We observed the gastric varices in l89 variceal patients with liver cirrhosis and in 129 patients with UGI bleeding by endoscopy. Gastric varices was found in 27 cases(14.2%) amoag 189 variceal cases. There was variceal bleeding in 74 cases(57.4%) beieg the toy cause of UGI: bleeding among l29 cases with UGI bleeding and 6(4.7%) had endoscopically proved gastric Variceal bleeding. Cardiac and fundic varices were observed in l8 and 12 cases, respectively end 12 cases of cardiac varices were mainly observed on the lesser curvature side. The incidence of isolated gastric varices being 30 % amoag gastric varices was far less than that of esophagogastric varices. There was no significant relations between the severity of liver cirrhosis and the kinds of varices These results suggest that gastric varices are not infrequent cause of UGI bleeding cases. Therefore all must have attention in gastric intestinal fiberscopic examination in portal hypertensive patients.
Endoscopy ; Esophageal and Gastric Varices* ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Play and Playthings ; Varicose Veins

OBJECTIVE: To evaluate the fixation strength and tissue reaction of the glue fixation and self-stabilizing leg fixation methods and to compare the results with those of the conventional tagging suture fixation method. MATER AND METHODS: Twelve healthy rabbits were selected and three different methods of implanting the port chamber were employed on the back of each rabbit. A total of thirty six port chambers were implanted with these three different methods, viz. the glue fixation method using tissue adhesive, the self-stabilizing leg method using a self-expandable stabilizing leg, and the suture fixation method. The fixation strength and the gross and histopathologic changes of each fixation method were evaluated at three days, one week, two weeks and four weeks after port implantation. RESULTS: The glue fixation method showed a good fixation strength, which was similar to that of the tagging suture method (p=0.3486). Five of the six ports (83%) implanted with the glue fixation method which were examined after two weeks showed cracks on the external surface, but this had no adverse effects on their function. A large amount of granulation tissue reaction was found at the bottom of the chamber (p=0.0025). The fixation with the self-stabilizing leg showed relatively lower fixation strength (p=0.0043), but no turning-over of the chamber occurred. The fixation strength improved with time after the first week, and minimal granulation tissue reaction was observed with this method. CONCLUSION: The glue fixation method exhibited equal fixation strength compared to the suture fixation, but showed cracking and a large amount of granulation tissue, whereas the fixation with a self-stabilizing leg showed weaker fixation strength.
Alloys ; Animals ; Capillaries/cytology/metabolism/pathology ; Cell Proliferation ; Device Removal ; Enbucrilate/therapeutic use ; *External Fixators ; Fibroblasts/metabolism/pathology ; Granulation Tissue/blood supply/metabolism/pathology ; *Implants, Experimental ; Models, Animal ; Rabbits ; Sutures/*utilization ; Time Factors ; Tissue Adhesives/*therapeutic use

BACKGROUNDS/AIMS: It has been shown that adefovir dipivoxil is an effective antiviral agent in the treatment of chronic hepatitis B (CHB), not only in wild-type hepatitis B virus (HBV) infection, but also in lamivudine-resistant (LAMV-R) cases. However, little is known about the durability of the virologic response to adefovir in LAMV-R CHB patients. METHODS: Fifteen HBV e-antigen (HBeAg)-positive, LAMV-R CHB patients showed a virologic response to adefovir monotherapy. These patients received additional adefovir for at least a further 12 months. The virologic relapse rate after discontinuation of adefovir was evaluated. In addition, predictive factors associated with virologic relapse were investigated. RESULTS: The median level of serum HBV DNA before adefovir administration was 7,457,840 IU/mL (range 107,920-99,524,960 IU/mL). The median duration of adefovir treatment was 30 months (range 14-46 months). During a median follow-up period of 14 months after discontinuation of adefovir, the 1-, 2-, 3-, 6-, and 12-month cumulative relapse rates were 26.7%, 53.3%, 73.3%, 80%, and 80%, respectively. High pretreatment HBV DNA levels were found to be the only factor that was predictive of off-therapy relapse. CONCLUSIONS: Our data suggest that the adefovir-monotherapy-induced virologic response is not durable in most patients with LAMV-R HBeAg-positive CHB, especially in those with a high pretreatment HBV DNA level.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Aged ; Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Viral ; Female ; Hepatitis B e Antigens/*blood ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Phosphonic Acids/*therapeutic use ; Recurrence ; Retrospective Studies ; Risk Factors

