OBJECTIVE: The results for finding the deficit in the anterior cingulate (ACC) in schizophrenic patients (SZ) have been inconsistent according to the studies that used different Stroop tasks, which is unlike the deficit in the dorsolateral prefrontal cortex (DLPFC). In order to explore for the core region that's responsible for the selective attention deficit in SZ, we examined the results of a functional neuroimaging study, which involved the performance of the Stroop task using high or low prefrontal cortex related loads in SZ. METHODS: Ten schizophrenic patients and healthy controls (HC) received functional magnetic resonance imaging (fMRI) during a Short/Long-term latency Stroop task. The changes in the neural activity were determined in well-known Stroop related regions of interest (ROIs) that consisted of the DLPFC, ACC, the parietal lobule and in the whole brain regions for both the main and interaction effects of latency, and the results of the short-term and long-term latency Stroop conditions were compared. RESULTS: The response times for both the congruency and latency effects were more prolonged in the schizophrenics than in the HC. For the congruency effect, the schizophrenics showed significantly less activation in the same site of the left DLPFC in both the short-term and long-term latency conditions, as compared with the HC. For the latency effect, the regions of the left-side language network were over- or under-activated in the schizophrenics, as compared with the HC. Any interaction effect was not found for both the behavioral and fMRI results. CONCLUSION: Our results indicate that the deficit in the left DLPFC is the core impairment of attentional processing in schizophrenics, regardless of other possible interactions such as the latency effect.
Brain ; Functional Neuroimaging ; Humans ; Magnetic Resonance Imaging ; Prefrontal Cortex* ; Rabeprazole ; Reaction Time ; Schizophrenia*

PURPOSE: To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome. CASE SUMMARY: A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2 days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes.
Adult ; Anterior Chamber ; Diaphragm ; Displacement (Psychology) ; Eye ; Female ; Humans ; Intraocular Pressure ; Methylprednisolone ; Microscopy, Acoustic ; Myopia ; Ophthalmic Solutions ; Subretinal Fluid ; Uveomeningoencephalitic Syndrome ; Visual Acuity

In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC) accompanied by hepatitis E virus (HEV) infection, hepatic failure often leads to debility. Here, we report about a 63-year-old man with alcoholic LC who was referred to our hospital with jaundice and abdominal distension 10 days earlier. Abdominal computed tomography showed necrotic HCC accompanied by left lobe shrinkage without tumor progression. Laboratory and imaging findings revealed no acute infection focus. The patient reported no herbal medicine or alcohol consumption, and there was no evidence of acute viral hepatitis. One month later, HEV immunoglobulin M positivity was confirmed, and deterioration of liver function due to HEV infection was suspected. The patient often ate raw oysters and sashimi, as well as boar meat, which is a well-known risk food for HEV infection. His umbilical hernia deteriorated due to tense ascites and infection by skin abrasion. The patient progressed to hepatorenal syndrome and eventually died. Liver function preservation is important when treating HCC patients. Therefore, clinicians should pay more attention to the prevention of HEV and others causes of direct liver injury.
Alcohol Drinking ; Alcoholics ; Ascites ; Carcinoma, Hepatocellular ; Hepatitis E virus ; Hepatitis E ; Hepatitis ; Hepatorenal Syndrome ; Herbal Medicine ; Hernia, Umbilical ; Humans ; Immunoglobulin M ; Jaundice ; Liver ; Liver Cirrhosis ; Liver Failure ; Meat ; Middle Aged ; Ostreidae ; Skin ; Transcutaneous Electric Nerve Stimulation

Bezoars are persistent concretions of indigestible matter, usually seen in the stomach. But very rarely have bezoars been reported in the esophagus.. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus. A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.
Aged ; Bezoars* ; Candidiasis* ; Constriction, Pathologic ; Endoscopy ; Esophagus ; Gastrectomy ; Humans ; Middle Aged ; Stomach ; Stomach Neoplasms

35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations.
Cicatrix ; Drinking ; Endoscopy* ; Esophagogastric Junction ; Esophagus ; Hematemesis ; Hemorrhage ; Humans ; Internal Medicine ; Lacerations ; Male ; Mallory-Weiss Syndrome ; Melena ; Precipitating Factors ; Stomach ; Vomiting

Fetomaternal hemorrhage is very common and the commonest cause of anernia in the newborn. But, few blood cells enter the maternal circulation in most pregnancies. Occasionally large intrauterine bleeding results in severe fetal and neonatal anemia, shock, and rarely death. To identify the fetal blood in the maternal circu1ation, acid elution technique of Kleihauer-Betke test is usually used. And imrnedate neonatal blood transfusion should be done for good prognosis. We report a case of massive feto-maternal hemorrhage (>100 ml) in a preterm neonate with severe anemia at birth, which was diagnosed by Kleihauer-Betke test and was treated with blood transfusion.
Anemia ; Anemia, Neonatal ; Blood Cells ; Blood Transfusion ; Female ; Fetal Blood ; Fetomaternal Transfusion ; Hemorrhage* ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Prognosis ; Shock

