A Case of SMA Syndrome after Stenting at the Isolated Dissection of SMA / 대한내과학회지

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. Various medical and psychiatric conditions may result in the initial rapid weight loss that causes narrowing of the aortomesenteric angle. Isolated dissection of the superior mesenteric artery (DSMA) is an uncommon cause of acute mesenteric ischemia. Several literature reports suggest that medical treatment in combination with close observation is reasonable in uncomplicated dissection with stable hemodynamic status. Recently, as several reports describe, rapid revascularization by percutaneous angioplasty and endovascular stent insertion can prevent bowel ischemia that progresses to irreversible bowel necrosis. However, the stability of endovascular stents at the DSMA has not been confirmed, because its use is reasonably infrequent. Here, we report a case of SMA syndrome, as a complication of endovascular stent placement at the DSMA.

Polyphenol (-)-epigallocatechin gallate targeting myocardial reperfusion limits infarct size and improves cardiac function / 대한마취과학회지

BACKGROUND: This experiment was performed to determine the effect of polyphenolic (-)-epigallocatechin (EGCG), the most abundant catechin of green tea, given at reperfusion period. METHODS: Isolated rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Green tea extract (GT) was perfused with the following concentrations; 0, 0.5, and 1 micrometer (GT-O, GT-0.5, and GT-1, respectively). In a next experiment, hearts were assigned randomly to one of the following groups; Control, EGCG-1 (1 micrometer of EGCG), and EGCG-10 (10 micrometer of EGCG). GT and EGCG were perfused for a period of 5 min before and 30 min after reperfusion. For comparison of cardioprotection among groups, morphometric measurement was performed by 2,3,5-triphenyltetrazolium chloride staning. RESULTS: GT 1 micrometer (10.3 +/- 2.1%, P < 0.05) significantly reduced infarct volume as a percentage of ischemic volume compared to untreated hearts (27.4 +/- 1.1%). EGCG 10 micrometer (13.2 +/- 4.0%) significantly reduced myocardial infarction compared to control hearts (27.2 +/- 1.4%, P = 0.002). After 2 h of reperfusion, cardiodynamic variables, including left ventricular developed pressure, rate-pressure produce, +dP/dt(max), and -dP/dt(min) were significantly improved by 10 micrometer of EGCG compared to control hearts (P = 0.01, 0.016, 0.009, and 0.019, respectively). CONCLUSIONS: EGCG treatment at an early reperfusion period reduces myocardial infarction and improves cardiodynamics in isolated rat hearts.

Polyphenol (-)-epigallocatechin gallate targeting myocardial reperfusion limits infarct size and improves cardiac function / 대한마취과학회지

BACKGROUND: This experiment was performed to determine the effect of polyphenolic (-)-epigallocatechin (EGCG), the most abundant catechin of green tea, given at reperfusion period. METHODS: Isolated rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Green tea extract (GT) was perfused with the following concentrations; 0, 0.5, and 1 micrometer (GT-O, GT-0.5, and GT-1, respectively). In a next experiment, hearts were assigned randomly to one of the following groups; Control, EGCG-1 (1 micrometer of EGCG), and EGCG-10 (10 micrometer of EGCG). GT and EGCG were perfused for a period of 5 min before and 30 min after reperfusion. For comparison of cardioprotection among groups, morphometric measurement was performed by 2,3,5-triphenyltetrazolium chloride staning. RESULTS: GT 1 micrometer (10.3 +/- 2.1%, P < 0.05) significantly reduced infarct volume as a percentage of ischemic volume compared to untreated hearts (27.4 +/- 1.1%). EGCG 10 micrometer (13.2 +/- 4.0%) significantly reduced myocardial infarction compared to control hearts (27.2 +/- 1.4%, P = 0.002). After 2 h of reperfusion, cardiodynamic variables, including left ventricular developed pressure, rate-pressure produce, +dP/dt(max), and -dP/dt(min) were significantly improved by 10 micrometer of EGCG compared to control hearts (P = 0.01, 0.016, 0.009, and 0.019, respectively). CONCLUSIONS: EGCG treatment at an early reperfusion period reduces myocardial infarction and improves cardiodynamics in isolated rat hearts.

