BACKGROUND: The relation between treadmill exercise testing and ambulatory ST segment monitoring in detection of ischemia in patients with coronary artery disease has not been well established, with pathophysiologic mechanisms underlying the development of ischemia in the ambulatory setting not being well elucidated. This study was performed to determine the relation between myocardial ischemic indexes on exercise testing and on Holter monitoring. METHODS: We analized 25 patients with stable angina and angiographically documented coronary artery disease, who exhibited ischemia both on a Bruce protocol exercise test and on 24-hr Holter monitoring while receiving routine antianginal medications. RESULTS: Mean heart rate at the onset of 1mm ST segment depression during exercise testing(74.4 VS 114.1 beats/min, p<0.01). Overall the correlations between ischemic indexes on both test were weak. But heart rate at the onset of ischemic episodes during Holter monitoring had a good correlation with heart rate at 1mm ST depression during exercise test. And the number of ischemic episodes on Holter monitoring revealed a weak negative correlation with duration of exercise during treadmill test. CONCLUSION: Ischemic indexes on exercise testing cannot accurately predict ischemic indexes on Holter monitoring in patients with coronary artery disease. In that regard, Holter monitoring may provide other clinical information in addition to that obtained by exercise testing in selected patients.
Angina, Stable ; Coronary Artery Disease ; Depression ; Electrocardiography, Ambulatory* ; Exercise Test* ; Heart Rate ; Humans ; Ischemia* ; Myocardial Ischemia

Matrix metalloproteinases are believed to play an important role in tumor invasion and metastasis. But little is known about the role of them in the gastric adenocarcinoma. We investigated the expression of matrix metalloproteinase-1,2,3 in eighty paraffin blocks of the primary gastric adenocarcinoma tissues with immunohistochemistry and analysed their correlation with lymph node metastasis and survival. MMP-1,2,3 were expressed most intensely in the fibroblasts around the tumor stroma. In our study the increased immunoreactivity of MMP-2 only showed statistically significant correlation with lymph node metastasis (P=0.0517, Odd's ratio=2.274). But MMP-1,2,3 all were correlated with survival. Type IV collagen was observed in the vascular basement membranes and tumor basement membranes and showed statistically significant correlation with lymph node metastasis (P=0.0002, Odd's ratio=0.194) and prognosis (P=0.0001). The immunoreactivity of MMP-2 and type IV collagen was inversely correlated (Kendall's Tau-b correlation = 0.37482, P=0.0001). Our results suggest that in human gastric adenocarcinoma the increased immunoreactivity of MMP-2 and the decreased immunoreactivity of type IV collagen has an important role in lymph node metastasis and prognosis. MMP-1,3 are not correlated with lymph node metastasis but correlated with survival. The mechanism responsible for the production of MMP by the host fibroblasts remains obscure and requires further investigation.
Adenocarcinoma* ; Basement Membrane ; Collagen Type IV* ; Fibroblasts ; Humans ; Immunohistochemistry ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Paraffin ; Prognosis*

No abstract available.
Humans ; Infertility* ; Luteinizing Hormone, beta Subunit*

The incidence of postspinal headache is one of the well known complications of spinal anesthesia. The development of postspinal headache is related to age and sex of patients, size and configuration of the needle, pregnancy, direction of needle bevel, number of dural puncture. I studied the effect of configuration and size of the needle (22 gauge 25 gauge Quinke needle and 22 gauge,25 gauge Whitacre needle ) on the incidence, onset, duration and severity of postspinal headache in the 200 males of the third decade after spinal anesthesia. The following results were observed: 1) The incidence of postspinal headache in 22 gauge, 25 gauge Whitacre needle groups(4%. 2%) is lower than that of 22 gauge, 25 gauge Quinke needle groups(10%, 8%). 2) The severity of headache was mild and moderate level in 7 cases, severe level in 2 cases of all the 9 cases with postspinal headache of Quinke needle groups but mild and moderate level in 3cases of all the 3 cases with postspinal headache of Whitacre needle groups. 3) The onset of headache was within 24 hours in 55.6% in Quinke needle groups, 100% in Whitacre needle groups and the duration of headache was within 5 days in 77.8% in Quinke needle groups, 100% in Whitacre needle groups postoperatively. 4) The sites of headache were 55.6% in frontal, 33.3% in occipital region in Quinke needle groups and 66.7% in frontal, 33.3% in occipital region in Whitacre needle groups. In conclusion, the headaches which occur following use of Whitacre needle have been lower in and of less severity than those seen after use of Quinke needle in young males of the third decade.
Anesthesia, Spinal ; Headache* ; Humans ; Incidence ; Male* ; Needles* ; Pregnancy ; Punctures

Pheochromocytoma is one of surgically curable hypertensive syndromes. The tumor is bilateral or extra-adrenal in 5% of cases in adults and in an even greater percentage in children and is most often familial. Herein we report two cases of pheochromocytoma, of which one is bilateral pheochromocytoma in a 20-year-old female and the other is left sided in a 27-year-old female.
Adult ; Child ; Female ; Humans ; Pheochromocytoma* ; Young Adult

Patients undergoing thoracotomy experience severe postoperative pain and marked respiratory impairment. Analgesics(narcotics or loeal anesthetics) administered via epidural catheter in epidural space have been shown to provide postoperative analgesia and improve respiratory mechanics after thoracotomy. Several different methods have been utilized in an attempt to reduce pain and pulmonary mechanics after thoracotomy. These include epidural blocks using local anesthetics, epidural narcotics, ketamine, steroid, and clonidine. These methods have been shown to provide pain relief with relative preservation of lung volumes in the postoperative period, but have disadvantages. Especially epidural local anesthetics may cause hypotension and motor blockade of lower extremities, and epidural narcotics may cause pruritus, nausea and vomiting, urinary retension and respiratory depression. In an attempt to provide excellent analgesia and improve pulmonary mechanics after thoracotomy and to decrease the side effects associated with the intermittent bolus administration of epidural narcotics or local anesthetics, we performed a study of continuously administered epidural infusion of small concentration of fentanyl combined with low concentration of bupivacaine. Twenty eight patients undergoing thoracotomy were randomized into groups based upon a postoperative pain regimen as indicated: Group I: intermittent intramuscualr injection of nalbuphine 0.2 mg/kg(n=13), Group II: continuous epidural injection of mixtures of 0.2/ bupivacaine and fentanyl 3 ug/ml(n= 15). Two, 8, 24 and 48 hours postoperative, the following indices were measured: visual analogue pain scale, vital capacity, tidal volume, arterial blood gas analysis(pH, PaCo2, PaO2), side effects, and 24 hour urine 17-ketosteroids. The results were as follows: 1) Pain score was evaluated by visual analogue pain scale postoperatively and the pain scores significantly decresed in group II as compaired with those in group L 2) Vital capacity and tidal volume in group II were more improved than group I. 3) There was no difference in arterial blood gas analysis except for decreased PaO2 at 2 hour and 24 hour compared with preoperative value in group L 4) Major complications in group II were two cases of nausea and vomiting, one case of urinary retension, whereas only I patient in group I complained of nausea and vomiting. 5) No significant difference occurred in 24 hour urine l7-ketosteroid at 24 hour and 48 hour postoperatively in group I and group II, which were within normal limits.
17-Ketosteroids ; Analgesia* ; Anesthetics, Local ; Blood Gas Analysis ; Bupivacaine* ; Catheters ; Clonidine ; Epidural Space ; Fentanyl* ; Humans ; Hypotension ; Injections, Epidural ; Ketamine ; Lower Extremity ; Lung ; Mechanics ; Nalbuphine ; Narcotics ; Nausea ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Respiratory Mechanics ; Thoracotomy* ; Tidal Volume ; Vital Capacity ; Vomiting

Sarcomatoid carcinoma of prostate has been rarely reported and occasionally difficult to distinguish from a true sarcoma or carcinosarcoma. A case of sarcomatoid carcinoma of the prostate, which has been occured in 61-year-old male patient is presented. The tumor consists of carcinomatous areas with epithelioid cells, sarcomatoid areas with spindle cells and foci of heterologous osteosarcoma component. The phenotypic nature of the tumor was confirmed immunohistochemically by positive reaction for cytokeratin, epithelial membrane antigen, vimentin and prostate specific acid phosphatase in both sarcomatous and carcinomatous components.
Male ; Humans

