Intramural dissection of the esophagus is rare esophageal disorder which has been seen predominantly in women in their seventh or eighth decade and presents as acute chest pain, accompanied by dysphagia. The etiology of this disorder remain uncertain and the diagnosis is made by esophageal endoscopy, contrast esophagography, or both. Patient with this disorder is best managed conservatively with nothing by mouth and intravenous hydration.
Chest Pain ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Esophageal Diseases ; Esophagus ; Female ; Humans ; Middle Aged* ; Mouth

BACKGROUND: Color Doppler echocardiography is sensitive in detecting mitral regurgitation and useful in quantitating its severity. The presence of an eccentric regurgitant jet suggests that regurgitation is caused by prolapsing or flail leaflet of mitral valve. Until recently the direction of regurgitant jet in mitral valve prolapse has been examined in a single(parasternal short axis view) or orthogonal plane using color Doppler echocardiography, and few in the apical rotation method of a transducer. The purpose of this study was to clarify the usefullness of the apical rotation method of a transducer in detection of the direction of mitral regurgitant jet and diagnosis of the sites of mitral valve prolapse. METHODS: Twenty four patients(8 men and 16 women, mean age:47.3+/-18.8 years) with mitral valve prolapse with eccentric regurgitant jet were examined by two-dimensional and color Doppler echocardiograply using conventional parasternal long and short axis views, and four apical longitudinal planes(four chamber, vertical, two chamber and transverse views) obtained by the apical retation method of a transducer. RESULTS: Thirty one regurgitant jets were detected in twenty four patients, eighteen patients had anterior, nine patints posterior, and three patients bi-leaflet(anterior and posterior) prolapse. In eighteen patients with anterior leaflet prolapse, ten had medial, eight had middle, three had lateral, and three had two portions(two, medial and middle; one, middle and lateral) prolapse. In nine patients with posterior leaflet prolapse, five had medial, three had middle, two had lateral, and one had two(medial and middle) scallop prolapse. CONCLUSION: Color Doppler echocardiography by the apical rotation method of transducer is useful in assessment of the site of prolapse in patients with mitral valve prolapse with eccentric regurgitation.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Echocardiography, Doppler, Color ; Female ; Humans ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prolapse* ; Transducers*

Myxomas are benign mesenchymal neoplasms composed of undifferentiated stellate cells in the myxoid stroma and can affect the heart, subcutaneous tissues, bone and skin. Myxomas arising from muscle tissue are called intramuscular myxomas, and account for 17% of all myxomas. Intramuscular myxomas are most commonly located in the large muscles of the thigh, shoulder, and buttocks.However, intramuscular myxomas of the head and neck region are rarely reported. In this study, we report a case of intramuscular myxoma arising from the paraspinal space of the head and neck region.
Head ; Head and Neck Neoplasms ; Heart ; Muscle Neoplasms ; Muscles ; Myxoma ; Neck ; Shoulder ; Skin ; Subcutaneous Tissue ; Thigh

Axin is a negative regulator of the Wnt/beta-catenin pathway and is involved in the regulation of axis formation and proliferation. Involvement of Axin in the regulation of other signaling pathways is poorly understood. In this study, we investigated the involvement of Akt in growth regulation by Axin in L929 fibroblasts stimulated by EGF. Akt activity was increased by EGF treatment and Ras activation, respectively. Both the EGF- and Ras-induced Akt activations were abolished by Axin induction, as revealed by both Western blot and immunocytochemical analyses. The proliferation and Akt activation induced by EGF were decreased by Axin induction, and the effects of EGF were abolished by treatment of an Akt-specific inhibitor. Therefore, Axin inhibits EGF-induced proliferation of L929 fibroblasts by blocking Akt activation.
Animals ; Cell Line ; Cell Nucleus/metabolism ; Cell Proliferation ; Epidermal Growth Factor/*pharmacology ; Fibroblasts/drug effects/physiology ; Mice ; Proto-Oncogene Proteins c-akt/antagonists & inhibitors/*metabolism ; Repressor Proteins/genetics/*physiology ; Signal Transduction ; ras Proteins/biosynthesis/genetics

No abstract available.
Lymphoma*

BACKGROUND/AIMS: Endoscopic ultrasound elastography (EUS-EG) has been widely used for the evaluation of pancreatic cancer in the Western world. To date, there is very little experience with EUS-EG in Korea. We described the results of comparison between normal pancreas and pancreatic cancer in Korea. METHODS: The present study was performed at a tertiary hospital on 35 subjects comprising 20 with normal pancreas (control group) and 15 with pancreatic cancer (disease group). We compared the EUS-EG performance of the two groups. RESULTS: The pancreas in the control group showed a mean elasticity value of 0.53% (95% confidence interval [CI], 0.45 to 0.61). The elasticity value was higher than that previously reported from Western country (0.47%; 95% CI, 0.38 to 0.57). In the disease group, the mean elasticity value of pancreatic lesions was 0.02% (95% CI, 0.01 to 0.02). The mean elasticity value of the disease group was significantly lower than that of the control group (p<0.0001). CONCLUSIONS: EUS-EG could be a highly sensitive diagnostic modality for pancreatic cancer in Korea with little EUS-EG experience. We also provided the reference range of elasticity value of normal pancreas, which might be valuable in the interpretation of pancreatic elasticity data for Korean adults.
Adult ; Elasticity ; Elasticity Imaging Techniques ; Endosonography ; Humans ; Korea ; Pancreas ; Pancreatic Neoplasms ; Reference Values ; Tertiary Care Centers ; Western World

