Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating bleeding esophageal varices in repeated sessions, but may be associated with some undesirable local and systemic complications. (continue...)
Esophageal and Gastric Varices* ; Follow-Up Studies* ; Hemorrhage* ; Ligation* ; Liver Cirrhosis ; Liver*

Mucosal bridge, endoscopically observed as a cord-like mucosal connection across the lumen, looking like a bridge, may infrequently arise anywhere from the esophagus to the colon. Mucosal bridges have been more frequently reported in the colon than in the esophagus, stomach, and duodenum. The causes of the mucosal bridge are congenital origin or acquired origin as the inflammatory diseases. We experienced a 49-year-old male patient who had multiple esophageal diverticula with mucosal bridges. We report this case with a review of relevant literatures.
Colon ; Diverticulum ; Diverticulum, Esophageal* ; Duodenum ; Endoscopy ; Esophagus ; Humans ; Male ; Middle Aged ; Stomach

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

BACKGROUND: Pores are the openings of the pilosebaceous unit or the apocrine gland. Increase in pore size or in the number of dilated pores may be a cosmetic problem. To date, epidemiological studies on the numbers of dilated pores have been rarely reported. OBJECTIVE: To analyze the distribution of pores and the factors affecting pores. METHODS: We compared the number of dilated facial pores on the face according to site, age group, and sex. The relations of pore counts to wrinkle severity and to the amount of hydration were also analyzed. Dermavision(TM), a device that can take cross-polarization, parallel polarization, and ultraviolet light images, was used. Parameters were measured at three points: the forehead, cheek, and nose. RESULTS: The results revealed that dilated pores were more common on the nose and forehead. The pore counts were increased with age, and the increment was significant between participants in their 30s and 40s. Moreover, dilated pore counts were affected by wrinkle severity. The amount of hydration did not affect the counts of dilated pores. CONCLUSION: In this study, the number of dilated pores differed depending on the location. Moreover, it was confirmed that pore counts were higher in older persons. The pore counts showed a correlation with wrinkle severity.
Aging ; Apocrine Glands ; Cheek ; Epidemiologic Studies ; Forehead ; Humans ; Nose ; Ultraviolet Rays

Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm. Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared. Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively. Conclusions Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm. Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared. Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively. Conclusions Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

OBJECTIVE: Eleven patients treated with posterior cerebral artery(PCA) aneurysm during 6.3-years period are retrospectively reviewed to determine treatment outcome. METHODS: Eleven patients with PCA aneurysm were treated from January 1998 to May 2004. Their medical records and radiologic studies were reviewed retrospectively. The records of these patients were analysed with particular reference to their demographic details, mode of presentation, and treatment outcome. RESULTS: Of the 11 patients, 8 patients presented with symptoms related aneurysmal bleeding. Three patients had unruptured PCA aneurysms. Open or endovascular surgery was performed in 9 patients; None of these patients exhibited a third nerve palsy, visual field deficit, or hemiparesis at the time of presentation. Postoperatively, 2 made a good recovery, 2 had a moderate disability because of cerebral infarction after surgery, and 5 had a severe disability because of cerebral infarction after surgery. Of 2 conservatively treated patients, 1 was doing well but the other died as a result of brain swelling. CONCLUSION: The treatment of the PCA aneurysms is difficult regardless of the aneurysmal size, site, and treatment modality. All reasonable treatment to reduce the risk of associated morbidity should be considered.
Aneurysm ; Brain Edema ; Cerebral Infarction ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Medical Records ; Oculomotor Nerve Diseases ; Paresis ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Retrospective Studies ; Treatment Outcome ; Visual Fields

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Aged ; Anti-Inflammatory Agents/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Crohn Disease/diagnosis/*drug therapy ; Female ; Gastrointestinal Diseases/pathology ; Humans ; Immunosuppressive Agents/therapeutic use ; Oral Ulcer/diagnosis

Patients with corrosive esophageal strictures have a high risk of developing carcinoma of the esophagus. For this reason, it is often recommended that resection of the esophagus should be considered for chronic caustic strictures in order to prevent the development of carcinoma. A 49-year-old woman who had undergone an esophagogastrectomy due to esophageal caustic stricture at the age of 23 was admitted with a 2-month history of dysphagia. Esophagoscopy showed a benign postoperative stricture in the remnant esophagus. After endoscopic balloon dilation of the stricture, which was about 5 cm in length, an ulcerative mass was noted distal to the stricture. This mass was diagnosed as squamous cell carcionoma. Nearly all the patients with corrosive carcinomas in the published literature had consumed an alkali drink, but our patient had a history of sulfuric acid ingestion.
Alkalies ; Constriction, Pathologic ; Deglutition Disorders ; Eating ; Esophageal Stenosis ; Esophagoscopy ; Esophagus ; Female ; Humans ; Middle Aged ; Sulfur ; Sulfuric Acids ; Ulcer

Duplication of the alimentary tract is an unusual congenital anomaly which may occur at any level, from the oral cavity to the rectum. Gastric duplication cyst is quite rare and most of them are presented in infancy with the sypmtoms of vomiting, abdominal pain, weight loss, gastrointestinal bleeding resulting from partial or complete obstruction. Some cases have not been diagnosed until adult when duplication cyst is not large enough to cause acute obstruction in infancy. Our case is more unusual in the aspect of its presence in adult and its nature resembles huge pancreatic pseudocyst. A 18-year man came to our hospital with complaint of epigastric pain for three days. A gastrofiberoscopy revealed a round protruding mass with smooth surface of normal mucosa at the fundus and computed tomography of the abdomen revealed the presence of 6.0 X 6.0 cm sized cystic mass between posterior wall of stomach and pancreas, and another 2.0 x 2.0 cm sized mass in ant. wall of stomach, which were regarded as mutiple pancreatic pseudocysts in perigastric region. Endoscopic retrograde cholangiopancreatography did not disclose any pancreatic ductal abnormality or communication with the cyst. Endoscopic ultrasonography showed anechoic cystic mass under 3rd layer of stomach wall, which was removed by surgical resection. Postoperative pathologic examination disclosed multiple gastric duplications.
Abdomen ; Abdominal Pain ; Adult ; Ants ; Cholangiopancreatography, Endoscopic Retrograde ; Endosonography ; Hemorrhage ; Humans ; Mouth ; Mucous Membrane ; Pancreas ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Rectum ; Stomach ; Vomiting ; Weight Loss