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1.
Dis Esophagus ; 29(7): 752-759, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26471351

RESUMEN

Early detection of synchronous esophageal squamous cell neoplasm (ESCN) in head and neck squamous cell carcinoma (HNSCC) patients can significantly affect their prognosis. We investigated the prevalence of synchronous ESCN and the risk factors for developing ESCN in patients with HNSCC, and evaluated the effect of routine endoscopic screening in these patients. Subjects who were diagnosed as HNSCC from May 2010 to January 2014 were eligible. All patients underwent conventional white light endoscopic examinations with narrow band imaging and Lugol chromoendoscopy. Among 458 subjects screened, 28 synchronous ESCN were detected in 24 patients (5.2%). The prevalence of ESCN was greatest in patients with hypopharyngeal cancer (20.9%). In multivariate analysis, pyriform sinus involvement was independent risk factor for developing synchronous ESCN (odds ratio 171.2, P < 0.001). During the follow-up period (median, 24 months), the 3-year overall survival rates was significantly lower in patients with ESCN than in patients without ESCN (54.2% vs. 78.3%, P = 0.0013). Routine endoscopic screening for detecting synchronous ESCN should be recommended for patients with HNSCC, especially those with pyriform sinus involvement.


Asunto(s)
Carcinoma de Células Escamosas/patología , Detección Precoz del Cáncer/métodos , Neoplasias Esofágicas/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Neoplasias Primarias Múltiples/diagnóstico , Vigilancia de la Población/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/patología , Esofagoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hipofaríngeas/patología , Yoduros , Masculino , Persona de Mediana Edad , Análisis Multivariante , Imagen de Banda Estrecha , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Oportunidad Relativa , Prevalencia , Pronóstico , Estudios Prospectivos , Seno Piriforme/patología , Factores de Riesgo , Carcinoma de Células Escamosas de Cabeza y Cuello , Tasa de Supervivencia , Adulto Joven
2.
Eur J Neurol ; 22(7): 1062-7, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25847359

RESUMEN

BACKGROUND AND PURPOSE: The inferior cerebellar peduncle (ICP) contains various fibres to and from the cerebellum relating to the integration of the proprioceptive and vestibular functions. However, the full clinical features of isolated unilateral ICP lesions have not been defined in humans. METHODS: Eight consecutive patients with isolated unilateral ICP lesions at the pontine level (six with stroke, one with multiple sclerosis and one with brainstem encephalitis) received bedside neurological and neuro-otological evaluations and underwent laboratory tests including measurements of the subjective visual vertical (SVV) and ocular torsion, bithermal caloric tests and pure tone audiometry. RESULTS: All patients developed isolated acute vestibular syndrome (AVS) with ipsilesional spontaneous nystagmus (n = 7) and contralesional ocular tilt reaction (OTR) and/or SVV tilt (n = 7). In view of the normal head impulse test in all patients and skew deviation in one, our patients met the criteria for AVS from central lesions. Five patients showed a directional dissociation between the OTR/SVV tilt and body lateropulsion that fell to the lesion side whilst the OTR/SVVtilt was contraversive. CONCLUSIONS: A unilateral ICP lesion at the pontine level leads to the development of isolated AVS. However, a negative head impulse test and directional dissociation between OTR/SVV tilt and body lateropulsion may distinguish lesions involving unilateral ICP at the pontine level from those affecting other vestibular structures.


Asunto(s)
Enfermedades Cerebelosas/patología , Bulbo Raquídeo/patología , Enfermedades Vestibulares/fisiopatología , Sustancia Blanca/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cerebelosas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome , Enfermedades Vestibulares/etiología
3.
Eur J Neurol ; 22(4): 648-55, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25641037

