Accelerated atherosclerosis is not only a frequent complication but also the most common cause of death in patients with chronic renal failure (CRF). Although mechanisms are unclear, disorder of lipid metabolism may be a major factor. Since apolipo-protein (apo) E is known to play a major regulatory role in lipid metabolism, we evaluated apo E genotype in 72 male patients with CRF and compared with that in 194 rnale normal controls. In addition, we measured plasma lipid and apolipoprotein concentrations and evaluated them according to apo E genotype in patients and controls. Apo E genotype was determined with the INNO-LiPA Apo E kit (Innogenetics, Belgium), which is based on reverse hybridization. The results are as follows ; 1) The distribution of the three major apo E alleles in patients with CRF ( e 2: 6.2%, e 3: 80.6%, e 4: 13.2%) was not different from that in controls ( e 2: 4.1%, e 3: 87.6%, e 4: 8.3%). 2) In patients with CRF, total cholesterol, lowdensity lipoprotein (LDL) and high-density lipoprotein (HDL) levels were significantly lower and the triglyceride and lipoprotein (a) levels were significantly higher than those in controls. 3) In controls, E 4/3 group had significantly lower levels of HDL than E 3/3 and E 3/2 groups. In patients with CRF, E 4/3 group had significantly higher levels of total cholesterol and apo B lipoprotein than E3/2 group. In conclusion, although there was no significant difference in the apo E genotype frequencies between male patients with CRF and controls, apo E polymorphism may play an important role in the determination of individual differences in plasma lipids in male patients with CRF.
Alleles ; Apolipoproteins B ; Apolipoproteins E ; Apolipoproteins* ; Atherosclerosis ; Cause of Death ; Cholesterol ; Genotype ; Humans ; Individuality ; Kidney Failure, Chronic* ; Lipid Metabolism ; Lipoprotein(a) ; Lipoproteins ; Male* ; Plasma* ; Triglycerides

PURPOSE: To assess the value of gray-scale stimulated acoustic emission in differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma. MATERIALS AND METHODS: Twenty-four cases of epatocellular carcinoma (HCC) in 23 patients and 26 cases of metastatic adenocarcinoma in 14 patients were prospectively examined using the pulse-inversion harmonic technique after intravenous SH U 508A administration. Gray-scale stimulated acoustic emission (SAE) was measured 5 mins after bolus injection of a contrast agent (4g, 400 mg/ml). The presence or absence of SAE signals at internal and marginal areas of the tumor and the appearance (smooth or irregular) of its border were compared. In addition, the SAE index [SAE (parenchyma) - SAE (tumor)/ SAE (parenchyma)] was histographically determined using a computerized program (PiView TM ; Mediface, Seoul, Korea). The statistics were analysed using student'st test. RESULT: Of the 24 HCC cases, 20 (83%) showed internal SAE signals, while 23 (96%) marginal signals were emitted. Of the 26 cases of metastatic adenocarcinoma, one (4%) showed internal SAE signals, while in five (19%), these signals were marginal. The tumoral border was irregular in 19 HCC lesions (79%) and smooth in 23 metastatic lesions (88%). For HCC and metastatic tumors, the mean SAE index was 0.38 +/-0.15 and 0.60 +/- 0.08, respectively (p < 0.001). CONCLUSION: Gray-scale stimulated acoustic emission can be a useful tool in differential diagnosis between heatocellular carcinoma and metastatic adenocarcinoma.
Acoustics* ; Adenocarcinoma* ; Carcinoma, Hepatocellular* ; Diagnosis, Differential* ; Humans ; Liver Neoplasms ; Microbubbles ; Prospective Studies ; Seoul

