PURPOSE: To evaluate the effects and complications of self-expandable metallic stent for the treatment of malignant esophagogastric strictures. MATERIALS AND METHODS: From September 1991 to March 1995, 110 stents were placed under fluoroscopic guidance in 103 patients. Of the 103 patients, there were 73 patients with esophageal cancer, 14 patients with gastric cancer, 12 patients with recurrence after surgery, three patients with esophageal compression by metastatic mediastinal lymphadenopathy, and one patient with esophageal invasion by lung cancer. Seventeen patients had esophagorespiratory fistulas. Under fluoroscopic guidance, 113 self-expandable metallic stents (99 Song stents, 14 Strecker stents) were placed in 103 patients. RESULTS: After stent placement, 68 (66%) of the patients could ingest solid food, 26 (25.2%) could ingest soft food, whereas three (2.9%) were not able to have food. Esophagorespiratory fistulas were occluded immediately after stent insertion. All stents were placed without any technical failures or procedural morbidity or mortality. Complications included restenosis in 13, gastroesophageal reflux in 11, stent tube migration in eight, massive bleeding in four, delayed esophageal perforation in one, stent obstruction by food impaction in one patient. CONCLUSION: Self-expandable metallic stent seems to be relatively safe and effective procedure in the palliative treatment of malignant esophagogastric stricture.
Constriction, Pathologic* ; Esophageal Neoplasms ; Esophageal Perforation ; Fistula ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Lung Neoplasms ; Lymphatic Diseases ; Mortality ; Music ; Palliative Care* ; Recurrence ; Stents* ; Stomach Neoplasms

BACKGROUND AND OBJECTIVES: Post-tonsillectomy pain is unavoidable and related to the dysphagia, dehydration and loss of time in returning to normal activities. This study was performed to investigate whether fibrin glue (Tissucol(R) Duo Quick, Baxter AG, Wien, Austria) applied to tonsillar bed after the completion of tonsillectomy reduced pain. SUBJECTS AND METHOD: Twenty-five adults scheduled for an elective tonsillectomy were included in this prospective double-blind study. After removal of both tonsils electrocauterization was done on both tonsillar bed for adequate hemostasis. And then, one side of tonsillar bed randomly selected by operating surgeon was coated with the fibrin glue and the other side was left without coating. Pain scores were measured at the first (postoperative day, POD1), third (POD3) and tenth (POD10) day of the operation by using visual analogue scale (VAS). RESULTS: The VAS scores of the side treated with fibrin glue and the non-coated side were 3.67+/-1.16/3.14+/-0.96/1.52+/-0.81 (POD1/POD3/POD10) and 5.33+/-1.28/4.19+/-1.21/1.71+/- 0.96 (POD1/POD3/POD10), respectively. The VAS score difference between both sides were 1.67+/-0.58/1.05+/-0.59/0.19+/-0.40 (POD1/PO3/POD10). CONCLUSION: This study shows that the application of fibrin glue on tonsillectomy site was effective for postoperative pain control. Moreover, the efficacy was prominent at early postoperative days known as period of severe pain.
Adult ; Deglutition Disorders ; Dehydration ; Double-Blind Method ; Fibrin ; Fibrin Tissue Adhesive ; Hemostasis ; Humans ; Pain, Postoperative ; Palatine Tonsil ; Prospective Studies ; Tonsillectomy

