The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

The purpose of this study was to determine the characteristics of masticatory muscle activity and various oral condition factors, and to analyze their associations in order to improve the prevention and diagnosis of masticatory musclerelated diseases. This study included 30 Korean females (mean age of 20 years, age range of 19–21 years). Participants were instructed to complete a self-written questionnaire on factors that may affect their muscle activity. Surface electromyography was used to measure the activity of the masseter and temporalis muscles. We also observed the buccal mucosa ridge, tongue indentation, tooth cracks and fractures, and mandibular tori in the oral cavity. Spearman correlation analysis and the nonparametric Mann–Whitney U test were applied to the data. When subjects had temporomandibular disorder, the right temporalis muscle exhibited significantly lower activity (P<0.05). Those who had received orthodontic treatment within the previous 2 years showed significantly lower activity of the left masseter muscle (P<0.05). Those who had a left buccal mucosa ridge exhibited lower activity of the left masseter muscle and higher activity of the right temporalis muscle compared with those without such a ridge (P<0.05). Participants with no tongue indentation showed significantly higher activity in the left masseter muscle (P<0.05). These results indicate that there are relationships between masticatory muscle activity and various factors related to the oral condition.

No abstract available.
Tuberculosis, Laryngeal*

Precision medicine stands for 4Ps - precise, preventive, participatory, and personal; in which “precision” is important because the current modern medicine starts from “trial and error,” and “one does not fit all”. Current targeted therapies for cancer have changed treatment approaches and led the precision medicine; however, clinical use of liquid biopsy, using blood or other liquid specimens to characterize circulating tumor cells (CTC) or tumor genes instead of biopsies of tumor tissues, still awaits availability of more information regarding non-invasive cancer detection and characterization, prediction of treatment response, monitoring the disease course and relapse possibilities, identification of mechanisms of drug resistance, and newer pathogenesis. In this review, we will introduce the basic concept of CTC, circulating cell free DNA, and exosomes and their possible application for gastric cancer relevant with Helicobacter pylori infection.
Biopsy* ; DNA ; Drug Resistance ; Exosomes ; Helicobacter Infections* ; Helicobacter pylori ; Helicobacter* ; History, Modern 1601- ; Humans ; Neoplastic Cells, Circulating ; Precision Medicine ; Recurrence ; Stomach Neoplasms*

Background/Aims: Integrated relaxation pressure (IRP) is a critical diagnostic criterion to define achalasia. However, there are some cases with typical symptoms and signs of achalasia but with normal IRP. The aim of this study is to evaluate the clinical characteristics of patients with achalasia with normal IRP and outcomes after peroral endoscopic myotomy (POEM). Methods: Patients with achalasia were collected in whom POEM was performed from November 2014 to April 2018 at CHA Bundang Medical Center. Achalasia with normal IRP was defined by findings compatible to achalasia in Eckardt score, endoscopy with endoscopic ultrasound, high-resolution manometry, impedance planimetry (EndoFlip), and timed esophagogram. Results: POEM was performed in 89 patients with achalasia; among them, 24 (27%) patients were diagnosed with achalasia with normal IRP. Patients with achalasia with normal IRP were older, had longer duration of symptom, and had a more tortuous esophagus. In EndoFlip, the distensibility index and cross-sectional area were higher in patients with normal IRP. Therapeutic outcomes showed no statistically significant differences. On correlation analysis, IRP had negative correlations with age, disease duration, and distensibility index. Conclusions Patients with achalasia of normal IRP value were older and had longer disease duration and higher distensibility index and crosssectional area than patients with achalasia with abnormal relaxation of lower esophageal sphincter. Therapeutic outcomes were not different between the 2 groups.

