Helicobacter pylori in middle ear of children with otitis media with effusion.

BACKGROUND: Otitis media with effusion (OME) is a common pediatric disease, but its pathogenesis remains uncertain. The relationship between OME and Helicobacter pylori (HP) is currently being studied, and a relationship has not yet been confirmed. The purpose of this study was to show that a relationship does exist between HP and OME. METHODS: The study consisted of 60 patients who were diagnosed with OME and had ventilation tube insertions with or without an adenoidectomy. This study included an additional 30 patients who had only received an adenoidectomy without being diagnosed with OME. The effusion samples were analyzed with polymerase chain reaction (PCR) and the campylobacter-like organism (CLO) test. The adenoid tissue samples were analyzed with the CLO test. RESULTS: Eighteen patients among the 60 patients (30%) tested positive for HP. In the cases with adenoids, 15.6% of the OME patients and 13.3% of the adenoidectomy only patients were positive for HP. There were no differences between the prevalence of HP in the adenoids of OME patients and the patients without OME. CONCLUSION: HP can be considered one of the causes of OME.

Percutaneous radiologic gastrostomy: a modified Chiba-needle puncture technique with single gastropexy.

BACKGROUND: To evaluate the feasibility, safety, and effectiveness of percutaneous radiologic gastrostomy (PRG) with a modified Chiba-needle puncture technique with the use of a single gastropexy in the same puncture tract. METHODS: In 80 patients with dysphagia, the stomach was punctured with a 21-gauge Chiba-needle, which was exchanged for a 6-Fr Neff catheter. Eleven patients with a high-lying stomach and four patients with surgically altered gastric morphology were included. A Cope suture anchor was then deployed into stomach lumens through the Neff catheter to achieve gastropexy. Then, following serial dilation, a 14-Fr diameter locking loop catheter was inserted. RESULTS: All 80 patients successfully underwent PRG. Only a single puncture attempt was required for 78 patients (98%) and two attempts for two patients each. The average procedure time was 5 min 38 s. Three patients (3.8%) had major complications such as hemorrhage, deep stomal infection, and worsening pneumoperitoneum requiring tube removal. Procedure-related mortality and 30-day mortality was 0% and 5%, respectively. CONCLUSIONS: PRG with the modified Chiba-needle puncture technique with use of single gastropexy in the same puncture tract was feasible, safe, and effective, especially in patients with high-lying or surgically altered stomachs.

Radiologic and clinical outcomes with special reference to tumor involvement pattern after stent placement for malignant bronchial obstructions.

BACKGROUND: Location of tumor within the tracheobronchial tree as well as its severity can affect the clinical outcome of patients who undergo airway stent placement. PURPOSE: To evaluate radiologic and clinical outcome, including survival data, with special reference to proposed tumor involvement pattern, in patients with malignant bronchial strictures. MATERIAL AND METHODS: A total of 35 patients who underwent stent placement for malignant bronchial strictures were enrolled over a 9-year period. Tumor involvement pattern was divided into three types based on computed tomography (CT) scans and selective bronchography. Type I was defined as tumor involving only the main stem bronchus; type II, tumor involving the bronchus intermedius and/or the lower lobar bronchus without involvement of the lower-lobe segmental bronchus; and type III, tumor involving the lower lobar bronchus with involvement of the lower-lobe segmental bronchus. Tumor stage, lung collapse/infiltration, radiologic improvement, clinical improvement, and survival were compared according to the tumor involvement pattern. RESULTS: Tumor involvement pattern was of type I, II, and III in 14, 13, and eight patients, respectively. When comparisons were made between types I/II and type III to evaluate the influence of lower-lobe segmental bronchial involvement, radiologic and clinical improvement was significantly lower in type III than in types I/II, while advanced stage, lung collapse/infiltration, and median overall survival were not significantly different between types I/II and type III. CONCLUSION: In patients with malignant bronchial obstructions involving the lower-lobe segmental bronchus, clinicians must be aware of the possibility of less radiologic and clinical improvement following stent placement.

Fluoroscopically guided nasojejunal enteral tube placement in infants and young children.

OBJECTIVE: The purpose of this study was to evaluate the feasibility, clinical effectiveness, and safety of fluoroscopically guided placement of a nasojejunal enteral tube in infants and young children. CONCLUSION: Fluoroscopically guided placement of a nasojejunal enteral tube is feasible, effective, and safe for infants and young children.

