Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.
Abdominal Pain ; Afferent Loop Syndrome* ; Amylases ; Constriction, Pathologic ; Endoscopes ; Gastrectomy ; Gastric Bypass ; Humans ; Lithotripsy* ; Middle Aged ; Pancreatic Ducts ; Pancreatitis

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Aged ; Anti-Inflammatory Agents/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Crohn Disease/diagnosis/*drug therapy ; Female ; Gastrointestinal Diseases/pathology ; Humans ; Immunosuppressive Agents/therapeutic use ; Oral Ulcer/diagnosis

BACKGROUND: Dendritic cell (DC)-based vaccines are currently being evaluated as a novel strategy for tumor vaccination and immunotherapy. However, inducing long-term regression in established tumor-implanted mice is difficult. Here, we show that deoxypohophyllotoxin (DPT) induces maturation and activation of bone marrow-derived DCs via Toll-like receptor (TLR) 4 activation of MAPK and NF-kappaB. METHODS: The phenotypic and functional maturation of DPT-treated DCs was assessed by flow cytometric analysis and cytokine production, respectively. DPT-treated DCs was also used for mixed leukocyte reaction to evaluate T cell-priming capacity and for tumor regression against melanoma. RESULTS: DPT promoted the activation of CD8+ T cells and the Th1 immune response by inducing IL-12 production in DCs. In a B16F10 melanoma-implanted mouse model, we demonstrated that DPT-treated DCs (DPT-DCs) enhance immune priming and regression of an established tumor in vivo. Furthermore, migration of DPT-DCs to the draining lymph nodes was induced via CCR7 upregulation. Mice that received DPT-DCs displayed enhanced antitumor therapeutic efficacy, which was associated with increased IFN-gamma production and induction of cytotoxic T lymphocyte activity. CONCLUSION: These findings strongly suggest that the adjuvant effect of DPT in DC vaccination is associated with the polarization of T effector cells toward a Th1 phenotype and provides a potential therapeutic antitumor immunity.
Animals ; Dendritic Cells ; Immunotherapy ; Interleukin-12 ; Lymph Nodes ; Lymphocyte Culture Test, Mixed ; Lymphocytes ; Mice ; Phenotype ; Podophyllotoxin ; T-Lymphocytes ; Toll-Like Receptors ; Up-Regulation ; Vaccination ; Vaccines

OBJECTIVE: To see whether there is a relationship between Korean Falls Efficacy Scale-International (KFES-I) developed for measuring fear of falling and frequency of fall. METHOD: KFES-I was composed with 16 items of activities of daily living including social activities and graded from 1 to 4 in each item. Surveys of 250 patients over 65 years of age from the public health center of Kang-dong and Seong-buk based on KFES-I and fall questionnaire such as presence, frequency and severity of fracture within last 6 months, and combined medical illness were taken. The data of KFES-I, fall questionnaire, and the inter-relationship of KFES-I items had been analyzed by Spearman and Kendall test. RESULTS: There was strong positive correlation between KFES-I total score and the frequency of falls. Four items (item 4, 7, 11, 15) of KFES-I showed strong correlation with the frequency of falls. There was significant difference in KFES-I total score between control and fracture groups (p<0.05). CONCLUSION: Our results showed that there was strong positive correlation between frequency of falls and KFES-I. It is suggested that frequency of falls can be predicted by KFES-I.
Activities of Daily Living ; Aged ; Humans ; Public Health ; Surveys and Questionnaires

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.
Aneurysm, Ruptured/diagnosis/*therapy ; *Embolization, Therapeutic ; English Abstract ; Female ; Humans ; Middle Aged ; *Splenic Artery

OBJECTIVES: The authors analyze the causes of mortality cases after transcranial aneurysm surgery for comparing the safety of the treating methods and for the improvement of treatment outcomes of transcranial surgery. METHODS: Patients recordings and radiological studies were retrospectively reviewed. Causes of postoperative mortality were divided into death related to vasospasm, procedure-related, medical complications and preoperative poor neurological conditions. RESULTS: Postoperative mortality cases were 61 (5.78%) of 1054 transcranial aneurysm surgery during a period of from Jul. 1996 to Nov. 2001. Delayed ischemia related to cerebral vasospasm was a leading cause of death following transcranial aneurysm surgery and accounts for 2% (n=21) of all transcranial surgery and 34.4% of all mortality cases. Procedure-related death were 1.23% (n=13) and were related to inadvertent major artery occlusion, vital perforator injury or intraoperative aneurysm rupture. Death related to medical complications (n=8, 0.75%) were mainly from pneumonia (n=6) in the old age (>65) patients. Patients of initial poor neurological grade (Hunt-Hess grade IV-V, n=19) were mainly from large intracranial hematoma (>30 cc) in temporal lobe or sylvian fissure or multiple aneurysmal bleeding before admission. CONCLUSION: The procedure-related mortality of the transcranial aneurysm surgery is about 1% in this large transcranial aneurysm surgery series and transcranial surgery can be a safe mean of treating intracranial aneurysms compared with other tratment modalities.
Aneurysm* ; Arteries ; Cause of Death ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Ischemia ; Mortality* ; Pneumonia ; Retrospective Studies ; Rupture ; Temporal Lobe ; Vasospasm, Intracranial

