An 8-year-old male was admitted because of dysphagia and substernal pain suffered while eating followed by postprandial vomiting for 2 years. He was always hungry due to postprandial vomiting and willing to eat again just after vomiting. After this meals, he used to jump up and down to shake off the substernal discomfort. A narrowing of the gastroesophageal junction was noted by esophagogram. Manometry revealed high Lower esophageal sphincter (LES) pressure (51.6mmHg), incomplete LES relaxation during swallowing, loss of esophageal peristalsis and a positive pressure of the esophageal body compared to intragastric pressure. After the 1st balloon dilatation, symptoms were much improved even though LES pressure still remained high (37.2mmHg). About 2 months after the 1st balloon dilatation, symptoms relapsed and we managed him with a 2nd balloon dilatation. Symptoms were more improved than after the 1st dilatation and LES pressure normalized as well. Since the 2nd dilatation, symptoms have not recurred for 3 years. We present an 8-year-old boy with achalasia successfully managed by the use balloon dilatation.
Child ; Deglutition ; Deglutition Disorders ; Dilatation* ; Eating ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Humans ; Male ; Manometry ; Meals ; Peristalsis ; Relaxation ; Vomiting

BACKGROUND: Even though the cardiovascular actions of insulin were first described shortly after introduction into clinical practice, the precise physiological role and mechanism of insulin-mediated cardiovascular actions are not known. The aim of the present study was to investigate the changes in hemodynamics after an insulin injection and the role of the autonomic nervous system in mediating the responses to insulin. METHODS: Nine mongrel dogs of the male sex, weighing 20 - 26 kg, were studied. Anesthesia was maintained with pentobarbital and vecuronium after the administration of the loading dose. Femoral and pulmonary artery catheters were placed for obtaining blood samples (ABGA, electrolytes, glucose and plasma catecholamines) and measuring hemodynamic variables. Real time power spectral analysis of R-R interval variability was displayed on the color power spectrum every 30 seconds by a simple connection between the EKG monitor and computer via an A/D converter. After control values were obtained, porcine insulin was administrated intravenously as a bolus injection (2 U/kg). Blood glucose and potassium were maintained within physiological range by simultaneous infusion of 50% glucose (2-4 ml/kg/h) and potassium (0.5-1.0 mEq/kg/h). Parameters were measured respectively in 9 steps; 10min before insulin injection (control), 1, 5, 10, 20, 30, 40, 50 and 60min after insulin injection. RESULTS: Heart rate, mean arterial blood pressure and cardiac output increased and systemic vascular resistance decreased significantly after the insulin injection. No significant changes in plasma norepinephrine and epinephrine levels could be detected. Power spectral density of low frequency and ratio oflow and middle frequency power to high frequency power increased significantly 1min after insulin injection but did not increase thereafter. High frequency power remained significantly below the control value after the insulin injection. CONCLUSIONS: Although catecholamine concentration itself did not show a significant change, PSA data reveals that insulin may exert a stimulatory action on the sympathetic nervous system and a depressive action on the parasympathetic nervous system independent of hypoglycemia immediately after an insulin injection and insulin-induced vasodilation is not related to the autonomic nervous system.
Anesthesia ; Animals ; Arterial Pressure ; Autonomic Nervous System* ; Blood Glucose ; Cardiac Output ; Catheters ; Dogs* ; Electrocardiography ; Electrolytes ; Epinephrine ; Glucose ; Heart Rate ; Hemodynamics* ; Humans ; Hypoglycemia ; Insulin* ; Insulin, Regular, Pork ; Male ; Negotiating ; Norepinephrine ; Parasympathetic Nervous System ; Pentobarbital ; Plasma ; Potassium ; Pulmonary Artery ; Sympathetic Nervous System ; Vascular Resistance ; Vasodilation ; Vecuronium Bromide

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate