The association between choledochal cysts and pregnancy is unlikely to be etiological, but may rather be an aggravation or precipitation of a preexisting condition. Although choledochal cysts rarely occur in pregnancy, the aim of this study is to elucidate the condition associated with pregnancy because delayed or inappropriate therapy may be catastrophic for both mother and child. Authors reviewed 18 cases of choledochal cyst, of which 2 were aggravated during pregnancy, managed at the Department of Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, during the period from 1990 to 1995. The results were as follows: The ratio of female to male was 2.6:1 which revealed predominance in female and most frequent age group was above sixty years old(33%). In non-pregnant patients, the most common symptoms were abdominal pain(78%) and all pregnant patients had pain, jaundice, nausea and vomiting, and indigestion. Transaminase and bilirubin were elevated in all pregnant patients. In all patients, US(88%, 100%) was the most common preoperative diagnostic study and one case was diagnosed during explo-laparotomy. Pregnant patients have cholecystitis in two cases and nonpregnant patients had cholecystitis(19%), CBD stone(19%), and others. The operative procedures were performed in 9 cases and pregnant patients were operated by cyst excision and Roux-en-Y hepaticojejunostomy in one case, and also Roux-en-Y choledochocystojejunostomy in one case. According to Todani's classification, in non pregnant patients, type I was the most common(63%), in pregnant patients, two cases were type I. Postoperative complications occurred in 3 cases, wound infection(6%) and cholangitis(6%) in non pregnant patients, pleural effusion(6%) in pregnant patients. Two cases of choledochal cyst in pregnancy were 25 years old at 29.4 weeks and 36 years old at 16 weeks into pregnancy.
Adult ; Bilirubin ; Child ; Cholecystitis ; Choledochal Cyst* ; Classification ; Dyspepsia ; Female ; Heart ; Humans ; Jaundice ; Male ; Mothers ; Nausea ; Postoperative Complications ; Preexisting Condition Coverage ; Pregnancy* ; Surgical Procedures, Operative ; Vomiting ; Wounds and Injuries

A subset of human growth hormone(GH)-secreting pituitary tumors contains the gsp oncogene that encodes an activation mutation of the alpha subunit of Gsalpha, a stimulatory GTP-binding protein. The purpose of this study was to investigate the frequency of the gsp oncogene in GH-secreting pituitary tumors in Korean acromegalic patients and to elucidate the clinical reaction of these patients to endocrine testing. Direct PCR sequencing revealed gsp oncogene mutation in nine of 21 tumors(43%) at amino acid 201 of the Gsalpha protein. A single nucleotide mutation in tumors carrying the gsp oncogene was observed in eight tumors, this replaced an arginine(CGT) in normal protein with cysteine(TGT), and in one, with serine(AGT). Patients in the in whom gsp oncogene mutation occurred were older(54 years vs. 41 years, p=0.01) than those in the normal group. Sex, tumor grade, basal GH and PRL levels, GH response to oral glucose loading, GH fluctuation, and paradoxical response to TRH or GnRH did not differ between the groups : gsp oncogene was found mostly in somatotroph adenomas. Octreotide-induced GH suppression was significantly higher in the mutation group than in the normal group(95% vs. 81%, p=0.03), but the GH response to bromocriptine did not differ between the groups. These results suggest that Gsalpha mutations of GH-secreting tumors occur in Korean acromegalic patients with a similar frequency to that found in Western countries. Patients with gsp oncogene are likely to be older than those without it, and show high levels of octreotide-induced GH suppression.
Bromocriptine ; Glucose ; Gonadotropin-Releasing Hormone ; Growth Hormone-Secreting Pituitary Adenoma ; GTP-Binding Proteins ; Humans ; Octreotide ; Oncogenes ; Pituitary Neoplasms* ; Polymerase Chain Reaction