RESUMEN

BACKGROUND AND PURPOSE: Generalized cerebral ischaemia from cardiovascular dysfunction usually leads to presyncopal dizziness, but several studies reported a higher frequency of rotatory vertigo in cardiovascular patients. Whether generalized cerebral ischaemia due to cardiovascular disorders may produce objective vestibular dysfunction was investigated. METHODS: Thirty-three patients with orthostatic dizziness/vertigo due to profound orthostatic hypotension and 30 controls were recruited. All participants underwent recording of eye movements during two orthostatic challenging tests: the Schellong and the squatting-standing tests. Most patients had neuroimaging, and patients with abnormal eye movements were subjected to follow-up evaluations. RESULTS: Symptoms associated with orthostatic dizziness/vertigo included blurred vision, fainting and tinnitus. Ten (30%) of 33 patients developed rotatory vertigo and nystagmus during the Schellong (n = 5) or squatting-standing test (n = 5). Four of them showed pure downbeat nystagmus whilst five had downbeat and horizontal nystagmus with or without torsional component. Patients with orthostatic nystagmus had shorter duration of orthostatic intolerance than those without nystagmus (1.0 ± 1.6 vs. 11.0 ± 9.7 months, P < 0.001). In two patients, orthostatic nystagmus disappeared during follow-up despite the persistence of profound orthostatic hypotension. CONCLUSIONS: Generalized cerebral ischaemia caused by orthostatic hypotension induces rotatory vertigo due to objective vestibular dysfunction. The presence of orthostatic vertigo and nystagmus has an association with the duration of orthostatic intolerance.


Asunto(s)
Isquemia Encefálica/complicaciones , Hipotensión Ortostática/complicaciones , Nistagmo Patológico/etiología , Intolerancia Ortostática/etiología , Vértigo/etiología , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nistagmo Patológico/fisiopatología , Intolerancia Ortostática/fisiopatología , Vértigo/fisiopatología
4.
Endoscopy ; 45(2): 133-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23364841

RESUMEN

Although endoscopic submucosal dissection (ESD) is increasingly utilized to treat early neoplasms of the gastrointestinal tract, its use for duodenal neoplasms is limited by the thin wall and narrow lumen of the duodenum. We have reviewed cases where ESD was used to treat sessile, nonampullary duodenal neoplasms. To do this, we retrospectively reviewed the medical records of patients treated with ESD for adenomas of the duodenum from January 2001 to December 2010, assessing the curative outcomes and complication rates. A total of 14 cases were reviewed. Mean patient age was 56.4 years. The mean size of tumors and mean size of the specimens were 17.1 mm and 26.4 mm, respectively. The en bloc resection rate with ESD was 78.6%, and the complete (R0) resection rate was 85.7%. No patient in the study experienced major bleeding. However, second-look endoscopy revealed minor bleeding requiring endoscopic homeostasis in one case (7.1%). Perforations were observed in five cases (35.7%). Two of the five patients with perforation underwent surgery. The ESD methods yielded acceptable curative resection rates for duodenal adenomas, although ESD was associated with a higher rate of perforation. Therefore, duodenal ESD should be performed with care and only in selected patients to avoid serious complications.


Asunto(s)
Adenoma/cirugía , Neoplasias Duodenales/cirugía , Duodenoscopía , Duodeno , Mucosa Intestinal/cirugía , Perforación Intestinal/etiología , Adenoma/patología , Disección/efectos adversos , Neoplasias Duodenales/patología , Duodenoscopía/efectos adversos , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Estudios Retrospectivos
5.
Endoscopy ; 44(12): 1114-20, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23188661

RESUMEN

BACKGROUND AND STUDY AIMS: Following noncurative endoscopic resection of early gastric cancer (EGC), the patient should be observed when the underlying disease is severe, the patient is elderly, or the patient refuses further treatment. The aim of this study was to analyze the clinical outcomes of patients with differentiated EGC who underwent noncurative endoscopic resection without additional treatment. PATIENTS AND METHODS: Included patients underwent noncurative endoscopic resection for differentiated EGC without additional treatment at the Asan Medical Center between July 1994 and January 2009. Clinical and oncological outcomes were analyzed. RESULTS: A total of 159 patients were included in the analysis. The median follow-up period was 33 months (interquartile range [IQR] 22 - 52 months). In total, 40 patients died (25.2 %) - 3 due to stomach cancer, 34 due to other causes, and 3 from unknown causes; the median survival time after endoscopic treatment for these patients was 27.5 months (IQR 13.8 - 48.3 months). Multivariate analysis showed that the rates of underlying disease (P < 0.001) and lymphovascular invasion (P = 0.005) were higher among the 40 patients who died than among the 119 survivors. The overall 3-  and 5-year survival rates were 82.9 % and 77.1 %, respectively; the rates of the patients with lymphovascular invasion were 61.9 % and 42.4 %, respectively, and the rates of patients without lymphovascular invasion were 86.1 % and 81.8 %, respectively (P < 0.001). CONCLUSIONS: Additional treatment provides fewer benefits to patients who do not have long life expectancies. Additional surgery can be considered for patients with lymphovascular invasion because of its high mortality rate; however, the benefits and risks of surgery should be considered carefully.


