Purpose: This study aimed to assess combined effects of early oral feeding after Cesarean section (C/S) under regional anesthesia on bowel function, gastrointestinal complications and surgical recovery. Methods: A systematic literature search was conducted using KISS, RISS, PubMed, CINAHL, EMBASE, CENTRAL and Google Scholar to identify randomized clinical trials comparing early oral feeding (EOF) with delayed oral feeding (DOF) after C/S. Outcome variables were bowel function and gastrointestinal complications and surgical recovery. Effect size was calculated using weighted mean differences (WMDs) and relative risks (RRs), with 95% confidence intervals (CIs). Results: Seven studies involving 1,911 patients from 568 studies, 7 studies were included in meta-analysis. EOF was significantly associated with shorter time to recover bowel movement compared with DOF (WMD, - 2.50; CI, - 3.50~- 1.50). EOF was not associated with nausea (RR, 1.15; CI, 0.87~1.53) and vomiting (RR, 0.96; CI, 0.65~1.42), but lower incidence of abdominal distension (RR, 0.70; CI, 0.50~0.98). EOF was significantly associated with shorter time to discontinuation of intravenous fluids (WMD, - 8.88; 95% CI, - 16.65~- 1.11) and removal of urinary catheter (WMD, - 15.23; CI, - 25.62~- 4.85). Conclusion This meta-analysis provides evidence that EOF after C/S under regional anesthesia not only accelerates return of bowel function and surgical recovery but also reduces gastrointestinal complications. These results suggest that EOF should be offered to women who have undergone C/S to improve the recovery experience and reduce overall medical costs.

Purpose: The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described.We aimed to investigate the reversibility of endoscopic features of EoE after treatment. Materials and Methods: Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE. Results: After treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%).Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment. Conclusion We outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.

Purpose: The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described.We aimed to investigate the reversibility of endoscopic features of EoE after treatment. Materials and Methods: Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE. Results: After treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%).Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment. Conclusion We outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.

Background: Angiolipoma is a disorder characterized by the development of distinct, encapsulated subcutaneous tumors. Unlike lipoma, angiolipoma is distinctively accompanied by tenderness, which does not respond to general painkillers. Additionally, the reason for the pain has not been elucidated yet. Objective: This study aims to investigate platelet aggregation as the potential cause of tenderness in angiolipoma. Methods: Twenty-three patients diagnosed with angiolipoma and lipoma were enrolled. Platelet aggregation was visualized by CD61 immunohistochemical staining. The area of platelet aggregation and vessel lumen in a high power field were measured with the QuPath software. The ratio between the area of platelet aggregation and vessel lumen (p/v ratio) was calculated from the captured images. Results: Eleven of 46 patients complained of tenderness (9/23 angiolipoma [39.1%], 2/23 lipoma [8.7%]).Angiolipoma demonstrated a higher p/v ratio than that observed in lipoma (0.27 vs. 0.09, p＜0.001). Furthermore, the mean p/v ratio was high in patients with tenderness (0.44 vs. 0.09, p＜0.01). Patients were divided into three groups according to the aggregation pattern, highly clustered, mixed, and particulated. Nine patients with angiolipoma presented a highly clustered pattern, meanwhile, only three patients with lipoma exhibited a highly clustered pattern. Moreover, the number of patients with tenderness was significant in the highly clustered group (63.6%). Additionally, among the highly clustered group, the mean p/v ratio was higher in patients with tenderness (0.52 vs. 0.24, p＜0.01). Conclusion As clustered platelet aggregation with a high p/v ratio demonstrated relevance to tenderness, medications inhibiting platelet aggregation could mitigate tenderness in patients with angiolipoma.

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Pneumatosis coli (PC) is a rare disease that is characterized by multiple, varying-sized cysts at the mucosa or submucosa in the colon and sigmoid colon. About 85% of PC is associated in other gastrointestinal, pulmonary and connective diseases. Ischemic colitis is rarely associated with PC. The symptoms of PC are not specific, and the patients with this malady present with hematochezia, abdominal pain, diarrhea and other symptoms associated with their underlying diseases. Colonoscopy and computed tomography are recommended for making the diagnosis. The underlying diseases should be treated and oxygen therapy, intra-venous antibiotics and/or surgical treatment can be used. The prognosis is generally good, but volvulus, intussusception, intestinal obstruction, bleeding and perforation can occur in 3% of these patients. We experienced two patients who initially presented with hematochezia and they were found to have PC and ischemic colitis according to the colonoscopy exams; these are the first such reported cases in Korea. Both patients were treated conservatively with low-dose oxygen therapy and intra-venous metronidazole. We report here on 2 cases of PC associated with ischemic colitis, and we review the relevant literature.
Abdominal Pain ; Anti-Bacterial Agents ; Colitis, Ischemic ; Colon ; Colon, Sigmoid ; Colonoscopy ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestinal Volvulus ; Intussusception ; Korea ; Metronidazole ; Mucous Membrane ; Oxygen ; Prognosis ; Rare Diseases

