The study was conducted to compare the side effects in myelography of the two non-ionic water-soluble contrastmedias, Iopamidol(Niopam) and Metrizamide(Amipaque). A total of 111 patients were examined, 64 with Iopamidol and47 with Metizamide. Side effects consisted of headache, nausea, vomiting, dizziness, urinary difficulty, muscularpain, seizure, neurobehavioral distrubance, neurologial sign change, vital sign change and etc. The common sideeffects were headache, nausea, vomiting and dizziness in order of frequency. Most of the side effcts were subsidedwithin 24 hours following meylography. Iopamidol myelography caused fewer and milder side effects than Metrizamidestudy. The side effects were more commonly observed in cervial, thoracic or total myelography than in lumbarmyelography with either lopamidol or Metrizamide. There was no significant correlation between incidence of theside effects and premedication with phenobarbital or valium injection before myelography and CSF sampling duringthe procedure.
Diazepam ; Dizziness ; Headache ; Humans ; Incidence ; Iopamidol ; Iothalamic Acid ; Metrizamide ; Myelography ; Nausea ; Phenobarbital ; Premedication ; Seizures ; Vital Signs ; Vomiting

Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of peristalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia.
Asthma ; Bronchiectasis ; Cough ; Deglutition Disorders ; Esophageal Achalasia* ; Esophagus ; Female ; Fever ; Ganglion Cysts ; Humans ; Lung Abscess* ; Lung* ; Manometry ; Middle Aged ; Myenteric Plexus ; Peristalsis ; Pneumonia, Aspiration ; Pulmonary Fibrosis ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

Free Tissue Flaps ; Humans ; Mandible ; Osteogenesis ; Osteolysis ; Osteolysis, Essential

BACKGROUND/AIMS: ALADIN gene has been known to cause achalasia, alacrima, adrenal abnormalities and a progressive neurological syndrome. A considerable proportion of achalasia patients has been known to show alacrima (decreased secretion of tear). However, the genetic mechanism between achalasia and alacrima has not been defined yet. We postulated that ALADIN gene may be involved in the occurrence of early-onset achalasia; thus, we investigated the correlation of ALADIN gene in early-onset achalasia patients. METHODS: From 1989 to 2007, patients who were diagnosed as primary achalasia before age 35 were enrolled. All of the enrolled patients were asked for (1) blood sampling for DNA, (2) Shirmer test and (3) dysphagia questionnaires. RESULTS: The ALADIN gene in exon 1, 2, 10, 11 and 12 from 19 patients was investigated (M:F = 12:7). The mean age of patients at diagnosis was 27 +/- 5 (15-35) years old. Eight out of 19 (42%) showed alacrima by the positive Shirmer test. In spite of thorough exam in the genetic study, there was no definite abnormal genetic finding in this study. CONCLUSIONS: A considerable number of achalasia patients showed alacrima. Due to the limitation of this study, it is difficult to conclude that early-onset achalasia may have significant correlations with the ALADIN gene.
Deglutition Disorders ; DNA ; Esophageal Achalasia ; Exons ; Eye Diseases, Hereditary ; Humans ; Lacrimal Apparatus Diseases

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is a novel technique for an en bloc resection of mucosal tumors over 2 cm in diameter. The aim of this study was to evaluate the efficacy, resection time and complications of ESD using a needle knife (needle-ESD) with a comparison those encountered using endoscopic mucosal resection (EMR) after a circumferential mucosal incision with a needle knife (needle-EMR). METHODS: Thirty-three consecutive patients with early gastric cancer or gastric adenoma who underwent needle-ESD at the Asan Medical Center between December 2004 and March 2005 were retrospectively reviewed, and compared with the data from 33 consecutive patients who underwent needle-EMR between March 2001 and June 2001. RESULTS: Both the enbloc resection and complete resection could be achieved by needle-ESD in all the patients, while the corresponding percentages were 76% (en bloc resection, 25/33) and 94% (complete resection, 31/33) in the needle-EMR group. The resection time was longer (22.7 vs. 11.6 min) in the needle-ESD group than in the needle-EMR group. However, there was no significant difference in the complication rate between the two groups. CONCLUSIONS: Compared with the needle-EMR, needle-ESD has significant benefits, particularly regarding the en bloc and complete resection rate despite the technical difficulty and longer resection time.
Adenoma ; Chungcheongnam-do ; Humans ; Needles* ; Retrospective Studies ; Stomach Neoplasms

