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

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: 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

Neurilemmoma is a benign and slowly growing neurogenic tumor. Intrathoracic neurilemmoma often develops in the chest wall and posterior mediastinum, but endobronchial neurilemmoma is extremely rare. The diagnosis of endobronchial neurilemmoma with preoperative imaging findings is challenging and is usually made via postoperative pathological examination. These authors encountered a case of primary endobronchial neurilemmoma in a 52-year-old woman who had no symptoms. A 3.0 x 2.6 cm mass in the right lower lobe projecting into the mediobasal segmental bronchus was shown in the results of the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the chest. Benign neurilemmoma was confirmed via bronchoscopic biopsy, and surgical resection (sleeve bronchial excision and end-to-end anastomosis) was performed.
Biopsy ; Bronchi ; Female ; Humans ; Magnetic Resonance Imaging ; Mediastinum ; Middle Aged ; Neurilemmoma ; Pulmonary Surgical Procedures ; Thoracic Wall ; Thorax

Refinement of surgical techniques has allowed hearing preservation after tumor resection to be prioritized. Moreover, restoration of hearing after tumor removal can be attempted in patients with bilateral vestibular schwannomas or those with a schwannoma in the only-hearing ear. Cochlear implantation (CI) has emerged as a proper method of acoustic rehabilitation, provided that the cochlear nerve remains intact. Studies of electrical promontory stimulation in patients after vestibular schwannoma resection have demonstrated favorable results. We describe herein two cases of hearing rehabilitation via CI implemented at the time of vestibular schwannoma resection. Tumors were totally removed, and cochlear implant electrodes were successfully inserted in both cases. Also, post operative CI-aided hearing showed improved results.
Acoustics ; Cochlear Implantation* ; Cochlear Implants* ; Cochlear Nerve ; Ear ; Electrodes ; Hearing ; Humans ; Methods ; Neurilemmoma ; Neuroma, Acoustic* ; Rehabilitation

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*

BACKGROUND: Laparoscopic cholecystectomy has become the gold-tandard treatment for symptomatic gallbladder diseases. The evaluation and the treatment of common duct pathology is an essential component in the surgical management of biliary tract disease. The purpose of the present study was to identify the value and the importance of laparoscopic cholangiography compared to endoscopic retrograde cholangiography (ERC) in a laparoscopic cholecystectomy and to suggest the role of laparoscopic cholangiography in the management of patients undergoing laparoscopic cholecystectomy. METHODS: A laparoscopic cholecystectomy was attempted in two hundred six consecutive patients treated at Hallym University between January 1993 and December 1996. Patients were divided into three groups: In group I, 167 patients were examined with preoperative ERC while in group II, 17 patients were examined with laparoscopic cholangiography; Group III included 22 patients who were not examined with preoperative ERC or laparoscopic cholangiography. RESULTS: The average age was 52.78 years in group I, 45.62 years in group II, and 49.22 years in group III. The average operative time was 76.88 minutes in group I, 131.47 minutes in group II, and 85.22 minutes in group III. The operative time in group II was longer than that in group I (p<0.001). The duration of postoperative hospitalization was 4.9 days in group I and 4.11 days in group II, but this difference was not statistically significant (p=0.166). Conversion to an open cholecystectomy was 17/167 (10%) in group I, 1/17 (5%) in group II and 5/22 (22%). No complications or deaths occurred that were due to laparoscopic cholangiography. The postoperative complications in group I/II/III included bile leakage (3/0/2), bleeding in the bed of the gallbladder (5/0/0), wound bleeding (2/1/1), recurrent common duct stones (2/0/0), subcutaneous emphysema (4/1/0), shoulder pain (12/3/0), and wound infections (15/2/1). CONCLUSIONS: Although cholangiography may not be indicated for all patients undergoing a laparoscopic cholecystectomy, it will eventually be required. We conclude that laparoscopic cholangiography, as well as ERC, is a good method for evaluating the biliary tree. Laparoscopic cholangiography is clinically useful in patients who have negative ultrasonography and a dilated bile duct. Also, laparoscopic cholangiography has many advantages, especially at a teaching hospital: it outlines the anatomy of the extrahepatic biliary tree, identifies anomalies of surgical importance in time before iatrogenic damage is inflicted, detects stones in the cystic duct, discovers unsuspected stones, and develops experience with the technique. However, it is technically diffult to cannulate cystic duct and extends the operating time.
Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Hemorrhage ; Hospitalization ; Hospitals, Teaching ; Humans ; Operative Time ; Pathology ; Postoperative Complications ; Shoulder Pain ; Subcutaneous Emphysema ; Ultrasonography ; Wound Infection ; Wounds and Injuries