OBJECTIVES: In the connective tissue disease patients, esophageal dysfunction is often closely associated with the presence of Raynaud's phenomenon. But there are no previous reports concerning the values of esophageal manometry in the connective tissue disease with Raynaud s phenomenon in Korea. Therefore, we performed this study to evaluate esophageal function in connective tissue disease with Raynaud' s phenomenon. METHODS: Total 86 subjects were employed in this study including 30 normal control group, 14 mixed connective tissue disease(MCTD), 21 systemic sclerosis, 16 systemic lupus erythematosus(SLE), and 5 Raynaud s phenomenon only. In each subject, esophageal manometric study was performed with lower compliance capillary infusion system. RESULTS: The mean age(+SD) of patients and controls were as follows : MCTD 34.1(+8.9), systemic sclerosis 44.9(+9. 3), SLE 32. 1(+7.9), and normal controls 31. 9 (+ 5. 3). All patients with MCTD and systemic sclerosis had Raynaud s phenomenon. Twelve out of 14 patients with MCTD, 17 out of 21 patients with systemic sclerosis, were abnormal in esophageal manometry. Nine out of 16 SLE had Raynaud s phenomenon. Among 9 SLE with Raynaud s phenomenon, 5 patients(55.5%) were abnormal in esophageal manometry, and among 7 SLE without Raynaud's phenomenon, 2 patients (28. 6%) were abnormal in esophageal manometry. Among 5 patients with Raynaud's phenomenon, 3 patients were abnormal in esophageal manometry. Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud's phenomenon compared with the patients without Raynaud's phenomenon (P=O. 0219). CONCLUSIONS: Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynauds phenomenon compared with the patients without Raynaud s phenomenon.
Capillaries ; Compliance ; Connective Tissue ; Connective Tissue Diseases ; Humans ; Korea ; Manometry ; Mixed Connective Tissue Disease ; Scleroderma, Systemic

Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket.
Aged ; Bezoars* ; Constriction, Pathologic ; Diverticulum ; Esophageal Motility Disorders ; Esophagus* ; Humans ; SNARE Proteins ; Stomach* ; Vomiting

BACKGROUND AND OBJECTIVES: Survivors of pediatric hematopoietic stem cell transplantation (HSCT) are at risk for developing hypertension. The objectives of this study are to evaluate the prevalence and risk factors of early onset hypertension during the engraftment period after HSCT. SUBJECTS AND METHODS: This is a retrospective study of 157 consecutive patients (mean age at HSCT: 9.1+/-5.1 years) who underwent HSCT for acute myeloid leukemia (n=47), acute lymphoblastic leukemia (n=43), severe aplastic anemia (n=41), and other reasons (n=26). Blood pressure data were collected at five time points: 0, 7, 14, 21, and 28 days after HSCT. Hypertension was defined as having systolic and/or diastolic blood pressure > or =95th percentile according to age, gender, and height. To analyze the risk factors related to hypertension, data, including patients' demographic and transplant characteristics, were reviewed. RESULTS: Hypertension developed in 59 patients (38%), among whom 12 (7.6%) required long term therapy. Thirty-two (54%) patients had systolic and diastolic, 8 (14%) had only systolic, and 19 (32%) had only diastolic hypertension. Younger age, acute graft-versus-host disease, sinusoidal obstruction syndrome, treatment with antifungal agent, and greater increase in serum creatinine (Cr) levels were associated with hypertension. Multivariate analysis showed that younger age at HSCT and greater increase in serum Cr level were independent risk factors for hypertension. CONCLUSION: Prevalence of hypertension during immediate post-HSCT period is high, especially in younger children. A greater increase in Cr after HSCT was significantly associated with hypertension. Further study is needed to elucidate long-term cardiovascular complications in pediatric HSCT survivors.
Anemia, Aplastic ; Blood Pressure ; Child ; Creatinine ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Hepatic Veno-Occlusive Disease ; Humans ; Hypertension* ; Incidence* ; Leukemia, Myeloid, Acute ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prevalence ; Retrospective Studies ; Risk Factors* ; Survivors

Acute sensory neuropathy (ASN) is rare and is characterized by acute onset of sensory ataxia, loss of deep tendon reflexes and impaired vibratory and joint position sensations. Similar to Guillain-Barre syndrome (GBS) with prominent sensory ataxia, a few cases of ASN associated with antiganglioside antibodies have been reported. This suggests that a common autoimmue mechanism operates in some cases of ASN and of GBS with sensory ataxia. We report a patient with ASN associated with anti-GD1b IgG antibody.
Antibodies ; Ataxia ; Guillain-Barre Syndrome ; Humans ; Immunoglobulin G ; Joints ; Reflex, Stretch ; Sensation

