Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy-responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

BACKGROUND/AIMS: In patients with gastroesophageal reflux disease (GERD), an increased esophagogastric junction (EGJ) distensibility has been described. Assessment of EGJ distensibility with the endoscopic functional luminal imaging probe (EndoFLIP) technique might identify patients responsive to transoral incisionless fundoplication (TIF), whereas postoperative measurement of EGJ distensibility might provide insight into the antireflux mechanism of TIF. Therefore, we investigated the value of the EndoFLIP technique in GERD patients treated by TIF. METHODS: Forty-two GERD patients underwent EGJ distensibility measurement before TIF using the EndoFLIP technique. In a subgroup of 25 patients, EndoFLIP measurement was repeated both postoperative and at 6 months follow-up. Treatment outcome was assessed according to esophageal acid exposure time (AET; objective outcome) and symptom scores (clinical outcome) 6 months after TIF. RESULTS: Multiple logistic regression analysis showed that preoperative EGJ distensibility (OR, 0.16; 95% CI, 0.03-0.78; P = 0.023) and preoperative AET (OR, 0.62; 95% CI, 0.42-0.90; P = 0.013) were independent predictors for objective treatment outcome but not for clinical outcome after TIF. The best cut-off value for objective outcome was 2.3 mm2/mmHg for preoperative EGJ distensibility and 11% for preoperative AET. EGJ distensibility decreased direct postoperative from 2.0 (1.2-3.3) to 1.4 (1.0-2.2) mm2/mmHg (P = 0.014), but increased to 2.2 (1.5-3.0) at 6 months follow-up (P = 0.925, compared to preoperative). CONCLUSIONS: Preoperative EGJ distensibility and preoperative AET were independent predictors for objective treatment outcome but not for clinical outcome after TIF. According to our data, the EndoFLIP technique has no added value either in the preoperative diagnostic work-up or in the post-procedure evaluation of endoluminal antireflux therapy.

Development and Evaluation of Nutrition Education Program for Middle Aged Men at Worksite / 대한지역사회영양학회지

The purpose of this study was to develop, implement and evaluate a nutrition education program for middle aged men at a worksite. To be read easily, induce interest, and selected at need, seven 6-page leaflet aets were developed, which was the most preferable from chosen by the subjects. The contents of leaflet set were [Changing life style], [Good food habit],[Weight control and diet],[Cardiovascualr disease and diet], [Alimentary disease and diet],[Diaabetes and diet],and [Liver disease and diet]. Nutrition education was provided for 61 middle aged men(30 professors, 31 office workers) at a worksite from 40 mins to one hour. And the level of nutrition knowledge and nutrition attitude were tested to evaluate the effects of the nutrition education program with a developed leaflet set before and after nutrition education. After the nutrition deucation. the nutrition knowledge score had increased significantly at p<0.001, from average 9.3 point to 11.4 point. The level of nutrition knowledge was increased significantly at p<0.001, and the prevalence of misconceptions and the uncertainty of knowledge were decreased significantly at p<0.05. There was a significant difference between professors and office workers both before and after the program. Also, there was a significant increase in the attitude about nutrition score after the program and this means that the subjects were flexibly more open minded about nutrition than before(from 39.9 point, at p<0.001). The difference in the nutrition attitude score between professors and office workers was not significant both before and after the nutrition deucation. The developed leaflet set was evaluated very positively in understanding, interest, timing, and usage by the subjects.

Atrial Ectopic Tachycardia in Infant

PURPOSE: Atrial ectopic tachycardia (AET) in older children and adult is characterized by being chronic, incessant and intractable. However, the nature of infantile AET is not defined yet. The purpose of this study was to evaluate our experience of infantile AET. METHODS: We retrospectively reviewed the medical records of 13 infants (mean onset age, 2.8 +/- 2.3 months) diagnosed at Seoul National University Children's Hospital from June, 1988 to June, 1996. Multifocal atrial tachycardia (AT) and postoperative AT were excluded. RESULTS: AET was presented with congestive heart failure in 8, fast heart rate in 4 and associated cardiac defect in 1. During tachycardia, atrial rates ranged 150-300 beats/min (mean +/- SD, 214 +/- 45 beats/min). Four had associated cardiac anomalies: atrial septal defects in 3, multiple cardiac tumor associated with tuberous sclerosis in 1. All infants with AET were received medical therapy: digoxin (D) only (4), D+beta-blocker (1), D+amiodarone (4), D+flecainide (3), D+amiodarone+flecainide+beta-blocker (1). Conventional drug with digoxin was partially effective. In intractable 7 cases, combination of D, amiodarone and/or class Ic drug (flecainide) was necessary to control AET. This medical regimen suppressed AET in all. During follow up (mean +/- SD, 37.1 +/- 15.8 months), all except 1 recovered from AET. In 1 with large atrial septal defect, AET could be controlled only after operation. A case died of sepsis. CONCLUSION: In this study, infantile AET showed good prognosis and resolved during follow up. Medical management was possible in all cases. However, proper selection and combination of complex antiarrhythmic drug, including amiodarone and class Ic drugs were necessary to control AET in almost all the cases.

