No abstract available.

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.
Cervical Vertebrae ; Deglutition Disorders ; Diskectomy ; Emergency Service, Hospital ; Esophageal Perforation ; Esophagus* ; Female ; Fever ; Humans ; Middle Aged ; Neck Pain ; Pneumonia, Aspiration ; Spine*

Usually, the papilla of Vater is located in the midportion or the distal half of the descending duodenum. Isolated cases of common bile duct termination in other sites, including the fourth portion of the duodenum, the pyloric ring, the duodenal bulb and the stomach, have been reported. A case is here in reported involving abdominal pain in the right upper quadrant area, in which an ERCP demonstrated an anomalous termination of the common bile duct and pancreatic duct into the duodenal bulb separately. This anomaly was associated with a bile duct dilatation and single common bile duct (CBD) stone. Trial of CBD stone removal during an ERCP failed. The patient's condition improved after a cholecystectomy and choledochojejunostomy.
Abdominal Pain ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Choledochostomy ; Common Bile Duct* ; Dilatation ; Duodenum ; Pancreatic Ducts* ; Stomach

No abstract available.
Humans ; Infant, Newborn* ; Mass Screening*

Subclinical hypothyroidism (SCH) is a common problem in pediatric population, and the natural history of SCH varies depending on its etiology. Whether Hashimoto’s thyroiditis (HT) negatively affects the natural course of SCH was investigated in pediatric patients without concomitant diseases. Predictors for levothyroxine medication were also evaluated. Medical records of 109 children with SCH (91 girls, 5−18 years) diagnosed between 2005 and 2014 were retrospectively reviewed. Patients were classified into HT (n = 37) and isolated non-autoimmune hyperthyrotropinemia (iso-NAHT, n = 72). During median 2 years of follow-up, only 10.1% of SCH patients eventually initiated levothyroxine, and HT patients showed a higher probability of requiring levothyroxine medication than iso-NAHT patients (21.6% vs. 4.2%). Underlying HT independently predicted deterioration of thyroid function, leading to levothyroxine medication (hazard ratios [HRs], 4.6 vs. iso-NAHT, P = 0.025). High titers of anti-thyroglobulin antibodies (TGAbs) predicted later medication in the HT group (HRs, 28.2 vs. normal TGAbs, P = 0.013). Most pediatric SCH showed benign and self-remitting courses. Underlying HT significantly increases the risk for levothyroxine medication, especially with high titers of TGAbs.
Antibodies ; Child* ; Female ; Follow-Up Studies ; Hashimoto Disease ; Humans ; Hypothyroidism* ; Medical Records ; Natural History ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis* ; Thyroxine

BACKGROUND: Since the introduction of atrial switch operation, the outlook for patients with complete transposition of the great arteries (TGA) has improved dramatically. However, many survivors are afflicted with postoperative complications and continue to demand medical attention. We therefore performed the study for the evaluation of the clinical course in the patients with complete TGA after atrial switch operation. METHODS: We analyzed the data of 51 patients who underwent the atrial switch operation for complete TGA at Seoul National University Hospital between January 1981 and June 1993 retrospectively. RESULTS: The patients were composed of 36 males and 15 females (mean age at operation, 15+/-30 months, range 2 months-18 years). Senning operation was undertaken in 43 and Mustard operation in 8. Among these, 27 had simple and 24 complex complete TGA. The early mortality rate within 1 month postoperatively was 39% and the late mortality rate 16%. The actuarial survival rate after 10 years was 78%. Of these, 17 cases have been followed up so far. Although the significant tricuspid regurgitation was noted in 9, right ventricular systolic function was maintained in all of them. Preoperative sinus node dysfunction was noted in 1 case. Postoperatively, premature ventricular contractions were found in 8 cases, atrial flutter in 4, and sinus node dysfunction in 7. Subclinical pulmonary venous obstruction was found in 2 and systemic venous obstruction in 1. At present, one takes digoxin for prevention of atrial flutter and 7 take digoxin, furosemide, and/or angiotensin-converting enzyme inhibitors for prevention of ventricular functional deterioration. Twelve cases were in New York Heart Association functional class I at the latest follow-up and 5 were in class II. CONCLUSION: This study revealed that morbidity and mortality were not low after atrial switch operation. However, considering the good long-term functional status in the survivors, atrial switch operation could be an alternative to arterial switch operation in complicated cases of TGA.
Angiotensin-Converting Enzyme Inhibitors ; Arteries* ; Atrial Flutter ; Digoxin ; Female ; Follow-Up Studies* ; Furosemide ; Heart ; Humans ; Male ; Mortality ; Mustard Plant ; Postoperative Complications ; Retrospective Studies ; Seoul ; Sick Sinus Syndrome ; Survival Rate ; Survivors ; Tricuspid Valve Insufficiency ; Ventricular Premature Complexes