BACKGROUND/AIMS: Achalasia is a primary motility disorder of esophagus. Many parameters represent esophageal function and morphologic changes, but their interrelationship is not yet established. We hypothesized that esophageal body would need to generate unusual pressure to empty the food bolus through the non-relaxing lower esophageal sphincter in patients with achalasia; therefore, higher is the residual lower esophageal sphincter pressure, greater would be the contraction pressure in the esophageal body in these patients. To verify the hypothesis, correlations among parameters from esophageal manometry, esophagography and esophageal transit study had been investigated. METHODS: A retrospective review of 34 patients was conducted. Resting lower esophageal sphincter pressure and contraction pressure of esophageal body were obtained from conventional esophageal manometry. Diameter of esophageal body was measured from barium column under esophagography. Radionuclide imaging was performed to assess the esophageal transit, designated as R30, which was the residual radioactivity at 30 seconds after ingesting radioactive isotope. RESULTS: In vigorous achalasia group, contraction pressure of esophageal body was negatively correlated to dilated diameter of esophageal body (P = 0.025, correlation coefficient = -0.596). Esophageal transit was more delayed as dimensions of esophageal body increased in classic achalasia group (P = 0.039, correlation coefficient = 0.627). CONCLUSIONS: Diameter of esophageal body in classic achalasia was relatively wider than that of vigorous achalasia group and the degree of delayed esophageal transit was proportionate to the luminal widening. Patients with vigorous achalasia had narrower esophageal lumen and relatively shorter transit time than that of classic achalasia group. Proper peristalsis is not present in achalasia patients but remaining neuromuscular activity in vigorous achalasia patients might have caused the luminal narrowing and shorter transit time.
Barium ; Contracts ; Esophageal Achalasia ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Manometry ; Peristalsis ; Phenobarbital ; Radioactivity ; Retrospective Studies

OBJECTIVE: Tributyltin (TBT), an endocrine disrupting chemical, has been reported to decrease ovarian function by causing apoptosis in the ovary, but the mechanism is not fully understood. Therefore, we examined whether TBT increases the expression of adipogenesis-related genes in the ovary and the increased expression of these genes is associated with apoptosis induction. METHODS: Three-week-old Sprague-Dawley rats were orally administered TBT (1 or 10 mg/kg body weight) or sesame oil as a control for 7 days. The ovaries were obtained and weighed on day 8, and then they were fixed for terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) or frozen for RNA extraction. Using the total RNA of the ovaries, adipogenesis- and apoptosis-related genes were analyzed by real-time polymerase chain reaction (PCR). RESULTS: The ovarian weight was significantly decreased in rats administered 10 mg/kg TBT compared to that in control rats. As determined by the TUNEL assay, the number of apoptotic follicles in ovary was significantly increased in rats administered 10 mg/kg TBT. The real-time PCR results showed that the expression of adipogenesis-related genes such as PPARgamma, aP2, CD36, and PEPCK was increased after TBT administration. In addition, apoptosis-related genes such as TNFalpha and TNFR1 were expressed more in the TBT-administered rats compared with the control rats. CONCLUSION: The present study demonstrates that TBT induces the expression of adipogenesis- and apoptosis-related genes in the ovary leading to apoptosis in the ovarian follicles. These results suggest that the increased expression of adipogenesis-related genes in the ovary by TBT exposure might induce apoptosis resulting in a loss of ovarian function.
Adipogenesis ; Animals ; Apoptosis ; DNA Nucleotidylexotransferase ; Female ; In Situ Nick-End Labeling ; Ovarian Follicle ; Ovary ; PPAR gamma ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Receptors, Tumor Necrosis Factor, Type I ; RNA ; Sesame Oil ; Trialkyltin Compounds ; Tumor Necrosis Factor-alpha

OBJECTIVE: Tributyltin (TBT), an endocrine disrupting chemical, has been reported to decrease ovarian function by causing apoptosis in the ovary, but the mechanism is not fully understood. Therefore, we examined whether TBT increases the expression of adipogenesis-related genes in the ovary and the increased expression of these genes is associated with apoptosis induction. METHODS: Three-week-old Sprague-Dawley rats were orally administered TBT (1 or 10 mg/kg body weight) or sesame oil as a control for 7 days. The ovaries were obtained and weighed on day 8, and then they were fixed for terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) or frozen for RNA extraction. Using the total RNA of the ovaries, adipogenesis- and apoptosis-related genes were analyzed by real-time polymerase chain reaction (PCR). RESULTS: The ovarian weight was significantly decreased in rats administered 10 mg/kg TBT compared to that in control rats. As determined by the TUNEL assay, the number of apoptotic follicles in ovary was significantly increased in rats administered 10 mg/kg TBT. The real-time PCR results showed that the expression of adipogenesis-related genes such as PPARgamma, aP2, CD36, and PEPCK was increased after TBT administration. In addition, apoptosis-related genes such as TNFalpha and TNFR1 were expressed more in the TBT-administered rats compared with the control rats. CONCLUSION: The present study demonstrates that TBT induces the expression of adipogenesis- and apoptosis-related genes in the ovary leading to apoptosis in the ovarian follicles. These results suggest that the increased expression of adipogenesis-related genes in the ovary by TBT exposure might induce apoptosis resulting in a loss of ovarian function.
Adipogenesis ; Animals ; Apoptosis ; DNA Nucleotidylexotransferase ; Female ; In Situ Nick-End Labeling ; Ovarian Follicle ; Ovary ; PPAR gamma ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Receptors, Tumor Necrosis Factor, Type I ; RNA ; Sesame Oil ; Trialkyltin Compounds ; Tumor Necrosis Factor-alpha