Cirrhosis with portal hypertension is a common disease which has a significant impact on the quality of patients' life. Esophagogastric devascularization (EGDV) has been demonstrated to be an effective method to treat portal hypertension, however certain complications are associated with it. The purpose of this study was to evaluate the effectiveness and clinical outcome of the selective EGDV (sEGDV) for the treatment of portal hypertension. The study was conducted prospectively from Jan. 1 2011 to Dec. 31, 2012, and 180 patients were randomized to the sEGDV group (n=90) or the non-sEGDV (n-sEGDV) group (n=90). Patients' demographics, preoperative lab test results and operative details were comparable between the two groups. Postoperative and short-term complications were analyzed in two groups. There was statistically significant difference (P<0.01) in the PVF reduction between the two groups. Post-operative complications showed no statistically significant difference between the two groups in the incidence of bleeding, ascites, acute portal vein thrombosis, fever and hepatic encephalopathy. Mortality between two groups was comparable. The incidence of splenic fossa effusion after the surgery was lower in sEGDV group than in n-sEGDV group. There were no significant differences in the short-term follow-up data such as esophageal varices and portal hypertensive gastropathy (P>0.05). It is suggested that sEGDV is a safe, simple and effective surgical procedure. It has both the advantages of the shunt and devascularization because it preserves body's voluntary diversion. With the advantage of low incidence of postoperative complications, it is an ideal surgical approach for the treatment of portal hypertension.

OBJECTIVES: The purpose of the study was to examine the relationships between temperament and character dimensions and family environments, and to investigate the influences of those factors on the antisocial personality traits in delinquent adolescents. METHODS: The subjects consisted of 160 male adolescents detained at the public prosecutor's office on the suspicion of crimes. To assess personality dimensions and family environmental factors, the Temperament and Character Inventory(TCI) and the Family Environment Scale(FES) were completed. Antisocial personality traits were assessed by the number of antisocial personality disorder symptoms of the Personality Disorder Questionnaire-Revised. RESULTS: Most of the TCI dimensions except Reward Dependence(RD) were highly correlated with the subscales of FES. Among temperament dimensions, Novelty Seeking(NS) and Persistence(P) were significantly affected by Organization, and Harm Avoidance(HA) was influenced by Expressiveness of FES. Self-Directednss(SD) was best predicted by Organization and Achievement-Orientation. While the Independence had significant effect on Cooperativeness, Expressiveness and Achievement-Orientation best predicted the level of Self-Transcendence(ST). On factor analysis, NS, HA, SD and ST were allocated to the same factors with subscales of FES. The level of antisocial personality trait was best predicted by NS, P and SD scores of TCI, and conflict subscale scores of FES. CONCLUSION: The findings of this study suggest that not only the character dimensions but also the temperament dimensions have close relationships with family environmental factors, and that the antisocial personality traits of delinquent adolescents may developed by the interaction between temperament/character dimensions and family environments.
Adolescent* ; Antisocial Personality Disorder* ; Crime ; Humans ; Personality Disorders ; Reward ; Temperament*

OBJECTIVE: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. METHODS: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). RESULTS: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. CONCLUSION: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Hypertension ; Intracranial Aneurysm ; Natural History ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Surgical Instruments

