BACKGROUND AND OBJECTIVES: Recurrent laryngeal nerve (RLN) damage commonly occurs from a thyroid surgery and causes communication impairment, aspiration and dysphagia. The purpose of this study is to develop a polycaprolactone (PCL) nerve guide conduit (NGC) coated with conductive materials for facilitating regeneration from the RLN defects and to evaluate the usefulness of the PCL NGC coated with conductive materials in a rabbit model. MATERIALS AND METHODS: The PCL NGCs coated with conductive materials were fabricated for this study. The types of conductive materials were single-walled carbon nanotubes (SWNTs) and poly (3,4-ethylenedioxythiophene): polystyrene sulfonate (PEDOT:PSS) which were coated on the PCL NGCs by layer-by-layer (LBL) assembly techniques. An 8-mm segment of left RLN was resected in 24 New Zealand white rabbits. Three different NGCs (PCL and PCL with two conductive materials) were interposed between both stumps and fixed with suture. For the assessment of functional regeneration, the vocal cord mobility was observed using endoscopic system after RLN stimulation, and the motion change was analyzed. The atrophies of thyroarytenoid muscle and nerve growth were evaluated by Hematoxylin-Eosin (H-E) and toluidine blue (T-B) staining, respectively. Immunohistochemical study using anti-neurofilament, S-100 staining was further performed to evaluate the nerve regeneration. RESULTS: In endoscopic evaluation, the group with conductive PCL NGCs showed an improved tendency of vocal cord mobility compared to that of the other group. Nerve growth was observed with the time for 8 weeks in all groups and immunohistochemical staining revealed the expression of neurofilament and S-100 in regenerated nerve in all groups. The atrophies of thyroarytenoid muscle in the group with conductive PCL NGCs was also shown to be decreased compared to that of the nonconductive PCL NGC group. CONCLUSION: The study shows that PCL NGC coated with conductive materials appears to be a good alternative option for the repair and regeneration of RNL damages.
Atrophy ; Deglutition Disorders ; Laryngeal Muscles ; Nanotubes, Carbon ; Nerve Regeneration ; Polystyrenes ; Rabbits ; Recurrent Laryngeal Nerve* ; Regeneration* ; Sutures ; Thyroid Gland ; Tolonium Chloride ; Vocal Cords

BACKGROUND/AIMS: The discrepancy of the histopathological diagnosis between endoscopic forcep biopsy, surgery and endoscopic mucosal resection (EMR), has been reported on in a previous study. We compared the results of endoscopic forcep biopsy and the histopathologic diagnosis after performing endoscopic submucosal dissection (ESD). METHODS: We retrospectively reviewed 434 lesions for which we were able to compare the post-ESD histopathologic results with the endoscopic biopsy. RESULTS: 1) Of the 14 lesions that showed chronic gastritis or atypia by endoscopic biopsy, 9 were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 2) fifty one of 141 lesions that showed low grade dysplasia on the endoscopic biopsy were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 3) Of the 60 lesions that showed high grade dysplasia on the endoscopic biopsy, 46 were diagnosis with carcinoma in situ or adenocarcinoma after ESD. CONCLUSIONS: The discrepancy of the histopathological diagnosis was found between ESD and forcep biopsy. In light of these results, if a lesion that is suspected to be EGC, although it is not diagnosed by endoscopic biopsy, then it should be confirmed by ESD.
Adenocarcinoma ; Biopsy ; Carcinoma in Situ ; Gastritis ; Light ; Retrospective Studies ; Surgical Instruments

No abstract available.
Angiography ; Coronary Sinus ; Coronary Vessels

Pedunculated thrombus in the aortic arch that is associated with cerebral infarction is very rare requires prompt diagnosis and treatment to prevent occurrence of another devastating complication. Transesophageal echocardiography is useful for detecting source of embolism including aortic thrombi. The treatment options of aortic thrombi involves anticoagulation, thrombolysis, thromboaspiration, and thrombectomy. Here we report a case of huge thrombus in the aortic arch, resulting in acute multifocal cerebellar embolic infarct in patient without any risk factors for vascular thrombosis. Thrombi in the aortic arch were diagnosed by transesophageal echocardiography and treated with anticoagulants successfully.
Anticoagulants ; Aorta, Thoracic ; Cerebral Infarction ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Humans ; Risk Factors ; Thrombectomy ; Thrombosis