BACKGROUND: Since the introduction of atrial switch operation, the outlook for patients with complete transposition of the great arteries (TGA) has improved dramatically. However, many survivors are afflicted with postoperative complications and continue to demand medical attention. We therefore performed the study for the evaluation of the clinical course in the patients with complete TGA after atrial switch operation. METHODS: We analyzed the data of 51 patients who underwent the atrial switch operation for complete TGA at Seoul National University Hospital between January 1981 and June 1993 retrospectively. RESULTS: The patients were composed of 36 males and 15 females (mean age at operation, 15+/-30 months, range 2 months-18 years). Senning operation was undertaken in 43 and Mustard operation in 8. Among these, 27 had simple and 24 complex complete TGA. The early mortality rate within 1 month postoperatively was 39% and the late mortality rate 16%. The actuarial survival rate after 10 years was 78%. Of these, 17 cases have been followed up so far. Although the significant tricuspid regurgitation was noted in 9, right ventricular systolic function was maintained in all of them. Preoperative sinus node dysfunction was noted in 1 case. Postoperatively, premature ventricular contractions were found in 8 cases, atrial flutter in 4, and sinus node dysfunction in 7. Subclinical pulmonary venous obstruction was found in 2 and systemic venous obstruction in 1. At present, one takes digoxin for prevention of atrial flutter and 7 take digoxin, furosemide, and/or angiotensin-converting enzyme inhibitors for prevention of ventricular functional deterioration. Twelve cases were in New York Heart Association functional class I at the latest follow-up and 5 were in class II. CONCLUSION: This study revealed that morbidity and mortality were not low after atrial switch operation. However, considering the good long-term functional status in the survivors, atrial switch operation could be an alternative to arterial switch operation in complicated cases of TGA.
Angiotensin-Converting Enzyme Inhibitors ; Arteries* ; Atrial Flutter ; Digoxin ; Female ; Follow-Up Studies* ; Furosemide ; Heart ; Humans ; Male ; Mortality ; Mustard Plant ; Postoperative Complications ; Retrospective Studies ; Seoul ; Sick Sinus Syndrome ; Survival Rate ; Survivors ; Tricuspid Valve Insufficiency ; Ventricular Premature Complexes

BACKGROUND/AIMS: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. METHODS: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean+/-SE%) over the basal period in response to a meal. RESULTS: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal MI during the first 30 min after the meal are significantly increased (p < 0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62+/-18 in A, 29+/-18 in B, 12+/-8 in C and 306+/-102% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p < 0.05). 3) In B and C, the percentage changes in the basal MI during the first 30 min after the meal in the descending colon were 105+/-38, 11+/-7, respectively, which shows a significant difference between the two groups (p < 0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62+/-18, 12+/-8, respectively, which shows a significant change between the two groups (p < 0.05). CONCLUSION: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome.
Catheters ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Humans ; Irritable Bowel Syndrome* ; Meals ; Motor Activity*

Trichostatin A (TSA), originally developed as an antifungal agent, is one of potent histone deacetylase (HDAC) inhibitors, which are known to cause growth arrest and apoptosis induction of transformed cells, including urinary bladder, breast, prostate, ovary, and colon cancers. However, the effect of HDAC inhibitors on human non-small cell lung cancer cells is not clearly known yet. Herein, we demonstrated that treatment of TSA resulted in a significant decrease of the viability of H157 cells in a dose-dependent manner, which was revealed as apoptosis accompanying with nuclear fragmentation and an increase in sub-G0/G1 fraction. In addition, it induced the expression of Fas/FasL, which further triggered the activation of caspase-8. Catalytic activation of caspase-9 and decreased expression of anti-aptototic Bcl-2 and Bcl-XL proteins were observed in TSA-treated cells. Catalytic activation of caspase-3 by TSA was further confirmed by cleavage of pro-caspase-3 and intracellular substrates, including poly (ADP-ribose) polymerase (PARP) and inhibitor of caspase-activated deoxyribonuclease (ICAD). In addition, a characteristic phenomenon of mitochondrial dysfunction, including mitochondrial membrane potential transition and release of mitochondrial cytochrome c into the cytosol was apparent in TSA-treated cells. Taken together, our data indicate that inhibition of HDAC by TSA induces the apoptosis of H157 cells through signaling cascade of Fas/FasL-mediated extrinsic and mitocondria-mediated intrinsic caspases pathway.
Signal Transduction ; Receptors, Death Domain/*metabolism ; Protein Isoforms/metabolism ; Mitochondria/*drug effects/*metabolism ; Lung Neoplasms/*metabolism/*pathology ; Hydroxamic Acids/*pharmacology ; Humans ; Histones/metabolism ; Enzyme Activation ; Cell Line, Tumor ; Catalysis ; Caspase 9/metabolism ; Caspase 8/metabolism ; Caspase 3/metabolism ; Apoptosis/*drug effects ; Acetylation

PURPOSE: This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a national-cancer management system and a comprehensive cancer control policy. MATERIALS AND METHODS: An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. RESULTS: In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was 58.2±11.5 years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. CONCLUSIONS: To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.
Cohort Studies* ; Diet ; Drug Therapy ; Humans ; Korea ; Male ; Occupational Groups ; Prospective Studies* ; Quality of Life ; Stomach Neoplasms*