This study was aimed to investigate the effect of baicalin on proliferation and apoptosis of HL-60 cells and its mechanism. Cell proliferation was assayed by using Cell Counting Kit-8. The morphological changes of HL-60 cells were examined by light microscopy and nucleolus morphological changes were observed by fluorescent microscopy after Hoechst 33342 staining. The early cell apoptosis was detected by using flow cytometry with Annexin V-FITC/PI double staining. The expression of caspase-3, caspase-9, Bcl-2 and Bax mRNA was detected by RT-PCR and Western blot assay was carried out to examine Bax, Bcl-2, caspase-8 and cleaved caspase-3 expression. The results showed that Baicalin inhibited the proliferation of HL-60 cells in a time- and concentration-dependent manner. HL-60 cells exhibited typical morphological features (for example, cell shrinkage, membrane blebbing and formation of apoptotic bodies). Cell apoptosis in early stage could be detected, the expression of caspase-3, caspase-9 and Bax mRNA was obviously up-regulated, while the Bcl-2 expression down-regulated, and accordingly Bcl-2/Bax ratio decreased. Such results were consistent with the expression of these proteins. In addition, the expression of cleaved caspase-8 protein was induced significantly after treated with baicalin. It is concluded that baicalin can significantly inhibit the proliferation of HL-60 cells and induce the apoptosis of HL-60 cells, which may occur through decreasing Bcl-2/Bax ratio by intrinsic pathway and through extrinsic pathway. It suggests that baicalin may be a promising drug for the therapy of acute myeloid leukemia.
Apoptosis ; drug effects ; Caspase 3 ; metabolism ; Caspase 8 ; metabolism ; Caspase 9 ; metabolism ; Cell Proliferation ; drug effects ; Flavonoids ; pharmacology ; HL-60 Cells ; Humans ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; bcl-2-Associated X Protein ; metabolism

PURPOSE: This retrospective study was conducted to estimate the effects of climate factors and air pollution on asthma exacerbations using a case-crossover analysis. METHODS: Patients who visited the emergency department (ED) of 2 university hospitals in Chuncheon for asthma exacerbations from January 1, 2006, to December 31, 2011, were enrolled. Daily average data for meteorological factors (temperature, daily temperature range, relative humidity, wind speed, atmospheric pressure, presence of rain, solar irradiation, and presence of fog) and the daily average levels of gaseous air pollutants (SO2, NO2, O3, CO, and PM10) were obtained. A case-crossover analysis was performed using variables about the weather and air pollution at 1-week intervals between cases and controls before and after ED visits. RESULTS: There were 660 ED visits by 583 patients with asthma exacerbations. Low relative humidity (lag 1 and 2) and high wind speed (lag 1, 2, and 3) were associated with ED visits for asthma. Fog (lag 2) showed protective effects against asthma exacerbations in Chuncheon (risk increase: -29.4% [95% CI=-46.3% to -7.2%], P=0.013). These relationships were stronger in patients ≤19 years old than in those >60 years old. High levels of ambient CO (lag 1, 2, and 3) and NO2 (lag 2 and 3) were associated with decreased ED visits for asthma. However, there were no significant relationships among levels of ambient CO or NO2 and asthma exacerbations after adjusting for wind speed and relative humidity. CONCLUSIONS: High wind speed and low humidity were associated with an increased risk of asthma ED visits. Fog was associated with a decreased risk of asthma ED visits after controlling for seasonal variations in weather and air pollution.
Air Pollutants ; Air Pollution* ; Asthma* ; Atmospheric Pressure ; Climate ; Emergencies* ; Emergency Service, Hospital* ; Gangwon-do* ; Hospitals, University ; Humans ; Humidity ; Korea* ; Meteorological Concepts ; Rain ; Retrospective Studies ; Seasons ; Weather* ; Wind

OBJECTIVE: This study examined the differences in psychiatric comorbidities and behavioral aspects in accordance with the severity of Internet addiction in male adolescents. METHODS: One hundred and twenty-five adolescents from four middle and high schools in Seoul were enrolled in this study. The subjects were divided into non-addict, abuse, and dependence groups according to a diagnostic interview by psychiatrists. The psychiatric comorbidities and behavioral aspects of subjects were evaluated through psychiatric clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition), the Children's Depression Inventory, the State-Trait Anxiety Inventory, the Internet Addiction Test, and a self-reported questionnaire about behavioral aspects. RESULTS: The psychiatric comorbidity distributions were significantly different in the abuse and dependence groups, particularly in terms of attention-deficit hyperactivity disorder and mood disorder items. The Children's Depression Inventory, the State-Trait Anxiety Inventory, and the Internet Addiction Test scores were also significantly different among the three groups. There were significant differences in 10 of the 20 items of the Internet Addiction Test between the non-addict, abuse, and dependence groups. There were significant differences in seven items between the non-addict and abuse groups, but no differences between subjects in the abuse and dependence groups. Significant differences were observed in three items between the abuse and dependence groups, but there were no significant differences between the non-addict and abuse groups. In terms of behavioral aspects, scores for abusive, sexual, and decreased social interest behaviors were highest in the dependence group, and lowest in the non-addict group. However, the behavioral aspects of decreased interpersonal relationships did not show this difference between groups. CONCLUSION: This study suggests that there are differences in psychiatric comorbidities and behavioral aspects between adolescent males with characteristics of Internet abuse and Internet dependence.
Adolescent* ; Anxiety ; Comorbidity* ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Internet* ; Male ; Mood Disorders ; Psychiatry ; Surveys and Questionnaires ; Seoul

OBJECTIVE: Direct surgical clipping of paraclinoid aneurysms is challenging due to nearby anatomic structures. However, as endovascular techniques advance, endovascular coil embolizations for paraclinoid aneurysms are more frequently performed. We reviewed our experience with endovascular coil embolization of paraclinoid aneurysms to evaluate its safety and efficacy. METHODS: From 2005 to 2011, 78 patients underwent endovascular procedures with detachable coils for 86 paraclinoid aneurysms at our institute. A retrospective review of the medical records was performed. RESULTS: Seventy-eight patients with 86 paraclinoid aneurysms were evaluated. Thirteen patients (16.7%) were men and 65 (83.3%) were women. Patient age ranged from 23 to 78 years (mean age, 48 years). Five patients (6.4%) presented with subarachnoid hemorrhage (SAH) with decreased consciousness and visual field defects. In the 86 treated aneurysms, the immediate post procedural angiogram demonstrated complete occlusion in 73 aneurysms (84.9%), near-complete occlusion in eight aneurysms (9.3%) and partial occlusion in five aneurysms (5.8%). We obtained angiographic follow-up in 46 cases. Minor recanalization occurred in two cases and major recanalization occurred in one case. One thromboembolic complication and one blurred vision occurred among the 78 patients. CONCLUSION: Despite difficulties with surgical approaches for paraclinoid aneurysms, these lesions can be successfully managed by endovascular treatment. Favorable outcomes with a low morbidity suggest endovascular techniques as alternatives to microsurgical therapy for treating paraclinoid aneurysms.
Aneurysm ; Consciousness ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments ; Vision, Ocular ; Visual Fields

OBJECTIVE: Unruptured intracranial aneurysms (UIA) accompanied by ischemic cerebrovascular disease (CVD), will be an increasing problem for neurosurgeons in the future, as the population ages. These patients are a high-risk group of treatment. UIA associated with ischemic CVD in seventeen patients were analyzed and their managements are discussed. METHODS: In the past four years, one hundred seventy seven cases of UIAs were treated in our hospital. Among them, seventeen patients suffered from ischemic CVD before treatment of aneurysm. The age of patients varied from 40 to 78 (mean 63.2) years old. The associated ischemic CVD was that transient ischemic attack (TIA) was nine, minor completed stroke in eight patients. There was permanent neurological deficit in two patients. Microsurgical treatment underwent for ten patients and seven patients were treated with endovascular technique. RESULTS: Fourteen patients were fully recovered from surgical and endovascular management. In clipping group, hemiparesis event occurred in one patient after the surgery. The patient suffered from ischemia-related permanent neurological worsening. There were two patients who developed neurological deficit following endovascular treatment for UIA in seven patients of coiling group. One patient was recovered after rehabilitation but the other patient didn't improve left hemiparesis until discharge. This patient had bilateral paraclinoid aneurysms. We treated these lesions simultaneously and coil embolization for the aneurysm was uneventful. However, left side weakness developed after the procedure. Angiography revealed occlusion of cortical branches of middle cerebral artery and MRI scan showed hyperintense areas in the right motor cortex. CONCLUSION: Our results suggest that surgical treatment of unruptured cerebral aneurysm is not contraindicated in patients with CVD. However, the treatment of UIA accompanied by CVD should be performed only after careful examination of the factors involved in the particular ischemic episodes. Careful case selection and perioperative management are mandatory for preventing surgical complications.
Aneurysm ; Angiography ; Endovascular Procedures ; Humans ; Intracranial Aneurysm ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Motor Cortex ; Paresis ; Stroke

OBJECTIVETo distinguish the edema, injury, or rupture in the traumatic skeletal muscle fiber in vivo using diffusion tensor imaging (DTI) and tractography on magnetic resonance imaging (MRI).

