Fundamental difficulties in psychiatric nosology lie in the most basic fact that it deals with subjective states of the human mind. Modern instrumental diagnostic classification systems, which amount to lists of symptom inventories, could not provide accurate concepts of psychiatric disorders. This is also true for schizophrenia, a representative mental disorder. Kraepelin's dementia praecox was a collection of controversially proposed diseases, which had some critical similarities in their clinical features, i.e., the course and outcome. Despite initial debates on the adequacy of this concept, dementia praecox was recognized as a disease entity quite early, so that the concept of dementia praecox or schizophrenia proliferated, became diversified, and was then altered. We can now find large discrepancies between Kraepelin's dementia praecox and today's schizophrenia. However, the myth of disease entity was seldom challenged and psychiatrists today implicitly believe that they are dealing with what Kraepelin had proposed. In order to navigate this impasse, we thought that historical studies on the concept of dementia praecox and underlying taxonomic principles established by 19th century alienists including Kraepelin would shed some light. The aim of this article is to comprehensively review the history of concepts of dementia praecox or schizophrenia, and to question critically how much today's schizophrenia has received the conceptual inheritance from original concepts. Through this process, we expect to attain a renewed understanding of schizophrenia.
Classification ; Equipment and Supplies ; Humans ; Mental Disorders ; Psychiatry ; Schizophrenia* ; Wills

No abstract available.

Endocrine adrenal tumors are uncommon but clinically significant because they can be managed successfully by surgical therapy. During pregnancy, adrenal tumors can be a cause of death for both mother and baby, unless they diagnoses antenatally and managed properly. To investigate clinical characteristics of endocrine adrenal tumors, we analyzed 26 cases of adrenal tumor diagnosed and managed in Chung Ang Gil Hospital including cases associated with pregnancy and also a rare case of paraganglioma in liver. 1) There were 7 cases of Cushing's syndrome among which two cases were due to Cushing's disease and five cases were due to adrenal adenoma. Six cases were managed successfully by appropriate surgery. Another one case was associated with pregnancy but the patient expired due to sudden development of pulmonary edema and hypotension during preoperative preparation.2) Among 9 cases of primary aldosteronism, 8 cases were aldosterone-producing adenoma(APA) and 1 case was idiopathic hyperaldosteronism(IHA). In differential diagnosis between APA and IHA, diagnostic accuracy of postural study and adrenal CT was 86%, 78% respectively. In each one case of APA and IHA, adrenal venous aldosterone sampling was used for the differential diagnosis. Six cases of APA were managed by appropriate surgery. One patient with APA who refuses surgery and one patient with IHA were placed on spironolactone with good response.3) Among 10 cases of pheochromocytoma, seven cases were from adrenal gland and three cases were paragangliomas including one case originating from liver and two cases from abdominal ganglia. One patient with pheochromocytoma was diagnosed in 1st trimester of pregnancy and she was successfully treated by surgery.We observed 26 cases of endocrine adrenal tumors which were successfully managed except one case. We think that it is important to pay attention to adrenal tumor for early diagnosis particulary when associated with pregnancy. Paraganglioma in liver, although very rare, should be included in the differential diagnosis of space occupying lesion in liver.
Adenoma ; Adrenal Glands ; Aldosterone ; Cause of Death ; Cushing Syndrome ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Ganglia ; Humans ; Hyperaldosteronism ; Hypotension ; Liver ; Mothers ; Paraganglioma ; Pheochromocytoma ; Pregnancy ; Pulmonary Edema ; Spironolactone

PURPOSE: This study was performed to investigate the growth pattern of the retinal vessel including retinal vascular endothelial cell and pericyte. METHODS: The sensory retina was detached from the eyecup obtained from donor's eye. The retinal vessel which was separated from the sensory retina was cultured in tissue culture media for 2, 3 and 4 weeks separately and examined by transmission electron microscopy. RESULTS: On the second week of tissue culture, both the retinal vascular endothelial cells and pericyte were intact in morphology in nuclear and cytoplasmic pattern. Both cells were partially detached from the surrounding basement membrane. On the third week of tissue culture, the cytoplasm of the retinal vascular endothelial cells and pericyte were degenerated, whereas the vascular endothelial cell were intact in nuclear and cytoplasmic profiles which were still partially surrounded by the basement membrane. CONCLUSIONS: These findings suggest that the survivability of the retinal vascular endothelial cells and pericyte may be limited for 2 and 3 weeks, separatedly under the ordinary culture medium.
Basement Membrane ; Culture Media ; Cytoplasm ; Endothelial Cells ; Microscopy, Electron, Transmission ; Pericytes ; Retina ; Retinal Vessels* ; Retinaldehyde*

