BACKGROUND: Untreated malignant gastrointestinal obstruction is rapidly fatal and causes various symptoms and malnutrition, and so decreases the quality of life and shortens the survival. We reviewed clinical characteristics and analyzed prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction. METHODS: We retrospectively reviewed the medical records of 63 patients with malignant gastrointestinal obstruction who had been confirmed by endoscopy or colonoscopy, upper gastrointestinal series or barium study and proper radiologic study at Sam Anyang hospital from May in 2002 to December in 2004. We excluded patients with palliative tumor resection. We analyzed prognostic factors for overall survival and symptom-free survival. RESULTS: There were 30 males (48%) and 33 females (52%), and median age of 63 patients was 64 years. The cause of malignant gastrointestinal obstruction was colorectal (26 patients, 41%), stomach (19, 30%), pancreas (4, 6%) and others (14, 23%). Twenty one patients (33%) had Eastern Cooperative Oncology Group (ECOG) performance status of 2 score and 42 patients (67%) 3 or 4 score. Forty two patients (67%) have been performed palliative procedures and 21 patients (33%) have not. Median survival of patients with palliative procedure was significantly higher than that of patients who have not been performed palliative procedures (144 days v 45 days, p=0.0001). By mutivariate analysis, palliative procedures and performance status were independent prognostic factors. However, age, gender, primary cancer, site of obstruction, and previous chemotherapy were not independent prognostic factors. Performance status was only independent prognostic factor that improves symptom free survival in patients with palliative procedures (p=0.014) and median symptom free survival was 90 days. There was no mortality on palliative procedures. CONCLUSIONS: We confirmed that palliative procedures and performance status are significant independent prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction.
Barium ; Colonoscopy ; Drug Therapy ; Endoscopy ; Female ; Gyeonggi-do ; Humans ; Male ; Malnutrition ; Medical Records ; Mortality ; Pancreas ; Prognosis ; Quality of Life ; Retrospective Studies ; Stomach

Numerous medications have the potential to induce acute pancreatitis. However, isoniazid-induced acute pancreatitis is extremely rare. Drug-induced acute pancreatitis can be diagnosed by improvement after stopping the drug and recurrence of pancreatitis when rechallenged. We present a case of severe acute pancreatitis accompanied by multiple large pseudocysts after isoniazid treatment for pulmonary tuberculosis. We confirmed that isoniazid induced pancreatitis by rechallenging after treatment cessation. Most previous reports of isoniazid-induced pancreatitis have been clinically mild forms, and the patient fully recovered with supportive management. However, this case presents severe and permanent pancreatic damage that developed with 5 weeks of isoniazid treatment. When a patient presents with manifestations of pancreatitis during treatment of tuberculosis that includes isoniazid, the physician should consider isoniazid-induced pancreatitis.
Humans ; Isoniazid ; Pancreatitis ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Withholding Treatment

BACKGROUND: Expression of recombinant antibodies and their derivatives fused with other functional molecules such as alkaline phosphatase in Escherichia coli is important in the development of molecular diagnostic reagents for biomedical research. METHODS: We investigated the possibility of applying a well-known Fos-Jun zipper to dimerize V(H) and V(L) fragments originated from the Fab clone (SP 112) that recognizes pyruvate dehydrogenase complex-E2 (PDC-E2), and demonstrated that the functional zipFv-112 and its alkaline phosphatase fusion molecules (zipFv-AP) can be produced in the cytoplasm of Origami(DE3) trxB gor mutant E. coli strain. RESULTS: The zipFv-AP fusion molecules exhibited higher antigen-binding signals than the zipFv up to a 10-fold under the same experimental conditions. However, conformation of the zipFv-AP seemed to be influenced by the location of an AP domain at the C-terminus of V(H) or V(L) domain [zipFv-112(H-AP) or zipFv-112(L-AP)], and inclusion of an AraC DNA binding domain at the C-terminus of V(H) of the zipFv-112(L-AP), termed zipFv-112(H-AD/L-AP), was also beneficial. Cytoplasmic co-expression of disulfide-binding isomerase C (DsbC) helped proper folding of the zipFv-112(H-AD/L-AP) but not significantly. CONCLUSION: We believe that our zipFv constructs may serve as an excellent antibody format bi-functional antibody fragments that can be produced stably in the cytoplasm of E. coli.
Alkaline Phosphatase ; Antibodies ; Clone Cells ; Cytoplasm ; DNA ; Escherichia ; Escherichia coli ; Immunoglobulin Fragments ; Indicators and Reagents ; Leucine Zippers ; Oxidoreductases ; Pathology, Molecular ; Pyruvic Acid ; Sprains and Strains

The interventional procedure is a percutaneous treatment modality using various devices such as a guide-wire and a catheter under a minimal incision. It is usually done under a fluoroscopy (X-ray radiography) guidance, therefore the operator would be exposed to X-ray irradiation. Recently, a new procedure using a master-slave robotic system is proposed for the intervention procedure, especially in the era of vascular disease. Many state of art intervention robots are under development and this approach can drastically reduce radiation exposure by replacing human effort by a robotic system for high radiation exposure procedures. However, robotic intervention is still more expensive and needs more efficient end effector and easier human interface for a safer and faster procedure. This article provides a comprehensive summary of vascular intervention and necessity of the vascular intervention robot system.
Catheters* ; Fluoroscopy ; Humans ; Radiation Exposure ; Vascular Diseases

The incidence of brain abscess in congenital heart disease marks 4-6%. Of these, tetralogy of Fallot is the most common congenital heart disase. We had experienced 2 cases of brain abscess associated with tetralogy of Fallot among 32 cases Of brain abscess from March -'57 to September-'74. Case 1;A 10 years old boy was admitted to our hospital in March-'66 because of headaches and vomiting. He had a history of Potts' operation under the impression of tetralogy of Fallot at the age of 5. Findings of clinical examination and diagnostic studies gave us an impression of a huge cystic mass in the right posterior temporo-occipital area. We aspirated about 80cc of pus, but no microoraganisms were noted on direct smear and culture. Case 2;A 7 years old boy was admitted to our hospital in August-'74 because of headaches and fever. He had been suffered from tetralogy of Fallot from the age of 3 without any surgical intervention. We made a burr hole on the right anterior temporal area under the impression of right posterior fronto-temporal mass, and aspirated about 15cc of pus. Multiple Gram positive cocci were noted on direct smear, but nothing on culture.
Brain Abscess* ; Brain* ; Child ; Fever ; Gram-Positive Cocci ; Headache ; Heart ; Heart Defects, Congenital ; Humans ; Incidence ; Male ; Suppuration ; Tetralogy of Fallot* ; Vomiting

Primary or secondary anaplastic large-cell lymphoma (ALCL) is an uncommon type of T-cell lymphoma and is extremely rare.1-3 It was said that only 15-20 cases of primary CNS-ALCLs have been reported in the literature.3 ALCL may present with a variety of symptoms and MRI findings. We report a case of a 10-year-old girl who presented with meningitis and later developed optic neuritis. She was initially diagnosed as tuberculosis meningitis after a positive interferon-γ test. Clinicians should be

BACKGROUND/AIMS: Gallstone disease (GSD) is a common gastrointestinal disorder. Clinical epidemiological studies revealed that alcohol consumption has a preventive effect on the development of GSD. This study aimed to evaluate the relative risks of drinking for GSD development and investigate the dose-response relationships. METHODS: A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases for studies published up to 2018 was performed. All studies that satisfied the following eligibility criteria were included: patients with GSD with or without cholecystitis; and cohort or case-control studies investigating the association between alcohol consumption and GSD development. RESULTS: Sixteen case-control studies including 24,401 gallstone cases and 76,185 controls, and eight cohort studies with 14,693 GSD cases among 2,432,471 person-years were enrolled. Alcohol consumption presented a decreased overall risk of GSD (pooled relative ratio [RR], 0.84; 95% confidence interval [CI], 0.79 to 0.89; p=0.02). Subgroup analyses according to drinking levels indicated a gradual risk reduction for GSD compared to nondrinkers (light: RR, 0.96; 95% CI, 0.94 to 0.99; p=0.75; moderate: RR, 0.80; 95% CI, 0.75 to 0.85; p=0.27; high: RR, 0.66; 95% CI, 0.56 to 0.79; p < 0.01). A nonlinear risk reduction was observed in a dose-response meta-analysis of all the studies (n=14, p < 0.01 for nonlinearity). CONCLUSIONS: In this systematic review with meta-analysis, alcohol consumption could decrease the risk of GSD, and the dose-response analysis revealed a dose-dependent linear risk reduction and a weakened linear trend between alcohol consumption levels less than and greater than 28 g/day.
Alcohol Drinking* ; Case-Control Studies* ; Cholecystitis ; Cohort Studies* ; Drinking ; Epidemiologic Studies ; Gallstones* ; Humans ; Risk Reduction Behavior

Background/Aims: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO). Methods: A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only. Results: A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34– 0.64; I2=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57–1.09; I2=7%; p=0.36). Conclusions RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.

Background and Objectives: The purpose of this study was to investigate the effect of unvoiced segments on the cepstral analysis in patients with vocal cord paralysis (VCP).Subjects and Method A total 302 subjects (173 subjects with VCP and 129 normal voice subjects) participated in this study. The sustained vowel /a/ 2 seconds and one sentence of ‘Sanchaek’ were edited, and analyzed by Praat script. The cepstral analyses were performed using sustained vowel (SV), continuous speech (CS), and extracted continuous speech (EXT) samples. The auditory-perceptual (AP) rating was also completed by three raters. Results: First, there were significant differences in all variables except low-to high spectral ratio(L/H ratio)_EXT between two groups. Second, cepstral peak prominence (CPP), smoothed cepstral peak prominence (CPPS), and L/H ratio showed significant differences in SV, CS, and EXT samples. Third, cepstral measurements were highly correlated with the AP ratings. Finally, the level of discrimination of dysphonia estimated from CPP and CPPS gotten from SV and CS values was more than area under the curve (AUC) of 0.941. AUC of 0.880 or more was also found in EXT. Conclusion In this study, we confirmed that both CS and EXT are highly predictive of pathologic speeches. Further study will also need to be validated for a more diverse group of voice disorders.

Esophageal small cell carcinoma is a very rare disease. Primary extra-pulmonary small cell carcinoma was reported to account for 4% of primary small cell carcinoma and only 2% of all esophageal malignancy. Because the rate of early distant metastasis is very high, the prognosis is very poor. In Korea, 20 cases were reported. Seventeen cases were located at the mid or lower esophagus and 3 cases were located at the upper esophagus. We have experienced a case of primary upper esophageal small cell cancer, a 65-year-old female with cervical lymph node metastasis, which were diagnosed by endoscopy, open surgical lymph node biopsy and immunohistochemical analysis.
Aged ; Biopsy ; Carcinoma, Small Cell ; Endoscopy ; Esophagus ; Female ; Humans ; Korea ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Rare Diseases