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Purpose@#Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience. @*Methods@#We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes. @*Results@#All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling. @*Conclusion@#Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.
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Objectives@#This study aimed to identify factors affecting the duration of untreated psychosis (DUP) in patients with schizophrenia spectrum disorder. @*Methods@#Six-hundred patients with schizophrenia spectrum disorder were recruited from mental health welfare centers in Gwangju Metropolitan City and Gyeonggi-do. Subjects were categorized into two groups according to median DUP. Demographic and clinical characteristics were compared between the two groups. @*Results@#The mean DUP was 80.8 weeks, and the median DUP was 15.9 weeks. Patients with Medicaid, higher age, and longer duration of the schizophrenia prodrome were more likely to have a longer DUP. The DUP was shorter in patients who were consulted by family/relatives prior to treatment. Patients visiting university hospitals were more likely to have a shorter DUP compared with those visiting psychiatric clinics or small-sized mental hospitals, i.e., with less than 100 beds. A multivariate regression analysis showed that the duration of the prodrome was a factor that significantly affected DUP. @*Conclusion@#The vulnerable group of patients with schizophrenia with a long DUP should be monitored closely. Moreover, it is necessary to develop a strategy to identify patients who have an insidious course of psychosis to reduce the DUP.
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The suicide rate in Korea has been declining steadily after peaking in 2011. However, to date, time-series analyses of Korean suicide rate data have mainly addressed factors related to increases in suicide rates. This study analyzed one of the most important evidence-based public health strategies to decrease suicide, that is, preventive effects of restricting access to lethal means via a charcoal-selling procedure improvement campaign, using multivariate time series analysis. The results showed the campaign in Gyeonggi Province had a significant effect on decreasing the number of charcoal-burning suicides in this area. It is believed that the present study has important implications in terms of providing the first empirical evidence for the charcoal-selling procedure improvement campaign in Korea. Further repeated research is needed to evaluate the impact of the intervention when the more enough observational data become available.
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Brûlures , Charbon de bois , Corée , Santé publique , SuicideRésumé
No abstract available.
Sujets)
Humains , Humains , Anxiété , Droits de l'homme , Santé mentale , Personnes atteintes de troubles mentaux , SchizophrénieRésumé
OBJECTIVE: The purpose of this study was to determine the key components of Korean disaster psychiatric assistant teams (K-DPATs), to set up new mental health service providing system for the disaster victims. METHODS: We conducted an analytic hierarchy process (AHP) involving disaster mental health experts, using a pairwise comparison questionnaire to compare the relative importance of the key components of the Korean disaster mental health response system. In total, 41 experts completed the first online survey; of these, 36 completed the second survey. Ten experts participated in panel meetings and discussed the results of the survey and AHP process. RESULTS: It was agreed that K-DPATs should be independent of the existing mental health system (70.1%), funding for K-DPATs should be provided by the Ministry of Public Safety, and the system should be managed by the Ministry of Health (65.8%). Experts shared the view that K-DPAT leaders would be suitable key decision makers for all types of disaster, with the exception of those involving infectious diseases. CONCLUSION: K-DPAT, a new model for disaster mental health response systems could improve the insufficiency of the current system, address problems such as fragmentation, and fulfill disaster victims’ unmet need for early professional intervention.