Asunto(s)
Esofagoscopía/métodos , Mucosa Gástrica/cirugía , Recurrencia Local de Neoplasia/patología , Neoplasias Gástricas/cirugía , Anciano , Análisis de Varianza , Biopsia con Aguja , Estudios de Cohortes , Detección Precoz del Cáncer , Femenino , Mucosa Gástrica/patología , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Cuidados Paliativos/métodos , Valor Predictivo de las Pruebas , Pronóstico , República de Corea , Estudios Retrospectivos , Medición de Riesgo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
6.
Endoscopy ; 43(3): 233-5, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21165828

RESUMEN

Endoscopic submucosal dissection (ESD) is an important therapeutic option for gastric adenoma and early gastric cancer (EGC). However, ESD is technically difficult when lesions are located in the pyloric area. Our aim was to introduce the transnasal endoscope-assisted ESD method, which provides for excellent cutting-line visualization through control of submucosal traction. A total of eight patients with gastric adenoma or EGC located in the pyloric area were consecutively enrolled. A primary operating endoscope was used to perform marking, incision, submucosal dissection, and hemostasis, while a thinner, transnasal endoscope operated by a second endoscopist was used to retract connective submucosal tissue to provide cutting-line visualization using V-shaped grasping forceps. En bloc resection was achieved in all eight cases, as was complete resection. The median longest lesion diameter was 19 mm (range: 12-25 mm), and the median procedure time was 37.5 minutes (range: 29-59 minutes). There were no incidents of significant bleeding or perforation. Transnasal endoscope-assisted ESD was useful for treating gastric neoplasms in the pyloric area. The procedure was relatively easy and safe, provided excellent visualization through tissue retraction, and allowed for complete en bloc resection.


Asunto(s)
Adenocarcinoma/cirugía , Adenoma/cirugía , Mucosa Gástrica/cirugía , Gastroscopía/métodos , Píloro/cirugía , Neoplasias Gástricas/cirugía , Anciano , Femenino , Mucosa Gástrica/patología , Gastroscopía/efectos adversos , Gastroscopía/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Píloro/patología , Resultado del Tratamiento
7.
Dis Esophagus ; 22(8): 676-81, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19222529

RESUMEN

The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing in Western countries. It is unclear, however, whether similar changes are occurring in Asia. We therefore investigated the incidence of AEG in Korea, and assessed the clinical characteristics of three types of AEG based on Siewert's classification. We retrospectively reviewed the medical records of 16 811 patients diagnosed with esophageal squamous cell carcinoma (ESC, n= 1450) or gastric noncardiac adenocarcinoma (GNCA, n= 14 751) between 1992 and 2006. The patients were divided into three 5-year cohorts (cohort A [1992-1996], n= 2734, cohort B [1997-2001], n= 5727, and cohort C [2002-2006], n= 8350), and the ratios of AEG (n= 610) to non-AEG (ESC and GNCA) in each cohort were compared. Using Siewert's classification, the tumors were categorized into one of three types, and patient demographic features and 5-year survival rates were compared. The ratio of AEG to non-AEG cases did not change over time (0.037, 0.034, and 0.039 for cohorts A, B, and C, respectively; P= 0.40). Of the 610 patients with AEG, 23 (3.7%) had type 1 tumors, 47 (7.7%) had type 2, and 540 (88.5%) had type 3. The 5-year survival rate of patients with type 1 AEG was much lower (4.8 +/- 4.7%) than that of those with type 2 (47.9 +/- 7.8%) and type 3 (47.4 +/- 2.5%) tumors. Unlike in Western countries, the ratio of AEG to non-AEG cases has not increased over time in Korea. Type 1 AEG was rarer and associated with a more unfavorable prognosis in Korea than in Western countries.


Asunto(s)
Adenocarcinoma/epidemiología , Neoplasias Esofágicas/epidemiología , Unión Esofagogástrica , Neoplasias Gástricas/epidemiología , Adenocarcinoma/clasificación , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Carcinoma de Células Escamosas/clasificación , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Cardias/patología , Neoplasias Esofágicas/clasificación , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Femenino , Gastrectomía , Humanos , Estimación de Kaplan-Meier , Corea (Geográfico)/epidemiología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Prevalencia , Estudios Retrospectivos , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía
9.
J Neurol Sci ; 275(1-2): 133-8, 2008 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-18817933

