PURPOSE: Endoscopic variceal sclerotherapy(EVS) has been considered the mainstay therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done of children. METHODS: We performed EVL in 9 children under 6 years of age(mear age, 2.5 year) with esophageal varices. Outcome was assessed with respect to survival, rebleeding, and complications. RESULTS: The causes of portal hypertension were 3 cases of congenital hepatic fibrosis, 3 cases of biliary atresia, 2 cases of portal vein thrornbosis, and one case of portal vein fibromuscular dysplasia. The age at diagnosis ranged from 10 months to 6 years. The patients underwent a mean of 2.6+/- 0.7 sessions of EVL(ranging from two to four). The numbers of bands per person were 5.6+/-1.8, and the numbers of bands per session were 2.2+/-1.0 Two complications of esophageal rebleeding were noted, and none of the cases experienced symptoms of esophageal stenosis, nor gastroesophageal reflux. CONCLUSION: EVL is safe and effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The cornplication rate is low and EVL is an acceptable and perhaps preferable altemative to EVS in children with esophageal varices. But regular periodic examination for recurrence of varices after eradication should be required.
Adult ; Biliary Atresia ; Child* ; Diagnosis ; Esophageal and Gastric Varices* ; Esophageal Stenosis ; Fibromuscular Dysplasia ; Fibrosis ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation* ; Portal Vein ; Recurrence ; Varicose Veins

PURPOSE: This study is aimed at identifying the effects of telephone counseling as nursing support on distress, anxiety, depression, and adverse events in cancer patients undergoing their first chemotherapy. METHODS: This was a randomized controlled trial (pretest-posttest design). A total of 70 patients who showed 4 or higher distress scores were selected from the screening process. Four patients dropped out; therefore, 66 patients participated in this research. Thirty-two and 34 patients were randomly assigned to the experimental and the control group, respectively. After a preliminary survey, telephone counseling support was given to the experimental group at three time points. The post survey was done before the second cycle of chemotherapy. RESULTS: Regarding distress, both groups showed a statistically significant decrease in the scores: 3.4 for the experimental group and 1.8 for the control group (p=.002). Furthermore, the experimental group demonstrated a statistically significant decrease relative to the control group. Anxiety and depression showed no statistically significant difference between the two groups. CONCLUSION: This study concludes that nursing support through phone counseling is effective in decreasing distress in patients undergoing chemotherapy for the first time.
Anxiety* ; Counseling* ; Depression* ; Drug Therapy* ; Humans ; Mass Screening ; Nursing ; Telephone*

Background/Aims: This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. Methods: This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. Results: Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. Conclusions Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

OBJECTIVE: Body weight is an important indicator of a person's health status. In this study, we evaluated the effectiveness of the body weight management system, HIMS (Health Improvement and Management System)-Diet, which instantly provides users with feedback on their measured weight using the database that stores the user.customized information. METHODS: The participants of this experimental study used the system two or three times a week for 10 weeks. We analyzed the changes in their body weight and body mass index (BMI) according to their respective usage of the system. RESULTS: Participants' body weight and BMI decreased with respect to their individual usage of the system. Participants that used the system frequently for a longer time period improved significantly in their body weight and BMI. CONCLUSION: The experimental study showed that the body weight management system, HIMS-Diet, was effective in controlling people's body weight.
Body Mass Index ; Body Weight ; Body Weight Changes

PURPOSE: To compare lumbar disc changes between initial lumbar spine (L-spine) MRI and follow-up (f/u) MRI that were performed due to recurred backaches. MATERIALS AND METHODS: A total 50 patients who had undergone f/u L-spine MRI were retrospectively reviewed. Five discs (L1-S1) were surveyed in each f/u MRI. Lumbar disc changes were defined as no change, aggravations, or improvements compared to initial disc states. These states were defined on the basis of morphologic status and disc levels. RESULTS: In a total of 250 discs in 50 patients, 31 discs (12.4%) showed morphologic changes of disc lesions, whereas 219 discs (87.6 %) showed no changes. Among the 31 disc lesions, 24 were aggravated and 7 were partially improved. And on the basis of disc status, initially abnormal discs revealed any morphologic changes of the degree of disc herniation. A total of 33.3% of the morphologic changes are noted in initially extruded discs. Fifteen morphologic changes of disc lesions were located at the L4-5 level. CONCLUSION: Our results suggest that correlations between lumbar disc herniations and back pain symptoms are limited, and that evaluations of extra disc lesions are required.
Back Pain ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Natural History ; Retrospective Studies ; Spine

