The extract of commercial mistletoe caused transient contraction of mouse ileum in vitro at the level of $7{\times}10^{-4}g/ml$ and augmented significantly its peristalsis. When the ileum was pre-treated With $10^{-6}g/ml$ of adrenaline the administration of the extract at a level of $10^{-4}g/ml$ blocked the contraction. The increase inperistalsis and intention was also observed in rabbit ileum in vitro with the administration of the extract at a level of $10^{-1}g/ml$ but these phenomenon were inhibited by the adrenaline treatment at a level of $10^{-6}g/ml.$ When the extract was applied to spirally cut strips of thoracic aorta at the level of $10^{-3}g/ml$ the contractile action of adrenaline was significantly inhibited. When the extract was infused to auricular blood vessel of rabbit at the rate of $10^{-4}g/ml,\;10^{-3}g/ml,\;10^{-2}g/ml$ and $10^{-1}g/ml$ increases in number of drops by 70%, 77%, 93% and 100% were observed if the maximum number of drops caused by $10^{-1}g/ml$ is considered to be 100%. The duration of prolongation was proportionate to the increase in concentration of the extract. Hypotensive action of the extract and its duration were proportionately increased as the quantity of the extract increased. The increase in number and depth of respiration observed during the hypotensive status was brought to the normal when the tension became normal. In view of these observations it is concluded that the extract of commercial mistletoe has a contractile action of acetylcholine effect in the ileum of mouse and rabbit, loosens both aorta and smooth muscle and promotes peripheral circulation. As for the hypotensive action it is concluded that the action is brought about by the decrease in peripheral circulatory resistance due to the antagonism between acetylcholine and adrenaline.
Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.
Noh, Seung Ho;Lee, Yong Woo;Park, Jin Su;Lee, Sang Hyuk
Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
/
v.28
no.1
/
pp.43-47
/
2017
Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.
Lee, Young Ho;Sim, Jae Jeong;Kang, Kyung Ho;Song, Gwan Gyu
Tuberculosis and Respiratory Diseases
/
v.43
no.5
/
pp.786-791
/
1996
Systemic sclerosis is a multisystemic disease of unknown origin charicterized by degenerative fibrotic and inflammatory changes in the skin, vessels, joints, muscles, and visceral organs. Involvement of the lung in systemic sclerosis is common, but pleural effusion is rare. Although vasculitis commonly accompanies many connective tissue disorders, it has been rarely reported in systemic sclerosis. A 43-year-old woman, with a 10-year history of Raynaud's phenomenon, was admitted due to right chest pain. Her hands showed diffuse thickening and swelling of skin. Chest X-ray showed pleural effusions and esophageal manometry showed hypotonic peristalsis and low lower esophageal sphincter tone compatible with scleroderma esophagus. Antinuclear antibodies were present (titer>1 : 160) with a speckled pattern. She was positive for rheumatoid factor, anti scl-70 and RNP antibodies, but negative for anti-Ro, La, and Sm antibodies. Histology of the pleura revealed the presence of leukocytoclastic vasculiti. After adminisrration of prednisolone 30 mg/day, her chest symptom was improved. We report a case of systemic sclerosis with pleural effusions due to leukocytoclastic vasculitis with review of the literatures.
Fourteen dogs referred to veterinary Medical Teaching Hospital, Seoul National University were diagnosed as esophageal foreign body (9 cases), megaesophagus (4 cases) and esophageal stricture (1 case). Patients showed a variety of clinical signs including regurgitation, vomiting, anorexia, hypersalivation, and retching. Survey radiographic examination included the entire esophagus, including the caudal pharynx and cranial abdomen. contrast radiographs were done to identify lesions or to characterize abnormal radiographic findings on survey films. In case static contrast studies were not sufficient were not sufficient to differentiate the diseases, dynamic fluoroscopic studies were performed. In thoracic megaesophagus, when gas filled, it provided several hallmark findings such as visualization of paired longus colli muscle and tracheal stripe sign. When gas-distended, the caudal thoracic esophagus was seen as a pair of thin, soft-tissue stripes that converged into a point overlying the diaphragm and cranial abdomen. All cases of megaesophagus could be solely identified by survey radiographs. In esophageal foreign body, 6 cases out of 9 patients had the history of having foreign body and others not. Most of esophageal foreign body could be diagnosed on survey radiographs and one case with radiolucent foreign body was confirmed by esophagram. It appeared as radiopaque material along the path of esophagus and the radiopacity was determined by its nature. Obstruction caused by foreign body eventually led to dilation of the esophageal lumen cranial to the site in 3 cases. In esophageal stricture, there was no remarkable findings on survey radiograph of the thorax. However, esophagography with barium sulfate showed the narrowing of the esophagus near hiatus. On fluoroscopy, swallowed barium was stagnated cranial to the site despite the esophageal peristalsis.
