PURPOSE: To evaluate the incidence,. degree, and clinical significance of non-obstructive intrahepatic bile duct di'latation encountered on follow up CT after gastrectomy for gastric carcinoma. MATERIALS AND METHODS: We retrospectively analyzed follow-up abdominal CT of 65 patients who had undergone gastrectomy with truncal vagotomy and subtotal gastrectomy for gastric carcinoma. We classified those patients who showed intrahepatic duct dilatation into non-obstructive or obstructive groups depending on the presence or absence of the lesions obstructing the duct. We also evaluated the incidence, degree and pattern, and appearance time of non-obstructive type of duct dilatation. RESULTS: Non-obstructive and obstructive biliary dilatations were present in 8 cases(12.3%) and 9 cases(13. 8%), respectively. The degree of non-obstructive group was mild in 6 cases(75%) and moderate in 2 cases (25%) who had taken cholecystectomy during the follow up period, and patterns were proportional dilatation of the central and peripheral intrahepatic ducts. It appeared on follow up CT obtained 6 to 12 months after operation in 7 cases and 3.5 months in one case. No statistical significance was noted between the type of surgery and the incidence of non-obstructive dilatation(p>0.05). CONCLUSION: Mild dilatation of the central intrahepatic ducts without evidence of mechanical biliary obstruction can be seen on follow-up CT obtained more than 6 months after gastrectomy for gastric carcinoma, and the incidence is about 12%. We think that this finding is non-obstructive and clinical evaluation is unnecessary.
Bile Ducts, Intrahepatic ; Cholecystectomy ; Dilatation* ; Follow-Up Studies ; Gastrectomy* ; Humans ; Incidence ; Retrospective Studies ; Tomography, X-Ray Computed ; Vagotomy, Truncal

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.
Airway Management ; Anesthesia ; Arousal ; Cough ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Manometry ; Masks* ; Orthopedics

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway (LMA), but the results of those studies were much different from one another. This conflicting results may be due to the time of the removal of LMA, which has been usually after the arousal (when the patient can open the mouth on command). So, the authors investigated the incidence of the gastroesophageal reflux and the regurgitation of gastric contents above the upper esophageal sphincter associated with the difference of the time of the removal of LMA. METHODS: Sixty three patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were allocated randomly to Group A (n=34, LMA was removed when the rejection signs such as struggle, restlessness, swallowing and cough came out.) or Group B (n=29, LMA was removed after arousal). For the detection of reflux and regurgitation episodes during anesthesia, a pH monitoring probe was positioned in the lower esophagus and a methylene blue (50 mg) gelatine capsule was swallowed just before induction. At the end of anesthesia, the episodes of reflux and regurgitation of gastric contents were analyzed according to the pharyngeal blue staining or pH< or = 4. RESULTS: The incidence of reflux (pH< or = 4) from the time of the rejection signs to the removal of LMA and the total incidence of reflux in Group B were significantly higher than that of Group A. No patient in both group showed pharyngeal staining of methylene blue. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: Maintenance of LMA until the patient can open the mouth on command seems to increase the incidence of the gastroesophageal reflux.
Anesthesia ; Arousal ; Cough ; Deglutition ; Esophageal Sphincter, Upper ; Esophagus ; Gastroesophageal Reflux ; Gelatin ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Laryngeal Masks* ; Methylene Blue ; Mouth ; Orthopedics ; Psychomotor Agitation

