Carcinoid is a neuroendocrine tumor and contains many peptide substances and biological active amines, so if it is released, it can cause carcinoid syndrome. However, most carcinoid tumors are unfortunately asymptomatic, and it is difficult to find one smaller than 1 cm because it doesn't have prominent mucosal elevation and change. We can reduce expenses and recovery period of the patient by using a relatively noninvasive endoscopic mucosal resection, unless it has distant organ and lymph node metastasis. Colonoscopy is an optimizing diagnostic tool for early detection of asymptomatic carcinoids. But according to colonoscopic guidelines of many institutes, they recommend to perform a screening colonoscopy in the asymptomatic fifties if there are no risk factors. However, a careful examination of colonoscopy is needed, because possibility of malignant tumor in aymptomatic young age. The authors report four cases of carcinoid tumor in asymptomatic thirties with review of several literatures.
Academies and Institutes ; Amines ; Carcinoid Tumor ; Colonoscopy ; Humans ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Risk Factors

Hemolytic-uremic syndrome (HUS) is the most common cause of acute renal failure in young children. It is classically characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and uremia. Further, not only is intussusception one of the differential diagnoses of HUS but it may also become a complication during disease progression. We report a case of HUS preceded by intussusception in a previously healthy 17-month-old boy. The patient presented at the emergency department with bloody stools that developed the day after reduction of intussusception. HUS was diagnosed 4 days after the reduction of intussusception. The patient was provided only supportive care and his laboratory test findings were normal at discharge.
Acute Kidney Injury ; Anemia, Hemolytic ; Child ; Diagnosis, Differential ; Disease Progression ; Emergencies ; Hemolytic-Uremic Syndrome ; Humans ; Infant ; Intussusception ; Thrombocytopenia ; Uremia

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke

PURPOSE: Epidemiologic data on emergency department (ED) patients with systemic inflammatory response syndrome (SIRS) are limited. We examined the prevalence, risk factors, etiologies and outcomes for the various forms of the SIRS, as well as their relationships with infection in ED. METHODS: The subjects were 16,718 non-trauma adult patients who visited a 900- bed university hospital ED between November 2006 and October 2007. ED records were reviewed, and all patients meeting the criteria for SIRS were enrolled retrospectively. SIRS patients were further subdivided into four groups (non-infectious SIRS, sepsis, severe sepsis, septic shock). Baseline characteristics, ED dispositions, and prognoses of patients in each group were analyzed. RESULTS: Among 16,718 patients, there were 2,790 SIRS patients (16.7%). The SIRS patient group was composed of 1,546 non-infectious SIRS patients (55.4%), 1,078 sepsis patients (38.6%), 119 severe sepsis patients (4.3%), and 47 septic shock patients (1.7%). ED patients with SIRS were older on average than non-SIRS patients (52 versus 48, p<0.001). The most common sources of SIRS was the gastrointestinal system (28.3%), followed by the respiratory system (22.9%) and the genitourinary system (11.8%). Pneumonia (18.9%) was the single most common cause of infectious SIRS. The admission rate was higher for SIRS patients than for non-SIRS patients (44% versus 21%). The 28-day mortality rate for non-infectious SIRS, sepsis, severe sepsis, and septic shock patients were 4.5%, 1.3%, 25.2%, and 63.8%. Sepsis severity was correlated with increased rates of both hospital admission and mortality (p<0.001). CONCLUSION: 55% of SIRS patients who visited the ED had a non-infectious cause. SIRS patients were older than non-SIRS patients, and hospital and ICU admission rates were also higher. Sepsis severity was correlated with older age, increased hospital admission rate, increased ICU admission rate, and increased mortality rate.
Adult ; Emergencies ; Epidemiologic Studies ; Hospitals ; Humans ; Pneumonia ; Prevalence ; Prognosis ; Respiratory System ; Retrospective Studies ; Risk Factors ; Sepsis ; Shock, Septic ; Systemic Inflammatory Response Syndrome ; Urogenital System