The flow of an incompressible Ellis fluid in an inclined asymmetric channel, driven by peristaltic waves was studied under low Reynolds number and long wavelength assumptions. The wave on each side of the channel are assumed to be an infinite train of sinusoidal waves, both having the same constant wave speed and wavelength however, they vary in wave amplitude, channel half width and phase angle. We derived expressions for the axial and transverse velocities, volume flow rate, pressure rise per unit wavelength and streamlines. The effects of varying the wave amplitudes, the phase angle, the channel width, the angle of inclination of the channel as well as the fluid parameters on the flow were analyzed. Trapping conditions were determined and the presence of reflux highlighted using the streamlines for the necessary channel and fluid conditions. By varying the fluid parameters, changes in the fluid that deviated from the Newtonian case resulted in a reduction in the axial velocity in the neighborhood of the center of the channel and a simultaneous increase in the velocity at the periphery of the channel. A nonlinear relation was observed with the pressure rise and the volume flow rate. This nonlinear relation is more pronounced with an increase in the absolute value of the volume flow rate. For Newtonian fluids a linear relation exists between these two variables. The fluid parameters had little effects on the streamlines. However, variations of the wave amplitudes, volume flow, channel width and phase angle had greater effects on the streamlines and hence the trapped region.
Classification of esophageal motility disorders not yet finalized and is still ongoing as the new disorders are reported, and the existing classification is changed or removed. In terms of radiology, the primary peristalsis does not exist, and the lower end of the esophagus show the smooth, tapered, beak-like appearance. The esophageal motility disorder, which mostly occurs in the smooth muscle area, show the symptoms of reduction or loss (hypomotility) or abnormal increase (hypermotility) of peristalsis of the esophagus. It is important to understand the anatomy and physiology of the esophagus for the appropriate radiological method and diagnosis. Furthermore, the symptom of the patient and the manometry finding must be closely referred for the radiological diagnosis. The lower esophageal sphincter can be normally functioning and open completely as the food moves lower. Sperandio M et al. argues that the name diffuse esophageal spasm must be changed to distal esophageal spasm (DES) as most of the spasm occurs in the distal esophagus, composed of the smooth muscle. According to Ott et al., usefulness of barium method for diagnosing the esophageal motility disorder is Achalasia 95%, DES 71% and NEMD 46%, with the overall sensitivity of 56%. However, excluding the nutcracker esophagus or nonspecific disorder which cannot be diagnosed with the radiological methods, the sensitivity increases to 89%. Using videofluoroscopy and 5 time swallows, the average sensitivity was over 90%. In conclusion, the barium method is a simple primary testing method for esophageal motility test. Using not only the image but also the videofluoroscopy with good knowledge of the anatomy and physiology, it is believed that the method will yield the accurate diagnosis.
