We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.
Appetite ; Blood Pressure ; Cardiovascular System ; Epilepsy ; Heart Rate ; Methylphenidate ; Tics

We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.
Appetite ; Blood Pressure ; Cardiovascular System ; Epilepsy ; Heart Rate ; Methylphenidate ; Tics

OBJECTIVES: This study was done in adolescents with a high risk of substance or internet addiction in order to confirm the assumption that insecure attachment formation and impulsivity-inattention problems are major risk factors in adolescent addictive behavior. METHODS: 2,188 middle and high school students including a nicotine dependent treatment group were assessed using self-reporting scales : Adolescent Drinking Index (ADI), Fagerstrom Tolerance Questionnaire, Young Internet Addiction Scale, Revised Adult Attachment Scale (RAAS), and the Conner and Well's Self-reporting Scale for ADHD (CASS) were used. Subjects were classified into risk groups including substance addiction, internet addiction, as well as a combined group. RESULTS: Significant correlations were found between attachment formation and internet addiction tendencies, with respect to dependence, anxiety, and closeness (r=-0.185, r=0.248, r=-0.147, p<0.01, respectively). Impulsivity-inattention problems had positive correlations with internet addiction, alcohol addiction and nicotine addiction groups (r=0.345, r=0.211, r=0.187, p<0.01). With regard to attachment formation, the four groups showed significant differences regarding dependence (F=19.427, p<0.01), anxiety (F=28.926, p<0.01), and closeness (F=12.853, p<0.01). In addition, the four groups showed significant difference with respect to impulsivity-inattention problems (F=83.857, p<0.01), of which the combined risk group showed the highest scores, and the non-addicted group had the lowest scores. CONCLUSION: Insecure attachment formation and impulsivity-inattention problems were major risk factors for adolescent addictive behavior including internet addiction.
Adolescent ; Adult ; Anxiety ; Behavior, Addictive ; Drinking ; Humans ; Internet ; Nicotine ; Surveys and Questionnaires ; Risk Factors ; Substance-Related Disorders ; Weights and Measures

BACKGROUND/AIMS: Well differentiated rectal carcinoid tumors which are less than 1cm in diameter can be treated by endoscopic resection. We aimed to evaluate the efficacy of endoscopic resection in treating small sized rectal carcinoids. METHODS: Medical records of 30 rectal carcinoid cases treated by endoscopic resection in Yonsei University College of Medicine, Severance Hospital between January 1995 and March 2007 were reviewed retrospectively. RESULTS: Mean age was 49.7 years and male to female ratio was 1:0.88. Mean size of tumor was 6.29+/-3.06 mm and 25 out of 30 patients (83.3%) had tumors of diameter less than 10 mm. Twenty-two out of 30 patients treated by conventional polypectomy, 6 by endoscopic mucosal resection using a transparent cap (EMR-C) and 2 by endoscopic submucosal dissection (ESD). Histological examination revealed that 9 patients had resection margin positive for tumor; 7 (31.8%) were in polypectomy group, 1 (16.7%) in EMR-C group, and 1 (50%) in ESD group (p=0.868). Five patients underwent transanal excision to remove residual tumor. No residual tumor was found in additionally resected tissue. Mean follow-up duration was 19. 3 months (range 0-122), and there were no recurrence. CONCLUSIONS: Endoscopic resection is an effective method in the treatment of small rectal carcinoids. However, long-term outcome remains to be elucidated by a large scaled prospective study.
Adult ; Aged ; Carcinoid Tumor/pathology/*surgery/therapy ; Demography ; *Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Humans ; Male ; *Microsurgery ; Middle Aged ; Rectal Neoplasms/pathology/*surgery/therapy ; Retrospective Studies ; Treatment Outcome

BACKGROUND/AIMS: Obstruction of the main pancreatic duct (MPD) has been considered one of the major causes for pain in chronic pancreatitis (CP). In this study, we evaluated the efficacy of MPD stenting in painful CP, and tried to determine a guideline for stent removal. METHODS: Sixteen patients with painful CP who underwent MPD stenting were included. Follow up ERCP was performed 3 months after stenting in all patients. Stents were removed in patients who achieved pain relief, complete stone clearance, and decreased MPD diameter after 3 months. RESULTS: Before stenting, ERCP showed MPD stricture in 11 cases, MPD dilatation by stone in 1 case, concomitant stricture and stone in 4 cases. After stenting, complete pain relief was achieved in 13 patients (81.3%) and partial pain relief was achieved in 3 patient (18.7%). There was no patient whose pain was not relieved. Stents were removed in 7 patients who achieved pain relief, complete stone clearance, and decreased MPD diameter after 3 months. Decrease of MPD diameter was significantly greater in patient who could remove stent than those who could not (72.9% vs. 127.9% of initial MPD diameter, p=0.008). CONCLUSIONS: If partial or full pain relief is achieved after MPD stenting and follow up ERCP after 3 months shows decreased MPD diameter compared to the initial one, stent removal might be considered.
Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Pancreatic Ducts* ; Pancreatitis, Chronic* ; Stents*

