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The anxiety disorders make up one of the most common groups of psychiatric disorders. Anxiety is an alerting signal ; it warns of impending danger and enables a person to take measures to deal with a threat. Three major schools of psychological theory-psychoanalytic, behavioral, and existential-have contributed theories about the causes of anxiety. Many drugs are effective in managing distressing signs and symptoms associated with anxiety disorders. As the symptoms are controlled by medication, patients are reassured and develop confidence that they will not be incapacitated by the disorder. Benzodiazepines are useful in panic disorder, phobias, and agitation. In general, benzodiazepines act as hypnotics at high doses and as anxiolytics or sedatives at low doses. The benzodiazepines have become the sedative-hypnotic drugs of first choice because they have a higher therapeutic index and significantly less abuse potential than do many of other sedative-hypnotics. The most common adverse effect of benzodiazepines is drowsiness. Some patients also experience dizziness and ataxia. The most serious adverse effects of benzodiazepines occur when other sedative substances are taken concurrently. When benzodiazepines are used for long periods, they usually cause significant tolerance, dependence, or withdrawal effects. Overdoses with benzodiazepines alone have a predictably favorable outcome. The benzodiazepines should be started at a low dosage, and the patient should be informed about the drug’s sedative properties and abuse potential. Serotonin-specific reuptake inhibitors (SSRIs) have a much more favorable profile of adverse effects and have significantly broadened the horizon for pharmacological treatment of anxiety disorder. Three fourths of patients experience no adverse effects at low starting doses, and doses may be increased relatively rapidly in these patients. In the remaining one fourth of patients, most of the SSRIs’ adverse effects appear within the first 1 to 2 weeks, and they generally subside or resolve spontaneously if the drugs are continued at the same dose.
Anti-Anxiety Agents ; Anxiety ; Anxiety Disorders ; Ataxia ; Benzodiazepines ; Dihydroergotamine ; Dizziness ; Humans ; Hypnotics and Sedatives ; Panic Disorder ; Phobic Disorders ; Sleep Stages

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Atypical Abdominal Pain.

Seung Ha PARK ; Chong Il SOHN

Journal of the Korean Medical Association.2002;45(8):1036-1040. doi:10.5124/jkma.2002.45.8.1036

Abdominal pain usually originates from the abdomen, but the lack of evidence of any abdominal disease suggests the pain originate from the thorax or have metabolic and neurogenic causes. Especially, neurogenic abdominal pain is recurrent and sustained causalgic pain, regardless of diet and without abdominal distension or rigidity, may be accompanied by signs of neurologic dysfunction. We have experienced a very rare case of abdominal pain arising from the intramedullary cavernous hemangioma of spinal cord. We report this case with a review of the literature.
Abdomen ; Abdominal Pain* ; Diet ; Hemangioma, Cavernous ; Neurologic Manifestations ; Spinal Cord ; Thorax

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Minimally Invasive Cardiac Surgery.

Jae Won LEE ; Sung Ho JUNG ; Hyung Gon JE

Journal of the Korean Medical Association.2008;51(4):335-346. doi:10.5124/jkma.2008.51.4.335

Traditional cardiac surgery has been performed via a "big" median sternotomy incision by significant complexity and invasiveness. The traditional big incision has presented with many problem, and at the same time, has given opportunity to make the procedures less invasive. During the past decade, improvement in endoscopic equipments and operative techniques has resulted in development of minimal invasive cardiac operations using small incisions with or without robotics. A number of cardiac procedures are currently performed by minimal invasive approaches and for many surgeons a minimal invasive cardiac surgery has become a standard practice. Herein, we reviewed the minimal invasive cardiac surgery in the aortic valve, mitral valve, tricuspid valve, atrial septal defect, and coronary artery disease.
Aortic Valve ; Coronary Artery Disease ; Heart Septal Defects, Atrial ; Mitral Valve ; Robotics ; Sternotomy ; Thoracic Surgery ; Tricuspid Valve

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Coronary Artery Disease and Coronary Artery Bypass Surgery in Patients of Middle Age.

Young Tak LEE ; Wook Sung KIM

Journal of the Korean Medical Association.2008;51(4):327-334. doi:10.5124/jkma.2008.51.4.327