Ischemic Postconditioning Inhibits Mitochondrial Permeability Transition Pore via Opioid Receptor Activation in Intact Rat Heart / 대한마취과학회지

BACKGROUND: Ischemic postconditioning (Post-C), brief cycles of myocardial ischemia and reperfusion during the early phase of reperfusion, is considered as a novel adjunct strategy to protect myocardium.However, the exact mechanism remains unclear and should be determined. METHODS: The hearts of male Wistar rats were subjected to 30 min ischemia and 2 hrs reperfusion.Control rats had no intervention either before or after left coronary artery occlusion.Post-C was elicited by 6 cycles of 10s reperfusioninterspersed by 10s ischemia immediately after onset of reperfusion.Subsets of postconditioning rats were treated with drugs as followings; naloxone (non-selective opioid receptor antagonist), naltrindole (a delta-opioid receptor antagonist), SB216763 (a glycogen synthase kinase 3beta inhibitor, GSK-3beta inhibitor), or atractyloside (a mitochondrial permeability transition pore opener, mPTP opener). RESULTS: Post-C significantly reduced infarct size (15.9 +/- 2.4%, P = 0.003) compared to control (29.9 +/- 3.7%).The anti-infarct effect by Post-C was blocked by both naloxone (25.5 +/- 3.9%, P = 0.044) and naltrindole (26.9 +/- 2.3%, P = 0.022).Infarct size limiting effect by Post-C was also abolished by atractyloside (30.6 +/- 3.6%, P = 0.003).In SB216763 with naloxone treated animals, the infarct size was decreased (17.4 +/- 3.2%, P = 0.007) but not in SB216763 with atractyloside treated animals (27.4 +/- 2.6%) compared to control. CONCLUSIONS: These data suggest that Post-C may protect myocardium by inhibiting mPTP opening via delta-opioid receptor activation.GSK-3beta is a downstream mediator of opioid receptors and an upstream mediator of mPTP opening in Post-C.

Classification and Management of Gynecomastia

Psychological and social disturbances can be caused by gynecomastia and nipple hypertrophy. Several corrections for these problems have been developed. Recently, social trends focus on a good body shape. Young male patients increasingly visit hospitals to correction of minor deformities of breasts. These patients don't visit the hospital for just one of pathologic problem but seek corrections for multiple problems. These problems are mild forms of gynecomastia, nipple hypertrophy and areolar hypertrophy. Ten patients have visited our hospital to correct various problems using multiple procedures. Liposuction was used to reduce breast tissue in gynecomastia. Protruding of areola was corrected by intra-areola or circum-areola parenchymal excision. Large areolas were reduced by intra-areola circular incision. Large nipples were reduced by Regnault tehnique or wedge resection. We conclude that new trends of male breast correction is to watch nipple-areola-breast as one complex. A combined procedures must be done for correction of these trends.

Anaesthesia Using Propofol for Plastic Surgery

Propofol is widely used for supportive sedation in local and regional anaesthesia in plastic surgical procedure. We studied comparative effect of propofol comparing fontanel and midazolam that was previously used. From April 2003 to July 2005, 118 patients were reviewed whom propofol was used intravenous sedation in various plastic surgical procedures. In some cases, midazolam were used initially then converted to propofol. Patients were questioned for their satisfaction in group of propofol alone and midazoline and propofol combination. Vital sign(Blood pressure, Respiration rate) and O2 saturaion, sedation time, side effect and subjective satisfaction were evaluated. The result reveals that propofol is effective medicine for supplement intravenous sedative medicine for plastic surgeries especially when it was used with combination of midazolam.

A Case of Necrotizing Fasciitis of Lower Leg Following Mandible Angle Ostectomy

Mandible angle ostectomy is the most widely-operated facial contour surgery. We experienced a rare case of necrotizing fasciitis of the lower leg following mandible angle ostectomy. A 20 years old female visited our department 5 days after mandible angle ostectomy. At the time, she was diagnosed as sepsis and on her 2nd admission day, she was diagnosed as necrotizing fasciitis on her left leg. She was treated by fasciotomy and necrotized tissue removal. Necrotizing fasciitis is a rare complication of any kinds of operation but once it develops, it causes fatal results, especially to cosmetic surgeries. Early diagnosis and aggressive operation is known as only treatment for the disease.

