To maintain an adequate airway in a patient with tracheobronchial narrowing coming from various causes, prosthetic tracheobronchial stents provide palliative treatment for narrowed airways where surgical resection is inadvisable. After insertion, precious reported complications were granuloma formation, dysphagia, suction catheter entrapment and fatal massive hemoptysis. We report a case of complication associated with expandible metallic scent with endobronchial stenosis due to tuberculosis.
Catheters ; Constriction, Pathologic* ; Deglutition Disorders ; Granuloma ; Hemoptysis ; Humans ; Palliative Care ; Stents* ; Suction ; Tuberculosis

No abstract available.
Radiation Oncology*

PURPOSE: A delta-shaped anastomosis (DA) is a widely accepted technique used for a totally laparoscopic distal gastrectomy (TLDG). Several studies have suggested various modifications to overcome the drawbacks of an original DA. We present our novel technique―a T-shaped modified delta anastomosis (TDA), and we report the early outcomes with its use in a case series. METHODS: We retrospectively reviewed the medical records of 40 patients who underwent a TLDG with TDA for early gastric cancer at OOO between February 2016 and May 2017. Perioperative outcomes, postoperative complications, and operating time were analyzed, and all data were expressed as means±standard deviation. RESULTS: We observed no major complications that required immediate postoperative intervention. Other minor and non-surgical complications were delayed gastric emptying (n=1), pneumonia (n=2), atelectasis (n=3), dumping symptom (n=1), and symptomatic bile reflux (n=1). No wound infection was reported in any patient. The total operative time was 206.5±25.4 min and the estimated blood loss was 27.8±33.5 ml. The mean time required to perform the anastomosis was 20.9±6.7 min, and the mean number of cartridges used during the operation was 4.78±0.66. CONCLUSION: We conclude that a TDA following a laparoscopic distal gastrectomy was successfully developed and showed acceptable clinical outcome.
Bile Reflux ; Gastrectomy ; Gastric Emptying ; Humans ; Laparoscopy ; Medical Records ; Operative Time ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Retrospective Studies ; Stomach Neoplasms ; Wound Infection

No abstract available.
Humans

No abstract available.
Eyebrows* ; Tattooing*

BACKGROUND: It has been known that Ginseng extract causes the hypotensive action while it rather produces the hypertensive action. Some studies have suggested that Ginseng extract causes a biphasic response on blood pressure, namely, transient fall followed by prolonged elevation. It has been also shown that administration of Korean Red Ginseng powder has no effect on blood pressure in normotensive and hypertensive rats. The present study was designed to examine the effect of total Ginseng saponin on contractile responses of vasoconstrictors in the rat aorta and to establish the mechanism of its action. METHODS: The ring segment of aorta was mounted in a muscle bath filled with oxygenated Krebs solution for the measurement of isometric tension. After the equilibration period, under the presence of total Ginseng saponin, isometric tension induced by some vasoconstrictors were observed and compared to the control responses. The data were expressed as % of the control tension. RESULTS: Phenylephrine (an adrenergic alpha1-receptor agonist) and high potassium (a membrane depolarizing agent) caused greatly contractile responses in the rat aorta, respectively. However, in the presence of total ginseng saponin (600 g/ml), the contractile responses of phenylephrine (10(-6) and 10(-5) M) and high potassium (3.5 x 10(-2) and 5.6 x 10(-2) M) were markedly potentiated whereas prostglandin F2alpha(5 x 10(-6) M)-induced contractile responses was not affected. The contractile responses induced by phenylephrine (10(-5) M) and high potassium (3.5 x 10(-2) M) even under the presence of total ginseng saponin (600 g/ml) were greatly inhibited by the pretreatment of nicardipine (10(-6) M), a calcium channel blocker. CONCLUSION: Taken together, these experimental results suggest that total ginseng saponin can enhance the contractile responses evoked by stimulation of adrenergic alpha1-receptor and the membrane depolarization in the isolated rat aortic strips, which seems to be associated to calcium influx.
Animals ; Aorta* ; Baths ; Blood Pressure ; Calcium ; Calcium Channels ; Membranes ; Nicardipine ; Oxygen ; Panax* ; Phenylephrine ; Potassium ; Rats* ; Saponins* ; Vasoconstriction ; Vasoconstrictor Agents*