RESUMEN

Cognitive deficits can be associated with cerebellar injury. The purpose of this study is to learn 1) if unilateral cerebellar injury might also cause hemispatial neglect, and if so, 2) if there is a left versus right asymmetry, 3) if the neglect is contralesional (CN) or ipsilesional (IN), and 4) if cerebellar injury might induce neglect by disruption of cerebellar-cortical networks. Participants were 28 patients with unilateral cerebellar stroke who were assessed for neglect within 2 months after the onset of stroke. To investigate if the cerebellar-cerebral network dysfunction induced neglect, 12 patients received perfusion single photon emission computed tomography (SPECT). Eight of the participants demonstrated neglect (28.6%), four with left cerebellar strokes (three with CN and one with IN) and four with right cerebellar strokes (three with IN and one with CN). Among five patients with neglect who had undergone SPECT, only one with ipsilesional neglect showed crossed cerebello-cerebral diaschisis. Neglect induced by cerebellar stroke might be more common than previously reported. Based on the cerebellar-cerebral network hypothesis we expected neglect to be more common with left than right cerebellar injury, but there was an equal number of patients with neglect from right and left sided strokes and the SPECT scan did not provide support of this hypothesis. Thus, this hypothesis cannot also explain the equal number of subject with ipsi- and contralesional neglect and in future studies alternative hypotheses such as vestibular hypothesis will have to be explored.


Asunto(s)
Cerebelo/fisiopatología , Lateralidad Funcional/fisiología , Trastornos de la Percepción/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/patología , Adulto , Anciano , Anciano de 80 o más Años , Mapeo Encefálico , Cerebelo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Percepción/diagnóstico por imagen , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto Joven
10.
Anim Biotechnol ; 18(4): 275-85, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17934901

RESUMEN

The 788-gene microarray was manufactured using selected elements from three different cDNA libraries in order to identify molecular processes that determine phenotypic characteristics between loin (M. longissimus thoracis) and round (M. semimembranosus) muscles. Microarray analyses identified 24 differentially expressed genes between the two muscles investigated. Five of the genes were verified by quantitative RT-PCR and three of them were mapped on bovine chromosomes using 5,000 rad bovine radiation hybrid (RH) panel. The map locations indicated that they were mapped in the same chromosomal regions where IMF and growth QTLs were located, suggesting that they are most possible positional candidate genes for the traits.


Asunto(s)
Bovinos/genética , Fibras Musculares Esqueléticas/fisiología , Músculo Esquelético/fisiología , Animales , Bovinos/metabolismo , Expresión Génica , Perfilación de la Expresión Génica/métodos , Perfilación de la Expresión Génica/veterinaria , Carne , Análisis de Secuencia por Matrices de Oligonucleótidos/veterinaria , Mapeo de Híbrido por Radiación/veterinaria
11.
Aliment Pharmacol Ther ; 24(5): 837-43, 2006 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-16918888

RESUMEN

BACKGROUND: Acid suppressing agents are widely used to treat the iatrogenic ulcers following endoscopic mucosal resection for gastric neoplasms. However, the relative merits of proton pump inhibitor or histamine(2)-receptor antagonist for endoscopic mucosal resection-induced ulcers are not known. AIM: To prospectively compare omeprazole and famotidine for the healing of endoscopic mucosal resection-induced ulcers and for bleeding control. METHODS: After endoscopic mucosal resection, patients were randomly assigned to omeprazole (20 mg/day) or to famotidine (40 mg/day) group for a 28-day treatment period. The ulcer sizes and stages, bleeding rates and ulcer-related symptoms were compared. RESULTS: A total of 100 patients were randomized equally to each group. Forty-one patients in each group were finally compared. The two groups were comparable in terms of baseline characteristics. Twenty-eight days after treatment, the two groups were not different with respect to ulcer stage (P = 0.137) or ulcer reduction ratio (P = 0.380). No difference was observed with respect to ulcer-related symptoms (P = 0.437) and no bleeding episode occurred in any of the 82 patients. In subgroup that underwent endoscopic submucosal dissection, fewer patients in the omeprazole group showed active ulcers than those in the famotidine group (P = 0.035). CONCLUSION: Our results demonstrate that omeprazole may be superior to famotidine for iatrogenic ulcers following endoscopic mucosal resection, especially for large ulcers.


