PURPOSE: We tried to identify the factors associated with intracranial hemorrhage (ICH) in patients with acute brain infarction receiving a tissue plasminogen activator. We assumed that ICH is increased if intracranial pressure has been increased in brain infarction patients who underwent IV thrombolysis. In this study, we selected the optic nerve sheath diameter (ONSD) in a way that intracranial pressure (ICP) measurement. ONSD measurements were compared with the occurrence of brain hemorrhage. METHODS: This study was a retrospective analysis of data acquired between January 2013 and December 2015. We included 100 acute brain infarction patients who received brain MRI and underwent IV thrombolysis in the emergency department. The ONSD measurements were taken with MRI in the axial view and compared with the occurrence of brain hemorrhage. The factors contributing to ICH in patients with thrombolysis was analyzed by a binary logistic regression analysis. Receiver operating characteristic (ROC) curves were used to find the cut-off value of ONSD that maximized the sum of the sensitivity and specificity. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean ONSD for patients without ICH was 5.50±0.57 mm, and for those with ICH was 5.97±0.54 mm. ONSD in the ICH group were significantly larger than in the non-ICH group (5.50±0.57 versus 5.97±0.54). CONCLUSION: ONSD in acute brain infarction patients who underwent IV thrombolysis is useful in the assessment of ICH risk.
Brain ; Brain Infarction ; Emergency Service, Hospital ; Humans ; Intracranial Hemorrhages* ; Intracranial Pressure ; Logistic Models ; Magnetic Resonance Imaging ; Optic Nerve* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tissue Plasminogen Activator

BACKGROUND/AIMS: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. Given the benign nature of the condition and the association of gastroesophageal reflux disease, empirical therapy with proton pump inhibitor seems reasonable for patients with typical globus. The aim of this study was to investigate the clinical predictors for symptom response to short-term proton pump inhibitor treatment in patients with globus symptom. METHODS: Fifty-four patients with globus symptom were enrolled prospectively. All patients were treated with pantoprazole 40 mg daily for 4 weeks. Treatment response was defined as a > 50% reduction in symptom scores between symptom assessments. Univariate and multivariate logistic regression analysis between responders and non-responders was performed to identify variables predicting response to pantoprazole treatment. RESULTS: Of the 54 consecutive patients considered, 13 were excluded on the basis of exclusion criteria and/or refusal to participate in the study. Finally, 41 patients were included in this study. After 4-week pantoprazole treatment, 22 patients (53.7%) were classified as responders. On multivariate analysis, the presence of reflux symptom was associated with a higher response rate to 4-week pantoprazole treatment (OR, 68.56; P = 0.043), and long symptom duration (> or = 3 months) were associated with a lower response rate to pantoprazole treatment (OR, 0.03; P = 0.034). CONCLUSIONS: Presence of reflux symptom and short symptom duration were independent predictors of responsiveness to 4-week pantoprazole treatment in patients with globus.
2-Pyridinylmethylsulfinylbenzimidazoles ; Foreign Bodies ; Gastroesophageal Reflux ; Humans ; Logistic Models ; Multivariate Analysis ; Pharynx ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Refusal to Participate ; Sensation ; Symptom Assessment

Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block.
Glottis ; Hiccup* ; Humans ; Intercostal Muscles ; Nerve Block ; Phrenic Nerve*

A case of pseudopseudohypoparathyroidism is reported. The patient, a 23-year-old man, has suffered from generalized tonic-clonic seizure for 16 years and gait disturbance for 4 years. He has the phenotypic features of Albright's hereditary osteodystrophy. But the levels of parathyroid hormone, serum calcium and phosphorus are all normal. The case is presented with the reviewed of the literature.
Calcium ; Gait ; Humans ; Parathyroid Hormone ; Phosphorus ; Pseudopseudohypoparathyroidism* ; Seizures ; Young Adult

BACKGROUND: This study was conducted to investigate the roles of the spinal and peripheral gamma-aminobutyric acid (GABA)-ergic systems for the mechanical hypersensitivity produced by chronic compression of the dorsal root ganglion (CCD). METHODS: CCD was performed at the left 5th lumbar dorsal root ganglion. The paw withdrawal threshold (PWT) to von Frey stimuli was measured. The mechanical responsiveness of the lumbar dorsal horn neurons was examined. GABAergic drugs were delivered with intrathecal (i.t.) or intraplantar (i.pl.) injection or by topical application onto the spinal cord. RESULTS: CCD produced mechanical hypersensitivity, which was evidenced by the decrease of the PWT, and it lasting for 10 weeks. For the rats showing mechanical hypersensitivity, the mechanical responsiveness of the lumbar dorsal horn neurons was enhanced. A similar increase was observed with the normal lumbar dorsal horn neurons when the GABA-A receptor antagonist bicuculline was topically applied. An i.t. injection of GABA-A or GABA-B receptor agonist, muscimol or baclofen, alleviated the CCD-induced hypersensitivity. Topical application of same drugs attenuated the CCD-induced enhanced mechanical responsiveness of the lumbar dorsal horn neurons. CCD-induced hypersensitivity was also improved by low-dose muscimol applied (i.pl.) into the affected hind paw, whereas no effects could be observed with high-dose muscimol or baclofen. CONCLUSIONS: The results suggest that the neuropathic pain associated with compression of the dorsal root ganglion is caused by hyperexcitability of the dorsal horn neurons due to a loss of spinal GABAergic inhibition. Peripheral application of low-dose GABA-A receptor agonist can be useful to treat this pain.
Animals ; Back Pain ; Baclofen ; Bicuculline ; GABA-A Receptor Agonists ; GABA-A Receptor Antagonists ; GABA-B Receptor Agonists ; gamma-Aminobutyric Acid ; Ganglia, Spinal ; Hyperalgesia ; Hypersensitivity* ; Muscimol ; Neuralgia ; Posterior Horn Cells ; Rats* ; Receptors, GABA ; Spinal Cord

Most of swallowed foreign bodies pass spontaneously. However, sharp objects are usually lodged in the proximal esophagus and cause aspiration, bleeding, obstruction, and perforation. Therefore, prompt retrieval of lodged foreign bodies are necessary. The safe extraction of sharp foreign bodies using endoscopic technique is difficult because sharp objects carry a significant risk of mucosal injury and perforation. Endoscopic techniques for retrieval of foreign body include methods using protector hood and overtube. The former is not available, the later is uncomfortable and its diameter is the limiting factor. Method using a latex glove is available, comfortable, and its diameter is not limited. The thickness of the glove is thinner than protector hood, but we think that a latex glove would seem to be a effective alternative. We report a case in which a sharp foreign body was endoscopically removed using a latex glove without complication.
Esophagus ; Foreign Bodies* ; Hemorrhage ; Latex*

Antithyroid drugs inhibit the synthesis and excretion of thyroid hormone from the thyroid gland. Propylthiouracil (PTU) and methimazole are well known as antithyroid drugs. In 2011, the American Thyroid Association and American Association of Clinical Endocrinologists published management guidelines for hyperthyroidism and other causes of thyrotoxicosis, and recommended methimazole as the first-choice antithyroid drug for the treatment of hyperthyroidism. Lower hepatotoxicity is an advantage of methimazole. Fulminant hepatitis rarely occurs in methimazole users, and spontaneous recovery is expected even if it does occur. We describe a rare case of acute liver failure after methimazole intake in a 60-year-old man who underwent liver transplantation.
Antithyroid Agents ; Hepatitis ; Humans ; Hyperthyroidism ; Imidazoles ; Liver ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Methimazole ; Middle Aged ; Nitro Compounds ; Propylthiouracil ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND/AIMS: Helicobacter pylori eradication therapy has been used as a first-line treatment for H. pylori-positive gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, the management strategy for H. pylori-negative MALT lymphoma remains controversial. Therefore, the aim of this study was to examine the success rate of each treatment option for H. pylori-positive and H. pylori-negative gastric MALT lymphomas. METHODS: In total, 57 patients with gastric MALT lymphoma diagnosed between December 2000 and June 2012 were enrolled in the study. The treatment responses were compared between H. pylori-positive and H. pylori-negative gastric MALT lymphomas. RESULTS: Of the 57 patients, 43 (75%) had H. pylori infection. Forty-eight patients received H. pylori eradication as a first-line treatment, and complete remission was achieved in 31 of the 39 patients (80%) with H. pylori-positive MALT lymphoma and in five (56%) of the nine patients with H. pylori-negative MALT lymphoma; no significant difference was observed between the groups (p=0.135). The other treatment modalities, including radiation therapy, chemotherapy, and surgery, were effective irrespective of H. pylori infection status, with no significant difference in the treatment response between H. pylori-positive and H. pylori-negative MALT lymphomas. CONCLUSIONS: H. pylori eradication therapy may be considered as a first-line treatment regardless of H. pylori infection status.
Adult ; Aged ; Antineoplastic Agents/therapeutic use ; Female ; Gastric Mucosa ; Gastroscopy/*methods ; Helicobacter Infections/complications/*therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications/*therapy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/complications/*therapy ; Treatment Outcome

BACKGROUND/AIMS: Magnifying endoscopy with narrow band imaging (ME-NBI) is a useful modality for the detailed visualization of microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. This study aimed to determine whether the MS and MV patterns in ME-NBI differ according to the histologic type, invasion depth, and mucin phenotype of early gastric cancers (EGCs). METHODS: The MS and MV patterns of 160 lesions in 160 patients with EGC who underwent ME-NBI before endoscopic or surgical resection were prospectively collected and analyzed. EGCs were categorized as either differentiated or undifferentiated and as either mucosal or submucosal, and their mucin phenotypes were determined via immunohistochemistry of the tumor specimens. RESULTS: Differentiated tumors mainly displayed an oval and/or tubular MS pattern and a fine network or loop MV pattern, whereas undifferentiated tumors mainly displayed an absent MS pattern and a corkscrew MV pattern. The destructive MS pattern was associated with submucosal invasion, and this association was more prominent in the differentiated tumors than in the undifferentiated tumors. MUC5AC expression was increased in lesions with either a papillary or absent MS pattern and a corkscrew MV pattern, whereas MUC6 expression was increased in lesions with a papillary MS pattern and a loop MV pattern. CD10 expression was more frequent in lesions with a fine network MV pattern. CONCLUSIONS: ME-NBI can be useful for predicting the histopathology and mucin phenotype of EGCs.
Endoscopy* ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Mucins* ; Narrow Band Imaging* ; Phenotype* ; Prospective Studies ; Stomach Neoplasms*

A Schwannoma is a benign tumor that originates from Schwann cells in the gastric wall. The tumor is mainly asymptomatic but sometimes can cause bleeding of the upper GI tract. We encountered a Schwannoma that was identified by gastroscopy as a submucosal mass that might be malignant. Therefore, surgery was considered as the primary treatment. The Schwannoma was confirmed retrospectively by a pathologic examination after excising the mass. This case report is a comparative study into Schwanoma with and without central ulceration. Pathologically, atypia of the cell was discovered in the case accompanied by an ulcer, which is a secondary phenomenon caused by the degeneration that does not indicate the malignancy.
Gastroscopy ; Hemorrhage ; Neurilemmoma* ; Retrospective Studies ; Schwann Cells ; Ulcer* ; Upper Gastrointestinal Tract