PURPOSE: The amount of salvaged myocardium is an important prognostic factor in patients with acute myocardial infarction (MI). We investigated if early Tl-201 SPECT imaging could be used to predict the salvaged myocardium and functional recovery in acute MI after primary PTCA. MATERIALS AND METHODS: In 36 patients with first acute MI treated with primary PTCA, serial echocardiography and Tl-201 SPECT imaging (5.8+/-2.1 days after PTCA) were performed. Regional wall motion and perfusion were quantified with on 16-segment myocardial model with 5-point and 4-point scaling system, respectively. RESULTS: Wall motion was improved in 78 of the 212 dyssynergic segments on 1 month follow-up echocardiography and 97 on 7 months follow-up echocardiography, which were proved to be salvaged myocardium. The areas under receiver operating characteristic curves of Tl-201 perfusion score for detecting salvaged myocardial segments were 0.79 for 1 month follow-up and 0.83 for 7 months follow-up. The sensitivity and specificity of Tl-201 redistribution images with optimum cutoff of 40% of peak thallium activity for detecting salvaged myocardium were 84.6% and 55.2% for 1 month follow-up, and 87.6% and 64.3% for 7 months follow-up, respectively. There was a linear relationship between the percentage of peak thallium activity on early redistribution imaging and the likelihood of segmental functional improvement 7 months after reperfusion. CONCLUSION: Tl-201 myocardial perfusion SPECT imaging performed early within 10 days after reperfusion can be used to predict the salvaged myocardium and functional recovery with high sensitivity during the 7 months following primary PTCA in patients with acute MI.
Angioplasty* ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Myocardial Perfusion Imaging* ; Myocardium* ; Perfusion ; Reperfusion ; ROC Curve ; Sensitivity and Specificity ; Thallium ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Procalcitonin (PCT) is a propeptide of calcitonin which is found in elevated concentration in the serum during systemic bacterial, fungal or protozoal infection. To evaluate clinical value of PCT for early differential diagnosis of causes in febrile patients, its levels were serially measured and compared with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). METHODS: Thirty-six patients meeting criteria for the systemic inflammatory response syndrome with fever were allocated into four groups. Sera were collected to measure PCT (immunoluminometric assay), ESR (Westergren method) and CRP (nephelometry) at the onset of fever and twice thereafter at 48 hours intervals. Group I included nineteen patients with bacterial infection who were diagnosed as acute pyelonephritis (n=7), sepsis (n=6), pneumonia (n=2), soft tissue infection (n=3) and infective endocarditis (n=1). Group II included patients diagnosed as viral meningitis (n=2), chickenpox (n=1), cryptococcal meningitis (n=1), and tuberculosis (n=4). Group III included four patients with malaria. Group IV included non-infectious febrile patients diagnosed as adult onset Still's disease (n=2), Kikuchi's disease (n=2) and drug fever (n=1). RESULTS: Patients in group I (median 1.34 ng/mL) and III (2.41 ng/mL) had markedly elevated serum PCT concentrations at the onset of fever, whereas patients in group II (0.20 ng/mL) and IV (0.11 ng/mL) had normal range PCT levels at the onset of fever (P<0.01). All the groups had elevated ESR and CRP levels at the onset of fever. After 48 hours and 96 hours, in patients group I and III, elevated PCT levels were declined with time course (P<0.05). But all the measured ESR and CRP levels had not changed significantly (ESR; P=0.89, CRP; P=0.23). CONCLUSION: Procalcitonin is a more useful serum marker than ESR and CRP for initial differential diagnosis of febrile systemic inflammatory response syndrome. It also provide patient's information earlier than ESR and CRP in febrile patients with bacterial infection and malaria.
Bacterial Infections ; Biological Markers ; Blood Sedimentation* ; C-Reactive Protein* ; Calcitonin ; Chickenpox ; Diagnosis, Differential ; Endocarditis ; Erythrocytes* ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Malaria ; Meningitis, Cryptococcal ; Meningitis, Viral ; Pneumonia ; Pyelonephritis ; Reference Values ; Sepsis ; Soft Tissue Infections ; Still's Disease, Adult-Onset ; Systemic Inflammatory Response Syndrome ; Tuberculosis

