No abstract available.
Animals ; DNA* ; LLC-PK1 Cells* ; Swine

PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.
Brachytherapy ; Catheters ; Colon ; Common Bile Duct ; Gallbladder ; Head and Neck Neoplasms ; Humans ; Palliative Care ; Radiotherapy* ; Stents* ; Stomach ; Survival Rate

No abstract available.
Adult* ; Humans ; Molecular Epidemiology* ; Oxalobacter formigenes* ; Seoul*

PURPOSE: There have been some efforts to diagnose intracranial aneurysm through a non-invasive method using MRA, although the process may be difficult when the lesion is less than 3mm. The present study prospectively compare the results of high resolution, fast speed slice interpolation MRA and DSA therapy examing the potentiality of primary non-invasive screening test. MATERIALS AND METHODS: A total of 26 cerebral aneurysm lesions from 14 patients with subarachnoid hemorrhage from ruptured aneurysm (RA) and 5 patients with unruptured aneurysm(UA). In all subjects, MRA was taken to confirm the vessel of origin, definition of aneurysm neck and the relationship of the aneurysm to nearby small vessels, and the results were compared with the results of DSA. The images were obtained with 1.5T superconductive machine(Vision, Siemens, Erlangen, Germany) on 4 slabs of MRA using slice interpolation. the settings include TR/TE/FA=30/6.4/25, matrix 160x512, FOV 150x200, 7minutes 42seconds of scan time, effective thickness of 0.7mm and an entire thickness of 102.2mm. The images included structures from foramen magnum to A3 portion of anterior cerebral artery. MIP was used for the image analysis, and multiplanar reconstruction(MPR) technique was used in cases of intracranial aneurysm. RESULTS: A total of 26 intracranial aneurysm lesions from 19 patients with 2 patients having 3 lesion, 3 patients having 2 lesions and the rest of 14 patients having 1 lesion each were examined. Among those, 14 were RA and 12 were UA. Eight lesions were less than 2mm in size, 9 lesions were 3-5mm, 7 were 6-9mm and 2 were larger than 10mm. On initial exams, 25 out of 26 aneurysm lesions were detected in either MRA or DSA showing 96% sensitively. Specificity cannot be estimated since there was no true negative of false positive findings. When MRA and MPR were used concurrently for the confirmation of size and shape, the results were equivalent to those of DSA, while in the confirmation of aneurysm neck and parent vessels, the concurrent use of MRA and MPR was far superior to the sole use of either MRA or DSA. CONCLUSION: High resolution MRA using slice interpolation technique showed equal results as those of DSA for the detection of intracranial aneurysm, and may be used as a primary nin-invasive screening test in the future.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Angiography, Digital Subtraction* ; Anterior Cerebral Artery ; Foramen Magnum ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Parents ; Prospective Studies ; Sensitivity and Specificity ; Subarachnoid Hemorrhage

A review of 234 patients with cervical cancer during the last 5 years was undertaken to evaluate the efficacy of routine cystoscopic examination in staging cervical cancer. Cystoscopic abnormalities suggesting bladder invasion of the cervical cancer were found in none of the 127 patients with clinical stage 1 and 65 patients with clinical stage 2. In 7(22.6%) out of 31 patients with clinical stage 3 and in 4(80%) out of 5 patients with clinical stage 4. markedly bullous edema and hyperemia suggesting suspicious bladder invasion was identified on cystoscopy. Mucosal biopsy was done in 5 or them which revealed no pathologic invasion. Incidentally found transitional cell carcinoma was found in one patient. From these observations, it can be concluded that routine cystoscopy is not recommended in cervical cancer with clinical stage 1 and 2, and is indicated only in clinical stage 3 or greater.
Biopsy ; Carcinoma, Transitional Cell ; Cystoscopy* ; Edema ; Humans ; Hyperemia ; Urinary Bladder ; Uterine Cervical Neoplasms*

PURPOSE: Oxalobacter formigenes is an intestinal flora degrading oxalate in the gut. However, microbiological detection of this organism is quite difficult. We tried to develop a simple, rapid and cost-effective PCR method for detecting Oxalobacter formigenes from fecal specimens and to determine whether O. formigenes could be detected from frozen fecal specimens as well as fresh stool. MATERIALS AND METHODS: Whole bacterial DNA was isolated directly from fresh and frozen stool samples obtained from 30 healthy volunteers known to be free from urolithiasis and from fresh stool samples obtained from 38 patients with urolithiasis. Genus specific oligonucleotide sequences corresponding to homologous regions residing in the oxc gene that encodes for oxalyl-coenzyme A decarboxylase were designed. A PCR-based assay was done in both fresh and frozen stool samples and the nucleotide sequences were analyzed to determine the details of oxc. RESULTS: PCR product of 416-bp molecular size encoding oxc gene was detected in 23 (77%) of 30 healthy volunteers and in 14 (37%) of 38 patients with urolithiasis. In healthy volunteers, the results of PCR for the fresh and the frozen stool proved identical in each subject. The nucleotide sequence analysis revealed that the sequence of the amplified product was compatible with that of oxc gene. CONCLUSIONS: O. formigenes could be identified easily and efficiently by this PCR-based detection system. Furthermore, as the PCR-based assay results in the frozen fecal samples were identical as that of fresh stool, immediate processing of the fecal samples may not be necessary to detect O. formigenes in the clinical setting.
Base Sequence ; DNA, Bacterial ; Healthy Volunteers ; Humans ; Oxalobacter formigenes* ; Polymerase Chain Reaction* ; Urolithiasis