METHODSThe skeletal muscle trauma models were made in 4 rabbits (eight hindlimbs) by iron discus (weight 1.0 kg, diameter 6 cm) falling down vertically from 45 cm height to rabbits' thighs. Conventional sequences and two-dimensional (2D) diffusion-weighted (DW) spin-echo (SE) echo planar imaging (EPI) sequence with fat suppression (b = 600 s/mm2) were performed on 1. 5T MRI scanner. The grading of edema, injury, and fiber rupture in the damaged muscle were made according to their histopathological views, which was consistent with the images. The mean apparent diffusion coefficient (ADC) values and fractional anisotropy (FA) values were measured from the region of interests (ROIs) of all groups on 2D DW images used for tractography. Analysis of variance test was performed to analyze all data.

RESULTSADC values of the areas in normal muscle, edema muscle, injury muscle, and ruptured muscle were (6.12 +/- 1.34) x 10(-3), (6.38 +/- 1.30) x 10(-3), (8.06 +/- 0.97) x 10(-3), and (9.57 +/- 0.93) x 10(-3) mm2/s, respectively. There was significant difference among groups (P < 0.001), but no difference between edema muscle and normal muscle group (P > 0.05). The FA values of normal muscle, edema muscle, injury muscle, and ruptured muscle were 0.42 +/- 0.12, 0.36 +/- 0.12, 0.26 +/- 0.09, 0.12 +/- 0.08, respectively, with a significant difference among groups (P < 0.001). In the edema muscle, the tracking cross-fiber could be seen but it decreased slightly. In the injury muscle, the tracking fiber decreased markedly. In the ruptured muscle, the transverse-orientation tracking fiber vanished, yet some interrupted longitudinal-orientation tracking fiber could be found.

CONCLUSIONThe edema, injury, and rupture of muscle fiber in rabbit damaged skeletal muscle can be verified according to the ADC and the FA on DTI and tractography.

Animals ; Anisotropy ; Diffusion Magnetic Resonance Imaging ; methods ; Echo-Planar Imaging ; Edema ; diagnosis ; pathology ; Male ; Muscle, Skeletal ; injuries ; pathology ; Rabbits ; Rupture ; diagnosis ; pathology ; Thigh ; injuries ; pathology

A 39-year-old woman, who 3 months prior had undergone sono-guided biopsy for pelvic masses, was admitted to our hospital with dyspnea. After the procedure, a large arteriovenous (AV) fistula was detected. The patient developed dyspnea with pain and swelling of the right leg and subsequently visited our hospital. Multiple cafe-au-lait spots and subcutaneous nodules were noted and a continuous bruit was heard in the right pelvic area. Transthoracic echocardiography revealed marked dilatation of the right atrium, right ventricle, and inferior vena cava. An angiogram showed multiple AV fistulas between the right iliac arteries and veins. The patient underwent aortoiliofemoral bypass surgery. Follow-up echocardiography after surgery showed dramatic improvement in heart function. Molecular analysis revealed a novel variation (c.4270-1G>a) at the 24th intron-exon splicing consensus sequence of the neurofibromin 1 (NF1) gene. This is a rare case of AV fistula that developed after biopsy and caused right-sided heart failure in a patient with neurofibromatosis.
Adult ; Arteriovenous Fistula ; Biopsy ; Cafe-au-Lait Spots ; Consensus Sequence ; Dilatation ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP) ; Female ; Fistula ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Iliac Artery ; Leg ; Neurofibromatoses ; Neurofibromatosis 1 ; Neurofibromin 1 ; Veins ; Vena Cava, Inferior