Early Results of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children

PURPOSE: Although the data of radiofrequency catheter ablation (RFCA) of supraventricular tachycardia in adults has been accumulated in several centers in Korea, few data are available on its efficacy and safety in pediatric ages. We reviewed the data in young patients who underwent this procedure in a pediatric cardiology center, to evaluate the indications, early results, complications, and short-term follow-up data. METHODS: We retrospectively reviewed the medical records and RFCA procedure reports of 17 children who underwent this procedure in pediatric cardiology center, Asan Medical Center, Seoul, Korea from January 1992 to July 1996. The mean follow-up periods was 17.8 months. RESULTS: 1) The median age of the patients was 12.3 years and all of them except two patients had structurally normal hearts. The indications of RFCA were preoperative open heart surgery in a patient, drug refractory tachycardia in 4 patients and patient's choice in other 12 patients. 2) The mechanisms of supraventricular tachycardia were 9 atrioventricular reentrant tachycardia, 6 atrioventricular nodal reentrant tachycardia (AVNRT), 1 atrial flutter and 1 atrial ectopic tachycardia (AET). Among accessory pathways, preexcitation was in 6 patients and accessory pathway located in the right side in 7 patients. In all patient with AVNRT except one, slow pathway was ablated. In the case of AET, ectopic focus located in the left atrium near the orifice of right lower pulmonary vein. 3) 16 of 18 procedures (88.9%) were successful and in 2 occasions with right sided accessory pathway and AET, the procedure failed. Ectopic focus was successfully ablated at the second attempt. The mean total procedure time was 2.7 hours (n=16) and the mean fluoroscopic time was 45.3 minutes (n=12). The average number of RF application was 11 times. There was no significant complications related with procedures. 4) There were 5 recurrences (29.4%), in 2 patients with accessory pathway and 2 patients with AVNRT. Most recurrences occured in 6 weeks after procedure. CONCLUSIONS: RFCA is a good alternative for the treatment of supraventricular tachycardia also in young patients as in adults. Early results of RFCA shows resonably good success rate but somewhat higher rate of recurrence in our center. We expect the results of RFCA in children will be improved in near future after some period of learning curve.

Radioprotective efficacy of HT + AET in encapsulated form.

Entrapment of 5-hydroxyl-L-tryptophan (HT) in erythrocyte ghost prepared by hypotonic method and high voltage electric discharge method are nearly same. Release of HT with beta-aminoethylisothiuronium bromide hydrobromide (HT + AET) in in vitro system is rapid but only a portion of the entrapped amount is released. Release of HT + AET in serum marginally increases at 2 hr. Compared to release in in vitro medium the release in serum is less. Survival studies with Swiss albino mice indicates that compared to HT alone, the combination of HT + AET shows about 9 times percentage survival. The same combination in the encapsulated form show comparable percentage survival though the amount needed is 1/200th times compared to free form.

Effect of some chemical radioprotectors on mouse bone marrow.

Effect of HT, AET and Se on mice bone marrow has been studied by counting bone marrow micronucleated cells and endogenous spleen colony count (CFU-S). Combination of HT and AET used as a radioprotector has not caused any significant variation in any of the parameter studied when administered once, it increases bone marrow micronucleated cells and decreases CFU-S slightly after daily administration for 7 days. The individual constituent of the combination administered singly does not increase micronucleated cell number. Seven consecutive doses of HT + AET and same in combination with Se enhances micronucleated cells to a higher level. Daily injection of Se alone up to 7 days also causes an increase in micronucleated cells upto same level. CFU-S pool does not show any significant change in number of bone marrow cells through out the study except in the groups where animals were treated with Se.

Use of hydroxylamine in improving radio protection of a combination of 5-hydroxy L-tryptophan and a thiol compound (AET) in small mammals.

Radioprotective effectiveness has been evaluated by 30 day survival studies and protection to bone-marrow cells in mice after radiation exposure and this has been further established by 24 hr deoxycytidine excretion in urine of rats following 5 Gy whole body gamma irradiation and protection to superoxide dismutase enzyme in marrow cells and red blood corpuscles. Radioprotective effectiveness as well as the duration of radioprotection have been improved by the administration (ip) of hydroxylamine (20 mg/kg), a decarboxylase inhibitor, prior to the use of a combination of 5-hydroxy L-tryptophan (5-HTP, 70 mg/kg) and 2-aminoethylisothiuronium bromide hydrobromide (AET, 20 mg/kg) ip in small mammals before whole body gamma irradiation.