BACKGROUND: The angiotensin coverting enzyme(ACE) gene(encoding kininase II, EC3.4.15.1) contains a polymorphism based on the presence(insertion [I]) or absence(deletion[D]) within an intron of a 287bp nonsense DNA domain, resulting in three genotypes(D/I) and I/I homozygotes, and I/D heterozygotes). Alu insertion is associated with lowerACE level than deletion allele(D) and it was observed that D/D individuals have twice theACE activity of I/I patients. Pregnancy induced hypertension(PIH) probably results fromdominating pressor systems owing to loss of antagonizing vasodilator autacoids. AngiotensinII is an extremely potent arteriolar vasoconstrictor. Overactivity or failure to supressresponsiveness to the increased activity of angiotensin II, which is generated by ACE,would seem to be a reasonable basis for the vasoconstriction of PIH. The aim of this studyis to evaluate the relationship between ACE genotype and PIH. METHODS: Blood sampling was taken from 39 patients with PIH. The hypertensivedisorders, confirmed at postpartum follow up, were classified as gestational hypertensionwithout proteinuria, preeclampsia(mild and severe) and eclampsia. The diagnosis ofpreeclampsia was made according to the American College of Obstetrics and Gynecology criteriaof hypertension and proteinuria(>300 mg/24 hr urine). Genomic DNA was extractedfrom blood sample. After PCR amplification of the respective fragments from intron 16 ofthe ACE gene, size fractionation and visualization by electrophoresis were performed. RESULTS: PIH group(including gestational hypertension, mild and severe preeclampsia: frequency of I allele 0.756 and D allele 0.244) had more I allele and less D allele whencompared with normal population(frequency of I allele 0.609 and D allele 0.391)(p < 0.05).And PIH group had more I/I homozygote individuals showing significant distortion fromHardy-Weinberg equilibrium of ACE genotype(p < 0.05). Moreover, severe preeclampsiagroup alon(frequency of I allele 0.759 and D allele 0.241) had more I allele and less Dallele when compared with normal population and had significantly more I/I homozygoteindividuals. CONCLUSION: As pregnancies with PIH had more ACE I allele and I/I homozygoteindividuals. PIH could be associated with I allele of the ACE gene. Considering the observedcodominant association between the D-I polymorphism and plasma ACE activity, our resultis in favor of the thesis that PIH primarily arises from defective synthsis of vasodilatingautacoids and renin-angiotensin system exerts secondary vasoconstrictive action. However,the relationship between ACE genotype and defective vasodilating mechanism during pregnancyis unknown at present.
Alleles ; Angiotensin II ; Angiotensins* ; Autacoids ; Diagnosis ; DNA ; Eclampsia ; Electrophoresis ; Female ; Follow-Up Studies ; Genotype ; Gynecology ; Homozygote ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Introns ; Obstetrics ; Peptidyl-Dipeptidase A ; Plasma ; Polymerase Chain Reaction ; Postpartum Period ; Pre-Eclampsia ; Pregnancy* ; Proteinuria ; Renin-Angiotensin System ; Vasoconstriction

OBJECTIVE: To explore the intracellular signal transduction pathways of IL-1beta and TNF-alpha in inducing matrix metalloproteinase-9 (MMP-9) in human myometrial smooth muscle cells. METHODS: We studied the expression of MMP-9 induced by cytokines (TNF-alpha and IL-1beta) with zymography. The influence of TNF-alpha and IL-1beta on the phosphorylation of Jun N-terminal kinase (JNK) and IkB were studied with immunoblotting for p-JNK and p-IkB. The intranuclear shifting of NF-kB and AP-1 after treatment with TNF-alpha and IL-1beta were evaluated by EMSA. RESULTS: TNF-alpha- and IL-1beta-induced MMP-9 expression was not suppressed by NF-kB inhibitor (CAPE), AP-1 inhibitor (curcumin) and PKC inhibitor (calphostin C) but was inhibited by tyrosine kinase inhibitor (genistein). After treatment of myometrial smooth muscle cells with TNF-alpha and IL-1beta, phosphorylation of JNK and phosphorylation of IkB with degradation of IkB were evidently observed. The intranuclear translocations of NF-kB and AP-1 were strongly enhanced after treatment with TNF-alpha and IL-1 beta as demonstrated in EMSA. CONCLUSION: In myometrial smooth muscle cells, MMP-9 is induced by TNF-alpha and IL-1beta through PKC activation and transcriptional activations of NF-kB and AP-1. Independent of PKC activation, the signaling of TNF-alpha and IL-1beta in the induction of MMP-9 seems to be transmitted by way of either NF-kB or AP-1 activation in myometrial smooth muscle cells.
Cytokines* ; Female ; Humans ; Immunoblotting ; Interleukin-1beta ; Matrix Metalloproteinase 9 ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; NF-kappa B ; Phosphorylation ; Phosphotransferases ; Pregnancy ; Pregnant Women* ; Protein-Tyrosine Kinases ; Signal Transduction* ; Transcription Factor AP-1 ; Tumor Necrosis Factor-alpha ; Uterus

OBJECTIVE: To evaluate pregnancy outcomes after electrosurgical conization. METHODS: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. RESULTS: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p<0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; <28 week, 6.5% vs. 8.0%, p=1.000; <34 week, 19.4% vs. 20.0%, p=1.000; <37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. CONCLUSION: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.
Cerclage, Cervical ; Cervix Uteri ; Conization ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Risk Factors

