• Title/Summary/Keyword: First stool

Search Result 97, Processing Time 0.022 seconds

A acupuncture therapy literature study on the hemorrhoids and hemorrhoids complicated by anal fistula (치창(痔瘡)과 치루(痔漏)에 대한 침구학적(鍼灸學的) 문헌고찰(文獻考察))

  • Song, Won-sub;Lee, Byung-ryul;Lee, Hyun;Chae, Sang-jin
    • Journal of Acupuncture Research
    • /
    • v.20 no.1
    • /
    • pp.131-143
    • /
    • 2003
  • Objective : The purpose of this study is to arrange the literature about acupuncture therapy on the hemorrhoids and hemorrhoid complicated by anal fistula. Methods : We arrange Huang Di Nei Jing and fifteen kinds of literature about the hemorrhoids and hemorrhoid complicated by anal fistula. Results : 1. The cause of hemorrhoids are overfatigue, overeating, imbalance of stool(const-ipation or diarrhea), uncontrol sexual excess or abstinence, pathgenic factors of wetness, heat, wind, dry, fire, chronical hemorrhoids that has not been treated, and general weakness. 2. Symptom of hemorrhoids is that skin is projected form the nine holes or varicose extension to become hemorrhoid. Hemorrhoids is small nodosity that projected on the anal inter or outer region, and hemorrhoid complicated by anal fistula is pus which comes out form one or some fistula on the anal around inter and outer region. 3. Therapy method of hemorrhoid and hemorrhoid complicated by anal fistula are elimination pathological heat from blood, promote blood flow to remove blood stasis, cold in nature and purge away fire, remove heat form the blood, promote blood flow to remove blood stasis, cold in nature and purge away fire, remove heat from the blood and eliminate dampness, tonify the spleen and replenish Ki, dispel wind and alleviate pain and so forth. Therapy method of hemorrhoid is to give the first consideration to relieve blood: eliminating pathological heat form blood complicated by anal fistula is to tonify the blood first, than after that eliminating pathological heat form blood. About external method are method of fumigation, method of ointment, method of close with medicine, necrotizing method and also operation(injection, bind etc.)was used for treatment. 4. The prescription are Gurgak-hwan, Wypi-hwan, Gunggyi-tang, Jingyochangchul-tang, Jingyobangpung-tang, Mokhyangbinrang-hwan, Ochi-san, Gamihyanso-san, Jojang-hwan, Sinyung-hwan used frequently. 5. food taboo on patient's diet of the hemorrhoid and hemorrhoid complicated by anal fistula are raw grain, cold or dampness food, alcohol, hot food, Singiberis rhizoma recens, Cinnamomi ramulus. 6. Acupuncture therapy on the hemorrhoid and hemorrhoid complicated by anal fistula are, in the first stage eliminating pathological heat form blood and eliminate dampness, and in the long term eliminate dampness, promote and remove meridian energy, remove that form the intestines, dispel channels and collaterals. 7. Acupuncture points at B2, CV1, B58, B36, B56, Sp5, S30, B25, B54, GV1, GV20, L6, B40 used frequently for the acupuncture therapy, and acupuncture point at GV4, GV1, B30, hemorrhoidal point used form moxibustion. Reduction blood at B40 and blue capillary of Sp9 and acupuncture Chungbaek, Ki-gack, Ki-jung, Ki-mun(Dongsh Kihyel) makes the treatment very effective.

  • PDF

Micrographic Comparison of Proglottids and Ova in Some Tapeworms(Family: Diphyllobothridae) from Man (인체기생 열두조충류의 형태비교 및 진단적 소견)