In the case of brachial plexus block, mixtures of local anesthetics can combine better features of both components, rapid onset and long duration. Combining effects may influence the onset and duration of neural blockade. Our study was undertaken in order to compare the onset time (time of injection to time of loss of pain on pin prick) and duration of analgesia (time of return of sense of pain on pin prick minus time required for onset of analgesia) of a lidocaine and bupivacaine mixture with 5 minutes interval injection of lidocaine and bupivacaine. The patients admitted to our hospital for hand or forearm operations were divided into three groups. In Group 1, 9 patients were injected with 0.5% bupivacaine 150 mg only, in Group 2, 11 patients were injected with a mixture of 29: lidocaine 200 mg and 0.5% bupivacaine 100 mg, in Group 3, 10 patients were injected with 2% lidocaine 200 mg and 5 minutes later, 0.5% bupivacaine 100 mg was injected through the same needle. Group 3 had the shortest onset time (7.2+/-0.2 minutes) with moderately long duration (9.4+/-2.4hours). Group 2 had a moderately rapid onset time (9.4+/-2.3 mintes) with the shortest duration (8.6+/-1.6 hours). Group 1 had the slowest onset time (14.8+/-4.3 minutes) with the longest duration (11.3+/-2. 4 hours). The time for analgesia to reach the C7 dermatome was the slowest in group 1 and Group 2, but in Group 3, there was no difference in the time needed to achieve analgesia in all dermatomes.
Analgesia ; Anesthetics, Local* ; Brachial Plexus ; Bupivacaine ; Forearm ; Hand ; Humans ; Lidocaine ; Needles

Prognostic factors in transitional cell carcinoma of the upper urinary tract were assessed with histopathological examination and flow cytometric analysis in a series of 33 patients treated between Jan. 1980 to Dec. 1990. During follow-up from 6 to 120 months, 14 patients died of transitional cell carcinoma. The rate of DNA aneuploidy pattern was 54.5 % and DNA aneuploidy pat tern showed significantly a poorer prognosis than diploidy pattern. DNA ploidy pattern was relatively correlated with grade, stage and clinical outcome. For stage TS (superficial tumor) and low grade, the occasional detection of DNA aneuploidy pattern identified an important subgroup which showed significantly a poorer survival. Only the stage and, to a lesser extent, tumor shape, grade and DNA ploidy pattern were determinants for prognosis in multivariate analysis. Based on these 4 variables 3 different subgroups of patients can be identified. In low risk group including stage TS (superficial tumor), low grade, DNA diploidy pattern and papillary tumor, 3 and 5 year survival rates were 88.9 % and 69.1 %. In high risk group including stage TE (extensive invaded tumor) and DNA aneuploidy pattern, 2 and 3 year survival rates were 15.3 %, 0.0 %. In intermediate risk group including stage TS (superficial tumor), DNA aneuploidy pattern, 3 and 6 year survival rates were 55.9 % and 43.5 %. In summary, DNA ploidy may be a useful parameter to identify risk groups, especially stage TS and low grade and to plan appropriate management of patients with primary transitional cell carcinoma of the upper urinary tract.
Aneuploidy ; Animals ; Carcinoma, Transitional Cell* ; Charadriiformes ; Diploidy ; DNA* ; Flow Cytometry* ; Follow-Up Studies ; Humans ; Kidney Pelvis* ; Multivariate Analysis ; Ploidies* ; Prognosis ; Survival Rate ; Ureter* ; Urinary Tract

BACKGROUND: The atrial repolarization waves might contribute to ST segment depression during the exercise loading test. As atrial repolarization waves are opposite in direction to P waves, they could shift the ST segment in the absence of myocardial ischemia. METHODS: The exercise test in 20 patients was seemed false positive because of normal coronary angiogram. Twenty-six patients with at least one coronary stenosis > or =50% served as a true positive group. The P waves, PR segments and ST segment were studied in leads II, III, aVF and V4 to V6 in those 46 patients whose exercise ECG suggested ischemia. RESULTS: The finding of steeply downsloping PR segment, particularly in the inferior ECG leads, in patients with longer exercise time and higher exercise heart rate might predict a false positive exercise test in those with a normal rest ECG and no apparent reason for a false positive test. The combination of downsloping PR segments in two of three inferior leads plus either exercise duration > or =5 min or peak heart rate > or =130 bests/min idenified false positive tests with a sesitivity of 75% and a specificity of 81% to 89%. CONCLUSIONS: Atrial repolarization waves might play a role in exercise induced ST segment depression.
Coronary Stenosis ; Depression ; Electrocardiography ; Exercise Test ; Heart Rate ; Humans ; Ischemia ; Myocardial Ischemia ; Sensitivity and Specificity