"Biliary cast syndrome" describes a cast formed from retained lithogenic material, and this cast is morphologically confined to the bile duct; this develops in 4~18% of liver transplant recipients. The pathogenesis of cast formation is not clearly understood. The proposing etiological factors for biliary cast syndrome include acute cellular rejection, a prolonged cold ischemic time, use of postoperative biliary drainage tubes and biliary infection. These casts are more likely to develop in the setting of hepatic ischemia and biliary stricture. Endoscopic and percutaneous cast extraction might achieve favorable results and this should be attempted before surgical therapy. We report here on a case of biliary cast syndrome that was secondary to orthotopic liver transplantation; this was successfully treated via percutaneous choledochoscopic removal. We also include a review of the literature.
Bile Ducts ; Cold Ischemia ; Constriction, Pathologic ; Drainage ; Humans ; Ischemia ; Liver Transplantation* ; Liver* ; Superior Mesenteric Artery Syndrome ; Transplantation

BACKGROUND: Cystic neoplasms of the pancreas are being recognized with increased frequency. In 1993, a report on 123 cases of cystic neoplasms of the pancreas diagnosed over a period of 32 years was published in Korea. Many changes on the concept of cystic neoplasms of the pancreas have been made, including classification and diagnostic criteria. The present study was conducted wherein a new survey on cystic neoplasms of the pancreas in Korea. METHODS: Cystic neoplasms of the pancreas diagnosed over a period of 12 years, from 1993 to 2004 in 25 university hospitals throughout Korea were collected. They were classified according to the World Health Organization classification of cystic neoplasms of the pancreas. RESULTS: A total of 1264 cases of cystic neoplasms of the pancreas were diagnosed. The diagnoses and frequencies are as follows: intraductal papillary mucinous neoplasm, 499 (39.5%); mucinous cystic neoplasm, 318 (25.2%); serous cystic neoplasm, 232 (18.4%); solid pseudopapillary neoplasm, 192 (15.2%); cystic endocrine neoplasm, 11 (0.8%); lymphoepithelial cyst, 8 (0.6%); acinar cell neoplasm, 3 (0.2%); mature teratoma, 1 (0.1%). Increase in the annual number of diagnoses was evident. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, a significant increase in mean age was seen in patients with malignant neoplasms. CONCLUSIONS: Cystic neoplasms of the pancreas are diagnosed with increasing frequency in Korea, the most common being intraductal papillary mucinous neoplasm of the pancreas. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, the grade of dysplasia increased with mean age, suggesting an adenoma-carcinoma sequence.
Acinar Cells ; Classification ; Diagnosis ; Hospitals, University ; Humans ; Korea* ; Mucins ; Pancreas* ; Teratoma ; World Health Organization

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has become a standard treatment for gastric mucosal neoplasm. A new EMR technique, using an insulated-tip electrosurgical knife (IT-EMR), was developed for large mucosal lesions. The aim of this study was to evaluate the efficacy and complication of IT-EMR. METHODS: IT-EMR was performed for 28 gastric mucosal lesions in 27 patients. En bloc resection rate, complete resection rate and complications were evaluated. RESULTS: IT-EMR was performed successfully in 27 lesions, and one lesion was failed because of the presence of a non-lifting sign. En bloc resections were achieved in 24 lesions (88.9%), and piecemeal resections in 3 lesions. Complete resections were achieved in 23 lesions (85.2%). There were 6 episodes (22%) of bleeding which were controlled completely by endoscopic treatment, and there was no perforation. Ten lesions (37%) were adenocarcinoma, 4 (14.8%) were high-grade dysplasia, and 12 (44.5%) were low-grade dysplasia. CONCLUSION: IT-EMR for large gastric mucosal neoplasm is a useful method for wide safety margin completeness of resection by en bloc resection.
Adenocarcinoma ; Hemorrhage ; Humans

Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis. When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Diagnosis ; Fibrosis ; Gallstones* ; Humans ; Inflammation ; Jaundice, Obstructive ; Middle Aged ; Pancreaticoduodenectomy ; Pancreatitis

BACKGROUND/AIMS: This study was designed to evaluate normal Korean pancreaticobiliary ducts and to assess the prevalence and pattern of variations and anomalies of theses structures. METHODS: We performed this multicenter study in which 7 university hospitals in Korea participated from March 1997 until June 1999. Total 10,243 ERCP cases were reviewed during this study period. RESULTS: 1) Maximal and midportion diameters of common bile ducts were 6.4+/-1.8 mm and 5.5+/-1.7 mm, respectively. Maximal and midportion diameters of pancreas head were 3.2+/-1.1 mm and 2.7+/-1.0 mm, respectively. Pancreaticobiliary duct diameters of subjects above the age of 40 were greater than those of subjects below the age of 40 (p<0.05). 2) The prevalence of choledochal cyst was 0.32%. The prevalence of gallbladder anomalies and anomalous union of pancreaticobiliary duct was 4.2% and 4.1%, respectively. The prevalence of pancreas divisum and annular pancreas was 0.49% and 0.05%, respectively. The most common type of pancreaticobiliary duct union was V shape (60.2%), followed by U shape (23.7%) and Y shape (16.1%). CONCLUSIONS: Understanding normal pancreaticobiliary structures and being aware of the prevalence and pattern of variations and anomalies of pancreaticobiliary structures will be helpful to diagnose and treat patients with pancreaticobiliary problems.
Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Gallbladder ; Head ; Hospitals, University ; Humans ; Korea ; Pancreas ; Prevalence