PURPOSE: To evaluate the significance of high signal intensity of the septum pellucidum in hydrocephalus on proton density-weighted brain MR images. MATERIALS AND METHODS: Authors reviewed the MR images of 418 cases of patients with normal(175 cases), hydrocephalic(35 cases), atrophic(58 cases), and other groups(150 cases) retrospectively. We analyzed the signal intensity of the septum pellucidum in the normal group and the incidences of high signal intensities of periventricular area of frontal horn of lateral ventricle(area 1), periventricular area except area 1(area 2), callososeptal area(area 3), and septum pellucidum(area 4) in the normal and abnormal groups. RESULTS: In the normal group, the septurn pellucidum was isointense to the head of caudate nucleus on proton density-weighted image. High signal intensity of the septurn pellucidurn was seen in 31 cases (22 cases of hydrocephalus, 5 cases of brain atrophy, and 4 cases of others), and showed high specificity(91.4%) for hydrocephalus in spite of low sensitivity(62.9%), as compared with periventricular hyperintensities of other areas. CONCLUSION: High signal intensity of the septum pellucidum on proton density-weighted image may be caused by transependymal CSF migration in the patients with hydrocephalus, and considered as an additional finding of hydrocephalus in the cases of ventriculomegaly.
Animals ; Atrophy ; Brain ; Caudate Nucleus ; Head ; Horns ; Humans ; Hydrocephalus* ; Incidence ; Protons ; Retrospective Studies ; Septum Pellucidum*

PURPOSE: This study was attempted to investigate the prevalence of the expression of c-fos protein, TGF-alpha and -beta, PCNA , DNA ploidy pattern and histopathological parameters of giant cell tumor (GCT) of bone and to correlate with prognosis and to extend our understanding on tumorigenesis of GCT. MATERIALS AND METHODS: Twenty eight cases of paraffin-embedded tissue were studied, classified as recurrent (5 cases) and non-recurrent group (12cases) within the limits of the cases which afforded surgical material on first operation. RESULTS: No significant difference was observed in cellularity of stromal cells, atypia of stromal and giant cells, presence of hemorrhage and necrosis between recurrent and non-recurrent group. However, presence of more than 10 mitotic figures in 10 high power fields in recurrent group was significantly higher than non-recurrent group (p<0.05). The immunoreactivity for PCNA was seen only in nuclei of stromal cells, whereas nuclei of giant cells showed negative staining. The positivity of PCNA revealed no significant difference between non-recurrent (mean; 40.9%) and recurrent group (34.4%). The expression of c-fos oncogene was seen in 5 cases (100%) in recurrent group, and 8 cases (66.7%) in non-recurrent group, and no significant difference was seen. No significant difference of expression of TGF-alpha was seen in 5 cases (100%) in recurrent group and in 11 cases (91.7%) in non-recurrent group. The expression of TGF-beta in stromal cells was significantly higher in non-recurrent group (80%) compared to recurrent group (100%) (p<0.05). In DNA analysis out of 18 cases, 4 cases (22.2%) were aneuploidy and 14 cases (77.8%) were diploidy. Among 4 aneuploidy cases, 3 cases (75%) had no recurrence, and 1 case (25%) had metastasis to lung and expired. No significant difference of DNA ploidy pattern was seen between the recurrent and non-recurrent group. CONCLUSION: Presence of more than 10 mitotic figures in 10 high power fields and less expression of TGF-beta are related to higher possibility of recurrence and it is suggested that the number of mitotic figure (more than 10/10HPF) and expression of TGF-beta could be helpful parameters in predicting recurrence of GCT.
Aneuploidy ; Carcinogenesis ; Diploidy ; DNA* ; Giant Cell Tumor of Bone* ; Giant Cell Tumors* ; Giant Cells* ; Hemorrhage ; Lung ; Necrosis ; Negative Staining ; Neoplasm Metastasis ; Oncogenes ; Ploidies ; Prevalence ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Recurrence ; Stromal Cells ; Transforming Growth Factor alpha ; Transforming Growth Factor beta ; Transforming Growth Factors*

BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

We reviewed four patients who underwent posterior C-D occipitocervical loop and autogenous bone graft. The mean postoperative follow-up period was 16 months. The indications for surgery were progressive neurological deficit, atlantoaxial instability and intractable pain. Of the four patients, one had os odontoideum, two rheumatoid arthritis and suboccipital dislocation combined fractures of C1 and C2. Bong union was confirmed in all cases at approximately 4 months postoperatively. Final outcome result was satisfactory in three patients and unsatisfactory in one patient. The cause of unsatisfactory result was recurrent neck pain secondary to swan neck deformity. The neurologic deficit were improved or remained same as preoperative status. Three patient were out of bed on average of the 14th day postoperatively. One patient could not ambulate due to tetraplegia who needed an artificial ventilator. There was no complication related to instrumentation.
Arthritis, Rheumatoid ; Congenital Abnormalities ; Dislocations ; Follow-Up Studies ; Humans ; Neck ; Neck Pain ; Neurologic Manifestations ; Pain, Intractable ; Quadriplegia ; Transplants ; Ventilators, Mechanical