CT Findings of Gastrointestinal Stromal Tumor versus Lymphoma of the Small Intestine

PURPOSE: To compare CT features of gastrointestinal stromal tumors (GIST) with those of lymphomas in the small intestine. MATERIALS AND METHODS: CT findings of 11 pathologically confirmed GIST patients and 10 lymphoma patients were retrospectively reviewed. CT findings were analyzed with regard to location, size, margin, growth patterns, internal character, enhancement, invasion, vascular encasement, lymphadenopathy, intestinal obstruction and ascites. RESULTS:An extraluminal mass was present in 82% (9/11) of the GIST patients versus 30% (3/10) of the lymphoma patients. Circumferential wall thickening was observed in 80% (8/10) of the lymphoma patients (p.05). CONCLUSION: Features revealed by CT scans are highly useful in differentiating GIST from lymphoma of the small intestine. Extraluminal growth and internal necrosis or gas are more common in patients with GIST compared with lymphoma. CT features of circumferential wall thickening and associated lymphadenopathy are more common in patients with lymphoma.

Radiologic Findings of Extraosseous Ewing's Sarcoma

PURPOSE: The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. MATERIALS AND METHODS: Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. RESULTS:The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm (mean, 5.2 cm), were mainly well circumscribed and showed no evidence of calcification prior to treatment. Margins were well defined in four out of the six patients. Four patients had subcutaneous lesions and the other two patients had intramuscular lesions. Muscle (two patients) and bone invasion (one patient) were present. The masses were heterogenous low signal intensity on T1 weighted images and heterogeneous high signal intensity on T2 weighted images compared with muscle. Heterogeneous enhancement within the lesion was observed in all patients on CT and MRI. Whole body scintigraphy using Tc-99 m MIBI showed increased uptake in the masses of two patients. CONCLUSION: Extraosseous Ewing's sarcomas were frequently seen as a well-circumscribed ovoid mass with nonspecific findings on CT and MRI. Despite being a relative rare tumor, it should be included in the differential diagnosis of a non-calcified soft-tissue mass, especially in subcutaneous tissue.

Percutaneous Radiofrequency Ablation of Inoperable Primary Lung Cancer

PURPOSE: To present the initial experience of percutaneous radiofrequency ablation (RFA) of inoperable primary lung cancer, and to assess the technical feasibility and potential complications. MATERIALS AND METHODS: Twenty patients with inoperable lung cancer underwent percutaneous RFA. Nineteen of 20 patients had stage III or IV non-small cell lung cancer, and the remaining one had stage I lung cancer with pulmonary dysfunction. The mean tumor size was 4.6+/-0.4 cm (range, 1.8-8.4 cm). RFA was performed with a single (n=18) or cluster (n=2) cool-tip RF electrode and a generator under CT guidance using local anesthesia and conscious sedation. Twenty tumors were treated in 28 sessions. Patients were assessed by contrast-enhanced CT in all cases at 1 week, 1 month, and 3 months. Eleven patients received chemotherapy (n=10) or radiotherapy (n=1) after RFA. RESULTS: RFA was technically successful and well tolerated in all patients. Complete necrosis was attained in 7 lesions (35%), near complete (90-99%) necrosis in 10 lesions (50%), and partial (50-89%) necrosis in 3 lesions (15%). During the mean follow up of 202 days (21 to 481 days), tumor size was decreased in 13 patients, unchanged in 3, and increased in 4. In the latter four, additional RFA was performed. One patient underwent surgery three months after RFA and the histopathologic findings showed a large cavity with thin fibrotic wall suggestive of complete necrosis. During or after the procedure, pneumothorax (n=10), moderate pain (n=4), blood tinged sputum (n=2), and pneumonia (n=2) were developed. Chest tube drainage was required in only 1 patient due to severe pneumothorax. Other patients were managed conservatively. Seven patients died at 61 to 398 days (mean, 230 days) after RFA. The remaining 13 patients were alive 21 to 481 days (mean, 187 days) after RFA. CONCLUSION: RFA appears to be a technically feasible and relatively safe procedure for the cytoreductive treatment of inoperable, non-small cell lung cancer and warrants further investigation as a complementary treatment to chemotherapy or radiation therapy.

Ingestion of a Mouthpiece Fragment during Intravenous Sedated Upper Gastrointestinal Endoscopy: Three Cases / 대한소화기내시경학회지

The demand for intravenous sedated upper gastrointestianl endoscopy is currently increasing steeply. Despite this trend, patient status complication due to this procedure is largerly neglected by most physicians. Recently, in three patients, mouthpiece fragment were left within the patients' body after intravenous sedated upper gastrointestinal endoscopy. They were transferred to our institution for the removal of the fragment. The patients complained of an uneasy sensation from within their body, around their necks and chests. After conducting therapeutic endoscopy, the fragment could be located around the distal part of their esophagus and within their stomach. The fragment were removed successfully by using snare in two patients, and by using forceps in another patient.

