Photodynamic therapy (PDT) is a promising new modality that utilizes the combination of a photosensitizing chemical and visible light for the management of various solid malignancies, including gastrointestinal (GI) cancer. PDT has some advantages over chemotherapy in terms of its greater safety and lower toxicity in the treatment of malignant lesions. However, PDT has not been used widely for treating upper GI cancer due to its relatively low cost-effectiveness and anatomical characteristics of the GI system. Nevertheless, PDT may be an effective alternative therapy for early upper-GI cancer patients who are at a high risk of curative surgical resection or systemic chemotherapy. In some clinical studies, PDT for various upper GI cancer showed positiveresults. To improve the efficacy of PDT for upper GI cancer, development of photosensitezer and light delivery system is needed.
Humans ; Light ; Photochemotherapy ; Triazenes

Circumferential resection by performing endoscopic submucosal dissection (ESD) in the antrum can cause pyloric stenosis. Treatment with balloon dilation usually requires repeated sessions and this may cause bleeding or perforation. There are several studies regarding the treatment of benign pyloric stenosis by the temporary placement of self-expandable metallic stent (SEMS), but these studies did not include any case of pyloric stenosis caused by ESD for treating early gastric cancer (EGC). We experience a case of a man who had EGC encircling the antrum. After ESD, pyloric stenosis occurred and so a SEMS was applied. Eight weeks later, the stent was removed without complications. Stent insertion for benign pyloric stenosis has not been accepted as a standard therapeutic modality. However, continuous dilation of a stenotic lesion can be expected without major complications, except for migration. Therefore, temporary stent insertion can be considered as an alternative treatment option for benign pyloric stenosis. Further study on the long term outcome of this procedure is needed.
Hemorrhage ; Pyloric Stenosis ; Stents ; Stomach Neoplasms

The accessory middle cerebral artery (MCA) is an anomalous vessel which arises from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along with the normal MCA. Here we present a case of acute cerebral infarction in a patient with stenosis of the accessory MCA. The accessory MCA, which originated from the proximal A1 segment of the ACA, had severe focal stenosis in its proximal part and the ischemic lesions were in the frontal subcortical white matter. This case illustrates the anomalous vessel and its territory, the atheromatous vascular change, and the related ischemic insults.
Anterior Cerebral Artery ; Cerebral Infarction ; Constriction, Pathologic ; Glycosaminoglycans ; Humans ; Middle Cerebral Artery

PURPOSE: For curative resection of recurrent gastric cancer, it is imperative that there be no unrecognized foci of tumoral disease outside the operation field. PET (positron emission tomography) with FDG (18 fluoro-2 deoxy-D-glucose) is a whole-body imaging technique that exploits the increased rate of glycolysis in tumor cells to detect disease. The authors evaluated the usefulness of FDG-PET in assessing resectability of recurrent gastric cancer. MATENRIALS AND METHODS: Seven patients with recurrent gastric cancer were studied with FDG-PET from December 1998 to October 2000. All FDG-PET images were interpreted in conjunction with conventional diagnostic methods. All imaging results were correlated with the pathological diagnosis and clinical outcome. Results: A final diagnosis of recurrence was obtained at 14 sites in all 7 patients by histology or clinical follow up. Locoregional recurrence, including distant metastasis, developed in 6 of 7 patients and distant recurrence in only one. FDG-PET detected all recurrent sites (5 locoregional and 5 distant) in 5 patients without peritoneal recurrence, but did not detect peritoneal seeding in 2 patients with peritoneal recurrence. The accuracy of FDG-PET in estimating resectability was 71.4% (5/7), and that of CT and PET together was 85.7% (6/7). A curative resection could be performed in three of the recurrent patients (2 locoregional and 1 distant recurrence). CONCLUSION: Our results suggest that FDG-PET may be useful for detecting locoregional and distant recurrence of gastric cancer and for selecting appropriate treatment. However, considering that FDG-PET was limited in detecting peritoneal seeding and determining the exact anatomical extension of tumor, it should be used in conjunction with other anatomical images.
Diagnosis ; Follow-Up Studies ; Glycolysis ; Humans ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms*

Juvenile Polyposis Syndrome is a rare condition that is characterized by the development of multiple polyps in the gastrointestinal tract. It is a hamartomatous disorder that was first described in families in 1964. Both sporadic and familial cases with autosomal dominant inheritance have been reported on. Juvenile Polyposis Syndrome is regarded as a distinct from the solitary juvenile polyps that develop in 2% of children and adolescents, and the latter have no malignant potential. We report here on a case of Juvenile Polyposis Syndrome in an 18 year old male along with a review of the relevant literature. The patient had various numbers of different sized pedunculated polyps that were observed throughout the entire gastrointestinal tract.
Adolescent ; Child ; Gastrointestinal Tract ; Humans ; Intestinal Polyposis ; Male ; Neoplastic Syndromes, Hereditary ; Polyps ; Wills

