To make an accurate diagnosis of esophageal rupture during balloon dilatation without the help of esophagograph, an infusion pump, a pressure transducer and a radiopaque esophageal balloon were connected through a three-way connector. The pressure transducer was connected consecutively to an amplifier, a differentiator and a speaker to detect a pressure drop in the esophageal balloon. Under fluoroscopic monitoring, a radiopaque balloon catheter was inserted in the mid-thoracic esophagus of 30 rabbits and inflated with air until the esophagus was ruptured. A pressure drop in the balloon at the time of esophageal rupture was not only recorded graphically, but also was identified through a speaker. To examine esophageal rupture grossly, the rabbits were sacrificed after esophagography. We could detect the time of esophageal rupture during balloon dilatation in all rabbits accurately by observing the pressure drop on the pressure recorder and by hearing the sound made on a speaker. In 8 patients with esophageal stricture, a deflated radiopaque balloon catheter was inserted to the position inside the narrowing point and inflated by injecting air until the 'hourglass' deformity created by the stricture disappeared from the balloon contour which the pressure change in the balloon was monitored with a pressure recorder. The balloon pressures at the time of disappearance of the "hourglass" deformity from the balloon contour ranged from 200 mmHg to 2000 mmHg in 8 patients with esophageal strictures. Esophageal ruptured did not occur in these patients. In conclusion, our results indicate that this new method is not only safe but promising for patients in the future with esophageal strictures. First, it would reduce the chance of mediastinitis in patients of esophageal rupture. Second, esophageal balloon dilatation can be performed more effectively and safely. Third, it is cost-effective. Forth, radiation esposure to the patient can be reduced.
Catheters ; Congenital Abnormalities ; Constriction, Pathologic ; Diagnosis* ; Dilatation ; Esophageal Stenosis ; Esophagus ; Hearing ; Humans ; Infusion Pumps ; Mediastinitis ; Methods ; Rabbits ; Rupture* ; Transducers, Pressure

To make an accurate diagnosis of esophageal rupture during balloon dilatation without the help of esophagograph, an infusion pump, a pressure transducer and a radiopaque esophageal balloon were connected through a three-way connector. The pressure transducer was connected consecutively to an amplifier, a differentiator and a speaker to detect a pressure drop in the esophageal balloon. Under fluoroscopic monitoring, a radiopaque balloon catheter was inserted in the mid-thoracic esophagus of 30 rabbits and inflated with air until the esophagus was ruptured. A pressure drop in the balloon at the time of esophageal rupture was not only recorded graphically, but also was identified through a speaker. To examine esophageal rupture grossly, the rabbits were sacrificed after esophagography. We could detect the time of esophageal rupture during balloon dilatation in all rabbits accurately by observing the pressure drop on the pressure recorder and by hearing the sound made on a speaker. In 8 patients with esophageal stricture, a deflated radiopaque balloon catheter was inserted to the position inside the narrowing point and inflated by injecting air until the 'hourglass' deformity created by the stricture disappeared from the balloon contour which the pressure change in the balloon was monitored with a pressure recorder. The balloon pressures at the time of disappearance of the "hourglass" deformity from the balloon contour ranged from 200 mmHg to 2000 mmHg in 8 patients with esophageal strictures. Esophageal ruptured did not occur in these patients. In conclusion, our results indicate that this new method is not only safe but promising for patients in the future with esophageal strictures. First, it would reduce the chance of mediastinitis in patients of esophageal rupture. Second, esophageal balloon dilatation can be performed more effectively and safely. Third, it is cost-effective. Forth, radiation esposure to the patient can be reduced.
Catheters ; Congenital Abnormalities ; Constriction, Pathologic ; Diagnosis* ; Dilatation ; Esophageal Stenosis ; Esophagus ; Hearing ; Humans ; Infusion Pumps ; Mediastinitis ; Methods ; Rabbits ; Rupture* ; Transducers, Pressure