Histologic influence of paclitaxel-eluting covered metallic stents in a canine biliary model.

BACKGROUND: Metallic stents for malignant biliary obstruction are susceptible to occlusion by tumor ingrowth or overgrowth. Paclitaxel-eluting metallic stents (PEMSs), however, may prevent occlusion from tumor ingrowth. OBJECTIVE: We evaluated the safety of PEMSs in a canine biliary model by analyzing tissue reactions by histologic examination. DESIGN: Animal study. SETTING AND INTERVENTIONS: Six PEMSs and 5 control stents (CSs) were endoscopically placed in the bile ducts of 11 mongrel dogs and followed up for 6 weeks. MAIN OUTCOME MEASUREMENTS: The animals were euthanized at 6 weeks, and gross and microhistologic examinations were done. A comparison was made between dogs with PEMSs and dogs with CSs. RESULTS: All 11 stents were successfully placed in the bile ducts, although the distal ends of 2 PEMSs were partially exposed to the duodenal lumen. All 11 dogs survived until death without evidence of jaundice. Gross histologic examination showed mucosal hyperplasia in 3 of 6 dogs in the PEMS group, but there was no evidence of mucosal hyperplasia in the CS group. Microscopically, the epithelial layers at the middle and distal ends of the stented segments were significantly thicker in the PEMS dogs than in the CS group. CONCLUSIONS: Placement of PEMSs in normal canine bile ducts was without significant technical complications; however, local drug delivery from the PEMS resulted in significant histologic changes. Therefore, it is important to choose a drug in adequate concentrations to exert an antitumor effect without damaging the adjacent normal bilary mucosa.

Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy.

AIM: To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. METHODS: We retrospectively reviewed 172 consecutive patients who had undergone pancreatico-duodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods. RESULTS: The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% (25/115), while the incidence was 8.8% (5/57) for younger patients; the difference was significant (P=0.03). Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct (P=0.001). Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION: Our study demonstrated that pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancreaticoduodenectomy.

Percutaneous self-expandable metallic stent placement for cancer recurrence at the hepaticojejunostomy site.

PURPOSE: To evaluate long-term outcomes of patients receiving percutaneous stent placement for cancer recurrence at the anastomotic hepaticojejunostomy site after curative or palliative biliary surgery. MATERIALS AND METHODS: Fourteen patients (mean age, 60.1 years; range, 43-81 years) who received stent placement for malignant biliary anastomotic recurrence were enrolled. The median interval between biliary surgery and stent placement was 21 months (range, 0.7-54 months). Technical success, complications, clinical success (ie, >30% decrease in serum bilirubin level 1 week after stent placement vs baseline), stent malfunction and management, stent patency, and patient survival were evaluated. RESULTS: The 14 patients received a total of 20 stents without procedure-related complications at the time of initial stent placement. Six patients each required two stents to drain both lobes of the liver. Clinical success was achieved in 10 patients (71%), and an additional two patients showed a decrease in total bilirubin level that was less than 30% versus baseline measurement. Stent malfunction occurred in 10 stents in seven patients (50%) and was managed with interventional procedures such as percutaneous transhepatic biliary drainage, balloon dilation, or a second biliary stent placement. Median overall stent patency was 5.0 months (range, 0.7-60 months), and median survival time was 10.0 months (range, 0.7-60 months). CONCLUSION: Stent placement was feasible, safe, and effective in patients with cancer recurrence at the anastomotic hepaticojejunostomy site.

Primary and conversion percutaneous gastrojejunostomy under fluoroscopic guidance: 10 years of experience.

The objective of this study was to evaluate the safety and effectiveness of primary and conversion percutaneous radiologic gastrojejunostomy (PRGJ) under fluoroscopic guidance. Between January 1998 and July 2007, 29 patients (M/F=26:3) were enrolled. Indications for primary PRGJ (n=16) included recurrent aspiration pneumonia (n=8), prevention of gastroesophageal reflux in cases of disrupted gastrointestinal tract (n=6), or bypass of surgical anastomosis (n=1) or duodenal obstruction (n=1). Indications for conversion PRGJ (n=13) included recurrent aspiration pneumonia (n=11), malignant duodenal obstruction (n=1), or previous gastrostomy-related complication (n=1). All 29 procedures were successfully completed with 10.2-16.5-Fr feeding gastrojejunostomy tube tip located in the proximal jejunum. A single anchor was used in all patients with primary PRGJ. Clinical success was achieved in all study patients. There were no major complications. There was no evidence of gastroesophageal reflux or aspiration aggravation in any patient during the follow-up period. Four tubes were electively removed after healing of the esophageal rupture. The indwelling period was 10 to 429 days (mean, 110 days) after tube placement in the remaining 25 patients. Primary and conversion PRGJ under fluoroscopic guidance was a safe and effective procedure for enteral feeding as well as for preventing gastroesophageal reflux or aspiration pneumonia. In cases of primary gastrojejunostomy, use of single gastropexy was feasible and sufficient.

