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

A case of postradiation sarcoma, found in a 52-year-old woman, who underwent a total hystrectomy under the diagnosis of cervical cancer 12 years ago, followed by radiation therapy. The tumor invasion was extensive involving the left innominate bon and upper end of the left femur including the head and neck. Histopathological findings revealed sarcomatous change with atypical osteoid formation and stromal proliferation. The case has been followed for 2 years since February 1974 and survives today.
Diagnosis ; Female ; Femur ; Head ; Humans ; Middle Aged ; Neck ; Osteosarcoma ; Pelvic Bones ; Sarcoma ; Uterine Cervical Neoplasms

No abstract available.
Snake Bites* ; Snakes*

Injuries in the industries has been steadily increasing in this country in recent years. Injuries in the industries intricate in accoriance with the industrial environment, mechanism of injuries and the other factors of employees. In 6 years 201 patients with industrial injuries underwent treatment in the Department of Orthopaedic Surgery of the National Medical Center, and the result of treatment is reported in this paper. 1. 70 cases out of 201 cases were in the age group between 21 to 30 year. 186 cases were male and 15 were female. The incidence is remarkably higher in male. 2. In 80 cases the injuries were caused by machinery with pressor parts. The patients were chiefly manual workers in factories. 3. Of 280 injuries, 148 (62.8%) were upper extremities, 105 (37.5%) were lower extremities and 27 (96%) were trunks. The most common site of injuries was hand. 4 Of 146 injuries with fractures, 94 were treated by manual reduction and cast, and 52 were treated by open reduction. 5. Treatment for open wounds was debridement followed by delayed primary closure and/or skin graft. The primarily closed open wounds by local clinics were observed and treated according to wound condition. 6, 17 cases out of 22 phalangeal bone fractures were treated by manual reduction and splint. 5 cases were treated by K-wire internal fixation, among them 3 cases had to be treated by amputation. 7. Incidence of early camplication was considerably high with 137 sites out of 280 sites and the late complication was 79 sites after treatment of the early complications.
Amputation ; Debridement ; Female ; Fractures, Bone ; Hand ; Humans ; Incidence ; Lower Extremity ; Male ; Skin ; Splints ; Transplants ; Upper Extremity ; Wounds and Injuries

ERCP was performed in 34 cases of obstructive janndice at Busan National University Hospital between June 1981 and October 1982, and those findings were compared with the final surgical operative diagnoses. The results were as follows: 1) The ratio of male to female was about l. 6: 1 and most of them were in the 5th decade to 7th decade, 2) Upper abdominal pain and tenderness were the cardinal symptom and sign, 3) Successful ERCP was obtained in 32 cases among the total of 34 cases(94.1%)Selective success rates by indications were 77.8%(21/27) in suspected biliary lesions and 85.7%(6/7) in suspected panceatic lesions. 4) ERCP diagnoses were biliary stone(11 cases), eholangiocarcinoma(6 cases), pancreatic head ca. (4 cases), Ampulla of Vater ca. (2 cases), normal cholangiogram(2 cases), and normal parcreatogram(2 cases). 5) Eighteen cases out of 24 surgical operative cases were diagnosed by ERCP alone, The diagnostic rates of ERCP by surgical operation in obstructive jaundce was 75%. Complications of ERCP were not clinically significant. It suggests that ERCP is a very useful diagnostic method in the differential diagnosis of obstructive jaundice.
Abdominal Pain ; Ampulla of Vater ; Busan ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Female ; Head ; Humans ; Jaundice, Obstructive* ; Male

BACKGROUND: The maximal removal rate of indocyanine green (ICG Rmax), which has been used as a useful indicator of quantitative assessment of the hepatic function, has some disadvantages such as high cost, requirement of multiple sampling, and long turn-around time. This study was designed to clarify that the measurement of the lidocaine metabolite, monoethylglycinekylidide (MEGX) test, can replace the ICG Rmax. And in healthy adults, MEGX forma pion was measured and compared according to methods of measurement and serf. METHOD: In 18 patients to whom ICG Rmax test was requested, ICG Rmax test was carried out at two doses of 0.5 mg/kg and 5 mg/kg and MEGX formation after 15 minute of 1 mg/kg lidocaine Injection was measured by fluorescence polarization immunoassay (FPIA) method. The correlation between them was analyzed, To 25 healthy volunteers included in this study as normal control, lidocaine was given intravenously at, a dose of 1 mg/kg and MEGX forma pion was measured IS and 30 minute later (MEGX15, MEGX30) using both high performance liquid chromatography (HPLC) and FPIA methods. RESULT: Patient group resealed significant correlation between ICG Rmax and MEGX15 (r=0.7674, p<0.001) and also between ICG Rl5 and MEGX15 (r=0.5612, p=0.008). There was significant difference between MEGX15 of 9 patients with chronic liver diseases and those of normal controls (22.24+/- 13.18 and 35.40+/- 14.43 ng/mL, respectively) (p=0.01). In normal controls, the correlation between methods was significant (p=0.001) and the values measured by FPIA method was significantly higher than that by HPLG (p(0.001). Of the normal controls, male group had higher MEGX15 values than female group in both methods (in HPLC method 33.89+/-15.95 and 22.53+/- 8.36, and in FPIA method 41.48+/-16.61 and 28.81+/-7.88 ng/mL, respectively), and in female group MEGX30 values was significantly elevated compared to MEGX15 (p<0.001). CONCLUSION: Inferred from the fact that the correlation between ICG Rmax and MEGX was good, MEGX test can be considered a replacement for ICG Rmax. In healthy adults, it is considered that there is serf-related difference In the rate of lidocaine metabolism so we should pay attention to it in interpreting the MEGX results.
Adult ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Female ; Fluorescence Polarization Immunoassay ; Healthy Volunteers ; Humans ; Indocyanine Green* ; Lidocaine ; Liver Diseases ; Male ; Mesons ; Metabolism

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.
Arteries* ; Carcinoma, Hepatocellular ; Defecation ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Infarction ; Liver ; Portal Vein ; Spinal Cord Injuries* ; Spinal Cord*

Since selective serotonin reuptake inhibitors were introduced in clinical practice in the 1990s, antidepressant prescriptions have steadily increased. In addition to the prescriptions by psychiatrists, antidepressant prescriptions by non-specialists have also increased. An advanced understanding of the pharmacological and clinical characteristics of antidepressants is essential to improving the treatment response of depressive disorders and the quality of life of patients. Antidepressant withdrawal or discontinuation syndrome can frequently occur if antidepressant maintenance is discontinued without a pre-planned clinical strategy. Nevertheless, it is often unrecognized or mistaken for other clinical situations. This causes patient distress and ultimately reduces long-term treatment compliance. Inappropriate therapeutic decisions can be made if clinicians do not recognize antidepressant discontinuation syndrome. Antidepressant withdrawal is common and preventable. This issue must be recognized because it can be adjusted through appropriate clinical management. This article systematically reviews the clinical features, biological mechanisms, coping strategies, and antidepressant discontinuation strategies related to antidepressant discontinuation syndrome.

Due to the low response rate of antidepressant treatment in late-life depression, brain stimulation techniques should be considered when treating elderly patients. Electroconvulsive therapy (ECT) is one of the most frequently used brain stimulation techniques, and shows favorable outcome and acceptable tolerability in the treatment of late-life depression. Hemodynamic change and cognitive impairment are common side effects of ECT, which are transient in most cases. Since cognitive impairment can lead to treatment non-compliance, it should be minimized by controlling electrode position, pulse-width, treatment frequency, etc. Because ECT is followed by rapid cardiovascular change, risk factors should be evaluated and managed properly. Transcranial magnetic stimulation (TMS) and magnetic seizure therapy (MST) are also shown to be effective in treating depression, with less cognitive impairment. However, further research is needed to establish their efficacy in late-life depression.
Aged ; Brain* ; Depression* ; Electroconvulsive Therapy ; Electrodes ; Hemodynamics ; Humans ; Risk Factors ; Seizures ; Transcranial Magnetic Stimulation

Electroconvulsive therapy (ECT) is a safe and effective treatment not only for various mental disorders including depression, mania, and schizophrenia, but also for inadequacy and resistance to pharmacotherapy and the psychiatric emergences. The historical ups and downs of ECT treatment since its first introduction in 1938 were ended by the validation impacts of evidence-based medicine in the 1980s and by other clinical issues. Clinical research for the optimization of ECT to maximize therapeutic effects and to minimize adverse effects is ongoing to establish standardized procedures and educational programs through the ECT center. In addition, guidelines for ECT practices are also being developed for the clinical excellence of ECT practices in accordance with the recommendations of international organizations such as World Psychiatric Association and American Psychiatric Association. This article was prepared by reviews of the literature, direct observations of ECT practices abroad, and interviews with ECT experts around the world in order to enhance therapeutic effects with recently updated ECT practices under the belief that the most appropriate treatments should be provided to the patients in need.
Bipolar Disorder ; Depression ; Drug Therapy ; Electroconvulsive Therapy* ; Evidence-Based Medicine ; Humans ; Mental Disorders ; Schizophrenia