Background/Aims: The risk for colonoscopic postpolypec-tomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, espe-cially those with liver cirrhosis. Methods: We retrospectively reviewed the medical records of patients with CLD who un-derwent colonoscopic polypectomy at Seoul National Univer-sity Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB. Results: A total of 1,267 consecutive patients with CLD were included in the study. Im-mediate PPB occurred significantly more often in the ChildPugh (CP) B or C cirrhosis group (17.5%) than in the CP-A (6.3%) and chronic hepatitis (4.6%) groups (p<0.001). More-over, the incidence of delayed PPB in the CP-B or C cirrhosis group (4.4%) was significantly higher than that in the CP-A (0.7%) and chronic hepatitis (0.2%) groups (p<0.001). The independent risk factors for immediate PPB were CP-B or C cirrhosis (p=0.011), a platelet count <50,000/μL (p<0.001), 3 or more polyps (p=0.017), endoscopic mucosal resection or submucosal dissection (p<0.001), and polypectomy per-formed by trainees (p<0.001). The independent risk factors for delayed PPB were CP-B or C cirrhosis (p=0.009), and pol-yps >10 mm in size (p=0.010). Conclusions Patients with CP-B or C cirrhosis had an increased risk for bleeding fol-lowing colonoscopic polypectomy.

Destruction of dopaminergic neurons in the substantia nigra pars compacta (SNpc) is a common pathophysiology of Parkinson's disease (PD). Characteristics of PD patients include bradykinesia, muscle rigidity, tremor at rest and disturbances in balance. For about four decades, PD animal models have been produced by toxin-induced or gene-modified techniques. However, in mice, none of the gene-modified models showed all 4 major criteria of PD. Moreover, distinguishing between PD model pigs and normal pigs has not been well established. Therefore, we planned to produce a pig model for PD by chronic subcutaneous administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), neurotoxin. Changes in behavioral patterns of pigs were thoroughly evaluated and a new motor scoring system was established for this porcine model that was based on the Unified Parkinson's Disease Rating Scale (UPDRS) in human PD patients. In summary, this motor scoring system could be helpful to analyze the porcine PD model and to confirm the pathology prior to further examinations, such as positron emission tomography-computed tomography (PET-CT), which is expensive, and invasive immunohistochemistry (IHC) of the brain.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine* ; Animals ; Brain ; Dopaminergic Neurons ; Electrons ; Humans ; Hypokinesia ; Immunohistochemistry ; Injections, Subcutaneous* ; Mice ; Models, Animal ; Muscle Rigidity ; Parkinson Disease* ; Pathology ; Substantia Nigra ; Swine ; Tremor

PURPOSE: We examined the effect of lowering prostate-specific antigen (PSA) threshold on the number of Korean men requiring a prostate biopsy. MATERIALS AND METHODS: We evaluated men who had serum PSA levels tested at routine physical check-ups between 1999 and 2005 at 11 domestic hospitals. Men with PSA> or =10ng/ml or patients with prostate cancer were excluded. A total of 45,074 men(aged 50 to 79 years) were enrolled and split into three age groups: 50-59 years, 60-69 years, and 70-79 years. For each age group, we calculated the number and proportion of men whose PSA level exceeded potential biopsy thresholds: 2.5ng/ml, 3.0ng/ml, and 4.0ng/ml. Results were extrapolated to the 4.992 million men older than 50 years old, or 21.3% of the Korean male population in 2005. RESULTS: The number of biopsy candidates at the threshold of 4.0ng/ml, 3.0ng/ml, and 2.5ng/ml were 1,321(2.9%), 2,248(5.4%), and 3,577(7.9%), respectively. Extrapolating to the male population in Korea, lowering the PSA threshold from 4.0ng/ml to 3.0 or 2.5ng/ml would increase the number of men needing biopsy by 1.75 and 2.49 times, respectively. CONCLUSIONS: Lowering the PSA threshold would increase the number of men receiving prostate biopsy despite the low reference age for PSA in Korea. Considering the low incidence of prostate cancer, physicians should be careful in altering the PSA threshold.
Biopsy ; Humans ; Incidence ; Korea ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

