BACKGROUND: This study was designed to evaluate the antihypertensive efficacy and safety of benidipine hydrochloride, a Ca(++)-channel blocker, in patients with mild to moderate essential hypertension. METHODS: Benidipine was administered in 2-8mg once daily for 10 weeks in 16 hypertensive patients with diastolic blood pressure over 95mmHg and adverse effects were checked every two weeks after benidipine administration. Chest X-ray, ECG, funduscopy, and laboratory examination were performed before and after benidipine administration. RESULTS: The antihypertensive effect of benidipine was evaluated in 15 patients and the safety in 16 patients. The blood pressure significantly reduced from 170+/-12mmHg/102+/-5mmHg to 137+/-15mmHg/86+/-8mmHg at 10-week administration of benidipine and the overall effective rate was 100%. Heart rate was not affected by benidipine. The slight increase of total protein, BUN, potassium, and glucose was observed at 10 weeks of benidipine administration. Four cases of headache and 1 case of frequent urination were observed and the medication was discontinued in one patient due to headache. CONCLUSION: Benidipine proved effective and safe in the treatment of essential hypertension.
Blood Pressure ; Electrocardiography ; Glucose ; Headache ; Heart Rate ; Humans ; Hypertension ; Potassium ; Thorax ; Urination

A 4-year-old boy visited the hospital with exotropia after brain hemorrhage caused by trauma. He had undergone decompressive craniectomy and cranioplasty 18 months prior to presentation at our hospital. An alternate prism cover test showed more than 50 prism diopters (PD) of left exotropia when he was fixing with the right eye and 30 PD of right exotropia when he was fixing with the left eye at near and far distance. On the Hirschberg test, 60 PD of left exotropia was noted in the primary position. Brain computerized tomography imaging performed 18 months prior showed hypodense changes in the right middle cerebral artery and anterior cerebral artery territories. Subfalcian herniation was also noted secondary to swelling of the right hemisphere. The patient underwent a left lateral rectus muscle recession of 7.0 mm and a left medial rectus muscle resection of 3.5 mm. Three weeks after the surgery, the Hirschberg test showed orthotropia. On alternate prism cover testing, 8 PD of left exotropia and 8 PD of right esotropia were noted at distance. We report a patient who developed dissociated horizontal deviation after right subfalcian subdural hemorrhage caused by trauma.
Brain Injuries/*complications ; Child, Preschool ; Decompressive Craniectomy/*adverse effects ; Esotropia/*etiology/surgery ; Exotropia/*etiology/surgery ; Hematoma, Subdural/etiology/radiography/*surgery ; Humans ; Male ; Oculomotor Muscles/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: The aim of this study was to develop a new middle cerebral artery occlusion (MCAO) model in rabbits using a less invasive, endovascular interventional technique. The new animal model's technical feasibility and its success in producing lesions was evaluated using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten rabbits were used to develop the MCAO models using a transfemoral catheter-based technique. After catheterization of the common carotid artery, a microcatheter was introduced coaxially through the catheter to cannulate the internal carotid artery and to embolize the MCA with polyvinyl alcohol particles. We evaluated how successful we were in selecting the vessels, catheterization, embolization, and also evaluated how many of the animals survived until the end of experiment. Diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were performed in one-hour intervals to monitor the ischemic lesion for a total of six hours following successful occlusion of the target artery. The relative volume of the lesion was calculated as a hemispheric lesion volume (HLV, %). The signals of the lesion and contralateral normal brain (control) were measured in each image at every time point. Lesion-to-control signal-intensity ratio (SIR) of DWI, and T2WI were obtained together with relative apparent diffusion coefficient (rADC). RESULTS: Catheterization and embolization of the internal carotid artery were successful in all 10 rabbits, which showed relevant lesions on MRI. All rabbits survived until the end of the experiment. The HLV (mean+/-standard deviation) was 35.7+/-14.6%. The relative ADC was 0.80+/-0.13. The lesion signals on DWI and T2WI showed a gradual increase as time passed, while the ADC value of the lesion gradually decreased (p<0.0001). CONCLUSION: The rabbit MCAO model using an endovascular interventional technique is technically feasible, and provides a reproducible lesion in the target arterial territory. MRI successfully revealed a typical finding of acute cerebral infarction. This model is also believed to be suitable for the MRI investigation of acute cerebral ischemia.
Animals ; Arteries ; Brain ; Brain Infarction ; Brain Ischemia ; Carotid Artery, Common ; Carotid Artery, Internal ; Catheterization ; Catheters ; Cerebral Infarction ; Diffusion ; Endovascular Procedures ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Models, Animal ; Polyvinyl Alcohol ; Rabbits*

PURPOSE: To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children. METHODS: The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later. RESULTS: Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 +/- 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher's exact test). CONCLUSIONS: While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.
Ambulatory Care ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Korea ; Lacrimal Duct Obstruction/congenital/*surgery ; Male ; Nasolacrimal Duct/*surgery ; Retrospective Studies ; Treatment Outcome

BACKGROUND/AIMS: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome(R) (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome(R) for cutting the distal PR. METHODS: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome(R) until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. RESULTS: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. CONCLUSIONS: The new technique of ES with the Iso-tome(R) is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths.
Adult ; Aged ; Aged, 80 and over ; Ampulla of Vater/surgery ; Biliary Fistula/*surgery ; Choledocholithiasis/*surgery ; Common Bile Duct Diseases/*surgery ; Duodenal Diseases/*surgery ; Female ; Humans ; Intestinal Fistula/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Sphincterotomy, Endoscopic/*instrumentation/methods ; Treatment Outcome