  • 류장근;양용상;강성구;백승한;임신영
    • Biomedical Science Letters
    • /
    • v.4 no.1
    • /
    • pp.65-72
    • /
    • 1998
  • Recently there have been frequent reports on human infection caused by the Diphyllobothridae in Korea. The adequate opportunities for Koreans to eat raw fish, the primary infection medium of cestodes and the human infection through drinking water by cyclops, the first intermediate host are believed to be main reasons for the infection. The first task of this study was to classify and diagnose the species by differentiating morphological characteristic between scolex and proglottids of cestodes. However, the initially available diagnosis was done with the patient's symptoms and the eggs obtained from his stool. It is important to differentiate the species by the eggs of Diphyllobothrium latum especially in that it can help get advance information for a more reliable analysis in the near future. The morphological and diagnostic results from proglottids and eggs of Diphyllobothrium latum, Diphyllobothrium latum parvum and Spirometra erinacei are as follows; In each kind of cestodes from the patient's stool, the shape and size of 50 eggs were measured. Eggs of Diphyllobothrium latum had an operculum and were ovoidal or ellipsoid to elliptical in shape. Eggs of Diphyllobothrium latum parvum were more ovoidal in shape and smaller in size than Diphyllobothrium latum. And eggs of Spirometra erinacei were asymmetrical in width and long and slender in shape. The average lengths and widths of Diphyllobothrium latum, Diphyllobothrium latum parvum and Spirometra erinacei were 61.4$\times$41.7 $\mu\textrm{m}$, 55.9$\times$41.4 $\mu\textrm{m}$ and 66.7$\times$36.4 $\mu\textrm{m}$, respectively. After the segments of each cestode were fixed, embedding and hematoxylin-eosin dyeing on a microtome-made specimen were done. The micrographs of the semicon's aceto-carmine dyed specimen showed that Diphyllobothrium latum and Diphyllobothrium latum parvum had a centrally-located genital gland and an opened uterine pore. The yolks were observed on both sides of proglottids and had a typical rosette pattern. Yet, Diphyllobothrium latum parvum was shown smaller than Diphyllobothrium latum in the micrograph. Proglottids of Spirometra erinacei displayed that the uterus was rolled spirally more than five to seven times, and connected successively to the seminal vesicle in the cirrus sac. Shown above, this study was performed to measure the size of eggs and analyze the morphological characteristics of proglottids and provided the measurements of three types of cestodes obtained by a light microscope.

  • PDF

Two cabob of natural human infection by Echinostoma hoytense and its second intermediate horst in Wonju area (Echinostoma hortense 인체감염 2예 및 제이중간숙주 조사)

  • 양용석;안영겸
    • Parasites, Hosts and Diseases
    • /
    • v.23 no.1
    • /
    • pp.33-40
    • /
    • 1985
  • Two cases of human Erhinostoma hortense infection and their probable infection source were identified by prasiqantel (Distocide) treatment of the patients and by examining two kinds of fresh water fish which were eaten raw by them. The result of the research can be summarized as follows: 1. The patients, each aged 31 and 30, were residing in the same house in Wonju City, Kangwon Province. The first case was hospitalized due to epidemic hemorrhagic fever (E.H. fever) and the second case was healthy but had slight degree of abdominal pain and diarrhea from time to time. In the stool examination, eggs of 5. hortense ($114.3{\times}71.0{\mu\textrm{m}}$) average from the first case and $119.1{\times}68.3{\mu\textrm{m}}$ average from the second) were found. By administering single dose of praziquantel (10~15mg/kg) and purgation with magnesium salt to them. sin adults of 5. hortense were collected from the diarrheal stools of the second case. 2. By examining 8:k Moroco oxycephalus and 20 Carassius carassius which were captured at the place where the two patients had captured and eaten the fresh water fish, the metacercariae of Echinostoma sp. were found from 3 (3.5%) M. oxycephalus. 3. After the experimental infection of 3 isolated metacercariae to one albino rat three adults of 5. hortense were recovered. By the present study, the two patients revealing the echinostomatid eggs in their stools were proven to be infected with 5. hortense and to be the second and third human cases of this luke infection in Korea. Mcroco oxycephalus harboured the metacercariae of E. hortense and appeared to be a new second intermediate host.

  • PDF

A Case of Posttransplant Lymphoproliferative Disease(PTLD) Following Renal Transplantation in a Child (소아에서 신이식후 발생한 Posttransplant Lymphoproliferative Disease(PTLD) 1례)

