The Schatzki ring, a submucosal fibrotic thickening of the lower esophagus, occurs at the squamocolumnar junction and is invariably associated with an esophageal histal hernia The ring is discrete narrowing covered with squamous epithelium on its superior aspect and columnar epithelium on its inferior aspect, with various degrees of submucosal fibrosis supporting the annulair ring. Symptoms, when present, are generally those of distal esophageal obstruction to the passage of solids and highly associated with ring diameter. The pathogenesis and etlology are obscure. But one theory suggests that they are caused by gastroesophageal reflux. The vast maiority of symptomatic Schatzki rings sre ameneble to dilation, a few patients will require surgical antireflux measures after dilatation. We have experienced a case of Schatzki ring associated with reflux esophagitis and esophageal hiatal hernia by the esophagogram after barium swallowing and endoscopy. So we report this case with brief review of the previous literatures.
Barium ; Carcinosarcoma ; Deglutition ; Dilatation ; Endoscopy ; Epithelium ; Esophageal Neoplasms ; Esophagitis, Peptic* ; Esophagus* ; Fibrosis ; Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal* ; Humans

The 4,725 cattle in the enzootic region, 6 counties of southern Korea, were surveyed for besnoitiosis epidemiologically by examining the scleral conjunctiva for the cysts and the following results were obtained. The survey showed that 285 cattle, representing 6 per cent of a total of 4,725 cattle examined had S.C. cysts. Only 49 (14 per cent) of them showed clinical sclerodermatitis and the ratio between clinical and inapparent cases was 1:5.8. On age distribution of the S.C. positive cases the highest incidence(10-12 per cent) was seen in amimals that were from 5 to 8 years of age, but clinically apparent cases occurred much more in younger age of animal. In local incidence of S.C. cysts positive cases the prevalence was higher in the secluded districts such as Koheung and Sancheoung counties(9 per cent).
parasitology-besnoitiosis ; epidemiology ; prevalence rate ; scleral conjunctiva cyst

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

To define the basic sequential events of the healing process in normal fracture and evaluate the role of growth regulatory molecules and extracellular matrix components, the expression of transforming growth factor β(TGF-β), platelet-derived growth factor(PDGF), type I and II collagen, and chemistry during the healing process of an experimental fracture of tibia in 41 adult rats for 7 weeks using ABC methods. The phases of inflammation, reparation, and remodeling followed each other in sequence. The inflammatory phase was characterized by hemorrhage, edema, and infiltration of inflammatory cells on the first day. During the reparative phase, the undifferentiated mesenchyme undergoes rapid chondrogenesis, followed by endochondral ossification and supplemented by appositional bone formation. At day 3, the expression of TGF-β and PDGF was noted in the undifferentiated mesenchymal cells and from day 5, these two growth factors were detected in the osteoblasts and extracellular matrix in areas of endochondral ossification and newly formed periosteal bone. From day 3, the expression of type I collagen and osteonectin was noted in the osteoblasts and extracellular matrix in both endochondral ossification and appositional bone growth as a marker of ossification. From day 3, type III collagen was mainly expressed in the plump mesenchymal cells showing chondroid differentiation and chondroid matrix as a marker of cartilaginous reparative phase. From day 14, these growth factors and extracellular matrix components were decreased in staining intensity and at the 5th week, the histology and immunostaining pattern were similar to the mature bone.
Adult ; Animals ; Bone Development ; Chemistry ; Chondrogenesis ; Collagen Type I ; Collagen Type III ; Collagen ; Edema ; Extracellular Matrix ; Fracture Healing ; Hemorrhage ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Mesoderm ; Osteoblasts ; Osteogenesis ; Osteonectin ; Rats ; Tibia ; Transforming Growth Factors