BACKGROUND/AIMS: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome(R) (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome(R) for cutting the distal PR. METHODS: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome(R) until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. RESULTS: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. CONCLUSIONS: The new technique of ES with the Iso-tome(R) is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths.
Adult ; Aged ; Aged, 80 and over ; Ampulla of Vater/surgery ; Biliary Fistula/*surgery ; Choledocholithiasis/*surgery ; Common Bile Duct Diseases/*surgery ; Duodenal Diseases/*surgery ; Female ; Humans ; Intestinal Fistula/*surgery ; Male ; Middle Aged ; Retrospective Studies ; Sphincterotomy, Endoscopic/*instrumentation/methods ; Treatment Outcome

BACKGROUND: Viral screening assays performed for blood donors are required to have high sensitivity because false negative results can lead to transfusion-transmitted infections. To minimize the number of false negative cases, a systematic quality assurance program is required to verify donor screening tests. METHODS: The current status of quality assurance (QA) for blood donor screening tests in Korea and other countries was reviewed. A quality assurance program using the national standards of the Korea Food and Drug Administration (KFDA) was done as a pilot study to evaluate both the need for such a program and the feasibility of such a program. RESULTS: Singapore had a national quality assurance programs for the anti-HIVdonor screening tests. In the United Kingdom, all laboratories use the NIBSC working standards as QA materials for the donors screening. Ninety-five % (84/80) of blood centers replied that they would participate in a national quality assessment program and 92% (84/77) of the blood centers also felt that an independent organization should be designated to operate the program. Quality control materials with a weak reactivity should be included in a quality assessment program for donor screening. CONCLUSION: We propose 2 models for a National Quality Assurance Program (NQAP). In the first model, an independent national reference laboratory (NRL) needs to be established that operates the national quality assurance program. The second model involves the integration of the national quality assurance program for donor screening into the External Quality Assurance Survey run by the Korean Association of Clinical Assurance for Clinical Laboratory (KAQACL) using the national standards.
Blood Donors ; Donor Selection ; Great Britain ; Humans ; Korea ; Mass Screening ; Pilot Projects ; Quality Control ; Singapore ; Tissue Donors ; United States Food and Drug Administration

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*pathology ; Cholangiocarcinoma/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; *Cytodiagnosis ; Female ; Gallbladder Neoplasms/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: During endoscopic retrograde cholangiopancreatography (ERCP), all efforts should be made to be aware of radiation hazards and to reduce radiation exposure. The aim of this study was to investigate the status of radiation protective equipment and the awareness of radiation exposure in health care providers performing ERCP in Korean hospitals. METHODS: A survey with a total of 42 questions was sent to each respondent via mail or e-mail between October 2010 and March 2011. The survey targeted nurses and radiation technicians who participated in ERCP in secondary or tertiary referral centers. RESULTS: A total of 78 providers from 38 hospitals responded to the surveys (response rate, 52%). The preparation and actual utilization rates of protective equipment were 55.3% and 61.9% for lead shields, 100% and 98.7% for lead aprons, 47.4% and 37.8% for lead glasses, 97.4% and 94.7% for thyroid shields, and 57.7% and 68.9% for radiation dosimeters, respectively. The common reason for not wearing protective equipment was that the equipment was bothersome, according to 45.7% of the respondents. CONCLUSIONS: More protective equipment, such as lead shields and lead glasses, should be provided to health care providers involved in ERCP. In particular, the actual utilization rate for lead glasses was very low.
Cholangiopancreatography, Endoscopic Retrograde ; Data Collection ; Delivery of Health Care ; Electronic Mail ; Eyeglasses ; Glass ; Health Personnel ; Humans ; Korea ; Postal Service ; Referral and Consultation ; Thyroid Gland

BACKGROUND/AIMS: Controversy still exists regarding the benefits of covered self-expandable metal stents (SEMSs) compared to uncovered SEMSs. We aimed to compare the patency and stent-related adverse events of partially covered SEMSs (PC-SEMSs) and uncovered SEMSs in unresectable malignant distal biliary obstruction. METHODS: A total of 134 patients who received a PC-SEMS or uncovered SEMS for palliation of unresectable malignant distal biliary obstruction were reviewed retrospectively. The main outcome measures were stent patency, stent-related adverse events, and overall survival. RESULTS: The median stent patency was 118 days (range, 3 to 802 days) with PC-SEMSs and 105 days (range, 2 to 485 days) with uncovered SEMSs (p=0.718). The overall endoscopic revision rate due to stent dysfunction was 36.6% (26/71) with PC-SEMSs and 36.5% (23/63) with uncovered SEMSs (p=0.589). Tumor ingrowth was more frequent with uncovered SEMSs (4.2% vs 19.1%, p=0.013), but migration was more frequent with PC-SEMSs (11.2% vs 1.5%, p=0.04). The incidence of stent-related adverse events was 2.8% (2/71) with PC-SEMSs and 9.5% (6/63) with uncovered SEMSs (p=0.224). The median overall survival was 166 days with PC-SEMSs and 168 days with uncovered SEMSs (p=0.189). CONCLUSIONS: Compared to uncovered SEMSs, PC-SEMSs did not prolong stent patency in unresectable malignant distal biliary obstruction. Stent migration was more frequent with PC-SEMSs. However, tumor ingrowth was less frequent with PC-SEMSs compared to uncovered SEMSs.
Humans ; Incidence ; Outcome Assessment (Health Care) ; Retrospective Studies ; Stents*