses in the peripheral bload showed 18% atypical lymphocytes (Sezary cell), an elevated LDH(746 U/liter), and abnormal lymphocyte subset proportions(ratio of Th/Ts is 4.08). A bone marrow puncture revealed the infiltrations of lymphoid cells and computed tamo-graphy showed no evidence of other organ involvement except the swelling of bilateral inguinal lymph nodes. Spontaneous partial regression of the tumors ensued on the way of oral antihistamines and topical corticosteroids for the relief of the pruritus. The tumorous skin lesions and onychodystrophy disappeared completely with 6 cycles of systemic chemotherapy of CHOP(cyclophosphamide, doxoru-bicin, vincristine, and prednisone).
Adrenal Cortex Hormones ; Adult ; Biopsy ; Bone Marrow ; Dermis ; Drug Therapy ; Extremities ; Histamine Antagonists ; Humans ; Lymph Nodes ; Lymphocyte Subsets ; Lymphocytes ; Lymphoma, T-Cell, Cutaneous* ; Physical Examination ; Pruritus ; Punctures ; Scalp ; Skin ; T-Lymphocytes ; Thigh ; Vincristine