Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

BACKGROUND: Atrial fibrillation (AF) is the most common cause of embolic cerebral infarction. This study was performed to determine new risk factors and the mechanism underlying thromboembolism (TE) in patients with AF. METHODS: 192 patients (M:F=137:55, 61+/-11 years) with AF were randomly selected and divided into a TE (n=95) and non-TE group (n=97). Another 71 patients with AF (M:F=38:33, 55+/-14) were studied for endothelial function by measuring the level of von Willebrand factor (vWF; factor 8 related antigen), inflammation by WBC, ESR, and high sensitive CRP and coagulation system by fibrinogen, fibrinogen degradation product and fibrin d-dimer; the results were compared with 25 patients with normal sinus rhythm. RESULTS: The TE group was older than non-TE group. Hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, smoking and fine AF (AF wave amplitude <1 mm) were more frequent in the TE group. Mitral valvular disease, an ejection fraction <40% and dilated cardiomyopathy were more frequent in the TE group and the left atrial (LA) dimension was greater in the TE group. The use of anticoagulants, an angiotensin-II receptor blocker and statins were less frequently observed in the TE group. The vWF-factor 8 related antigen was higher in patients with advanced age, LV dysfunction, HTN, DM, mitral stenosis and positively correlated with age, LA dimension, LV end-diastolic and end-systolic dimension, ejection fraction, NYHA class and AF duration. The fibrinogen level was positively correlated with age, NYHA class, LA dimension and d-dimer with NYHA class. Markers for inflammation or coagulation were not significantly different in the atrial fibrillation and the sinus rhythm group. CONCLUSIONS: No use of an angiotensin-II receptor blocker or statin and fine AF may be new risk factors for TE in patients with AF. The TE risk factors are thought to increase TE by impairing endothelial function.
Anticoagulants ; Atrial Fibrillation* ; Cardiomyopathy, Dilated ; Cerebral Infarction ; Diabetes Mellitus ; Fibrin ; Fibrinogen ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Hypertension ; Inflammation ; Mitral Valve Stenosis ; Risk Factors* ; Smoke ; Smoking ; Thromboembolism ; von Willebrand Factor

Degenerative disc disease of the lumbar spine caused leg pain with associated calf weakness and atrophy. However, an unusual case of leg pain and calf atrophy due to neural compression is reported. We reported a rare case of a Baker's cyst causing common peroneal nerve and tibial nerve entrapment neuropathy. Initially, after arthroscopic menisectomy and cyst decompression, Baker's cyst was recurred and then open excision was done. Until 1 year after surgery, the cyst was not recurred, increased muscle bulk was noted and EMG showed improved findings. But she continued to complain of lower leg weakness and sole paresthesia owing to delayed diagnosis and cyst decompression.
Atrophy ; Decompression ; Delayed Diagnosis ; Leg ; Paresthesia ; Peroneal Nerve* ; Popliteal Cyst* ; Spine ; Tibial Nerve*

OBJECTIVE: To evaluate the association of level of CA-125 and severity of dysmenorrhea with lesion depth in adenomyosis. METHODS: Sixty-eight women who had undergone hysterectomy and were found to have pure adenomyosis on histopathologic examination were reviewed retrospectively. Specimens were stratified according to the degree of adenomyosis penetration into 4 groups: group A consisted of specimens with adenomyosis penetration into myometrium of up to 25%; group B, 26-50%; group C, 51-75%, and group D, >75%. All women were submitted to serum determination of CA-125. Severity of dysmenorrhea was assessed by means of a modification of 10-point verbal rating scale. RESULTS: Each group was not correlated with severity of dysmenorrhea (p=0.7394 Fisher's exact test). The means of serum CA-125 levels was increased corresponding to depth of adenomyosis (p=0.0441 ANOVA test). CONCLUSION: In this study, serum CA-125 level is associated with the depth lesion and severity of dysmenorrhea is not. Therefore, the level of serum CA-125 might be useful indicator in management of adenomyosis before surgery.
Adenomyosis* ; Animals ; Dysmenorrhea* ; Female ; Humans ; Hysterectomy ; Mice ; Myometrium ; Retrospective Studies