BACKGROUND: The metabolic risks associated with obesity are closely correlated with a central rather than a peripheral fat pattern. These complications of obesity have been attributed to increase in visceral adipose tissue. The aim of this study was to investigate whether the dual- energy X-ray absorptiometry (DEXA) method offers a good alternative to computed tomography (CT) for the prediction of visceral fat in the obese women in correlation of metabolic complication markers. METHODS: The design is a cross-sectional analysis. Total body fat and truncal fat amounts were measured by using DEXA, while total abdominal fat area was measured by CT, and divided into visceral abdominal fat area and subcutaneous fat area. Partial correlation after controlling for age and multiple regression analyses after adjusting for age and total percent body fat were performed to relate the metabolic variables to the CT and DEXA body composition variables. RESULTS: For serum uric acid, total abdominal fat area by CT had the largest R2 values (R2=0.259). For AST, ALT, total cholesterol and log triglyceride, visceral fat area had the largest R2 values (R2= 0.360, 0.407, 0.147, and 0.339), respectively, and for log insulin, truncal fat by DEXA had the largest R2 values (R2=0.275). CONCLUSION: Truncal fat amount measured by DEXA had a strong correlation with visceral fat area measured by CT. Truncal fat amount measured by DEXA and correlated significantly with visceral abdominal fat area measured by CT reflected most of the metabolic complication markers.
Abdominal Fat ; Absorptiometry, Photon ; Adipose Tissue ; Adult* ; Body Composition ; Cholesterol ; Cross-Sectional Studies ; Female ; Humans ; Insulin ; Intra-Abdominal Fat ; Obesity* ; Subcutaneous Fat ; Triglycerides ; Uric Acid

Klippel-Feil syndrome (KFS) displays congenital fusion of the cervical vertebrae; it is a relatively common condition and has many associated malformations such as Sprengel's deformity, scoliosis, rib anomalies, congenital defects of the brain or spinal cord, renal anomalies, congenital heart disease, deafness, cleft palate, cranial and facial asymmetry, and enteric cysts. There are various types of cervical fusion observed in KFS. However, fusion of the odontoid process with the atlas is a very rare finding. We report here on a 4-year-old boy with unilateral fusion of a separated odontoid process with the lateral mass of the atlas, and this was associated with a spontaneously closed ventricular septal defect, a small patent ductus arteriosus and a horseshoe kidney.
Brain ; Cervical Vertebrae ; Child, Preschool ; Cleft Palate ; Congenital Abnormalities ; Deafness ; Ductus Arteriosus, Patent ; Facial Asymmetry ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Kidney ; Klippel-Feil Syndrome* ; Male ; Odontoid Process* ; Ribs ; Scoliosis ; Spinal Cord

OBJECTIVE: Several studies have suggested the efficacy of bupropion and escitalopram on reducing the excessive internet game play. We hypothesized that both bupropion and escitalopram would be effective on reducing the severity of depressive symptoms and internet gaming disorder (IGD) symptoms in patients with both major depressive disorder and IGD. However, the changes in brain connectivity between the default mode network (DMN) and the salience network were different between bupropion and escitalopram due to their different pharmacodynamics. METHODS: This study was designed as a 12-week double blind prospective trial. Thirty patients were recruited for this research (15 bupropion group+15 escitalopram group). To assess the differential functional connectivity (FC) between the hubs of the DMN and the salience network, we selected 12 regions from the automated anatomical labeling in PickAtals software. RESULTS: After drug treatment, the depressive symptoms and IGD symptoms in both groups were improved. Impulsivity and attentional symptoms in the bupropion group were significantly decreased, compared to the escitalopram group. After treatment, FC within only the DMN in escitalopram decreased while FC between DMN and salience network in bupropion group decreased. Bupropion was associated with significantly decreased FC within the salience network and between the salience network and the DMN, compared to escitalopram. CONCLUSION: Bupropion showed greater effects than escitalopram on reducing impulsivity and attentional symptoms. Decreased brain connectivity between the salience network and the DMN appears to be associated with improved excessive IGD symptoms and impulsivity in MDD patients with IGD.
Brain ; Bupropion* ; Citalopram* ; Depression ; Depressive Disorder, Major* ; Humans ; Immunoglobulin D ; Impulsive Behavior ; Internet* ; Magnetic Resonance Imaging ; Prospective Studies ; Video Games

