Anatomical localization of submandibular gland for botulinum toxin injection.

The aim of this study was to document the anatomical landmarks of the submandibular gland (SMG) for a botulinum toxin injection. Thirty-four SMGs from 20 cadavers were examined. The mean length of a reference line between the angle of the mandible and the gnathion was 94.8 ± 5.9 mm, the proximal and distal point of the SMG from the angle of the mandible was 10.6% (11.5 ± 3.5 mm) and 41.8% (40.9 ± 5.2 mm), respectively. The facial artery came out of the SMG at 11.6% (14.6 ± 3.4 mm) and the position of the intersection of the facial artery with the inferior border of the mandible was located at 24.4% (28.0 ± 5.5 mm) from the angle of the mandible. The shape of the SMG was generally triangular or irregular round on the anatomical position. The mean superior-inferior diameter, anterior-posterior diameter and medial-lateral diameter of the gland was 28.8 ± 4.1, 30.0 ± 6.1 and 15.1 ± 3.5 mm, respectively. The safety zone for the injection was 20-35% from the mandible angle on the inferior view and 1.5 cm below the inferior line of the mandible on the lateral view. In addition, the needle should be inserted to a depth of 2.0 cm from the skin surface on the inferior view. These results may assist in determining a accurate localization of injection sites for the SMG, particularly for injections without ultrasound guidance.

Antioxidant nutrient intakes and corresponding biomarkers associated with the risk of atopic dermatitis in young children.

BACKGROUND/OBJECTIVES: To investigate the association of antioxidant nutritional status with the risk of atopic dermatitis (AD) in young children in a case-control, population-based study. SUBJECTS/METHODS: Identified from preschools by using the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC). Final analysis included 180 AD (mean age 5.3+/-0.9 years) and 242 non-AD (mean age 5.2+/-1.0 years) children. Diet was assessed using a validated semi-quantitative food frequency questionnaire. Fasting blood samples were used for analyses of fat-soluble vitamins (retinol, alpha-tocopherol, and beta-carotene) and vitamin C. RESULTS: AD was associated negatively with intakes of antioxidant-related nutrients. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were 0.44 (0.22-0.88) for the highest (vs lowest) quintile of beta-carotene. A similar association was observed for dietary vitamin E (OR=0.33, 95% CI=0.16-0.67), folic acid (OR=0.37, 95% CI=0.18-0.73), and iron (OR=0.39, 95% CI=0.19-0.79). Reduced AD risk was found with 1 s.d. increase of serum alpha-tocopherol [OR=0.64, 95% CI=0.41-0.98) and retinol (OR=0.74, 95% CI=0.58-0.96) concentrations, and marginally with that of serum beta-carotene levels (P=0.0749 for trend). There was no relationship of AD risk with dietary and plasma vitamin C as well as nutrient supplement intake regardless of nutrient type. AD was predicted better by the intake measure than the corresponding blood biomarker regarding vitamin E and beta-carotene. CONCLUSIONS: These findings suggest that higher antioxidant nutritional status reduces the risk of AD and that such risk-reduction effects depend on nutrient type.

The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury.

BACKGROUND: The status of the main pancreatic duct (MPD) is the most important determinant of the morbidity and mortality associated with pancreatic trauma. Early diagnosis and optimal treatment are critical, especially when there is MPD injury. METHODS: Twenty-three patients with pancreatic trauma were studied prospectively with respect to clinical and laboratory findings, CT, and endoscopic retrograde pancreatography (ERP). Treatment modalities and clinical outcome were assessed in relation to ERP findings. RESULTS: The pancreatic duct was injured in 14 of 23 patients (11 MPD, 3 branch duct). Contrast leakage from the MPD into peritoneal cavity at ERP confirmed MPD injury in 8 patients, who underwent surgical exploration. Three patients with leakage from a branch duct into the pancreatic parenchyma recovered with conservative treatment. Three patients in whom ERP demonstrated contrast leakage from the MPD confined to the parenchyma underwent successful transpapillary stent insertion with complete resolution of the leak at 3-month follow-up. Patients who underwent ERP more than 72 hours after trauma had a significantly higher rate of pancreas-associated complications and a tendency to remain hospitalized longer than patients who underwent ERP earlier. CONCLUSION: Early ERP is one of the most useful methods for demonstrating MPD injury. ERP assists with treatment planning based on the degree of pancreatic duct injury.

