Abdominal pain usually originates from the abdomen, but the lack of evidence of any abdominal disease suggests the pain originate from the thorax or have metabolic and neurogenic causes. Especially, neurogenic abdominal pain is recurrent and sustained causalgic pain, regardless of diet and without abdominal distension or rigidity, may be accompanied by signs of neurologic dysfunction. We have experienced a very rare case of abdominal pain arising from the intramedullary cavernous hemangioma of spinal cord. We report this case with a review of the literature.
Abdomen ; Abdominal Pain* ; Diet ; Hemangioma, Cavernous ; Neurologic Manifestations ; Spinal Cord ; Thorax

No abstract available.
Bilirubin* ; Humans ; Infant, Newborn* ; Kernicterus*

BACKGROUND/AIMS: Adenosine is an endogenous modulator of nociception. Its role in visceral nociception, particularly in visceral hyperalgesia, has not been studied. The aim of this study was to determine the effects of adenosine receptor agonists in a model of visceral hyperalgesia. METHODS: The visceromotor response (VMR) in rats to colorectal distension (CRD; 80 mmHg, 20 seconds) was quantified by electromyographic recordings from the abdominal musculature. Three hours after the intracolonic administration of zymosan (25 mg/mL, 1 mL), VMRs to CRD were measured before and after either subcutaneous or intrathecal administration of an adenosine receptor agonist. RESULTS: Subcutaneous injection of 5'-N-ethylcarboxyamidoadenosine (NECA; an A1 and A2 receptor agonist), R(-)-N6-(2-phenylisopropyl)-adenosine (R-PIA; a selective A1 receptor agonist), or CGS-21680 hydrochloride (a selective A2a receptor agonist) dose-dependently (10-100 mg/kg) attenuated the VMR to CRD, although hindlimb weakness occurred at the higher doses tested. Intrathecal administration of NECA or R-PIA dose-dependently (0.1-1.0 microgram/kg) decreased the VMR, whereas CGS-21680 hydrochloride was ineffective over the same concentration range. Higher intrathecal doses of the A1/A2 receptor agonist NECA produced motor weakness. CONCLUSIONS: Adenosine receptor agonists are antihyperalgesic, but also produce motor weakness at high doses. However, activation of the spinal A1 receptor significantly attenuates the VMR to CRD without producing motor weakness.
Adenosine ; Adenosine-5'-(N-ethylcarboxamide) ; Animals ; Hindlimb ; Hyperalgesia ; Injections, Subcutaneous ; Nociception ; Purinergic P1 Receptor Agonists ; Rats ; Receptors, Purinergic P1 ; Zymosan

No abstract availble.
Adult ; *Balloon Dilatation ; Endoscopes, Gastrointestinal ; *Endoscopy, Gastrointestinal/methods ; Humans ; Male ; Meckel Diverticulum/*diagnosis

No abstract available.
Manometry

Patients, aged ≥ 50 years, with gastric neoplasm are reported to be at increased risk for colorectal neoplasia (CRN), while data regarding the risk of CRN in young patients, aged < 50 years with gastric neoplasm are limited. We aimed to investigate the risk of CRN according to the presence of gastric neoplasm in patients, aged < 50 years, and conducted a cross-sectional study on 131,888 asymptomatic examinees who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy as part of a health screening program between 2010 and 2014. The prevalence of overall CRN (8.6% vs. 13.2%, P = 0.251) and advanced colorectal neoplasia (ACRN) (0.0% vs. 1.3%, P = 0.345) did not significantly differ according to the presence of gastric neoplasm in subjects, aged < 50 years. However, among subjects aged ≥ 50 years, patients with gastric neoplasm had a significantly higher proportion of overall CRN (48.2% vs. 31.7%, P < 0.001) and ACRN (12.5% vs. 4.5%, P < 0.001) compared with those without gastric neoplasm. Particularly, gastric neoplasm was an independent risk factor for ACRN after controlling for confounding factors among subjects, aged ≥ 50 years. In conclusion, gastric neoplasm was a risk factor for CRN in patients, aged ≥ 50 years, but not in patients, aged < 50 years. Young patients, aged < 50 years with gastric neoplasm do not need to undergo colonoscopy, whereas patients, aged ≥ 50 years with gastric neoplasm, should be considered a higher priority for colonoscopy.
Adenoma* ; Colonoscopy ; Colorectal Neoplasms ; Cross-Sectional Studies ; Endoscopy, Digestive System ; Humans ; Mass Screening* ; Prevalence ; Risk Factors ; Stomach Neoplasms

