So-called, the double channel pylorus has been, relatively rarely, reported through out the world. All reported cases were almostly those of gastroduodenal fistula as a complication of peptic ulcer disease. The congenital forms of double pylorus were reported even more rarely. We found three cases of double channel pylorus in 25,000 cases endoscopy done at our unit. All those three cases were thought to be acqired form endoscopically, radiographically and histologically. One of those was undergone to operative resection because of uncontrollable bleeding and the others were on medical theraphy with satisfaction.
Endoscopy ; Fistula ; Hemorrhage ; Peptic Ulcer ; Pylorus*

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival.
Aged ; Female ; Humans ; Intestinal Obstruction/etiology/radiography/*surgery ; Neoplasm Recurrence, Local ; Prosthesis Implantation/*methods ; *Stents ; Stomach Neoplasms

The majority of patients with medulloblastoma present with hydrocephalus. It has been reported, however, that not all medulloblastoma patients will continue to have hydrocephalus after the tumor is resected, and in fact, only selected patients need permanent shunts. To retrospectively identify the prognostic factors indicating this requirement, we analysed several charateristics in patients without preoperative shunts suffering from medulloblastoma combined with hydrocephalus. We studied 32 patients and divided them into two groups: those requiring shunts within 4 weeks of surgery, and those not shunted. Nine patients(28%) required a permanent shunt. We found that these patients were younger(4.8+/-4.3 vs. 9.6+/-7.4 years; p<0.05), had more extensive tumors (Chang's stage T2 vs. T3; p<0.050), and that postoperatively, some tumor remained(p<0.05). However, with regard to gender, symptoms of increasedintracranial pressure(ICP), the duration of these symptoms, positive cerebrospinal fluid(CSF) cytology, perioperative external ventricular drainage, and degree of preoperative hydrocephalus, there were no differences between the groups. It was thus concluded that younger patients with extensive preoperative tumors and tumors remaining after surgery may benefit from postoperative CSF diversion. It was thought that patients not fitting the above criteria can probably be managed with perioperative corticosteroids alone.
Adrenal Cortex Hormones ; Drainage ; Humans ; Hydrocephalus* ; Medulloblastoma* ; Retrospective Studies

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.
Absorptiometry, Photon ; Ambulatory Care Facilities ; Body Weight ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Fractures, Compression* ; Hip ; Humans ; Intervertebral Disc Degeneration ; Osteoarthritis, Spine* ; Osteoporosis ; Osteoporotic Fractures ; Postmenopause ; Rheumatic Diseases ; Risk Factors ; Spine ; Zygapophyseal Joint

PURPOSE: An increase of glucose uptake and glycolytic metabolism has been reported in malignant cells as compared with normal cells and tissues. We hypothesized that human erythrocyte glucose transporter-1 (GLUT1) expression is increased in breast carcinoma and may be correlated with long term clinical outcome. METHODS: Two hundred ninety formalin fixed, paraffin embedded sections of infiltrating ductal carcinomas of the breast were immunostained with anti-GLUT1. RESULTS: Among the known clinicopathological prognostic factors, GLUT1 expression was correlated positively with histological grade (p=0.000) and tumor size (p=0.003). In a multivariate analysis, lymph node involvement and GLUT1 expression were statistically significant prognostic factors. The cummulative survival rates of GLUT1 expression and LN involvement were statistically significant (p=0.0061, p=0.0009) respectively. Our results suggest that 1) GLUT1 expression is correlated with histological grade and tumor size, and 2) GLUT1 expression correlates with a poorer prognosis in patients with infiltrating ductal carcinoma of the breast. CONCLUSION: The results of our study suggest that immunohistochemical staining of GLUT1 expression is strongly associated with neoplastic progression in breast carcinoma, and that GLUT1 expression has value in estimating the prognosis of patients with breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Erythrocytes ; Formaldehyde ; Glucose ; Humans* ; Lymph Nodes ; Metabolism ; Multivariate Analysis ; Paraffin ; Prognosis* ; Survival Rate

PURPOSE: An increase of glucose uptake and glycolytic metabolism has been reported in malignant cells as compared with normal cells and tissues. We hypothesized that human erythrocyte glucose transporter-1 (GLUT1) expression is increased in breast carcinoma and may be correlated with long term clinical outcome. METHODS: Two hundred ninety formalin fixed, paraffin embedded sections of infiltrating ductal carcinomas of the breast were immunostained with anti-GLUT1. RESULTS: Among the known clinicopathological prognostic factors, GLUT1 expression was correlated positively with histological grade (p=0.000) and tumor size (p=0.003). In a multivariate analysis, lymph node involvement and GLUT1 expression were statistically significant prognostic factors. The cummulative survival rates of GLUT1 expression and LN involvement were statistically significant (p=0.0061, p=0.0009) respectively. Our results suggest that 1) GLUT1 expression is correlated with histological grade and tumor size, and 2) GLUT1 expression correlates with a poorer prognosis in patients with infiltrating ductal carcinoma of the breast. CONCLUSION: The results of our study suggest that immunohistochemical staining of GLUT1 expression is strongly associated with neoplastic progression in breast carcinoma, and that GLUT1 expression has value in estimating the prognosis of patients with breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Erythrocytes ; Formaldehyde ; Glucose ; Humans* ; Lymph Nodes ; Metabolism ; Multivariate Analysis ; Paraffin ; Prognosis* ; Survival Rate