PURPOSE: Continuous cardiac monitoring in a stroke unit (SU) may improve detection of atrial fibrillation (AF), and SU care may improve the rate of anticoagulation by better adherence to a standardized treatment protocol in patients with AF. We investigated the effects of the SU on the detection of AF and the rate of warfarin therapy in patients with AF. MATERIALS AND METHODS: Acute stroke patients who had been admitted before or after the opening of the SU were included in our study. SU patients were monitored continuously with electrocardiography. Rates of AF and warfarin therapy were compared between patients admitted to the SU (SU group) and those admitted to the general ward (GW) prior to the opening of the SU (GW group). RESULTS: Total 951 patients had been admitted to the GW prior to the opening of the SU (from January 2000 to November 2002), and 2349 patients to the SU (from January 2003 to December 2008). AF was found in 149 patients (15.7%) in the GW group and in 487 (20.7%) in the SU group. Most of AF detected during admission was paroxysmal AF (84.8%). The frequency of newly detected AF was higher in the SU group than the GW group (2.5% vs. 0.7%, p=0.001). The rate of anticoagulation consideration was also higher in the SU group. CONCLUSION: SU care improved the detection of AF and the rate of anticoagulation consideration in acute stroke patients. Our findings support the benefits of continuous cardiac monitoring in the SU for stroke patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use ; Atrial Fibrillation/*diagnosis ; Child ; Electrocardiography/*methods ; Female ; *Hospital Departments ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; *Neurology ; Recurrence ; Stroke/*diagnosis ; Treatment Outcome ; Warfarin/therapeutic use

Catamenial hemoptysis is syndrome characterized by bleeding from the bronchial trees and lungs that occurs synchronously with the female menstrual cycle. Etiologic mechanism of pulmonary endometriosis is still controversial, and the diagnosis is usually made on the basis of the clinical history and exclusion of other causes of recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations have been proved to be a useful confirmatory test. We experienced a 33-year-old female patient who had been previously diagnosed as pelvic endometriosis pathologically, experienced cyclic hemoptysis during menstruations. The diagnosis of pulmonary endometriosis was made based on her history and changes in the character of the lesions as documented on radiologic studies of the chest. She was treated successfully with GnRH analogue and there is no evidence of recurrence.
Female ; Humans

PURPOSE: To evaluate the efficacy and toxicity of combination chemotherapy with low-dose paclitaxel and cisplatin in patients with advanced non-small cell lung cancer. MATERIALS AND METHODS: Chemotherapy-naive patients with unresectable, pathologically proven non-small cell lung cancer were eligible for inclusion in the study. Patients received paclitaxel (145 mg/m2 iv 3 hour D1) and cisplatin (60 mg/m2 iv D1) every 3 weeks. RESULTS: Forty-two patients were enrolled between February 2000 and February 2001. The median age was 53.5 years. Patients with adenocarcinoma numbered 29, squamous cell carcinoma 7, large cell carcinoma 3, and undifferentiated carcinoma 3. Seventeen patients had stage IIIB, 19 had stage IV disease and the remaining 6 displayed recurred disease after previous surgical resection. Four patients terminated treatment early because of hypersensitivity (1) and severe emesis (3). Of the 38 evaluable patients, 14 had PR and the response rate was 36.8%. Among partial responders, 6 patients received additional chest radiation. The median duration of response was 47.9 weeks and the median overall survival was 54.0 weeks. Of the total 176 courses, 14 were delayed, 22 required dose reduction, and grade 3~4 neutropenia occurred in 5.6% of courses. Only one episode of neutropenic fever developed and there were no treatment- related mortalities. Other toxicities were generally mild. CONCLUSION: The combination chemotherapy with low-dose paclitaxel and cisplatin was effective and tolerable in patients with advanced non-small cell lung cancer.
Adenocarcinoma ; Carcinoma ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Fever ; Humans ; Hypersensitivity ; Mortality ; Neutropenia ; Paclitaxel* ; Thorax ; Vomiting

BACKGROUND: To investigate the clinical significance of flow diversion (FD) of the anterior cerebral artery (ACA) or posterior cerebral artery (PCA), a transcranial doppler (TCD) was used in patients with middle cerebral artery (MCA) occlusive disorders. METHODS: This is a retrospective study of 51 patients from 1999 to 2001. FD was determined using TCD. Leptomeningeal collateral channels (LMCs) were identified by conventional angiography. The author analyzed the sensitivity, specificity, positive and negative predictability of FD of ACA or PCA to predict the LMCs, and also evaluated the relationship between FD and leptomeningeal collateral circulation. RESULTS: LMC was noted in 41% of patients with M1 (MCA) occlusive disorders. It showed a tendency of increasing prevalence with an increasing degree of M1 MCA stenosis (rho=0.605, p<0.001). FD was noted in 47% of patients with MCA occlusive diseases. It also had a tendency of high prevalence with an increasing degree of M1 MCA stenosis (rho=0.382, p=0.006). To predict the presence of LMCs, FD of ACA or PCA had a sensitivity of 81%, specificity of 76%, positive predictive value of 71% and negative predictive value of 85%. FD of ACA or PCA had a good correlation with LMCs in patients with MCA occlusive disorders (rho=0.568, p<0.001). CONCLUSIONS: These results suggest that FD had good sensitivity and specificity to predict the LMCs, and demonstrated that FD was a reliable source of evidence of LMCs in patients with M1 MCA occlusive disorders. Patients with M1 MCA stenosis had heterogeneous hemodynamics in the development of collateral circulation.
Angiography ; Anterior Cerebral Artery ; Collateral Circulation* ; Constriction, Pathologic ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity

No abstract available.
Aneurysm, False ; Brachial Plexus Neuropathies ; Vertebral Artery ; Vertebral Artery Dissection

PURPOSE: To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. MATERIALS AND METHODS: 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. RESULTS: Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. CONCLUSION: Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
Analgesics, Opioid ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Euthanasia ; Humans ; Medical Futility ; Renal Dialysis ; Ventilators, Mechanical ; Withholding Treatment ; Surveys and Questionnaires