Hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal hemorrhage.Reports of hemobilia date back to the 1600s,but due to its relative rarity and challenges in diagnosis,only in recent decades has hemobilia been more critically studied.The majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver,pancreas,bile ducts and/or the hepatopancreatobiliary vasculature,with trauma and malignancy rep-resenting the two other leading causes.A classic triad of right upper quadrant pain,jaundice,and overt upper gastrointestinal bleeding has been described(i.e.Quincke's triad),but this is present in only 25％-30％of patients with hemobilia.Therefore,prompt diagnosis depends critically on having a high index of suspicion,which may be based on a patient's clinical presentation and having recently undergone(peri-)biliary instrumentation or other predisposing factors.The treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic,interventional radiologic,or surgical intervention.Here we provide a clinical overview and update regarding the eti-ology,diagnosis,and treatment of hemobilia geared for specialists and subspecialists alike.

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Erythrocytes*

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OBJECTIVE: In this five-year cohort study, we hypothesize that factors of temperament and character in professional baseball players predict the speed of obtaining success and the quality of success as well as anxiety control. METHODS: Participants included 120 male rookie players from the Korea Baseball Organization (KBO) and 107 male non-players with no history of playing baseball. The personality/characters and state/trait anxieties of participants were assessed with the Temperament and Character Inventory (TCI) and Spielberg's State-Trait Anxiety Inventory-Y (STAI-Y). Over the duration of five years, all the players were subsequently classified into either a success group (major leaguers) or a non-success group (non-major leaguers), depending on their status in the professional baseball league in Korea. RESULTS: The players in the group of starters had higher novelty seeking (NS) scores than those of non-starters. The reward dependence (RD) scores of the success group were higher than those of the non-success group. The state anxiety scores in the starter group were negatively correlated with NS scores. The state and trait anxieties in the non-success group were positively correlated with RD scores. CONCLUSION: The results of this study suggest that predictive temperamental factors for success in baseball players include traits of novelty seeking and reward dependence.
Anxiety ; Baseball* ; Cohort Studies ; Humans ; Korea ; Male ; Reward ; Temperament*

Prostate cancer has a high prevalence and a rising incidence in many parts of the world. Although many screen-detected prostate cancers may be indolent, prostate cancer remains a major contributor to mortality in men. Therefore, the appropriate diagnosis and treatment of localized prostate cancer with lethal potential are of great importance. High-risk, localized prostate cancer has multiple definitions. Treatment options that should be individualized to each patient include observation, radical prostatectomy, external beam radiotherapy, brachytherapy, androgen deprivation, and combined modality treatment. Specific outcomes of radical prostatectomy and combined modality treatment for high-risk prostate cancer are reviewed. The rationale for extended pelvic lymphadenectomy at the time of surgery is discussed, as is the role for surgery in the setting of node-positive, high-risk disease. There is not yet a biomarker that accurately identifies lethal prostate cancer, but rigorous clinical studies have identified methods of optimizing oncologic outcomes in high-risk men.
Brachytherapy ; Humans ; Incidence ; Lymph Node Excision ; Male ; Prevalence ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms

INTRODUCTIONThe objective of the study was to determine the trend of malaria, the epidemiological characteristics, the frequency of local transmission and the preventive and control measures taken.

MATERIALS AND METHODSWe analysed the epidemiological records of all reported malaria cases maintained by the Communicable Diseases Division, Ministry of Health, from 1983 to 2007 and the Anopheles vector surveillance data collected by the National Environment Agency during the same period.

RESULTSThe annual incidence of reported malaria ranged from 2.9 to 11.1 per 100,000 population, with a sharp decline observed after 1997. There were 38 deaths, 92.1% due to falciparum malaria and 7.9% due to vivax malaria. Of the reported cases, 91.4% to 98.3% were imported, with about 90% originating from Southeast Asia and the Indian subcontinent. Among the various population groups with imported malaria, the proportion of cases involving work permit/employment pass holders had increased, while that of local residents had decreased. Between 74.8% and 95.1% of the local residents with imported malaria did not take personal chemoprophylaxis when they travelled overseas. Despite the extremely low Anopheles vector population, a total of 29 local outbreaks involving 196 cases occurred. Most of the larger outbreaks could be traced to foreign workers with imported relapsing vivax malaria and who did not seek medical treatment early. One of the outbreaks of 3 cases in 2007 was caused by Plasmodium knowlesi, a newly recognised simian malaria which was probably acquired in a forested area where long-tail macaques had been sighted.