We present two cases with dissecting aneurysm of intracranial vertebral artery. One of them had brain stem infarction and the other one developed subarachnoid hemorrhage. Cerebral angiogram revealed fusiform dilatation with proximal and distal narrowing of the affected vessel. Magnetic resonance imaging showed subacute blood clot inthe right vertebral artery which suggested dissection. Differentiation from vasospasm and from atherosclerosis is critical. At surgical exposure, the aneurysms were appeared as dark-purplish sausage like masses. The proximal portions of the intracranial vertebral arteries were clipped. The post-operative courses were benign and at present they regained their normal daily lives.
Aneurysm ; Aneurysm, Dissecting* ; Atherosclerosis ; Brain Stem Infarctions ; Dilatation ; Magnetic Resonance Imaging ; Subarachnoid Hemorrhage ; Vertebral Artery*

OBJECTIVES: The aim of this cross-sectional study was to compare the subjective quality of life in the four groups of antipsychotics according to the risk of weight gain in patients with schizophrenia. METHODS: One hundred and thirty-two patients with schizophrenia that had taken the same antipsychotics for more than 1 year were enrolled in the analyses. Anti-psychotic agents were classified by the risk of weight gain into four groups : serious, common, not unusual, and unusual. The quality of life was measured with the Schizophrenia Quality of Life Scale Korean version, 4th Revision (SQLS-R4K). We analyzed the correlation between the total score of SQLS-R4K and clinical variables. RESULTS: The SQLS-R4K score was significantly different in the four anti-psychotic groups (F=5.200, p=0.002). Gender, type of anti-psychotics (typical, atypical), duration of treatment with current antipsychotics, duration of illness, and Body Mass Index were not significantly correlated with the SQLS-R4K score. CONCLUSION: The subjective quality of life was different according to the risk of weight gain groups of anti-psychotic agents.
Antipsychotic Agents ; Body Mass Index ; Cross-Sectional Studies ; Humans ; Quality of Life ; Schizophrenia ; Weight Gain

BACKGROUND: Intrathecal injection of analgesic agents such as opioids, clonidine, ketamine and nalbuphine with a local anesthetic produces analgesia in patients. Recently, the analgesic effect of intrathecal neostigmine has been investigated; however, the use of epidural neostigmine has not been investigated. The purpose of this study was to define the analgesic effectiveness and the side effects of epidural neostigmine. METHODS: Forty patients undergoing a total abdominal hysterectomy were divided into 4 groups. After intramuscular 0.1 mg/kg midazolam premedication, patients were randomized to receive epidural bupivacaine with saline (control group), 1 microgram/kg epidural neostigmine (Group I), 2 microgram/kg epidural neostigmine (Group II), or 3 microgram/kg epidural neostigmine (Group III) postoperatively. The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Pain was assessed by using the visual analog scale at 1, 3, 6, 9, 12, and 24 h postoperatively, and intramuscular 90 mg diclofenac was available at the patient's request. RESULTS: The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among neostigmine groups. The analgesic consumption in 24 hours and the pain visual analog scale score at 3 h, 12 h, and 24 h were significantly decreased in neostigmine groups compared with control groups. CONCLUSIONS: Epidural neostigmine coadministered with bupivacaine produces a dose-independent analgesic effect compared to the control group and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, General* ; Bupivacaine* ; Clonidine ; Diclofenac ; Humans ; Hysterectomy ; Incidence ; Injections, Spinal ; Ketamine ; Midazolam ; Nalbuphine ; Neostigmine* ; Premedication ; Visual Analog Scale

OBJECTIVES: Many antipsychotics are associated with hyperprolactinemia and sexual dysfunction. This study investigated the prevalence of hyperprolactinemia and amenorrhea and explored the association between hyperprolactinemia and sexual dysfunction. METHODS: We analyzed 285 patients with schizophrenia or schizoaffective disorder who had been taking antipsychotics more than one year, examining their serum prolactin levels and administering the Arizona Sexual Experience Scale (ASEX) to evaluate for sexual dysfunction. We conducted an ANCOVA to evaluate the effect of hyperprolactinemia on ASEX score and amenorrhea. RESULTS: We found hyperprolactinemia in 52.3% of the patients, finding it to be more common in females (60.8%) than in males (49%). Patients taking risperidone had the highest prevalence of hyperprolactinemia (86.5%), and patients taking aripiprazole showed no hyperprolactinemia. Amenorrhea prevalence was 21.5%. Hyperprolactinemia did not significantly affect ASEX scores, but it significantly affected amenorrhea. CONCLUSION: Many patients taking antipsychotics still experience hyperprolactinemia in a real clinical setting. The prevalence of hyperprolactinemia varies among antipsychotics. Clinicians should consider the possibility of antipsychotic-induced hyperprolactinemia, with its potential adverse effects, when treating such patients.
Amenorrhea ; Antipsychotic Agents ; Arizona ; Female ; Humans ; Hyperprolactinemia ; Male ; Piperazines ; Prevalence ; Prolactin ; Psychotic Disorders ; Quinolones ; Risperidone ; Schizophrenia ; Aripiprazole