The endoscopic fine needle aspiration cytology may add to the diagnostic accuracy of endoscopic biopsy and brush cytology. It is also of particular value in submucosal, infiltrative and ulceronecrotic tumors. Endoscopic fine needle aspiration cytology was done with sclerotherapy needle(23 gauge) in. the 17 patients with submucosal tumor(18 cases), extrinsic compression(2 cases), infiltrative gastric cancer(one case) and cancer of the ampulla of Vater(one case) on the upper gastrointestinal endoscopy. Endoscopic fine needle aspiration cytology established the diagnosis in 6 cases(submucosal tumor of the stomach; 2 cases, submucosal tumor of the duodenum; one case, extrinsic mass of the duodenum; one case, infiltrative cancer of the stomach; one case, and the cancer of ampulla of Vater; one case) of 17 cases. There were negative results for malignancy in 7 cases and material insufficiency in 4 cases. Five cases of the positive results with endoscopic fine needle aspiration cytology were not diagnosed with endoscopic forceps biopsies. There was no complication. We conclude that endoscopic fine needle aspiration cytology is a simple and safe technique and is of particular value in submucosal tumor, extrinsic compression of the upper gastrointestinal tract by tumor, and infiltrative gastric cancer.
Ampulla of Vater ; Biopsy ; Biopsy, Fine-Needle* ; Diagnosis* ; Duodenum ; Endoscopy, Gastrointestinal ; Humans ; Sclerotherapy ; Stomach ; Stomach Neoplasms ; Surgical Instruments ; Upper Gastrointestinal Tract

OBJECTIVE: The aim of this study is to evaluate the acceleration of the center of mass (COM) of the body in stroke patients. METHOD: Seventeen stroke patients and 9 normal subjects were participated. Three dimensional gait analysis was used to classify gait phases for the reference. The accelerometer held over the COM were used to record vertical and medio- lateral accelerations of the COM of the body. Modified Ashworth scale and Brunnstrom stage were used to evaluate the clinical status of stroke patients. RESULTS: In normal subjects, the acceleration showed symmetric pattern. The maximum peak of vertical acceleration occurred in loading response. In stroke patients, the acceleration wave was characterized by asymmetry and polyphasicity. Maximum peak in affected side was higher than that in unaffected side (p<0.05). There were significant correlations between several elements of hemiplegic gait and the correspondent acceleration values; interval of successive peak I in vertical acceleration vs. step time, walking velocity and swing symmetry ratio vs. mean peak I, swing symmetry ratio vs. affected side peak I, step length symmetry ratio vs. peak I symmetry ratio. CONCLUSION: The accelerometer can be an easy and useful way to evaluate gait characteristics in stroke patients.
Acceleration ; Gait Disorders, Neurologic ; Gait* ; Humans ; Stroke* ; Walking