  • Eun, Byung-Wook;Park, Eun-Sil;Lee, Seong-Yong;Hahn, Hye-Won;Jang, Ju-Young;Park, Kyung-Mi;Kim, Chul-Woo;Kang, Gin-Han;Ko, Jae-Seong;Ha, Il-Soo;Lee, Hoan-Jong;Cheong, Hae-Il;Seo, Jeong-Kee
    • Childhood Kidney Diseases
    • /
    • v.6 no.1
    • /
    • pp.123-130
    • /
    • 2002
  • Posttransplant lymphoproliferative disease (PTLD) represents a diverse lymphoproliferative disorder ranging front nonspecific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus (EBV) infection and high dose immunosuppression. PTLD after renal transplantation was reported at first in adult in Korea in 1997. In children there have been several cases of PTLD after liver transplantation but PTLD after renal transplantation has not been reported. This is a case report of PTLD developed 4 months after renal transplantation in a 9-year-old boy. The major clinical manifestations were fever, multiple lymph nodes enlargement and blood-tinged stool. EBV was detected by in-situ hybridization in the enlarged cervical lymph node and the colonic tissue. Histological examination revealed B-cell lineage. Use of ganciclovir and reduction of the immunosuppression level resulted in complete remission of PTLD. This is the first pediatric case report of PTLD following renal transplantation in Korea. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 123-30)

  • PDF

Studies on the method and the theory of moxibustion in "BianQueXinShu(扁鵲心書) (vol. I)" ("편작심서(扁鵲心書).권상(卷上)"에 나타난 뜸법에 대한 연구(硏究))

  • Kim, Hyun-Dong;Lee, Yong-Bum
    • Journal of Korean Medical classics
    • /
    • v.20 no.2
    • /
    • pp.175-193
    • /
    • 2007
  • A theory of the school which attach great importance to moxibustion therapy was more developed from 'Ge Hong(葛洪)', 'Wang Tao(王燾)' up to "BianQueXinShu(扁鵲心書)" of 'Dou Cai(竇材)' in Song Dynasty. The first volume of "BianQueXinShu" was described about the principles of health preserving method, diagnosis, treatment related with meridian system, support Yang theory, moxibustion therapy over the 10 chapters and in the continued 3 chapters, explained the symptoms and related moxibustion therapies. The summary is as follows. The Yang energy is the essence of the human body and it is minutely explained in "Hwangdineijing(黃帝內經)". However, the younger scholars after 'Zhang Zhongjing(張仲景)' held different views with "Hwangdineijing" so they didn't control serious diseases. Supporting the Yang energy, it will be possible to human body in good health and long life and perennial youth and longevity. To do like this, the first important thing is a moxibustion, the second is a Taoist hermit medication(丹藥) and the third is well usage of Radix Aconiti Lateralis Preparata. According to the sequence of Yang energy deficiency, the stages of diseases are classified as Ordinary Gi(平氣), Latter deficient state(微虛), The more deficient state(甚虛), Exhausting state(將脫), Exhausted state(已脫) and in the consideration of each stage, it is used gradually with warm-natured berbs, warm-acrid herbs, warm-heated herbs and moxibustion therapy. If it comes to the stage of Exhausted state, the Yang energy is too weak to treat a disease. Therefore it is easy to harm human body with usage the treatment of the Purgationist school theory or the Cold and cool medical school theory, so it is needed a great attention to use these therapies. To summarized the keynote of 'Du Jae''s moxibustion therapy, the one is a minority of selection of points(1$^{\sim}$2 acupuncture points), the second is a majority of moxibustion units(50$^{\sim}$500 units), and the other is a focused selection of points on spleen and kidney(especially Gwanwon, CC4). And in this book, it was explained concretely about the size of moxibustion, according to the experiment with mentioned size, the burning time of moxibustion was almost 4 min 40 sec, so the big size moxibustion was one of the characteristic of moxibustion therapy revealed in this book. Also it was used 'Suseongsan(睡聖散)' - a kind of analgesic herb complexes - to reduce a pain during the usage of moxibustion therapy in this book. To develop the moxibustion theory, it is more investigated in the future that there wasn't significant relation between Gwanwon(CC4) and spleen and kidney meridian in theory, compared to many used Gwanwon(CC4) in the prescription, where as mentioned the importance of spleen and kidney in treatment, that considering the burning time(1 unit - 4 min 40 sec, 12 units an hour, maximum 288 units a day) there were no guidances about meals, sleeping, stool and urine, and that there was no concrete study about the toxicity of 'Suseongsan' as analgesic moxibustion therapy.

