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*

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

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*

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*

PURPOSE: To estimate the age and spherical equivalent related changes in the wavefront aberrations. METHODS: The age related difference in the wavefront aberrations were measured using a WASCA aberrometer on 63 eyes from 38 persons ranging in age from 18 to 60 years with a mean spherical equivalent of -0.55 diopter. The total RMS (root mean square), the high order RMS, coma and spherical aberration were analyzed and compared according to age(second, third, fourth, fifth and sixth decade). The spherical equivalent related difference in the wavefront aberrations were also measured on 118 eyes from 62 persons with a spherical equivalent ranging from +0.5 D to -10.5 D (average -4.87 D). The total RMS, high order RMS and spherical aberration were analyzed and compared according to the spherical equivalent. RESULTS: With increasing age, the total RMS showed no statistically significant increase (p>0.05), but a high order RMS and spherical aberration showed a significant increase (p<0.05) and there was increase in the incidence of coma but without statistical significance (p>0.05). With the increasing amount of spherical equivalent, the total RMS increased significantly (p<0.05), but the incidence of coma and the spherical aberration did not (p>0.05). CONCLUSIONS: In emmetropia, the total RMS and high order aberration increased significantly with increasing age. With increasing amount of spherical equivalent, the total RMS increased significantly while coma and the spherical aberrations did not.
Coma ; Emmetropia ; Humans ; Incidence

Ambient air monitoring(environmental monitoring) and biological monitoring of mixed organic solvents exposure have been used in exposure assessment of these compounds in the work environment. Environmental monitoring is more useful when assessing low level exposure to these compounds. The specific objectives of this study were to measure air organic solvent levels in the work environment, to test the agreement of items measured in this study with items which have been reported to the administrative agency, and finally to evaluate the appropriateness of environmental monitoring items. The study subjects were 13 small companies in which less than 300 employees were working and presumably exposed to mixed organic solvents(e.g. automotive repair and painting, 6; textile dyeing, 2; printing, 2; electronics, etc, 3). Personal air samplings were performed by the flow-lite sampling pump(MSA) and the 600mg charcoal tube with air velocity of 100ml/min for qualitative analysis and 2l/min for quantitative analysis. Samples were analysed by gas chromatography/mass spectrometry(Hewlett-Packard 5890/5970). High levels of toluene, n-hexane, and MIBK were detected in most study companies and low levels of ethylbenzene, xylene, n-butylacetate were also detected. When these measured items were compared with those of reported items, only 6 of 13 companies showed relatively good agreement between them. Two companies failed to report items exceeding the limit value. In conclusion, qualitative analysis of ambient air organic solvents seemed to be as important as quantitative analysis of these compounds and a periodic evaluation of monitoring items reported to the administrative agency should be required.
Charcoal ; Environmental Monitoring* ; Humans ; Mass Spectrometry ; Paint ; Paintings ; Solvents* ; Textiles ; Toluene ; Workplace* ; Xylenes