Asunto(s)
Antiulcerosos/uso terapéutico , Famotidina/uso terapéutico , Mucosa Gástrica/cirugía , Enfermedad Iatrogénica , Omeprazol/uso terapéutico , Úlcera Gástrica/tratamiento farmacológico , Femenino , Hemorragia Gastrointestinal/prevención & control , Gastroscopía/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias Gástricas/cirugía , Resultado del Tratamiento
12.
Handb Clin Neurol ; 137: 317-40, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27638081

RESUMEN

Dizziness/vertigo and imbalance are the most common symptoms of vertebrobasilar ischemia. Even though dizziness/vertigo usually accompanies other neurologic symptoms and signs in cerebrovascular disorders, a diagnosis of isolated vascular vertigo is increasing markedly by virtue of recent developments in clinical neurotology and neuroimaging. It is important to differentiate isolated vertigo of a vascular cause from more benign disorders involving the inner ear, since therapeutic strategies and prognosis differ between these two conditions. Over the last decade, we have achieved a marked development in the understanding and diagnosis of vascular dizziness/vertigo. Introduction of diffusion-weighted magnetic resonance imaging (MRI) has greatly enhanced detection of infarctions in patients with vascular dizziness/vertigo, especially in the posterior-circulation territories. However, well-organized bedside neurotologic evaluation is even more sensitive than MRI in detecting acute infarction as a cause of spontaneous prolonged vertigo. Furthermore, detailed evaluation of strategic infarctions has elucidated the function of various vestibular structures of the brainstem and cerebellum. In contrast, diagnosis of isolated labyrinthine infarction still remains a challenge. This diagnostic difficulty also applies to isolated transient dizziness/vertigo of vascular origin. Regarding the common nonlacunar mechanisms in the acute vestibular syndrome from small infarctions, individual strategies may be indicated to prevent recurrences of stroke in patients with vascular vertigo.


Asunto(s)
Mareo/etiología , Isquemia/complicaciones , Vértigo/etiología , Encéfalo/patología , Encéfalo/fisiopatología , Humanos
13.
J Physiol Pharmacol ; 66(3): 415-20, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26084223

RESUMEN

UNLABELLED: This study was aimed to determine the expression and localization of nerve growth factor (NGF) and several neural peptides in porcine esophagus. Transmural esophageal specimens were obtained from euthanized pigs. STUDIES: 1) histologic evaluation, 2) expressions of NGF and its tropomyosin receptor kinase A (TrkA) receptor, calcitonin generelated peptide (CGRP), neuronal nitric oxide synthase (nNOS), and neuronal enolase using immunostaining and quantification of signal distribution and intensity. Immunostaining for NGF, CGRP, nNOS and neuronal specific enolase (NSE) showed their strong and differential expression and localization in the neuronal network. NGF was strongly expressed in the majority of neurons and nerves, distribution of TrkA was complementary; its signal was 1.5-fold weaker P < 0.001 than NGF). Quantitatively the signal intensity was: CGRP > nNOS > NGF > NES > TrkA. In addition to neural structures, nNOS, NGF and TrkA were expressed in keratinocyte progenitor cells of esophageal mucosa and in endothelial cells of blood vessels. We conclude that a strong expression of NGF in majority of esophageal neurons and nerves indicates important, but previously unrecognized regulatory roles in the esophagus; 2) This study showed expression of NGF and some of the neuropeptides in neural elements, keratinocyte progenitor cells and endothelial cells of blood vessels, which indicates local interactions between neural, epithelial and endothelial cells.


Asunto(s)
Péptido Relacionado con Gen de Calcitonina/metabolismo , Esófago/metabolismo , Factor de Crecimiento Nervioso/metabolismo , Óxido Nítrico Sintasa de Tipo I/metabolismo , Fosfopiruvato Hidratasa/metabolismo , Receptor trkA/metabolismo , Animales , Células Endoteliales/metabolismo , Epitelio/metabolismo , Esófago/citología , Neuronas/metabolismo , Células Madre/metabolismo , Porcinos
14.
Neurogastroenterol Motil ; 27(2): 246-57, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25521290

RESUMEN

BACKGROUND: High-resolution manometry using the Chicago classification, which utilizes parameters including integrated relaxation pressure (IRP), distal contractile integral (DCI), and contractile front velocity (CFV), shows better diagnostic ability than previous conventional criteria. However, the current normal cut-off values for the Chicago classification are based on individuals aged 19-48 years and do not include older people. Here, we aimed to assess the normal values for the Chicago classification in individuals aged 20-67 years and compare the parameters across age groups. METHODS: Fifty-four asymptomatic healthy individuals (27 male and 27 female; age range. 20-67 years) were prospectively enrolled. To evaluate the effect of age and sex on manometric profiles, we attempted to enroll equal numbers of male and female subjects for each decade. Manometry was performed in both the supine and sitting positions. KEY RESULTS: The distal latency (DL) was significantly shorter with increasing age in both measurement positions. Furthermore, IRP was significantly higher with increasing age in both positions. Spearman's ranked correlation coefficient analysis indicated that DCI and IRP in both positions were positively correlated with age. CONCLUSIONS & INFERENCES: Age affects the key parameters currently used in the Chicago classification, including IRP, DCI, and DL. Larger prospective studies with older subjects are needed to determine the age-related normal values for the Chicago classification system.