  • PDF

An epidemiological study of human paragonimiasis by means of micro-ELISA (면역효소진단법을 이용한 폐흡충증 유행의 역학조사)

  • 조승열;이동근강신영김석일
    • Parasites, Hosts and Diseases
    • /
    • v.21 no.2
    • /
    • pp.246-256
    • /
    • 1983
  • As epidemiological parameters of human paragonimiasis, the positive rates of intradermal test and the sputum/stool ekaminations have long been employed in population surveys. However, both the specificity of the intradermal test and the sensitivity of sputumjstool examination have been gradually declined as the endemicity was lowered; thus the gap between above two parameters widened. In such context, the development of a new epidemiologic parameter or tool which makes it possible to accurately discriminate the active paragonimiasis cases was necessary. In the present study, the detection rate of Paragonimus-speclac IgG antibody by micro-ELISA was evaluated as an indicator of epidemiologic status of human paragonimiasis in a population. A total of 4, 285 students and inhabitants living in Bukpyeong Myeon and Bukil Myeon, Haenam Gun, Jeonlanam Do was surveyed in October, 1983 by intradermal test first. Out of them, 244 cases (5.7%) were found positively reacted to VBS antigen of F. westermani. Out of 168 positive reactors, 7 cases (4.2%) were egg positive either by two times of sputum examination or by one stool examination. That indicated that only 0. 16% of total surveyed were confirmed as active paragonimiasis by egg detection. When sera collected from 239 positive reactors of Intradermal test were tested by micro-ELISA for their specific IgG antibody, 40 cases(16.7%) were found to be positive. All of 7 egg positive cases were again positive for specific IgG antibody. Among remaining 232 intradermal test positive cases, 33 cases were positive for IgG antibody. In contrast to those, none of 42 positive reactors to intradermal test for Cloncrchis and of 128 intradermal test negative cases showed positive for Paragcnimus-specIfic IgG antibody. The rate of specific IgG antibody as detected by micro-ELISA appeared to be increased with the wheal size of the intradermal test. When the wheal sixte was over 13mm in diameter, about 50% of them were positive for specific IgG antibody. Thirty-one specific antibody positive cases were clinically evaluated by laboratory examinations (repeated sputum examination, peripheral eosinophil count and chest roentgenogram) and by history taking. Out of them 24 cases were associated with one or more positive laboratory findings: thus considered as active paragonimiasis cases. Out of 7 lab. finding-free cases 3 revealed past history of typical paragonimiasis symptoms, suggesting that they were in chronic or in convalescent stages. The remaining 4 cases were considered as either mild or ectopic infection cases; the possibility of cross-reaction with other helminthiases could not be ruled out. From the above results, it was inferred that the detection of Paragonimus-specIfic IgG antibody by micro-ELISA was very much helpful in detecting the active cases as well as in proper evaluation of the endemicity of human paragonimiasis in a population. The convenience of mass haildling of sera in micro-ELISA was considered another superiority as an epidemiologic tool.

  • PDF

Clinical Analysis of Intussusception Delayed in the Final Diagnosis (발병 초기에 진단하지 못한 장중첩증에 관한 고찰)

  • Kim, Eo Jin;Lee, Min Hae;Lee, Hae Young;Kim, Jum Su;Seo, Ji Hyun;Lim, Jae Young;Choi, Myoung Bum;Park, Chan Hoo;Woo, Hyang Ok;Youn, Hee Shang
    • Pediatric Gastroenterology, Hepatology & Nutrition
    • /
    • v.7 no.1
    • /
    • pp.16-23
    • /
    • 2004
  • Purpose: In this study, we tried to evaluate the clinical characteristics or circumstances that lead to unintentionally the delay in the diagnosis of intussusception or to the wrong direction that prevent the proper management early. Methods: All the patients of intussusception with delayed diagnosis in the department of pediatrics or emergency room at Gyeongsang National University Hospital from 1990 to 2003 were enrolled and reviewed retrospectively. Results: There were 8 boys and 6 girls and their median age was 8 months (range 2 months to 10 years). Their initial symptoms and signs were vomiting, seizure, diarrhea, lethargy, irritability, bloody stool, palpable abdominal mass, foul odor of urine and tachycardia. Clinical diagnosis or impressions at admission consisted of acute gastroenteritis, shigellosis and toxic encephalopathy, convulsive disorders, urinary tract infections, sepsis, abdominal mass and intestinal obstruction. Eight patients were luckily diagnosed due to the delayed manifestations of cyclic irritability or currant jelly stool. Six patients were not paid attentions for the possibilities of intussusception and diagnosed serendipitiously by the abdominal sonography or CT during the evaluation of the abdominal mass or distension. Only five of 14 cases (35.7%) were successfully managed by barium or air reductions. The other 9 cases needed surgical operations. Conclusion: Delayed diagnosis of intussusception arise when doctors initially diagnose the patients incorrectly due to the unusual presentations or when they overlook the newly arising symptoms or signs suggestive intussusception after the admission because they are ardently attached to the first impressions or initial clinical diagnosis.