STATEMENT OF PROBLEM: Since the concept of osseointegration in dental implants was introduced by Branemark et al, high long-term success rates have been achieved. Though the use of dental implants have increased dramatically, there are few studies on domestic implants with clinical and objective long-term data. PURPOSE: The aim of this retrospective study was to provide long-term data on the Neoplant(R) implant, which features a sandblasted and acid-etched surface and external connection. MATERIAL AND METHODS: 96 Neoplant(R) implants placed in 25 patients in Yonsei University Hospital were examined to determine the effect of the factors on marginal bone loss, through clinical and radiographic results during 18 to 57 month period. Results: 1. Out of a total of 96 implants placed in 25 patients, two fixtures were lost, resulting in 97.9% of cumulative survival rate. 2. Throughout the study period, the survival rates were 96.8% in the maxilla and 98.5% in the mandible. The survival rates were 97.6% in the posterior regions and 100% in the anterior regions. 3. The mean bone loss for the first year after prosthesis placement and the mean annual bone loss after the first year for men were significantly higher than that of women (P<0.05). 4. The group of partial edentulism with no posterior teeth distal to the implant prosthesis showed significantly more bone loss compared to the group of partial edentulism with presence of posterior teeth distal to the implant prosthesis in terms of mean bone loss for the first year and after the first year (P<0.05). 5. The mean annual bone loss after the first year was more pronounced in posterior regions compared to anterior regions (P<0.05). 6. No significant difference in marginal bone loss was found in the following factors: jaws, type of prostheses, type of opposing dentition, and submerged /non-submerged implants (P<0.05). CONCLUSION: On the basis of these results, the factors influencing marginal bone loss were gender, type of edentulism, and location in the arch, while the factors such as arch, type of prostheses, type of opposing dentition, submerged / non- submerged implants had no significant effect on bone loss. In the present study, the cumulative survival rate of the Neoplant(R) implant with a sandblasted and acid-etched surface was 97.9% up to a maximum 57-month period. Further long-term investigations for this type of implant system and evaluation of other various domestic implant systems are needed in future studies.
Dental Implants ; Dentition ; Female ; Humans ; Jaw ; Male ; Mandible ; Maxilla ; Osseointegration ; Prostheses and Implants ; Retrospective Studies ; Survival Rate ; Tooth

PURPOSE: To describe the MR imaging findings of post-operative change and residual/recurrent tumor following resection of the glioma and to determine whether there are any specific MR imaging findings useful for differentiation of post-operative change from a residual/recurrent tumor. MATERIALS AND METHODS: We retrospectively analysed 71 post-operative follow-up brain MR images of 26 patients who had undergone surgical resection of intracranial glioma. They consisted of 49 MRI studies of 12 patients with post-operative change and22 MRI studies of 14 patients with residual/recurrent tumors. The follow-up MRI examinations were performed fromone to 75 months after tumor resection. The lesion was defined as post-operative change when any enhancing lesion disappeared or diminished during follow-up MRI studies of at least 20 months. The diagnosis of residual/recurrent tumor was established when on MR images, lesion size increased definitively during the follow up period of between four and 66 months ; residual/recurrent tumors were surgically proven in five patients. The shape, degree of contrast enhancement and time of appearance and disappearance of the lesions were analysed. RESULTS: Post-operative change consisted of hemorrhage(n=3), marginal(n=7) and nodular(n=1) enhancement of sugical bed, adjacent dural enhancement(n=9), extracerebral fluid collection(n=4) and only tissue defect(n=1). Hemorrhage was obseved at between two and eight months ; marginal and nodular enhancement of surgical bed were seen at between three and 30 months (usually less than one year) ; dural enhancement and fluid collection were seen at between three and 75 months. Residual/recurrent tumor appeared most frequently as enhancing solid nodules(n=7) or solidand cystic masses(n=2) followed by non-enhancing solid nodules(n=3). In five of seven cases, marginal enhancement of a residual/recurrent tumor appeared after more than one year. CONCLUSION: Marginal and dural enhancement around surgical tissue defects are the most common finding of post-operative change, whereas nodular enhancementis the most frequent finding of the residual/recurrent tumor. Marginal enhancement lasting longer than one year may, however, be an early finding of residual/recurrent tumor.
Brain ; Diagnosis ; Follow-Up Studies ; Glioma* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To evaluate the clinical usefulness and limitation of FLAIR (fluid attenuated inversion recovery) MR sequence in various intracranial pathologic conditions. MATERIALS AND METHODS: In prospective fashion, we used a 1.0T MR unit to obtain FLAIR sequence MR images, together with T1-weighted (TIWI), proton-density weighted (PDWI), and T2-weighted spin echo images (T2WI) in 24 patients with various intracranial diseases. Forty-two lesions in 24 patients were classified into three categories: nonhemorrhagic noncavitary lesions (n=20), hemorrhagic lesions (n=10), and cavitary lesions (n=12). Hemorrhagic lesion was divided into two types; type 1 showed high signal intensity on both T1WI and T2WI and type 2 showed marked low signal intensity on T2WI such as hemosiderin. Cavitary lesion was defined as one with signal intensity which paralleled CSF on all pulse sequences. Visually, we compared the lesion conspicuity on FLAIR with that on T2WI. Quantitatively, we also compared lesion/white matter (WM) contrast, lesion/WM contrast to noise ratio (CNR), lesion/CSF contrast, and lesion/CSF CNR on FLAIR with those on T2WI. RESULTS: For visual conspicuity of nonhemorrhagic noncavitary lesions and type 1 hemorrhagic lesions, FLAIR was superior to PDWI and T2WI, but for type 2 hemorrhangic lesions, PDWI and T2WI were superior to FLAIR. For cavitary lesions, there was no significant difference between T2WI and FLAIR. In the quantitative assessment of nonhemorrhagic noncavitary lesions, FLAIR was superior to PDWI for lesion/CSF contrast, and CNR, and lesion/WM contrast, but for lesion/WM CNR FLAIR was inferior to PDWI. For lesion/CSF contrast in cavitary lesions, FLAIR was superior to PDWI. There was no significant difference between PDWI and FLAIR for hemorrhagic lesions types 1 and 2. In assessing nonhemorrhagic noncavitary lesions, FLAIR was superior to T2WI for lesion/CSF contrast, but for lesion/WM CNR, FLAIR was inferior to T2WI. In cavitary lesions, T2WI was superior to FLAIR for lesion/WM contrast and CNR. In type 2 hemorrhagic lesions, there was no significant difference between T2WI. CONCLUSION: The FLAIR sequence is more useful than T2WI for the detection of nonhemorrhagic noncavitary lesions, but in the evaluation of cavitary and hemorrhagic lesions, it has limitations. The results suggest that the FLAIR sequence can be used as a complementary imaging sequence, but should not replace the routine T2WI.
Diagnosis* ; Hemosiderin ; Humans ; Noise ; Prospective Studies