PURPOSE: In response to a growing threat of violence in hospitals, we examined a specific educational effort to reduce emergency department (ED) violence in the shortterm. METHODS: Cross-sectional prospective surveys were conducted at Chosun University Hospital Emergency Center during a baseline period from May 26 to Jul. 9. 2003, and during a post-education period from Aug. 7 to Sep. 20. 2003. Questions addressed the degree of violence, the reason for the violence, demographic information about the perpetrator of the violence, the outbreak time of the violence and the response of emergency personnel. RESULTS: After an education program on violence, the rate of violent events in the ED was decreased by 23.5%. A notable change was that ED workers handled the violence more positively during the post-education period by isolating or restraining the aggressor. Almost all of the violence was caused by males, particularly those in their third or fourth decade. The violence occurred mostly on the night shift. Of the violence, 52.4% was caused by the patient while 34.8% was caused by the patient's guardian. The leading causes of violence were drunkenness and delays in laboratory tests and treatment. Verbal abuse and threats were the most concern forms of violence. CONCLUSION: Violent events are frequent in the ED. Education programs may reduce the number of events at least temporarily.
Alcoholic Intoxication ; Education* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Male ; Prospective Studies ; Violence*

PURPOSE: To assess the agreement and compare the performance of glaucoma diagnosis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements between two different spectral-domain optical coherence tomography (SD-OCT) devices. METHODS: Eighty nine eyes of 56 patients with glaucoma and 42 eyes of 25 healthy individuals were imaged with Cirrus and Spectralis OCT in a single visit. Agreement between RNFL thickness measurements was assessed using intraclass coefficient (ICC) and Bland-Altman plots. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC) for quadrants and average RNFL thickness. RESULTS: ICC values for agreement between both instruments were good for quadrants and average RNFL thickness (all ≥ 0.81). However, Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant (difference = 4.27 µm in normal group, 3.91 µm in glaucoma group, p < 0.001 for both). The RNFL thickness parameter with the largest AUCs was the average RNFL thickness for the Spectralis OCT and the Cirrus OCT (0.85 vs. 0.87, p = 0.30). The pair-wise comparison among the receiver operating characteristic curves showed no statistical difference for all parameters. CONCLUSIONS: Although Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant, agreement of RNFL measurement between both the devices was generally good and there was no statistically significant difference in the performance of glaucoma diagnosis between both instruments.
Area Under Curve ; Diagnosis ; Glaucoma ; Humans ; Nerve Fibers* ; Retinaldehyde* ; ROC Curve ; Tomography, Optical Coherence*

PURPOSE: There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO. METHODS: Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed. RESULTS: A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P=0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery. CONCLUSION: Surgical management should be considered among adhesive SBO patients with elevated amylase (> or =90 IU/L) and ESR (> or =11 mm/hr) and with large drainage amount through the Levin tube (> or =500 mL/day).
Adhesives ; Amylases ; Blood Sedimentation ; Creatine Kinase ; Drainage ; Humans ; Laparotomy ; Medical Records ; Multivariate Analysis ; Retrospective Studies

BACKGROUND: There are numerous therapeutic options for molluscum contagiosum (MC) and these may be broadly subdivided into surgical procedures (curettage, squezzing), chemical application (silver nitrate, cantharidin) and immunological therapies (imiquimod). However, in young children it is quite difficult to treat the condition due to pain associated with these procedures. Therefore, physicians need to consider more tolerable treatment options in pediatric patients. OBJECTIVE: We evaluated 20 children with MC for clinical effectiveness and side effects of imiquimod application. METHODS: Twenty children with MC were asked to apply 5% imiquimod cream three times per week at nights every other day for between 8~12 weeks. RESULTS: Nine of the 20 patients (45%) achieved complete clearance after a mean treatment period of 6.9 weeks. Partial clearance was observed in 10 patients (50%) and no response in 1 patient (5%). No patients dropped out due to adverse effects. Twelve children (60%) reported erythema and five children (25%) reported itching. CONCLUSION: Therapy with imiquimod cream was found to be effective, safe and painless in the treatment of MC in children. However, large-scale, double-blind, controlled prospective studies are needed to confirm the effectivenss of Imiquimod cream.
Child* ; Erythema ; Humans ; Molluscum Contagiosum* ; Pruritus