Solid pseudopapillary tumors of the pancreas are rare and typically occur in young women. Compared with pancreatic adenocarcinoma, solid pseudopapillary tumors are characterized by notable indolent biological behavior associated with a favorable prognosis. Despite their large size, these tumors rarely metastasize. Even in cases of hepatic metastasis, most lesions are usually solitary in distribution and are amenable to resection. We report a case of a 55-year-old man with a small solid pseudopapillary tumor (≤3-cm diameter) mimicking a pancreatic adenocarcinoma, with multiple hepatic metastases. The diagnosis was confirmed by endoscopic ultrasound-guided fine-needle biopsy using a 22-G core needle. Unfortunately, rapid tumor progression led to patient mortality 5 months after diagnosis. To our knowledge, this is the first case report that describes a small solid pseudopapillary tumor of the pancreas with multiple hepatic metastasis and poor prognosis in a patient who was diagnosed with this condition at the time of initial diagnosis.

OBJECTIVES: To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid. METHODS: The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months. RESULTS: Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication. CONCLUSIONS: With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.
Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Hypothyroidism* ; Lithium* ; Mood Disorders ; Risk Factors ; Sample Size ; Seoul ; Thyroid Gland ; Thyrotropin ; Valproic Acid*

Rhynchophylline (RP) is a major tetracyclic oxindole alkaloid of Uncariae Ramulus et Uncus which has been used to treat hypertension, seizures, pain and anxiety in the oriental countries. A recent report revealed that RP attenuated ischemia-induced neuronal damage and kainite-induced convulsions in animals. This study was performed to investigate whether RP enhances pentobarbital-induced sleep behaviors and modulates sleep architecture in mice. Locomotor activity was significantly inhibited by RP at 0.25 and 0.5 mg/kg, similar to 2 mg/kg diazepam (a benzodiazepine agonist) in mice. RP shortened sleep latency and increased total sleep time in a dose-dependent manner when administrated with pentobarbital (42 mg/kg, i.p.). RP also increased the number of sleeping mice and total sleep time by concomitant administration with the sub-hypnotic dosage of pentobarbital (28mg/kg, i.p.). On the other hand, RP (0.25mg/kg, p.o.) itself significantly inhibited sleep-wake cycles, prolonged total sleep time, and rapid eye movement in rats. In addition, RP also increased chloride influx in the primary cultured hypothalamic neuronal cells. In addition, we found that glutamic acid decarboxylase (GAD(65/67)) was activated by RP. In conclusion, RP augments pentobarbital-induced sleeping behaviors, and can be a candidate for treating insomnia.
Animals ; Anxiety ; Benzodiazepines ; Diazepam ; Electroencephalography ; Glutamate Decarboxylase ; Hand ; Hypertension ; Mice ; Motor Activity ; Neurons ; Pentobarbital ; Rats ; Rodentia* ; Seizures ; Sleep Initiation and Maintenance Disorders ; Sleep, REM* ; Uncaria*

No abstract available.
Adult ; Biopsy ; *Brunner Glands/pathology/surgery ; Duodenal Diseases/*complications/diagnosis/surgery ; Duodenal Obstruction/diagnosis/*etiology/surgery ; Duodenoscopy ; Gastric Outlet Obstruction/diagnosis/*etiology/surgery ; Hamartoma/*complications/diagnosis/surgery ; Humans ; Male ; Tomography, X-Ray Computed ; Treatment Outcome

Sinomenium acutum has been long used in the preparations of traditional medicine in Japan, China and Korea for the treatment of various disorders including rheumatism, fever, pulmonary diseases and mood disorders. Recently, it was reported that Sinomenium acutum, has sedative and anxiolytic effects mediated by GABA-ergic systems. These experiments were performed to investigate whether sinomenine (SIN), an alkaloid derived from Sinomenium acutum enhances pentobarbital-induced sleep via γ-aminobutyric acid (GABA)-ergic systems, and modulates sleep architecture in mice. Oral administration of SIN (40 mg/kg) markedly reduced spontaneous locomotor activity, similar to diazepam (a benzodiazepine agonist) in mice. SIN shortened sleep latency, and increased total sleep time in a dose-dependent manner when co-administrated with pentobarbital (42 mg/kg, i.p.). SIN also increased the number of sleeping mice and total sleep time by concomitant administration with the sub-hypnotic dosage of pentobarbital (28 mg/kg, i.p.). SIN reduced the number of sleep-wake cycles, and increased total sleep time and non-rapid eye movement (NREM) sleep. In addition, SIN also increased chloride influx in the primary cultured hypothalamic neuronal cells. Furthermore, protein overexpression of glutamic acid decarboxylase (GAD(65/67)) and GABA(A) receptor subunits by western blot were found, being activated by SIN. In conclusion, SIN augments pentobarbital-induced sleeping behaviors through GABA(A)-ergic systems, and increased NREM sleep. It could be a candidate for the treatment of insomnia.
Administration, Oral ; Animals ; Anti-Anxiety Agents ; Benzodiazepines ; Blotting, Western ; China ; Diazepam ; Eye Movements* ; Fever ; Glutamate Decarboxylase ; Japan ; Korea ; Lung Diseases ; Medicine, Traditional ; Mice ; Mood Disorders ; Motor Activity ; Neurons ; Pentobarbital ; Receptors, GABA-A ; Rheumatic Diseases ; Rodentia* ; Sinomenium* ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. METHODS: We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. RESULTS: PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6+/-2.9 and 5.4+/-6.4 in the unresected PARS group, 5.8+/-2.1 and 11.3+/-7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. CONCLUSION: The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.
Arthrodesis ; Body Mass Index ; Humans ; Neurologic Manifestations ; Spine

