Syphilis was known to be generalized disease and it had been decreased until 1960's. But, it has been increased again recently. The author analysed the 22 cases of congenital syphilis which were treated at department of orthopaedic surgery at Ewha Womans University Hospital from Jan. 1979 to July 1983 and the following results were obtained. 1. There were no significant changes of the number of patient by years. 2. Common symptom and sign were hepatosplenomegaly(84%), fever(62%) and skin changes(50%), and pseudoparalysis was observed in one case. 3. Radiologic bone changes were observed in 11 cases (50%) and the following results were obtained: a. Below the two week old, there was relatively low incidence of bone change with 22%. b. There was high incidence of bone change in prematurity with 75%. c. Common features of bone changes were periosteal reaction, osteochondritis and metaphysitis (91%). Pathologic fracture was observed. in one case. 4. Although we have observed the bone changes only in 50% of cases, all the other reports has reported more than 80% and we thought that radiologic bone change would aid the diagnosis of congenital syphilis.
Clinical Study ; Diagnosis ; Female ; Fractures, Spontaneous ; Humans ; Incidence ; Osteochondritis ; Skin ; Syphilis ; Syphilis, Congenital

BACKGROUND: It is well known that there is an adverse effect of longterm cigarette smoking on pulmonary function. But there are few reports about the effect of different habits of cigarette smoking on pulmonary function. Some smokers think that different habits of cigarette smoking are more safe than athers and this can be, an obstacle to the education of smoking cessation. Therefore, we have obtained applicable basic information for education of smoking cessation by analysing the effects of different habits of cigarette smoking on pulmonary function. METHODS: We surveyed current smokers on different habits of smoking who had performed puhnonary function test at the pulmonary function laboratory of one tertiary hospital in Seoul and pulmonary function test was done as a part of comprehensive health check-up at health promotion center of one secondary hospital at Ulsan from May 1998 to July 1998. We analysed the effects of different habits of cigarette smoking on pulmonary function in 160 subjects who has no specific respiratory disease. RESULTS: The factors were age, height, weight and amount of total smoking that had effect on pulmonary function. There were six different habits of smoking that we could analyse time of first smoking after sleep, average time of one cigarette smoked, current amount of smoking, length of one cigarette smoked, effort to quit smoking, smoking with drinking and all these six habits of sking had no relationship with the results of the pulmonary function test. CONCLUSIONS: The damage in pulmonary function was not protected by different habits of smoking that were previously known to be more safe or healthy. Therefore, we concluded that smoking cessation is the only way to prevent the damage in pulmonary function from cigarette smoking.
Drinking ; Education ; Health Promotion ; Respiratory Function Tests ; Seoul ; Smoke* ; Smoking Cessation ; Smoking* ; Tertiary Care Centers ; Tobacco Products ; Ulsan

A retrospecive clinical observation was done on 325 cases of hypertension admitted to Department of internal Medicine of Seoul Red Cross Hospital from January, 1979 to December, 1982. The following results have been obtained. 1) The observed patients were 157 males and 168 females, and the prevalence rate of malignant hypertension among 325 hypertensions was 16 cases (4.9 percent). Among 16 cases of malignant hypertension 9 cases were male and 7 cases were female. Most frequently in 50, 60 and 40 years of age in this order each sex. 2) The average admitted dates are 7 days. 27 cases (8.3percent) were readmitted above 2 times after one discharged. 3) The most freqeuntly observed duration of Known hypertension 37.9 percent was 6-10 years and the next frequently observed duration 37.4 percent was 3-5 years. 4) The highest percentage of malignant hypertension had systolic blood pressure between 190-209mmHg and diastolic blood pressure between 150-169mmHg. 5) The highest percentage of seasonal number was spring (31.1 percent) and the next autumn, summer, winter in this order and the prevalence rates of hypertention are increased average 1.9% of each year. 6) The 78.5 percent of the patients were found that their blood pressure were abnormaly high when they were examined with related symptoms on admission, and they major symptorms were headache and dizziness. 7) The physical examination on admission, tachycardia (56percent), tachypnea (15.1percent), semicoma to coma (12.9 percent) in this order. 8) The status of treatment in hypertension on admission was as follows; imtermittent treatment 54.5 percent, no treatment 31 percent and continuous treatment 14.5 percent in this order. 9) In the chest X-ray on admission, the most frequent finding was cardiomegaly, and normal finding was the next frequency. The pulmonary Tbc was noted in 12.6 percent. 10) According to the degree of fundoscopic abnormality by K-W classification stage III was 68.8 percent and stage IV was 31.2 percent. 11) Electrocardiogram abnormalities were 44.9 percent, and 87.5 percent of malignant hypertension revealed electrocardiographic abnormalities and left ventricle hypertrophy was observed in 70.5 percent. 12) Hypercholesterolemia 78 percent, Hypernatremia 69.8 percent, Hypokalemia 22.8 percent, serum chloride 34.5 percent (<95m Eg/l), BUN 53.8 percent (>20mg/dl) and creatinine 45.8 percent (>3mg/dl) on admission. 13) Proteinuria was observed in 87.5 percent of malignant hypertension. 14) Marked improved for clinically was 24 percent and mortality rate was 5.2 percent, most common cause of death are cardiovascular accident (64.7percent) and renal failure (23.5percent).
Blood Pressure ; Cardiomegaly ; Cause of Death ; Classification ; Coma ; Creatinine ; Dizziness ; Electrocardiography ; Female ; Headache ; Heart Ventricles ; Humans ; Hypercholesterolemia ; Hypernatremia ; Hypertension ; Hypertension, Malignant ; Hypertrophy ; Hypokalemia ; Internal Medicine ; Male ; Mortality ; Physical Examination ; Prevalence ; Proteinuria ; Red Cross ; Renal Insufficiency ; Seasons ; Seoul ; Tachycardia ; Tachypnea ; Thorax