PURPOSE: The purpose of this experiment is to measure the expression of TGF-beta and alpha-SM actin (smooth muscle actin) from fibroblast culture by the duration of culture days and to analyze the inhibition of alpha-SM actin expression in fibroblast by the antibodies for TGF-beta. METHODS: The levels of alpha-SM actin from the paired NIH3T3 cell cultures with TGF-beta 1 containing medium (10 ng/ml) and with the antibody (for TGF-beta) medium (1 or 2 ug/ml) were determined by SDS PAGE for cell lysate protein, Western blot with ECL autoradiography and immuno - slot blot. RESULTS: In NIH3T3 culture, the expression of alpha-SM actin increased at culture days 4, 5, 6. TGF-beta was expressed from 2nd day of culture and increased by day 7. The addition of TGF beta (10 ng/ml) did not increased the expression of alpha-SM actin. But alpha-SM actin expression decreased in the presence of anti-TGF beta antibody. The decrease of expression was proportional to the concentration of antibody and duration of exposure to the antibody. CONCLUSIONS: Endogenous TGF-beta produced by fibroblast cultures is sufficient to express the alpha-SM actin from the myofiboblast. There was no additive expression of alpha-SM actin with exogenous TGF-beta 1. The antibody for TGF- beta inhibits the production of the alpha-SM actin during wound healing and may prevent the wound contracture.
Actins* ; Antibodies ; Autoradiography ; Blotting, Western ; Cell Culture Techniques ; Contracture* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts* ; Myofibroblasts ; Transforming Growth Factor beta* ; Wound Healing ; Wounds and Injuries*

No abstract available.
Animals ; Constitution and Bylaws* ; Mice* ; Oocytes*

The disorders of cardiac and pulmonary function as complications of scoliosis, have been described by numerous investigators since Hippocrates. The abnormalities of respiratory and cardiovascular function in scoliosis include reduced lung volume and compliance of the total respiratory system, arterial hypoxemia, which may be associated with hypercapnia, impaired chemical regulation of ventilation and increased pulmonary vascular resistance. We recently had experienced of two cases of severe scoliosis of Cesarean section (onse was a severe kyphoscoliotic patient) in Eul Zi Hospital, and was anesthetized with halothane or ethrane. The following conclusions were observed: 1) Arterial blood gas must be checked serially. 2) Anesthesiologists must know the degree of abnormality of the spine and the cardiopulmonary dysfunction. 3) During anesthesia, intermittent positive pressure breatheing(IPPB) or positive end expiratory pressure(PEEP) is needed for good oxygenation. 4) Intubation tube length and tube location are very important. 5) For treatment of postoperative complications, digitalization, bronchodilators, and mechanical ventilation may be needed.
Anesthesia ; Anoxia ; Bronchodilator Agents ; Cesarean Section* ; Compliance ; Enflurane ; Female ; Halothane ; Humans ; Hypercapnia ; Intubation ; Lung ; Oxygen ; Postoperative Complications ; Pregnancy ; Research Personnel ; Respiration, Artificial ; Respiratory System ; Scoliosis ; Spine ; Vascular Resistance ; Ventilation

No abstract available.
Amino Acids* ; Blastocyst* ; Embryonic Structures*

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.
Constriction, Pathologic ; Deglutition Disorders ; Duodenal Ulcer ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Laparoscopy ; Parkinsonian Disorders ; Retrospective Studies ; Stomach Neoplasms ; Superior Mesenteric Artery Syndrome

PURPOSE: Conventional laparoscopy using a two-dimensional (2D) has limited performance because of insufficient representation of the stereoscopic effect. Development of three-dimensional (3D) imaging technology has improved depth perception, shortened the execution time and reduced error number. This study was designed to identify the effects of 3D imaging on surgical performance for skilled professionals and surgical residents. METHODS: Two laparoscopic skills tasks, each with three repetitions, were performed by seven experienced laparoscopic surgeons, two minimally experienced laparoscopic surgeons, and three inexperienced surgical residents under both 2D and 3D conditions with two cadavers. Outcome measures were time for task completion and subjective assessment of performance. RESULTS: Suturing was completed by all participants and anchoring with V-Loc was performed by 10 participants. Suturing and anchoring time were significantly shorter with 3D laparoscopic in all participants (suturing time, p=0.011; anchoring time, p=0.005). Significant differences were observed between experienced and minimally experienced surgeons (suture time, p=0.021; anchoring time, p=0.018). There was no significant difference among inexperienced surgical residents, but they preferred 3D imaging over 2D. CONCLUSION: 3D laparoscopy is associated with a significantly shorter time for performance by experienced surgeons. Our results suggest that 3D laparoscopy will be helpful for surgeons conducting laparoscopic procedures.
Cadaver* ; Depth Perception ; Imaging, Three-Dimensional ; Laparoscopy* ; Outcome Assessment (Health Care) ; Surgeons

