Association Between Constipation-Predominant Irritable Bowel Syndrome and Dietary Habits of the Elderly Aged Over 65

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most common diseases of the digestive system, with a worldwide prevalence of approximately 20%. However, studies on constipation-predominant IBS in the elderly are scarce. Since Korea has the highest elderly population, with 38.2% of its population expected to be aged over 65 years by the year 2050, a study on the presence of IBS in this population is warranted. METHODS: In the present study, IBS was defined and classified according to the Rome III criteria. This study was performed by using the case and control method at the outpatient Department of Family Medicine and the health promotion center of a hospital in Gwangju. The questionnaire for the demographic characteristics and dietary habits was administered to 128 patients with IBS and 193 controls. RESULTS: Individuals who had a tendency of overeating for >3 days a week, compared to those who had a tendency of overeating for 3 days a week, compared to those who had it for <2 days a week; and the time of meals showed statistically significant results. Meanwhile, the number and regularity of meals and having breakfast were not relevant factors. CONCLUSION: The weekly frequency of overeating and intake of spicy food as well as short time for meals are related to constipation-predominant IBS in the elderly aged above 65 years.

Altered Dilator Responses to Heptanol and Octanol in Aorta from Renal Hypertensive Rats / 대한신장학회잡지

BACKGROUND: Cells rely on gap junctions for intercellular communication, which is important for growth and contractility. The present study was conducted to test the hypothesis that contractile responses in aortic rings from two-kidney, one clip (2K1C) hypertensive rats are more dependent on gap junctional communication compared to those from normotensive rats. METHODS: 2K1C hypertension was induced by clipping the left renal artery and age-matched rats received a sham operation. Heptanol and octanol were used as inhibitors of gap junctional activity. RESULTS: The contraction induced by phenylephrine or KCl was completely reversed by either heptanol or octanol, and the relaxant response to inhibitors was more enhanced in 2K1C hypertensive rats compared to sham-operated rats. Vessels from hypertensive rats also relaxed more to nifedipine when precontracted with KCl, although it did not differ in aortic segments contracted with phenylephrine in between normotensive and hypertensive rats. CONCLUSION: These results suggest that gap junctional communication and voltage-operated calcium channels are differentially regulated in 2K1C renal hypertension.

Altered Dilator Responses to Heptanol and Octanol in Aorta from Renal Hypertensive Rats / 대한신장학회잡지

BACKGROUND: Cells rely on gap junctions for intercellular communication, which is important for growth and contractility. The present study was conducted to test the hypothesis that contractile responses in aortic rings from two-kidney, one clip (2K1C) hypertensive rats are more dependent on gap junctional communication compared to those from normotensive rats. METHODS: 2K1C hypertension was induced by clipping the left renal artery and age-matched rats received a sham operation. Heptanol and octanol were used as inhibitors of gap junctional activity. RESULTS: The contraction induced by phenylephrine or KCl was completely reversed by either heptanol or octanol, and the relaxant response to inhibitors was more enhanced in 2K1C hypertensive rats compared to sham-operated rats. Vessels from hypertensive rats also relaxed more to nifedipine when precontracted with KCl, although it did not differ in aortic segments contracted with phenylephrine in between normotensive and hypertensive rats. CONCLUSION: These results suggest that gap junctional communication and voltage-operated calcium channels are differentially regulated in 2K1C renal hypertension.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax / 대한흉부외과학회지

BACKGROUND: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. MATERIAL AND METHOD: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. RESULT: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8+/-3.8 months) in group I were none, but in group II (21.5+/-5.3 months) were 2 cases. CONCLUSION: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax / 대한흉부외과학회지

BACKGROUND: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. MATERIAL AND METHOD: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. RESULT: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8+/-3.8 months) in group I were none, but in group II (21.5+/-5.3 months) were 2 cases. CONCLUSION: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

Initiation of Herpes Zoster Treatment and Postherpetic Neuralgia

BACKGROUND: Herpes zoster is a significant and troublesome disease. The pain of acute herpes zoster may be severe, but is usually transitory. Some patients, especially the elderly at particular risk, go on to develop neuralgia. Unfortunately, neuralgia is often severe and refractory to most forms of treatment. The purpose of this study was to estimate improved rates of neuralgia according to associated factors. METHODS: We observed the improved rates of neuralgia in 123 patients who had herpes zoster with severe pain and treated with antiviral therapy after admission. Also, we compared them by age group, dermatomal distribution, and initiating day of antiviral therapy. RESULTS: At 4 weeks of treatment, the improved rates of neuralgia according to age younger group was high and older group was low. The improved rates of neuralgia according to the starting day of treatment was high 100% in 1 day, 76.5% in 2, 65.0% in 3days, and 18.2% in 7 days after skin eruption. CONCLUSION: In herpes zoster with severe pain, age and initiation of antiviral therapy are significant predictors of neuralgia.