Protection to glycolysis by a combination of 5-hydroxy-L-tryptophan and 2-aminoethylisothiuronium bromide hydrobromide in lethally irradiated rats.

Rate of glycolysis in vivo at different time intervals following 8 Gy [LD100(30)] whole body gamma radiation (WBGR) was evaluated by estimating liver glycogen, blood sugar, serum lactic dehydrogenase (LDH) and blood lactic acid concentration in adult male Sprague Dawley rats. Within 1 hr of radiation exposure, a significant fall in liver glycogen was observed in rats fed food and water ad libitum. The glycogen content increased after 24 hr and had returned to control level on 7th day after radiation exposure. Blood sugar, serum LDH and blood lactate levels increased significantly as compared to non irradiated controls. Pretreatment with 5-hydroxy-L-tryptophan (5-HTP; 100 mg/kg) + 2-aminoethylisothiuronium bromide hydrobromide (AET; 20 mg/kg) ip 30 min before 8 Gy WBGR, modified these values and restored them to normal level on 7th day post-irradiation.

Differential radioprotection of tissues in C3H/J mice by a combination of 5-hydroxy L-tryptophan with 2-aminoethylisothiuronium bromide hydrobromide.

Differential radioprotection between normal tissues and carcinoma was observed in C3H/J mice treated with a combination of 5-hydroxy L-tryptophan (5-HTP, 100 mg/kg) and 2-aminoethylisothiuronium bromide hydrobromide (AET, 20 mg/kg). Protection to normal tissues was judged by LD50(30) and by radiation induced damage to bone marrow(BM) using clonogenic ability of blood forming stem cells (10 day CFUs) as the criteria. Pretreatment with 5-HTP + AET combination 30 min before whole body gamma radiation (WBGR) enhanced the recoveries of the number of blood forming stem cells in BM of irradiated mice after 0, 7th and 10th day of irradiation. LD50(30) for C3H/J mice was 7.3 Gy and the dose modifying factor (DMF) of 5-HTP + AET combination was 1.76. On the contrary, pretreatment with this combination did not protect the mammary carcinoma transplanted in C3H/J mice, when exposed to 80 Gy soft X-rays.

Anesthetic Experience for Thymectomy in the Patient with Myasthenia Gravis Associatied with Thymoma / 대한마취과학회지

Efforts from various approaches have been made to anesthetize myasthenic patients associated with thymoma and, on a ehoice of kinds and dosage of the muscle relaxants, there were considerable solicitude of the anesthesiologist. In recent years, intermediate aeting none depolarizing muscle relaxants were developed and its use tends to increase. we used with the divided dose administration of small amount vecuronium and observed the degree of relaxation using peripheral nerve stimulator for endotracheal intubation and maintenance of anesthesia. On the basis of our experience, we would like to recommand techniques that administrate the divided dose of small amount vecuronium as a musde relaxant and use peripheral nerve stimulator during general anesthesia.

A Study on the Influence of Serum IgE Level on T cell Function in Atopic Dermatitis / 대한피부과학회지

The influence of serum IgE level on T cell function and number in atopic dermatitis was performed. For the study we selected 2 groups of atopic derrnatitis patients which were 10 cases of atopic dermatitis patients with more than 400 IU/ml of serum 1gE level and 1(l cases with less than 400 IU/ml, The lymphocyte transformation test with phytohernagglutinin and E-rosette test with AET treated sheep cell were perforrned in each group and compare the result of each group with each other and al'o with those of control group. The reults are as follows; l. The mean serum level of IgE in AD(538. 8 407.42 IU/ml) was higher than in normal control(126. 5 133, R8 IU/ml) (p<0.01). 2 The mean LTT S.I. in AD(8.83 -3.85) was lower than in nomnal control (13.99 5.55) (p<0.01). 3. The mean percentage of E-rosette in AD(68,65+6.6g) was lower than 4pp IU/ml(mean+2x SD of serum IgE of control groups), 1) The LTT S, I. was decreased in both groups according to increment of serum IgE, The higher IgE group(8.64+3,9p) had statistical significance compared to normal control(13.gg+5.55) (p<0.01) but not in low IgE group(9.08:4.11).2) The percentage of E-rosette was decreased in both groups according to increment of serum IgE. The both groups of low IgE(71.08.-6,24) and high IgE(66. 22 6. R7) had statistical significance compared to normal control(77.65+4.39 %) (p 0.01).