OBJECTIVE: It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorf's suture in cold knife conization and to investigate various measures employed to reduce blood loss. METHODS: The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. RESULTS: Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. CONCLUSION: Cold knife conization using Sturmdorf's suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several days? admission is needed and the other alternative methods seem to be more convenient.
Ambulatory Care Facilities ; Biopsy ; Cervical Intraepithelial Neoplasia ; Conization* ; Diagnosis ; Electrocoagulation ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Postoperative Hemorrhage ; Sutures*

BACKGROUND AND OBJECTIVE: A new porcine model of acute myocardial infarction (AMI), ischemic heart failure and pathologic findings of coronary artery by a transcatheter intracoronary ethyl alcohol injection has been developed. MATERIALS AND METHODS: Twelve female pigs underwent a transcatheter injection in the left anterior descending artery (LAD), using alcohol, to produce an apicoanteriorseptal AMI. Low pressure ballooning using a 2.5 mm over-the-wire balloon, just above the second and first diagonal branches, followed by a 1 mL injection of 99.9% ethyl alcohol was administered to 8 and 4 pigs, respectively. Follow-up coronary and left ventricular (LV) angiograms and echocardiography were performed 4 weeks after the alcohol injection. Myocardial SPECT using 201Tl (and 99mTc-MIBI) and triphenyl tetrazolium chloride (TTC) stain were performed after sacrifice. The quantity of TTC stain and amount of 201Thallium uptake were compared using the Vision Workstation. The histopathological findings of the infarcted myocardium and coronary artery were demonstrated after 28 days. RESULTS: Procedure-related mortality was observed in two-pigs of the proximal LAD injection group. Four pigs suffered from ventricular tachycardia, which was converted into sinus rhythm by dc cardioversion. The four-week follow-up coronary angiography revealed persistently occluded LAD in all pigs. The LV angiogram showed akinetic movement in the apicoanteriorseptal wall with an ejection fraction of 46.5+/-3.3%. Myocardial SPECT revealed a perfusion defect in the apicoanterior wall of all pigs. The percentage area of perfusion defect was 22.2+/-3.06%. The TTC did not stain the myocardium in the apicoanterior wall. The percentage of non-stained myocardium was 23.5+/-2.70%. A histological examination revealed severe fibrosis in the infarcted myocardium and massive thrombus, with organization and calcification. CONCLUSION: The porcine model of acute myocardial infarction using an intracoronary ethanol injection into the distal LAD is safe, reliable and reproducible, and can be used for future research into myocardial regeneration and ischemic LV failure.
Angioplasty ; Arteries ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Electric Countershock ; Ethanol* ; Female ; Fibrosis ; Follow-Up Studies ; Heart Failure* ; Heart* ; Humans ; Mortality ; Myocardial Infarction ; Myocardium ; Perfusion ; Regeneration ; Swine ; Tachycardia, Ventricular ; Thrombosis ; Tomography, Emission-Computed, Single-Photon

Although arteriovenous malformation (AVM) of the uterus is a very rare cause of menometrorrhagia or postmenopausal vaginal bleeding, it is notable to think in the assessment of a woman with abnormal uterine bleeding because correct diagnosis can yield proper therapy to be designed and avoid hysterectomy in women who want to continue their reproductive capacity. AVM may be congenital or acquired. In times past, the diagnosis is usually made after hysterectomy, but currently it may be made before treatment by ultrasound, pelvic angiography, or magnetic resonance imaging. We have experienced one case of AVM of uterus, which is diagnosed after hysterectomy.
Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Humans ; Hysterectomy ; Magnetic Resonance Imaging ; Ultrasonography ; Uterine Hemorrhage ; Uterus*

OBJECTIVE: To investigate the efficacy of PAP smear as a screening tool for cervical cancer by evaluating the result of a review of 34,970 cases of PAP smear at Pohang St. Mary's Hospital. METHODS: From January, 1992 to December, 2001 cytologic examination of 34,970 women were analysed and the results were reviewed. RESULTS: 1. The average of annual screening rate was 14.8%. 2. Abnormal cytology rate was 2.02% including 1.02% of ASCUS, 0.99% of class III, 0.20% of class IV and 0.30% of class V. 3. 8.28% of the women screened were aged less than 30 years, 31.8% <40 years, 33.2% <50 years, 17.5% <60 years, 7.3% <70 years and 1.9% >or=70 years respectively. 4. Of the 188 patients who had a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS), 127 (68%) were followed up, 99 (78%) were normal and 28 (22%) had squamous intraepithelial lesion. 5. The prevalence rate of cervical neoplasia confirmed by histopathology for the past 10 years was 1.53%. Of those the rate of invasive cervical cancer was 0.65%. 6. The false negative rate was 17.3% and false positive rate was 4.5%. 7. The sensitivity and specificity and positive predictive value of PAP smear were 82.7%, 95.5% and 90.2%. CONCLUSION: For PAP smear to be early detecting tool for cervical cancer, continuous effort is required to raise annual screening rate, to lower the false negative rate, and to raise the sensitivity of PAP smear.
Diagnosis ; Female ; Gyeongsangbuk-do ; Humans ; Mass Screening ; Prevalence ; Sensitivity and Specificity ; Uterine Cervical Neoplasms