BACKGROUNDS/AIMS: Identifying pancreatic cancer patients at high risk of early mortality following surgical resection for pancreatic cancer is important to make optimal treatment decisions in multidisciplinary setting. The purpose of this study was to identify the factors related to early mortality in patients who underwent pancreatic resection for pancreatic adenocarcinoma. METHODS: We reviewed our institution's experience with all consecutive patients who underwent pancreatectomy for pancreatic adenocarcinoma from January 2000 to December 2010. One thousand patients were eligible for our study. Fifty-three patients who did not meet the study criteria were excluded. Based on 12 months after surgery, patients were divided into early mortality group or the remaining group. We performed logistic regression analysis to identify predictors of early mortality. RESULTS: Among 947 patients who met our study criteria, 302 (31.9%) early mortality (defined as experiencing death within 12 months after surgery) occurred. Multivariate analysis revealed that patient age and surgery time period were statistically significant predictors of early mortality within six months after surgery. Poorly differentiated tumor and adjuvant chemotherapy were statistically significant predictors of early mortality within 12 months after surgery. Total pancreatectomy and lymphovascular invasion were significant (p<0.05) prognostic factors of early mortality within 6 or 12 months after surgery. CONCLUSIONS: We suggest followings to avoid early mortality after pancreatic resection: patients with multiple risk factors related to early mortality after pancreatectomy should be considered for alternative treatment; patient's general condition and surgical technique improvement are important; and adjuvant therapy should be taken into consideration.
Adenocarcinoma* ; Chemotherapy, Adjuvant ; Humans ; Logistic Models ; Mortality* ; Multivariate Analysis ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Prognosis ; Risk Factors

The necessity for routine prophylactic nasogastric tube decompression after a gastrectomy is still in controversy. Several reports have indicated that nasogastric tube decompression is unnecessary and that the tube may even be harmful with serious discomforts. A D2 gastrectomy (which means a D2 lymph node dissection during gastric cancer surgery) for a gastric carcinoma is an extensively destructive procedure which takes a longer operation time than a conventional gastrectomy, destroys both sympathetic and parasympathetic nerve fibers in the upper retroperitoneum, and may interfere with the gastrointestinal motility after the operation. Therefore, we have carried out a retrospective study with 206 gastrectomized gastric-cancer patients to evaluate the necessity of nasogastric tube decompression and whether the tube influences the gas-passing time, the morbidity, and mortality after operation.
Decompression ; Gastrectomy* ; Gastrointestinal Motility ; Humans ; Lymph Node Excision ; Mortality ; Nerve Fibers ; Retrospective Studies ; Stomach Neoplasms

BACKGROUND: The processed electroencephalograms are useful surrogate measures of quantification of volatile anesthetics effect. We hypothesized that there is a certain relationship between the end-tidal concentration of sevoflurane and approximate entropy (ApEn). The aim of this study was to investigate the effect of sevoflurane on ApEn during induction. METHODS: Fourteen patients were enrolled. With recording of the electroencephalogram at the F3, F4, P3, and P4 montages, anesthesia was induced by increasing the vapor setting of sevoflurane by 1 vol% up to 8 vol% via a facemask. When the end-tidal concentration of sevoflurane did not show any further change, we increased vapor setting of sevoflurane by 1 vol%. When the end-tidal concentration of sevoflurane did not show any further change with 8 vol% of sevoflurane vapor setting, measurement of electroencephalogram was finished. The relation between end-tidal sevoflurane concentration and ApEn was tested by Spearman correlation. RESULTS: ApEn showed a significant correlation (R = -0.7551, P < 0.0001) with end-tidal sevoflurane concentration. The final pharmacodynamic parameters estimated by a sigmoid E(max) model were described as follows: E(0) = 0.91, E(max) = 0.28, C(e50) = 1.36 vol%, gamma = 1.27, kappa(e0) = 0.67 min(-1). CONCLUSIONS: Sevoflurane induction with gradual increase of end-tidal sevoflurane concentration increases the amount of regularity in approximate entropy.
Anesthesia ; Anesthetics ; Colon, Sigmoid ; Electroencephalography ; Entropy ; Humans ; Methyl Ethers