OBJECTIVE: This study was to estimate the prevalence of and identify the predisposing risk factors of delirium and to determine the effect of delirium on the prognosis, especially death in burn patients. METHOD: The study was completed by thorough examination of medical records, with additional confirmation, of the 245 patients who were admitted to the Burn ICU in Burn treatment center of Hangang Sacred Heart Hospital during last one year (Jan. 1. 1998-Dec. 31. 1998). Delirium was retrospectively diagnosed according to DSM-IV. Only when disturbance of consciousness and attention, cognitive dysfunction especially disorientation, or perceptual disturbance were observed, diagnosis of delirium were given. Final outcome such as death was discriminated through examination of medical records or question to those who knew the patient. RESULTS: One year prevalence of delirium in burn patients is 34.4%. Statistically significant predisposing risk factors of delirium were five;Age 65 and over (OR=45.51, 95% CI:6.07-341.11), burn size over 60% of total body surface (OR=6.48, 95% CI:3.16-13.28), current psychiatric disorder (OR=6.81, 95% CI:1.42-32.57), current medical disease (OR=3.00, 95% CI:1.40-6.45), alcohol abuse (OR=3.17, 95% CI:1.07-9.43) Statistically significant deathrelated risk factors were three;burn size over 60% of total body surface (OR=4.58, 95% CI:2.00-10.46), delirium (OR=2.94, 95% CI:1.25-6.94), current psychiatric disorder (OR=4.09, 95% CI:1.05-15.87). Aging is not the death-related factor in this study. CONCLUSION: Three factors, such as delirium, organic brain damage, and burn size over 60% of total body surface may predict higher risk of death in burn patients.
Aging ; Alcoholism ; Brain ; Burns* ; Consciousness ; Delirium* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart ; Humans ; Critical Care* ; Medical Records ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVE: The purpose of this study is to evaluate the safety and efficacy of cervical interbody fusion with implantable titanium cage(RABEA(TM)). The authors retrospectively analysis the result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of degenerative cervical disease. METHODS: 78 patients with radiculopathy with or without myelopathy due to degenerative cervical diseases were underwent anterior cervical discectomy and interbody fusion with titanium cages(RABEA(TM)) which were not filled with autogenous bone from June 1999 to December 2002. Among them, 33 patients could be followed-up for at least 6 months. Mean follow-up period was 13.3 months(ranged 6-30 months). RESULTS: Good or excellent results were found in approximately 82.0%. Preoperatively, the mean height of the disc space was 4.27mm(range 3~6mm), and at 1 day postoperatively it was 7.87mm(range 7~9mm). The mean height of the disc space after 1 year was 6.07mm(range 1~8mm). Due to subsidence of cage, 7 patients showed decrease of disc space height to preoperative disc space height. Among them, 1 patients showed poor results. A solid fusion was achieved in all patients. In this context, causes of subsidence are represented by osteoporosis and degree of cage recess. CONCLUSION: Titanium cages appear safe and effective in the treatment of degenerative cervical disease. But subsidence of cage, so far limited in number, appeared to be important risk factor for recurrence of the symptoms.
Diskectomy ; Follow-Up Studies ; Humans ; Osteoporosis ; Radiculopathy ; Recurrence ; Retrospective Studies ; Risk Factors ; Spinal Cord Diseases ; Titanium* ; Transplants