A case of multiple endocrine neoplasia type 1 combined with papillary thyroid carcinoma.

This is the first report of papillary thyroid carcinoma combined with multiple endocrine neoplasia type 1 (MEN1) in Korea. MEN1 is a hereditary disease comprising neoplastic disorders such as pituitary, parathyroid and pancreatic neuroendocrine tumor, such as gastrinoma. But papillary thyroid cancer was never regarded as its component before in Korea. Herein we present a 39-year-old woman who manifested typical features of MEN1 with a coincidental papillary thyroid carcinoma. Although the family history of MEN1 was definite, her genetic analysis of DNA had revealed no germline mutation in MEN1 gene locus. Unidentified culprit gene unable us further genetic study to find LOH (loss of heterogeneity) in 11q13, the possible explanation of papillary thyroid carcinoma as a new component of MEN1. As we have first experienced a case of MEN1 combined with papillary thyroid carcinoma in Korea, we report it with the review of literature.

Cutting balloon treatment for recurrent benign bronchial strictures.

OBJECTIVE: Benign airway strictures refractory to balloon dilatation or stent placement remain a challenge in interventional radiology. This article describes the successful use of a cutting balloon to treat three cases of recurrent tuberculous bronchial strictures. CONCLUSION: In three patients, cutting balloon dilatation was found to be safe and effective and did not cause complications. Although the dilated lumen showed partial reduction over the 6- to 12-month follow-up, subjective functional symptoms and dyspnea grade improved.

Esophageal achalasia: comparison of fluoroscopically-guided double vs. endoscopically-guided single balloon dilation.

PURPOSE: To compare the long-term clinical effectiveness of fluoroscopically guided double and endoscopically guided single balloon dilations in esophageal achalasia. MATERIALS AND METHODS: Thirty-two fluoroscopically guided balloon dilations were performed in 21 patients (group A) and 48 endoscopically guided balloon dilations were performed in 37 patients (group B). The double balloon dilation technique (10 + 20-mm, 15 + 20-mm or 20 + 20-mm in diameter), with preceding single balloon dilation (10, 15, or 20-mm in diameter), was used in group A, whereas the single balloon dilation technique (30, 35, or 40-mm in diameter) with gradually increased internal pressure was used in group B. Technical success, clinical success, complications, and primary/secondary patency rates were compared between the two groups. RESULTS: All procedures were technically successful without esophageal perforation. Clinical success was achieved in 97% (31/32) and 92% (44/48) of balloon dilations in groups A and B, respectively. The symptomatic improvement in dysphagia was significantly higher in group A than in group B. Incidence of complications was the same (18.8%) in both groups. Group A showed significantly longer primary and secondary patency periods than did group B (P < 0.05). CONCLUSION: Fluoroscopically guided double balloon dilation has greater long-term effectiveness than endoscopically guided single balloon dilation in the treatment of esophageal achalasia.

Percutaneous antegrade removal of double J ureteral stents via a 9-F nephrostomy route.

PURPOSE: To evaluate the safety and clinical efficacy of an antegrade approach in the removal of double J ureteral stents via preexisting nondilated nephrostomy routes under fluoroscopic guidance. MATERIALS AND METHODS: Under fluoroscopic guidance and local anesthesia, antegrade removal of 39 ureteral stents in 27 patients was attempted by using a snare or basket. Indications for percutaneous stent removal included the presence of a preexisting nephrostomy route (n = 8), a surgical history resulting in an inaccessible retrograde route (n = 8), urethral stricture (n = 5), upward stent migration (n = 2), inability to obtain a lithotomy position (n = 1), fragmentation of the proximal stent (n = 1), and inability to find the ureteral orifice with a cystoscope (n = 2). RESULTS: Thirty-seven of the 39 stents (95%) were successfully removed by using a snare or basket. Two stents (5.1%) could not be removed with a snare or basket because they were embedded against the renal calyx or pelvis. There were no major complications. Blood clot formation or laceration or tract leakage of the pelvicalyceal system occurred in six and two patients, respectively, all of which resolved spontaneously. CONCLUSIONS: Percutaneous antegrade removal of double J ureteral stents with a snare or basket via a nondilated nephrostomy route is effective without major complications in patients with an available nephrostomy route or an inaccessible retrograde option.

