No abstract available.
Ear, Middle*

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.
Adenoma ; Gastrectomy ; Hemorrhage ; Humans ; Ligation ; Lymph Nodes ; Mucous Membrane ; Prospective Studies ; SNARE Proteins ; Stomach ; Stomach Neoplasms*

Zolpidem is a non-benzodiazepine drug that has selectivity for the gamma-aminobutyric acid (GABA) receptors. We experienced paradoxical effect of zolpidem in a 48-year-old male patient with hypoxic-ischemic brain injury after cardiac arrest. The patient was in stupor and could not communicate. His Glasgow Coma Scale (GCS) was E2M4V2 and Rancho Los Amigos (RLA) was grade III to IV. Zolpidem was prescribed to induce sedation but paradoxically, he became alert (GCS 15, RLA VII) and was able to communicate. The arousal lasted for 2 hours repeatedly following each administration of the medication. While he was alert, electroencephalogram showed the reversal of slow wave into beta range fast activity and F-18 flumazenil positron emission tomography (PET) showed increased GABAergic receptor activity in both frontoparietotemporal cortices. Single photon emission computed tomography (SPECT) also showed increased cerebral perfusion and reversal of cerebellar diaschisis.
Anoxia ; Arousal* ; Brain Injuries ; Electroencephalography ; Electrons* ; Flumazenil* ; gamma-Aminobutyric Acid ; Glasgow Coma Scale ; Heart Arrest ; Humans ; Male ; Middle Aged ; Perfusion ; Positron-Emission Tomography* ; Stupor ; Tomography, Emission-Computed, Single-Photon*

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems. Although the etiology of SLE remains unclear, it is widely accepted that genetic factors could be involved in its pathogenesis. A number of genome-wide association studies (GWASs) have identified novel single-nucleotide polymorphisms (SNPs) associated with the risk of SLE in diverse populations. However, not all the SNP candidates identified from non-Asian populations have been validated in Koreans. In this study, we aimed to replicate the SNPs that were recently discovered in the GWAS; these SNPs have not been validated in Koreans or have only been replicated in Koreans with an insufficient sample size to conclude any association. For this, we selected five SNPs (rs1801274 in FCGR2A and rs2286672 in PLD2, rs887369 in CXorf21, rs9782955 in LYST, and rs3794060 in NADSYN1). Through the replication study with 656 cases and 622 controls, rs1801274 in FCGR2A was found to be significantly associated with SLE in Koreans (odds ratio, 1.26, 95% confidence interval, 1.06 to 1.50; p = 0.01 in allelic model). This association was also significant in two other models (dominant and recessive). The other four SNPs did not show a significant association. Our data support that FCGR polymorphisms play important roles in the susceptibility to SLE in diverse populations, including Koreans.
Autoimmune Diseases ; Genome-Wide Association Study ; Lupus Erythematosus, Systemic ; Polymorphism, Single Nucleotide ; Sample Size

BACKGROUND: The clinical characteristics of seizures in adults with localization-related epilepsy have been clearly described and classified. But few researches and data are available in childhood intractable epilepsy. METHODS: We analyzed 334 videotaped seizures from 41 pediatric patients who underwent epilepsy surgery at Dong San Medical Center between 1993 and 1997. Twenty- one of 41 patients had temporal lobe epilepsy, and the remaining 20 patients had extratemporal lobe epilepsy. We divided the patient sample into two groups : (a) those with total cases, (b) those with good outcome (seizure-free or more than 90% reduction of seizures after surgery). We compared temporal lobe epilepsy (TLE) with extratemporal lobe epilepsy (ETE) by clinical symptoms and initial ictal symptoms. In addition, we analyzed the lateralizing value of ictal dystonia, head turning, head deviation and automatism. RESULTS: The aura and head deviation of TLE and the motor arrest, head deviation and dystonic posture of ETE were observed more frequently in total group (P<0.05). In contrast, the vocalization and secondary generalization of TLE and the motor arrest, dystonic posture and dysarthria of ETE were observed more frequently in good outcome group (P<0.05). In cases of the initial ictal symptoms, the aura and hand automatism of TLE and the motor arrest and dystonic posture of ETE were observed more frequently in both groups (P<0.05). Of the ictal motor phenomena, ipsilateral hand automatism and contralateral dystonic posture were useful in lateralizing the seizure focus (P<0.05). CONCLUSION: The clinical ictal manifestations in children are very helpful to localize or lateralize the epileptic focus, like in adults case. Because of the lack of younger age group in our study, however, we suggest more rigorous studies based on more comprehensive data.
Adult ; Automatism ; Child ; Dysarthria ; Dystonia ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Generalization (Psychology) ; Hand ; Head ; Humans ; Posture ; Seizures* ; Temporal Lobe*

