Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal.
Endoscopes ; Endoscopy ; Esophageal Achalasia ; Esophageal and Gastric Varices ; Foreign Bodies ; Hemorrhage ; Humans ; Lacerations ; Ligation* ; Stomach

About 5% of burn patients come with other injuries. When patients with multiple rib fractures are put under general anesthesia, there is a higher rate of a variety of complications, such as hemothorax, pneumothorax, lung contusion, and etc. Also, symptoms of the complications are likely to get worse. Therefore, it is important to decide when it is appropriate to perform surgery. Our hospital delayed operation time on two burn patients who had multiple rib fractures and then performed surgery under general anesthesia, treating patients without any particular complications.
Anesthesia, General ; Burns* ; Contusions ; Hemothorax ; Humans ; Lung ; Pneumothorax ; Rib Fractures* ; Thoracic Injuries

Background: Family support and medical staff support of hemodialysis patients are related to sick-role behavior, and sick-role behavior is related to physiological indicators such as interdialytic weight gain and control of potassium and phosphorus in the blood. Methods: The subjects were 139 hemodialysis patients. Data were collected on demographic and disease- related characteristics, social support (family support and medical staff support), sick-role behavior, and physiological indicators (interdialytic weight gain, blood potassium, and blood phosphorus). Results: Degrees of family support and medical staff support were both nearly 3.85 points, and sick-role behavior was 3.96 points. Family support (r=0.449, P<0.001) and medical staff support (r=0.421, P<0.001) were positively correlated with sick-role behavior, and sick-role behavior was inversely correlated with interdialytic weight gain (r=-0.218, P=0.010) and blood phosphorus (r=-0.170, P=0.045). Conclusions The higher the degree of family support and medical staff support, the higher the degree of sick-role behavior. In addition, the higher the level of sick-role behavior, the lower the physiological indicators of interdialytic weight gain and blood phosphorus. Therefore, in order to improve sick-role behavior and physiological indicators, it is necessary to develop and apply an enhanced intervention program through family support and medical staff support.

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan–Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02–6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.
Acute Disease ; Aged ; Cardiovascular Diseases/etiology ; Cohort Studies ; Diabetes Mellitus, Type 2/complications/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/epidemiology/mortality ; Prognosis ; Proportional Hazards Models ; Registries ; Survival Analysis ; Time Factors

PURPOSE: Serious acetaminophen (AAP) poisoning causes hepatotoxicity. N-acetylcysteine (NAC) is the most effective therapy for AAP poisoning and can be administered orally and intravenously (IV). Several studies have compared the efficacy of these two routes of administration and the results have been controversial. The purpose of this study was to compare the efficacy of oral and IV NAC for the prevention of hepatic toxicity in Korean patients whose serum AAP levels were higher than normal. METHODS: A retrospective before/after study was performed, in which the patients presented to the emergency department with an AAP overdose from February 1995 to March 2012. A 3-day oral NAC regimen was used in the beginning, and a 20-hr intravenous regimen was then used from 2007. This study assessed the complications of an AAP overdose, such as hepatotoxicity, hepatic failure and renal failure as well as the side effects of the treatment regimen. RESULTS: A total of 41patients was enrolled in this study. The median ALT and AST were 63 (IU/L) and 57 (IU/L) for the oral NAC treated patients, and 14 (IU/L) and 20 (IU/L) for the IV NAC treated patients (p=0.004 and p=0.001, respectively). The incidence of complications was similar in the treatment groups (p=0.399). Among the patients, 7 patients developed hepatotoxicity and were treated successfully with oral or IV NAC. CONCLUSION: This study suggests that IV NAC and oral NAC can prevent and successfully treat hepatic toxicity in patients whose serum AAP levels are higher than normal.
Acetaminophen ; Acetylcysteine ; Administration, Intravenous ; Emergencies ; Humans ; Incidence ; Liver Failure ; Oligopeptides ; Renal Insufficiency ; Retrospective Studies

BACKGROUND: Low back pain (LBP) is known to be the significant reason for absenteeism and can develop long-term disability. So the airline authorities have made an effort to reduce the incidence of LBP by applying their physical standards. As a LBP Prevention Program, Airline A has provided health education, counseling and physical examinations. The purpose of this study is to analyze the relationship between LBP and physical characteristics, age and work duration, and this result will provide basic information for improving the LBP Prevention Program. METHOD: The subjects were the 585 flight attendants who had undergone regular physical check-ups with Airline A Medical Center from October 2000 to September 2001. We reviewed their absence records and physical characteristics, age and work duration. These data were analyzed statistically by the t-test and Lositic regression. RESULT: The LBP history group accounted for 18% of the study group. The male LBP history group had the more thin waist than the no history group. There were no differences (P<0.05) between LBP and other male and female physical characteristics. The age and work duration of male LBP history group was lower than the no history group (P<0.05). But the female comparison revealed that only the work experience in the LBP history group was lower than the No history group (P<0.05). Waist, age, work duration was analyzed statistically by logistic regression. Only female's work experience was significant. The fewer work experience was the more LBP. CONCLUSION: The results of this study suggest LBP is associated with work experience rather than physical characteristics. This is the first step toward improving a LBP Prevention Program for the cabin crew. It will be useful to conduct another review to assess various other reasons, such as psychosocial job factors, duration of work disability and muscle strength, related to LBP.
Absenteeism ; Counseling ; Female ; Health Education ; Humans ; Incidence ; Logistic Models ; Low Back Pain* ; Male ; Muscle Strength ; Physical Examination