BACKGROUND AND OBJECTIVES: Heavy metal ions released from a stainless steel stent can induce an inflammatory reaction that might be associated with in-stent restenosis. A carbon ion implantation technique, which physically integrates carbon ions into the surface of the stainless steel lattice, can block heavy metal ion diffusion, and improve the biocompatibility. This study was designed to evaluate the efficacy of a carbon ion implanted Arthosinert stent on the reduction of in-stent restenosis and the improvement in the clinical outcomes. SUBJECTS AND METHODS: 193 de novo coronary lesions in 191 anginal patients at 14 centers, with reference diameters from 2.75 to 4.5 mm, were randomly assigned to either an Arthosinert (100 patients, 102 lesions) or an Arthos (91 patients, 91 lesions) stent. The lesion length was 14.1+/-5.7 mm. The ACC/AHA (American College of Cardiology/American Heart Association) lesion classifications were A:15.0%, B1:36.8%, B2:35.8% and C:12.4%. The study end points are angiographic restenosis, during a six-month follow-up, and Major adverse cardiac event. In-stent restenosis was defined as a diameter of stenosis > or =50%. RESULTS: A six-month angiographic follow-up was obtained for 72.3% (138/191) of the subjects. There were no significant differences between the Arthosinert and Arthos groups in the rates of restenosis (17.8% vs. 31.8%, p=0.055) and Target vessel revascularization (7.0% vs. 11.0%, p=0.476). There were no deaths or non-fatal myocardial infarction in either group. CONCLUSION: The treatment of de novo coronary stenosis, with carbon ion implanted stents, showed a tendency for lower six-month angiographic restenosis rates than the conventional 316L stainless steel stents. A larger trial will be needed to confirm the efficacy of the carbon ion implanted stent.
Carbon* ; Classification ; Constriction, Pathologic ; Coronary Restenosis ; Coronary Stenosis ; Diffusion ; Follow-Up Studies ; Heart ; Humans ; Ions ; Myocardial Infarction ; Stainless Steel ; Stents

OBJECTIVE: A number of soluble factors,which play important role in the pathophysiology of rheumatoid synovitis are also known to be involved in osteoclast differentiation and activation through RANKL (Receptor activator of NF-kB ligand). To investigate the importance of RANKL in the pathogenesis of bone erosion in rheumatoid arthritis (RA) patients, we analyzed the expression of RANKL and Osteoprotegerin (OPG) and examined the formation of osteoclasts in rheumatoid synovial fibroblasts under the influence of various osteotropic factors. METHODS: Primary culture synoviocytes or fibroblast-like synoviocytes isolated from synovial tissues of 8 RA patients were cultured and treated with IL-1beta (2 ng/ml), TNF-alpha (2 ng/ml), INF-gamma(1000 micro/ml), IL-15 (10 ng/ml), IL-12 (10 ng/ml), dexamethasone (10(-9) M), PMA (10 ng/ml) or 1,25 (OH)2D3 (10(-9) M) for 18 hours. Expression RANKL or OPG mRNA was measured by semiquantitative RT-PCR within linear amplification condition. TRAP (+) MNC (tartrate resistant acid phosphatase-positive multinucleated cell) formation was induced from primary culture synoviocytes or in coculture system of synovial fibroblasts with PBMCs in the presence of M-CSF and 1,25 (OH)2D3. RESULTS: 1. The intensity of base-line expression was different from patient to patient. Primary culture synoviocytes and synovial fibroblasts express RANKL and OPG mRNA with decreasing intensity when they are passaged. 2. Expresssion of RANKL mRNA was significantly increased by 1,25 (OH)2D3 and IL-1beta (158.8+/-21% and 197.2+/-17% of controls, p<0.05 and p<0.005, respectively), while decreased significantly by dexamethasone (25.6+/-4.6% of controls, p<0.005). Expression of RANKL mRNA was significantly increased by IL-1beta and decreased by dexamethasone, in a dose- and time-dependant manner. 3. TRAP (+) MNCs are formed from primary culture synoviocytes or in coculture system of synovial fibroblasts and PBMC in the presence of M-CSF and 1,25 (OH)2D3. Dexamethasone clearly inhibited TRAP (+) MNCs formation from synovial cells. CONCLUSION: The regulatory mechanism for the expression of RANKL or OPG in rheumatoid synoviocytes might be different from that in bone marrow cells. Modulating the expression of these molecules could have potential therapeutic implication targeting bone destruction in RA.
Arthritis, Rheumatoid ; Bone Marrow Cells ; Coculture Techniques ; Dexamethasone ; Fibroblasts* ; Humans ; Interleukin-12 ; Interleukin-15 ; Macrophage Colony-Stimulating Factor ; NF-kappa B* ; Osteoclasts* ; Osteoprotegerin ; RNA, Messenger ; Synovitis ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: Intracoronary stenting now constitute the majority of coronary interventions, and subsequently in-stent restenosis has become a significant clinical problem. Recently, several studies on intracoronary radiation therapy, in patients with in-stent restenosis, have demonstrated a reduction in binary angiographic restenosis and target lesion revascularization compared with control groups. The effects of beta-radiation therapy on non-stented adjacent segments in in-stent restenosis have not been sufficiently evaluated. beta-radiation therapy for in-stent restenosis was performed with a 188Re-MAG3 filled balloon. SUBJECTS AND METHODS: We evaluated, and compared, the effects of beta-radiation therapy on non-stented adjacent segments, in in-stent restenosis, by intravascular ultrasound (IVUS) analysis, between 50 patients who received radiation therapy and 9 controls. The changes (delta: follow-up-post-intervention) of the external elastic membrane (EEM), the lumen and other IVUS variables, were compared between the segments having received radiation therapy and those in the controls. RESULTS: Significant differences were found between the 2 groups, and were as follows: the delta EEM and delta lumen areas were 0.3mm2 and -1.0mm2, (p=0.005) and 0.2mm2 and -1.3mm2, (p<0.001) in those radiated and the controls, respectively. CONCLUSION: In conclusion, compared with the changes on the vessel shrinkage of the control group, there was significant vessel enlargement in the non-stented adjacent segments having received radiation therapy.
Brachytherapy ; Coronary Artery Disease ; Humans ; Membranes ; Stents ; Ultrasonography* ; Ultrasonography, Interventional