Helicobacter pylori (H. pylori) has been etiologically linked with primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma and gastric carcinoma; however, synchronous and metachronous development of these two neoplasm is a rare finding. The metachronous development of early gastric cancer following gastric MALT lymphoma is even more exceptional, and less than 10 cases have been reported on the literature. We encountered one case of early gastric cancer which occurred 38 months after the complete remission of H. pylori associated gastric MALT lymphoma. We report here on this case along with a review of the literature.
Helicobacter pylori* ; Helicobacter* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Stomach Neoplasms*

BACKGROUND/AIMS: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). METHODS: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. RESULTS: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn's disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn's disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. CONCLUSIONS: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Endoscopes, Gastrointestinal ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Intestinal Diseases/*diagnosis/radiography ; *Intestine, Small/pathology/radiography ; Male ; Middle Aged

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.
Adolescent ; Adult ; Aged ; *Biopsy, Needle ; *Colonoscopy ; English Abstract ; Female ; Humans ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Tuberculosis, Gastrointestinal/complications/*diagnosis ; Tuberculosis, Pulmonary/complications

BACKGROUND/AIMS: Lactobacillus rhamnosus GG (LGG) has been used in acute colitis treatment. However, it is unclear whether the LGG prevents chronic colitis. The aim of this study was to examine the prophylactic effect of LGG on animal colitis, cytokine secretion, and mucin gene expression. METHODS: BALB/c mice (n=64) were exposed to 5% dextran sulfate sodium (DSS) for 7 days followed by 10 days recovery period and repeatedly exposed for 4 days. Then, the mice were devided into three group; group of oral LGG adminstration throughout the recovery and repeated colitis period; PBS group of PBS administration; control group. Colon length, histologic score, tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10) levels, mucin gene expressions were determined at each period. RESULTS: In acute colitis period, the LGG group showed higher levels of disease activity index (DAI), histologic score, TNF-alpha, IL-10, but shorter colon length, lower levels of mucin gene expressions than the control group. However, in repeated colitis period, the LGG group showed markedly lower levels of DAI and IL-10 but significantly longer colon length than PBS group (p<0.05). There was no difference in the mucin gene expression. CONCLUSIONS: These results suggest that LGG prevents chronic murine colitis. It may be associated with cytokine modulation and competitive inhibition of pathogenic bacteria. However, it may not be related with gene expression.
Animals ; Colitis/*prevention & control ; Cytokines/*metabolism ; English Abstract ; Gene Expression/*drug effects ; *Lactobacillus ; Mice ; Mice, Inbred BALB C ; Mucins/*genetics/metabolism ; Probiotics/*therapeutic use

BACKGROUND: Constipation occurs frequently in diabetes mellitus (DM). However, there are few reports that investigated the characteristics of constipation associated with DM. The purpose of this study was to evaluate the clinical features of constipation associated with DM. METHODS: Among constipated patients who visited Asan Medical Center from January 2000 to December 2004, 45 patients with DM (DM group) and 104 patients without DM (non-DM group) were included in this study. We reviewed the clinical presentation, results of anorectal manometry, colon transit time study, and defecogram. We also analyzed the response to biofeedback therapy. RESULTS: The severity of constipation symptoms before treatment was not different between DM and non-DM group. Patients with colon transit time over 56 hours were more frequent in DM group than in non-DM group (21/45, 46.7% vs. 31/104, 29.8% ; p=0.047). Among DM group, colon transit time and the duration of DM showed positive correlation (r=0.431, p=0.003). The resting anal sphincter pressure was significantly lower in DM group than in non-DM group (43.5+/-21.5 mmHg vs. 51.7+/-22.6 mmHg ; p=0.048). The results of defecography were similar between DM and non-DM group. Successful responses to biofeedback therapy were not different between DM and non-DM group (19/34, 55.9% vs. 43/79, 54.4% ; p=0.887). CONCLUSIONS: Slow transit constipation was more frequent in DM group than in non-DM group. The successful responses to biofeedback therapy appear to be similar between DM and non-DM group.
Anal Canal ; Biofeedback, Psychology ; Chungcheongnam-do ; Colon ; Constipation* ; Defecography ; Diabetes Mellitus* ; Humans ; Manometry ; Time and Motion Studies