Attention is a phenomenon hard to define, but can be conceptualized as a mental function ranging from sustaining readiness to perceive stimuli to understanding the nature and value and selecting stimuli that are most relevant to the given situation. Manifestations of attention include vigilance, and focused, directed, selective, divided, and sustained attentions. While basic attentional tone is controlled by the interaction among reticular activating system, thalamus, and prefrontal cortex, direction and selection of attention is controlled by neural circuits of prefrontal, posterior parietal, and limbic cortex. It is expected that understanding of attention and its neural could provide answers to the relationship between pathophysiology and clinical symptoms of some major psychiatric disorders. More effort are required to develop tools to assess more detailed and various aspects of attention in Korea.
Attention ; Korea ; Prefrontal Cortex ; Rabeprazole ; Thalamus

It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

Malignant thymoma is usually manifested as a mediastinal mass. Occasiomally, these tumors may be associated with a variety of systemic syndromes, such as myasthenia gravis, pure red cell aplasia or hypogammaglobulinemia. However, it is generally accepted that thymomas rarely metastasize and the frequency of extrathoracic metastasis has been reported as 1 to 15%. In general, nuclear changes of tumor cells such as enlarged size, irregular shape and altered textures are determining feactors in the assessment of the grade of malignancy. We experienced a case of malignant thymoma of anterior mediastinum in a 35-year-old woman. After 3 years, she developed recurrent malignant thymoma in the right supraclavicular area, diagnosed by aspiration biopsy cytology.
Adult ; Agammaglobulinemia ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Female ; Humans ; Mediastinum ; Myasthenia Gravis ; Neoplasm Metastasis ; Red-Cell Aplasia, Pure ; Thymoma*

OBJECTIVES: Mechanisms of clinical synergistic effects, induced by co-treatments of lithium and valproate, are unclear. Extracellular signal-regulated kinase (ERK) has been suggested to play important roles in mechanisms of the action of mood stabilizers. In this study, effects of co-treatments of lithium and valproate on the ERK1/2 signal pathway and its down-stream transcription factors, ELK1 and C-FOS, were investigated in vitro. METHODS: PC12 cells, human pheochromocytoma cells, were treated with lithium chloride (30 mM), valproate (1 mM) or lithium chloride + valproate. The phosphorylation of ERK1/2 was analyzed with immunoblot analysis. Transcriptional activities of ELK1 and C-FOS were analyzed with reporter gene assay. RESULTS: Single treatment of lithium and valproate increased the phosphorylation of ERK and transcriptional activities of ELK1 and C-FOS, respectively. Combined treatments of lithium and valproate induced more robust increase in the phosphorylation of ERK1/2 and transcriptional activities of ELK1 and C-FOS, compared to those in response to single treatment of lithium or valproate. CONCLUSIONS: Co-treatments of lithium and valproate induced synergistic increase in the phosphorylation of ERK1/2 and transcriptional activities of its down-stream transcription factors, ELK1 and C-FOS, compared to effects of single treatment. The findings might suggest potentiating effects of lithium and valproate augmentation treatment strategy.
Animals ; Genes, Reporter ; Humans ; Lithium Chloride ; Lithium* ; PC12 Cells* ; Pheochromocytoma ; Phosphorylation* ; Phosphotransferases ; Signal Transduction ; Transcription Factors ; Valproic Acid*

BACKGROUND/AIMS: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. METHODS: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. RESULTS: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. CONCLUSIONS: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture.
Bile Ducts ; Catheters ; Constriction, Pathologic* ; Drainage* ; Duodenoscopes ; Hemorrhage ; Hepatic Duct, Common ; Humans ; Palliative Care ; Plastics ; Sphincterotomy, Endoscopic ; Stents*

Gastric antral vascular ectasia (GAVE) is a rare but important cause of chronic gastrointestinal bleeding. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Many treatment modalities of the gastric antral vascular ectasia exist. One of them, the argon plasma coagulation (APC) is an excellent therapeutic tool. Inactive argon gas is converted to ionized form by means of electrical energy. Ionized argon plasma conducts high frequency electrical energy to tissues and leads coagulation necrosis of tissues. We experienced a case of gastric antral vascular ectasia presenting melena for about one month in a 72-year-old man treated endoscopically in four sessions with argon plasma coagulation.
Aged ; Argon Plasma Coagulation* ; Argon* ; Biopsy ; Diagnosis ; Endoscopy ; Gastric Antral Vascular Ectasia* ; Hemorrhage ; Humans ; Melena ; Necrosis ; Plasma ; Pylorus