Comparison of the efficacy and safety of different formulations of omeprazole-based triple therapies in the treatment of Helicobacter pylori-positive peptic ulcer.

Little is known about the efficacy and safety of different formulations of omeprazole-based triple therapy regimens for the treatment of Helicobacter pylori-positive peptic ulcer. We compared the efficacy and safety of two formulations of omeprazole used in triple therapies in patients with H. pylori-positive active peptic ulcer. Seventy-four patients with endoscopically proven H. pylori-positive active peptic ulcer were randomized to two groups, each with 37 patients, to receive either OAC-I (6 weeks of "A" formulation of omeprazole [20 mg twice daily] plus 2 weeks of amoxicillin [1.0 g twice daily] and clarithromycin [500 mg twice daily] or OAC-II (6 weeks of "B" formulation of omeprazole [20 mg twice daily] plus 2 weeks of the same antibiotics. The H. pylori and ulcer healing status were assessed at the baseline and at the 6-week endpoint of therapy. Gastrointestinal symptoms, documentation of adverse events, and standard laboratory examinations were assessed at each visit. Eradication of H. pylori (intention to treat [n = 74]/per protocol [n = 66]) and healing of the ulcer were successful in 83.8%/96.9% and 93.8%, respectively, of the OAC-I group patients, and in 91.9%/100% and 97.1%, respectively, of the OAC-II group patients (P = 0.477; P = 0.608). The OAC-I group experienced rapid resolution of symptoms, but no significant differences were found between the two groups for number of days taken for resolution of gastrointestinal symptoms, adverse events, and laboratory findings. The two different formulations of omeprazole used in triple therapy regimens produced similar efficacy and safety results after 6 weeks of treatment in patients with H. pylori-positive active peptic ulcer.

Dorsal internal carotid artery aneurysm treated by coil embolization--case report.

A 50-year-old male presented with an extremely rare dorsal wall aneurysm of the internal carotid artery manifesting as intracerebral hemorrhage. Computed tomography demonstrated intracerebral hemorrhage on the frontal base. Magnetic resonance imaging clearly showed the hemorrhage was related to an aneurysm of the internal carotid artery. Cerebral angiography disclosed an elongated aneurysm of the dorsal wall of the internal carotid artery. The aneurysm was packed as fully as possible with Guglielmi detachable coils to achieve complete obliteration. The patient was discharged without neurological deficits. Dorsal internal carotid artery aneurysms have a high risk of premature rupture due to their unusual shape and position, adhesion to the brain tissue, and fragile neck. Direct clipping requires careful brain retraction, necessary exposure of the aneurysm, and gentle neck manipulation. Endovascular treatment is an alternative method for obliteration of the aneurysmal sac.

Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerous lesions: comparison of its therapeutic efficacy with surgical resection.

Endoscopic mucosal resection with a ligation device (EMR-L) has become important in the curative treatment of precancerous lesions and early gastric cancers (EGCs), but little is known of the long-term efficacy and survival rates of EMR-L compared with surgical resection. We analyzed the therapeutic efficacy and safety of EMR-L in cases of EGC and precancerous lesions and compared the results of EMR-L with those of gastrectomy in patients with EGC over the same periods. EMR-L was performed on 20 EGCs and 54 precancerous lesions including tubular adenomas with or without severe dysplasias in 74 patients. Macroscopic type, size and location of the lesion were determined by endoscope, and the depth of invasion in EGCs was determined by endoscopic ultrasonography and confirmed by pathologic examination of the resected specimens. All the EGC cases were endoscopically followed up for at least 18 months (range, 18-66 months). Patients were selected that underwent subtotal gastrectomy and the survival rates were compared with those that underwent EMR-L. Complete resection was made in a single EMR-L treatment session in 61 cases (82.4%; 91.5%, were precancerous lesions and 65% were EGCs). After a repeat trial of EMR-L, the total rate of complete resection of precancerous lesions and EGCs was 92.6% and 85.0%, respectively. The survival rate of EGCs showed that complete resection by EMR-L resulted in 2 and 5 year survival rates of 100% and 95%, which are comparable to those of surgery (100% and 100%). This study suggests that EMR-L is a technically simple, minimally invasive and highly safe and effective treatment modality for selective EGCs, and offers an alternative to surgical treatment.