OBJECTIVE: 1) To compare prolactin responses to (and related clinical manifestations of) haloperidol, risperidone, and other atypical antipsychotics (clozapine, olanzapine, quetiapine, zotepine) with data from previous reports. 2) To investigate the association between changes in serum prolactin levels after the administration of antipsychotics and 44-bp insertion/deletion polymorphism in 5-HT transporter-linked polymorphic region (5-HTTLPR) in Korean schizophrenics. METHODS: The subjects were 136 patients diagnosed schizophrenic according to the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 3 months. The 136 patients consisted of the following 82 taking haloperidol (48 males and 34 females), 25 taking risperidone (14 males and 11 females), and 29 taking other atypical antipsychotics (18 males and 11 females). We measured serum prolactin concentrations by radioimmunoassay and investigated the clinical manifestations. We examined the genotype distribution and allele frequency of the 5-HTTLPR in all subjects by polymerase chain reaction of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Chi-square test, ANOVA and tukey test were used for statistical analysis with SAS 8.1 and p values of 0.05 or less were regarded as significant difference. RESULTS: Serum prolactin levels of patients taking haloperidol and risperidone were significantly higher than those taking other atypical antipsychotics (p<0.05). Females showed significantly higher prolactin levels than males (p<0.05). There was no significant difference in the genotype distribution and allele frequency of 5-HTTLPR among groups taking haloperidol, risperidone, and other atypicals. There was also no significant difference in genotype distribution and allele frequency of 5-HTTLPR between male and female schizophrenic patients. CONCLUSIONS: These results suggest that there was no association between serum prolactin levels after the administration of antipsychotics and 5-HTTLPR polymorphism in Korean schizophrenics.
Antipsychotic Agents* ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Female ; Gene Frequency ; Genotype ; Haloperidol ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Prolactin* ; Promoter Regions, Genetic ; Radioimmunoassay ; Risperidone ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins ; Serotonin*

OBJECTIVE: There were many instruments introduced for direct repair of spondylolysis. But those instruments were not designed for direct repair of spondylolysis originally. Dynesys implants consist of pedicle screws and cords or laminar hooks that were designed for lumbar dynamic stabilization. We used pedicle screws and cord or laminar hook of Dynesys spinal system for repairment of spondylolysis. METHODS: July 2005 to March 2009, Six patients with lumbar spondylolysis were treated with a new technique using a pedicle screw with a u-shaped rod or laminar hook combined with bone grafting of the transverse process and lamina of the same level, bypassing the spondylolytic defect. There were 5 males and 1 female. Ages ranged from 18-48 years(average of 34.5 years). A total of 8 vertebral levels were fused(one patient had spondylolytic defects at 3 levels). Five defects were at L5, two at L4, and one at L3. The patients had low back pain that was unimproved after 3-6 months of conservative management. None demonstrated spondylolisthesis or instability, disc degeneration on MRI, nor radiculopathy. All symptoms resolved after isthmus block. The patients were followed-up for a period of 3-27 months(average of 14.8 months). The authors compared pre-operative and post-operative clinical symptoms and radiographic findings retrospectively. Success of the procedure was determined by the following criteria: impro- vement of clinical symptoms(VAS score), absence of isthmic motion on plain radiographs, and evaluation for the presence of a bone mass bridging the transverse processes and laminae using plain radiographs and reconstruction CT scan. RESULTS: All patients demonstrated improvement in pain scores(average of 8.3 to an average of 3.2). A fusion rate of 87.5% was achieved(7 out 8 levels). No complications were noted. The authors were able to demonstrate a potential benefit in using this new technique for the treatment of lumbar spondylolysis. CONCLUSION: Direct repair of spondylolysis with Dynesys spinal system is technically easy and fixes strongly biome- chanically.
Bone Transplantation ; Female ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Male ; Radiculopathy ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis

OBJECTIVE: Using alendronate after spinal fusion is a controversial issue due to the inhibition of osteoclast mediated bone resorption. In addition, there are an increasing number of reports that the endplate degeneration influences the lumbar spinal fusion. The object of this retrospective controlled study was to evaluate how the endplate degeneration and the bisphosphonate medication influence the spinal fusion through radiographic evaluation. METHODS: In this study, 44 patients who underwent single-level posterior lumbar interbody fusion (PLIF) using cage were examined from April 2007 to March 2009. All patients had been diagnosed as osteoporosis and would be recommended for alendronate medication. Endplate degeneration is categorized by the Modic changes. The solid fusion is defined if there was bridging bone between the vertebral bodies, either within or external to the cage on the plain X-ray and if there is less than 5degrees of angular difference in dynamic X-ray. RESULTS: In alendronate group, fusion was achieved in 66.7% compared to 73.9% in control group (no medication). Alendronate did not influence the fusion rate of PLIF. However, there was the statistical difference of fusion rate between the endplate degeneration group and the group without endplate degeneration. A total of 52.4% of fusion rate was seen in the endplate degeneration group compared to 91.3% in the group without endplate degeneration. The endplate degeneration suppresses the fusion process of PLIF. CONCLUSION: Alendronate does not influence the fusion process in osteoporotic patients. The endplate degeneration decreases the fusion rate.
Alendronate* ; Bone Resorption ; Humans ; Lumbar Vertebrae ; Osteoclasts ; Osteoporosis ; Retrospective Studies ; Spinal Fusion