BACKGROUND/AIMS: There are few studies that have evaluated active small bowel bleeding. The aim of this study was to evaluate patients with active small bowel bleeding that had been considered as obscure gastrointestinal bleeding an was confirmed by the use of double balloon enteroscopy (DBE). METHODS: We retrospectively reviewed the medical records of 12 patients with active small bowel bleeding as detected on DBE from January 2005 to September 2007. RESULTS: The mean patient age was 63 years (age range, 45~80 years) and the patients consisted of seven men and five women. The mean hemoglobin level at admission was 7.6 g/dL (range, 5.8~9.0 g/dL). The mean transfusion volume was 4.4 pints (range, 0~7 pints). Angiodysplasia was the most common cause of bleeding (n=6, 50%), followed by small bowel tumors (n=4, 33%). Other causes included diverticula and a nonspecific ulcer. The most common location of bleeding was the jejunum. Diagnostic yields of capsule endoscopy, a 99mTc RBC scan, an abdomen CT scan, angiography and a small bowel series were 40%, 33%, 25%, 0% and 0%, respectively. Endoscopic treatment was performed successfully in eight patients (67%). CONCLUSIONS: The most common etiology for active small bowel bleeding is angiodysplasia followed by a small bowel tumor. Other diagnostic methods for the small bowel showed low diagnostic yields. Further investigation of active small bowel bleeding is needed to confirm our results.
Abdomen ; Angiodysplasia ; Angiography ; Capsule Endoscopy ; Diverticulum ; Double-Balloon Enteroscopy ; Female ; Gastrointestinal Stromal Tumors ; Hemoglobins ; Hemorrhage ; Humans ; Jejunum ; Male ; Medical Records ; Retrospective Studies ; Ulcer

BACKGROUND/AIMS: Until recently, only indirect procedures were available to provide images of the small bowel. Double-balloon enteroscopy (DBE) has the ability to obtain tissue for diagnosis and endoscopic interventions. This study was designed to determine the usefulness of DBE in patients with small bowel diseases by evaluating diagnostic yields and the impact on treatment. METHODS: From November, 2004 to November, 2006 a total 81 patients with suspected small bowel disease were investigated by DBE. We analyzed the diagnostics and therapeutics rates according to the indications of DBE. RESULTS: A total of 114 DBE procedures were performed. Gastrointestinal bleeding (64.2%) was the most common indication, followed by chronic abdominal pain/diarrhea (29.6%). A diagnosis was obtained in 44 of 52 patients with gastrointestinal bleeding and 17 of 24 patients with chronic abdominal pain/diarrhea. DBE resulted in therapeutic intervention in 17 patients with gastrointestinal bleeding and 13 patients with chronic abdominal pain/ diarrhea. DBE was diagnostic in 75.3% of the patients and played a role in the subsequent treatment of 37.0% of the patients. CONCLUSIONS: DBE was a useful and safe method for diagnosis and treatments in patients with small bowel diseases.
Diarrhea ; Double-Balloon Enteroscopy ; Hemorrhage ; Humans

BACKGROUND AND OBJECTIVES: The Mayo clinic quadratic (MCQ) glomerular filtration rate (GFR) equation accurately estimates the GFR when the presence of kidney disease is unknown. The aim of this study is to evaluate the usefulness of the MCQ GFR equation for predicting contrast-induced nephropathy (CIN) in patients with angina pectoris and who are undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: One hundred seven patients diagnosed with stable or unstable angina and who had normal serum creatinine levels (SCr <1.5 mg/dL) were enrolled. The MCQ GFRs, corresponding to before and 48 hours post CAG and/or PCI were calculated using the SCr as a previously described protocol. CIN was defined as a 25% elevation in the SCr or an absolute increase of 0.5 mg/dL (44 micromole /L). RESULTS: Overall, CIN occurred in 14 (13.1%) patients. CIN developed in 4 (57.1%) patients who had an estimated MCQ GFR less than 60 mL/min/1.73 m2 and in 10 (10%) patients who had a GFR over 60 mL/min/1.73 m2 (p=0.005). On univariate analysis, CIN was associated with the baseline MCQ GFR (p=0.001), the C-reactive protein (CRP) level (p=0.001), the volume of contrast agent (p=0.005), the left ventricular ejection fraction (p=0.001) and the low density lipoprotein cholesterol level (p=0.030). On multivariate analysis, a baseline MCQ GFR < or =60 mL/min/1.73 m2 [odds ratio (OR)=2.0, p=0.001], the volume of contrast agent > or =250 mL (OR 17.1, p=0.002), a CRP level > or =0.5 mg/dL (OR 4.7, p=0.037) and a left ventricular ejection fraction < or =40% (OR 1.7, p=0.020) were the independent risk factors for CIN. CONCLUSION: The pre-coronary angiography MCQ GFR is a useful predictor for the development of CIN. Strong preventive strategies are needed to avoid developing CIN in these high-risk patients.
Angina Pectoris ; Angina, Unstable ; Angiography ; C-Reactive Protein ; Cholesterol ; Cholesterol, LDL ; Contrast Media ; Coronary Angiography ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney Diseases ; Lipoproteins ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Risk Factors ; Stroke Volume