PURPOSE: Epidemiological data indicate that obesity is a risk factor in asthma, however effects related to obesity and adipokines on airway inflammation and bronchial hyper-responsiveness (BHR) have not yet been demonstrated in the human airway. The aim of this study was to investigate the relationship between serum adipokine levels and BHR to mannitol in asthmatic children. METHODS: Serum adipokine levels were measured and pulmonary function tests were perfomed: baseline, postbronchodilator inhalation, methacholine inhalation, and mannitol inhalation. The response to mannitol was expressed as the dose causing a 15% decrease in forced expiratory volume in one second (FEV1) (PD15), and as the response-dose ratio (RDR) (% fall in FEV1/cumulative dose). RESULTS: Sixty-nine prepubertal children between the ages of 6 and 10 years were participated in the study. They comprised asthmatic children (n=40) and healthy (n=29). Twenty-two subjects (55.5%) with asthma had a positive mannitol bronchial provocation test (BPT) result. The body mass index (BMI) was higher in those asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (19.30 kg/m2 vs. 17.60 kg/m2 vs. 17.93 kg/m2, P=0.035, P=0.046). Serum leptin levels were also significantly higher in asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (10.58 ng/mL vs. 5.49 ng/mL vs. 6.75 ng/mL, P=0.002, P=0.016). Leptin values were significantly associated with a PD15 (r=-0.498, P=0.022) and RDR to mannitol (r=0.346, P=0.033) in asthmatic children after adjustment for BMI. CONCLUSION: Serum leptin levels were significantly associated with BHR to mannitol in asthmatic children.
Adipokines ; Asthma ; Body Mass Index ; Bronchial Provocation Tests ; Child* ; Forced Expiratory Volume ; Humans ; Inflammation ; Inhalation ; Leptin* ; Mannitol* ; Methacholine Chloride ; Obesity ; Respiratory Function Tests ; Risk Factors

PURPOSE: In order to evaluate the efficacy of PEFL (cisplatin, etoposide, 5-fluorouracil and leucovorin) chemotherapy and to identify favorable subsets, we conducted a phase II trial of PEFL regimen for patients with carcinomas of unknown primary origin (CUPO). MATERIALS AND METHODS: A total of 38 patients was enrolled in this study between May 1995 and September 1997. CUPO was defined as the presence of metastatic cancer documented in the absence of an identifiable primary site. All entered patients were treated with PEFL combination chemotherapy (cisplatin 20 mg/m(2)/day i.v, days 1-5, etoposide 100 mg/m(2)/day i.v. days 1, 3 & 5, 5-fluorouracil 800 mg/m(2)/day continuous infusion days 1-5, and leucovorin 20 mg/m(2)/day i.v, days 1-5; repeated every 4 weeks). The end points of this study were response and survival. To identify favorable subsets, univariate and multivariate analyses were perfonned. RESULTS: Among 38 patients, 29 had measurable lesions. Three (11%) out of 27 evaluable patients had a complete response and 7 (26%) had a partial response (response rate 37%; 95% confidence interval 19~55%). The median survival of the total 38 enrolled patients was 9.1 (range; 1~21.9+) months. The median progression-free survival of the 27 evaluable patients was 5.3 (range 0~ 16.0) months. Among total 132 cycles of chemotherapy, leukopenia of grade II or more was observed in 15% and thrombocytopenia of grade I in 4%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting (79%), stomatitis (70%), and neurotoxicity (33%). The prognostic factor analyses identified 2 favorable subgroups; One was the patient group whose disease had poorly differentiated histology and presented in cervical lymph node. This group of patients had better response rate than other patients (response rate; 71% vs 25%, p=0.02). The other was the patient group who had normal tumor markers (CEA, CA 125 and CA 19-9). This group of patients had better survival than other patients(median survival; 14.8 vs 8.4 months, p=0.05). CONCLUSION: PEFL chemotherapy seemed to be moderately active and tolerable in patients with CUPO. Among heterogenous patients with CUPO, the subset with cervical lymph node and poorly differentiated histology responded better to the chemotherapy and those with normal tumor markers tended toward longer survival.
Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Fluorouracil ; Humans ; Leucovorin ; Leukopenia ; Lymph Nodes ; Multivariate Analysis ; Stomatitis ; Thrombocytopenia ; Biomarkers, Tumor