Role of the Inferior Thyroid Vein after Left Brachiocephalic Vein Division During Aortic Surgery / 대한흉부외과학회지

BACKGROUND: In aortic surgery, division and ligation of the left brachiocephalic vein(LBV) may improve exposure of the aortic arch but controversy continues about the safety of this division and whether a divided vein should be reanastomosed after arch replacement was completed. The safety of LBV division and the fate of the left subclavian venous drainage after LBV division were studied. MATERIAL AND METHOD: From November 1998 to January 2001, planned division and ligation of the LBV on the mid-line after median sternotomy was performed in 10 patients during the aortic surgery with the consideration of local anatomy and distal aortic anastomosis. Assessment for upper extremity edema and neurologic symptoms, measurement of venous pressure in the right atrium and left internal jugular vein, and digital subtraction venography(DSV) of the left arm were made postoperatively. RESULT: In 10 patients there was improvement in access to the aortic arch for procedures on the ascending aorta or aortic arch. The mean age of patients was 62 years(range 24 to 70). Follow-up ranged from 3 weeks to 13 months. One patient died because of mediastinitis from methicilline-resistant staphylococcus aureus strain. All patients had edema on the left upper extremity, but resolved by the postoperative day 4. No patient had any residual edema or difficulty in using the left upper extremity during the entire follow-up period. No patient had postoperative stroke. Pressure difference between the right atrium and left internal jugular vein was peaked on the immediate postoperative period(mean peak pressure difference = 25mmHg), but gradually decreased, then plated by the postoperative day 4. In all DSV studies left subclavian vein flowed across the midline through the inferior thyroid venous plexus. CONCLUSION: We conclude that division of LBV is safe and reanastomosis is not necessary if inferior thyroid vein, which is developed as a main bridge connecting the left subclavian vein with right venous system, is preserved.

Guillain-Barre Syndrome After Resection of Lung Cancer / 대한흉부외과학회지

A 68-year-old man with Guillain-Barre syndrome after the resection of right upper lobe for squamous cell lung cancer is presented. He developed a sudden, symmetric, extremity weakness, respiratory insufficiency, and sensory ataxia on postoperative day 6. He was intubated emergently and placed on a ventilator. Electrodiagnostic studies were performed on days 2, 20, and 40 following the onset of weakness. Motor nerve conduction abnormalities were the predominant findings. Prolonged motor distal latencies, temporal dispersion, and partial motor conduction blocks were present and formed the diagnostic features of Guillain-Barre syndrome. With supportive care and additive use of intravenous immunoglobulin, the illness resolved 6 weeks later after the onset of weakness.

Guillain-Barre Syndrome After Resection of Lung Cancer / 대한흉부외과학회지

A 68-year-old man with Guillain-Barre syndrome after the resection of right upper lobe for squamous cell lung cancer is presented. He developed a sudden, symmetric, extremity weakness, respiratory insufficiency, and sensory ataxia on postoperative day 6. He was intubated emergently and placed on a ventilator. Electrodiagnostic studies were performed on days 2, 20, and 40 following the onset of weakness. Motor nerve conduction abnormalities were the predominant findings. Prolonged motor distal latencies, temporal dispersion, and partial motor conduction blocks were present and formed the diagnostic features of Guillain-Barre syndrome. With supportive care and additive use of intravenous immunoglobulin, the illness resolved 6 weeks later after the onset of weakness.

Altered Vascular Response to the K+induced Vasorelaxation in Aortic Smooth Muscle of Renal Hypertensive Rats

BACKGROUND: An increase of the extracellular K+concentrations up to about 8 mM in the isolated vessels causes relaxation in pre-contracted state. In order to elucidate the mechanisms of K+induced relaxation and compare with that of 2-kidney, 1 clip (2K1C) renal hypertensive rats, we recorded aortic vascular tension using an organ bath study. METHOD: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Thoracic aortic rings were mounted in tissue baths for measurement of isometric contractile force. RESULTS: Exposure to K+(from 2 to 8 mM) relaxed a phenylephrine (2 x 10-6 M)-induced contraction in K+free Krebs-Ringer solution, dose-dependently. Ouabain (10-5 M) enhanced the K+induced relaxation in above 2 mM K+ The K+induced relaxation was still induced in endothelium-denuded condition. Incubation with the K+channel blockers such as tetraethylammonium (TEA, 1 mM), glibenclamide (10-5 M), 4-aminopyridine (3 mM), barium (5 mM) and cesium (2 mM) did not affect on the K+induced relaxation. In renal hypertensive rats, the K+induced relaxation was markedly suppressed and ouabain enhanced it. CONCLUSIONS: These results suggest that the K+induced relaxation in aorta be mediated by Na-pump independent mechanisms, and the decrease of the K+induced relaxation in the renal hypertensive rats may be a possible mechanism of hypertension.

Altered Vascular Response to the K+induced Vasorelaxation in Aortic Smooth Muscle of Renal Hypertensive Rats

BACKGROUND: An increase of the extracellular K+concentrations up to about 8 mM in the isolated vessels causes relaxation in pre-contracted state. In order to elucidate the mechanisms of K+induced relaxation and compare with that of 2-kidney, 1 clip (2K1C) renal hypertensive rats, we recorded aortic vascular tension using an organ bath study. METHOD: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Thoracic aortic rings were mounted in tissue baths for measurement of isometric contractile force. RESULTS: Exposure to K+(from 2 to 8 mM) relaxed a phenylephrine (2 x 10-6 M)-induced contraction in K+free Krebs-Ringer solution, dose-dependently. Ouabain (10-5 M) enhanced the K+induced relaxation in above 2 mM K+ The K+induced relaxation was still induced in endothelium-denuded condition. Incubation with the K+channel blockers such as tetraethylammonium (TEA, 1 mM), glibenclamide (10-5 M), 4-aminopyridine (3 mM), barium (5 mM) and cesium (2 mM) did not affect on the K+induced relaxation. In renal hypertensive rats, the K+induced relaxation was markedly suppressed and ouabain enhanced it. CONCLUSIONS: These results suggest that the K+induced relaxation in aorta be mediated by Na-pump independent mechanisms, and the decrease of the K+induced relaxation in the renal hypertensive rats may be a possible mechanism of hypertension.

Cardiac Surgery for the Patient with VVI Unipolar Pacing System: One Case / 대한흉부외과학회지

A 56-year-old female with a permanent unipolar pacing (VVI) system underwent elective coronary bypass surgery and mitral valve replacement. Because the unipolar sensing is subject to considerable nonmyocardial electrical noise, the pacing function may be disturbed by the use of electrocautery. Temporary atrial and ventricular bipolar epicardial leads and external generator were used for maintaining A-V sequential pacing during the use of electrocautery. Before aortic cross-clamp was released after cardiac operation, regular cardiac rhythm could spontaneously be resumed with an integrated cardioplegic strategy, avoiding the use of defibrillator.

Stapling and Suturing of Blebs and Bullae without Excision in Thoracoscopic Surgery / 대한흉부외과학회지

BACKGROUND: Prolonged air leak is a common complication after thoracoscopic bullectomy. MATERIALS AND METHODS: A technique is described to minimize postoperative air leak in thoracoscopic surgery for the treatment of recurrent or persistent spontaneous pneumothorax. RESULTS: A 3.5cm utility incision is made in the anterior axillary line at the level of the third intercostal space, and blebs and bullae are stapled and sutured without excision, using standard surgical instruments and stapler. CONCLUSIONS: This technique may be useful to reduce prolonged air leak after removal of the bleb and bullous lesion, and may minimize the delayed recurrence of ipsilateral pneumothorax.

Clinical Evaluation of Video-assisted Thoracoscopic Surgery / 대한흉부외과학회지

Video-assisted thoracoscopic surgery has recently evolved as an alternative to thoracotomy for several thoracic disorders. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indication. Using video-assisted operative thoracoscopy, we operated on 33 patients during the 2 years of our experience from June 1993 to June 1995. They were diagnosed as recurrent pneumothorax in 16, visible bulla on X-ray in 6, prolonged air leakage (longer than 7days) in 4, bilataral pneumothorax in 3, hyperhidrosis in 2, previous contralateral pneumothorax in 1, primary hemopneumothorax 1. The average duration of chest tube placement was 2.1+/-0.4 days. The mean postoperative hospital stay was 3.4+/-0.6 days. The complication was persistent air leakage (longer than 48 hours) in 3 case. Video-assisted thoracic surgery is safe, decreased pain, and shortens hospital stay.