Agranulocytosis is a severe hematologic complications of clozapine, but risperidone was not shown to induce agranulocytois. Nevertheless, some cases of risperidone-induced agranulocytosis were being reported, but there was no report yet in Korea. Recently we experienced that a female patient taking risperidone suffered by fever and agranulocytosis, so treated by discontinuation of risperidone and granulocyte-colony stimulating factor (G-CSF). A 54 year-old depressed and psychotic women started a treatment with risperidone. On hospital day 11, agranulocytosis accompanied with fever developed. Risperidone was discontinued and G-CSF was administered. On hospital day 13, the hematologic complication was improved. Thereafter olanzapine was administerd for treatment of psychotic symptoms. On hospital day 41, the patient discharged with normal hematologic profile and improved state of depressive and psychotic symptoms. Agranulocytosis induced by risperidone is not frequent, but it can develop in some vulnerable patients. So, if a patient taking risperidone shows fever, chill, sore throat, hematologic examination should be carried out. Once agranulocytosis develops, immediate discontinuation of risperidone and other potential drug. Thereafter, preventive antibiotics and shortening in duration of aganulocytosis are needed.
Agranulocytosis* ; Anti-Bacterial Agents ; Clozapine ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Humans ; Korea ; Middle Aged ; Pharyngitis ; Risperidone*

OBJECTIVES: Medically unexplained physical symptoms comprised the predominant complaints of patients with depression in clinical settings. Previously, tricyclic antidepressants, which inhibit both presynaptic reuptake of serotonin and norepinephrine, had been used to relieve pain as well as treat depression. The objective of this study was to evaluate the efficacy of venlafaxine ER, which also has the effects on both serotonin and norepinephrine, in patients suffering from depression with somatic symptoms. METHODS: The subjects were recruited from outpatients who had been treated for depression with venlafaxine ER. They were divided into two groups, based on whether they voiced somatic symptoms as their chief complaint (somatic group) or not (non-somatic group). In addition, they were also divided into two groups according to whether they met the criteria of multisomatoform disorder (DSM-IV, Primary Care Version). The duration from the time venlafaxine ER was used to the point when treatment was changed because of the recurrence of symptoms or side effects was assessed and compared using survival analysis in the two groups. RESULTS: Sixty-four patients fulfilled the inclusion criteria of this study, and 39 patients 'were placed into the somatic group', while the other 25 patients 'were placed into the non-somatic group'. The survival rates of maintenance treatment in the somatic group was significantly higher than in the non-somatic group (logrank test p=0.033), and the mean duration of maintenance treatment in the somatic group was 41.5+/-3.38 weeks, while that in the non-somatic group was 26.0+/-4.95 weeks. When the subjects were classified by the criteria of multisomatoform disorder, no significant difference was observed between the two groups (logrank test p=0.314). CONCLUSION: In the present study, treatment venlafaxine ER was maintained longer in patients suffering from depression with somatic complaints, which suggests the efficacy of venlafaxine ER on somatic symptoms of these patients. Large-scale, controlled trials are needed to confirm our findings.
Antidepressive Agents, Tricyclic ; Depression ; Depressive Disorder, Major* ; Humans ; Norepinephrine ; Outpatients ; Primary Health Care ; Recurrence ; Serotonin ; Survival Rate ; Venlafaxine Hydrochloride