DNA analysis by flow cytometry in early gastric cancer.

OBJECTIVES: Flow cytometric analysis of a paraffin-embedded block of tissue provides rapid and accurate means of analyzing the DNA content of a tumor. The aim of this study was to clarify the clinical significance of flow cytometric findings in early gastric cancer(EGC). Thus we conducted this study to investigate whether DNA contents of tumor cells can correlate with known prognostic indices in patients with EGC. METHODS: The flow cytometric DNA analysis was performed with paraffin-embedded specimens from tumors of 107 patients with EGC. Flow cytometric analysis was performed using a FACScan (Becton Dickinson). In constructing the histogram, 30,000 cells were scanned from each section and results were scored. The S-phase fraction was obtained according to the CellFit cell cycle analysis (Becton Dikinson). Frequencies of aneuploidy in tumors with various clinical and pathologic parameters were compared using the chi-square test. Mean SPF/PI valuse were compared by the student t-test. RESULTS: Diploidy pattern was observed in 80 (75%) cases while aneuploidy was seen in 27(25%) cases. Aneuploidy was more frequently detected in tumors with submucosal involvement (32.7%) and lymph node (+) group (30.8%) than in the mucosal tumor (17.3%) and lymph node (-) group (24.5%), but the differences were not significant. Frequency of aneuploidy was not affected by either the histologic type or morphologic classification. On the other hand, high proliferative activities (SPF/PI) significantly correlated with the submucosal tumor invasion (66.7% vs. 45%; p < 0.05) and lymph node metastasis (28.6% vs. 7.5%; p < 0.05). CONCLUSION: Tumor aggressiveness is not directly related to DNA aneuploidy but proliferative activities are responsible for the aggressive nature of early gastric cancer. The results of this study show that DNA analysis by flow cytometry in considered to be one method of determining the biological activity of gastric cancer cells.

Role of interleukin 6 and corticosteroids in the regulation of expression of glutathione S-transferases in primary cultures of rat hepatocytes.

The effect of recombinant interleukin 6 (rIL-6) on the transcript levels of rat glutathione S-transferase (GST) genes rGSTA2, rGSTP1, rGSTM1 and rGSTM2 was examined in primary cultures of rat hepatocytes. rIL-6 had little effect on the increase in expression of rGSTP1 that occurs in cultured hepatocytes. Dexamethasone (DEX), in contrast, prevented the expression of rGSTP1 by hepatocytes, and rIL-6 in combination with DEX had no additional effect. Neither rIL-6 nor DEX alone had a significant effect on the transcript levels of rGSTA2, rGSTM1 and rGSTM2 in cultured hepatocytes. However, when both were present (15 ng/ml rIL-6 and 10(-7) M DEX) the transcript levels of rGSTA2, rGSTM1 and rGSTM2 decreased significantly (P < 0.05) after 48 h in culture. If the rIL-6 was removed from the cultures after 24 h, the levels of transcripts recovered and were the same at 48 h as cells cultured without rIL-6 for the entire period. Dose-response relationships of rIL-6 with 10(-7) M DEX were determined for transcripts of each GST isoenzyme and the IC50 values were between 1.5 and 7.5 ng/ml. Declines in transcript levels of rGSTA2 were observed with rIL-6 plus 10(-8) or 10(-7) M DEX but not with rIL-6 plus 10(-9), 10(-6), or 10(-5) M DEX. To determine if the cytokine and glucocorticoid effects were mediated by sequences in the 5'-flanking sequence of rGSTA2, a plasmid construct containing a 1.6 kb fragment of the 5'-flanking sequence of the rGSTA2 gene and the chloramphenicol acetyltransferase (CAT) reporter gene was used to transfect rat hepatocytes in primary culture. The addition of rIL-6 and DEX to the culture medium caused a significant (P < 0.05) decrease in CAT activity after 48 h in culture. If rIL-6 was removed after 24 h in culture, CAT activity after an additional 24 h in culture was greater than the CAT activity in cells cultured for 48 h without rIL-6. Therefore cytokines and glucocorticoids may be important physiological regulators of GST expression.

