OBJECTIVES: The causes of benign esophageal stricture were postoperative, corrosive, peptic and after esophageal sclerotheraphy, etc. The patients mainly suffered from dysphagia and insufficient nutrition. Recently, balloon and bougie dilatation were introduced to these patients. This study was performed to evaluate the effectiveness and safety of both procedures in different types of strictures METHODS: 32 patients who presented dysphagia enrolled from March 1996 to August 1997 who visited Pusan National University Hospital. Balloon dilatation was performed on 22 patients and bougie on 10 patients. RESULTS: 1) The causes of stricture were postoperative (18 cases), corrosive (10 cases), hypertensive LES (2 cases), peptic (1 case) and web (1 case). 2) Overall cure rate was 59% in bougie dilatation and 40% in balloon dilatation 3) The cure rate of postopertive stricture was 59% which is significantly higher than that of corrosive stricture (27%), and cure rate of hypertensive LES, peptic stricture and web was 100%. 4) The cure rate of corrosive stricture was significantly higher on bougie dilatation than balloon dilatation. 5) The cure rate of postoperative stricture was similiar between balloon and bougie dilatation 6) The length of stricture was inversly affected on cure rate of both dilatation procedures. 7) Overall complication was 5.6% and similiar between balloon and bougie dilatation. CONCLUSIONS: These results suggested that bougie dilatation was recommended on corrosive stricture and balloon dilatation on postopertive stricture
Busan ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation* ; Esophageal Stenosis* ; Humans

Acute respiratory distress syndrome (ARDS) is difficult to treat and it is often fatal. If the medical treatment for ARDS is not effective, then extracorporeal membrane oxygenation (ECMO) can be applied to the patient. A 22-year-old female who suffered multiple traumatic injuries due to a car accident presented with acute respiratory distress syndrome. Veinarterial extracorporeal membrane oxygenation (VA ECMO) was started to treat her respiratory failure. With the VA ECMO, the systemic oxygen saturation remained at only 84%, and so the ECMO system was switched to V-VA ECMO via an additional venous outflow through the right jugular vein to increase both the systemic and pulmonary oxygen saturation. After conversion to the V-VA type ECMO, the systemic oxygen saturation increased to 94% and the partial pressure of oxygen (PaO2) increased to 65 mmHg. We report here on a successful case of ECMO conversion from the VA type to the V-VA type in a patient with severely hypoxic respiratory failure.
Extracorporeal Membrane Oxygenation ; Female ; Humans ; Jugular Veins ; Multiple Trauma ; Oxygen ; Partial Pressure ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Young Adult

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

BACKGROUND: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. MATERIAL AND METHOD: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax underwent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a bleb larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant bleb via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. RESULT: Multiple or single bleb lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and bleb was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of 30+/-3 months, no recurrence occurred in both the operative group and the non-operative group. CONCLUSION: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.
Anesthesia, Local ; Blister ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Pneumothorax ; Recurrence ; Thoracoscopes ; Thoracoscopy

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs.group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

