No abstract available.
Pyloric Stenosis, Hypertrophic*

Esophageal cancer may induce progressive dysphagia. Insertion of a self-expandable metallic stent is widely used to relieve dysphagia. There are previous case reports that have described the use of membrane-covered stents to seal esophageal perforations. Complications of the use of an esophageal stent include bleeding, fistula formation, perforation, pain, tumor ingrowth and migration of the stent. A perforation may occur during or after the insertion of a stent from a contact ulcer due to the sharp ends of the metallic stents. We report a case of esophageal perforation after the insertion of a membrane-covered esophageal stent, which showed perforation at the middle portion of stent due to expansion of the stent. The perforation was sealed without surgical treatment or additional stent insertion.
Deglutition Disorders ; Esophageal Neoplasms ; Esophageal Perforation ; Esophagus ; Fistula ; Hemorrhage ; Stents ; Ulcer

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.
Acetylcholinesterase ; Consciousness ; Hospitals, Teaching ; Humans ; Intubation ; Miosis ; Organophosphate Poisoning ; Prognosis ; Prospective Studies ; Republic of Korea ; Respiration, Artificial ; Salivation ; Urinary Incontinence

Human adjuvant disease means the autoimmune disease or autoimmune disease like syndrome developed after plastic surgery using foreign body implantation. After first report of HAD by Miyoshi at 1964, a number of cases have been reported especially from Japan. Silicone has been known as biologically inert material, but a couple of side reaction and experimental data argue against such conventional idea. It is impossible to identify the exact role of implanted substance in the occurrence of autoimmune disease, but there are a few indirect evidences for adjuvant effect of silicone. The spectrum of HAD are as follows: unclassifiable connective disease like syndrome, rheumatoid arthritis, SLE, polymyositis, adult Still's disease, ITP, Hashimoto's thyroiditis, etc. We experienced two cases of HAD manifesting as SLE who had been injected with silicone fluid with for augmentation mammoplasty and report this with a review of the literature.
Adult ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Female ; Foreign Bodies ; Humans* ; Japan ; Mammaplasty ; Polymyositis ; Silicones ; Surgery, Plastic ; Thyroid Gland ; Thyroiditis