BACKGROUND: There have been unexpected cases of failed alcoholic sympathectomy, even though satisfactory effects had been obtained in test blocks with a mixture of contrast media and local anesthetics. It was plausible to suspect the contrast media as a cause of the failure of alcoholic sympathectomy. So, the purpose of this study was to evaluate whether the contrast media can hinder the action of alcohol in alcoholic sympathectomy or not. METHODS: In Sprague - Dawley rats (200 300g), thoracic paravertebral sympathetic chains were exposed and planned regimens were injected in these regions. The rats were divided randomly into seven groups, group C (control group), group D (administration of dye just after exposure), group D-A30 (administration of dye just after exposure, administration of alcohol 30 min. after dye), group A30 (administration of alcohol 30 min. after exposure), group D-A0 (administration of dye just after exposure, administration of alcohol just after dye), group D-A60 (administration of dye just after exposure, administration of alcohol 60 min. after dye) and group D-A90 (administration of dye just after exposure, administration of alcohol 90 min. after dye). Degrees of cytoplasmic contraction were evaluated in the ganglion cells of each member of the experimental groups. RESULTS: The contraction ratios of cytoplasms in group D-A30 and A30 were greater than that of group C and D. The contraction ratios of cytoplasm in group D-A60 and D-A90 were greater than those of group D-A0 and D-A30. CONCLUSIONS: According to our results, the contrast media seems to hinder the action of alcohol in alcoholic sympathectomy.
Alcoholics* ; Anesthetics, Local ; Animals ; Contrast Media* ; Cytoplasm ; Ganglion Cysts ; Humans ; Rats ; Sympathectomy*

Since introduce of antithyroid drugs (ATDs) in 1941, they have been widely used for treatment of Graves' disease and other hyperthyroid disorders. However, agranulocytosis, the most serious adverse effect of ATD treatment, has been occasionally reported. Agranulocytosis should be diagnosed and be treated promptly due to possible fatality.We have experienced a 17 year-old girl with PTU (propylthiouracil)-induced agranulocytosis. Initial graulocyte count was 400/mm2, and presenting symtoms were fever and sore throat. She has recovered from agranulocytosis without complications after use of G-CSF (granulocyte-colony stimulating factor). We reviewed and analyzed additional 7 cases of ATD-induced agranulocytosis in Yonsei University Hospital (From 1988 to 1998). We found that ATD-induced agranulocytosis, of which incidence is known to be ranged from 0.1 to 1 per cent, does not seem to have a distinct correlation with sex, age, dosage, and the kind of ATD. Event of agranulocytosis has a tendency to occur within 3 months, and in a few case it has been occasionally detected in asymptomatic patients, routine monitoring of the white blood cell count within 3 months after the start of ATD medication can be helpful in predicting and in detecting agranulocytosis. The treatment of ATD-induced agranulocytosis has been mainly composed of conservative care, but according to introduction and popular application of G-CSF, the use of G-CSF seems to be a promise of a reduction in morbidity and mortality.
Adolescent ; Agranulocytosis* ; Antithyroid Agents ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Graves Disease* ; Humans ; Incidence ; Leukocyte Count ; Mortality ; Pharyngitis

OBJECTIVE: To determine the clinical value of human papillomavirus deoxyribonucleic acid(HPV DNA) testing by polymerase chain reaction(PCR), specifically to examine whether HPV testing could identify the women with Pap smears read as mostly atypical squamous cells of undetermined significance(ASCUS) or more. METHODS: HPV DNA testing by PCR for 3 high-risk cancer associated genotypes(HPV 16, 18, 33), repeat Pap smears and colposcopically directed punch biopsies were performed concurrently on 169 women referred for cervical cancer screening test with a previous Pap smear read as ASCUS or more. RESULTS: HPV DNA testing positivity was significantly associated with abnormal cytology and high-grade squamous intraepithelial lesion(HSIL) and squamous cell carcinoma(SCC) in histology(P=0.034). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) of Pap smear and HPV testing for identifying 38 cases of histologically confirmed HSIL and carcinoma by different triage protocols(HPV positive or HSIL or SCC) among 169 women were 65.8%(25/38), 85.5%(112/131), 56.8%(25/44) and 89.6%(112/125), respectively. Also sensitivity, specificity, PPV and NPV were varied by ages and more higher in older. CONCLUSION: HPV DNA testing by PCR appears to offer an effective means by which women whose cervical Pap smears have been read as ASCUS or more could be triaged for colposcopically directed biopsy. The sensitivity for HSIL could be maintained in high and specificity markedly improved by HPV genotypes 16, 18, 33.
Biopsy ; Chromosome Aberrations* ; Female ; Genotype ; Human Papillomavirus DNA Tests ; Humans ; Mass Screening ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage ; Uterine Cervical Neoplasms

Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.