Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well know through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.
Antipsychotic Agents* ; Benzodiazepines ; Bone Marrow ; Carbamazepine ; Clozapine ; Cytochrome P-450 Enzyme System ; Cytochromes ; Delirium ; Drug Interactions* ; Fluoxetine ; Fluvoxamine ; Half-Life ; Humans ; Isoenzymes ; Metabolism ; Parents ; Paroxetine ; Respiratory Insufficiency ; Risperidone ; Schizophrenia ; Smoke ; Smoking

We attempted to identify parasite DNA in the biliary stones of humans via PCR and DNA sequencing. Genomic DNA was isolated from each of 15 common bile duct (CBD) stones and 5 gallbladder (GB) stones. The patients who had the CBD stones suffered from cholangitis, and the patients with GB stones showed acute cholecystitis, respectively. The 28S and 18S rDNA genes were amplified successfully from 3 and/or 1 common bile duct stone samples, and then cloned and sequenced. The 28S and 18S rDNA sequences were highly conserved among isolates. Identity of the obtained 28S D1 rDNA with that of Clonorchis sinensis was higher than 97.6%, and identity of the 18S rDNA with that of other Ascarididae was 97.9%. Almost no intra-specific variations were detected in the 28S and 18S rDNA with the exception of a few nucleotide variations, i.e., substitution and deletion. These findings suggest that C. sinensis and Ascaris lumbricoides may be related with the biliary stone formation and development.
Aged ; Aged, 80 and over ; Animals ; Ascaridida/genetics/isolation & purification ; Ascaris lumbricoides/genetics/isolation & purification ; Base Sequence ; Clonorchis sinensis/genetics/isolation & purification ; Common Bile Duct/*parasitology ; DNA, Helminth/*genetics ; DNA, Ribosomal/genetics ; Face/parasitology ; Female ; Gallbladder/parasitology ; Gallstones/*parasitology ; Helminths/genetics/*isolation & purification ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Polymerase Chain Reaction/*methods ; RNA, Ribosomal, 18S/genetics ; RNA, Ribosomal, 28S/genetics ; Sequence Alignment

A l3-year-old boy was admitted to our hospital with severe hypertension, visual blurring, excessive sweating, polyuria and polydipsia. On admission, the blood pressure was persistently elevated at 230/180 mmHg. and an ophthalmologist was consulted, the funduscopic examination showed bilateral grade IV retinopathy. Cardiomegaly with dyspneic on exertion and persistent tachycardia were present. In urine examinations, proteinuria was sustained and glycosuria was traced. B. U. N. was 9.4 mg/dl. Urinary catecholamine was 12480 mic.g./day ; urinary V. M. A. was 20.2 mg./day. Regitine test was positive but histamine test was not performed. Presacral air insufflation with nephrotomography showed egg sized soft tissue mass locating at just above the upper pole of left kidney. He was operated with transabdominal approach. There were bilateral pheochromocytomas on suprarenal areas. Two weeks after operation, he was discharged with good general condition and we report this case with review of literatures.
Blood Pressure ; Cardiomegaly ; Glycosuria ; Histamine ; Humans ; Hypertension ; Insufflation ; Kidney ; Male ; Ovum ; Phentolamine ; Pheochromocytoma* ; Polydipsia ; Polyuria ; Proteinuria ; Sweat ; Sweating ; Tachycardia

No abstract available.
Empyema, Subdural* ; Haemophilus influenzae* ; Haemophilus* ; Meningitis*

Pulmonary embolism is a common clinical problem in patients with immobilization, cancer, indwelling central venous catheter and surgery. However, although rare, it may occur in patients with inherited thrombophilia. Protein S deficiency is known to increase the risk of venous thrombosis and pulmonary embolism. There are many reports of venous thrombosis with protein S deficiency, but there are few reports of arterial thrombosis, especially recurrent acute pulmonary embolism. Here, we report a case of recurrent pulmonary embolism associated with type II protein S deficiency.
Blood Coagulation Disorders, Inherited ; Central Venous Catheters ; Humans ; Immobilization ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.
Catheterization ; Catheters ; Compliance ; Deceleration ; Echocardiography ; Echocardiography, Doppler ; Exercise Tolerance ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Multivariate Analysis ; Tricuspid Valve Insufficiency

