OBJECTIVES: Restless legs syndrome (RLS) is a common sleep disorder in adults with diabetes. This study investigated the frequency of RLS and clinical correlations in children and adolescents with type 1 diabetes. METHODS: This study included 55 consecutive patients (21 males, age 12.6 +/- 3.4 years) with type I diabetes that were regularly treated at the Department of Pediatric Endocrinology. RLS was diagnosed by intensive interviews which also included the Epworth Sleepiness Scale (ESS) and International RLS Rating Scale (IRLSRS). Patients also received neurological examinations and laboratory tests for diabetes, iron metabolism and renal function. RESULTS: Thirteen patients (23.6%, 6 males) were compatible for the diagnostic criteria of RLS. None of the RLS patients showed abnormal findings in neurological evaluations and 7 patients had familial history of RLS. Demographic and laboratory findings were not different between the patients with or without RLS. The RLS group showed significantly increased ESS and IRLSRS scores. CONCLUSION: RLS was prevalent in children and adolescents with type I diabetes. The association between RLS and diabetes-related laboratory findings requires further investigation.
Adolescent* ; Adult ; Child* ; Endocrinology ; Humans ; Iron ; Male ; Metabolism ; Neurologic Examination ; Restless Legs Syndrome*

Gallstone diseases include gallbladder stones, extrahepatic bile duct stones and intrahepatic duct stones. In the past, the main treatment modality was a surgical operation. With the development of endoscopic treatment, the main treatment modality is shifting towards endoscopic treatment. After the development of endoscopic sphincterotomy, endoscopic stone removal using a basket or balloon has been the major treatment modality for extrahepatic bile duct stones. For huge extrahepatic bile duct stones, mechanical or laser lithotripsy are used as ancillary equipment. Direct peroral cholangioscopic methods using a slim endoscopy or a Spyglass system now being rapidly developed instead of the "mother and baby" scope. If extrahapatic bile duct stones fail to be removed with peroral endoscopic treatment, then the stones can be treated via a percutaneous route (a percutaneous transhepatic route or a percutaneous transabdominal route). For intrahepatic duct stones, the location of stones, the site and degree of bile duct stricture and the existence of parenchymal atrophy are important factors to decide the treatment modality. The treatment modality is usually decided on according to the Tsunoda classification. Gallbladder stones usually need cholecystectomy because of recurrence. Endoscopic treatment is an indication for treating inoperable calculous cholecystitis patients. Endoscopic treatment for gallstone disesae will continue to rapidly develop in the future to the benefit of both the patients and endoscopists.
Atrophy ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholecystectomy ; Cholecystitis ; Constriction, Pathologic ; Endoscopy ; Gallbladder ; Gallstones ; Humans ; Lithotripsy, Laser ; Recurrence ; Sphincterotomy, Endoscopic

BACKGROUND/AIMS: This study was designed to determine the effect of supplementary argon plasma coagulation (APC) after piecemeal resection of a gastric adenoma or an intramucosal adenocarcinoma. METHODS: Cases of 62 lesions of 56 consecutive patients with either a gastric adenoma or carcinoma were retrospectively reviewed at the Ajou University Medical Center. APC was performed after an endoscopic complete resection using the piecemeal method of endoscopic mucosal resection (EMR) for patients in the EMR-APC group. For patients in the EMR group, APC was not performed. RESULTS: There was no significant difference in the recurrence rate of the cancers for both groups (9.7%, for the EMR group, 6.5% for the EMR-APC group). The recurrence rate of a low grade dysplasia was 6.7% (EMR group) and 6.3% (EMR-APC group) (p=1.000), the recurrence rate for a high grade dysplasia was 11.1% (EMR group) and 25.0% (EMR-APC group) (p=1.000), and the recurrence rate for an intramucosal adenocarcinoma was 14.3% (EMR group) and 0% (EMR-APC group) (p=0.389). The recurrence rates of lesions in which the lesion size was less than 20 mm and over 20 mm for each group were 6.7% and 9.1% (EMR group) (p=1.000) versus 12.5% and 0% (EMR-APC group) (p=0.520). There was also no significant statistical difference in the recurrence rates for both groups according to the location and macroscopic type of lesion. CONCLUSIONS: Supplementary treatment with APC could not significantly reduce the recurrence rate after complete piecemeal resection determined macroscopically. A large- scale and prospective study is necessary to elucidate the clinical significance of supplementary APC for gastric neoplasm treatment.
Academic Medical Centers ; Adenocarcinoma ; Adenoma* ; Argon Plasma Coagulation* ; Argon* ; Humans ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.
Humans ; Liver/radiography/ultrasonography ; Liver Abscess, Pyogenic/*diagnosis/microbiology ; Male ; Middle Aged ; Salmonella Infections/*diagnosis

