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.

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'.

Radiation Dose-escalation Trial for Glioblastomas with 3D-conformal Radiotherapy / 대한방사선종양학회지

PURPOSE: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received 63~70 Gy (Median 66 Gy, fraction size 1.8~2 Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. RESULTS: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were 15+/-1.65 and 11+/-0.95 months, respectively. There was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were 21+/-5.03 and 12+/-1.59 months, respectively, while for Arm 2 patients they were 14+/-0.94 and 10+/-1.63 months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; 44.7% versus 19.2%. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. CONCLUSION: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.

The Effects of Retinoids on Expression of beta4 Integrin and Growth of the Head and Neck Squamous Cell Carcinoma Cell Lines / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retinoids have been used in chemoprevention trials for a variety of epithelial malignancies. However, high incidence of toxicity and drug resistance remains as problems. Increase of the retinoid metabolism by cytochrome P450 has been known as one of the several mechanisms explaining these toxicity and the aquired resistance. There have been many studies about the biological effects of retinoids in head and neck squamous cell carcinoma (HNSCC), but there is no information about the effects of the retinoids metabolism on cell biology. The study presented here is designed to examine the relationship between cytochrome P450 induction and responses to retinoids in the HNSCC cell lines. MATERIAL AND METHODS: We used a human HNSCC cell lines (AMC-HN-4, AMC-HN-6). The change of metabolic activity was analyzed using thin layer chromatography (TLC). The effects of retinoids on cell proliferation were evaluated with CellTiter 96 TMAQueous Cell Proliferation Assay. The effects of retinoids on beta4 integrin expression were evaluated with flow cytometry. RESULTS: The inhibitory effects of retinoids on cell proliferation were higher in AMC-HN-4 cell line (cytochrome P450 uninducible) than in AMC-HN-6 cell line (cytochrome P450 inducible) (p<0.05). The expression of beta4 integrin was more effectively suppressed in the AMC-HN-4 cell line than in the AMC-HN-6 cell line. CONCLUSION: The results of this study suggest that cytochrome P450 inducilbility may be an important factor to determine the biological effects of retinoids in HNSCC cells.

Bone Resorption of Cultured Middle Ear Cholesteatomatous Epithelium-In Vitro Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bone resorption is an important cause of complications of chronic cholesteatomatous otitis media. Authors cultured the calvarial bone of fetal rat and measured the calcium release by keratinocytes and fibroblasts from cholesteatoma and postauricular skin (PAS). MATERIALS AND METHODS: Keratinocytes and subepithelial fibroblasts were cultured from cholesteatoma and PAS. The pregnant rats were sacrificed 24 hours after subcutaneous injection of Ca45 and the fetal calvarial bones were cultured with or without the supernatants of keratinocytes and fibroblast culture. The amount of released radioactive calcium was analyzed using beta-ray counter. RESULTS: The percentage (%) of calcium release was 28.95+/-4.0% in the control and 31.86+/-3.0% in the supernatant of PAS keratinocytes. In the cholesteatomatous keratinocytes, the released calcium was 34.99+/-6.1% and significantly greater than the values of control and PAS. Using the supernatants from the fibroblast culture, cholesteatoma and PAS showed higher calcium release than the control, but there was no significant difference between the two tissues. CONCLUSIONS: Through this study, authors showed the in-vitro bone resorption by cholesteatoma and concluded that cholesteatomatous epithelial cells can be involved in the bone resorption.

A Case of Glomus Tympanicum / 대한이비인후과학회지

Glomus tympanicum has to be considered to differentiate the etiology of middle ear mass with pulsatile tinnitus. MRI helps to differentiate the mass. Angiography helps to identify its feeding vessels and to embolize to reduce bleeding on operation. When the mass is not focally localized, tympanotomy combinded with mastoidectomy approach via posterior auricular incision is helpful to remove the mass completely.