Tuberculosis remains as a major public health problem worldwide. In addition to classic pulmonary tuberculosis, tuberculosis may sometimes present atypically. In the case of atypical tuberculosis, the unusual sites and properties that mimic other diseases can lead to a misdiagnosis and therapeutic delay. Abdominal and pharyngeal tuberculosis are uncommon extrapulmonary manifestations of tuberculosis. To the best of our knowledge, a combination of abdominal and pharyngeal tuberculosis with endobronchial tuberculosis has not been reported. We report a case of concurrent abdominal and pharyngeal tuberculosis in a patient with chronic endobronchial tuberculosis mimicking a metastatic malignancy on computed tomography and FDG-PET.
Diagnostic Errors ; Humans ; Neoplasm Metastasis ; Public Health ; Tuberculosis* ; Tuberculosis, Pulmonary

Tuberculosis remains as a major public health problem worldwide. In addition to classic pulmonary tuberculosis, tuberculosis may sometimes present atypically. In the case of atypical tuberculosis, the unusual sites and properties that mimic other diseases can lead to a misdiagnosis and therapeutic delay. Abdominal and pharyngeal tuberculosis are uncommon extrapulmonary manifestations of tuberculosis. To the best of our knowledge, a combination of abdominal and pharyngeal tuberculosis with endobronchial tuberculosis has not been reported. We report a case of concurrent abdominal and pharyngeal tuberculosis in a patient with chronic endobronchial tuberculosis mimicking a metastatic malignancy on computed tomography and FDG-PET.
Diagnostic Errors ; Humans ; Neoplasm Metastasis ; Public Health ; Tuberculosis* ; Tuberculosis, Pulmonary

Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction.
Aorta ; Bile ; Diagnosis ; Duodenum ; Humans ; Laparoscopy* ; Ligaments ; Mesenteric Artery, Superior* ; Mesentery ; Nausea ; Superior Mesenteric Artery Syndrome* ; Ultrasonography ; Vomiting ; Weight Loss

PURPOSE: Human papillomavirus (HPV) infection has a significant role in cervical carcinogenesis, and HPV oncoprotein E7 plays an important part in the formation and maintenance of cervical cancer. Interleukin-12 (IL-12) has been reported to induce a cellular immune response, and to suppress the tumor growth and the E7 production. Here we describe the use of adenoviral delivery of the HPV 16 E7 subunit (AdE7) along with adenoviral delivery of IL-12 (AdIL-12) in mice with HPV-associated tumors. MATERIALS AND METHODS: Mice were injected with TC-1 cells to establish TC-1 tumor, and then they were immunized with AdIL-12 and/or AdE7 intratumorally. The anti tumor effects induced by AdIL-12 and/or E7 were evaluated by measuring the size of the tumor. E7-specific antibody and INF-gamma production in sera, and the T-helper cell proliferative responses were then measured. Cytotoxic T-lymphocyte (CTL) and T cell subset depletion studies were also performed. RESULTS: Combined AdIL-12 and AdE7 infection at the tumor sites significantly enhanced the antitumor effects more than that of AdIL-12 or AdE7 single infection. This combined infection resulted in regression of the 9 mm sized tumors in 80% of animals as compare to the PBS group. E7-specific antibody and INF-gamma production in the sera, and the T-helper cell proliferative responses were significantly higher with coinfection of AdIL-12 and AdE7 than with AdIL-12 or AdE7 alone. CTL response induced by AdIL-12 and AdE7 in the coinjected group suggested that tumor suppression was mediated by mostly CD8+ and only a little by the CD4+ T cells. CONCLUSION: IL-12 and E7 application using adenovirus vector showed antitumor immunity effects against TC-1 tumor, and this system could be use in clinical applications for HPV-associated cancer.
Adenoviridae ; Animals ; Carcinogenesis ; Coinfection ; Human papillomavirus 16 ; Humans* ; Immunity, Cellular ; Immunization* ; Interleukin-12* ; Mice ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic ; Uterine Cervical Neoplasms

Capillary hemangioma of the testis is extremely rare. Because it is difficult to differentiate from malignant testicular tumors clinically and radiologically, radical orchiectomy is usually performed. Although the fate of hemangiomas of the testis left untreated is unknown, there is no evidence that hemangiomas become malignant. We report a case of a 2-year-old child with capillary hemangioma of the testis which was diagnosed as a malignant tumor preoperatively.
Capillaries* ; Child ; Child, Preschool ; Hemangioma ; Hemangioma, Capillary* ; Humans ; Orchiectomy ; Testicular Neoplasms ; Testis*