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Maladies transmissibles , Prise de décision , Victimes de catastrophes , Catastrophes , Gestion financière , Santé mentale , Services de santé mentaleRésumé
PURPOSE: Thrombosis of the portal vein, known as pylephlebitis, is a rare and fatal complication caused by intraperitoneal infections. The disease progression of superior mesenteric venous thrombosis (SMVT) is not severe. This study aimed to determine the clinical features, etiology, and prognosis of SMVT. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 41 patients with SMVT from March 2000 to February 2017. We obtained a list of 305 patients through the International Classification of Disease-9 code system and selected 41 patients with SMVT with computed tomography. Data from the medical records included patient demographics, comorbidities, review of system, laboratory results, clinical courses, and treatment modalities. RESULTS: The causes of SMVT were found to be intraperitoneal inflammation in 27 patients (65.9%), malignancy in 7 patients (17.1%), and unknown in 7 patients (17.1%). Among the patients with intraperitoneal inflammation, 14 presented with appendicitis (51.9%), 7 with diverticulitis (25.9%), and 2 with ileus (7.4%). When comparing patients with and without small bowel resection, the differences in symptom duration, bowel enhancement and blood culture were significant (P=0.010, P=0.039, and P=0.028, respectively). CONCLUSION: SMVT, caused by intraperitoneal inflammation, unlike portal vein thrombosis including pylephlebitis, shows mild prognosis. In addition, rapid symptom progression and positive blood culture can be the prognostic factors related to extensive bowel resection. Use of appropriate antibiotics and understanding of disease progression can help improve the outcomes of patients with SMVT.
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Humains , Antibactériens , Appendicite , Classification , Comorbidité , Démographie , Évolution de la maladie , Diverticulite , Iléus , Inflammation , Dossiers médicaux , Ischémie mésentérique , Veine porte , Pronostic , Études rétrospectives , Thrombose , Thrombose veineuseRésumé
OBJECTIVES: Though the youth suicide rate in Korea is similar to those in other OECD countries, it was the first cause of death among youths in Korea during the five years from 2009 to 2013. This study aims to evaluate the effects of a school based suicide prevention program for adolescents. METHODS: A survey was conducted with 134 first grade students in middle school in Gyeonggi-do. The independent samples t-test was performed to detect differences in the suicide attitude between the experimental and control groups, and the levels of suicide prevention knowledge and activities were analyzed by χ² (chi-squared) analysis. RESULTS: The difference in the effectiveness of the suicide prevention program for adolescents on the suicide attitude between the control group (−1.12±2.08) and experimental group (1.24±4.51) turned out to be statistically significant (t=3.893, p<0.001). The experimental group was more likely to show a positive change than the control group. Moreover, since it raised the suicide prevention knowledge (χ²=6.041, p=0.049) and activities (χ²=16.284, p<0.001) compared to the control, it was confirmed that the suicide prevention program for adolescents would be very effective. CONCLUSION: The adolescent's suicide prevention program of Gyeonggi-do is considered to reinforce teenagers' values against suicide and bring about behavioral changes leading to effective suicide prevention. Further studies are needed for the evaluation and expansion of the long-term effects of the program.
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Adolescent , Humains , Cause de décès , Corée , Organisation de coopération et de développement économiques , SuicideRésumé
OBJECTIVES: Disasters exert substantial effects on the mental health of victims and bereaved populations. Thus, a systematic framework for preparing and providing psychosocial and mental health services is necessary. The current attitudes toward and knowledge of disaster mental health-related factors among the general population provides one component for development of the disaster mental health services framework. METHODS: The authors analyzed a web-based survey for disaster mental health-related factors among the general population. Responses for the knowledge and perception for the disaster mental health services were compared between people who experienced and did not experience disaster. RESULTS: One thousand and three people completed the questionnaire. One hundred and seventy (16.9%) people experienced more than one disaster. People who experienced a disaster were more disturbed by disaster broadcasting or reporting than people who had not. People who experienced a disaster gave disaster mental health services an average score 63.5. People who experienced a disaster perceived group psychotherapy and self-help meetings as less important than those who had not. The recognition of both community mental health center and disaster mental health center was higher in the experienced group than non-experienced. CONCLUSION: This study revealed that general satisfaction with the current disaster mental health service is low, particularly among people who have used disaster mental health services. A national mental health system for disaster victims should be established with consideration for efficiency, effectiveness and accessibility.
