Esophageal ulcers induced by doxycycline is a rare complication. These patients usually complain of sudden onset of symptoms, ie acute substernal or chest pain and odynophagia without prior hietory of esophageal syraptoms. On esophagoscopic examination, there are upper or midesophageal ulcers, which heal after diseontinuation of the drug within 2 weeks. A history of ingestion of the doxycycline,with liquid jost before bedtime can be elicited. The exact eause of the xaucosal ulceration is not clear, but a direct irritant effeet on esophageal mucosa seems most likely. We report 5 cases of esophageal uleeration secondary to the ingestion of doxycydine. Esophagoscopy revealed esophageal ulcers in all patients and the patients hecame asymptomatic following stopping of tbe drugs and taking antacids.
Antacids ; Chest Pain ; Doxycycline* ; Eating ; Esophagoscopy ; Humans ; Mucous Membrane ; Ulcer*

Moyamoya disease is an unusual vascular disorder highlighted by progressive bilateral internal carotid artery occlusion and collateralization of intracranial blood flow. The purposes of the bypass procedures : 1) reduce or arrest of the chance of repeated ischemic attack by making the additional collateral blood flow, 2) decrease the chance of repeated bleeding by reducing the number of moyamoya vessels. During the period from June 1989 through February 1991, 8 moyamoya diseases associated with intraventricular hemorrhage were operated by STA-MCA anastomosis plus EMS. Results are as follows : 1) Slightly female dominancy in incidence(5 : 3), and all of the patients were middle aged(range 32 to 55 years). 2) All of the patients had sudden onset of headache, and most patients whad neck stiffness and vomiting. 3) In all of the patients, confirmatory diagnosis could be done by angiography, and all of the patients had gypical angiographic findings of moyamoya disease. 4) All of the patients had IVH in brain CT scan. 5) All of the patients were surgically treated : STA-MCA anastomosis plus EMS. 6) The postoperative revascularization rate was 89%(8 sides in 9 sides). 7) The postoperative results were excellent in 5, good in 1, and death in 2. The rarity of such lesions in KOrea and their surgical results are reviewed briefly.
Angiography ; Brain ; Carotid Artery, Internal ; Diagnosis ; Female ; Headache ; Hemorrhage* ; Humans ; Korea ; Moyamoya Disease* ; Neck ; Tomography, X-Ray Computed ; Vomiting

PURPOSE:Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor, and stomach is the major site of ghrelin secretion. The purpose of this study is to compare the serum ghrelin concentrations between patients with type 2 diabetes mellitus (DM) and normal adults. We studied also whether serum ghrelin levels in the patients with type 2 DM are correlated with body mass index (BMI), serum insulin, lipid profiles, and creatinine levels. METHODS:Forty patients with type 2 DM and forty normal adults were included in this study. We measured heights and weights of the subjects and calculated their BMIs. Blood samples were obtained to measure the ghrelin concentration and their sera were stored at -20degreeC until used. In all subjects, serum ghrelin levels were measured using the commercially available Ghrelin(human) EIA kit. RESULTS:No differences of mean values were detected between the control group and the type 2 diabetic group for age, body weight, BMI, and the levels of serum total cholesterol, triglyceride, HDL cholesterol, and creatinine. But ghrelin level of the type 2 diabetic group (71.1+/-30.5 ng/L) was significantly lower than the control group (139.7+/-36.9 ng/L). In the control group, the ghrelin level showed positive correlation with HDL cholesterol (Pearson's correlation coefficient=0.37, P<0.05). In the diabetic group, the ghrelin level showed weakly positive correlation with insulin concentration. However, there was no significant relationship between serum ghrelin and various parameters in the diabetic patients group. CONCLUSION: In this study, ghrelin concentration in type 2 diabetic patients was lower than that in the control group. In the control group, serum ghrelin concentrations were positively correlated with HDL cholesterol. In the type 2 diabetic group, there was no significant correlation between insulin and ghrelin concentrations.
Adult ; Body Mass Index ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Ghrelin* ; Humans ; Insulin ; Receptors, Ghrelin ; Stomach ; Triglycerides ; Weights and Measures