BACKGROUND: alpha-Bungarotoxin, decamethonium or lidocaine has a neuromuscular blocking effect. The aim of this study was to evaluate the pharmacodynamic properties of these drugs at the neuromuscular junction and the reversal effects of antagonists in vitro. METHODS: The effects of evoked twitch tension response have been studied on the isolated phrenic nerve hemidiaphragm preparation of the rat, using a single twitch (0.1 Hz) and the train of four (TOF; 2 Hz for 2 s) stimulation. The cumulative concentration effect and TOF ratio at each point of twitch depression after alpha-bungarotoxin, decamethonium or lidocaine were measured mechanomyographically. The EC50 and EC95 of alpha-bungarotoxin, decamethonium or lidocaine were calculated using an inhibitory sigmoid Emax model. The reversal effects of various doses of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) to the partial neuromuscula r block produced by EC50 of alpha-bungarotoxin, decamethonium or lidocaine were determined. RESULTS: The EC50 and EC95 of alpha-bungarotoxin, decamethonium or lidocaine were 0.179 and 0.320 microgram/ml, 17.07 and 26.84 microgram/ml or 76.80 and 105.70 microgram/ml. TOF fade was produced by alpha-bungarotoxin or decamethonium but not by lidocaine. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by alpha-bungarotoxin, decamethonium or lidocaine. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). CONCLUSIONS: alpha-Bungarotoxin, decamethonium or lidocaine produced different degree of TOF fade, and it means that this may be due to different site of action of these drugs. 4-AP reversed effectively the partial neuromuscular block induced by alpha-bungarotoxin, decamethonium or lidocaine, whereas neostigmine or pyridostigmine did not.
4-Aminopyridine ; Animals ; Bungarotoxins* ; Colon, Sigmoid ; Depression ; Lidocaine* ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Junction ; Phrenic Nerve ; Pyridostigmine Bromide ; Rats*

BACKGROUND: Lidocaine, verapamil or a lidocaine-verapamil mixture was effectively applied for blunting extubation during recovery from anesthesia. However, these drugs can enhance neuromuscular blockade and cardiovascular depression. We investigated the neuromuscular and the cardiovascular effect of lidocaine, verapamil or a lidocaine-verapamil mixture before extubation in the recovery from anesthesia. METHODS: We studied ninety nine healthy adult patients (ASA class I or II), excluding the patients with cardiovascular diseases and with factors affecting neuromuscular function. Induction of anesthesia was performed with thiopental sodium 5 mg/kg and fentanyl 0.1 mg, and maintained with O2-N2O (50%)-enflurane (2%). Supramaximal single twitch stimuli (0.1 Hz) were applied to the ulnar nerve and the twitch response of the adductor pollicis was recorded by the Gould TA 240 recorder via a 2 kg Load Cell Strain Gauge modification. After stabilization of the twitch response, mivacurium (0.16 mg/kg) or vecuronium (0.1 mg/kg) was administered intravenously and endotracheal intubation was performed. Twitch heights were spontaneously recovered without a reversal agent from the neuromuscular blockade as a spontaneous group. Pyridostigmine 10 mg and glycopyrrolate 0.2 mg were administered intravenously around the time of 10% recovery of baseline twitch height as a reversal recovery group. At the time of 100% recovery of twitch height, train of four (TOF) stimuli was applied and then lidocaine, verapamil or a lidocaine-verapamil mixture was administered intravenously in both groups. Maximum depression of twitch height and the TOF ratio at this point, recovery index (RI) measured, and mean arterial pressure and pulse rates were measured before and at 2, 5, 10, 20 and 30 min. after the lidocaine-verapamil mixture administration. RESULTS: Twitch heights were depressed slightly after lidocaine, verapamil or a lidocaine-verapamil mixture administration; however, there were no significant differences to compare with the control. TOFratios were unchanged after lidocaine, verapamil or lidocaine-verapamil administration compared at the 100% twitch height recovery. RI indices were not significant between groups in reversal recovery or in spontaneous recovery. Mean arterial pressure was reduced significantly until 20 min after a lidocaine-verapamil mixture administration, pulse rates were increased at 2 min only after a lidocaine- verapamil mixture administration. CONCLUSIONS: Twitch height and TOF ratios were not affected by clinical doses of lidocaine, verapamil or a lidocaine-verapamil mixture. However, mean arterial pressure and pulse rates were changed significantly by a lidocaine-verapamil mixture.
Adult ; Anesthesia ; Arterial Pressure ; Cardiovascular Diseases ; Depression ; Fentanyl ; Glycopyrrolate ; Heart Rate ; Humans ; Intubation, Intratracheal ; Lidocaine* ; Neuromuscular Blockade* ; Pyridostigmine Bromide ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide ; Verapamil*