BACKGROUND: It has been suggested that cytotoxin associated gene A (cagA) is a marker of more virulent strains of H. pylori and cagA bearing H. pylori is more pathogenic in the gastrointestinal diseases. On the other hand, according to several reports H. pylori causes the cell proliferation, which may be an important mechanism of gastric carcinogenesis. So, we studied to elucidate whether there is the association of the cagA positive H. pylori infection with cell proliferation on the gastric mucosae of the patients with gastritis and gastric cancer or not. METHODS: In this study, 27 gastritis and 35 gastric cancer patients were included. PCR assay for the detection of H. pylori(ureA PCR) and cagA bearing H. pylori(eagA PCR) were performed on the gastric mucosal biopsy specimen. Immunohistochemical study using the MIB 1 Ab against Ki 67 antigen was carried out to evaluate the cell proliferation. RESULTS: The prevalence of H. pylori infection was 85.2%(23/27) in the patients with gastritis and 54.3%(19/ 35) in the patients with gastric cancer. The prevalence of cagA+ strain of H. pylori was 52.2%(12/23) and 47.4%(9/ 19) in the patients with gastritis and gastric cancer. In the patients with gastritis, the degree of cell proliferation was not different in the ureA positive(24.8%) and ureA negative(21.7%) gastric mucosae. Moreover, the difference of cell proliferation was not observed according to the presence or absence of cagA gene(29.4% vs 19.9%) among the ureA positive gastric mucosae. In the patients with gastric cancer, cell proliferation indices were 25.5% and 27.5% in the ureA postive and cagA negative gastric mucosae, 28.1% and 22.2% in the cagA positive and cagA negative group among the ureA positive gastric mucosae. There was no significant difference statistically. CONCLUSIONS: There was no association of cagA+ strain of H. pylori with cell proliferation in the gastric mucosae of the patients with gastritis and gastric cancer. It was presumed that more studies are needed to elucidate the role of H. pylori infection in the gastric carcinogenesis.
Biopsy ; Carcinogenesis ; Cell Proliferation* ; Gastric Mucosa* ; Gastritis* ; Gastrointestinal Diseases ; Hand ; Helicobacter pylori* ; Helicobacter* ; Humans ; Ki-67 Antigen ; Polymerase Chain Reaction ; Prevalence ; Stomach Neoplasms* ; Urea

OBJECTIVES: Achalasia is primary esophageal motility disorder characterized by aperistalsis in body and incomplete lower esophageal sphincter(LES) relaxation. The aim of this study was to evaluate the parameters of successful balloon dilatation predicting long term outcome METHODS: 17 patients with primary esophageal achalasia from March 1995 to December 1996 were included in this study. 5 patients were performed re-balloon dilatation due to recurrence of symptoms. We used Rigiflex Achalasia Balloon with diameter of 30 and 35mm and balloon is dilated for 1 minute at a 5 minute interval. Esophageal manometry and scintigraphy before and after 1 month of balloon dilation were compared between groups with good long term results and relapsed RESULTS: 1) After balloon dilatation, LES pressure, basal esophageal pressure and retention rate were significantly decreased 2) After 6 months of dilatation, 12 patients were successfully treated and 5 patients were recurred 3) No significant pre-dilatation parameters were found to predict the recurrence 4) After 1 month of dilatation, patients with recurrence of symptoms showed significant higher LES pressure and retention rate 5) 2 patients showed recovery of the peristasis, and in these patients, amplitude of esophageal body contraction of pre- and post-balloon dilatation were significantly high CONCLUSION: After 1 month of dilatation, LES pressure and retention rate can predict the outcome after balloon dilatation and high amplitude of esophageal body contraction predict recovery of peristalsis and long term good result
Dilatation ; Esophageal Achalasia* ; Esophageal Motility Disorders ; Humans ; Manometry ; Peristalsis* ; Radionuclide Imaging ; Recurrence ; Relaxation

BACKGROUND: Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation. MATERIALS AND METHODS: From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months). RESULTS: Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group. CONCLUSION: The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.
Chest Tubes ; Drainage ; Hemorrhage ; Humans ; Operative Time ; Reoperation ; Retrospective Studies ; Sternotomy ; Thoracic Surgery ; Thoracotomy

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.
Deglutition Disorders ; Esophagus* ; Polyps*

BACKGROUND: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. MATERIAL AND METHODS: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4+/-15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP(R) (Medtronic Inc, Minneapolis, MN) or RMI(R) (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS(R); Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.4~3.0 L/min/m2 and an activated clotting time (ACT) of around 180 seconds. RESULTS: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. CONCLUSION: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.
Adoption ; Adult ; Anoxia ; Catheterization ; Catheters ; Emergencies ; Extracorporeal Membrane Oxygenation ; Female ; Glycosaminoglycans ; Hemorrhage ; Humans ; Male ; Membranes ; Oxygenators, Membrane ; Pneumonia ; Shock, Cardiogenic ; Tokyo ; Vital Signs ; Weaning