OBJECTIVE: The aim of this study was to describe and evaluate the clinical data and short-term treatment response in patients with obsessive-compulsive disorder (OCD) based on an outpatient setting. METHODS: A group of patients with OCD underwent mean 12-weeks treatment with selective serotonin reuptake inhibitors. The patients were divided into two groups according to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35% and CGI of 1 or 2. RESULTS: 1) Among the 249 patients, 24.1% had checking type and 23.7% washing type. Among these two types, 31.9% had mood disorder, 15.0% had anxiety disorder and 24.5% personality disorder as co-morbidity. One hundred fourteen patients (45.8%) responded to the treatment and 135 (54.2%) did not. The responders decreased Y-BOCS scores from 27.9+/-7.2 at baseline to 21.3+/-6.4 and 19.3+/-3.8 at post-treatment 8 and 12 weeks, respectively (repeated measure ANOVA, p=0.039). There were no differences among the treatment responses to serotonin reuptake inhibitors. CONCLUSION: About half of the OCD patients showed a response to pharmacological treatment using SSRI in the outpatient clinic setting for 12 weeks. Long-term and contrast studies of OCD may elucidate further clinical aspects of this disorder in the future.
Ambulatory Care Facilities ; Anxiety Disorders ; Comorbidity ; Humans ; Mood Disorders ; Obsessive-Compulsive Disorder* ; Outpatients ; Personality Disorders ; Serotonin Uptake Inhibitors

OBJECTIVE: The aim of this study was to evaluate which clinical variables might influence the antiobsessional responses to proserotonergic drugs in a sample of patients with obsessive-compulsive disorder (OCD). METHODS: Two hundred forty-nine patients with DSM-IV OCD under-gone mean 13-month treatments with selective serotonin reuptake inhibitors. According to the treatment response, defined as a reductions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score > or =35%, patients were divided into two groups. RESULTS: One hundred fourteen patients responded to the treatment and the other one hundred thirty five patients did not. Responders had a significant long duration of medication in YUMC OCD clinic, short total duration of past treatment in other institutes, and higher frequency of drug naive cases and lower baseline Y-BOCS scores. CONCLUSION: The pre-treatment factors including total duration of past treatment, drug naive or not, baseline OCD symptoms and the factor of duration of the treatment may influence drug treatment response in OCD patients.
Academies and Institutes ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Obsessive-Compulsive Disorder ; Serotonin Uptake Inhibitors

OBJECTIVE: To compare the advantages and disadvantages between total vaginal hysterectomy (VTH) and laparoscopically assisted vaginal hysterectomy (LAVH) including the indications and safety. METHODS: We reviewed the medical records of patients who underwent VTH from July 1998 to December 1999 and those who underwent LAVH from January 2000 to April 2002. We evaluated age, parity, previous abdominal operations, indications for hysterectomy, combined operations, operation time, bleeding amount, hemoglobin change, weight of uterus, and postoperative complications. RESULTS: 1. Age was not a notable factor but parity was significantly lower in LAVH group. 2. In VTH group, 48% of patients had previous operations compared with 46% in LAVH group. 3. The most common indication for hysterectomy of both group was uterine myoma. 4. The weight of hysterectomized specimen was 256 g in VTH group and 237 g in LAVH group. 5. In VTH group, 38% received concurrent surgical procedures of which colporrhaphy was the most common (14 cases). In LAVH group, 72.5% received concurrent surgical procedures of which salpingoo- phorectomy was most common. 6. The operation time showed a notable difference; 78.6 min. in VTH group and 105.4 min. in LAVH. 7. There was no significant difference in bleeding amount and hemoglobin change. 8. Postoperative complication was higher in VTH group (14%) than LAVH group (7.5%). However all the patients recovered with conservative treatment and close observation. CONCLUSION: Both VTH and LAVH had the following advantages compared with abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages, lower prevalence. In this study we found out that in VTH, the procedure could be done safely even if the uterus was big or with previous abdominal operations. Limited operation field and the fact that we couldn't check the abdominal cavity were some disadvantages. In comparison, LAVH offered a view of the abdominal cavity which make easy adnexal operation but because of expensive operative tools, cost was a problem. In order to satisfy the patient and lower the cost, appropriate study on the indications and training on procedures will be necessary.
Abdominal Cavity ; Bleeding Time ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Length of Stay ; Medical Records ; Parity ; Postoperative Complications ; Prevalence ; Uterine Prolapse* ; Uterus