PURPOSE: To assess the differences in bone mineral density (BMD) of lumbar spine and wrist between preterm infants of postconceptional age 40 weeks and normal full-term infants. MATERIALS AND METHODS: Sixty-eight preterm infants born at conceptional age 26 -36 weeks and 31 normal full-term infants born at 38 -42 weeks were investigated. Bone mineral densities of the lumbar spine (from the second to the fourth segment) and wrist were measured by dual energy X-ray absorptiometry. In preterm infants, the corrected age of 0 month was defined as postconceptional 40 weeks. Full-term infants were evaluated within three days of birth, and the average bone mineral densities of preterm and full-term infants were compared. In the preterm group, birth weight and conceptional age were correlated with lumbar spinal and wrist bone mineral densities. Data were analyzed by student's t-test and Pearson's correlation coefficient, and a pvalue of less than 0.05 was considered significant. RESULTS: In preterm in fants, the values of bone mineral densities of the lumbar spine and wrist were 0.137 +/- 0.018 g/cm2(0.061 -0.202 g/cm2) and 0.089 +/-0.013 g/cm2 (0.065 -0.123 g/cm2), respectively, while the respective values for full-term infants were 0.214 +/-0.030 g/cm2 (0.160 -0.296 g/cm2) and 0.118 +/-0.014 g/cm2(0.096 -0.162 g/cm 2). In the preterm group, lumbar spinal BMD correlated significantly with conceptional age(r=0.384, p<0.05) and birth weight (r=0.438, p<0.05). While wrist BMD correlated significantly with birth weight (r=0.281, p<0.05), its correlation with conceptional age was not significant (r=0.223, p>0.05). CONCLUSION: The lumbar spinal and wrist BMDs of preterm infants at corrected age 0 were lower than those of normal full-term infants. In the preterm group, BMD values for the lumbar spine were lower in infants of lower conceptional age and birth weight.
Absorptiometry, Photon* ; Birth Weight ; Bone Density* ; Humans ; Infant* ; Infant, Newborn ; Infant, Premature ; Parturition ; Spine* ; Wrist*

BACKGROUND AND OBJECTIVES: A histological finding that is the most characteristic of cholesteatoma is the proliferation of the squamous cell. Signal transduction through phospholipase C(PLC) participates in the regulation of epidermal cell growth and differentiation. EGF, PDGF, and TGF-alpha bind to their receptors and thereby induce tyrosine phosphorylation of the phospholipase C-gamma1 (PLC-gamma1). PLC-gamma1 is a substrate for several receptor tyrosine kinases and its catalytic activity is increased by tyrosine phosphorylation. Tyrosine kinase phosphorylation of PLC-gamma1 stimulates PLC activation and cell proliferation. The G-protein has been shown to specifically activate PLC-beta1. However, the signal transduction pathway and the significance of PLC in cholesteatoma is unknown. This study attempted to provide some evidence that PLC plays a role in cholesteatoma by investigating the distribution and quantity of PLC-beta1 and PLC-gamma1 in the posterior auricular skin and cholestsatoma. MATERIALS AND METHODS: Western blotting and immunohistochemical study were performed for 20 cholesteatoma specimens obtained from patients who underwent operation. RESULTS: Western blot analyses revealed that PLC-beta1 protein and PLC-gamma1 protein were detectable in cholesteatoma and that these proteins were in higher levels compared with the control. In the imm-unohistochemical study, PLC-gamma1 was detected in the horny cell layer of posterior auricular skin but not in the suprabasal layer and the horny cell layer of cholesteatoma. PLC-beta1 was detected in the primary basal layer and a minor reaction was also noted in the spinous layer of posterior auricular skin. However, there were detactable reactions in both the basal and the suprabasal layers of cholesteatoma. CONCLUSION: The results of this study suggest that there are signal transduction pathways through PLC, over-expression of PLC, the different signaling mechanism by PLC in the basal and the suprabasal layer of cholesteatoma.
Blotting, Western ; Cell Proliferation ; Cholesteatoma* ; Epidermal Growth Factor ; GTP-Binding Proteins ; Humans ; Phospholipase C beta* ; Phospholipases* ; Phosphorylation ; Phosphotransferases ; Protein-Tyrosine Kinases ; Signal Transduction ; Skin ; Transforming Growth Factor alpha ; Tyrosine

BACKGROUND AND OBJECTIVES: The exact pathogenesis of cholesteatoma remains unknown in spite of several theories that have been formulated. The most characteristic histologic finding of cholesteatoma is the proliferation of the squamous cell lining of the lesion. Protein Kinase C (PKC) is a family of phospholipid-dependent serine/threonin protein kinase that sends extracellular signals across the cell surface in order to regulate epithelial cell groweth and differentiation. This study attempted to provide the evidence for the role of PKC in cholesteatoma. MATERIALS AND METHODS: Twenty-five cholesteatoma specimens were obtained from patients for western blotting, immunohistochemical study, RT-PCR, and densitometry. RESULTS: The results of western blotting revealed that considerably lower levels of PKCalpha, PKCbeta, and PKCepsilon protein were detected in cholesteatoma than in the posterior auricular skin. In the immunohistochemical study, PKCalpha, PKCbeta, and PKCepsilon were detected both in the basal and suprabasal layer of posterior auricular skin, but they were not detectable in cholesteatoma. The results of PCR for PKCalpha, PKCbeta, and PKCepsilon showed that there were no differences between cholesteatoma and posterior auricular skin regarding the mRNA expression. CONCLUSION: Downregulation of PKCalpha, PKCbeta, and PKCepsilon in cholesteatoma suggests that abnormal epithelial growth is a possible mechanism of cholesteatoma. The results suggest the following there is an abnormal signal transduction through the PKC pathway in cholesteatoma: downregulation of PKC takes place in the post-transcription phase, and downregulation of PKC is associated with prolonged chronic inflammation of cholesteatoma.
Blotting, Western ; Cholesteatoma* ; Densitometry ; Down-Regulation* ; Epithelial Cells ; Humans ; Inflammation ; Polymerase Chain Reaction ; Protein Kinase C* ; Protein Kinases* ; RNA, Messenger ; Signal Transduction ; Skin

Polymicrobial peritonitis is a relatively uncommon complication and it's clinical characteristics, risk factor and optimal managernent remain controversial. To identify indications for catheter removal in polymicrobial peritonitis, we reviewed the 340 episodes that occured in 168 patients of CAPD peritonitis during past 7 years to identify those. Polymicribial peritonitis was the 18 epoisodes in 18 patients of all peritonitis. First, 18 patients with polymicrobial peritonitis (P-P) did not show significant differences in the demographic features compared to 130 patients with single organism peritonitis (S-P). In contrast to Staphylococcus in S-P, the most common causative organisrn in P-P was pseudomonas (23%). Also sgnificantly more catheters were removed in P-P than S-P (P=0.001). Second, we cornpared group I, the patients responded to antibiotics only, and group II, those who needed catheter removal. The group I was 7 (39%) and the group II was 11 (61%). No patient of group I died and two patients of group II died. Between group I and group II, there were no significant differences in the demographic features. However, patients whose dialysate-WBC counts were below 100 at 3rd day after start of antibiotics were more significantly frequent in group I than group II. Among combination of causative organisms in P-P, most of Pseudornonas (6/9) and fungus (4/4) were treated by catheter removal. In conclusion, more catheters were removed in P-P than S-P. When dialysate WBC at 3rd day after start of antibiotics were over 100 and causative organism included pseudomonas or fungus in P-P, catheter removal was needed. We suggest that the kinds of organisms isolated and early response to antibiotics influence on the outcome of polymicrobial peritonitis.
Anti-Bacterial Agents ; Catheters* ; Fungi ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Risk Factors ; Staphylococcus

BACKGROUND AND OBJECTIVES: Smoking is regarded as one of the factors that bring about nonspecific hypersensitivity in allergic nasal mucosa. But it is uncertain how chronic smoking affects hypersensitivity in nasal mucosa. This study was designed to evaluate the relationship between smoking and nasal hypersensitivity. In this study, histamine is used since it is commonly used to evaluate nasal hypersensitivity. MATERIAL AND METHODS: Twelve smokers and 9 nonsmokers were participated in this study. Nasal mucosae of each subjects were stimulated by thiorphan followed by substance P. After stimulation, several dilutions of 10 to 5X104 ng/ml of histamine was instilled to both nasal cavity at intervals of 10 minutes. We measured the volume of nasal cavity by acoustic rhinometry in each step and counted the number of sneezing and nasal blowing at every 10 minute intervals. Changes in volume after each dillutions of histamine instillations were compared with the values measured after the stimulation by thiorphan and substance P., and this value was expressed as the percentage volume change. RESULTS: The nasal volume of smoker group was increased upto 100 ng/ml of histamine and decreased from 1000 ng/ml of histamine. The nasal volume of nonsmoker group decreased more than the smoker group with each dilution of histamine. The number of sneezing and nasal blowing increased in each group with each dilution of histamine. CONCLUSIONS: Chronic smoking may decrease susceptibility of hypersensitivity to histamine in nasal mucosa.
Histamine ; Hypersensitivity* ; Nasal Cavity ; Nasal Mucosa ; Rhinometry, Acoustic ; Smoke ; Smoking ; Sneezing ; Substance P ; Thiorphan