BACKGROUND/AIMS: Inflammation plays a key role in the pathogenesis and progression of cardiovascular disease (CAD). A small number of recent studies reported anti-inflammatory therapy achieved a reduction of CAD progression. The aim of the present study was to explore the roles of inflammatory markers and the conventional risk factors for CAD progression. METHODS: One hundred and fifty patients (58+/-10 years, 112 men) who underwent percutaneous coronary intervention and follow-up angiography (mean duration, 7.5+/-2.0 months) were enrolled in this study. On comparison of the coronary angiographic findings, the patients were divided into the progression and non-progression groups. The serologic inflammatory markers were angiography measured at the time of follow up. The clinical characteristic and inflammatory markers were compared between the two groups and the independent predictors of CAD progression were analyzed. CAD progression was defined as more than 30% diameter reduction of a pre-existing luminal stenosis. RESULTS: CAD progression occurred in 32 patients (21.3%). The frequency of diabetes mellitus (37.5% versus 19.5%, respectively, p=0.033) and the number of the disease vessels (p=0.003) were higher in the CAD progression group. In terms of the inflammatory markers, the progression patients had higher hsCRP (p=0.023), MCP-1 (p=0.036), sVCAM-1 (p=0.000), sP-selectin (p=0.000) and sCD40L (p=0.001) levels. Multiple logistic regression analysis of the variables showed that the logCRP (relative risk (RR) 5.016, CI=1.384-18.177, p=0.014) logVCAM-1 (RR 11.854, CI=1.883-74.614, p=0.008) and triple vessel disease of the coronary arteries (RR 5.037, CI=1.550-16.350, p=0.007) were independent predictors of CAD progression. CONCLUSION: In the present study, the extent of coronary artery disease and inflammatory markers like hsCRP and VCAM-1 were independent predictors for the progression of atherosclerotic lesions.
Angiography ; Atherosclerosis ; Cardiovascular Diseases ; Cell Adhesion Molecules ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Diabetes Mellitus ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Inflammation ; Logistic Models ; Percutaneous Coronary Intervention ; Phenobarbital ; Risk Factors ; Vascular Cell Adhesion Molecule-1

BACKGROUND/AIMS: Propofol is widely used for sedation during endoscopy. Because propofol may cause hepatic encephalopathy, hemodynamic compromise, and respiratory depression, cautious use is required in patients with liver cirrhosis. We evaluated the safety and efficacy of propofol in compensated cirrhosis during endoscopic examination. METHODS: Thirty-nine cirrhotic patients (19 and 20 cases of Child Pugh classes A and B, respectively) and 56 control subjects were included. The initial dose of propofol (40 mg) was increased by 20-mg increments until moderate sedation was achieved. The number connection test, flapping tremor test, blood pressure, heart rate, oxygen saturation, liver enzymes, and prothrombin time were evaluated before and after endoscopy. RESULTS: No significant change was observed in any parameter compared to baseline in either group. The mean dose of propofol was significantly lower in cirrhotic versus control subjects (49.7+/-15.8 versus 65.0+/-17.9 mg, respectively; p<0.001). Scores based on a visual analog scale evaluating patient satisfaction did not differ between groups (72+/-27 versus 64+/-26, respectively; p=0.196), nor did mean recovery time (16.4+/-9.8 versus 14.2+/-6.7 min, respectively; p=0.186). CONCLUSION: Propofol is safe and effective for moderate sedation in compensated liver cirrhosis.
Child ; Conscious Sedation ; Endoscopy ; Fibrosis ; Heart Rate ; Hematologic Tests ; Hemodynamics ; Hepatic Encephalopathy ; Humans ; Liver ; Liver Cirrhosis ; Oxygen ; Patient Satisfaction ; Propofol ; Prothrombin Time ; Respiratory Insufficiency ; Tremor

Autoimmunity is thought to play a central role in the pathogenesis of inflammatory bowel disease and associated extraintestinal manifestations. Autoimmune hemolytic anemia associated with ulcerative colitis is a rare occurrence. No more than 50 cases have been described in the international literatures, and only 2 cases reported in Korea. A 29-year-old woman who was diagnosed as ulcerative colitis two years ago was complicated with autoimmune hemolytic anemia, and did not respond to steroid therapy. Ultimately, total colectomy and splenectomy were carried out for the treatment of ulcerative colitis and hemolytic anemia. After the operation, anemia was resolved. We present the case with a review of literature.
Adult ; Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology ; Colectomy ; Colitis, Ulcerative/complications/*diagnosis/pathology ; Drug Resistance ; Female ; Humans ; Splenectomy ; Steroids/therapeutic use