Studies on the Cytotoxicity and Antineoplastic Activity of Methyl Gallate / 대한해부학회지

In order to develop antitumor agent which indicates weak side effects and strong antitumor activity, cytotoxicity and antitumor effects of MG was evaluated by MTT assay and SRB assay of colorimetric assay methods on the cultured NIH 3T3 fibroblasts and human oral epithelioid carcinoma cells (KB cells). KB cells were cultured in EMEM and RPMI 1640 media containing 10% fetal bovine serum, antibiotics and fungizone. After incubation for 24 hrs, the cells were treated with MG by dose dependent manner for 48 hrs under the same condition. The MTT and SRB quantity were measured by ELISA reader (Spectra Max 250, USA). The microscopic study was carried out to observed morphological change, Ag-NORs (argyrophylic nucleolar organizer region) number and PAS positive reacton of cultured KB cells. The results were as follows; 1. The MTT50 were 16677 micrometer in NIH 3T3 cell and 65.55 micrometer in KB cells treated with MG. 2. The SRB50 were 8701.23 micrometer in NIH 3T3 cell and 168.81 micrometer in KB cells treated with MG. 3. The number of Ag-NORs was not significant in cultured NIH 3T3 cells, but the number of Ag-NORs was significantly decreased in cultured KB cells treated with MG. 4. PAS reaction of cultured NIH 3T3 cells was not changed, but PAS reaction of cultured KB cells was changed to negative reaction. 5. Morphological changes of cultured NIH 3T3 cells treated with MG was weak, but KB cell treated with MG was severe. These results indicate that MG have noncytoxicity on NIH 3T3 fibroblasts and high cytotoxicity on KB cells.

Inflammatory Pseudotumor of the Lung: CT Findings and Pathologic Correlation

PURPOSE: To define the CT findings of inflammatory pseudotumor of the lung, and determine pathologiccorrelation. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of seven patients withpathologically-proven (surgery:n=6; automated gun biopsy:n=1) inflammatory pseudotumor of the lung. Postcontrastscans were obtained in six cases, while one underwent only precontrast scanning. In all cases, these resultscorrelated with pathologic findings. RESULTS: In five cases, CT showed that irregular, spiculated nodules ormasses contacted with the pleura; in one, a well-defined nodule contacted with the fissure; and in one, there wasconsolidation. On postcontrast CT images, all six cases showed enhancement, with a central, low-density component. In four cases, ground-glass opacity surrounding the lesion was identified, and in three focal pleural thickeningadjacent to the lesion was noted. The predominant pathologic composition of the enhanced portions of the lesion,as seen on CT, was chronic inflammatory or spindle cells, and the angiogenesis of small vessels was also noted.Non-enhanced, central, low-density areas were accounted for by hemorrhaging, necrosis and the focal aggregation ofacute and chronic inflammatory cells. Surrounding gound-glass opacity corresponded pathologically to organizingpneumonia, cellular infiltration along the alveolar wall, and alveolar collapse. CONCLUSION: The CT features ofinlammatory pseudotumor of the lung were mainly peripheral irregular, spiculated nodule or mass, withcontrast-enhancement and a central low-density component, combined with surrounding ground-glass opacity. Allthese findings correlated well with pathologic findings.

Expandable Metallic Stents in the Palliative Treatment of Malignant Tracheobronchial Stenosis

PURPOSE: To report the outcome of using expandable metallic stent in the management of malignanttracheobronchial stenosis with dyspnea. MATERIALS AND METHODS: Under fluoroscopic and bronchoscopic guidance,seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause ofstenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the tracheain one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the leftmain bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chestradiography(n=7), bronchoscopy(n=5), pulmonary function test(PFT)(n=3), and spirometry(n=1) were performed beforeand after stent placement. RESULTS: In all seven patients, the stent was successfully placed at the lesion sitesand dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed anincrease in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume inone second(FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min.During median follow-up of 67(41-1565)days, one stent migration occurred. In one patient, proximal tumorovergrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. CONCLUSION: For in thepalliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal steuts issafe and effective.

Correction of Malfunctioning peritoneal Dialysis Catheter with Guidewire and Stiffener Under fluoroscopic Guidance

PURPOSE: To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. MATERIALS AND METHODS: Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate (n=14) and painful dialysis (n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. RESULTS: Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15 (47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. CONCLUSION: The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.