During the period from March 1990, through September 1993, 11 patients with moyamoya disease underwent superficial temporal artery(STA)-to-middle cerebral artery(MCA) anastomosis and encephalomyosynangiosis(EMS) bilaterally. The mean follow-up period was 30.6 months(range 17 to 42 months). The most frequent computed tomographic findings were intraventricular hemorrhage in adult patients and cortical infarction in pediatric patients. In all of the patients, confirmatory diagnosis could be made by angiography, and all had typical angiographic finding of moyamoya disease. According to angiographic classification by Suzuki, the most frequent phase was stage three. A modified continuous suture technique was used during anastomosis. The advantages of this microvascular suture technique are saving time for the surgical procedure, lessening bleeding from the anastomotic site and the ease and safety with which anastomosis can be achieved in the deep cranial cavity. Postoperatively, follow-up angiography was taken between 1 year and 2 years after operation. The angiography revascularization rate was 100%, excellent in 6, and good in 5. The typical postoperative angiography findings are as follows : 1) reduction of moyamoya vessels, 2) normalization or improvement of abnormal posterior circulation, 3) visualization of MCA territory through MCA-STA bypass, and 4) dilatation of STA. There were no major complication in patients with surgery, and no poor outcomes. These results indicate that the STA-MCA anastomosis and EMS in moyamoya disease can normalize cerebral circulation and reduce repeat ischemic attack and repeated bleeding.
Adult ; Angiography ; Cerebral Arteries* ; Classification ; Diagnosis ; Dilatation ; Follow-Up Studies* ; Hemorrhage ; Humans ; Infarction ; Moyamoya Disease* ; Suture Techniques

Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta which originates just distal to the level of the origins of the coronary arteries. It may be localized or diffuse, and includes a wide spectrum of pathologic changes. A 16 years old school boy was admitted because of exertional dyspnea for 6 years. Clinical diagnosis of supravalvular and valvular aortic stenosis with bicuspid aortic valves and myocardial hypertrophy was made by echocardiography and angiocardiography. Surgical correction was performed successfully. We presented a case of supravalvular and valvular aortic stenosis with a review of literatures.
Adolescent ; Angiocardiography ; Aorta ; Aortic Stenosis, Supravalvular ; Aortic Valve ; Aortic Valve Stenosis* ; Bicuspid ; Congenital Abnormalities ; Coronary Vessels ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Hypertrophy ; Male

It is well known that the spatial patterns of basement membrane[BM] components show a close correlation with the morphogenetic process in developing organs during pre- and postnatal period. But little is known about the chronological changes in BM components during the development of thyroid gland. To investigate the correlation of the distribution of BM components with the development of the thyroid gland, immunohistochemical localization of the BM components was performed, using rat fetuses[from 15 to 21 days of gestation] and pups[from 1 to 14 days]. According to the histological features with H.E. staining, prenatal development[El5-21] of the rat thyroid could be divided into 3 representative stages : 1] Undifferentiated primordium of thyroid epithelia, forming cell cords or cell nests [until El5 day]. 2] An intervening stage of cell proliferation with the pattern of lobulation[El6-17 days]. 3] Stage of maturing follicles[El8-21 days]. It could be concluded that differentiation of the thyroid follicle are terminated during the prenatal period and growth in size and number occurs during the first two weeks after birth. By the immunohistochemical localization of laminin[LM], fibronectin[FN], type IV collagen[CIV], the basement membranes investing thyroid follicles could be clearly delineated at 15 days of gestation. Reactivity for LN and CIV associated with BM increased with advancing development, while that of FH was apparently weakened during the 2 weeks after birth. On the other hand immunoreactivity for CIV in the same age group increased, compared to that of previous swage of development. These results indicate that BM components were expressed in distinct spatial patterns with advancing development of thyroid gland. Based on these observations, it could be concluded that these BM components are important determinants in epithelial growth and differentiation during thyroid development.
Animals ; Basement Membrane* ; Cell Proliferation ; Collagen Type IV ; Fibronectins ; Hand ; Humans ; Laminin ; Parturition ; Pregnancy ; Rats* ; Thyroid Gland*

