Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus

Swallowing is a rare cause of neurally mediated syncope. The mechanism of swallow syncope that contributes to hypotension, bradycardia, or to both is complex. A 59-year-old man had experienced a recurrent loss of consciousness during swallowing of carbonated beverages or sticky foods. Another 59-year-old man had complained of intermittent syncope just after eating foods. These two patients had no significant structural or functional abnormalities in the esophagus or heart. Both cases showed bradycardia when the lower esophagus was stretched by balloon inflation. The activation of mechanoreceptors in the lower esophagus can be regarded as an initiating factor of these cardioinhibitions. The patients were treated with permanent pacemaker implantation and instructed to change eating habits, respectively.

A Case of Enteritis Cystica Profunda in the Duodenal Bulb / 대한소화기내시경학회지

Enteritis cystica profunda (ECP) is characterized by mucin-filled cystic spaces that are partially lined by non-neoplastic columnar epithelium, and these are found in the wall of the small bowel. This is a very rare disease compared to cystica profunda involving the stomach or colon. The cause of ECP is still unclear. Most ECP is related to or it may accompany other intestinal diseases. We encountered one case of ECP of the duodenal bulb that presented as polyp, and this was not related to adenocarcinoma or any other intestinal diseases like Crohn's disease or ulcerative colitis. Endoscopic polypectomy was done and the ECP was later confirmed through histological evaluation.

Effectiveness of Esophagography as a Screening Test of LPR / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR), a most common cause of non-infectious laryngitis, occupies 20~30% of ENT outpatients, and over a half of patients who complains of voice disorder and laryngeal symptoms are associated with LPR. So we evaluate the usefulness of the esophagography as an initial screening test for patients suspected of LPR. SUBJECTIVES AND METHOD: From 2000 to 2002, we performed esophagography with water-siphon (WS) test for 540 patients with typical symptoms and telescopic findings. The results of esophagography were compared with those of 113 patients confirmed with gastroesohageal reflux (GER) and 174 patients without LPR or GER. The results of WS test were classified into normal, mild, moderate and severe according to the degree of reflux. RESULTS: In the WS test of LPR group, 48 patients were normal (8.9%), 166 mild (30.7%), 143 moderate (26.5%) and 183 severe degree of reflux (33.9%). We evaluated moderate and severe degree of reflux as having positive findings of the WS test because mild degree of reflux can be seen in physiologic conditions. In the LPR group, the positive ratio of WS test was 60.4%. In GER group, 12 patients were normal (10.6%), 30 mild (26.5%), 31 moderate (27.7%), 40 severe degree of reflux (35.4%) and 62.8% of positive WS test. In 174 patients without LPR or GER, 73 patients were normal (42.0%), 40 mild (23.0%), 17 moderate (9.8%) and 44 presented severe degree of reflux (25.2%). Fourty-two patients of the 540 LPR group (7.8%) showed esophageal lesions in esophagography. CONCLUSION: In literature, the sensitivity of esophagography is reported as 33%, but reflux provocation using the WS test increases the sensitivity over 60%. Also, esophagography can demonstrate esophageal abnormalities that might otherwise be missed. So we confirmed the effectiveness of esophagography as a strong initial screening test for LPR.

The Characteristics of Korean Smoker, Enrolled in'5 day Smoking Cessation4 School' and The Effect of Inpatient Smoking Cessation Program / 결핵및호흡기질환

BACKGROUND: Cigarette smoking is the single biggest avoidable cause of death and disability in most countries. Effective prevention of cigarette Smoking and help for those wishing to quit can therefore yield enormous health benefits for populations and individuals. Although most of smokers try to stop smoking for themselves, the success rate of quitting smoking is very low. Promoting and supporting smoking cessation should be an important health policy priority for healthcare professionals in all clinical settings. In this study, we tried to evaluate the effect of the educational program for smoking cessation of our hospital, the smoking pattern, and characteristics of adult smokers enrolled in the program. METHODS: We enrolled 640 smokers, who has visited the '5 day stop smoking school' for smoking cessation from Jan 1998 to 2001. we evaluated the characteristics of the smokers based on the self report questionnaire at the beginning of the program and we also checked 100 smokers, enrolled in Inpatient Smoking Cessation Educational program, their smoking behavior and the cessation rate with postal questionnaire after finishing this program from Nov 2002 to Jan 2003. RESULTS: The health was most common motivation for smoking cessation. The stress was the most important motivation of smoking. The overall smoking cessation rate of the smokers enrolled in inpatient smoking cessation school was 60%. The age of starting smoking and the kind of occupation have a significant difference between the success group and failure group of smoking cessation. CONCLUSION: The inpatient smoking cessation program was effective smoking cessation intervention in the adult smokers who enrolled in '5 day stop smoking school'.

A Case of Atypical McCune-Albright Syndrome Associated with Hyperthyroidism and Hypersecretion of Growth Hormone / 대한내분비학회지

McCune-Albright syndrome is characterized by polyostotic fibrous dysplasia, Caf -au-lait pigmentation and precocious puberty or other endocrinopathy. It can be caused by substitution of His, Cys or Gly for Arg 201st amino acid of the Gs protein subunit. The case of a 32-year-old woman, with atypical McCune-Albright syndrome, is reported. She had no skin lesion or precocity puberty. The polyostotic fibrous dysplasia was examined by a simple radiological image and whole body scan. She developed hyperthyroidism, with a multinodular toxic goiter. No thyroid related autoantibodies were detected. The cause of hyperthyroidism was thought to be a non- autoimmune thyroid hyperfunction. The level of growth hormone was not suppressed by oral glucose load. After a bromocriptine suppression test, the level of growth hormone decreased. There was no mass in the pituitary gland on a sellar MRI. A case of atypical McCune-Albright syndrome, including hyperthyroidism and hypersecretion of growth hormone, is reported.

A case of Deletion of Chromosome 4p / 대한산부인과학회잡지

We have known that deletion of chromosomal 4p resulted Wolf-Hirschhorn syndrome. Wolf-Hirschhorn syndrome, first described in 1965 by Wolf et al and Hirschhorn et al, is defined multiple congenital anomalies and mental retardation syndrome resulting from deletion involving chromosomal band 4p. The main features of this syndrome are microcephaly, frontal bossing, dolycocephaly, hypoplasia of the eye socket, ptosis, strabismus, nystagmus, bilateral epicanthic folds, cleft lip, palate, beaked nose, hypospadias, cardiac malformations and mental retardation (IQ 20-30). As we experience a case of deletion of chromosome 4p by doing cytogenetic study due to abscence of fetal stomach on sonography and increased fetal nuchal folds, we report our case with a literature review.

A case of abnormally exposed nodular shaped-bronchial vessel occurred massive hemorrhage during bronchoscopy / 결핵

A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.

A case of abnormally exposed nodular shaped-bronchial vessel occurred massive hemorrhage during bronchoscopy / 결핵

A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.