Eisenmenger's syndrome is defined as pulmonary hypertension with right-to-left or bidirectional shunting of blood through an intracardiac or aorto-pulmonary commumication. It can occur with complex congenital cardiac malformations, such as septal defect and patent ductus arteriosus. Parturients with Eisenmenger's syndrome are at high risk for peripartum morbidity and mortality. We experienced a case of parturient for cesarean section with Eisenmenger's syndrome and performed epidural anesthesia with fractionated doses of 2% lidocaine and fentanyl. The sensory block reached to T10 level and blood pressure was maintained with intravenous phenylephrine. After baby out, sudden hypotension with severe bradycardia developed and arterial oxygen saturation dropped. Immediate intubation and resuscitation was done, but cardiac rhythm disturbance, hypoxemia, and acidosis did not corrected. Cardiac standstill developed and stopped resuscitation. The neonate's Apgar score was 7 and he was transferred to pediatric ICU.
Acidosis ; Anesthesia, Epidural* ; Anoxia ; Apgar Score ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Ductus Arteriosus, Patent ; Eisenmenger Complex* ; Female ; Fentanyl ; Hypertension, Pulmonary ; Hypotension ; Intubation ; Lidocaine ; Mortality ; Oxygen ; Peripartum Period ; Phenylephrine ; Pregnancy ; Resuscitation

No abstract available.
Cholesterol* ; Female ; Hypertension, Pregnancy-Induced* ; Lipoproteins* ; Metabolism* ; Pregnancy ; Pregnancy*

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

No abstract available.
Kidney Failure, Chronic*

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard for the surgical treatment for benign prostatic hyperplasia (BPH), but the procedure's limitations are its invasiveness and the high prevalence of complications. Photoselective vaporization of the prostate (PVP) using an 80w high power potassium-titanyl-phosphate (KTP) laser has recently been developed as a less invasive treatment. We assessed the efficacy of PVP as an alternative to TURP for the treatment of BPH. MATERIALS AND METHODS: The medical records of 324 patients who were surgically treated for BPH from July 2005 to December 2007 were retrospectively reviewed. Among the 324 patients, 190 patients of Group I were treated by TURP and 134 patients of Group II were treated by PVP. Before treatment, assessing the serum PSA level transrectal ultrasound and urodynamic study were done. The primary efficacy parameters were the postoperative international prostatic symptom score and the uroflow parametersat 6 months after the operation. The secondary efficacy parameters were perioperative factors such as the duration of the hospital stay, the operative time and the catheter-indwelling period. Any adverse reactions were monitored. RESULTS: There was no significant difference in the basal characteristics of the study subjects between both the groups. The primary efficacy parameters, the IPSS, the Qmax and thepostvoid residual urine volume were significantly improved in both groups, but there were no significant differences between both the groups. In group II, the perioperative parameters such as the operation time, the hospitalization day and the catheter-indwelling periodwere significantly shorter than those of group I (p<0.05). But the urethral complications such as urethral stricture, dysuria and bladder neck contracture were more common in group II. CONCLUSIONS: These results suggest that PVP using an 80w high power KTP could be an alternative for TURP in terms of efficacy. For the general, safe use of PVP, PVP should be carefully done until the causes of the urethral complications of PVP are determined.
Contracture ; Dysuria ; Hospitalization ; Humans ; Laser Therapy ; Length of Stay ; Medical Records ; Neck ; Operative Time ; Prevalence ; Prostate ; Prostatic Hyperplasia ; Retrospective Studies ; Transurethral Resection of Prostate ; Urethral Stricture ; Urinary Bladder ; Urodynamics ; Volatilization

BACKGROUND: Protease-activated receptor 2 (PAR2) belongs to a family of G protein- coupled receptors activated by proteolytic cleavage. Trypsin-like serine proteases interact with PAR2 expressed by a variety of tissues and immune cells. The aim of our study was to investigate whether PAR2 stimulation can lead to the activation of human macrophages. METHODS: PAR2-mediated proliferation of human macrophage cell line THP-1 was measured with MTT assay. We also examined the extracellular regulated kinase (ERK) phosphorylation and cytokine production induced by trypsin and PAR2-agonist using western blot and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: Treatment of trypsin or PAR2-activating peptide increased cell proliferation in a dose-dependent manner, and induced the activation of ERK1/2 in THP-1 cells. In addition, trypsin-induced cell proliferation was inhibited by pretreatment of an ERK inhibitor (PD98059) or trypsin inhibitor (SBTI). Moreover, PAR2 activation by trypsin increased the secretion of TNF-alpha in THP-1 cells. CONCLUSION: There results suggest that PAR2 activation by trypsin-like serine proteases can induce cell proliferation through the activation of ERK in human macrophage and that PAR2 may play a crucial role in the cell proliferation and cytokine secretion induced by trypsin-like serine proteases.
Blotting, Western ; Cell Line* ; Cell Proliferation ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Macrophages* ; Phosphorylation ; Phosphotransferases ; Receptor, PAR-2* ; Serine Proteases ; Trypsin ; Tumor Necrosis Factor-alpha