This study was performed to evaluate the factors influencing the Quality of Life(QOL) in hemodialysis patients. Authors surveyed and analyzed the questionnaires about social characteristics, symptom, social support, satisfaction with life and quality of life. With these questionnaires, authors compared the hemodialysis patients(N=240, >6 month with hemodialysis) with the control group(N=240). Additionally authors eva- luated the anemia state, nutritional state and dialysis effect, and then analyzed the correlation between these laboratory findings and quality of life in hemodialysis patients. The results were as follows ; 1) The mean age of control group was 33.4 +/- 8.2 yrs, and the patients group was 48.812yrs. 2) Of 294 patients, 73 had the religion(75.2%), 173 had studied above high school(58.8%), 211 were married(71.8%), and 94 were homemaker(3296). Economically, 130 of 294 patients(44.2M) were the middle classes. The patients without occupation were 121 of 294 patients(41.2M), while those with occupation were 77(26.1%) and remainder were housemaker. The patients with medical insurance were 59.9%, those with 1st Medicaid were 22.4%, and those with 2nd Medicaid were 17%. 3) The causes of ESRD were CGN(29.5%), DM (22.3%), etc. Total duration of hemodialysis was 51.4 43.8 months in average, and weekly hemodialysis time was 11.541.98 hours in average. Average BMI was 20.6 +/- 2.79, and in 236 of 294 patients(80.1%), EPO was injected. Of all the complication, 96(32.9%) was cardiovascular problem. Iron storage state was relatively good in all the patients, and the mean level of PTH-i was 174.3 +/- 307.9pg/dl, hemoglobin 8.5 +/- 1.3g/dl, cholesterol 161.536.6mg/dl, total protein 6.60.5g/dl, albumin 3.960.4g/dl. The URR was 65.36.9%, and KtV was 1.3 +/- 0.3. The comparison about laboratory finding between male and female was as followed; Hb. and albumin level was signifi- cantly higher in male compared with female patients, and cholesterol, URR and Kt/V was significantly higher in female than in male. 4) The result of statistic analysis about several variables and Questionnaires. (1) The subjective and objective instrument about QOL showed positive correlation, and the QOL was correlated positively to symptom, physical health state and social support. (2) Of social characteristics, the direct influencing factors for QOL were occupation, economic state, marriage state, and educational state, whereas in- direct factors were a fee for medical treatment and social support. In clinical and laboratory characteristics, the significant factors were age, DM, symptoms, albumin, pre-dialytic creatinine, sodium and calcium. The effect of dialysis did not correlate with QOL. In conclusion, to increase QOL in dialysis pa- tients, all of the community, family, and medical team should make an effort. Firsty, the concern and the support of the community about the dialysis patients should be promoted in social welfare and the opportunity of employment. Secondly, the patients should promote the self-reliance and self- efficacy to take a share of their role in the community and a family by their own efforts. Lastly, the medical team should make an effort to decrease the symptom, to correct the anemia and malnutrition, to treat the complication, and to promote the physical activity. Through these efforts, the health of patients will be elevated. Elevation of the patient's health will increase the possibility of employment and self-reliance, and subsequently will increase the economics. If so, the burden of a fee for the medical treatment will be reduced. Additionally, if social and familial support increase, the QOL of the dialysis patients will be better.
Anemia ; Calcium ; Cholesterol ; Creatinine ; Dialysis ; Employment ; Fees and Charges ; Female ; Humans ; Insurance ; Iron ; Kidney Failure, Chronic ; Male ; Malnutrition ; Marriage ; Medicaid ; Motor Activity ; Occupations ; Quality of Life* ; Renal Dialysis* ; Social Welfare ; Sociology ; Sodium ; Surveys and Questionnaires

Background: The Omicron variant has become the most prevalent SARS-CoV-2 variant. Omicron is known to induce milder lesions compared to the original Wuhan strain. Fatal infection of the Wuhan strain into the brain has been well documented in COVID-19 mouse models and human COVID-19 cases, but apparent infections into the brain by Omicron have not been reported in human adult cases or animal models. In this study, we investigated whether Omicron could spread to the brain using K18-hACE2 mice susceptible to SARS-CoV-2 infection. Results: K18-hACE2 mice were intranasally infected with 1 × 105 PFU of the original Wuhan strain and the Omicron variant of SARS-CoV-2. A follow-up was conducted 7 days post infection. All Wuhan-infected mice showed > 20% body weight loss, defined as the lethal condition, whereas two out of five Omicron-infected mice (40%) lost > 20% body weight. Histopathological analysis based on H&E staining revealed inflammatory responses in the brains of these two Omicron-infected mice. Immunostaining analysis of viral nucleocapsid protein revealed severe infection of neuron cells in the brains of these two Omicron-infected mice. Lymphoid depletion and apoptosis were observed in the spleen of Omicron-infected mice with brain infection. Conclusion Lethal conditions, such as severe body weight loss and encephalopathy, can occur in Omicron-infected K18-hACE2 mice. Our study reports, for the first time, that Omicron can induce brain infection with lymphoid depletion in the mouse COVID-19 model.

PURPOSE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS: We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS: Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm2, 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm², 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm² for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm² for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION: Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
Angiography ; Cerebral Angiography ; Fluoroscopy ; Humans ; Intracranial Aneurysm* ; Korea ; Patient Safety ; Radiation Exposure*