  • PDF

Clinical Features of Dietary Protein Induced Proctocolitis (식이 단백 유발 직결장염의 임상적 고찰)

  • Im, Sun Ju;Kim, Seong Heon;Bae, Sang Nam;Park, Jae Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
    • /
    • v.8 no.2
    • /
    • pp.157-163
    • /
    • 2005
  • Purpose: Dietary protein induced proctocolitis (DPIPC) can be considered as a cause of rectal bleeding or blood streaked stool in otherwise healthy-looking infants in the first several months of life. Failure to appreciate this entity may lead to inappropriate diagnostic or therapeutic intervention. This study aimed to ascertain the clinical features, treatment and prognosis of DPIPC. Methods: We reviewed 13 infants retrospectively, presented with bloody stool in early infancy. They were diagnosed as DPIPC clinically in Pusan National University Hospital from May 2002 to June 2004. Results: Seven males and six females were included. The mean age at onset of bleeding was $96.8{\pm}58.8days$. The mean frequency of hematochezia was $2.6{\pm}2.5$ times a day. Duration from onset of symptom to diagnosis was $35.5{\pm}55.0days$ and duration from onset of symptom to resolution of bleeding was $58.7{\pm}67.0days$. Nine (69.2%) were exclusively breast-fed infants and two (15.4%) were formula-fed infants. All but one infant did not have family history of other allergic diseases. A dietary history of ingestion of cow's milk, nut or shellfish was present in three mothers. Peripheral eosinophil count was normal to slightly elevated (total WBC count $10,555{\pm}3,145/mm^3$, relative eosinophil count $6.3{\pm}3.0%$, absolute eosinophil count $659.0{\pm}532.2/mm^3$). Sigmoidoscopy revealed lymphonodular hyperplasia with surrounding hemorrhagic spots in the rectosigmoid colon in 6 infants. Histopathologic finding of colonic biopsies in 5 infants showed chronic inflammation with lymphoid follicular hyperplasia (5 infants), crypt abscess (3 infants), or mild infiltration of eosinophils (less than 20/high power field) in the lamina propria. Spontaneous resolution of rectal bleeding occurred in all infants without dietary change or medicine. Conclusion: Most infants with DPIPC experience a very benign course and have spontaneous resolution of rectal bleeding without changes in the mother's diet. In the case of strong evidence for DPIPC we suggest deferring further invasive investigation and continuing breast feeding.

  • PDF

Comparison of Group A, B and C Rotaviral Gastroenteritis among Children in Korea: Prevalence and Clinical Features (한국 소아에서의 로타 장염군의 비교: 유병율과 임상증상)

  • Bae, Kil-Seong;Bae, Woo Ri;Kim, Ji Hoon;Bin, Joong Hyun;Kim, Hyun Hee;Lee, Hee Jin;Lee, Wonbae
    • Pediatric Infection and Vaccine
    • /
    • v.21 no.2
    • /
    • pp.96-103
    • /
    • 2014
  • Purpose: The aim of this study is that the prevalence of rotavirus infection was evaluated by each group and clinical features of group A, B and C rotaviruses infections were described respectively to compare one with another. Methods: Between January 2010 and December 2010, we enrolled a group of children below 10 years of age admitted for management of acute diarrhea at the Catholic University of Korea Bucheon St. Mary's Hospital. A total of 310 stool samples documented to be free of common bacterial pathogens were collected from children with diarrhea. The presence of group A, B or C rotavirus is indicated by amplification of DNA segments of the expected lengths after the first and second PCRs Results: In a total of 310 stool specimens, 40 (12.9%) specimens were positive for rotaviruses. These included 23 (7.4%) positive for group A, 5 (1.6%) for group B and 12 (3.9%) for group C rotaviruses. Group B rotavirus infected patients had significantly less diarrheas per day (group A: P =0.01, group C: P =0.01) and shorter duration of vomiting days (group A: P =0.03, group C: P =0.03) than those with group A and C rotaviruses infection respectively. All the group B rotaviruses had been isolated in March and October. Group C rotavirus infections were prevalent during late summer and early winter and peaked in October. Conclusion: These findings indicate that group B and C rotaviruses are notable causes or the contributing causes of diarrhea among infants and children in Korea.