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Victimes de catastrophes , Catastrophes , Politique de santé , Services de santé mentale , Santé mentale , Psychothérapie de groupe , Santé publiqueRésumé
On 16 April 2014, the Sewol ferry, carrying 476 people, sank in the ocean off the south coast of South Korea. Two hundred and ninety five are confirmed dead and 9 remain missing. The Korean Neuropsychiatric Association (KNPA) set up a Disaster Mental Health Committee (KDMHC) for out-reach services and to provide general strategies for promoting mental health and resilience. Mem bers of KDMHC and Volunteering Psychiatrists of the KNPA had participated in disaster mental health services organized by Gyeonggi-Ansan disaster mental health support team. Their activities were composed of psychoeducation, supportive individual and familial counseling and referring service to professional institutes. This report has described the outline of the initial and acute mental health care responses by KDMHC and volunteers among KNPA members.
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Académies et instituts , Assistance , Catastrophes , Corée , Services de santé mentale , Santé mentale , Psychiatrie , BénévolesRésumé
Treatment of schizophrenia is one of the most challenging areas in the field of psychiatry. There has been much improvement in psycho-pharmacotherapy, and at present, psycho-pharmacotherapy along with milieu therapy and social rehabilitation is the standard first-line treatment for schizophrenia. Healing environment, a concept which has arisen from the architectural field, has similarities in meaning to milieu therapy in psychiatry. In other words, healing environment may be an encountering point between psychiatry and architecture. In this encountering, each field can understand each other and expand its concept to aid the treatment of schizophrenia and to plan the build-up of the entire environment considering its social and psychological effects. In this paper, we aim to establish the basic concept of healing environment to alleviate the psychopathologies in schizophrenic patients. We worked under the premise that physical setting affects human behavior and mind, and that physical setting should play a role as a medium with therapeutic potential for patients with medical problems. The aims of this paper are as follows. First, theoretical discussion of the concept and the constructs of healing environment : second, understanding of the schizophrenic symptoms that may be affected by supporting environment : and third, discussion of supporting environment that may alleviate the symptoms of schizophrenia.
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Humains , Psychothérapie par le milieu , Réadaptation , SchizophrénieRésumé
PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.
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Humains , Cathéters , Voies veineuses centrales , Études rétrospectives , Facteurs de risque , Traitement thrombolytique , Thrombose , Thrombose veineuse profonde du membre supérieur , Activateur du plasminogène de type urokinase , Veine cave supérieureRésumé
This study aimed to analyze the patterns of antipsychotic prescription to patients with schizophrenia in Korea. Using the Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS), which was a stratified sampling from the entire population under the Korean national health security system (2009), descriptive statistics for the patterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, and prescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patients prescribed only with first- and second-generation antipsychotics. Of 126,961 patients with schizophrenia (age 18-80 yr), 13,369 were prescribed with antipsychotic monopharmacy and the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to 31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), mood stabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who were prescribed only with first-generation antipsychotics (n=26,254) were characterized by significantly older age, greater proportion of male, higher proportion of medicaid, higher total medical cost, lower self-payment cost, and higher co-medication rates of antiparkinson agents and anxiolytics than those who were prescribed only with second-generation antipsychotics (n=67,361). In this study, it has been reported substantial prescription rates of first-generation antipsychotics and antipsychotic polypharmacy and relatively small prescription rate of clozapine to patients with schizophrenia. Since this study has firstly presented the patterns of antipsychotic prescription to schizophrenic patients in Korean national population, the findings of this study can be compared with those of later investigations about this theme.
