A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.
Adolescent ; Adult ; Brain ; Bullying ; Child ; Depression ; Early Intervention (Education) ; Epilepsy ; Epilepsy, Temporal Lobe* ; Epilepsy, Tonic-Clonic ; Female ; Fluoxetine ; Hallucinations ; Humans ; Magnetic Resonance Imaging ; Male ; Memory, Episodic ; Residence Characteristics ; Sclerosis* ; Sex Offenses ; Suicidal Ideation ; Aripiprazole

PURPOSE: This study aimed to identify the neural basis of executive function (EF) in amnestic mild cognitive impairment (aMCI) according to beta-amyloid (Aβ) positivity. Furthermore, we explored if the identified brain areas could serve as predictors for clinical progression. MATERIALS AND METHODS: We included individuals with aMCI using data from [¹⁸F]-florbetapir-positron emission tomography (PET), fluorodeoxyglucose-PET, and EF scores, as well as follow-up clinical severity scores at 1 and 5 years from baseline from the Alzheimer's Disease Neuroimaging Initiative database. The correlations between EF score and regional cerebral glucose metabolism (rCMglc) were analyzed separately for aMCI with low Aβ burden (aMCI Aβ−, n=230) and aMCI with high Aβ burden (aMCI Aβ+, n=268). Multiple linear regression analysis was conducted to investigate the associations between rCMglc and clinical progression. RESULTS: Longitudinal courses differed between aMCI Aβ− and aMCI Aβ+ groups. On average, aMCI Aβ− subjects maintained their level of clinical severity, whereas aMCI Aβ+ subjects showed progression. EF impairment in aMCI Aβ− was related to the anterior cingulate cortex (ACC), whereas that in aMCI Aβ+ was related to Alzheimer's Disease-vulnerable brain regions. ACC and the posterior cingulate cortex were associated with clinical progression in aMCI Aβ− and aMCI Aβ+, respectively. CONCLUSION: Our findings suggest that although MCI subjects showed similar behavioral phenotypes at the time of diagnosis, EF and further progression were associated with different brain regions according to Aβ burden. Clarification of the etiologies and nature of EF impairment in aMCI are critical for disease prognosis and management.
Alzheimer Disease ; Amyloid ; Brain ; Cognition ; Diagnosis ; Executive Function ; Follow-Up Studies ; Glucose ; Gyrus Cinguli ; Linear Models ; Metabolism ; Mild Cognitive Impairment ; Neuroimaging ; Phenotype ; Positron-Emission Tomography ; Prognosis

Objectives: ：This study aimed to investigate the prevalence of internet game addiction and its association with environmental characteristics such as parent supervision, gaming hour (time spent on gaming) and attention-deficit hyperactivity disorder (ADHD) symptoms among middle school students. Methods: ：A total of 596 (416 males and 180 females) first grade middle-school students in Gwang-ju metropolitan city were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Internet Gaming Use-Elicited Symptom Screen (IGUESS), Attention deficit hyperactivity disorder (ADHD) symptom, environmental factor such as parent supervision, and game related factor like game hours. Internet Game addiction and non-addiction group were defined using IGUESS score of 10 as a cut-off. The data were analyzed using hierarchical regression analyses. Results: ：Internet Game addiction group was fifty-two subjects (8.7%). Male students were significantly higher than female students (OR 25.01). IGUESS score was statistically negatively correlated with parent attachment and parent supervision, while IGUESS score was positively correlated with time spent on gaming per day, the longest time spent on gaming per day and violent game and ADHD score. Among variables, IGUESS score showed the highest correlation with the longest time spent on gaming per day (r=0.373, p<0.01). Using hierarchical regression analyses, the longest time spent on gaming per day was also the highest predicting factor affecting internet game addiction among variables. Conclusion ：Our findings indicate that parent supervision, parent attachment and game related characteristics such as gaming per day, the longest time spent on gaming per day and violent game and ADHD were associated with internet game addiction.