Coronary artery disease in young patients (< 40 years) is not common. However, when it occurs it has symptoms that are more frequent and a more rapid progression when compared to older affected patients. Younger patients are more likely to have normal coronary arteries and have nonobstructive disease < 70%, single-vessel disease and less extensive coronary artery atherosclerosis. Therefore, it is likely that there are differences in the cardiac risk factors in young patients undergoing coronary artery bypass surgery. Smoking, hypercholesterolemia, unstable angina, and myocardial infarction were more frequent in the young age group, and diabetes and hypertension were more common in older patients. The need for repeated interventions, additional surgery andlate myocardial infarction were more common in younger patients. Favorable factors associated with increased survival included the absence of unstable angina, a left ventricle ejection fraction of =45% and the use of the internal thoracic artery for procedures. The patency of saphenous vein grafts in younger patients was inferior to vein graft patency in the older patients. Risk factors such as hyperlipidemia, smoking and a family history of coronary artery disease may be related to the early graft failure in young patients. The patency of the internal thoracic artery to the left anterior descending artery was above 90% over 10 years; however, it was around 50% for the saphenous vein. Therefore, the aggressive use of internal thoracic arteries, for coronary artery bypass surgery in young patients, was essential for improved late survival and the event free survival (reduced additional interventions, surgeries and hospital admissions). The Ycomposite graft technique or sequential anastomosis, improves the coronary artery anastomosis with fewer arterial grafts. Other arterial grafts such as the gastroepiploic artery, radial artery and inferior epigastric artery could be used for coronary artery bypass surgery in young patients for free grafts, in situ grafts or Y-composite grafts. Young patients that have coronary artery bypass surgery have a favorable prognosis when the internal thoracic arteries or other arterial grafts are used. In addition, such as the Y-composite graft technique and sequential anastomosis can also be used with a high success rate.
Angina, Unstable ; Arteries ; Atherosclerosis ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Disease-Free Survival ; Epigastric Arteries ; Gastroepiploic Artery ; Heart Ventricles ; Humans ; Hypercholesterolemia ; Hyperlipidemias ; Hypertension ; Mammary Arteries ; Middle Aged ; Myocardial Infarction ; Prognosis ; Radial Artery ; Risk Factors ; Saphenous Vein ; Smoke ; Smoking ; Transplants ; Veins

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Drug Therapy and Catheter Ablation for Atrial Fibrillation.

Young Hoon KIM

Journal of the Korean Medical Association.2008;51(4):317-326. doi:10.5124/jkma.2008.51.4.317

In all clinical trials comparing rate versus rhythm control of atrial fibrillation (AF) by drugs, there was no survival benefit associated with a rhythm control strategy. Currently used antiarrhythmic drugs are not only frequently ineffective at eliminating AF, but may be life threatening in some patients. Catheter ablation (CA) of AF has evolved rapidly and has become accepted as one of the therapeutic modalities for controlling AF. The effective strategies for CA of AF consist of pulmonary vein isolation (PVI) and/or complete encirclement around PVs with or without additional ablation lines. Selection of patients, who may be benefited by CA or not, is an important issue. Precise electroanatomic mapping for the triggers and the substrate of the atria is central for customizing ablation target and for enhancing efficacy of CA for AF. With further development of new energy sources of ablation, cardiac imaging, navigation, and mapping systems, the CA can be simplified and standardized, which may enable the CA to become more effective, safer, and more applicable to many different subsets of AF.
Anti-Arrhythmia Agents ; Atrial Fibrillation ; Catheter Ablation ; Catheters ; Humans ; Pulmonary Veins

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Treatment of Medically Intractable End-Stage Heart Failure.

Jin Ho CHOI ; Eun Seok JUN

Journal of the Korean Medical Association.2008;51(4):306-316. doi:10.5124/jkma.2008.51.4.306

Heart failure is the final pathway for myriad diseases that affect the heart. Patients with refractory symptoms of heart failure despite ultimate medical therapy have very poor prognosis. In these patients, replacement of failing heart with permanent organ transplantation or ventricular assist device, which is temporarily or permanently implanted, is often life-saving and can improve long term prognosis. Cardiac transplantation is the established standard for the treatment of end-stage cardiac disease refractory to medical therapy. The clinical success of transplantation has been streadily improving with the refinement of recipient selection, better donor management, and better immunosuppressive agents. Recent substantial evolution of mechanical circulatory assist devices improved dramatically the outcome of not only patients in decompensated heart failure but also a large proportion of acute heart failure patients in cardiogenic shock. With this evolution, implantable sophisticated devices are being used as destination therapy as a substitute for transplantation and are expected to diminish the intrinsic shortage of donor compared to the epidemic of heart failure.
Heart ; Heart Diseases ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Prognosis ; Shock, Cardiogenic ; Tissue Donors ; Transplants

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Drug-Eluting Stent: Present and Future.

Seung Jung PARK

Journal of the Korean Medical Association.2008;51(4):299-305. doi:10.5124/jkma.2008.51.4.299

Since a successful balloon angioplasty of coronary artery stenosis in a patient in 1977, the development of percutaneous coronary intervention was remarkable. The drug-eluting stent reduces the occurrence of in-stent restenosis and the need for subsequent target vessel revascularization, when compared with the bare-metal stent. However, the safety of the drugeluting stent has been called into question because of an apparent increase in late stent thrombosis. With adequate antiplatelet therapy and other optimal medical treatment, the net clinical benefit of the drug-eluting stent may outweigh their risks. The use of drug-eluting stent in the real world is in some cases beyond the indications evaluated in the randomized trials. In a highrisk or complex subset of lesions such as chronic total occlusion, bifurcations, small vessels, long lesions, and saphenous vein grafts, the data appear to be convincing enough to support extended applications. However, in other clinical subsets such as diabetes, multivessel disease, unprotected left main disease, and acute myocardial infarction, more data and longer clinical followups are necessary before implantation of a drug-eluting stent.
Angioplasty, Balloon ; Coronary Stenosis ; Drug-Eluting Stents ; Glycosaminoglycans ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Saphenous Vein ; Stents ; Thrombosis ; Transplants

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