The aim of this study was to determine the effects of cytokines IL-1beta, TNF-alpha, and TGF-beta on the proliferation and ciliary beat frequency (CBF) of human nasal epithelial cells (HNECs) in vitro. Subcultured HNECs were incubated in a medium containing recombinant human (rh) cytokines rhIL-1beta rhTNF-alpha and rhTGF-beta at concentrations of 0.01 ng/ml, 0.1 ng/ml, 1 ng/ml, 10 ng/ml, and 100 ng/ml. After a two-day incubation with these cytokines, daily cell proliferation was measured by MTT assay for six days. The CBF was measured at concentrations of 1 ng/ml of rhIL-1beta 10 ng/ml of TNF-alpha and 1 ng/ml of TGF-beta solutions. While rhIL-1beta inhibited proliferation of HNECs in concentration-dependent and time-dependent manners, rhTNF-alpha stimulated HNEC growth at concentrations ranging from 0.01 ng/ml to 10 ng/ml in concentration-dependent and time-dependent manners. In contrast, rhTGF-beta inhibited HNEC growth irrespective of concentration and incubation time. The CBF of the human nasal ciliated epithelial cells increased after the addition of rhIL-1beta and rhTNF-alpha The CBF increased progressively for four hours after the addition of rhIL-1beta and rhTNF-alpha The increased CBF continued for 24 hours and decreased after two days. However, no variation of the CBF was observed after the addition of rhTGF-beta regardless of concentration or incubation time. The results of this study suggest that during acute inflammation, IL-1beta TNF-alpha and TGF-beta may have important roles in the repair and defense mechanism of the human nasal epithelium by regulating the proliferation and CBF of nasal epithelial cells.
Cell Proliferation ; Cytokines* ; Epithelial Cells* ; Humans* ; Inflammation ; Nasal Mucosa ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Well differentiated rectal carcinoid tumors which are less than 1cm in diameter can be treated by endoscopic resection. We aimed to evaluate the efficacy of endoscopic resection in treating small sized rectal carcinoids. METHODS: Medical records of 30 rectal carcinoid cases treated by endoscopic resection in Yonsei University College of Medicine, Severance Hospital between January 1995 and March 2007 were reviewed retrospectively. RESULTS: Mean age was 49.7 years and male to female ratio was 1:0.88. Mean size of tumor was 6.29+/-3.06 mm and 25 out of 30 patients (83.3%) had tumors of diameter less than 10 mm. Twenty-two out of 30 patients treated by conventional polypectomy, 6 by endoscopic mucosal resection using a transparent cap (EMR-C) and 2 by endoscopic submucosal dissection (ESD). Histological examination revealed that 9 patients had resection margin positive for tumor; 7 (31.8%) were in polypectomy group, 1 (16.7%) in EMR-C group, and 1 (50%) in ESD group (p=0.868). Five patients underwent transanal excision to remove residual tumor. No residual tumor was found in additionally resected tissue. Mean follow-up duration was 19. 3 months (range 0-122), and there were no recurrence. CONCLUSIONS: Endoscopic resection is an effective method in the treatment of small rectal carcinoids. However, long-term outcome remains to be elucidated by a large scaled prospective study.
Adult ; Aged ; Carcinoid Tumor/pathology/*surgery/therapy ; Demography ; *Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Humans ; Male ; *Microsurgery ; Middle Aged ; Rectal Neoplasms/pathology/*surgery/therapy ; Retrospective Studies ; Treatment Outcome

BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between the sinus mucosal hypertrophy and ciliary beat frequency (CBF) in patients with chronic sinusitis in vitro. MATERIALS AND METHODS: In 14 patients with chronic sinusitis, mucosal samples were obtained from the superior, inferior, and lateral walls of the maxillary sinus. Using a video-computerized analysis technique, we measured two parameters for ciliary activity at five different sites selected randomly from each sample=the ciliated area (%) showing CBF equal to or higher than 10 Hz (A10) and the weighted frequency (Fw). Mucosal hypertrophy of the maxillary sinus was calculated using a computer program on CT scans. RESULTS: A(>or=10) and Fw were 91% and 11.3 Hz in control group, respectively, whereas they were 47% and 9.1 Hz in chronic sinusitis group, respectively (p=0.03). There was a significant inverse correlation between A(>or=10) or Fw and mucosal hypertrophy of the maxillary sinus (p=0.001). CONCLUSION: The results of this study suggest that the severity of mucosal hypertrophy on CT scan may correlate with the ciliary activity.
Humans ; Hypertrophy* ; Maxillary Sinus* ; Sinusitis* ; Tomography, X-Ray Computed

Leiomyomas, originating in the bile duct, are very rare, and only few cases have been reported in the literature. We experienced a case of leiomyoma of the distal common bile duct, mimicking bile duct cancer. A 39-year-old woman presented with intermittent jaundice and general weakness for three months. Clinical profiles showed obstructive jaundice, and the abdominal computed tomography and cholangiography revealed diffuse bile duct dilatation with distal common bile duct stricture. A pylorus-preserving pancreaticoduodenectomy was performed and the pathologic specimen disclosed leiomyoma of the common bile duct accompanying severe fibrosis. This is the first case of leiomyoma in the bile duct reported in Korea.
Adult ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Female ; Humans ; Leiomyoma/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy