Tracheoesophageal fistula is a rare disease of abnormal communication between esopha- gus and respiratory system. The common causes are the acquired origins in adult such as trauma, infection of the adjacent organs, malignant tumor, and foreign body. Among the traumatic origins, chemical drug, the procedure of the dilatation on the stenotic area, blunt trauma(fall, collisions), penetrating trauma(bullet, knife), and pressure injury are much more common than others. Recently, trauma and foreign body in the esophagus and bronchus are becoming the main cause of the tracheoesophageal fistula, however the frequency of the development of tracheoesophageal fistula caused by the infectious diseases is getting decreased. Fibrinogen-thrombin glue stimulates the healing process of the wound and the ulcer. We treated a 52-year-old male patient with nan-inalignant tracheoesophageal fistula, who had symtoms of pharyngolaryngeal and chest discomfort concomitant with a paroxysmal cough on swallowing food which were caused by fish bone. The diagnosis of tracheoesophageal fistula was made by the esophagogram, chest CT, and esop aecopy. By using the therapeutic endoscopy with an injection of the fibrinogen-glue, the tracheoesopeal fistula was obliterated completely with dramatic symptomatic improvement. Here we conqluded that this method would be the one of the best methods for the treatment of tracheoesophageal fistula.
Adhesives* ; Adult ; Bronchi ; Communicable Diseases ; Cough ; Deglutition ; Diagnosis ; Dilatation ; Endoscopy ; Esophagus* ; Fibrinogen* ; Fistula ; Foreign Bodies ; Humans ; Intestines* ; Male ; Middle Aged ; Rare Diseases ; Respiratory System ; Stomach* ; Thorax ; Thrombin* ; Tomography, X-Ray Computed ; Tracheoesophageal Fistula* ; Ulcer ; Wounds and Injuries

BACKGROUND AND OBJECTIVE: Eosinophil is a major inflammatory cell in allergic diseases and parasitic infestations. Various cytokines such as GM-CSF, IL-3 and IL-5 are known to activate eosinophils and prolong their survival. Among them, IL-5 is the most potent stimulator of eosinophil survival. Recently, it was reported that increased expression of Bcl-2 is related to prolonged survival of IL-5 stimulated eosinophil. Theophylline is a useful drug in bronchial asthma, due not only to bronchial dilation but also to its anti-inflammatory effects. It has been suggested that anti inflammatory action of theophylline derives from the reduction of inflammatory cells in the airways which is mechated by stimulat on of apoptosis of inflammatory cells. In this study, we investigated, by measuring Bcl-2 expression of IL-5 stimulated eosinophil, the effect of theophylline on apoptosis as one of the anti-inflammatory action. MATERIAL AND METHOD: Peripheral eosinophils were isolated from atopic patients by using Perco- 11 discontinuous gradient and purified by negative selection technique using MACS. Eosinophil viability and apoptosis were measured by FACscan. Expression of Bcl-2 protein in eosinophils was detected by Western blot and ELISA. RESULTS: IL-5 increased the percentage of viable eosinophils and reduced the apoptosis of eosinophils in a dose dependent manner. The increased survival of IL-5 stimulated eosinophils was reduced by theophylline via activation of apoptosis. Bcl-2 was increased when eosinophils were cultured with IL-5 only, but when theophylline was cocultured, reduced Bcl-2 was seen with Western blot and ELISA. CONCLUSION: IL-5 increases the survival of eosinophil through the enhanced expression of Bcl- 2. Theophylline has counter action against IL-5 via inhibition of Bcl-2 induced by IL-5. Inhibiting the prolongation of eosinophil survival caused by IL-5 might be one possible mechanism of antiinflammatory effects of theophylline.
Apoptosis ; Asthma ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Eosinophils* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-3 ; Interleukin-5 ; Theophylline*

Biofilms are commonly associated with an increased risk of catheter-associated infection. To study the efficacy of materials designed to reduce biofilm formation, microbial biofilms on clinically used urinary catheter were examined. We performed 2, 3-bis (2-methyoxy-4-nitro-5-sulfo-phenyl)-2H-tetrazolium-5-carboxanilide (XTT) reduction assay to determine of biofilm formation ability and observed with scanning electron microscopy (SEM) to analyze biofilm architecture. Additionally, we calculated relative cell surface hydrophobicity (CSH) to measure hydrophobicity of microorganisms. On SEM, catheter surfaces made of latex or anti-infective (IC)-latex were rough but those of silicone, hydrogel-coated silicone (HCS), or silver-alloy-coated silicone (SCS) were relatively smoother. According to XTT reduction assay, biofilm formation was reduced on the surface of smooth silicone-based catheters compared to rough latex-based catheters. The greatest to lowest formation of microbial biofilm were as follows for these material types: silicone-elastomer-coated (SEC) latex > latex > silicone > IC-latex > HCS > SCS. Catheter materials can affect the microbial biofilm formations. First, rougher surfaces on the catheter made the microbial attachment easier and a greater amount of biofilm was formed. Second, when chemicals that inhibit growth and attachment of microorganisms on the inner and outer surfaces of the catheters were applied, the biofilm formation was inhibited. SCS was found to be the most effective in reducing the microbial biofilm formation. These results indicate that microbial biofilm formation may be closely related to the surface roughness and microbial CSH.
Biofilms* ; Catheter-Related Infections ; Catheters ; Hydrophobic and Hydrophilic Interactions ; Latex ; Microscopy, Electron, Scanning ; Silicon ; Silicones ; Urinary Catheters*