PURPOSE: Billroth I and II reconstructions are commonly performed after a distal subtotal gastrectomy. However, both may cause duodenogastric and duodenogastroesophageal reflux, which are conditions reported to have carcinogenic potential. This study investigated which reconstructive procedure would be most effective in prevent bile reflux into the gastric remnant after a distal gastrectomy. METHODS: A group of 43 patients who underwent a curative distal gastrectomy for gastric cancer were assigned to three groups prospectively according to the reconstructive procedure undertaken: 14, Billroth I (B-I); 14, Billroth II with Braun anastomosis (B-II with Braun); and 15 Billroth II (B-II). The bile reflux period (percent time) for the gastric remnant was measured using a Bilitec 2000 under standardized conditions. The endoscopic findings for reflux gastritis were classified into four grades. RESULTS: The mean standard error time of bile reflux in B-I, B-II with Braun and the B-II groups was 30.9+/-3.9%, 32.8+/-5.1% , and 60.9+/-7.0%, respectively. The B-II group showed significantly higher levels of the % time of bile reflux than the B-I or B-II with Braun groups (P<0.001). Regarding the endoscopic classification for reflux gastritis, the remnant stomach after B-II showed significantly more severe and extensive gastritis than that after the B-I and B-II with Braun procedures (P=0.003). There was also a positive correlation between the degree of % time of bile reflux and the extent of gastritis in the gastric remnant (P<0.001). CONCLUSION: After a distal subtotal gastrectomy, a B-II reconstruction is associated with a high reflux of duodenal content, whereas a Braun enteroenterostomy after a B-II reconstruction minimized the reflux at the levels of a B-I reconstruction.
Bile Reflux ; Classification ; Duodenogastric Reflux* ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Prospective Studies ; Stomach Neoplasms

PURPOSE: To evaluate the effectiveness and problems of Gianturco stent for treatment of esophagorespiratory fistulas caused by esophageal carcinoma. MATERIALS AND METHODS: In a 6~year period, we have treated 95 patients of esophageal carcinomas with silicone-covered modified Gianturco stent. Among those patients, ten had an esophagorespiratory fistula. We retrospectively analyzed the effect of stent for the occlusion of esophagorespiratory fistula, food intake capacity of patients, clinical and procedural problems of the stent. RESULT: After procedure, all fistulas were occluded successfully. Of the 10 patients, two could swallow all kinds of food, four most of foods, three soft foods, and one only liquid foods. In one patient, the fistula was reopened probably resulting from the reflux due to the presence of another lesion in the distal esophagus at 1 week after procedure. Two patients complained of dyspnea due to tracheal compression by the proximal tip of the stent and tracheal invasion of tumor after 4 and 11 weeks. In one patient, fistula was recurred due to tumor overgrowth on proximal and distal portion after 24 weeks. The fistulas recurred from the tumor overgrowth or reflux were sucessfully treated with another esophageal stent. The tracheal compression by the proximal tip of the stent and invasion by esophageal cancer was treated with tracheal stent and radiation therapy. CONCLUSION: Insertion of silicone-covered modified Gianturco stent was an effective method for the palliative treatment of esophagorespiratory fistula caused by esophageal cancer. Simultaneous use of tracheal stent is also recommended in patients with tracheal compression by the proximal tip of the stent and invasion by esophageal cancer.
Dyspnea ; Eating ; Esophageal Neoplasms ; Esophagus ; Fistula* ; Humans ; Palliative Care ; Retrospective Studies ; Stents*

No abstract available.
Hypokalemia

PURPOSE: We evaluated the therapeutic efficacy and complications of percutaneous cholecystostomy in acalculou s acute cholecystitis. MATERIALS AND METHODS: We performed percutaneous cholecystostomy under ultrasound guidance for the treatment of 18 patients with acalculous acute cholecystitis. We retrospectively analyzed the therapeutic efficacy and complications. RESULTS: A dramatic improvement in clinical condition was observed in 16(88%) patients within 24 --48 hours. One patient was successfully treated with second trial because of technical failure at initial trial. No major complications occured except a gallbladder laceration. Most of patients complained minor symptoms such as fever, pain, mild dyspnea and refered pain to right shoulder, and these symptoms were resolved within one week. There was no complications related to vasovagal reflex. CONCLUSION: In the treatment of acalculous acute cholecystitis, percutaneous cholecystostomy is a safe and effective method.
Acalculous Cholecystitis* ; Cholecystitis, Acute ; Cholecystostomy* ; Dyspnea ; Fever ; Gallbladder ; Humans ; Lacerations ; Reflex ; Retrospective Studies ; Shoulder ; Ultrasonography