BACKGROUND/AIMS: The aim of this study was to compare the patient's satisfaction and tolerance of transnasal (TN) and transoral (TO) endoscopy prospectively. METHODS: 120 patients were assigned to undergo TN (age: 49.5, M : F=65 : 55) or TO (age: 47.4, M : F=63 : 57) endoscopy according to their wishes. RESULTS: The patients' satisfaction was higher in the TN group than in the TO group (8.45 vs. 4.95, p <0.05). The degree of choking sensation, nausea, and throat soreness was lower in the TN group than the TO group. There was no difference in endoscopists' satisfaction between the two groups. The duration for TN was longer than for TO. Epistaxis and nasal pain were the common complications in the TN group. All complications were mild and were relieved spontaneously. An endoscopic examination could be completed in all patients in the TO group. In the TN group, examination failure was quite common in the early phase but the incidence decreased with increasing experience. It took the experience of at least 20 cases for the endoscopist to adapt to the TN route. CONCLUSIONS: TN endoscopy is believed to be a comfortable and safe procedure for improving the patients' satisfaction and for reducing the level of inconvenience.
Airway Obstruction ; Endoscopy* ; Epistaxis ; Humans ; Incidence ; Nausea ; Pharynx ; Prospective Studies ; Sensation

BACKGROUND: Assessing public knowledge concerning stroke and its risk factors is the starting point in developing the effective stroke prevention program. The aim of this study was to investigate the awareness of stroke risk factors and factors influencing it. METHODS: All who participated in the second stroke prevention campaign were encouraged to answer the survey. It was performed using a standard questionnaire designed to assess the awareness of stroke risk factors, its correlation with usual demographic characteristics, history of stroke, and self-assessment of stroke risk. The number of established risk factors on an open question estimated the awareness of stroke risk factors. RESULTS: Nationwide 4065 persons took part in the campaign and 43% of them (1749) responded the survey (age=65.4+/-12.2, male=34.2%). A total of 986 responders (56.4%) correctly listed at least one of the established stroke risk factors to open question. Age and schooling were the significant predictors for listing at least one of the established stroke risk factors on multivariate analysis. Number of classic risk factors of stroke in each subject was significantly correlated with self-assessment of stroke risk. Most of the individual risk factors of stroke were also correlated with self-assess-ment of stroke risk but smoking and old age (65 years or more) were not. CONCLUSIONS: This study suggests that the level of stroke risk awareness in Korea is not high, especially among the elderly and the lowly educated. The systematic public education program is warranted.
Aged ; Education ; Humans ; Korea* ; Multivariate Analysis ; Surveys and Questionnaires ; Risk Factors ; Self-Assessment ; Smoke ; Smoking ; Stroke*

BACKGROUND/AIMS: Endoscopic sclerotherapy and band ligation have been well documented beneficial therapeutic options of esophageal variceal bleeding. But acute variceal bleeding is refractory to sclerotherapy in upto one-hird of patients, and rebleeding occurs in 30% to 50%. Recently alternative endoscopic modality, N-utyl--yanoacrylate (Histoacryl) injection is performed in intravariceal sclerotherapy but its efficacy and safty are not clearly established. We evaluated the efficacy of Histoacryl on esophageal variceal bleeding and compared with that of endoscopic band ligation in the present study. MATERIALS/METHODS: From March 1994 to March 1998, ninety seven patients with endoscopically documented esophageal variceal bleeding were enrolled. Histoacryl injection (Histoacryl group, n=33) or endoscopic band ligation (EVL group, n=64) was done for esophageal variceal bleeding. We evaluated the rebleeding rate and in-ospital mortality in both groups. RESULTS: Baseline characteristics were similar but active bleeding on first endoscopic session was significantly higher in Histoacryl group (Histoacryl group; 90.7%, EVL group; 26.6%, p=0.002). Successful hemostasis was done at 87.9% in Histoacryl group, 95.3% in EVL group (not significant). There were no significant differences on early rebleeding rate (18.2% vs 23.4%), late rebleeding rate (39.4% vs 37.5%) and in-ospital mortality (24.2% vs 15.6%) between Histoacryl group and EVL group. There were no technique-elated fatal complications at Histoacryl injection group. CONCLUSION: Therapeutic efficacy of Histoacryl injection was similar to the endoscopic band ligation in patients with esophageal varix bleeding in terms of hemostasis and rebleeding. Histoacryl is effective therapeutic option for esophageal variceal bleeding as well as gastric variceal bleeding.
Enbucrilate ; Esophageal and Gastric Varices* ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Mortality ; Sclerotherapy

BACKGROUND: Peroral intubation of a self-expanding metal stent is usually difficult in malignant antral obstruction in patients with unresectable gastric cancer, due to the curved gastroduodenal structure. METHODS: The delivery catheter of a self-expanding nickel-titanium coil stent was modified, which was originally used in obstructive esophagocardial cancer. Peroral intubation of the coil stent was attempted in patients suffering from intractable vomiting due to unresectable gastric cancer with antral obstruction. RESULTS: Fifteen of 18 patients (83.3%) were successfully managed without immediate complications such as stent migration, serious bleeding, bowel perforation, and procedure- related mortality. One patient, who failed the peroral intubation, was managed by percutaneous intubation of the coil stent via the route of percutaneous endoscopic gastrostomy. After insertion of the coil stent, food ingestion and symptomatic improvement of vomiting was achieved in 15 (93.8%) of 16 patients. The mean survival time was 3.7 months (range, 1-10 months). No delayed stent migration and occlusion by tumor overgrowth occurred. Stent occlusion by food materials occurred in one patient during the follow-up period, which was corrected by endoscopic flushing. CONCLUSION: These results suggest that peroral intubation of a self-expanding coil stent is a safe and effective palliation for unresectable gastric cancer with antral obstruction.
Catheters ; Eating ; Flushing ; Follow-Up Studies ; Gastrostomy ; Hemorrhage ; Humans ; Intubation* ; Mortality ; Stents* ; Stomach Neoplasms* ; Survival Rate ; Vomiting

Palliative treatment of malignant biliary obstructions represent the principal indications of endoscopic or percutaneous transhepatic implantation of endoprostheses. Many kinds of biliary stents have been used to maintain patency of the bile ducts obstructed by benign or malignant strictures. However, the biliary stent in current use, has a tendency to become blocked. In order to maintain a long-term stent patency before clogging, biliary stents with large diameters are needed and some kinds of expandable metal stents are proposed. The Hanaro stent (Sooho medi-tech Co. LTD, Seoul, Korea) is a modified Gianturco Z biliary stent, made of 0,01-inch stainless steel wire with a zigzag pattern. It has a spiral, cylindrical configuration and is 10 mm in expanded diameter. It hes been used only with the percutaneous transhepatic technique. In this article, we describe a new method for endoscopic retrograde placement of a modified Gianturco Z biliary stent. This report describes our experience on endoscopic application of a modified Gianturco Z biliary stent in a patient with malignant obstruction of the distal common bile duct.
Bile Ducts ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Palliative Care ; Seoul ; Stainless Steel ; Stents*

Gastrointestinal cytomegalovirus (CMV) disease most frequently occurs in adults with immune deficiency due to acquired immune deficiency syndrome (AIDS), organ trans- plantation, cancer chemotherapy, and steroid therapy. Because the number of patients with immune deficiency has increased in recent years in Korea and CMV is one of the most common infecting complications in these settings, the number of patients with CMV disease is also increasing. Most cases of CMV disease are due to reactivation of a latent virus. The pathogenesis of this intestinal disease is vascular endothelial involvement with subsequent ischemic mucosal injury. An endoscopy usually reveals large, well defined ulcers greater than 3 cm. Deep longitudinal serpiginous ulcers represent a coalescence of adjoining smaller ulcers. CMV infection produces a characteristic cytomegalic cell containing a intranuclear inclusion, which is sometimes surrounded by a clear halo ("owl's eye"). The presence of cytomegalic cells on mucosal biopsy specimens stained with hematoxylin and eosin has been considered the golden standard for establishing the diagnosis of CMV gastrointestinal disease. Immunohistochemistry with monoclonal antibody to CMV antigens and in situ hybridization for CMV DNA are useful in the diagnosis. We report 2 cases of CMV esophagitis and proctitis which showed characteristic endoscopic and histologic findings of the CMV infection.
Acquired Immunodeficiency Syndrome ; Adult ; Biopsy ; Cytomegalovirus ; Diagnosis ; DNA ; Drug Therapy ; Endoscopy ; Eosine Yellowish-(YS) ; Esophagitis* ; Gastrointestinal Diseases ; Hematoxylin ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Intestinal Diseases ; Intranuclear Inclusion Bodies ; Korea ; Proctitis* ; Ulcer