There are three compartments of regional lymph node to which metastases from thyroid cancers can occur: central, lateral, and mediastinal compartment. The mediastinal metastases from thyroid cancers are extremely rare, comparing the relatively common forms of metastases to central or lateral compartments. The importance of complete surgical lymph node dissection of central or lateral compartment for thyroid cancer has been well described, but mediastinal lymph node dissection has been sporadically reported. For mediastinal compartment metastases, operation techniques consist of sternal split, thoracoscopic surgery, or VATS (Video-assisted thoracoscopic surgery). Robotic surgery system was introduced recently with the objective of enhancing the dexterity and view during procedure that uses a videoscope. Many institutions report the experience with minimally invasive resection of mediastinal mass using robotic surgery system. We report that one case of robot-assisted mediastinal lymph node dissection for metastatic papillary thyroid cancer.
Carcinoma, Papillary ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Lipoprotein lipase(LPL) plays a pivotal role in triglyceride-rich lipoprotein metabolism. It removes TG-rich lipoprotein from circulation by hydrolysing TG and produces active form of HDL. It also affects the development and maintenance of obesity by regulating the fatty acid metabolism of the adipose tissue. Many studies about the association of the genetic variation of LPL and dyslipidemia have been performed, but the results were not consistent. We tried to characterize the phenotypes of the LPL genetic variation in Korean. METHODS: Healthy Korean adults (n=110) were genotyped for Hind III/Pvu II RFLP and Ser447Ter mutation of the LPL gene by PCR-digestion method. We investigated the association of the genetic variations with the lipids, the lipoprotein concentrations and the body mass index(BMI). RESULTS: The allele frequencies of Hind III RFLP, Pvu II RFLP and Ser447Ter mutation were H1:H2=33%:67%, P1:P2=40%:60% and Ser447: Ter447=90%:10%. Ser447Ter mutation carriers had higher HDL cholesterol level than non-carriers (59+/-10mg/dl versus 53+/-11mg/dl, p=0.049) and the Pvu II RFLP is associated with increased body mass index. (P1P1:P1P2:P2P2 = 22.1+/-2.0 kg/m2: 23.5+/-2.7 kg/m2: 24.5+/-2.6 kg/m2, p=0.003) CONCLUSION: The genetic variations of the LPL gene in healthy Korean adult resulted in increased HDL cholesterol and increased BMI. These results were different from previous studies. This difference may reflect the racial difference from the diet and the linkage disequilibrium
Adipose Tissue ; Adult* ; Body Mass Index* ; Cholesterol, HDL ; Diet ; Dyslipidemias ; Gene Frequency ; Genetic Variation ; Humans ; Linkage Disequilibrium ; Lipoprotein Lipase* ; Lipoproteins* ; Metabolism ; Obesity ; Phenotype ; Polymorphism, Restriction Fragment Length

BACKGROUND: The effectiveness of ultraviolet (UV) radiation, visible light, or infrared light therapy for the treatment of acne is the subject of ongoing scientific debate. OBJECTIVE: This study was conducted to investigate changes in sebum production and the expression of inflammatory cytokines, matrix metalloproteinases (MMPs), and antimicrobial peptides (AMPs), following exposure of cultured human sebocytes to UVA radiation and light at wavelengths of 650 nm and 830 nm. METHODS: Reverse transcription polymerase chain reaction assays were performed to measure the gene expression levels of inflammatory cytokines (interleukin [IL]-1beta, IL-6, IL-8, and tumor necrosis factor-alpha), MMPs (MMP-1, MMP-3, and MMP-9), and AMPs (psoriasin, hBD-2, hBD-3, and LL-37) in cultured sebocytes after exposure to UVA radiation (2 J/cm2, 3 J/cm2, and 5 J/cm2) and light at wavelengths of 650 nm (14 J/cm2, 29 J/cm2, and 87 J/cm2) and 830 nm (5 J/cm2, 10 J/cm2, and 30 J/cm2). Expression of inflammatory cytokine proteins and sebum production were measured using enzyme-linked immunoassays and a lipid analysis kit, respectively. RESULTS: Exposure of cultured sebocytes to UVA radiation and light at wavelengths of 650 nm and 830 nm did not show a significant increase in the expression of inflammatory cytokines, MMPs, or AMPs. Sebum production was not significantly decreased after exposure to UVA radiation and light at both wavelengths. CONCLUSION: We propose that UVA radiation, visible light, and infrared light can be used to target Propionibacterium acnes for the treatment of acne, without an increase in the expression of inflammatory biomarkers and sebum production.
Acne Vulgaris ; Biomarkers ; Cytokines ; Gene Expression ; Humans ; Immunoassay ; Interleukin-6 ; Interleukin-8 ; Light ; Matrix Metalloproteinases ; Necrosis ; Peptides ; Phototherapy ; Polymerase Chain Reaction ; Propionibacterium acnes ; Reverse Transcription ; Sebum*