PURPOSE: This study was conducted to investigate the relationship between serum total testosterone levels and scores on the Aging Male's Symptom (AMS) scale and the International Index of Erectile Function (IIEF) in men with erectile dysfunction with testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: From January 2005 to July 2008, 134 patients who complained of sexual dysfunction such as erectile dysfunction or decreased libido as the main symptoms of TDS with serum total testosterone levels less than 3.5 ng/ml were evaluated by independent t-test and linear regression analysis, respectively. Patients with treated hypogonadism within 6 months, with a history of taking a PDE5 inhibitor or an antidepressant for a depressive disorder, or who had metabolic syndrome were excluded from this study. RESULTS: The AMS scale and its 3 subdomain scores were not significantly correlated with the total testosterone level. By contrast, the total IIEF score and the score of each IIEF domain except sexual desire showed a weakly significantly positive correlation with serum total testosterone. CONCLUSIONS: In TDS patients with erectile dysfunction, there was a low relationship between serum total testosterone levels and the AMS scale and a weakly positive correlation between total testosterone levels and all IIEF domains except sexual desire. There was a low relationship between the AMS scale, the sexual desire domain score of the IIEF, and total testosterone. We should understand these limitations when evaluating patients with erectile dysfunction with TDS. New scales should be developed for the evaluation of erectile dysfunction in these patients.
Aging ; Depressive Disorder ; Erectile Dysfunction ; Humans ; Hypogonadism ; Libido ; Linear Models ; Male ; Sorbitol ; Testosterone ; Tyramine ; Weights and Measures

OBJECTIVE: The causal link between oncogenic HPV(Human Papilloma Viruses) and the development of CIN (rvical intraepithelial neoplasia) and cervical cancer are now well established. Several medical therapeutic candidates aimd at the treatment of precancerous lesions and invasive carcinoma of the cervix. The objective of this study was to develop the pH-sensitive chitosan/alginate gels (pH=3.8-4.5) and temperature sensitive multiblock copolymers of PEG/PLA (poly (L-lactic acid)/polyethylene glycol) gels (temperature=37 degrees C) for controlled delivery of the paclitaxel (PTX). We had also evaluated whether PTX entrapped in chitosan/alginate gels or multiblock copolymers of PEG/PLA 1 could inhibit tumor growth in vivo. METHODS: PTX entrapped as microsphere in Chitosan/Alginate Microspheres were obtained using a spray-drying method. PTX-entrapped PEG/PLA gels were prepared by the solvent displacement method. We had prepared the multiblock copolymers of PEG/PLA which has the sol-gel-sol transition temperature at body temperature. The in-vivo efficacy of PTX in chitosan microphere or PTX in PEG/PLA mutiblock copolymer micelle were conducted in HeLa-tumor bearing Balb/c Nu/Nu athymic mice at an equivalent paclitaxel dose of 10 mg/kg with 48 hr interval. The inhibition of tumor growth was evaluated after 8 days of treatment. RESULTS: On 8 days after the transcutaneous treatment of PTX-containing chitosan microphere or PTX in PEG/PLA mutiblock copolymer micelle. significant inhibition in tumor growth was observed in balb/c nu/nu nude mouse carrying xenograft tumors (HeLa cells; HPV-18 positive state). Among these formulations, PTX in PEG/PLA mutiblock copolymer have shown improved therapeutic efficacy as compared to PTX-ivgroup. CONCLUSION: PTX-containing chitosan microphere or PTX in PEG/PLA mutiblock copolymer nanoparticles are a unique pH-sensitive and temperature sensitive drug delivery system. These formulations elicits enhanced efficacy as an effective and minimally invasive treatment in mice bearing human cervical cancer (HeLa Cells) xenograft.
Animals ; Body Temperature ; Cervix Uteri ; Chitosan ; Drug Delivery Systems ; Female ; Gels ; Heterografts ; Human papillomavirus 18 ; Humans ; Mice ; Mice, Nude ; Microspheres ; Nanoparticles ; Paclitaxel ; Papilloma ; Polymers* ; Transition Temperature ; Uterine Cervical Neoplasms

To investigate the toxic effects of cheonggukjang (CKJ) manufactured using mixed cultures of Bacillus subtilis MC31 and Lactobacillus sakei 383 on the liver and kidney of ICR mice, an alteration on the related markers including body weight, organ weight, urine composition, liver pathology and kidney pathology were analyzed after oral administration at dosage of 25, 50 and 100 mg/kg body weight/day of CKJ for 14 days. Any significant toxicity was not observed on the body and organ weight, clinical phenotypes, urine parameters and mortality in the CKJ-treated group compared with the vehicle-treated group. Also, liver toxicity analysis revealed no significant increase in alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) or lactate dehydrogenase (LDH) in response to CKJ. Additionally, the specific pathological features induced by most toxic compounds were not observed upon liver histological analysis. Furthermore, kidney toxicological analysis revealed that blood urea nitrogen (BUN) and the serum creatinine (Cr) levels and pathological features on histological sections did not differ significantly between the vehicle- and CKJ-treated groups. Overall, these results suggest that CKJ does not induce any specific toxicity in liver and kidney organs of ICR at dose of 100 mg/kg body weight/day as no observed adverse effect level (NOAEL).
Administration, Oral ; Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Bacillus subtilis* ; Blood Urea Nitrogen ; Body Weight ; Creatinine ; Kidney* ; L-Lactate Dehydrogenase ; Lactobacillus* ; Liver* ; Mice ; Mice, Inbred ICR* ; Mortality ; No-Observed-Adverse-Effect Level ; Organ Size ; Pathology ; Phenotype ; Soybeans*