Pilot Research about Influential Factors and Efficacy Judgement of Acupoint Sticking in Dog-Days (삼복첩(三伏貼)의 영향 요인 및 임상 효과 판정에 관한 예비 연구)

  • Lee, Sun-Haeng;Kim, Cho-Young;Chang, Gyu-Tae
    • The Journal of Pediatrics of Korean Medicine
    • /
    • v.25 no.1
    • /
    • pp.72-81
    • /
    • 2011
  • Backgrounds: Sticking warm and hot herbs to acupoint in Dog-Days where the strongest Yangqi takes place, Acupoint sticking in Dog-Days is one of Oriental medical treatment to cure winter diseases in the summer. This treatment is widespread in China and Taiwan, and is becoming popular in South Korea nowadays. Objectives: The research has been conducted to evaluate the influencial factors and efficacy in Acupoint sticking in Dog-Days. Methods: We visited one kindergarten in Dog-Days of 2010, and attached pills which are made of Sinapis Semen(白芥子), Corydalis Tuber(玄胡索), Asari Herba Cum Radix(細辛), Juice of Zingiber Officinale(薑汁) to BL-13(肺兪), BL-15(心兪), BL-17(膈兪) of 56 children for 4-6 hours(34 boys, 22 girls, $52.64{\pm}16.85$ months, 19-78 months). Exacerbating effect or non-significant changes in respiratory symptoms before and after the treatment were ified.. The influentialfactors of efficacy were analyzed by Pearson's $x^2$-test and Fisher's exact test. In addition, the efficacy and satisfaction among once, twice, and three times treatment groups were verified by ANOVA. Results: 27 children (48.2%) were effective, but efficacy felt by parents is 45 cases (80.4%). Sex, perspiration, stool, urine, sleep, cold of hands and feet, cold sensitivity, and frequency of Acupoint sticking in Dog-Days has no relation to efficacy(p>0.05). However, the efficacy is poor in 1 and 2 age(p=0.030). Difference among efficacy of once, twice, and three times treatment groups is not significant(p=0.069), whereas there are linear association in frequency of Acupoint sticking in Dog-Days and efficacy(p=0.030). 36 parents (64.3%) are satisfied with Acupoint sticking in Dog-Days, and we observed significant difference among once, twice, three times treatment groups(p=0.041). 19 parents (33.9%) had been known about Acupoint sticking in Dog-Days, but 53 parents (94.6%) wanted repetition, and 41 parents (73.2%) intended to recommend it to acquaintance. Side effects are minor itching in two cases. Twenty seven participants showed positive effect, and forty five people (80.4%) felt beneficial. Sex, perspiration, stool, urine, sleep, cold hands and feet, sensitivity in cold, and frequency of Acupoint sticking in Dog-Days has no relation to the efficacy(p>0.05). Though the efficacy was poor in one and two year old infants, it was linearly correlated with the frequency count and responses from the treatment (p=0.030). Thirty six participants (64.3%) satisfied with the treatment, and so did the first, second, and third participant groups (p=0.041). Even though, only nineteen participants (33.9%) were familiar with Acupoint sticking in Dog-Days, fifty three participants (94.6%) preferred to repeat the treatment, and 41 parents were preferable to recommend the treatment to others. Side effects of minor itching has been reported in a couple cases. Conclusions: Acupoint sticking in Dog-Days is effective in children older than three year old. The effect would be greater when going through the treatment three times. Based on significant satisfaction, intention of repetition and recommendation, strong promotion on Dog-Days are needed to make a better use of Acupoint sticking in Dog-Days for the effective treatment.