Asunto(s)
Trastornos de la Motilidad Esofágica/diagnóstico , Manometría/métodos , Manometría/normas , Adulto , Factores de Edad , Anciano , Trastornos de la Motilidad Esofágica/clasificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Postura , Factores Sexuales , Adulto Joven
15.
Transplant Proc ; 47(2): 451-6, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25769589

RESUMEN

BACKGROUND: Adequate nutritional support for patients undergoing major surgery significantly affects postoperative recovery. Data on enteral feeding after liver transplantation (LT) are scarce. The aim of this work was to determine the efficacy and complications of feeding tubes inserted with the use of fluoroscopic assistance, endoscopic assistance, or transperitoneal jejunostomy in patients who underwent LT. METHODS: From January 2008 to August 2013, 2,058 LTs were performed at Asan Medical Center, Seoul, Korea. Enteral feeding tubes were inserted in 155 patients (7.5%) after LT: with the use of fluoroscopic placement in 81 (52%), endoscopic placement in 49 (32%), and transperitoneal jejunostomy in 25 (16%). We retrospectively analyzed the efficacy and complications of enteral feeding tubes. RESULTS: The median age was 55 years (interquartile range [IQR] 49-60). Enteral feeding indications were a high risk of gastric aspiration (n = 90), gastric stasis (n = 27), pneumonia (n = 23), gastrointestinal bleeding (n = 12), and bowel rest (n = 3). Median enteral feeding durations were 14.5 days (IQR 8.0-30.7) for fluoroscopic placement, 20.0 days (IQR 8.0-40.0) for endoscopic placement, and 37.5 days (IQR 18.2-86.2) for transperitoneal jejunostomy. Times to establishment of oral feeding were 13.0 days (IQR 6.2-25.7) for fluoroscopic placement, 24.0 days (IQR 10.5-43.5) for endoscopic placement, and 37.0 days (IQR 17.0-64.2) for transperitoneal jejunostomy. After tube insertion, tube dislocation and blockage occurred in 34 patients (22%) and 16 patients (25%), respectively. CONCLUSIONS: Enteral feeding tube insertion in patients who can not maintain a nasogastric tube or start oral intake for a long time is important for nutritional support after LT. Proper feeding method selection according to patient condition can help patients by improving nutritional support after major operations such as LT.


Asunto(s)
Nutrición Enteral/métodos , Intubación Gastrointestinal/métodos , Trasplante de Hígado , Cuidados Posoperatorios/métodos , Adulto , Anciano , Endoscopía Gastrointestinal , Nutrición Enteral/efectos adversos , Femenino , Fluoroscopía , Humanos , Intubación Gastrointestinal/efectos adversos , Yeyunostomía , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Radiografía Intervencional , Estudios Retrospectivos
16.
Dev Comp Immunol ; 23(2): 165-77, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10227483

RESUMEN

A cDNA encoding chicken interleukin-15 was cloned from a CD4+ T cell hybridoma expression library by screening with a rabbit antibody against a protein fraction of conditioned medium containing T cell growth promoting activity. The chicken IL-15 cDNA contains an open reading frame of 143 amino acids with a single potential N-linked glycosylation site. The predicted m.w. of the encoded protein (16 kDa) matched the size of an immunoreactive band on Western blots of E. coli expressing the recombinant IL-15. Amino acid and nucleotide sequence analyses of chicken IL-15 revealed 31% and 46% identity with bovine IL-15 respectively and lesser homologies to other mammalian IL-15s. Chicken IL-15 contained all 4 highly conserved cysteine residues present in mammalian IL-15 sequences. RT-PCR demonstrated that the chicken IL-15 gene is expressed in many tissues including spleen, intestine, and muscle and in established macrophage, T lymphoma and fibroblast cell lines. Activation of spleen cells with Con A enhanced the expression of IL-15 gene transcripts in a time-dependent manner. CHO-K1 cells transfected with the chicken IL-15 cDNA secreted a biologically active protein supporting the growth of Con A activated spleen lymphocytes. Continuous culture of spleen Con A lymphoblasts with chicken IL-15 over two months resulted in an enriched T lymphocyte population expressing the gammadeltaTCR, CD8alpha, and CD3 cell surface antigens.