Treacher Collins syndrome is inherited as an autosomal dominant trait with variable penetrance. It shows a marked variability even in the same family. This syndrome is developmental defect affecting the branchial arches. It is not usually associated with acute respiratory distress, but has symptoms of microtia, hypoplastic zygomatic bones, hypoplastic mandibular rami, and bilateral coloboma. It usually requires an emergency operation immediately after the birth. We experienced an infant with Treacher Collins syndrome who showed retrognathia, glossoptosis, microtia, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty associated with airway obstruction, and swallowing difficulty were also observed. To relieve severe upper airway obstruction caused by retrognathia and glossoptosis, we simultaneously performed tongue-lip adhesion and subperiosteal release of the floor of the mouth. The respiratory and swallowing difficulties were relieved and the tongue repositioned anteriorly. We report the present case with a review of the literature.
Airway Obstruction* ; Branchial Region ; Cleft Palate ; Coloboma ; Cyanosis ; Deglutition ; Depression ; Emergencies ; Humans ; Infant* ; Mandibulofacial Dysostosis* ; Mouth ; Parturition ; Penetrance ; Retrognathia ; Thorax ; Tongue

Primary malignant melanoma of tbe esophagus is extremely rare and its incidence is below 0.1%. The tumor is polypoid and tend to be large, which is covered with false membrane, friable, hemorrhagic, and necrotic. Hematogenous and lymphogenic metastasis are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, and postoperative irradiation may be useful. But, despite these measures, prognosis is poor, with a 5-year survival of 4.2%. We report a case of 58-year-old man with primary malig- nant melanoma of the epophagus, and review of the literature in presented related studies.
Esophagus* ; Humans ; Incidence ; Intestines* ; Melanoma* ; Membranes ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Stomach*

PURPOSE: To evaluate the significance of thrombophilic factors in retinal vein occlusive diseases. METHODS: Thirty-two patients with retinal vein occlusion (19 patients at the age of 55 or less, 13 patients at the age of 56 or more) underwent laboratory evaluation for CBC, lipid profile, VDRL/TPHA, homocysteine, protein C activity, protein S activity, lipoprotein (a), platelet aggregation test, Factor V Leiden, lupus anticoagulant, anticardiolipin antibody, fibrinogen, and antithrombin III. RESULTS: The abnormal laboratory findings (high homocysteine, hyperlipidemia, thrombocytosis, lipoprotein (a), high ESR, and decreased protein S activity) were found more often in patients of 55 years or less than those of 56 or more. CONCLUSIONS: The thrombophilic factors were more common positive findings at or less than 55 years. Thrombophilic factor tests are recommended in young patients with retinal vein occlusion.
Antibodies, Anticardiolipin ; Antithrombin III ; Factor V ; Fibrinogen ; Homocysteine ; Humans ; Hyperlipidemias ; Lipoprotein(a) ; Lupus Coagulation Inhibitor ; Platelet Aggregation ; Protein C ; Protein S ; Retinal Vein Occlusion ; Retinal Vein* ; Retinaldehyde* ; Thrombocytosis

PURPOSE: To evaluate the effects of transpupillary thermotherapy(TTT) for several intraocular tumor. METHODS: The 5 intraocular tumors (2 capillary hemangioma, 1 metastatic tumor, 1 retinal angioma, 1 melanocytoma) were treated with transpupillary thermotherapy. We compared preoperative visual acuity, size, fundus finding, ultrasonogram to postoperative data. RESULTS: The one capillary hemangioma and metastatic tumor were improved in fundus finding. The other tumors were not improved. The visual acuity of patient with metastatic tumor was improved from F.C/30cm to 0.15. CONCLUSIONS: Transpupillary thermotherapy was effective tool for intraocular tumors. We may need the guideline for treatment of intraocular tumor by using transpupillary thermotherapy.
Hemangioma ; Hemangioma, Capillary ; Humans ; Hyperthermia, Induced* ; Retinaldehyde ; Ultrasonography ; Visual Acuity