Objective To observe the histopathological and ultrastructural changes,alterations in the expressions of type Ⅳ collagenases(MMP-2 and MMP-9),the tissue inhibitors(TIMP-1 and TIMP-2)and intercellular adhesion molecule-1(ICAM-1)in the internal carotid arteries(ICAs)of patients with moyamoya disease(MD),and explore the pathogenesis of MD.Methods The bilateral ICAs were obtained during autopsy from two MD patients.HE staining and Weigert staining was used for histological observation,and transmission electron microscopy Was employed to observe the ultrastructure of the ICAS.The expression of ICAM-1 in the ICAs was detected using immunohistochemical staining,and the mRNA expressions of MMLP-2,MMP-9,TMP-1 and TIMP-2 were assayed using in situ hybridization.The ICA specimens from two patients died from non-vascular diseases were used as the control.Restilts HE staining revealed thinning of the ICAs of the MD patients with luminal stenosis,obstruction and calcification.Weigert staining identified fibrous thickening of the intima,thinning and fragmentation of the elastica interna(EI)and elastica externa(EE),degenerafion of the smooth muscle cells in the media,and thinning and local exfoliation of the adventitia.Immunohistochemistry showed ICAM-1 expression in the ICAs of both MD and control patients,but the MD patients exhibited a stronger ICAM-1 positivity in the ICAs localized primarily in the tunica intima.The ICA wall was positive for MMP-9 mRNA expression,which Was especially intense in the elastica intema,as shown by in situ hybfidization.Conslusions The high expression of MMP-9 and ICAM-1,destruction of the elastic layer and adventitia,and collapse of the vascular wall result in luminal stenosis or everi obstruction of the ICAs,which can be associated with the occuITence of MD.

Ischemic colitis is a frequent disorder of large bowel in elderly persons or in debilitated patients with a variable underlying medical problems. Ischemic colitis may result from alterations in the systemic circulation or anatomic or functional changes in the local mesenteric vasculature. In most cases, no specific cause for the ischemic colitis is identified. Cases of ischemic colitis after enema for bowel cleansing have been rarely reported, but there has been no case report after normal saline enema. We report a case of ischemic colitis in a 72-year old patient with well-controlled hypertension, presenting as bloody diarrhea which developed after normal saline enema for preoperative bowel cleansing.
Aged ; Colitis, Ischemic/*diagnosis ; Diarrhea/*diagnosis ; *Enema ; Hemorrhage/diagnosis ; Humans ; Male ; Sigmoidoscopy ; Sodium Chloride/*administration & dosage ; Tomography, X-Ray Computed

Medullary thyroid carcinoma (MTC) is a relatively rare malignant thyroid disease that accounts for approximately 1% to 5% of all thyroid carcinomas. MTC occurs as a sporadic disease and as an inherited disease with the multiple endocrine neoplasia type 2A (MEN2A), MEN2B, and familial non-MEN medullary carcinoma (FMTC). MEN2A is characterized by MTC, pheochromocytoma, and parathyroid adenoma. The mutation of RET proto-oncogene plays an important role in MEN2A syndromes. Recently the authors diagnosed MEN2A patient and screened his family with thyroid ultrasonogram and RET proto-oncogene analysis. A genetic analysis of the peripheral leukocyte showed a codon 618 mutation (Cys618Arg) at exon 10 of the RET proto-oncogene in a family presenting third generations from age 7 to age 56 years. We report this case of MEN2A with a review of the related literatures.
Carcinoma, Medullary ; Codon ; Exons ; Family Characteristics ; Humans ; Leukocytes ; Multiple Endocrine Neoplasia Type 2a* ; Multiple Endocrine Neoplasia Type 2b ; Multiple Endocrine Neoplasia* ; Parathyroid Neoplasms ; Pheochromocytoma ; Proto-Oncogenes* ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography

Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5 x 1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa.
Adult ; Duodenum ; Gastric Mucosa* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intestinal Obstruction ; Metaplasia ; Polyps

The gastric carcinoma displays various macroscopic appearances ranging from well defined protuberant to diffuse infiltrating tumors but its histological diagnosis is usually simple when performing an endoscopic biopsy. A few gastric cancinomas resemble submucosal tumors (SMT). A gastric carcinoma with a SMT-like appearance is extremely rare, and reportedly accounts for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A histological diagnosis of a SMT-like gastric carcinoma by repeated endoscopic biopsies is often difficult as the tumors are almost entirely covered with normal mucosa. When one sees the lesions in an upper gastrointestinal endoscopy, one should be careful about the location of depression, redness and coating that deviates from the top of the tumor. Here we report two cases of SMT-like gastric carcinomas, diagnosed by the usual endoscopic biopsy method and treated with surgery, with an accompanying review of the recent literature.
Adenocarcinoma* ; Biopsy ; Depression ; Diagnosis ; Endoscopy, Gastrointestinal ; Japan ; Mucous Membrane

OBJECTIVES: While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. METHODS: Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. RESULTS: Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. CONCLUSIONS: Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.
Adult ; Educational Status ; Female ; Health Care Surveys ; Healthcare Disparities ; Humans ; Korea ; Mass Screening/*utilization ; Middle Aged ; Odds Ratio ; Patient Acceptance of Health Care/*statistics & numerical data ; *Social Class ; Uterine Cervical Neoplasms/*diagnosis ; Women's Health

BACKGROUND/AIMS: Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whether exercise programs decrease the fear of future falls in elderly patients who have fallen previously. METHODS: A randomized controlled study was performed that included 65 elderly community-dwelling subjects who had fallen in the previous year. Subjects were randomized into two groups: an exercise group (EG, n = 36) and a control group (CG, n = 29). The EG participated in three exercise sessions per week for 12 weeks. Muscle strength, balance, agility, flexibility, and muscular endurance were measured at baseline and after 12 weeks. RESULTS: After the 12-week exercise program, the subjects in the EG demonstrated remarkable improvement in their walking speed, balance (p = 0.003), back strength (p = 0.08), lower extremity strength (p = 0.004), and flexibility (p < 0.001). When asked whether they were afraid of falling, more participants in the EG than in the CG responded "not at all" or "a little." CONCLUSIONS: The 12-week exercise program described here reduced the fear of falling (p = 0.02). It also improved the balance, flexibility, and muscle strength of the participants and was associated with improved quality of life.
Accidental Falls/*prevention & control ; Aged ; Exercise Therapy/*methods ; Fear ; Female ; Humans ; Male ; Middle Aged ; Muscle Strength ; Postural Balance ; Republic of Korea

A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping.
Diverticulum* ; Duodenum ; Endoscopes ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Jaundice ; Pancreatitis