Asunto(s)
Interleucina-15/genética , Interleucina-15/inmunología , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Células CHO , Bovinos , Pollos , Clonación Molecular , Cricetinae , ADN Complementario , Humanos , Datos de Secuencia Molecular , ARN Mensajero , Conejos , Receptores de Antígenos de Linfocitos T gamma-delta/inmunología , Análisis de Secuencia de ADN , Homología de Secuencia de Aminoácido , Distribución Tisular
17.
Vet Immunol Immunopathol ; 73(3-4): 309-21, 2000 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-10713343

RESUMEN

Continuous culture of concanavalin A (Con A)-activated spleen cells in the presence of chicken recombinant IL-2 (rIL-2) promoted preferential growth of gammadelta T-cells. These cells displayed a high level of spontaneous cytotoxicity against LSCC-RP9 tumor cells, an avian NK cell target. Stimulation of IL-2-dependent gammadelta T-cells with Con A induced IFN-gamma and IL-2 mRNA transcripts, whereas stimulation with rIL-2 induced only IFN-gamma mRNA. Subcutaneous injection of 3-week-old chickens with IL-2 DNA increased splenic cells, expressing the CD8 and gammadelta TCR antigens. To investigate the role of IL-2 and gammadelta T-cells in parasitic infection, chickens were orally infected with Eimeria acervulina and the expression of IL-2 mRNA transcripts in the spleen and duodenum and the percentage of gammadelta T-cells in the duodenum were examined. Following both, the primary and secondary infections, a significant enhancement of IL-2 mRNA transcripts in the spleen and intestine and increased percentage of intraepithelial gammadelta T-cells in the duodenum were observed. These results indicate that host immune responses to E. acervulina involve an up-regulation of IL-2 secretion and an increased duodenum gammadelta T-cells.


Asunto(s)
Pollos/inmunología , Coccidiosis/veterinaria , Duodeno/inmunología , Eimeria , Interleucina-2/genética , Enfermedades de las Aves de Corral/inmunología , ARN Mensajero/biosíntesis , Receptores de Antígenos de Linfocitos T gamma-delta/inmunología , Animales , Coccidiosis/inmunología , Concanavalina A/farmacología , Citotoxicidad Inmunológica , Cartilla de ADN/química , Citometría de Flujo/veterinaria , Interferón gamma/genética , Interleucina-2/biosíntesis , Interleucina-2/farmacología , Células Asesinas Naturales/inmunología , Activación de Linfocitos/efectos de los fármacos , Reacción en Cadena de la Polimerasa/veterinaria , Enfermedades de las Aves de Corral/parasitología , Proteínas Recombinantes/farmacología , Bazo/inmunología , Linfocitos T/inmunología , Regulación hacia Arriba
18.
Vet Immunol Immunopathol ; 73(3-4): 297-308, 2000 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-10713342

RESUMEN

Twelve mabs against native or recombinant chicken IFN-gamma were produced and characterized by virus neutralization, ELISA, and Western blot assays. No data were obtained to suggest that the form of the immunogen (native versus recombinant) influenced the antigenic specificity of the mabs produced. While only two antibodies inhibited the in vitro virus neutralizing activity of IFN-gamma, other evidence indicated that the specificity of these mabs was indeed directed against IFN-gamma. By Western blot analysis, all antibodies identified a 17-kDa IFN-gamma polypeptide. Using a direct binding ELISA incorporating these mabs, a high correlation with IFN-gamma detected by in vitro virus neutralization was observed. The IFN-gamma ELISA was also capable of measuring cytokine levels in the sera of chickens orally infected with Eimeria maxima. At 8 and 10 days post-primary infection, significantly higher (p<0. 001) levels of serum IFN-gamma were detected in E. maxima infected chickens compared to uninfected controls. These results indicate that a mab-based direct binding ELISA is suitable to measure chicken IFN-gamma in a variety of formats.