BACKGROUND: Several recent studies have reported that generation of inflammatory cytokines and activation of complements may be associated with febrile nonhemolytic transfusion reactions (FNHTR). However, few data are available for whole blood, which is still commonly utilized for massive transfusion and for autologous transfusion. METHODS: A total of 15 whole blood units from healthy adult donors was collected and stored at 4degrees C for 35 days. During the storage time, samples for analyses of cytokines including interleukin-1alpha (IL-1alpha), IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNFalpha) and anaphylatoxins such as C3a and C5a were obtained on day 0, 1, 3, 5, 7, 14, 28, and 35. Cytokines were measured by enzyme-linked immunosorbent assay and anaphylatoxins by radioimmunoassay. RESULTS: IL-1alpha (<0.5 pg/mL), IL-2 (<7 pg/mL), and TNFalpha (<4.4 pg/mL) were not detectable. IL-6 was measured in 4 units with low level (1.1-4.0 pg/mL) and IL-8 showed slightly higher level (10.5 pg/mL) on day 35. Anaphylatoxins (C3a and C5a) were detectable at the level of 1350.0 ng/mL on day 21 and of 14.6 ng/mL on day 14, respectively, which were significantly increased levels compared with those on day 0. The levels of C3a and C5a reached 2513.3 ng/mL and 18.4 ng/mL on day 35, respectively. CONCLUSIONS: It is not likely that cytokines generated during storage of whole blood under normal blood banking condition could explain FNHTR. However, anaphylatoxins are elevated in whole blood after 2 weeks of storage, which might be due to complement activation by the plastic surface of blood bag.
Adult ; Anaphylatoxins* ; Blood Banks* ; Blood Group Incompatibility ; Complement Activation ; Complement System Proteins ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-1alpha ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Plastics ; Radioimmunoassay ; Tissue Donors ; Tumor Necrosis Factor-alpha

BACKGROUND: In developed countries, food-born diseases have decreased and hospital laboratory have taken more simple method rather than complex enrichment-selective methods. But detection rate of pathogenic bacteria in stool culture was not so high. METHODS: We mixed 4 pathogenic bacteria (S. typhi, S. flexneri, V. cholerae and Y. enterocolitica) with 3 stool specimens from healthy persons (for Y. enterocolitica, 5 specimens) and innoculated directly or after enrichment (105 bacteria/plate). After proper incubation, we counted suspected colonies and calculated true positive rate after identification of each colonies. RESULTS: For S. typhi, in the case of direct innoculation on the MacConkey, XLD and SS agar, positive rate of selected colonies were below 36.6%. After enrichment in SF broth for 8 hours, the rate were 80.0%, 83.0% and 70.0% respectively. For S. flexneri, the rates were 86.7%, 100%, 93.3% in direct innoculation, and were highest after enrichment in GN broth for two hours (93.3% in MacConkey and 100.0% in both XLD and SS agar). For V. cholerae, inspite of screening by catalase and oxidase tests, positive rate of selected colonies were 0% (0/7 colonies) in direct innoculation on the MacConkey. After enrichment in APW about 1 day and on TCBS agar, the rate were 100%. For Y. enterocolitica, after incubation at room temperature for 2 days, most selected colonies were Y. enterocolitica on CIN media. CONCLUSION: For more efficient detection of pathogenic bacteria in stool culture, combination of direct innoculation on MacConkey agar and on one or two selective media after proper enrichment process, should be considered.
Agar ; Bacteria ; Catalase ; Cholera ; Developed Countries ; Humans ; Laboratories, Hospital ; Mass Screening ; Oxidoreductases ; Salmonella ; Shigella ; Vibrio ; Yersinia

It has been suggested that diseased and anomalous kidneys are more susceptible to injury. While horseshoe kidney is the most common congenital anomaly of renal fusion, occurring in about one in every 400-500 births, reports of the horseshoe kidneys associated with renal trauma are rare. Herewe now report our experiences with two cases of renal trauma on horseshoe kidney.
Kidney* ; Parturition

BACKGROUND: Optimal head and neck positioning and clinical experience are important factors for successful endotracheal intubation in patients with a difficult airway. This study aimed to investigate the rate of successful endotracheal intubation between the sniffing and ramped positions in patients with an expected difficult intubation. METHODS: The study included 204 patients with an expected difficult intubation (airway difficulty score > or = 8) based on the preoperative airway assessment. The patients were randomized into the following groups: group S was placed in the sniffing position, and group R was placed in the ramped position during direct laryngoscopy. The primary outcome was successful endotracheal intubation and the secondary measure was laryngeal view in the ramped or sniffing position when the operating table was placed at two different heights. RESULTS: Group R showed a higher rate of successful endotracheal intubation and better laryngeal view than group S (P < 0.05). The rate of successful endotracheal intubation was higher in group R than in group S at both heights of the operating table; but, it was not different within each group. Laryngeal view was not different between the two groups and within each group when the two heights of the operating table were used. Fully trained and experienced attending anesthesiologists achieved a higher rate of successful endotracheal intubation than less experienced residents in group R (P < 0.05) but not in group S. CONCLUSIONS: Ramped position and clinical experience can be important factors for laryngeal view and success rate of endotracheal intubation in patients with an expected difficult intubation.
Architectural Accessibility ; Head ; Humans ; Intubation* ; Intubation, Intratracheal* ; Laryngoscopy ; Neck ; Operating Tables ; Prospective Studies*