BACKGROUND/AIMS: Nasogastric administration of cola for dissolution of phytobezoar was reported but the mechanism is not well understood. We aimed to evaluate the efficacy of cola ingestion for upper gastrointestinal endoscopy in patients who have had distal gastrectomy. MATERIALS AND METHODS: Patients were enrolled from July 2007 to October 2007 and all previously received subtotal gastrectomy. We conducted a randomized case-control study which the patients were randomly assigned to two groups. Group A had preparation with cola and group B had no preparation. Cola preparation group ingested about 1,500 mL of cola between 7 PM to 10 PM in the evening before the procedure. Two examiners who were blinded to the type of preparation performed the endoscopy. We assessed the degree of food residue and bile reflux by Japanese classification. RESULTS: A total of 70 patients were included. The comparison of clinical and laboratory characteristics between the two groups showed no statistically significant difference. During endoscopy, food residue was less found in group A than B, but without statistically significance (group A=12.1%, group B=21.6%, P=0.087). However, bile reflux was significantly less found in group A than B (group A=36.4%, group B=67.6%, P=0.015). Multivariate analysis, cola preparation significantly reduced food residue (OR, 0.032; P=0.001) and bile reflux (OR, 0.102; P=0.001). CONCLUSIONS: Preparation with cola in the evening before endoscopic examination may provide a good quality of preparation in patient with remnant stomach after distal gastrectomy.
Asian Continental Ancestry Group ; Bile Reflux ; Case-Control Studies* ; Classification ; Cola* ; Eating* ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrectomy ; Gastric Stump* ; Humans ; Multivariate Analysis

BACKGROUND/AIMS: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. METHODS: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. RESULTS: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1beta was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-alpha and IL-6 did not differ between the two groups. CONCLUSIONS: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1beta expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed.
2-Pyridinylmethylsulfinylbenzimidazoles ; Alkaline Phosphatase ; Animals ; Bone Density ; Calcium ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Injections, Intraperitoneal ; Interleukin-6 ; Interleukins ; Mice ; Mice, Inbred ICR ; Osteocalcin ; Osteoclasts ; Osteogenesis ; Osteoporosis ; Phosphorus ; Proton Pump Inhibitors ; Proton Pumps ; RNA, Messenger ; Sample Size ; Tibia ; Tumor Necrosis Factor-alpha

BACKGROUND: Laboratory studies as diagnostic tools of scrub typhus have shown PCR to be sensitive and specific, but there have been few clinical studies. The aims of this study were to determine the diagnostic accuracy and clinical usefulness of the nested PCR through a prospective comparison of the nested PCR and indirect immunofluorescence assay (IFA). MATERIALS AND METHODS: We conducted a multicenter prospective study of patients with possible scrub typhus. Adult patients who have had fever together with eschar or a maculopapular skin rash and more or equal to two of the following symptoms: headache, malaise, myalgia, coughing, nausea, and abdominal discomfort were enrolled. Each patient was admitted between September, 2004 and December, 2004 to Chosun University Hospital and one of its three community branch hospitals (Haenam General Hospital, Jangheung Hospital, Muan Hospital), which are all located in the southwest of Korea. Whole blood samples were collected for PCR testing and sera were obtained for serology evaluation using the IFA and passive hemagglutination assay (PHA). RESULTS: We enrolled 135 possible scrub typhus patients, and 118 scrub typhus patients were confirmed on the basis of either a single indirect immunofluorescent specific IgM titer against O. tsutsugamushi of > or =1:10 or 4-fold or greater rise in IFA follow up titer. One hundred eighteen patients were confirmed as scrub typhus, 7 patients were undetermined and 10 patients were confirmed as the other diseases. The result of nested PCR assay demonstrated a sensitivity of 82.2% (95% confidence interval 0.74-0.88), a specificity of 100% (95% confidence interval 0.66-1), positive predictive value of 1 (95% confidence interval 0.95-1) and negative predictive value of 0.32 (95% confidence interval 0.17-0.51). 96 patients out of 118 patients were positive for IgM on the admission day. Of 22 patients with negative for IgM antibody at admission, 19 had positive results for nested PCR using buffy coat. CONCLUSION: The nested PCR assay of buffy coat is useful for rapid and reliable test for confirmation of the diagnosis of scrub typhus.
Adult ; Cough ; Diagnosis* ; Exanthema ; Fever ; Fluorescent Antibody Technique, Indirect ; Follow-Up Studies ; Headache ; Hemagglutination ; Hospitals, General ; Hospitals, Satellite ; Humans ; Immunoglobulin M ; Korea ; Myalgia ; Nausea ; Orientia tsutsugamushi ; Polymerase Chain Reaction* ; Prospective Studies* ; Scrub Typhus* ; Sensitivity and Specificity