BACKGROUND: Pilomatricoma (PM) is benign follicular tumor composed of the basophilic cells, transitional cells, shadow cells, squamoid cells and keratin filaments/amorphous debris. At present, PM is assumed to differentiate toward hair-forming cells of hair follicles but definite direction is not clear. OBJECTIVES: This study was made in order to investigate the pathways of cell differentiation associated with sudden keratinization in PM. METHODS: In the present study, 19 cases of human PM was histopathologically examined and classified into 4 groups according to the chronological stages. RESULTS: In the chronological stages according to Kaddu's classification, there were 2 cases of early lesion, 6 cases of fully developed lesion, 7 cases of early regressive lesion and 4 cases of late regressive lesion. The basophilic cells changed into the shadow cells or amorphous debris through the transitional cells moving toward the exterior of the PM, as well as toward the interior. As keratinization occurs, some inner basophilic cells which had been located in marginal areas of keratinization lost their tight cell-cell bonding. These cells showed edematous/vesicular and squamoid changes. High molecular weight cytokeratin was expressed in a linear pattern in some early and fully developed lesions. There were fewer layers of basophilic cells between the stroma and squamoid cells/amorphous debris than between the stroma and shadow cells. Ki-67 was expressed strongly both basal and overlying basophilic cells. Apoptotic bodies were detected in most transitional cell layers and some amorphous debris zones. CONCLUSIONS: The present study suggests dual pathways of cell differentiation in PMs. In the sudden keratinization pathway, the basophilic cells, transtional cells, shadow cells, and squamoid cells are suddenly keratinized, and the basophilic cells become early the transitional cells or squamoid cells. Cytoplasmic expressions of Ki-67 and cytokeratin in the basophilic cells show that the basophilic cells differentiate toward the innermost layer of the outer root sheath cells.
Apoptosis ; Basophils ; Cell Differentiation ; Classification ; Cytoplasm ; Hair Follicle ; Humans ; Keratins* ; Molecular Weight ; Pilomatrixoma*

BACKGROUND: Chemokines and their receptors are important players in tumorigenesis by facilitating tumor proliferation and metastasis. Little is known about the possible function of chemokine receptors in relation to the development and progression of malignant cutaneous tumors. OBJECTIVE: The aim of this study was to determine the chemokine receptor CCR3 expression pattern and the protein expression level in selected malignant cutaneous tumors. METHODS: Four types of cell lines (G361, A431, SK-MEL-2, SK-MEL-24) were analyzed, using Western blotting, for the expression of CCR3 protein. Immunohistochemical staining for CCR3 was done on 36 skin cancer tissue samples that included 16 squamous cell carcinomas (SCCs), 16 basal cell carcinomas (BCCs), 16 malignant melanomas (MMs) and 6 normal tissue samples. RESULTS: Western blot analysis showed that CCR3 protein was more expressed in the MM cell lines (G361, SK-MEL-2,SK-MEL-24) than that in the SCC cell line (A431), and the immunohistochemical analysis showed that CCR3 protein was overexpressed in MM and SCC, it was mildly expressed in BCC and it was hardly expressed in normal tissue. CONCLUSION: This study demonstrated via immunochemistry that CCR3 was more expressed in MM, followed by SCC and BCC. The existence of CCR3 protein may enhance the tumorigenic potential of malignant cutaneous tumors.
Blotting, Western ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cell Line ; Cell Transformation, Neoplastic ; Chemokines ; Immunochemistry ; Melanoma ; Neoplasm Metastasis ; Receptors, CCR ; Receptors, Chemokine ; Skin Neoplasms