Epiploic appendagitis is a relatively rare cause of acute abdominal pain. Usually, epiploic appendagitis is a benign and self-limited condition, but it can be clinically misdiagnosed as acute appendicitis or diverticulitis, so an inaccurate diagnosis may lead to unnecessary treatment. We recently managed 7 cases of epiploic appendagitis during 1 year and review these cases with an emphasis on the clinical diagnostic features. The main pathophysiologic mechanism underlying epiploic appendagitis is thought to be triggered by appendageal torsion and caused by a subsequent blood flow disturbance. This medical condition must be kept in mind when a patient with acute abdominal pain has well-localized pain which is characteristically sharp in nature and a mild systemic inflammatory response compared to the severity of the pain.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Diagnosis, Differential ; Diverticulitis ; Humans

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.
Adenoma, Villous/*diagnosis/pathology/radiography ; Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*radiography/secretion/surgery ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND: Although proton pump inhibitors (PPIs) combined with antibiotics have been known to increase the antimicrobial activity, the effect of PPIs on the eradication of Helicobacter pylori (H. pylori) is controversial. The aims of the present study were to evaluate the effect of omeprazole on the amoxicillin activity for the eradication of H. pylori using prospective double-blind clinical trial and to assess the inhibitory activity of amoxicillin on the H. pylori according to the pH in vitro. METHODS: Thirty healthy volunteers with endoscopically proven H. pylori infection were randomized to either OA group (n=14); 2 weeks omeprazole (20 mg, b.i.d.) plus amoxicillin (750 mg, b.i.d.) or PA group (n=16); 2 weeks placebo plus the same antibiotic. The H. pylori status was assessed at baseline and at 6-week after the initiation of treatment, and the eradication rate of H. pylori was compared between two groups. Intragastirc pH and serum gastrin level were measured before and 1-week after the treatment also. In vitro, minimal inhibitory concentrations (MICs) of amoxicillin were assessed at the different pHs of media. RESULTS: Intragastric pH significantly increased in OA group (p=0.02), however, did not change in PA group. The changes of intragastric pH parameters after 1-week treatment were significantly different between two groups (p<0.01). The eradication rates of H. pylori were 28.6% in OA group and 18.7% in PA group, and did not show a significant difference between two groups. In OA group, three intragastric pH parameters tended to be higher in the H. pylori eradication group than the non-eradication group, but the difference did not reach statistical significance. MIC of amoxicillin decreased with pH increment in vitro (r=-0.98, p=0.01). CONCLUSION: Intragastric pH increment using omeprazole might increase the antibacterial activity of amoxicillin, however, did not affect the apparent improvement (>50%) in the eradication rate of H. pylori.
Amoxicillin ; Anti-Bacterial Agents ; Gastric Acid ; Gastrins ; Healthy Volunteers ; Helicobacter pylori* ; Helicobacter* ; Hydrogen-Ion Concentration* ; Omeprazole* ; Prospective Studies ; Proton Pump Inhibitors

BACKGROUND: Eosinophilic inflammation of the airway is usually associated with airway hyper-responsiveness in bronchial asthma. However, there is a small group of patients which has the eosinophilic inflammation in the bronchial tree with normal spirometry and no evidence of airway hyper-responsiveness, which was named eosinophilic bronchitis. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features and course of eosinophilic bronchitis. METHODS: We evaluated 92 patients who had persistent cough for 3 weeks or longer. In addition to routine diagnostic protocol, we performed differential cell count of sputum. Eosinophilic bronchitis was diagnosed when the patient had normal spirometric values, normal peak expiratory flow variability, no airway hyper-responsiveness and sputum eosinophilia (>3%). RESULTS: The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, chronic bronchitis in 15% and eosinophilic bronchitis in 12% of the study subjects. Initial eosinophil percentage in the sputum of patients with eosinophilic bronchitis was 26.8+/-6.1% (3.8-63.7%). Treatment with inhaled steroid is related with a subjective improvement of cough severity and a significant decrease of sputum eosinophil percentage (from 29.1+/-8.3% to 7.4+/-3.3%). During the follow-up period, increase in sputum eosinophil percentage with aggravation of symptoms were found. CONCLUSION: Eosinophilic bronchitis is one of the important cause of chronics cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Cough in eosinophilic bronchitis is effectively controlled by inhaled corticosteroid, but may follow a chronic course.
Adult ; Aged ; Anti-Inflammatory Agents, Steroidal/therapeutic use ; Asthma/complications/epidemiology ; Bronchitis/*complications/diagnosis/drug therapy/epidemiology ; Budesonide/therapeutic use ; Chronic Disease ; Cough/epidemiology/*etiology ; Eosinophilia/*complications/diagnosis/drug therapy/epidemiology ; Female ; Gastroesophageal Reflux/complications/epidemiology ; Human ; Male ; Middle Age ; Respiratory Function Tests ; Severity of Illness Index ; Sputum/chemistry/immunology