PURPOSE: The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS: A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS: During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION: Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.
Abdominal Pain ; Appendicitis ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Secondary Care Centers* ; Tomography, X-Ray Computed*

No Abstract Available.
Head* ; Osteonecrosis* ; Rabbits*

BACKGROUND/AIMS: The diagnosis and prognosis of malignant pheochromocytoma are important. Other than distant metastasis, the pathology is insufficient to diagnose malignant versus benign pheochromocytoma. METHODS: We analyzed 33 pheochromocytoma cases using the histological grade on the Thompson and Kimura scales. We compared the Thompson and Kimura scores with the degree of immunohistochemical staining for Ki-67 and heat shock protein 90 (Hsp90). RESULTS: The most frequent symptom was hypertension (17 cases; 51.5%) and four patients had accompanying tumors: one case each of multiple endocrine neoplasm, papillary carcinoma of the thyroid, gastric adenocarcinoma, and neurofibroma. The mean Thompson score was 3.67 in benign pheochromocytoma and 10 in malignant pheochromocytoma, and the Kimura score was 2.17 and 5, respectively. The average immunohistochemical staining for Ki-67 was 5.77 and 10.44 in benign and malignant pheochromocytoma, respectively, while Hsp90 immunohistochemical staining was positive only in the cytoplasm of malignant pheochromocytoma. CONCLUSIONS: Immunohistochemical staining for Ki-67 and Hsp90 was seen in malignant pheochromocytoma. The Thompson and Kimura scales and immunohistochemical results could help to differentiate benign and malignant pheochromocytoma.
Adenocarcinoma ; Adrenal Glands ; Carcinoma, Papillary ; Cytoplasm ; Heat-Shock Proteins ; Humans ; Hypertension ; Ki-67 Antigen ; Neoplasm Metastasis ; Neurofibroma ; Pheochromocytoma ; Prognosis ; Thyroid Gland ; Weights and Measures

A 21-year-old phenotypic female with 46,XY genotype presented with primary amenorrhea, headache, absence of secondary sex characteristics, and hypertension.Further evaluation confirmed male pseudohermaphroditism having no nterus and adnexase.After basic hormonal study and ACTH stimulation test, we concluded 17alpha-hydroxylase deficiency. Owing to the high risk of gonadal neoplasia in XY gonadal streaks, prophylactic removal of the steaks is recommended. Traditionally this procedure has been performed by laparotomy, but in this case laparoscopic gonadctomy was performed. Following treatment with hydrocrtisone, potassium, progesterone, 11-deoxycorticosterone, corticosterone and urinay pregnanediol levels were normalized. normal blood pressure measurements were achieved during treatment with hydrocortisone and estrogen with the patient. We report this case with a breif review of the literatures.
46, XY Disorders of Sex Development* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Amenorrhea ; Blood Pressure ; Corticosterone ; Estrogens ; Female ; Genotype ; Gonads ; Headache ; Humans ; Hydrocortisone ; Laparotomy ; Male* ; Potassium ; Pregnanediol ; Progesterone ; Sex Characteristics ; Young Adult

Hemangiopericytoma is a rare vascular tumor that usually occurs in adults. The tumor is believed to originate from pericytes that are closely related to the capillary walls. Congenital hemangiopericytoma is a more rare disease that occurs in approximately 0.03% of all heamngiopericytomas. Herein, we describe a 1-month-old male newborn with huge congenital hemangiopericytoma in the retroperitoneum that exhibited a typical morphological vascular pattern.
Adult ; Capillaries ; Hemangiopericytoma ; Humans ; Infant, Newborn ; Male ; Pericytes ; Rare Diseases

BACKGROUND: To assess the current level of development of emergency medicine (EM) systems in Asia. METHOD: Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. RESULTS: 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. CONCLUSION: Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.
Asia ; Asian Continental Ancestry Group* ; Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Financial Management ; Humans ; Internship and Residency ; Intubation ; Patient Care ; Patient Transfer ; Peer Review ; Triage ; Ultrasonography