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

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

No abstract available.
Angiography ; Coronary Sinus ; Coronary Vessels

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

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

Gastrointestinal bleeding from an unknown origin occurs in 2~10% of patients with a small bowel lesion. The recent developments in capsule endoscopy and double- balloon enteroscopy have helped improve the accuracy of a diagnosis of small bowel bleeding. Inflammatory myofibroblastic tumors are most often observed in the lungs of young adults but have rarely been reported in conjunction with a small bowel bleeding episode. We report a case of a bleeding inflammatory myofibroblastic tumor in the jejunum that had been diagnosed as non specific jejunal bleeding by capsule endoscopy and confirmed by double- balloon enteroscopy.
Capsule Endoscopy ; Double-Balloon Enteroscopy ; Hemorrhage ; Humans ; Jejunum ; Lung ; Myofibroblasts ; Young Adult

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: The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors. METHODS: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M: F=10 : 5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection. RESULTS: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5x21.1 mm. The mean procedure time was 49.4 minutes (range: 8~103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery. CONCLUSIONS: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin.
Endosonography ; Gastrointestinal Stromal Tumors ; Hemangioma ; Humans ; Leiomyoma ; Lipoma ; Muscles ; Pancreas ; Stomach