CONCLUSIONSSingapore remains both vulnerable and receptive to the reintroduction of malaria and a high level of vigilance should be maintained indefinitely to prevent the re-establishment of endemicity. Medical practitioners should highlight the risk of malaria to travellers visiting endemic areas and also consider the possibility of simian malaria in a patient who has no recent travel history and presenting with daily fever spikes and with malaria parasite morphologically similar to that of P. malariae.

Adolescent ; Adult ; Animals ; Anopheles ; Child ; Child, Preschool ; Disease Outbreaks ; Emigrants and Immigrants ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Insect Vectors ; Malaria ; epidemiology ; prevention & control ; transmission ; Malaria, Falciparum ; epidemiology ; prevention & control ; transmission ; Malaria, Vivax ; epidemiology ; prevention & control ; transmission ; Male ; Middle Aged ; Plasmodium knowlesi ; Plasmodium malariae ; Population Surveillance ; Recurrence ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Travel ; Young Adult

Attention-deficit/hyperactivity disorder (ADHD) is a common developmental neuropsychiatric disorder. Although ADHD can often be treated with stimulant class medications to alleviate symptoms, such treatments may cause undesirable side effects. Recently, Traditional Chinese medicine (TCM) has been gaining interest with treatment potential for ADHD and the lack of the stimulant-associated undesirable side effects. Animal models are useful for study the efficacy and mechanisms of TCM treatment for ADHD, however, previous studies of TCM on ADHD animal models, in general, have not considered appropriate experiemental designs. There were many concerns regarding the choice and source of the model and control animals, drug administration methods, behavioral and biochemical testing criteria, humane use of animals, and statistical power, etc. In this review, we discuss these issues present in the previous literature of animal research, and propose guidelines for future studies in particular consideration with the unique characteristic of Chinese medicine itself.
Animals ; Attention Deficit Disorder with Hyperactivity ; drug therapy ; Disease Models, Animal ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Mice ; Rats

BACKGROUND AND OBJECTIVES: Fas and Fas ligand (Fas-L) interactions mediate apoptosis of eosinophils. It is possible that reduction of Fas/Fas-L or Fas-L expression on eosinophils could induce the eosinophilia seen in Samter's triad. The purpose of this study was to analyse the release of LT and Fas/Fas-L expression pattern following exposure to varying concentrations of aspirin in aspirin sensitive nasal polyp (ASP) and non-aspirin sensitive nasal polyp (NASP) patients. MATERIALS AND METHODS: Twenty NASP patients and 16 ASP patients were recruited. Nine healthy subjects served as normal controls. LT levels and Fas/Fas ligand expressions were analysed by ELISA and flow cytometry. RESULTS: Both NASP and ASP patients showed increased release of LT on aspirin exposure in blood and nasal polyps. But ASP patients showed an even greater release of LT on aspirin exposure in blood as compared to NASP patients (p<0.05). LT release from peripheral blood elements do not necessarily coincide with those results obtained from nasal polyps. Eosinophils in ASP patients have significantly decreased Fas expression when compared to NASP patients (p<0.0001). CONCLUSION: These results suggested the role of LT and eosinophils in aspirin intolerance mechanisms in both blood and nasal polyp tissues. The decreased expression of the Fas receptor or defect of Fas/Fas-L interaction could be an important role in pathogenesis of nasal polyp regardless of their association with aspirin sensitivity.
Antigens, CD95 ; Apoptosis ; Aspirin* ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Fas Ligand Protein ; Flow Cytometry ; Humans ; Nasal Polyps* ; Viperidae