Shin Jang-Woo;Son Jin-Young;Yim Yun-Kyoung;Choi Sun Mi;Koo Sung-Tae;Son Chang-Gue
The Journal of Korean Medicine
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v.27
no.1
s.65
/
pp.146-154
/
2006
Objectives : Siguan points (LI4, LR3) have been most frequently applied for various diseases, especially different digestive disorders such as constipation, abdominal pain or various intestinal inflammatory diseases. The fact that gastrointestina movement is closely connected with physiologic functions or pathologic process of alimentary canal led us to ask the question if Siguan points affects on intestinal motility. Design: To investigate the effect of Siguan acupuncture on the intestinal movement in both physiologic and pathologic conditions, we divided the experimental animals into 12 groups. Six groups were pre-treated with loperamide (0.5 mg/kg, sc) or scoploamine (0.5 mg/kg, sc) to suppress the intestinal movement and another three groups were pretreated with carbachol (0.5 mg/kg, po) to activate it, whereas the rest three groups didn't receive any pretreatment to be kept in the physiological condition. After the administration with charcoal meal, mice were acupunctured bilaterally on sham point or Siguan points as the manner of tap-stimulation, with the exception of no acupuncture groups. Methods : Mice were scarified in twenty minutes after the administration of charcoal to measure the distance of charcoal passage from stomach-duodenal junction. The effect on intestinal movement was presented by calculating the relative distance where charcoal arrived to total length of small intestine. Results : In physiological state, charcoal meal passed around 53%, and there was no significant difference between Siguan points and sham points groups. On the other hand. Siguan points-sitimulation significantly ameliorated loperamide or scoplolamine-induced suppressed travel rate of 17.3 % and 18.6% in sham point into 26% and 26.3% respectively (p<0.05). In carbachol-induced accelerated condition, Siguan points-stimulation didn't affect intestinal motility comparing to sham point group passed about 97.6%. Conclusions : These results postulate that acupuncture at Siguan points have a therapeutic effect by restoring cholinergic activity on pathogenically suppressed intestinal peristalsis, but does not affect the gastrointestinal motility in the normal or accelerated condition.
Kim, Dong-Geon;Jin, Young-Geon;Jin, Ju-Youn;Kim, Sang-Cheol;Kim, Seong-Cheol;Han, Chang-Hoon;Lee, Young-Jae
Korean Journal of Plant Resources
/
v.24
no.1
/
pp.61-68
/
2011
Loperamide-induced constipation reduced gastric emptying, small-intestinal and colonic motility, and these effects were prevented by Actindia chinensis(Gold Kiwi Fruit, GKF). In this study, the effects of Actindia chinensis on constipated male Sprague-Dawley rats induced by loperamide(2 mg/kg, s.c.,5 days) were investigated. Rats were randomly assigned to the normal control rats(regular diet), constipated rats(regular diet plus loperamide), constipated rats treated with 2.5% GKF(regular diet supplemented with 2.5% GKF plus loperamide), constipated rats treated with 5% GKF (regular diet supplemented with 5% GKF plus loperamide). There was less fecal excretion and lower fecal water content in loperamide-treated rats than in control rats. Oral administration of GKF blocked the decrease of fecal excretion and fecal water content in the loperamide-treated rats. Mucus production of crypt cell and mucus contents at fecal and mucosa surface were reduced by loperamide-treated rat. But colonic crypt cell contained increased mucin in the GKF treated group and mucus layer stained with alcian blue was significantly thicker in GKF treated rats compared with in loperamide-treated rats. In isolated rat ileum, loperamide produced inhibition of ileal motility. Pretreatment with methanolic extracts of GKF in isolated rat ileum prevented inhibition by loperamide. These findings indicated that the GKF was effective for alleviation of inhibition of colonic peristalsis by loperamide and that GKF might be of value in the prevention of constipation.
Hepatoma is one of 3 most common malignancies in Korea, the survival rate is not improved since last decades because of delayed diagnosis and limited treatment conditions. Radiation was one of treatment options but the impact on the survival is not remarkable. High dose exposure to target area was suggested for improved effect but low tolerance dose of normal liver tissue is the main limited factor. IMRT is the advanced form of 3DCRT, for focusing high dose on target with minimal dose to surrounding normal tissues. Motion of the tumor by respiration, cardiac pulsation and peristalsis is the main treatment harrier of IMRT for treatment of hepatoma patients. Development of QA technique for acceptable geometrical uncertainties and dose error on target volume is essential for IMRT in clinical treatment but proper QA technique is not yet developed. This study compared the verification film dosimetry with measured dose in phantom and calculated dose in planning computer on exactly same conditions of patient treatments. Within 3% dose differences between 3 groups were confirmed. We suggest that our verification QA technique is easy, economic, iterative and acceptable in clinical application for advanced hepatoma patients.
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