The experiments of this study was performed to investigate the effects of sulfur dioxide on the changes of glycoconjugates of respiratory system of the rat. Sprague -Dawley male rats weighing about 200 ~250g were divided into a control group and SO2 exposed groups. Again SO2 exposed groups were divided into 10 ppm, 25 ppm, 50 ppm, 100 ppm and 200 ppm subgroups according to concentrations of SO2 and each SO2 exposed groups were divided into 1, 3 and 6 hours groups. For the histological changes, H -E(hematoxylin -eosin) and PAS(periodic acid Schiff) staining were used and to investigate the change of sugar residues of glycoconjugates, biotinylated lectins(DBA, SBA, PNA, BSL -1, sWGA, UEA -1, LCA and Con A) were applied. Generally, the effects of SO2 on the rat nasal respiratory region were more serious at the high concentrations. Moreover, as the exposed time was longer even at the low concentrations, the effects of SO2 were similar to those of high concentration. Compared with all SO2 concentrations, the longer exposed time was, the more serious the effects of SO2 were. In the SO2 exposed groups the binding of PNA, RCA -1 and UEA -1 of cilia in the nasal septal respiratory epithelium tended to increase in the 10 ppm and 25 ppm SO2 exposed groups but it tended to decrease in the 100 ppm and 200 ppm SO2 exposed groups. In the cytoplasm of columnar cells of nasal septal respiratory epithelium, Con A binding increased in all the SO2 exposed groups. In the goblet cells DBA, SBA, PNA, RCA -1 and UEA -1 binding increased remarkably in the 50 ppm SO2 exposed groups but it decreased largely or disappeared in the 100 ppm and 200 ppm SO2 exposed groups. The binding of SBA, PNA, BSL -1, UEA -1 and Con A in the intraepithelial mucous cells which were not detected in the control group, increased in the 25 ppm and 50 ppm SO2 exposed groups while it tended to decrease in the 100 ppm and 200 ppm SO2 exposed groups. The binding of sWGA increased according to the concentrations of SO2 were higher and exposed times were longer. In the superior nasal septal gland, the binding of PNA increased in the 50 ppm and 100 ppm SO2 exposed groups and that of Con A increased in the 25 ppm and 50 ppm SO2 exposed groups. In the inferior nasal septal gland, except for LCA, the binding of the other lectins increased remarkably in the 25 ppm and 50 ppm SO2 exposed groups but it tended to decrease in the 100 ppm and 200 ppm SO2 groups. In the mucous duct cells, the reaction of PNA and RCA -1 increased compared with that of the control group. And the reaction of BSL -1 and UEA -1 increased in the lower concentrations of 50 ppm SO2 exposed group but it decreased in the 100 ppm and 200 ppm SO2 exposed groups. The binding of Con A increased in the 25 ppm and 50 ppm SO2 exposed groups. Consequently, from the results above mentioned that SO2 affected serious changes on glycoconjugates metabolism in the nasal cavity.
Animals ; Cilia ; Cytoplasm ; Glycoconjugates* ; Goblet Cells ; Humans ; Lectins ; Male ; Metabolism ; Nasal Cavity* ; Rats* ; Respiratory Mucosa* ; Respiratory System ; Sulfur Dioxide

Behcet's disease characterized by recurrent oral and genital ulceration and ocular inflammation has been recognized as a multi-system disorder with numerous manifestations including gastrointestinal tract. Terminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behcet's disease and esophageal involvement is very uncommon. We experienced a case of Behcet's disease involved esophageal and ileocecal region which had been diagnosed by endoscopy. A 20-year-old male was admitted by dysphagia and substernal discomfort. There was a history of recurrent aphthous stomatitis and genital ulcers. The large geographic ulcers surrounded with edematous mucosa were found at mid esophagus and the huge ulcer with exudate was noted on ileocecal valve area in endoscopic examination. The microscopic finding of endoscopic biopsy showed chronic nonspecific inflammation with necrotic inflammatory exudate. Pathergy test was positive. So he was diagnosed as Behcet's disease, and his symptoms and signs were resolved after steroid treatment.
Biopsy ; Cecum ; Deglutition Disorders ; Endoscopy ; Esophagus ; Exudates and Transudates ; Gastrointestinal Tract ; Humans ; Ileocecal Valve* ; Ileum ; Inflammation ; Male ; Mucous Membrane ; Stomatitis, Aphthous ; Ulcer ; Young Adult

Duodenal divertula are relatively frequent findings in the adult gastrointestinal tract. The majority of them are asymptomatic, but vague gastrointestinal complaints have often been attributed to these lesions. These diverticula occasionally result in the obstruction of the biliary and pancreatic ducts, which leads to jaundice and pancreatitis. Other complications such as hemorrhage, perforation, sepsis, and death can occur. With the advent of therapeutic endoscopy, the diagnosis and primary treatment of duodenal diverticula associated with bleeding has changed dramatically since its first reported occurrence. Effectiveness of therapeutic endoscopy is very high in patients with diverticular bleeding in the medial aspect of sencond portion of the duodenum because of its high operative mortality. A cases of a patient suffering from gastrointestinal bleeding in the duodenal diverticulum who was diagnosed and managed by endoscopy alone is herein reported with review of relevant literature.
Adult ; Diagnosis ; Diverticulum* ; Duodenum ; Endoscopy ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Jaundice ; Mortality ; Pancreatic Ducts ; Pancreatitis ; Sepsis

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure