Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils.
Aneurysm ; Aneurysm, False* ; Arteries* ; Gelatin Sponge, Absorbable ; Hemorrhage ; Ligation ; Mortality ; Pancreatitis, Chronic*

The computed tomographic(CT) findings of fourteen patients with inflammatory disease and 28 with neoplasm who had an abnormal colonic wall thickening, were retrospectively studied to establish CT criteria for each disorder in differentiating inflammatory from neoplastic lesions. According to homogeneity, density and contour of mural thickening and pericolic inflammatory change in enhanced CT scans, we classified colonic wall abnormalities into 6 patterns: I) multilayering with inner and outer hyper- and middle hypodensities, II) homogeneously hyperdense with pericolic inflammatory change, III) heterogeneously hyperdense with pericolic inflammatory change, IV) homogeneously heperdense with lobulated contour, V) heterogeneously hypodense with lobulated contour and VI) heterogeneously mixed densities with irregular lobulated contour. Type I, II and III were distinctively identified in inflammatory disease, type IV, V in neoplasm, and type VI in boty diseases. We conclude that enhanced CT could be helpful in the initial diagnosis and/or suggestion of abnormal colonic wall disease and differentiation of inflammatory from neoplastic diseases.
Colon* ; Diagnosis ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Thyroid Gland* ; Thyroiditis*

Control of blood pressure is maintained by the interaction between the arterial baroreflex and vestibulosympathetic reflex during postural changes. In this study, the contributions of vestibular receptors and baroreceptors to the maintenance of blood pressure following acute hypotension were compared in terms of phosphorylated extracellular regulated protein kinase (pERK) expression in the nucleus tractus solitaries (NTS). Expression of pERK in the NTS was measured in conscious rats that had undergone bilateral labyrinthectomy (BL) and/or sinoaortic denervation (SAD) 5, 10, 20, and 40 min following acute hypotension induced by sodium nitroprusside (SNP) infusion. Expression of pERK increased significantly in the NTS in the control group following SNP infusion, and the expression peaked at 10 min after SNP infusion. The number of pERK positive neurons increased following SNP infusion in BL, SAD, and BL+SAD groups, although the increase was smaller than in control group. The BL group showed a relatively higher reduction in pERK expression than the SAD group, and the pERK expression in the NTS was localized to the caudal portion of the nuclei in the BL and SAD groups. These results suggest that the vestibular receptors may play a key role in maintaining blood pressure following acute hypotension; thus, the vestibular system may contribute to compensate for orthostatic hypotension.
Animals ; Baroreflex* ; Blood Pressure ; Denervation ; Hypotension* ; Hypotension, Orthostatic ; Neurons ; Nitroprusside ; Pressoreceptors ; Protein Kinases ; Rats* ; Reflex* ; Solitary Nucleus*

BACKGROUND: Ischemia-reperfusion injury related to unsuccessful myocardial protection affects postoperative ventricular function and mortality during open-heart surgery. We prospectively compared the effects of administration of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia (CBC) on myocardial protection and clinical outcome in patients undergoing mitral valve surgery. MATERIAL AND METHOD: Seventy patients with mitral regurgitation (MR) undergoing mitral valve surgery were randomly divided into the HTK group (n=31) and the CBC group (n=31); eight patients were excluded. Perioperative hemodynamics, cardiac medications, pacing, postoperative outcomes and complications were recorded during the hospital stay. All patients received follow-up for at least 6 months postoperatively for morbidity and mortality. RESULT: There were no significant differences in the hemodynamics between the groups during the study period, except for the mean pulmonary artery pressure (MPAP), PCWP and CVP that were lower in the HTK group at 15 min after weaning of CBP. There were no differences for inotropic support and pacing during the 12 hrs postoperatively between the groups. CK-MB values on day 1 and day 2 were 77+/-54 and 41+/-23 for the HTK group and 70+/-69 and 44+/-34 for the CBC group, respectively (p=NS). Postoperative clinical outcomes were similar in both groups for at least 6 months during the follow-up period. CONCLUSION: These results suggest that the use of HTK solution is as safe as cold blood cardioplegia in terms of myocardial protection.
Cardioplegic Solutions* ; Follow-Up Studies ; Heart Arrest, Induced ; Hemodynamics ; Humans ; Length of Stay ; Mitral Valve Insufficiency ; Mitral Valve* ; Mortality ; Prospective Studies ; Pulmonary Artery ; Reperfusion Injury ; Ventricular Function ; Weaning

Propofol is a rapidly acting intravenous anesthetic agent used for the induction of anesthesia, with a low incidence of side effects. But pain on injection of propofol has limited its use. The additional effect of lidocaine on painful injection of propofol was studied, during induction of general anesthesia in 75 patients in a prospective, randomized method. They were allocated randomly to three groups to receive propofol 2.0 mg/kg(group A), propofol 2.0 mg/kg with lidocaine 0.2 mg/kg(group B), propofol 2.0 mg/kg with lidocaine 0.3 mg/kg(group C). Pain score was assessed on a simple scale graded from 0 (no pain) to 3 (severe pain). Mean arterial blood pressure and heart rate were monitored at 1, 3, 5, 7 minutes after endotracheal intubation. In group B and C, significantly smaller pain score was observed. On the other hand, changes of mean arterial blood pressure and heart rate after endotracheal intubation was not significant. It is concluded that the addition of small amount of lidocaine can significantly reduce the severity of pain on injection of propofol.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Hand ; Heart Rate ; Humans ; Incidence ; Injections, Intravenous ; Intubation, Intratracheal ; Lidocaine* ; Propofol ; Prospective Studies

Hypotension is one of the potential causes of dizziness. In this review, we summarize the studies published in recent years about the electrophysiological and pharmacological mechanisms of hypotension-induced dizziness and the role of the vestibular system in the control of blood pressure in response to hypotension. It is postulated that ischemic excitation of the peripheral vestibular hair cells as a result of a reduction in blood flow to the inner ear following hypotension leads to excitation of the central vestibular nuclei, which in turn may produce dizziness after hypotension. In addition, excitation of the vestibular nuclei following hypotension elicits the vestibulosympathetic reflex, and the reflex then regulates blood pressure by a dual-control (neurogenic and humoral control) mechanism. In fact, recent studies have shown that peripheral vestibular receptors play a role in the control of blood pressure through neural reflex pathways. This review illustrates the dual-control mechanism of peripheral vestibular receptors in the regulation of blood pressure following hypotension.
Blood Pressure* ; Dizziness ; Ear, Inner ; Epinephrine ; Glutamic Acid ; Hair Cells, Vestibular ; Hypotension* ; Reflex ; Vestibular Nuclei

PURPOSE: We previously reported that forkhead transcription factors of the O class 1 (FOXO1) expression in gastric cancer (GC) was associated with angiogenesis-related molecules. However, there is little experimental evidence for the direct role of FOXO1 in GC. In the present study, we investigated the effect of FOXO1 on the tumorigenesis and angiogenesis in GC and its relationship with SIRT1. MATERIALS AND METHODS: Stable GC cell lines (SNU-638 and SNU-601) infected with a lentivirus containing FOXO1 shRNA were established for animal studies as well as cell culture experiments. We used xenograft tumors in nude mice to evaluate the effect of FOXO1 silencing on tumor growth and angiogenesis. In addition, we examined the association between FOXO1 and SIRT1 by immunohistochemical tissue array analysis of 471 human GC specimens and Western blot analysis of xenografted tumor tissues. RESULTS: In cell culture, FOXO1 silencing enhanced hypoxia inducible factor-1alpha (HIF-1alpha) expression and GC cell growth under hypoxic conditions, but not under normoxic conditions. The xenograft study showed that FOXO1 downregulation enhanced tumor growth, microvessel areas, HIF-1alpha activation and vascular endothelial growth factor (VEGF) expression. In addition, inactivated FOXO1 expression was associated with SIRT1 expression in human GC tissues and xenograft tumor tissues. CONCLUSION: Our results indicate that FOXO1 inhibits GC growth and angiogenesis under hypoxic conditions via inactivation of the HIF-1alpha-VEGF pathway, possibly in association with SIRT1. Thus, development of treatment modalities aiming at this pathway might be useful for treating GC.
Angiogenesis Modulating Agents ; Animals ; Anoxia ; Blotting, Western ; Carcinogenesis ; Cell Culture Techniques ; Cell Line ; Down-Regulation ; Forkhead Transcription Factors ; Heterografts ; Humans ; Lentivirus ; Mice ; Mice, Nude ; Microvessels ; RNA, Small Interfering ; Stomach Neoplasms* ; Tissue Array Analysis ; Transcription Factors* ; Vascular Endothelial Growth Factor A

The technique of in situ hybridization using synthetic oligonucleotides labelled by non-radioactive method was developed to localize vasoactive intestinal polypeptide, arginine-vasopressin and oxytocin mRNAs in the rat brain. Also double in situ hybridization technique where combination of non-radioactive and radioactive probes were applied was developed to localize 2 neuropeptide mRNAs in single tissue section. The results were as follows; In non-radioactive in situ hybridization methods using digoxigenin-labelled oligonucleotide probe, alkaline-phosphates method using NBT and BCIP as substrates gave the best result that specific hybridization signals were observed. In radioactive in situ hybridization methods using 35S-labelled oligonucleotide probe, specific hybridization signals were observed in both nuclear track emulsion and X-ray film autoradiography. In double in situ hybridization methods using combination of 35S-labelled and digoxigenin-labelled oligonucleotide probes, specific hybridization signals were observed in the group where K5 emulsion was applied as nuclear track emulsion. The technique of in situ hybridization using digoxigenin-labelled oligonucleotide applied in this study will be useful as alternative for radioactive in situ hybridization technique. Moreover, combination of non-radioactive and radioactive labelled probes in double in situ hybridization technique will be a useful tool for the simultaneous localization of various mRNAs in single section for the study of various neurotransmitters, neuropeptides, receptors and signal transduction molecules.
Aging ; Animals ; Autoradiography ; Brain* ; Corpus Callosum ; Digoxigenin ; In Situ Hybridization* ; Magnetic Resonance Imaging ; Mesencephalon ; Neuropeptides ; Neurotransmitter Agents ; Oligonucleotide Probes ; Oligonucleotides ; Oxytocin* ; Pons ; Rats* ; RNA, Messenger* ; Signal Transduction ; Vasoactive Intestinal Peptide* ; Vasopressins* ; X-Ray Film

Profound hypothermia protects cerebral function during total circulatory arrest(TCA) in the surgical treatment of a variety of cardiac and aortic diseases. Despite its importance, there is no ideal technique to monitor the brain injury from ischemia. Since 1994, we have developed compressed spectral array(CSA) of electroencephalography(EEG) and monitored cerebral activity to reduce ischemic injury. The purposes of this study are to analyse the efficacy of CSA and to establish objective criteria to consistently identify the safe level of temperature and arrest time. We studied 6 patients with aortic dissection(AD, n=3) or aortic arch aneurysm(n=3, ruptured in 2). Body temperatures from rectum and esophagus and the EEG were monitored continuously during cooling and rewarming period. TCA with cerebral ischemia was performed in 3 patients and TCA with selective cerebral perfusion was performed in 3 patients. Total ischemic time was 30, 36 and 56 minutes respectively for TCA group and selective perfusion time was 41, 56 and 92 minutes respectively for selective perfusion group. The rectal temperatures for flat EEG were between 16.1 and 22.1 degrees C (mean:18.4+/-2.0); the esophageal temperatures between 12.7 and 16.4 degrees C(mean : 14.7+/-1.6). The temperatures at which EEG reappeared 5~15.4 degrees C for esophagus. There was no neurological deficit and no surgical mortality in this series. In summary, the electrical cerebral activity reappeared within 23 minutes at the temperature less than 16degrees C for rectum. It seemed that 15 degrees C of esophageal temperature was not safe for 30 minutes of TCA and continuous monitoring the EEG with CSA to identify the electrocerebral silence was useful.
Aorta, Thoracic ; Aortic Diseases ; Body Temperature ; Brain Injuries ; Brain Ischemia ; Electroencephalography ; Esophagus ; Humans ; Hypothermia* ; Hypothermia, Induced ; Ischemia ; Mortality ; Perfusion ; Rectum ; Rewarming