2.Secondary Adrenal Insufficiency Initially Misdiagnosed as Depression: A Case Report.
Duk Soo MOON ; Won Sub KANG ; Jong Woo PAIK ; Ji Young SONG ; Jong Woo KIM
Korean Journal of Psychosomatic Medicine 2011;19(2):109-114
The abnormalities in Hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situation, differential diagnosis with depression is needed when clinicians were met a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
Adrenal Insufficiency
;
Anxiety
;
Appetite
;
Axis
;
Depression
;
Diagnosis, Differential
;
Endocrine System Diseases
;
Fatigue
;
Fever
;
Growth Hormone
;
Headache
;
Humans
;
Hypopituitarism
;
Hypothyroidism
;
Sleep Initiation and Maintenance Disorders
;
Weight Loss
3.Changing Trends in the Occurrence and Management of Delirium for 5 Years in a University Hospital.
Jae Ho BAE ; Won Sub KANG ; Jong Woo PAIK ; Jong Woo KIM
Korean Journal of Psychosomatic Medicine 2012;20(2):112-119
OBJECTIVES: Delirium is a disorder defined as a sudden disturbance in thinking, speaking, acting and sleep pattern due to altered level of consciousness and cognitive function. The objective of this study is to analyze characteristics and therapeutic methods of the delirious patients during the recent 5 years, and provide basic data for further studies and investigation regarding delirium in the occurrence and treatment. METHODS: We retrospectively reviewed medical records of 475 patients who were consulted for delirium in Kyunghee University Medical Center from January 2007 to December 2011. RESULTS: During the 5 years, among the 475 patients who were diagnosed as delirium, men were more common(61.7%). The most commonly consulted reason and cause were sleep disturbance(80.8%) and post-operational delirium(30.9%), respectively. The medication prescription percentage was 76.6% and was significantly increased year after year. Ratio of using antipsychotics were 76.4% among prescribed medication and the most frequently prescribed antipsychotic drug was quetiapine(46.8%). Other specialists commonly misdiagnosed delirium when the patient was previously diagnosed as dementia(6.8%). CONCLUSIONS: In our study, post-operational delirium was the most commonly referred reason and the percentage of medication prescription tended to increase. Patients with history of dementia were more easily misdiagnosed as diseases other than delirium. Our study suggests that we should evaluate symptoms, causes, reasons of consultation, management tendency of delirium. We should also closely observe changes in sleep patterns and establish the prevention strategies for post-operational delirium and therapeutic bases for pharmacotherapy.
Academic Medical Centers
;
Antipsychotic Agents
;
Consciousness Disorders
;
Delirium
;
Dementia
;
Humans
;
Male
;
Medical Records
;
Prescriptions
;
Retrospective Studies
;
Specialization
;
Thinking
4.The case reports of laparoscopic assisted right hemicolectomy.
Bong Hwa LEE ; Hyo GONG ; Kyoung Sub YOON ; Ze Hong WOO
Journal of the Korean Surgical Society 1993;44(6):916-922
No abstract available.
5.Effects of Glycopyrrolate and Atropine on Heart Rate During Anesthesia for Strabiemus Surgery in Children.
Jin Woo PARK ; Yung II JO ; Kyu Sub CHUNG
Korean Journal of Anesthesiology 1984;17(2):102-107
The objectives of this study were to investigate the efficacy and dose-effect relationship for glycopyrrolate in the suppression of the oculocardiac reflex, and to compare glycopyrrolate with the reported equivalent dose of atropine. Glycopyrrolate 5 and 7.5ug/kg and atropine 10 and 15ug/kg were studied in 40 paediatric patients to assess more fully the dose of glycopyrrolate required for adequate prevention of the oculocardiac reflex. The results obtained were summarized as follows: 1) The increase in the mean heart rate 5 min after the test drug was statistically significant in all of the four groups. 2) Both drugs showed a dose-related response for reduction in slowing of heart rate after rectus muscle traction. 3) There is great individual variation in response to muscle traction within each group, no group being fully protected from marked slowing in heart rate. 4) The frequency of arrhythmias with low doses of both drugs was more than in high doses with both drugs.
Anesthesia*
;
Arrhythmias, Cardiac
;
Atropine*
;
Child*
;
Glycopyrrolate*
;
Heart Rate*
;
Heart*
;
Humans
;
Reflex, Oculocardiac
;
Traction
6.Short Term Chemotherapy in Urinary Tuberculosis.