BACKGROUND: The diagnostic criteria of laryngopharyngeal reflux disease (LPRD) is defined differently according to the location of the proximal pH probe: upper esophagus, upper esophageal sphincter (UES) or hypopharynx. Clinically the location of proximal probe is determined by the location of distal probe, which is usually fixed on 5 cm above the lower esophageal sphincter. This study was performed to evaluate the difference in the diagnosis of LPRD between the results from considering the location of the proximal probe and not considering it. METHODS: This study consisted of 76 patients performed esophageal manometry and 24 hour ambulatory pH monitoring of esophagus using the dual probe. According to location of the proximal probe, the patients were divided into 3 groups : upper esophagus, UES and hypopharynx group. Firstly, we used the diagnostic criteria not considering the location of the probe concordantly in all 76 patients : criteria of the upper esophagus, UES and hypopharynx respectively. And then, we used the diagnostic criteria considering the location of the proximal probe. The results were compared. RESULTS: When the diagnostic criteria of upper esophagus was used, 3.9% (3/76) was diagnosed as LPRD. In the case of UES and hypopharynx, 18.4% (14/76) and 38.2% (29/76) was diagnosed as LPRD. When the diagnostic criteria considering the location of the proximal probe was used, 27.6% (21/76) was diagnosed as LPRD. Significant difference was found between the result considering the location of the probe and 3 results not considering it (p<0.01). CONCLUSION: It is thought to be appropriate to use the diagnostic criteria considering the location of the proximal probe for the more accurate diagnosis of LPRD.
Diagnosis ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Humans ; Hydrogen-Ion Concentration* ; Hypopharynx ; Laryngopharyngeal Reflux* ; Manometry ; Monitoring, Ambulatory

BACKGROUND/AIMS: Serum HBV DNA levels are correlated with hepatic histologic activity in chronic HBV infection based on HBeAg. Liver injury may persist, even though HBV DNA are not detected by hybridization assay. This study was to investigate whether serum HBV DNA levels determined by more sensitive quantitative method are correlated with histologic activities in chronic HBV infections. METHODS: This study included 66 chronic HBV infected patients. HBV DNA level was quantified by Cobas Amplicor HBV Monitor(TM). RESULTS: Serum HBV DNA levels in HBeAg-positive patients were significantly higher than HBeAg-negative patients. In HBeAg-positive patients, serum HBV DNA levels showed a significant negative correlation with portal-periportal activity and fibrosis (r=-0.451, -0.446 respectively). AST levels were correlated with lobular, portal-periportal activity and fibrosis (r=0.432, 0.365, 0.301 respectively), whereas ALT levels were related to lobular activity (r=0.294). Elevated AST levels predicted lobular activity, portal-periportal activity, and fibrosis with moderate to severe degree (OR 1.733, 95% CI 1.083-2.775; OR 1.518, 95% 1.028-2.243, p=0.336; OR 17.897, 95% CI 1.517-211.208, p=0.022, respectively). CONCLUSIONS: In HBeAg-positive patients, serum HBV DNA level correlates inversely with histologic activity. On the other hands AST level correlates with histologic activity and the stage of moderate or severe degree.
Adolescent ; Adult ; Child ; Child, Preschool ; DNA, Viral/*blood ; Female ; Hepatitis B e Antigens/analysis ; Hepatitis B virus/genetics/*isolation & purification ; Hepatitis B, Chronic/pathology/*virology ; Humans ; Liver/*pathology ; Male ; Middle Aged

OBJECTIVE: The purpose of this study is to investigate the prevalence and course of autonomic nervous system related adverse effects (ARAEs) reported in patients treated with clozapine. METHOD: Ninety-one patients treated with clozapine were recruited from the Seoul National University Hospital Treatment-Resistant Schizophrenia Clinic. Medical records were reviewed for the prevalence and course of 14 ARAEs related to clozapine treatment. ARAEs with the prevalence greater than 10 % were selected and analyzed for their relationship with the demographic variables of the subjects and for the distribution of the duration of treatment and daily dosage of clozapine. RESULTS: Eighty-one(97.8%) patients experienced at least one ARAE during treatment with clozapine. The most frequent ARAE was hypersalivation, followed by constipation, tachycardia, orthostatic hypotension, nausea, diaphoresis, frequency, enuresis, vomiting, blurred vision, dry mouth, diarrhea, incontinence and urinary retention. None of the 7 selected frequent ARAEs had significant relationship with the age or sex of the subjects. Most of them developed within 8 weeks of clozapine treatment and at the dose of clozapine under 200mg/day. Among the total 248 events of ARAEs, 35 events required additional medications to alleviate the symptoms, 8 required other medical interventions, and 3 required reduction of clozapine dose. There was no case which necessitated withdrawal of clozapine therapy. CONCLUSION: The findings from this study suggest that almost all patients treated with clozapine experienced one or more ARAEs. Most of them occurred during the initial phase of treatment and managed without further medical treatment.
Autonomic Nervous System* ; Clozapine* ; Constipation ; Diarrhea ; Enuresis ; Humans ; Hypotension, Orthostatic ; Medical Records ; Mouth ; Nausea ; Prevalence ; Schizophrenia ; Seoul ; Sialorrhea ; Tachycardia ; Urinary Retention ; Vomiting

Situs inversus totalis is a rare condition with a genetic predisposition that is autosomal recessive. We report an elderly patient with situs inversus, multiple choledocholithiasis, and he was treated via endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, and then his multiple CBD stones were removed with basket and balloon. This paper further expands the application of these techniques and shows that they can be safely and effectively applied in the setting of situs inversus, although attention must be paid to the details of left-right reversal.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis* ; Genetic Predisposition to Disease ; Humans ; Situs Inversus*