Tc-99m ciprofloxacin imaging in acute cholecystitis.

AIM: To evaluate the efficacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic findings. RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.

The level of 2-h post-challenge glucose is an independent risk factor of carotid intima-media thickness progression in Korean type 2 diabetic patients.

OBJECTIVE: To evaluate the relationship between the metabolic abnormalities commonly associated with diabetes and the changes in carotid intima-media thickness (IMT) in Korean type 2 diabetic patients who do not have clinically manifest cardiovascular disease (CVD). DESIGN: In a prospective study, a total of 152 type 2 diabetic patients were recruited from a group of outpatients at the Yonsei University Hospital. MATERIALS AND METHODS: The carotid IMTs of 152 subjects with type 2 diabetes (mean age 63.5+/-7.0 years) were determined at baseline and after a mean follow-up time of 23.7+/-3.7 months. Fasting plasma glucose, serum total cholesterol (TC), serum triglyceride, high-density lipoprotein cholesterol (HDL-C), HbA1c, oral glucose tolerance test (OGTT) results for 2-h post-challenge glucose (2hPG), and blood pressure measurements were collected every 3 months and averaged. RESULTS: The highest quartiles of baseline C-peptide and homeostatic model assessment (HOMA) index showed more IMT progression than the lowest quartiles. The change in the mean IMT correlated with average values of HbA1c (r=.219, P=.007), the 2-h post-challenge glucose (r=.239, P=.003), HDL-C (r=-.228, P=.005), LDL-C (r=.175, P=.033), and non-HDL-C (r=.194, P=.016). Multiple regression analysis demonstrated that the independent risk factor for the mean IMT change in diabetic patients was the average 2hPG level (P=.004). The change in the mean IMT of those in the lowest quartile of average 2hPG (<11.1 mmol/l) was 823+/-176 to 841+/-146 microm (P=.276). In the highest quartile (2hPG >15.3 mmol/l), however, the mean IMT increased from 794+/-127 to 882+/-153 microm (P<.001). CONCLUSION: The 2hPG parameter among the various metabolic parameters exerts the greatest influence upon the prevention of carotid IMT progression in type 2 diabetic subjects. The level of 2hPG is an independent risk factor for the progression of carotid IMT in Korean type 2 diabetic patients.

Comparison of body fat composition and serum adiponectin levels in diabetic obesity and non-diabetic obesity.

OBJECTIVE: Clinical aspects of diabetes and obesity are somewhat different, even at similar levels of insulin resistance. The purpose of this study was to determine differences in body fat distribution and serum adiponectin concentrations in diabetic and non-diabetic obese participants. We were also interested in identifying the characteristics of insulin resistance in these two groups, particularly from the standpoint of adiponectin. RESEARCH METHODS AND PROCEDURES: Adiponectin concentrations of 112 type 2 diabetic obese participants and 124 non-diabetic obese participants were determined. Abdominal adipose tissue areas and midthigh skeletal muscle areas were measured by computed tomography. A homeostasis model assessment of the insulin resistance score was calculated to assess insulin sensitivity. The relationships among serum adiponectin, body fat distribution, and clinical characteristics were also analyzed. RESULTS: Both abdominal subcutaneous and visceral fat areas were higher in the non-diabetic obese group, whereas midthigh low-density muscle area was higher in the diabetic obese group. The homeostasis model assessment of the insulin resistance score was similar between groups, whereas serum adiponectin was lower in the diabetic obese group. Abdominal visceral fat (beta = -0.381, p = 0.012) was a more important predictor of adiponectin concentration than low-density muscle (beta = -0.218, p = 0.026) in cases of non-diabetic obesity, whereas low-density muscle (beta = -0.413, p = 0.013) was a better predictor of adiponectin level than abdominal visceral fat (beta = - 0.228, p = 0.044) in diabetic obese patients. DISCUSSION: Therefore, factors involved in pathophysiology, including different serum adiponectin levels and body fat distributions, are believed to be responsible for differences in clinical characteristics, even at similar levels of insulin resistance in both diseases.

