A Case of Mucosal Necrosis of the Stomach after Endoscopic Injection Therapy with Hypertonic Saline-Epinephrine (HS-E) for a Bleeding Peptic Ulcer with an Exposed Vessel / 대한소화기내시경학회지

Peptic ulcer bleeding is a frequent cause of upper G-I bleeding. Endoscopic injection therapy with hypertonic saline-epinephrine (HS-E) is a cost-effective and widely used therapy for hemostasis; however, 1~3% of patients experience bleeding or perforation. A 70 year-old male patient was admitted with melena and hematemesis. An endoscopy on admission showed the presence of a 1 cm- sized well-demarcated ulcer with pulsatile bleeding at the lesser curvature of the distal antrum. Approximately 28 mL of HS-E solution was injected around the exposed vessel. Follow-up endoscopy performed 7 days later showed the presence of a 2 cm-sized newly developed mucosa necrosis at the lesser curvature of the pyloric channel, which was caused by ischemic necrosis of the gastric mucosa after HS-E injection. Endoscopic injection therapy with HS-E solution is a relatively safe technique, but mucosa necrosis can occur with the use of a dose of HS-E that is considered safe. We report a case of gastric mucosa necrosis following endoscopic HS-E injection therapy of a bleeding peptic ulcer.

Clinical Characteristics of Pilomatricoma in the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pilomatricoma, also known as calcifying epitheliomas of Malherbe is uncommon, benign skin neoplasm that arise from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. In more than half of the cases, pilomatricoma typically involves the head and neck followed by upper extremities and trunk, with the majority occurring in children. The purpose of this study is to analyze the data from the author's experience with head and neck pilomatricoma and to discuss diagnostic and therapeutic management. SUBJECTS AND METHOD: A retrospective analysis of the patients of pilomatricoma treated between 1994 and 2004 revealed 21 cases of head and neck pilomatricoma. RESULTS: The typical clinical manifestation of pilomatricoma was non-tender, firm, subcutaneous, and nodular mass. The age range was from 9 months to 62 years (mean 17.4 years). The male-to-female ratio was 4 : 3. The common sites of occurrence were the neck (33%), cheek (24%), suboccipital (14%), preauricular (14%). The size of the mass ranged from 0.5 cm to 3 cm, and the mean was 1.1 cm. CT with contrast enhancement scans revealed densely calcified, mild enhancing and well circumscribed soft tissue densities in subcutaneous tissues. Additionally, MRI with gadolinum enhancement scans revealed partially enhanced, well demarcated and intermediate signal intensity mass lesions. Surgical excision was curative in all cases. CONCLUSION: Pilomatricoma is cutaneous neoplasms that occur commonly in the head and neck region. Even if the preoperative diagnosis may be difficult in some cases, pilomaticoma must be considered in the differential diagnosis of a superficial head and neck mass.

Histochemical Study of Musculature of the Human Upper Esophageal Sphincter / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngoesophageal musculature plays an important role in swallowing, and prevents aspiration and supraesophageal reflux. These muscles are closed during the resting state and opens with swallowing to allow the passage of food. In this study, the histochemical characteristics of the upper esophageal sphincter muscles in human were investigated. MATERIALS AND METHODS: Muscle samples from the inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle and sternocleidomastoid (SCM) muscle were obtained from the healthy portion of nine laryngectomized specimen. We used the H&E staining for identifying the gross anatomy of these muscles, and the myofibrillar ATPase staining and the NADH-TR staining for differentiating the muscle fiber type. RESULTS: Analysis of the muscle fiber types of the upper esophageal sphincter muscle revealed a predominance of type I in the cricopharyngeus (78.9%) and the upper esophageal muscle (85.2%), and type II in the inferior pharyngeal constrictor muscle (80%). In the SCM muscle, the percentage of each fiber type was almost the same. The proportion of oxidative fibers within these muscles correlated well to that of the type I fibers. CONCLUSION: The distribution of the type I fibers tended to be higher in the upper esophageal muscle than in the inferior pharyngeal constrictor. These findings about fiber types represents well the physiological features of each muscle, i.e. the inferior pharyngeal constrictors are capable of short rapid contraction and the upper esophageal muscles are capable of slow rhythmic movement.