BACKGROUND: Scid.adh is a recently developed murine thymic lymphoma cell line, which has been used as in vitro model for the study of double negative stage III thymocytes. In this study, we compared the expression profile of a number of genes and proteins, which are tightly related to T cell development and apoptosis, in thymic lymphoma cell lines, R1.1, EL-4, and Scid.adh for the developmental staging. METHODS: We examined the expression of development marker genes and proteins in three lymphoma cell lines by flow cytometry and RT-PCR. In addition, the expression of apoptosis-related molecules including bcl-2, bax and Fas was also investigated. RESULTS: As previously reported, Scid.adh cell line expressed CD8 and CD25 but not TCR alpha chain, while R1.1 cells expressed TCR alpha chain and both CD4 and CD8 transcripts. These suggest that R1.1 might be in double positive stage, and low level of CD44 expression and the absence of CD25 support this suggestion. In contrast, EL-4 cells showed high level of TCR alpha chain transcript, and low-level of CD4 expression, suggesting that EL-4 is in more mature stage than R1.1. Further, this suggestion was supported by the lack of mT-20 in EL-4 cells, which is expressed in the immature thymocytes, and Scid.adh and R1.1 cell lines, but not in the terminally differentiated thymocytes and peripheral T cells. Among the apoptosis-related gene, transcripts of bcl-2 gene were detected in both R1.1 and EL-4 but not in Scid.adh cells, while bax was expressed in all cell lines. Fas expression was the highest in EL-4 cells and low in Scid.adh cell line. CONCLUSION: R1.1 cell may represent double positive stage, and EL-4 is more differentiated cell line. In addition, Scid.adh and EL-4 cell lines are suspected to be useful for the study of function of bcl-2 family and Fas during the thymocyte development, respectively.
Apoptosis ; Cell Line* ; Flow Cytometry ; Genes, bcl-2 ; Humans ; Lymphoma* ; T-Lymphocytes ; Thymocytes

PURPOSE: Home exposure to aeroallergens are an important environmental factor in allergic sensitization and in the development and exacerbation of asthma. Most studies of aeroallergens were dust mite in Korea, but cockroach distribution was little been known in Korea. The aim of this study was to evaluate species of cockroaches and seasonal distribution of cockroaches in Seoul area. METHODS: The study was performed during April 2000 through January 2001, from 63 houses in Korea. The total of 63 residential homes from different districts in Seoul were selected for the home environment survey. Bait traps (10 x 20 x 4 cm2, Zoro Zoro, Taisho Pharmacy, Tokyo, Japan) were placed on four different places of kitchen floor and one in the side of balcony in the house and left for 5 days to capture cockroaches. RESULTS: The cockroaches were captured in 23 houses(36.5%) out of 63 houses. And the inhabitant density of cockroaches was highest in the autumn(43.3%) followed by summer (29.2%), spring(18.3%) and winter(9.2%). In only 3 species were collected in Seoul area. The most common species were Blattella germanica showing 72.5% of the collected cockroaches, followed by Periplaneta japonica(25.2%) Periplaneta americana(2.3%). The total number of captured cockroaches was 504 and the number of nymph was 314(62.2%). Isolated house type showed higher trapping rates than the apartment. Positive skin test rates were 46.2% in the healthy control group and 43.8% in the allergy patients. CONCLUSION: Periplaneta americana was captured in Seoul area, which had not been found previously. The inhabitant density of cockroaches was the lowest in the winter.
Allergens* ; Asthma ; Cockroaches* ; Dust ; Humans ; Hypersensitivity ; Korea ; Mites ; Nymph ; Periplaneta ; Pharmacy ; Seasons* ; Seoul* ; Skin Tests