Echocardiography was done on 51 cases with various cardiovascular disease and on 23 cases of normal control subjects from April, 1981 to March, 1982 in the Department of internal medicine, Eul Ji General Hospital, Seoul, Korea. The results obtained were as follows: 1. The left ventricular mass estimated by the measurements made with standard convention was 261+/-8gm in patient group and 126+/-6gm in control group. With penn convention, the left ventricular mass of the patients group was 297+/-11gm and that of control group was 127+/-6gm. The differences between both conventions were significant statistically. 2. In measurements made with standard convention, those who showed increased left ventricular posterior wall thickness were 37 cases(73%) and those who showed increased left ventricular internal dimension were 15 cases(29%). On the other hand, number of cases who showed increased left ventricular mass were 45 cases(88%) and this results suggested estimation of left ventricular mass seems to be more useful method in the diagnosis of left ventricular hypertrophy than simple measurements of left ventricular posterior wall thickness of left ventricular internal dimension. 3. The correlation coefficient between left ventricular mass and maximum voltage of electrocardiography, left ventricular posterior wall thickness left ventricularinternal dimension was 0.70, 0.74 0.51 respectively in standard method and 0.82, 0.76, 0.44 respectively in penn convention. Left ventricular mass was correlated fairly closely with the maximum voltage of electrocardiography and left ventricular posterior wall thickeness, less closely with the left ventricular internal dimension.
Cardiovascular Diseases ; Diagnosis* ; Echocardiography* ; Electrocardiography ; Hand ; Hospitals, General ; Humans ; Hypertrophy, Left Ventricular* ; Internal Medicine ; Korea ; Seoul

BACKGROUND/AIMS: Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB. MATERIALS AND METHODS: Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated. RESULTS: NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses. CONCLUSIONS: NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.
Blood Transfusion ; Christianity ; Hemodynamics ; Hemorrhage* ; Hemostasis, Endoscopic ; Hospital Mortality ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Medical Records ; Mortality ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Rupture

BACKGROUND/AIMS: Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB. MATERIALS AND METHODS: Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated. RESULTS: NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses. CONCLUSIONS: NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.
Blood Transfusion ; Christianity ; Hemodynamics ; Hemorrhage* ; Hemostasis, Endoscopic ; Hospital Mortality ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Medical Records ; Mortality ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Rupture

PURPOSE: To assess the clinical and pathologic features of each type of intrahepatic cholangiocarcinoma,which is divided into three types according to gross appearance, and to determine the efficacy of CT in detectingthis tumor. MATERIALS AND METHODS: The pathologic and CT features of 53 surgically proven cases of intrahepaticcholangio-carcinoma were reviewed. On the basis of their gross appearance, the tumors were divided into threetypes, as follows: mass forming (n=33), periductal infiltrating (n=6), and intraductal growth type (n=14). CTscans were analyzed for sensitivity of detection and correlation between a tumors appearance and itshistopathology. RESULTS: The most common histopathologic feature of mass forming and periductal infiltrating typewas tubu-lar adenocarcinoma, while in the intraductal growth type, papillary adenocarcinoma (100%) was common.With regard to pattern of tumor spread, intrahepatic and lymph node metastasis were more common in the massforming and periductal infiltrating type than in the intraductal growth type. CT findings including intra-hepaticmass, ductal wall thickening or intraductal mass associated with segmental dilatation of intrahepataic bile ducts,corresponded with these morphologic types. CONCLUSION: This classification according to gross appearance is ofconsiderable value when interpreting the pathologic features of intrahepatic cholangiocarcinoma. CT seems to be auseful modality for the detection of tumors and may be consistent with their gross morphologic findings.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Bile ; Cholangiocarcinoma* ; Classification ; Dilatation ; Lymph Nodes ; Neoplasm Metastasis