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversibility of airway obstruction. However, many asthmatics have evidence of residual airway obstruction. It has become evident that the repair of the chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for the change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characteristics in asthmatics with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups : Asthmatics with emphysema and the ones without emphysema. REWSULTS: Of the 58 patients, 7 were revealed to have emphysema. (1) 6 asthmatics with emphysema were smokers, but one patient was a nonsmoker. (2) Highly significant differences between asthmatics with and without emphysema were found in cigarette smoking (p< 0.01) and smoking consumption (p< 0.01). (3) There were no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There were no significant differences in FEV1(%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%) and DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickeness (p< 0.05) and in total Ig E levels (p=0.07). CONCLUSION: These results indicate that smoking is a main factor in causing emphysema in asthmatics.
Adolescent ; Adult ; Aged ; Asthma/*complications/physiopathology/radiography ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Pulmonary Emphysema/*etiology/physiopathology/radiography ; Respiratory Function Tests/statistics & numerical data ; Smoking/adverse effects ; Tomography, X-Ray Computed/methods

BACKGROUND: Wheezes are the oscillation of airway walls that occures when there is airflow limitation, as may be produced by bronchospasm, airway edema or collapse or intraluminal obstruction by neplasm or secretions. Wheezes can be observed in about 34% of bronchiectasis, that defined as abnormal and permanent dilatation of bronchi. Bronchiectasis is associated with bronchial asthma in 2.7-42%. We studed the clinical significance of wheeze observed in bronchiectasis and interrelationships between the bronchiectasis with wheeze and bronchial asthma. METHODS: We reviewed the 32 patients with bronchiectasis confirmed by HRCT. Exclusion criteria are acute exacerbation of bronchiectasis, neoplasm, bronchial asthma. The controlled group is 29 bronchial asthma patients and their diagnositc criteria is when the %change of FEV1 after inhaled bronchodilators is 12% or more and absolute change value is >or =200 mL. All patients were performed spirometry, bronchodilator test, bronchial hyperresponsiveness to methacholine, skin prick test and sputum analysis for cell counts. RESULTS: The Wheeze observed in 43.7% of bronchiectasis patients. Wheeze group revealed the more obstructive pattern in spirometry than non-wheeze group (FEV1% 71.0+/-8.2% vs 91.7+/-5.5%, p=0.04; FEV1/FVC 61.1+/-4.4% vs 78.2+/-3.7%, p=0.009), more bronchodilator responses (8.4+/-2.1% vs 4.9+/-1.7%, p=0.045) and more bonchial hyperresponsiveness (positive results in PC20 : 2 in 6 patients vs no positive in 3 patients). Asthma control group has no significant differences with wheeze group. But compared with non-wheeze group, it has significantly decreased lung function (FEV1/FVC 65.5+/-2.9% vs 78.2+/-3.7, p=0.004), more bronchodilator responses (14.8+/-0.6% vs 4.9+/-1.7%, p=0.001) and more eosinophilic airway inflammations (sputum eosinphile% 11.4+/-2.0 vs 0.8+/-0.4, p=0.05). CONCLUSIONS: The wheezes observed in bronchiectasis are associated with bronchial hyperres ponsiveness and eosinophilic airway inflammations.
Asthma* ; Bronchi ; Bronchial Neoplasms ; Bronchial Spasm ; Bronchiectasis* ; Bronchodilator Agents ; Cell Count ; Dilatation ; Edema ; Eosinophils ; Humans ; Inflammation ; Lung ; Methacholine Chloride ; Respiratory Sounds ; Skin ; Spirometry ; Sputum

PURPOSE: We analyzed the correlation between the year-end student academic scores (grade score), the trial examination scores, and the Korean Medical Licensing Examination (KMLE) score by correlation analysis and multiple regression method. METHODS: Our subjects included 217 graduates between the years 2002 and 2003. Yearly, trial examinations, composed according to the principles of KMLE setting, are performed four times. For correlation and regression analysis, all scores were transformed to the standard score according to the standard score norm. RESULTS: In the regression analysis among each grade scores, the lower grade score always affected the higher grade score. Also all academic grade scores correlated significantly with the trial examination scores and KMLE score in bivariate correlation analysis (P< 0.05). But only grade score during the senior years (5th and 6th) affected the trial examination and KMLE score in multiple regression. According to the multiple regressions by each grade score and trial examination score, the 6th grade score and trial exanimation score except the 1st trial examination score have a significant effect on the KMLE score. And we can also establish the regression formula such as [KMLE score]=11.377+0.752*[mean of trail examination] with significant high power of explanation (R (2) =0.709, P< 0.001). CONCLUSION: Our results show that previous scores always affect the latter scores; and the last score in time sequence is a result of the accumulation of previous education and learning. From this point of view, the trial examination is a useful tool for not only the final assessment of medical achievements but also for preparing for the KMLE.
Education ; Humans ; Learning ; Licensure*