Chung Sub JUNG ; Woo Chul MOON ; Young Sun KIM
Korean Journal of Urology 1989;30(5):727-733
Recently short term chemotherapy has become popular for the treatment of genitourinary tuberculosis. But it is questionable weather short term chemotherapy can cure all cases of genitourinary tuberculosis regardless of their severity ;and the role of nephrectomy in patients with renal tuberculosis is still controversial. Herein we analyzed 52 patients with confirmed urinary tuberculosis who were treated with triple drugs, including isoniazid, rifampicin and ethambutol, for 6 to 9 months. The patients ranged from 13 to 71 years of age, and the male to female ratio was 2.4: 1. Follow up period ranged from 6 to 65 months with a mean period of 19.7 months. The patients were classified according to the severity of renal tuberculosis on pyelography into Group I ( minimal, 8 patients), II (moderate, 9 patients) and III (severe, 35 patients), and treatment result were analyzed in each group. Of 52 patients, 19 were treated by chemotherapy only and 33 (63.5%) reconstructive surgery. Success rates of short term chemotherapy in terms of cure of tuberculosis and preservation of functional renal tissue were :overall 75%, 100% in Group I , 77% in Group II and 68.6% in Group III. Two of 9 patients in Group II and 10 of 17 in Group III who were treated with chemotherapy only, deteriorated with loss of the kidney. Poor vascular pyonephrotic kidney and progressive ureteral stricture were suggested as the main cause of failure. Ureteroneocystostomy and double J enting were helpful not only in the preservation of the kidney but also in the rapid cure of a renal tuberculosis. 24 patients who were treated with 6 to 9 months chemotherapy after removal of their nonfunctioning kidney were relapse-free on follow up. In conclusion, 6 to 9 months chemotherapy is adequate minimal urinary tuberculosis. For the treatment of moderate to advanced urinary tuberculosis, a longer period of chemotherapy may be adequate, and meticulous follow up with IVP and aggressive management of ureteral stricture is essential. A far advanced, nonfunctioning, unilateral tuberculosis kidney is better to be removed early, followed by 6 to 9 months' chemotherapy.
Constriction, Pathologic
;
Drug Therapy*
;
Ethambutol
;
Female
;
Follow-Up Studies
;
Humans
;
Isoniazid
;
Kidney
;
Male
;
Nephrectomy
;
Rifampin
;
Tuberculosis*
;
Tuberculosis, Renal
;
Ureter
;
Urography
;
Weather
7.A Pediatric Case of Korean Hemorrhagic Fever Confirmed by Fluorescent Antibody Technique.
Young Ill PARK ; Joon Hee OH ; Sang Woo KIM ; Jin Young CHOI ; Tae Sub SHIM
Journal of the Korean Pediatric Society 1978;21(10):685-
A case of Korean hemorrhagic fevery confirmed by fluorescent antibody technique in a 8years old boy was reported with a brief review of references.
Fluorescent Antibody Technique*
;
Hemorrhagic Fever with Renal Syndrome*
;
Humans
;
Male
8.Magnetization Transfer Ratio of Brain Tissue: Normal Value and Effect of TR/TE.
Tae Sub CHUNG ; Eun Kee JEONG ; Tae Joo JEON ; Duk Jae KIM ; Hyuk Woo KWON
Journal of the Korean Radiological Society 1995;32(4):535-540
PURPOSE: Magnetization transfer imaging(MTI) is a new imaging contrast technique. Our MT pulse sequence is designed as fixed time interval between echo and MT pulse. This study was peformed to evaluate the influence of variations in TR/TE on MTR in T1 weighted image of normal brain tissue on this kind of MT pulse sequence. MATERIALS AND METHODS: Seven healthy volunteers in twenties of age as the objectives, MRI was taken under various TR/TE(TR/TE ;700/14, 650/14, 750/14, 700/20 and 1500/20 msec). MTR was calculated from signal intensities measured at the same point in both pre and post MT images and statisticslly analyzed. The MR imager used in this study was 1.0T Magnetom 42SP(Siemens, Erlangen, Germany) and the parameters of additional MT pulse sequence were offset 1000Hz and bandwidth 250Hz, and posteriorly located to echo with 7.7 msec fixed interval. Offset of this MT pulse was variable. RESULT: In white matter of brain tissue from a normal person, MTR was 34-39%(average 37%) for TR and TE of 700/14 in T1WI and 33-36%(average 35%) for TR/TE of 650/14, and 34-38%(average 35%) for TR/TE of 750/14 which showed no statistical difference. However, in case of 1500/20 of TR/TE, MTR was 26-28%(average 26%) which is statistically significant. With TR/TE of 700/14 as the standrd value, the MTR of gray and white matter were 37% and 29% respectively, showing a definite difference of statistical means. Signal from CSF in ventricles is rarely influenced by MT pulse. CONCLUSION: Conclusively, a subtle variation in TR/TE in T1WI has little influence on MTR but wide range of variation in TR/TE as in proton density image induces significant difference in MTR on this kind of MT pulse sequence. Therefore, the exchangeable usage of MTR data would be possible in narrow range of TR/TE change but difficult in wide range of variation.