Groin pain in athletes is a complex diagnostic and therapeutic challenge. Sports hernia is one of the common causes of groin pain. We report a case of sports hernia, initially presented as groin pain and aggravated by sports activity. A 19-year-old soccer player visited the outpatient department of general surgery and was referred to the rehabilitation center due to no abnormalities detected in the abdomen and pelvis by computed tomography. An incipient direct bulge of the posterior inguinal wall was detected with dynamic ultrasound when abdominal tension was induced by raising both legs during a full inhalation. Surgery was performed and preoperatively both groins showed the presence of inguinal hernia. Diagnosing sports hernia is very challenging. Through careful history documentation and physical examination followed by dynamic ultrasonography, we identified his posterior inguinal wall deficiency for early management.
Abdomen ; Athletes ; Athletic Injuries ; Diagnosis* ; Groin* ; Hernia* ; Hernia, Inguinal ; Humans ; Inhalation ; Leg ; Outpatients ; Pelvis ; Physical Examination* ; Rehabilitation Centers ; Soccer ; Sports* ; Ultrasonography* ; Young Adult

Gastrointestinal stromal tumors (GISTs) are uncommon tumors that originate from primitive mesenchymal cells. Because GISTs develop throughout the gastrointestinal tract, they present variable heterogenous clinical manifestations such as gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding from jejunal stromal tumor mimicking arteriovenous malformation.
Arteriovenous Malformations ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage* ; Jejunum

Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with initial presentation of isolated chest wall pain. Computed tomography of the chest with contrast revealed a 2.5-cm nodule over the left upper lung. Biopsy confirmed the diagnosis of adenocarcinoma. Later, cerebrospinal fluid cytology exam also confirmed leptomeningeal seeding. It is rare for leptomeningeal carcinomatosis patients to present with chest wall pain. Therefore, a high index of suspicion is mandatory for accurate and prompt diagnosis.
Adenocarcinoma ; Biopsy ; Breast Neoplasms ; Cerebrospinal Fluid ; Chest Pain ; Diagnosis ; Humans ; Lung ; Lung Neoplasms ; Melanoma ; Meningeal Carcinomatosis* ; Neoplasm Metastasis ; Thoracic Wall* ; Thorax

OBJECTIVE: To confirm a relationship between the pharyngeal response and bolus volume, and examine whether increasing the fluid bolus volume can improve penetration and aspiration for stroke dysphagic patients. METHODS: Ten stroke patients with a delayed pharyngeal response problem confirmed by a videofluoroscopic swallowing study (VFSS) were enrolled. Each subject completed two swallows each of 2 mL, 5 mL, and 10 mL of barium liquid thinned with water. The pharyngeal delay time (PDT) and penetration-aspiration scale (PAS) were measured and the changes among the different volumes were analyzed. RESULTS: PDTs were shortened significantly when 5 mL and 10 mL of thin barium were swallowed compared to 2 mL. However, there was no significant difference in PAS as the bolus volume increased. CONCLUSION: The increased fluid bolus volume reduced the pharyngeal delay time, but did not affect the penetration and aspiration status.
Barium ; Deglutition Disorders* ; Deglutition* ; Fluoroscopy ; Humans ; Pilot Projects* ; Reaction Time ; Respiratory Aspiration ; Stroke ; Swallows ; Water

Eosinophilic enteritis is characterized by massive infiltration of eosinophil throughout the entire or each layer of intestinal wall with marked submucosal edema. The etiology of this disease is not clear until now, and parasite infestation should be considered as a cause of eosinophilic enteritis like this case. We experienced a case of eosinophilic enteritis manifested by intermittent periumbilical pain and bloody ascites. After partial resection of ileum, we confirmed the eosinophilic abscess from Anisakis infestation and successfully treated this patient without sequalae and report it with literatures review.
Abscess* ; Anisakiasis* ; Anisakis ; Ascites* ; Edema ; Enteritis ; Eosinophils* ; Humans ; Ileum* ; Parasites