BACKGROUND: Laboratory studies as diagnostic tools of scrub typhus have shown PCR to be sensitive and specific, but there have been few clinical studies. The aims of this study were to determine the diagnostic accuracy and clinical usefulness of the nested PCR through a prospective comparison of the nested PCR and indirect immunofluorescence assay (IFA). MATERIALS AND METHODS: We conducted a multicenter prospective study of patients with possible scrub typhus. Adult patients who have had fever together with eschar or a maculopapular skin rash and more or equal to two of the following symptoms: headache, malaise, myalgia, coughing, nausea, and abdominal discomfort were enrolled. Each patient was admitted between September, 2004 and December, 2004 to Chosun University Hospital and one of its three community branch hospitals (Haenam General Hospital, Jangheung Hospital, Muan Hospital), which are all located in the southwest of Korea. Whole blood samples were collected for PCR testing and sera were obtained for serology evaluation using the IFA and passive hemagglutination assay (PHA). RESULTS: We enrolled 135 possible scrub typhus patients, and 118 scrub typhus patients were confirmed on the basis of either a single indirect immunofluorescent specific IgM titer against O. tsutsugamushi of > or =1:10 or 4-fold or greater rise in IFA follow up titer. One hundred eighteen patients were confirmed as scrub typhus, 7 patients were undetermined and 10 patients were confirmed as the other diseases. The result of nested PCR assay demonstrated a sensitivity of 82.2% (95% confidence interval 0.74-0.88), a specificity of 100% (95% confidence interval 0.66-1), positive predictive value of 1 (95% confidence interval 0.95-1) and negative predictive value of 0.32 (95% confidence interval 0.17-0.51). 96 patients out of 118 patients were positive for IgM on the admission day. Of 22 patients with negative for IgM antibody at admission, 19 had positive results for nested PCR using buffy coat. CONCLUSION: The nested PCR assay of buffy coat is useful for rapid and reliable test for confirmation of the diagnosis of scrub typhus.
Adult ; Cough ; Diagnosis* ; Exanthema ; Fever ; Fluorescent Antibody Technique, Indirect ; Follow-Up Studies ; Headache ; Hemagglutination ; Hospitals, General ; Hospitals, Satellite ; Humans ; Immunoglobulin M ; Korea ; Myalgia ; Nausea ; Orientia tsutsugamushi ; Polymerase Chain Reaction* ; Prospective Studies* ; Scrub Typhus* ; Sensitivity and Specificity

BACKGROUNDGlehnia littoralis, as a traditional herbal medicine to heal various health ailments in East Asia, displays various therapeutic properties including antioxidant effects. However, neuroprotective effects of G. littoralis against cerebral ischemic insults have not yet been addressed. Therefore, in this study, we first examined its neuroprotective effects in the hippocampus using a gerbil model of transient global cerebral ischemia (TGCI).

METHODSGerbils were subjected to TGCI for 5 min. G. littoralis extract (GLE; 100 and 200 mg/kg) was administrated orally once daily for 7 days before ischemic surgery. Neuroprotection was examined by neuronal nuclear antigen immunohistochemistry and Fluoro-Jade B histofluorescence staining. Gliosis was observed by immunohistochemistry for glial fibrillary acidic protein and ionized calcium-binding adapter molecule 1. For neuroprotective mechanisms, immunohistochemistry for superoxide dismutase (SOD) 1 and brain-derived neurotrophic factor (BDNF) was done.

RESULTSPretreatment with 200 mg/kg of GLE protected pyramidal neurons in the cornu ammonis 1 (CA1) area from ischemic insult area (F = 29.770, P < 0.05) and significantly inhibited activations of astrocytes (F = 22.959, P < 0.05) and microglia (F = 44.135, P < 0.05) in the ischemic CA1 area. In addition, pretreatment with GLE significantly increased expressions of SOD1 (F = 28.561, P < 0.05) and BDNF (F = 55.298, P < 0.05) in CA1 pyramidal neurons of the sham- and ischemia-operated groups.

CONCLUSIONSOur findings indicate that pretreatment with GLE can protect neurons from ischemic insults, and we suggest that its neuroprotective mechanism may be closely associated with increases of SOD1 and BDNF expressions as well as attenuation of glial activation.