Intra-abdominal desmoplastic small round cell tumor (DSRCT) is a highly malignant tumor of uncertain histogenesis. Here we report a case of DSRCT involving the stomach, initially misdiagnosed as gastric cancer. A 12-year-old boy presented with upper abdominal pain developed 1 month prior. On gastroscopy, a 7-cm mass was noted involving the esophago-gastric junction to the fundus, and positron emission tomography showed multiple hot uptakes suggesting distant metastasis. Gastroscopic biopsy showed poorly differentiated malignant cells. We diagnosed as stage IV gastric cancer and treated with 6 cycles of chemotherapy. Laparotomy revealed a huge gastric mass along with peritoneal disseminations. Palliative proximal gastrectomy was performed. Pathological examination revealed transmural involvement of DSRCT, and t(11;22)(p12;q12) was demonstrated on fluorescence in situ hybridization test. The chemotherapeutic regimen was changed and the patient underwent 8 additional cycles of post-operative chemotherapy. The patient is now alive and the residual tumor shows no significant changes after chemotherapy.
Abdominal Pain ; Biopsy ; Child ; Desmoplastic Small Round Cell Tumor ; Fluorescence ; Gastrectomy ; Gastroscopy ; Humans ; In Situ Hybridization ; Laparotomy ; Neoplasm Metastasis ; Neoplasm, Residual ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms

No abstract available.
Echocardiography, Transesophageal* ; Foramen Ovale, Patent*

BACKGROUND: It has been postulated that the derangement of gut perfusion is a factor of the development of multi-organ dysfunction and increasing postoperative morbidity. Gastric mucosal pH (pHim) correlates with splanchnic perfusion and the persistent gastric mucosal acidosis has been supposed to be a predictor of complications after cardiac surgery. The purpose of this study is to measure the change of pHim induced by hypothermic cardiopulmonary bypass (CPB). METHODS: Twelve patients undergoing cardiac surgery were anesthetized with fentanyl and isoflurane. Gastric mucosal PCO2 (PrCO2) and pHim were measured by Tonocap. Temperature was maintained about 28oC during CPB and arterial blood gas tension was managed by alpha-stat mode. Measurement was made at: (1) baseline, after induction of anesthesia, (2) 30 minutes after starting CPB, (3) 60 minutes after starting CPB, (4) at the end of CPB, (5) at the end of operation and (6) at 24 hours after CPB. Statistical analysis was performed using one-way ANOVA and Student t test. RESULTS: The PrCO2 and the CO2 gap (PrCO2 - PaCO2) increased at the end of CPB and maintained the increased state for 24 hours after CPB. The pHim decreased during CPB and maintained the decreased state for 24 hours after CPB. The difference between pHim and pHa increased significantly after CPB. CONCLUSION: We conclude that the hypothermic CPB induces gastric mucosal acidosis and it did not recover for 24 hours after CPB.
Acidosis ; Anesthesia ; Cardiopulmonary Bypass* ; Fentanyl ; Humans ; Hydrogen-Ion Concentration* ; Isoflurane ; Perfusion ; Thoracic Surgery