Thyroid gland is composed of follicles surrounded by basement membrane, which is known to be related to the regenerative processes in several organs. This study was performed to observe the morphological details and changes of the basement membrane components, which are the presumtive factors in thyroid regeneration, with time sequences after partial thyroidectomy and then the relations between the components and thyroid regeneration were confirmed. Thyroid galnds of adult male rats were examined before and 1, 2, 3, 4, 5, 7 and 10 days after bilateral partial[50-60%] thyroidectomy. The basememnt membranes of follicles were prominent with high eosinophilicity at later stage when H & E stained. But in PAS and EM staining, the basement membrane of the operated groups didn`t show any specific changes comparing with control group but the dense collagenous fibers at the interfollicular space outside the membrane. Immunostaining of proliferating cell nuclear antigen[PCNA], which reflects the growth fraction, showed 2.3% positivity of total follicular cells in control group. The PCNA positive ratio in experimental groups were 10.3%, 15.9%, 19.9%, 12.2%, 10.5%, 1.9%, 2.7% on postoperative 1, 2, 3, 4, 5, 7, 10 days respectively. In unilaterally thyroidectomized rats, the resected lobe revealed 18.2% of PCNA positive ratio 3 days after operation, while that in the unresected lobe was only 5.9%. This suggested the predominence of local factors in thyroid regeneration. Meanwhile, with the double immunostaining of calcitonin and PCNA discriminate between follicular cells and C-cells among the PCNA positive cells, PCNA positive C-cells were very rare. The immunostaining of laminin, fibronectin, and collagen IV showed varying intensity with the progress of regeneration. Stainability for collagen IV was maintained in all groups with some increase in 5- and 7-day groups. Laminin was well localized to the basement membrane of the control follicle, and the staining intensity for laminin was markedly increased with additional cytoplasmic staining in follicular cells in 1- to 3-day groups and then decreased to attain the control level in 10-day group. In case of fibronectin, the control follicle showed scarce staining, but the resected group showed strong positivity for fibronectin with the most intense staining in 1- to 3-day groups. Immunostaining for fibronectin still showes in 10-day group with the gradual disappearance of immunoreactivity in the center of the lobe. This study revealed the accompaning changes of the basement membrane components during the regeneration process of partially resected thyroid glands. Among them, collagen IV seems to support the structural integrity of the basement membrane. Laminin and fibronectin were supposed to be related to the thyroid follicular regeneration.
Adult ; Animals ; Basement Membrane ; Calcitonin ; Collagen ; Collagen Type IV ; Cytoplasm ; Eosinophils ; Extracellular Matrix* ; Fibronectins ; Humans ; Laminin ; Male ; Membranes ; Proliferating Cell Nuclear Antigen ; Rats* ; Regeneration ; Thyroid Gland* ; Thyroidectomy

In the treatment of fractures of the thoracolumbar junctiion area, surgical intervention was performed when posterior part of veretbral body, posterior structure supporting ligaments were involved and body compression more than 40%. Number of cases satisfying above criteria were seven between Aug. 1990 and Jun. 1991. Age distribution ranged from 15 to 57 years. Sex ratio was 4:3(F:M). Four patients presented with nerve root sign, one patient with cauda equina signs, and two patients were normal neurologically. In all cases, spinal canal decompression, internal instrument fixation, and bone fusion with iliac bone were performed via anterolateral approach. After surgical treatment, neurological deficits disappeared and kyphotic angle returned to normal range of thoracolumbar junction area in all cases. Percentage of body compression was improved from preop. 55% to postop. 21% in average. According to above results, we concluded that anterior instrumental fixation combined with bone fusion using iliac bone was supperior to posterior approach in providing biomechanical stability and decompression of protruding ventral bone fragments.
Age Distribution ; Cauda Equina ; Decompression ; Humans ; Ligaments ; Reference Values ; Sex Ratio ; Spinal Canal

Idiopathic arterial hypertension, termed "essential" or "neurogenic", is a common generalized cardiovascular syndrome comprised of a sequence of pathologic changes and accommodations. Although an extensive literature exists concerning that, the primary etiology has been unclear yet. However, Jannetta and coworkers have reported a possible etiological connection between essential hypertension and intraoperatively observed neurovascular compression of the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves on the left, recently. They have also introduced one of new therapeutical concept for essential hypertension by microvascular decompression(MVD) of offending vessels. Based on Jannetta and coworker's hypothesis, the authors have made some operations for the control of hypertension. Seven essential hypertensive patients have been underwent retromastoid craniectomy and MVD in the left ventrolateral medulla between July 1992 and June 1993. Five of them showed multiple episodes of intracerebral hemorrhages, one was an intractable hypertension case and the other one had a left hemifacial spasm with essential hypertension. The most common offending vessel was the posterior inferior cerebellar artery and it had been confirmed during operation. Postoperatively, in three cases, blood pressure was lowered to normal without medications. Of remaining four cases, blood pressure was significantly improved in one and slightly improved in three. There were no major complications in patients with surgery and no poor outcomes. These results indicate that the MVD for essential hypertension is relatively safe procedure and alternative choice as one of the management of intractable essential hypertension, repeated hypertensive intracerebral hemorrhages and left cranial nerve hyperfunction disorders combined with essential hypertension.
Arteries ; Blood Pressure ; Cerebral Hemorrhage ; Cranial Nerves ; Hemifacial Spasm ; Humans ; Hypertension* ; Intracranial Hemorrhage, Hypertensive ; Microvascular Decompression Surgery* ; Vagus Nerve

Emphysematous pyelonephritis is a rare, life-endangering suppurative infection of the renal parenchyma and perirenal tissues. The disease is encountered mainly in the diabetic patient with or without ureteral obstruction and is characterized by the production of intrarenal and occasionally, perirenal gas. We report a case of emphysematous pyelonephritis, treated by left nephrectomy, in 55-year-old diabetic woman.
Female ; Humans ; Middle Aged ; Nephrectomy ; Pyelonephritis* ; Ureteral Obstruction