Endoscopic mucosectomy using an esophageal variceal ligation device for minute gastric cancer.

We present here a modified technique for endoscopic mucosal resection using the technique of esophageal variceal ligation for minute gastric cancer. This method of endoscopic mucosal resection requires only the commonly-used one-channel endoscope, an esophageal variceal ligation device, and some clinical experience with the ligation of esophageal varices and snare polypectomy. It can therefore be considered technically simple and safe. We treated four patients with minute gastric cancer using this endoscopic mucosal resection technique. All tumors were completely resected without major complications. Resected specimens were 1.0-1.5 cm in diameter, sufficient for histopathological evaluation, and curative resection was achieved in all patients.

Clonorchiasis and metagonimiasis in the inhabitants along Talchongang (River), Chungwon-gun.

To evaluate the status of clonorchiasis and metagonimiasis of the inhabitants near Talchongang (River) in Chungwon-gun, Chungchongbuk-do, the stools of 67 inhabitants were examined by formalin-ether sedimentation method from August to September, 1993. Also freshwater fish caught in Talchongang were examined by slide compression method. The egg positive cases of Clonorchis sinensis and Metagonimus sp. were 22 (32.8%), and 14 (20.9%), respectively. Of 17 species of examined fish. 14 species were infected with C. sinensis and 13 species with Metagonimus sp. The adult worm collected from 2 patients after treatment with praziquantel was Metagonimus Miyata type. Also the adult worm obtained from the experimental mice infected with metacercariae from Zacco platypus was Metagonimus Miyata type. We found the highly endemic area of clonorchiasis and metagonimiasis along Talchongang.

The gastric juice urea and ammonia levels in patients with Campylobacter pylori.

The authors studied gastric juice ammonia and urea nitrogen levels to determine how they are altered by gastric Campylobacter pylori (CP) infection. Patients with chronic gastritis (20), peptic ulcer (24), hepatic cirrhosis (10), chronic renal failure (13), or gastric remnant (20) were included. Endoscopic biopsy specimens stained with the Warthin-Starry stain were evaluated for the presence of CP. Blood and gastric juice analysis was performed for 11 of the patients with chronic renal failure and 37 patients from the remaining groups. CP was identified in gastric biopsies from 50 of 87 (57.5%) patients, including 87.5% with peptic ulcer and 40-50% of those with chronic gastritis, cirrhosis, chronic renal failure, or gastric remnant. CP infection had no effect on blood urea nitrogen or blood ammonia levels in any group of patients. The urea nitrogen level of gastric juice was higher in patients with chronic renal failure than in other groups but was not related to CP infection. CP infection was associated with a significant increase in gastric juice ammonia levels, both in patients with chronic renal failure (23.3 mmol/L vs. 2.90 mmol/L; [P less than 0.05]) and in other groups (5.48 mmol/L vs. 1.26 mmol/L [P less than 0.0001]). The authors conclude that elevation of gastric juice ammonia level is an indicator of gastric CP infection.

Intussusception into the enteroanastomosis after Billroth II gastric resection; diagnosed by gastroscopy.

A case of retrograde intussusception (acute type) of efferent limb into Braun side-to-side jejuno-jejunal anastomosis is presented. Intussusception, though infrequent, is well recognized complication after gastric surgery. Patient was 50 year old man who was admitted with epigastric pain and abdominal mass for 6 hours. Patient had a history of total gastrectomy 2 years before admission due to stage II gastric cancer. Seven hours after admission, hematemesis developed. Emergency fiberopticgastroscopy revealed type 4 jejunogastric intussusception. Segmental resection with end-to-end reanastomosis was performed.