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Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Anxiolytiques/usage thérapeutique , Antidépresseurs/usage thérapeutique , Antiparkinsoniens/usage thérapeutique , Neuroleptiques/usage thérapeutique , Clozapine/usage thérapeutique , Association de médicaments , Assurance maladie , Types de pratiques des médecins , Polypharmacie , République de Corée , Schizophrénie/traitement médicamenteuxRésumé
OBJECTIVES: The purpose of this study was to make empirical evidence of community based detection, assessment and allocation system for early psychosis. METHODS: We analysed 222 youths who were referred to Seoul Early Management and Improvement Services (SEMIS) for early psychosis during six years from 2007 to 2012. RESULTS: 44% of referrals were from suicide hotline, 23% from web-based SEMIS assessment program, 20% from other service areas such as military services and 11% were self referred. Among 222 youths, 139 (62.6%) were completed Structured Interview for Prodromal Syndrome (SIPS). After SIPS, 23% had untreated or early psychosis, another 17% were found to be at high risk of psychosis and 18% of completed SIPS were found to have other mental illness such as depression, yielding an efficiency ratio of 58%. 70% of youths who were categorized as psychosis or high risk of psychosis or other mental illness were referred to psychiatric hospital or case management services. CONCLUSION: This study shows the effectiveness and limitations of community-based assessment and intervention system for early psychosis. Integrated community program is necessary to improve the efficiency of early intervention and for the better outcomes.
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Adolescent , Humains , Prise en charge personnalisée du patient , Dépression , , Hôpitaux psychiatriques , Assistance par téléphone , Personnel militaire , Symptômes prodromiques , Troubles psychotiques , Orientation vers un spécialiste , SuicideRésumé
OBJECTIVES: The aim of this study was to investigate the correlated factors that may influence the length of stay in mental health related facilities. METHODS: We chose 2253 patients with mental illness using a stratified multi-stage cluster sampling from 48 psychiatric hospitals, twelve psychiatric clinics, five psychiatric welfare facilities, and five mental rehabilitation facilities. The investigation involved psychiatrists, psychology practitioners, and social workers, and lasted from August 1, 2008 to November 15, 2008. Assessment and investigation of diverse factors was performed using one-way analysis of variance in order to examine their influence on length of stay. RESULTS: Factors showing significant correlation with length of stay included the types of mental health related facilities, age, marital status, socioeconomic status, type of medical security, familial support, type of admission, diagnosis, age of onset of the illness, number of admissions, severity of psychiatric symptoms, daily living and social function, GAF score, prominent thought/perception disability, memory/orientation disturbance, odd behavior/prominent regression, personal hygiene, communication/personal relationship, management of money, and public transportation/facility utilization. CONCLUSION: Findings of this study suggest that the type of mental health related facilities and the type of medical security are the most significant factors showing correlation with length of stay.
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Humains , Âge de début , Hôpitaux psychiatriques , Hygiène , Durée du séjour , Situation de famille , Santé mentale , Psychiatrie , Classe sociale , Travailleurs sociauxRésumé
OBJECTIVES: The purpose of this study was to make empirical evidence for a community based case management program for the first episode of psychosis. METHODS: We provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement. RESULTS: Significant improvement was observed in all sub-domains of PANSS and significant changes were also observed in the areas of symptoms and function of HoNOS. Significant improvement was observed in awareness of mental illness itself and its outcomes. The treatment maintenance rate was 87.5%, including three patients who stopped their medication with the doctor's order. The rate of participation in meaningful social activities, such as school or job showed an increase, from 25% at baseline to 81% after the program. CONCLUSION: Results of this study demonstrate the possibility of community programs for prevention of relapse, improvement of symptoms and function, and facilitation of return to meaningful social activities of first episode psychosis patients.