Radiation-induced osteosarcoma is a very rare complication of radiation therapy, with a poor prognosis. We experienced a case of radiation-induced osteosarcoma of the sternum, in a patient who had had breast cancer treated with surgery, adjuvant chemotherapy, and adjuvant radiation therapy 6 years earlier. A 53-year-old woman complained of a painful anterior chest wall mass. The mass was diagnosed as osteosarcoma on biopsy. The radiation-induced osteosarcoma had an aggressive nature.
Biopsy ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Female ; Humans ; Middle Aged ; Osteosarcoma ; Prognosis ; Sternum ; Thoracic Wall

OBJECTIVE: The Korean Medication Algorithm for the Treatment of Schizophrenia was developed by the extensive review and questionnaires. To evaluate the impact of a history of antipsychotic treatments on clinical response and algorithm application, using the data derived from the feasibility study of the Medication Algorithm for patients with schizophrenia. METHOD: Outcomes of treatment with the Medication Algorithm for 108 schizophrenics up to 4 months are presented. Measures of changes included clinical symptoms, functioning, and side effects. Comparison was done between patients with and without a history of antipsychotic treatments. RESULTS: 100 individuals (with a history=71 ; without a history=29) were analyzed for the comparison. Most of subjects without a history of antipsychotic treatments were administered on risperidone in the initial treatment. When compared with the subjects with a treatment history, the subjects without a history showed better treatment effects on clinical symptoms at the first evaluation. At 4-month, there were similar effects between the two groups except negative symptoms, in which the group with a history showed significantly more improvement than without a history. There were no significant differences in assessment of subjective opinion and well-being to drugs and quality of life, and objective evaluation of drug side effects. Among the subjects with a history, the ones starting with stage 1 showed higher positive symptoms, anxiety scores, and briefer duration of antipsychotic exposure than the ones starting with stage 2 or more advanced. CONCLUSION: This study suggests that despite some limitation, an antipsychotic treatment history may have an impact on application of medication algorithm and these data will be helpful for revision of the Medication Algorithm for the Treatment of Schizophrenia.
Anxiety ; Feasibility Studies ; Humans ; Quality of Life ; Surveys and Questionnaires ; Risperidone ; Schizophrenia

OBJECTIVE: Stress and elevated levels of glucocorticoids in patients with major depressive disorder (MDD) have been hypothesized to be associated with damage to the hippocampus. However the relationship between depression and hippocampal structure is unconfirmed. We investigated whether the chemical changes will occurr in the hippocampus of patients with MDD by using 1H-magnetic resonance spectroscopy (MRS) and explored the clinical meanings of hippocampal metabolites. METHODS: Fourteen female, right-handed patients with major depressive disorder and 12 healthy controls (age, sex, education and their dextrality matched) were included. We measured variables of time course of illness, severity of illness, levels of NAA, Cho and Cr in both hippocampus using 1HMRS. In addition, we performed neuropsychological tests in depressed subjects. RESULTS: There were no significant difference in the NAA/Cr, Cho/Cr, Cho/NAA between depressed and control subjects. In depressed subjects, significant negative correlations were observed between hippocampal NAA/Cr and duration of illness, duration of unmedication, severity of illness, respectively. Right hippocampal NAA/Cr was correlated with RCFT scores. CONCLUSION: These findings indicate damage to the hippocampus may not be a common feature in all depressed patients. However the results suggest that the illness burden and past treatment may influence hippocampal neurons and neuronal network in patients with MDD. Also, chemical changes in hippocampus may be associated with severity of illness and memory function.
Cost of Illness ; Depression ; Depressive Disorder, Major* ; Education ; Female* ; Glucocorticoids ; Hippocampus ; Humans ; Magnetic Resonance Spectroscopy ; Memory ; Neurons ; Neuropsychological Tests ; Spectrum Analysis

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for schizophrenia to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Schizophrenia patients in clinical settings in Korea. METHODS: A total of 108 schizophrenia and schizophreniform disorder patients were enrolled at 19 centers and treated according to the algorithm. PANSS (Positive and Negative Symptom Scale) and CGI (Clinical Global Impression) were used to evaluate symptom severity. Also UKU (UKU side effect rating scale) and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale), DAI-10 (Drug Attitude Inventory-10), PPS (Patient Preference Scale), SWN (Subjective Well-Being under Neuroleptic treatment) and WHOQOL (World Health Organization Quality of Life) were used to evaluate tolerability and satisfaction of patient respectively. RESULTS: Overall ratings including symptom severity, compliance of medication, side effect of medication, quality of life were favorable. The treatment response (PANSS improvement > or = 20%) rate was 63%, 75% at the first Clinical decision point (CDP) and 4 month respectively. CONCLUSION: Symptom improvement, tolerability and quality of life were all favorable. These results suggest that this algorithm can be useful in clinical practices.
Compliance ; Humans ; Korea ; Psychotic Disorders ; Quality of Life ; Schizophrenia ; World Health Organization