PURPOSE: This is study of whether 3-D conformal radiotherapy for carcinomas of the ethmoid sinus were better than those treated with conventional 2-D plan. MATERIALS AND METHODS: The 3-D conformal treatment plans were compared with conventional 2-D plans in 4 patients with malignancy of the ethmoid sinus. Isodose distribution, dose statistics, and dose volume histogram of the planning target volume were used to evaluate differences between 2-D and 3-D plans. In addition, the risk of radiation exposure of surrounding normal critical organs are evaluated by means of point dose calculation and dose volume histogram. RESULTS : 3-D conformal treatment plans for each patient that the better tumor coverages by the planning target volume with improved dose homogeneity, compared to 2-D conventional treatment plans in the same patient. On the other hand, the radiation dose distributions to the surrounding normal tissue organs, such as the orbit and optic nerves are not significantly reduced with our technique, but a substantial sparing in the brain stem and optic chiasm for each patient. CONCLUSION : Our findings represented the potential advantage of 3-D treatment planning for dose homogeniety as well as sparing of the normal tissue surrounding the tumor. However, further investigational studies are required to define the clinical benefit.
Brain Stem ; Ethmoid Sinus* ; Hand ; Humans ; Optic Chiasm ; Optic Nerve ; Orbit ; Radiotherapy, Conformal*

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

We report two cases of adrenal abscesses that occurred following a Histoacryl(R) (N-butyl-2-cyanocrylate) injection for variceal bleeding. Patients had been diagnosed with alcoholic liver cirrhosis and gastric varices bleeding and received a Histoacryl(R) injection for the variceal bleeding. Patients had fever and abdominal tenderness and were diagnosed with an adrenal abscess at 2 months following the Histoacryl(R) injection. One patient received open drainage and the other underwent percutaneous drainage. When a patient has previously been injected with Histoacryl(R) for the treatment of variceal bleeding and presents with fever, an evaluation for an unusual complication such as adrenal abscess is recommended.
Abscess ; Drainage ; Enbucrilate ; Esophageal and Gastric Varices ; Fever ; Hemorrhage ; Humans ; Liver Cirrhosis, Alcoholic

BACKGROUND: It is well known that body core temperature reduces during general anesthesia. Midazolam premedication for relieving anxiety might also reduce body core temperature by inhibiting tonic thermoregulatory vasoconstriction in elderly patients. Therefore, an effort to maintain temperature must be started before anesthesia. This study was designed to evaluate the effect on body core temperature of midazolam, atropine and glycopyrrolate, which are commonly used for premedication. METHODS: Six hundred and eleven patients of ASA physical status 1 or 2, aged 18 to 65, were involved in this study. They were randomly assigned to premedication with: 1) saline control (n = 92); 2) midazolam 0.04 mg/kg (n = 96); 3) midazolam 0.04 mg/kg with glycopyrrolate 0.004 mg/kg (n = 117); 4) midazolam 0.04 mg/kg with atropine 0.01 mg/kg (n = 93); 5) glycopyrrolate 0.004 mg/kg (n = 116); and 6) atropine 0.01 mg/kg (n = 97). All premedication was given intramuscularly about 30 min before operation. Temperatures were measured at the tympanic membrane at the time of premedication and 30 min after premedication. RESULTS: Temperatures increased slightly after injection in the control (0.14 +/- 0.36oC; mean +/- SD) and this increase was less in the midazolam group (0.07 +/- 0.39oC). The changes of temperature in the midazolam with glycopyrrolate (0.16 +/- 0.39oC), midazolam with atropine (0.19 +/- 0.40oC), and in the glycopyrrolate group were no different from that of the control group. However, there was a statistically significant increase in temperature after injection in the atropine group (0.26 +/- 0.42oC) versus the control group. Compared with the midazolam group, a statistically significant increase in temperature was observed in the midazolam with atropine, the glycopyrrolate, and in the atropine group. CONCLUSIONS: From these results, low dose midazolam (0.04 mg/kg), midazolam with glycopyrrolate, and midazolam with atropine for premedication have little affect on temperature. Midazolam with glycopyrrolate premedication is recommended for preserving body core temperature.
Aged ; Anesthesia ; Anesthesia, General ; Anxiety ; Atropine ; Glycopyrrolate ; Humans ; Midazolam ; Premedication* ; Tympanic Membrane ; Vasoconstriction