The Study of Manometry and Gastric Emptying Time in Patients after Esophagectomy / 대한소화관운동학회지

BACKGROUND/AIMS: Resection of the esophagus for malignant disease or a benign stenosis, has a choice not only of palliative surgery, but also of replacement of the esophagus with a transposed stomach, jejunum, or colon. The first-line method is replacement with a tubulized stomach. The purpose of this study was to investigate the association of esophageal motor dysfunction and gastric emptying time with symptoms after esophagectomy. METHODS: We performed the esophageal manometry and gastric emptying time after esophagectomy for esophageal cancer in 12 patients and for benign esophageal disease in 2 patients. RESULTS: In manometric studies, a zone of high pressure in the esophago-gastric anastomosis distal to the upper esophageal sphincter was associated with symptoms after esophagectomy. The gastric emptying rate was slowed in 7 out of 14 patients, but not associated with symptoms after esophagectomy. CONCLUSIONS: Our data suggest that a high-pressure zone distal to the upper esophageal sphincter was associated with symptoms after esophagectomy in manometric study. The gastric emptying rate was not associated with postoperative symptoms.

A Case Report of Floxuridine Hepatic Arterial Infusion Therapy for a Metastatic Liver Tumor from Advanced Gastric Cancer

A 45-year-old man was found to have advanced cancer of the gastric antrum and lower body with multiple liver metastases. A palliative subtotal gastrectomy was performed, and multiple hepatic lesions were treated by hepatic arterial infusion therapy with floxuridine (FUdR) 3 weeks after the operation. This therapy was given for 14 days every 3 weeks. He received 4 cycles of the therapy. A systemic combination of chemotherapy with 5-FU and cisplatin was also perfomed. These two courses of intraarterial infusion therapy produced marked regression of liver metastases and necrosis. The effect was, thus, rated as a partial response. However, after the 4th course of the therapy, the patient dropped out for personal reasons. A brain metastasis was found 4 months later, and this intraarterial infusion therapy could no longer be performed. This case indicates that intraarterial infusion chemotherapy with FUdR may be useful in treating multiple liver metastases from gastric cancer.

Usefulness of expression of protease as biologic marker in 5-FU resistant human colon cancer cell line HT29 / 대한내과학회지

There have been many reports that colon cancer responds poorly to chemotherapy. Several classes of matrix metalloproteinases(MMPs) have been implicated in the process of invasion of epithelial and endothelial basement membranes in several steps of tumor invasion and metastasis. This study was performed to determine the biologic behavior and the histopathological characteristics of a 5-FU resistant colon cancer cell line. METHODS: We performed several biologic assays including liver colonization assay, cell adhesion assay, invasion assay and zymogram for protease activity using parental HT29 cell and 5-FU resistant HT29 cell (HT29-FU cell). RESULTS: In liver colonization assay, HT29-FU cell revealed a 2.5-fold increase in the liver weight and tumor burden compared with HT29 cell. HT29-FU cell showed moderate increase in adhesion and invasion assays in comparison to HT29 cell. HT29-FU cell revealed increased activity of MMPs and serine protease. Xenograft tumors of HT29-FU cell formed moderately differentiated adenocarcinoma with more glandular formations of mucin. CONCLUSION: The increased expression of MMPs in 5-FU resistant colon cancer cell can explain poor prognosis. These are potentially poor prognostic indicators in 5-FU resistant colon cancer. Consequently, it can be suggested that modulation of MMPs is needed to prevent invasion and metastasis in colon cancer by using inhibitors of these enzymes.

Torsade de Pointes in Advanced Atrioventricular Block: A Cause of Syncope

Advanced or complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks even though escape rhythm is maintained. Torsades de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Maintaining ventricular rate over 70 beats/min is known to be important to normalize QT interval and to reduce the possibility of bradycardia-related TdP recurrence after pacemaker implantation. We report one case of syncopal attacks associated with TdP in a 70 year old female patient with advanced AV block and prolonged QT interval. She was referred to evaluate palpitation and syncope. Advanced AV block and QT interval prolongation were seen with electrocardiography, but junctional escape rhythm was maintained. Syncopal attacks occurred during temporary pacemaker insertion. Multiple episodes of nonsustained polymorphic ventricular tachycardia and TdP related to syncopal attacks were demonstrated by 24-hour Holter monitoring. A permanent pacemaker was implanted and ventricular rate was set over 70 beats/min resulting in no recurrence of TdP and syncope.

Transradial Approach for Coronary Angiography and Interventions: Practical Applicability at a High-volume Laboratory and Safety in Korean Patients

BACKGROUND AND OBJECTIVES: Radial approach was introduced as a route for coronary angiography or interventions. We assessed clinical applicability at a high-volume laboratory and safety. MATERIALS AND METHOD: Procedure-related results were compared between phase I period including learning curve and phase II period in 326 patients, in whom coronary angiography or interventions were performed by radial approach. RESULTS: 1) Success rate was 90% (292/326) in all patients, which significantly increased to 95% (246/259) during phase II compared to 69% (46/67) during phase I. 2) Time from local anesthesia to sheath placement and time for first coronary cannulation were 4.3+/-2.7min, 3.1+/-1.9min, respectively, in all patients, which significantly decreased to 3.8+/-3.6min, 2.7+/-2.4min during phase II compared to 7.0+/-3.2min, 5.7+/-4.7min during phase I. Total examination time was 21.7+/-5.5min in all patients, which significantly decreased to 20.4+/-6.2min during phase II compared to 28.3+/-8.0min during phase I. 3) Overall procedural success rate of coronary interventions was 94% (98/104). Guidewire didn't pass in 5 (5%) patients with chronic total occlusion and stent wasn't delivered in 1 (1%) due to poor guiding backup. 4) During follow-up of 61+/-25 days, weak or absent radial pulse, abnormal reverse Allen test were observed in 13 (5%), 3 (1%), 15 (6%) patients, respectively, but no claudication observed. CONCLUSION: Coronary angiography and interventions by radial approach was safe and performed without more time delay after learning curve.

A Case of Hypertension Secondary to Paraganglioma of the Posterior Mediastinum

The familial form in primary pulmonary hypertension is inherited as an autosomal dominant trait and is associated with a pattern of "genetic anticipation", a worsening of disease in subsequent generation, manifestated by greater severity or earlier onset. Familial primary pulmonary hypertension acounted for 6 percent of the 187 cases in the NIH registry. But, there is no reported case on Korea. We report on 25 years old woman who had PPH presenting with exertional dyspnea and dry coughing during second baby pregnancy and whose brother dies of PPH in other Hospital. Her simple chest X ray, 2-D Echocardiography, pulmonary angiogram and cardiac catheterization findings were compatible with typical primary pulmonary hypertension. Pulmonary function test was normal and perfuion lung scan had no evidence of pulmonary thromboembolism. There was no evidence of connective tissue diseases including SLE, RA, polymyositis and dermatomyositis and so on in the laboratory findings. Her younger brother had been admitted to other hospital due to aggravation of dyspnea, progressing slowly for 3 years and his case diagnosed as PPH through echocardiography, cardiac catheterrization, open lung biopsy and so on.