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Humains , Prise en charge personnalisée du patient , Troubles mentaux , Troubles psychotiques , Qualité de vie , Récidive , Poids et mesuresRésumé
BACKGROUND: The use of ambulatory blood pressure monitoring (ABPM) in childhood hypertension has been in great advance. ABPM has been able to detect significantly high blood pressure (BP) and also helpful for identifying white coat hypertension. METHODS: Between March 2007 and December 2009, we evaluated individuals aged from 7 to 19 years who were referred as high BP with ABPM, echocardiogram, and abdominal computerized tomography, calculation of body mass index (BMI) at Ajou University Hospital. ABPM was performed using the Tonoport V monitors and SpaceLab 90217 monitors. Seventy were evaluated with 55 boys and 5 girls. The mean age of them was 13.1 +/- 2.8 years (mean +/- standard deviation). RESULTS: Forty of seventy (57.1%) were diagnosed as hypertension in ABPM and 8 of 40 were diagnosed as secondary hypertension with underline diseases such as hyperthyroidism, chronic renal disease, Takayasu's arteritis, coarctation of aorta. The mean BMI in 40 was 24.8 +/- 4.72 kg/m2. Twenty-three of seventy (32.8%) were obese with higher prevalence than in general population. White coat hypertension was diagnosed in 30 of 70 (42.9%). CONCLUSIONS: ABPM could provide more detailed data including mean values of BP, load, and night dip in assessment of children's BP. According to increasing children's obesity, use of ABPM was thought to be necessary for evaluation of their risk of hypertension and useful for diagnosis of masked hypertension and white coat hypertension. Further more study of ABPM in children and adolescents would be needed for absolute standards of ABPM.
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Adolescent , Sujet âgé , Enfant , Humains , Coarctation aortique , Surveillance ambulatoire de la pression artérielle , Indice de masse corporelle , Hypertension artérielle , Hyperthyroïdie , Hypertension masquée , Obésité , Prévalence , Insuffisance rénale chronique , Maladie de Takayashu , Hypertension de la blouse blancheRésumé
OBJECTIVE: The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level. METHODS: A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region. RESULTS: The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions. CONCLUSION: The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.
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Femelle , Humains , Mâle , Dépression , Modèles logistiques , Prévalence , Enquêtes et questionnaires , Classe socialeRésumé
PURPOSE: Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis. METHODS: We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications. RESULTS: In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 +/- 11.9 vs. 69.7 +/- 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 +/- 2.9 vs. 22.6 +/- 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001). CONCLUSION: In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.
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Humains , Abdomen aigu , Douleur abdominale , Appendicite , Indice de masse corporelle , Diverticulite , Incidence , Hyperleucocytose , Nausée , Pisum sativum , VomissementRésumé
Thrombotic microangiopathy (TMA) is a known complication of hematopoietic stem cell transplantation (HSCT). Here, we describe a case of TMA after autologous HSCT, which was associated with ganciclovir treatment. A 5-year-old boy presented with Coombs-negative hemolytic anemia, thrombocytopenia, gross hematuria, massive proteinuria, and hypertension during ganciclovir treatment after autologous HSCT. TMA was confirmed by renal biopsy which showed swelling of endothelial cells, occlusion of the glomerular lumina, duplication of glomerular basement membranes, and mesangiolysis. There was complete resolution of TMA in both laboratory and clinical manifestations after ganciclovir cessation only with supportive cares and hydration.
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Humains , Anémie hémolytique , Biopsie , Cytomegalovirus , Infections à cytomégalovirus , Cellules endothéliales , Ganciclovir , Membrane basale glomérulaire , Transplantation de cellules souches hématopoïétiques , Cellules souches hématopoïétiques , Hématurie , Hypertension artérielle , Enfant d'âge préscolaire , Protéinurie , Thrombopénie , Microangiopathies thrombotiquesRésumé
Thrombotic microangiopathy (TMA) is a known complication of hematopoietic stem cell transplantation (HSCT). Here, we describe a case of TMA after autologous HSCT, which was associated with ganciclovir treatment. A 5-year-old boy presented with Coombs-negative hemolytic anemia, thrombocytopenia, gross hematuria, massive proteinuria, and hypertension during ganciclovir treatment after autologous HSCT. TMA was confirmed by renal biopsy which showed swelling of endothelial cells, occlusion of the glomerular lumina, duplication of glomerular basement membranes, and mesangiolysis. There was complete resolution of TMA in both laboratory and clinical manifestations after ganciclovir cessation only with supportive cares and hydration.