Brain*
;
Healthy Volunteers
;
Humans
;
Magnetic Resonance Imaging
;
Protons
;
Reference Values*
9.The Changes of the Retinal Ganglional Cells in the Pressure-induced Ischemic Rabbit Retina.
Tae Kwann PARK ; Won Sub SON ; Hyung Woo KWAK
Journal of the Korean Ophthalmological Society 2001;42(5):772-782
PURPOSE: There were many studies on the distributions of the retinal ganglion cells(RGC) in the experimental model of the retinal ischemia. RGC was known to be more sensitive to the ischemic injury than the other types of the retinal cells. So, we would identify the changes of the retinal ganglion cell morphologies and distribution after the iatrogenic retinal ischemia induced by intraocular pressure(IOP) elevation. METHODS: Eight pigmented and six white rabbits were used and retinal ischemia was induced by increasing IOP higher than 120 mmHg for 60 minutes. Electroretinogram were recorded at 6 days or 13 days, and histologic findings were observed at 7 or 14 days. RESULTS: After 7 days, RGC densities decreased, cytoplasmic staining disappeared, and the intranuclear hyperpigmentation was noted. RGC densities decreased significantly at 14 days. In the vertical retinal section, some flattening of retinal ganglion cell layer and inner plexiform layer was observed. Changes in the cellular morphologies were prominent. CONCLUSIONS: It may be more appropriate to examine both the retinal whole-mount and the vertical tissue section for the estimatation of the changes of retinal ganglion cell layer in the pressure-induced retinal ischemia.
Cytoplasm
;
Ganglion Cysts*
;
Hyperpigmentation
;
Ischemia
;
Models, Theoretical
;
Rabbits
;
Retina*
;
Retinal Ganglion Cells
;
Retinaldehyde*
10.Morphometric Study on the Development of the Human Fetal Heart after Mid-term.
Ho Dirk KIM ; Chul Woo KIM ; Bong Jin RAH ; Hae Sung LEE ; Tae Sub SHIM
Korean Journal of Physical Anthropology 1990;3(1):1-12
A total of 23 human fetal hearts from 18 to 40 weeks of gestation were provided for histologic and morphometric studies. The fetuses were the products of spontaneous or artificial abortions and were found to have no congential anomalies or associated lesions at autopsy. Maxima thickness of the left anterior, left lateral, left posterior, right anterior, right lateral, right posterior ventricular wall, and of the interventricular septal wall were measured and the left / right wall thickness ratio was calculated. The cross-sectional area of each ventricle parallel to the base of the heart at about 3-5mm below from the origin of the aorta was measured under drawing attachment-equipped light microscope with the application of point counting or cut-and-weigh method. Data were analyzed by the Anderson-ell ABSTAT dBASE ll statistical package program. The ventricular wall consisted of endocardium, myocardium and epicardium. The myocardium showed epithelial character by stratification of barrel-shaped myocardial cells, but the epithelial character progressively changed to as in adult myocardial tissue from the myocardial area close to the epicardium with increasing fetal age. However, any significant histologic difference between the left and the right ventricular wall at the same fetal age was not found. The growth pattern of both ventricular wall, the interventricular septal wall, and of the cross sectional area were linear (p<0.01). However, there was no significant difference in the wall thickness between the left and right ventricle at the same fetal age, and the left / right thickness ratio was nearly constant with increasing fetal age. The cross sectional area was greater in the right than in the left ventricle in the fetuses after 18 weeks of gestation (p<0.01), and there was no significant difference in the morphometric values between point counting and cut-and-weigh method (p>0.1).
Adult
;
Aorta
;
Autopsy
;
Endocardium
;
Fetal Heart*
;
Fetus
;
Gestational Age
;
Heart
;
Heart Ventricles
;
Humans*
;
Methods
;
Myocardium
;
Pericardium
;
Pregnancy