Among many kinds of internal fixation techniques for the transverse fracture of the patella, AO modified tension band wiring technique and Pyrford technique have been widely used. However, it seems that those techniques are not strong enough to withstand immediate full weight bearing and full range of motion exercise postoperatively. Instead, a load sharing wiring technique seems to be more effective fixation technique. A comparative study was performed to evaluate the load sharing wiring technique using porcine patellae. Transverse fractures of thirty knees were made and were fixed with 3 different fixation technique. 1) AO modified tension band wiring technique, 2) Pyrford technique, and 3) Load sharing wiring technique. Then, those knees were mounted on the material testing system (Instron 4204(R)) and longitudinal traction was applied. The result showed that the separation of the fracture fragments was much less with the load sharing wiring technique than with the AO modified tension band wiring technique and the Pyrford tehchnique when 5 kg to 25 kg of traction was applied(P<0.05). The load sharing wiring technique showed less than 0.4mm of separation at 25~50kg of traction, where other techniques led specimen to failure. From this study, it was suggested that the load sharing wiring technique was proved to be more effective fixation technique compared to other techniques.
Knee ; Patella* ; Range of Motion, Articular ; Traction ; Weight-Bearing

BACKGROUND: Balloon angioplasty of ostial left anterior descending coronary artery lesions has been associated with high rate of acute complications and late restenosis. Recently, coronary stenting has been proposed as one of effective treatment modalites of ostial left anterior descending artery lesions. METHODS: To evaluate the effects of stent design on the development of late restenosis, we retrospectively analyzed the efficacy of slotted tube stent implantation (40 patients, Palmaz-Schatz stent) and coil stent implantation (15 patients, tantalum Cordis stent) of ostial left anterior descending artery stenosis. Six-month angiographic follow-up data were obtained in 31 patients (82%) with slotted tube stent implantation and 12 patients (86%) with coil stent implantation. Angiographic restenosis was defined as > or = 50% diameter stenosis. RESULTS: Angiographic resten-osis rate was significantly lower in slotted tube stent implantation (32%) than in coil stent implantation (67%) (p<0.05). Target lesion revascularization rate of slotted tube stent implantation was significantly lower (26%) than that of coil stent implantation (57%) (p<0.05). CONCLUSIONS: Coil stent implantation of ostial left anterior descending artery lesions was associated with higher late restenosis compared with slotted tube stent impla-ntation. In conclusion, slotted tube stent implantation might be considered for ostial left anterior descending artery lesions to improve late clinical outcomes.
Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stents* ; Tantalum

BACKGROUND: The results of new devices for long coronary stenotic lesion is disappointing. We evaluate the feasibility and efficacy of single long coronary stenting for long coronary stenosis, we implanted two types of long stents, newly developed less shortening Wall stent and Gianturco-Roubin II stent. METHODS: This study reports on the use of stents in 106 patients with 109 lesions with long lesion. Long coronary disease was defined as a lesion length longer than 20 mm. After the implantation of the stent, the stented coronary segment was dilated further with high pressure balloon inflation to achieve angiographic optimization. RESULTS: The mean age was 59+/-9 years. Mean stent length was 35+/-11 mm. Vessel distribution was 2 (2%) left main, 66 (61%) LAD, 10 (9%) LCX and 31 (28%) RCA. Implanted stents were 57 (52%) Gianturco-Roubin II stents and 52 (48%) Wall stents. Procedural success was achieved in 109 (100%) lesions. The MLD at lesion site increased from 0.8+/-0.4 mm to 3.2+/-0.5 mm. Procedure associated complications included 4 non-Q myocardial infarction. Angiographic follow up at 6 months was performed on 78 (72%) eligible lesions. There was one myocardial infarction and no death during follow up period. Restenosis by 50% diameter stenosis criteria was present in 39 (50%) of lesions. The target lesion revascularization was performed in 21 (19%) lesions. CONCLUSIONS: Stent implantation for long coronary disease is associated with excellent procedural success rates and low complication rates in the majority of patients. However, the restenosis rate is high regardless of the stent used. Further study needs to be done to improve the long-term clinical outcome.
Constriction, Pathologic ; Coronary Disease ; Coronary Stenosis ; Follow-Up Studies* ; Humans ; Inflation, Economic ; Myocardial Infarction ; Stents*