Surgical Repair of Inferior Sinus Venosus Defect: A Report Four Cases / 대한흉부외과학회지

Inferior sinus venosus defect is a rare lesion in which there is a large interatrial communication adjacent to the atrial connection of the inferior caval vein. The defect is located posteriorly and inferiorly, outside the confines of the true atrial septum, and partial anomalous pulmonary venous connections are the rule. We underwent surgical repair in four patients with inferior sinus venosus defect and partial anomalous pulmonary venous return. There were three males and one female with an age range from four months to 25 years. A cross-sectional echocardiogram and cardiac catheterization had been performed preoperatively in all patients, but the correct diagnosis had been made in only one case. Surgical repair was indicated due to congestive heart failure, and one patient of 4-month-old needed urgent operation. The repair was accomplished by suturing a untreated autologous pericardial patch to the right of the pulmonary veins, so that the defect was closed and all the pulmonary venous blood was directed to the left atrium. The preoperative knowledge of the unusual anatomy allows the surgeon to repair the anomaly without difficulties. For the patients in whom interatrial communication and anomalous pulmonary venous return are suggested, surgeon has to pay careful attention to the anatomical landmarks to avoid incorrect placement of the patch.

A Clinical Evaluation of Tuberculous Pleurisy: Report of 52 Cases / 대한흉부외과학회지

A clinical analysis was performed on 52 cases of tuberculous pleurisy experienced in the department of thoracic and cardiovascular surgery and department of medicine, Chosun University Hospital during a period from Jan. 1994 to Dec. 1995. Among them, male was 39 cases, female was 13 cases, with age ranged from 7 to 73 years. The common symptoms were chest pain 75%, dyspnea 59.6%, cough 55.8%. The most common diagnostic tool was pleural biopsy. The protein levels in the tuberculous pleural effusion were 0.9~6.5 gm%, and ratios of effusion protein to serum protein were 0.48~1.06. The glucose levels in the tuberculous pleural effusion were 37~112 mg%. The LDH levels in the tuberculous pleural effusion were 80~2440 unit/ml, and ratios of tuberculous pleural effusion LDH to serum LDH were 0.48~1.03. The ADA levels in the tuberculous pleural effusion were 24-63 IU/L. The common surgical methods of treatment in the tuberculous pleurisy were closed thoracostomy in 18 cases(66.7%), and thoracentesis in 5 cases(18.5%). his study compares the clinical results of group A and group B. There were no significant differences for age and sex, lag period from initial symptoms to admission, diagnostic method, and protein, pH, LDH, glucose, ADA levels in tuberculous pleural effusion. Authors noted that the discharge after admission on the tuberculous pleurisy was more faster in patients with surgical treatment than in patients with only medical treatment.

Immunocytochemical Characteristics of the Short-term cultured Mesothelial Cells / 대한세포병리학회지

Reactive human mesothelial cells were examined by immunocytochemical stain with intermediate filaments(cytokeratin [CK1, CK7, CK8, CK18, CD19/, vimentin, desmin, actin), epithelial membrane antigen, carcinoembryonic antigen(CEA), MHC class II antigen(HLA-DR), LeuM-1(CD15), alpha1-antitrypsin(ACT), alpha1-antichymotrypsin (ACHT), CD68(KP-1) and FcgammaRIII(CD16). The mesothelial cells were isolated from patients with liver cirrhosis and pleural effusion, and short-term cultured in RPMI 1640 media containing 10% heat inactivated fetal calf serum and 1% identical supernatant fluid of the patients' transudates. The results obtained are as follows. 1. The cultured-reactive mesothelial cells were positive for the protein of cytoskeleton such as cytokeratin and vimentin, but negative for desmin and actin. The resting mesothelial cells showed positive reactions for cytokeratin, but negative for vimentin, desmin and actin. 2. The primary antibodies to the cytokeratin were strongly reactive for CK1, CK8 and CK18 but negative for CK7 and CK19 in both reactive and resting mesothelial cells. 3. Resting mesothelial cells showed negative reactions for CEA, but strong positive reactions in cultured-reactive mesothelial cells. 4. The markers for the monocytes\histiocytes (CD11b, CD14, CD16, CD68, lysozyme and alpha1-antitrypsin and alpha1-antichymotrypsin) were nonreactive in resting mesothelial cells, but lysozyme and alpha1-antitrypsin were weakly reactive in reactive and proliferative mesothelial cells. 5. MHC Class II molecule(HLA-DR antigen) was negative in both resting and reactive mesothelial cells. These results suggest that the short-term cultured, reactive mesothelial cells show a newly aberrant expression of the vimentin and carcino-embryonic antigen. The reason of the aberrant expression of the intermediate filament and oncofetal antigen in reactive and proliferative mesothelial cells should be further evaluated.

Surgical treatment of esophageal atresia with tracheoesophageal fistula / 대한흉부외과학회지

No abstract available.