OBJECTIVE: Psychiatric patients often require emergency injection and they are sometimes received psychotropic medication injection before the completion of a medical history and laboratory studies. The aim of this study is to find out laboratory differences between patients with severe psychomotor agitation who were injected emergently and those who were not. METHODS: Medical records of all patients 18 years or older admitted to psychiatric unit were reviewed. Subjects in this study were patients who showed psychotic symptoms, psychomotor agitation or violent behavior within 7 hospital days. Demographic and laboratory variables were compared between injected and non-injected patients. RESULTS: One hundred twenty three patients were included. Twenty seven patients received emergency injection and ninety six patients didn't receive. Patients received emergency injection had lower platelet count (p<0.01), and potassium level (p<0.05) and higher electrocardiogram QTc interval (p<0.05). They are also more likely to have abnormal levels of platelet count (p<0.05), and creatine phosphokinase (p<0.05). CONCLUSION: Emergently injected patients in the psychiatry service were more likely to have abnormal laboratory results before injection. These findings suggest that patients who need emergency injection may have additional physical problems which require further medical attention. Therefore before injection, we consider that emergently injected patients may have risks.
Creatine Kinase ; Electrocardiography ; Emergencies ; Humans ; Inpatients* ; Medical Records ; Platelet Count ; Potassium ; Psychomotor Agitation

Fusarium species, which are common soil saprophytes, have been implicated as a pathogen causing a variety of opportunistic infections such as keratitis, onychomycosis, burn wound infection or disseminated systemic infections in immunocompromised hosts. We report a case of cutaneous infection caused by F. verticillioides in a 59-year-old man, with a long history of diabetes mellitus and alcoholic liver cirrhosis. He presented with a few papules and fluctuant cutaneous nodules on both forearms traumatized by woodstick 4 months ago. The diagnosis of F. verticillioides infection was established by histopathologic examination and finding of tissue cultures.
Burns ; Diabetes Mellitus* ; Diagnosis ; Forearm ; Fusarium* ; Humans ; Immunocompromised Host ; Keratitis ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver* ; Middle Aged ; Onychomycosis ; Opportunistic Infections ; Soil ; Wound Infection

OBJECTIVE: In Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), a new specifier of major depressive disorder (MDD) "with anxious distress" allows characterization of additional symptoms. The aim of this study was to investigate difference in treatment outcome of MDD with versus without anxious distress specifier in DSM-5. METHODS: Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of MDD in a period from March 2013 to September 2014 was conducted. We reviewed anxious distress symptoms, medications and detailed clinical information at index episode. We compared treatment outcomes of anxious distress group with those of non anxious distress group. RESULTS: There were differences in remission rate after 4 weeks later (18.5% vs. 44.4%, p=0.040) and at discharge (33.3% vs. 66.7%, p=0.014) between anxious distress and non anxious distress. However, no significant differences were observed in the sociodemographic characteristics, treatment regimens, and response rate. CONCLUSION: Anxious distress specifier might be worthwhile to be further evaluated as a diagnostic entity of its own requiring specific diagnosis and therapeutic attention.
Depression* ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Retrospective Studies ; Treatment Outcome*

The anticonvulsant lamotrigine has been reported to be efficacious and well tolerated in treatment of bipolar patients. Recently, its efficacy in rapid cycling states has attracted interest, however there was no reports about lamotrigine in treatment of ultra-rapid cycling bipolar disorder. Here we present the case of a male patient with bipolar disorder who developed an ultra-rapid cycling state. The addition of lamotrigine to prior valproate treatment succeeded to improve the ultra-rapid cycling.
Bipolar Disorder* ; Humans ; Male ; Valproic Acid

OBJECTIVE: It is well known that antipsychotic drugs induce extrapyramidal symptoms such as dystonia, akathisia and parkinsonian symptoms even early in the treatment. With the advent of atypical antipsychotic drugs, the incidence of extrapyramidal symptoms has decreased, but danger still exists. Hence, anticholinergic agents are often indicated in treatment of schizophrenia with antipsychotics. METHODS: In this observational retrospective study, we examined the use of anticholinergic agents among schizophrenic patients who were initiated on risperidone, olanzapine, or quetiapine, the three most widely prescribed atypical antipsychotics. We reviewed medical records of schizophrenic patients who were initiated on risperidone, olanzapine or quetiapine from January 2004 through December 2004 and continuously treated with the antipsychotics for 6 months. The data were analysed using one way ANOVA, Mann-Whitney U test, chi-square test or Fisher's exact tests. RESULTS: The study yields two major findings. Firstly, compared with risperidone initiators, there were significantly fewer olanzapine initiators who used anticholinergic agent concomitantly. Secondly, there were significantly fewer olanzapine or quetiapine initiators than risperidone initiators who prescribed anticholinergic agent on the same day when antipsychotics was initiated. CONCLUSION: As the use of anticholinergic agent is a proxy for the presence of extrapyramidal symptom, these findings suggest that risperidone may be more associated with extrapyramidal symptoms than olanzapine or quetiapine. Controlled studies comparing them to one another should be of particular interest.
Antipsychotic Agents* ; Cholinergic Antagonists* ; Dystonia ; Humans ; Incidence ; Medical Records ; Proxy ; Psychomotor Agitation ; Retrospective Studies ; Risperidone ; Schizophrenia ; Quetiapine Fumarate