In this study, high frequency oscillatory ventilator was designed and constructed. Using designed by phase-lock loop system, in order to accurately and easily treat both the outlet volume and rpm. A system has been designed and is being evaluated using CD4046A PLL IC. We use this PLL IC for the purpose of motor controls. The device consists of PLL system, pumping mechanism, piston, cylinder, and special crank shaft are required. This system characteristics were as follows: 1) Frequency: 20-1800 rpm 2) Outlet air volume: 1-50 cc
Ventilators, Mechanical*

PURPOSE: To evaluate the incidence,. degree, and clinical significance of non-obstructive intrahepatic bile duct di'latation encountered on follow up CT after gastrectomy for gastric carcinoma. MATERIALS AND METHODS: We retrospectively analyzed follow-up abdominal CT of 65 patients who had undergone gastrectomy with truncal vagotomy and subtotal gastrectomy for gastric carcinoma. We classified those patients who showed intrahepatic duct dilatation into non-obstructive or obstructive groups depending on the presence or absence of the lesions obstructing the duct. We also evaluated the incidence, degree and pattern, and appearance time of non-obstructive type of duct dilatation. RESULTS: Non-obstructive and obstructive biliary dilatations were present in 8 cases(12.3%) and 9 cases(13. 8%), respectively. The degree of non-obstructive group was mild in 6 cases(75%) and moderate in 2 cases (25%) who had taken cholecystectomy during the follow up period, and patterns were proportional dilatation of the central and peripheral intrahepatic ducts. It appeared on follow up CT obtained 6 to 12 months after operation in 7 cases and 3.5 months in one case. No statistical significance was noted between the type of surgery and the incidence of non-obstructive dilatation(p>0.05). CONCLUSION: Mild dilatation of the central intrahepatic ducts without evidence of mechanical biliary obstruction can be seen on follow-up CT obtained more than 6 months after gastrectomy for gastric carcinoma, and the incidence is about 12%. We think that this finding is non-obstructive and clinical evaluation is unnecessary.
Bile Ducts, Intrahepatic ; Cholecystectomy ; Dilatation* ; Follow-Up Studies ; Gastrectomy* ; Humans ; Incidence ; Retrospective Studies ; Tomography, X-Ray Computed ; Vagotomy, Truncal

OBJECTIVE: The purpose of this study was to review the clinical features, treatments and prognosis of the borderline malignant tumors of the ovary. METHODS: Thirty-two patients with borderline malignant tumors of the ovary were admitted, operated and confirmed with postoperative histopathological study at department of obstetrics and gynecology, Yonsei University Wonju Christian Hospital. The data were collected retrospectively and all charts were reviewed. RESULTS: The incidence of borderline malignant ovarian tumor was 19.2% (32/167). Age distribution revealed between 18 and 77 years old, the mean age was 43.1 years old. As for the parity distribution of borderline malignant tumor, nulliparity was most common (43.8%). The most common chief complaint was abdominal distension (34.4%). Histologic subtypes were mucinous in 19 cases (59.4%), serous in 13 cases (40.6%). According to FIGO classification, 28 cases (87.5%) were stage I, 1 case (3.1%) was stage II, 3 cases (9.4%) were stage III. Sixteen cases (50%) underwent conservative surgery (unilateral salpingooophorectomy or cystectomy). Sixteen cases (50%) were treated with total abdominal hysterectomy and bilateral salpingooophorectomy. Fifteen cases (46.9%) received adjuvant postoperative chemotherapy. Excluding 5 cases lost to follow up, patients were alive and were followed from 9 months to 100 months. (mean 36 months).
Age Distribution ; Aged ; Classification ; Drug Therapy ; Female ; Gangwon-do ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lost to Follow-Up ; Mucins ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies

OBJECTIVE: The purpose of this study was to review the clinical features, treatments and prognosis of the borderline malignant tumors of the ovary. METHODS: Thirty-two patients with borderline malignant tumors of the ovary were admitted, operated and confirmed with postoperative histopathological study at department of obstetrics and gynecology, Yonsei University Wonju Christian Hospital. The data were collected retrospectively and all charts were reviewed. RESULTS: The incidence of borderline malignant ovarian tumor was 19.2% (32/167). Age distribution revealed between 18 and 77 years old, the mean age was 43.1 years old. As for the parity distribution of borderline malignant tumor, nulliparity was most common (43.8%). The most common chief complaint was abdominal distension (34.4%). Histologic subtypes were mucinous in 19 cases (59.4%), serous in 13 cases (40.6%). According to FIGO classification, 28 cases (87.5%) were stage I, 1 case (3.1%) was stage II, 3 cases (9.4%) were stage III. Sixteen cases (50%) underwent conservative surgery (unilateral salpingooophorectomy or cystectomy). Sixteen cases (50%) were treated with total abdominal hysterectomy and bilateral salpingooophorectomy. Fifteen cases (46.9%) received adjuvant postoperative chemotherapy. Excluding 5 cases lost to follow up, patients were alive and were followed from 9 months to 100 months. (mean 36 months).
Age Distribution ; Aged ; Classification ; Drug Therapy ; Female ; Gangwon-do ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lost to Follow-Up ; Mucins ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies

This study aimed to investigate the independent and interactive influences of apolipoprotein E (APOE) epsilon4 and beta-amyloid (Abeta) on multiple cognitive domains in a large group of cognitively normal (CN) individuals and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Participants were included if clinical and cognitive assessments, amyloid imaging, and APOE genotype were all available from the Alzheimer's Disease Neuroimaging Initiative database (CN = 324, MCI = 502, AD = 182). Individuals with one or two copies of epsilon4 were designated as APOE epsilon4 carriers (epsilon4+); individuals with no epsilon4 were designated as APOE epsilon4 non-carriers (epsilon4-). Based on mean florbetapir standard uptake value ratios, participants were classified as Abeta burden-positive (Abeta+) or Abeta burden-negative (Abeta-). In MCI, APOE epsilon4 effects were predominantly observed on frontal executive function, with epsilon4+ participants exhibiting poorer performances; Abeta positivity had no influence on this effect. Abeta effects were observed on global cognition, memory, and visuospatial ability, with Abeta+ participants exhibiting poorer performances. Measures of frontal executive function were not influenced by Abeta. Interactive effects of APOE epsilon4+ and Abeta were observed on global cognition and verbal recognition memory. Abeta, not APOE epsilon4+, influenced clinical severity and functional status. The influences of APOE epsilon4+ and Abeta on cognitive function were minimal in CN and AD. In conclusion, we provide further evidence of both independent and interactive influences of APOE epsilon4+ and Abeta on cognitive function in MCI, with APOE epsilon4+ and Abeta showing dissociable effects on executive and non-executive functions, respectively.
Aged ; Aged, 80 and over ; Alzheimer Disease/genetics/pathology ; Amyloid beta-Peptides/*metabolism ; Aniline Compounds/chemistry ; Apolipoprotein E4/*genetics ; Brain/radiography ; Cognition ; Databases, Factual ; Demography ; Ethylene Glycols/chemistry ; Female ; Genotype ; Humans ; Male ; Mild Cognitive Impairment/genetics/*pathology ; Positron-Emission Tomography

PURPOSE: Recently, a percutaneous aspiration with sclerotherapy has become the treatment of choice for the symptomatic, large, and simple renal cyst because of its minimal invasiveness and high effectiveness. The recurrence rate of a percutaneous aspiration only, was reported to range from 30 to 70%. This study was performed to evaluate the effects of percutaneous aspiration with sclerotherapy. MATERIALS AND METHODS: The results of the treatment in 36 cases of simple renal cysts from October 1993 to December 1999 were evaluated. The symptoms associated with simple renal cysts were: flank pain or discomfort (50%), none (47.2%) and a palpable mass (2.8%). The simple renal cysts were treated with a percutaneous aspiration only in 6 cases, a percutaneous aspiration with sclerotherapy using 99% ethanol in 21 cases or a 10% minocycline solution in 9 cases. All patients were followed up by ultrasound for 6 to 56 months (mean 18 months). RESULTS: Complete collapse, and partial collapse rate of the renal cysts were 1/6 (16.7%), 2/6 (33.3%) in the aspiration only group, 6/21 (28.6%), 14/21 (66.7%) in the 99% ethanol group and 3/9 (33.3%), 4/9 (44.4%) in the 10% minocycline solution group, respectively. CONCLUSIONS: Therefore, a percutaneous aspiration with sclerotherapy using either 99% ethanol or 10% minocycline solution appears to be an effective way to the prevent re-accumulation of cystic fluid. However, the success rates in the percutaneous aspiration with sclerotherapy using 99% ethanol and 10% minocycline solution were not significantly different.
Ethanol ; Flank Pain ; Humans ; Minocycline ; Recurrence ; Sclerotherapy* ; Ultrasonography

BACKGROUND: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. MATERIAL AND METHOD: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). RESULT:The durations of chest tube placement after the procedure were 7.0+/-4.0 days (group A) and 6.7+/-3.6 days (group B). The hospital stays were 24.3+/-9.4 days (group A) and 30.7+/-21.5 days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group A=8.5+/-2.2 months, group B 8.0+/-7.4 months). The collapsed portions of lung were better expanded in group A than in group B (p-value= 0.011). CONCLUSION: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.
Chest Tubes ; Diagnosis ; Dyspnea ; Humans ; Length of Stay ; Lung ; Palliative Care ; Pleura ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis ; Pulmonary Atelectasis ; Talc* ; Thoracoscopy