Asunto(s)
Anticuerpos Monoclonales/análisis , Pollos/inmunología , Coccidiosis/veterinaria , Eimeria , Ensayo de Inmunoadsorción Enzimática/veterinaria , Interferón gamma/inmunología , Enfermedades de las Aves de Corral/inmunología , Animales , Anticuerpos Monoclonales/biosíntesis , Especificidad de Anticuerpos , Western Blotting/veterinaria , Coccidiosis/inmunología , Coccidiosis/parasitología , Citocinas , Ratones , Ratones Endogámicos BALB C , Mitógenos/farmacología , Pruebas de Neutralización/veterinaria , Enfermedades de las Aves de Corral/parasitología , Proteínas Recombinantes , Bazo/efectos de los fármacos
19.
Vet Immunol Immunopathol ; 71(3-4): 263-75, 1999 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-10587306

RESUMEN

Inbred chickens SC (B2B2) and TK (B15B21) display different levels of susceptibility to Eimeria acervulina infection. Following primary and secondary infections, SC chickens showed significantly lower oocyst production compared to TK chickens. Both strains produce significantly fewer oocysts during secondary infection (si) indicating that a protective host immune response had developed subsequent to primary infection (pi). To elucidate the immunologic differences between SC and TK chickens that may account for their different levels of disease susceptibility, cellular and molecular parameters of intestinal immunity were compared. CD4 T-lymphocytes increased significantly and more rapidly post-pi and si in SC relative to TK chickens during the later stages of infections. However, later during the infections, CD4 cells were higher in TK compared to SC chickens. Although the percentage of CD8 lymphocytes increased in both strains after pi, following si the percentage of these cells continued to increase in SC chickens but showed a marked decrease in TK chickens. Contrary to the effects on CD4 cells, the percentage of TCR1 cells was higher in TK chickens early after pi while the same cell subset was higher in SC chickens later following infection. The percentages of TCR2 cells were significantly higher in both strains following pi. At the molecular level, IFN-gamma mRNA expression in caecal tonsils and splenic lymphocytes was generally higher in SC compared to TK chickens following E. acervulina infection, while intraepithelial lymphocytes from the duodenum demonstrated reduced levels of this cytokine in both the strains, particularly following pi. TGF-beta4 mRNA levels generally increased in lymphocytes from the caecal tonsils, spleen and duodenum from both the strains. These differences in lymphocyte subpopulations and cytokine mRNA expression between SC and TK chickens following E. acervulina infection indicate a complex genetic control of the native immune response to coccidiosis.


Asunto(s)
Pollos/inmunología , Coccidiosis/inmunología , Duodeno/inmunología , Eimeria/inmunología , Interferón gamma/genética , ARN Mensajero/análisis , Subgrupos de Linfocitos T/inmunología , Factor de Crecimiento Transformador beta/genética , Animales
20.
Vet Immunol Immunopathol ; 58(3-4): 321-33, 1997 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-9436275

RESUMEN

A cDNA encoding chicken interferon-gamma (chIFN-gamma) was cloned from a CD4+ T-cell hybridoma by reverse transcription-polymerase chain reaction (RT-PCR) and expressed in Escherichia coli, COS- and CEC-32 fibroblast cell lines. In general, recombinant chicken IFN-gamma (rchIFN-gamma) expressed in the COS- and CEC-32 cell lines showed high bioactivity in vitro. The kinetics of IFN-gamma gene expression were examined in concanavalin A (Con A)-activated spleen lymphocytes by Northern blot and RT-PCR. IFN-gamma mRNA was detected as early as 30 min after Con A activation, reached peak expression at 2 h and then decreased starting at 4 h post Con A activation. A rabbit serum made to a synthetic peptide of IFN-gamma immunoprecipitated a 60 kDa E. coli maltose-binding fusion protein of recombinant IFN-gamma (MBP-IFN) and a 26-27 kDa secreted protein from COS cells and Con A-activated spleen cells. IFN-gamma inhibited vesicular stomatitis virus (VSV) mediated cytotoxicity of chicken embryonic fibroblast (CEF) cells and upregulated the expression of many macrophage cell surface antigens, including class I and class II major histocompatibility complex (MHC) proteins. These results show that chicken IFN-gamma possesses anti-viral activity and immunoregulates macrophage activities.


Asunto(s)
Interferón gamma/farmacología , Animales , Pollos , Clonación Molecular , Concanavalina A/farmacología , Interferón gamma/biosíntesis , Activación de Linfocitos , Activación de Macrófagos/efectos de los fármacos , Reacción en Cadena de la Polimerasa , ARN Mensajero/análisis , Conejos , Proteínas Recombinantes
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