Expression of RANKL and OPG in middle ear cholesteatoma tissue.

OBJECTIVES: The objective of this study was to investigate how the expression of the RANK-RANKL-OPG system mediates the formation and differentiation of osteoclasts and causes bone resorption in cholesteatoma. METHODS: An immunohistochemical analysis was carried out in 22 cholesteatoma tissues obtained during middle ear surgery and 15 normal postauricular skin tissues to examine the expression of RANKL and OPG. RESULTS: All 22 cases of cholesteatoma and the 15 cases of normal postauricular skin expressed RANKL and OPG. The count and rate of RANKL-positive cells in cholesteatoma was significantly higher than in normal postauricular skin. The count and rate of OPG-positive cells in normal postauricular skin was significantly higher than in cholesteatoma. The ratio of the positive expression rates of RANKL and OPG in cholesteatoma was statistically higher than in normal postauricular skin. CONCLUSIONS: We provide evidence suggesting that RANKL, which activates osteoclasts, plays a significant role in the mechanism of bone destruction in cholesteatoma, and that the ratio of RANKL to OPG may be a reliable indicator of bone destruction in cholesteatoma.

Effects of genetic polymorphisms of MDR1, FMO3 and CYP1A2 on susceptibility to colorectal cancer in Koreans.

The aim of the present study was to evaluate the effects on the susceptibility to colorectal cancer (CRC) of genetic polymorphisms in P-glycoprotein (PGP) and the metabolic enzymes cytochrome P450 1A2 (CYP1A2) and flavin-containing monooxygenase 3 (FMO3). We analyzed five single-nucleotide polymorphisms (SNP) in 93 cancer-free volunteers and 111 patients with CRC: one common genetic variant of the PGP-encoding MDR1 gene and four SNP in genes for metabolic enzymes (two SNP in FMO3 and two SNP in CYP1A2). The genotypes and allele frequencies of the MDR1/C3435T, FMO3/G488A, FMO3/A923G and CYP1A2/G-3860 A polymorphisms were not significantly different in cancer-free subjects and CRC patients. However, a significant association was found between the CYP1A2/A-163C polymorphism and the risk of CRC, particularly in elderly (>55 years) subjects and smokers. A phenotyping study in normal smokers showed that the CYP1A2 activity of subjects with the CYP1A2/-163 AA genotype was significantly lower than that of subjects carrying the CYP1A2/-163C allele. Combined results show that the CYP1A2/-163C allele is significantly associated with an increase in CYP1A2 activity and a consequent increased risk of CRC in Koreans, particularly in elderly people and smokers.

Effects of ERCC1 expression in peripheral blood on the risk of head and neck cancer.

Squamous cell carcinoma of the head and neck (SCCHN) accounted for 3.5% of all cancers registered in Korea during 2001. Although tobacco smoking and alcohol consumption are known risk factors of SCCHN, only a small fraction of the populations exposed to tobacco or alcohol develop SCCHN. Therefore, differences in the susceptibility of SCCHN with respect to DNA repair and xenobiotic metabolisms have focused upon attempts to determine the causes of SCCHN. Here, we investigated factors that affect ERCC1 mRNA expression in peripheral blood. The study subjects were all Koreans (67 patients and 73 control subjects); 72.9% of all subjects were male; 68.4% were current or former smokers; and 62.4% were current or former alcohol drinkers. We also studied the association between ERCC1 mRNA expression and the C8092A polymorphism of ERCC1, and found lower ERCC1 mRNA expression in SCCHN patients than in controls (P<0.01). In the present study, we found that ERCC1 C8092A polymorphism is not related to the risk of SCCHN or expression of ERCC1 mRNA. In addition, we found a positive association between ERCC1 mRNA expression in peripheral blood and tumour tissues and inverse associations between ERCC1 mRNA expression and age or the number of cigarettes smoked. Therefore, our study suggests that ERCC1 mRNA expression is reduced by age and smoking and has a weak effect on SCCHN risk as compared with the effects of age and tobacco-smoking expression.