A fifty year old Korean female was admitted with a few months history of general malaise. On admission, positive HBs Ag, negative HBs Ab and HBe Ag was negative. The liver function tests showed AST 274 U/L, ALT 126 U/L, CEA 1.87 ng/ml. With the clinical impression of chronic hepatitis B, abdominal CT and ERCP were performed and demonstrated a narrowing of the distal common bile duct suggesting a malignant etiology. The Whipple's procedure was done. The intraoperative finding revealed neoplastic involvement of the distal 1 cm of the common bile duct with severe narrowing and proximal dilatation. Microscopic findings demonstrated cystically dilated ductular structures and intervening irregular hypertrophic smooth muscle bundles.
Adenomyoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Dilatation ; Female ; Hepatitis B, Chronic ; Humans ; Liver Function Tests ; Muscle, Smooth ; Tomography, X-Ray Computed

No abstract available.
Rho(D) Immune Globulin*

BACKGROUND: It is believed that stimulation of the P6 acupoint minimizes nausea and vomiting, and has been used to prevent and treat nausea and vomiting in various situations. The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) in female patients undergoing laparoscopic cholecystectomy. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, we investigated 59 ASA I or II female patients who underwent laparoscopic cholecystectomy under general anesthesia using isoflurane or enflurane. We used a ReliefBand(R) unit (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. Patients were randomly divided into two groups; in the P6 group (n = 29) the activated ReliefBand(R) was placed at the P6 acupoint; and in the placebo group (n = 30) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and remained in place for 24 h. We evaluated the incidence and severity of PONV, and need for rescue antiemetics during the first 6 h and 24 h after surgery. RESULTS: No differences in age, weight, previous PONV history, or duration of anesthesia were present between groups. The incidence of PONV was significantly lower (34%) in the P6 group than in the placebo group (63%) during the first 24 h after surgery. The severity of nausea and vomiting was also significantly lower in the P6 group than in the placebo group. However, the need for rescue antiemetics was similar in the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduces the incidence and severity of PONV in female patients undergoing laparoscopic cholecystectomy during the first 24 h after surgery.
Acupuncture ; Acupuncture Points* ; Anesthesia ; Anesthesia, General ; Antiemetics ; Cholecystectomy, Laparoscopic* ; Enflurane ; Female ; Humans ; Incidence ; Isoflurane ; Nausea ; Postoperative Nausea and Vomiting* ; Prospective Studies ; Transcutaneous Electric Nerve Stimulation* ; Vomiting

BACKGROUND: Because moving means can be easily shiftable according to their crude data, we made a selective expected ranges to calculate the moving means. Bull's mean (exponential factor, P=0.50) and Exponentially Adjusted Moving Mean (EAMM, P=0.66) were assessed. we studied to determine appropriately expected range and exponential factor. METHODS: We made the target values from RBC indices being measured with H-2 hematology autoanalyzer from 800 patients and the expected range from red cell indices data of additional 600 patients. Both moving means using this expected ranges were calculated. The % difference of Bull's mean and EAMM was compared and total mean of (deltaBull's mean/deltaBatch mean) and (deltaEAMM/deltaBatch mean) was compared. RESULTS: The target values were MCV: 90.6 fL, MCH: 29.8 pg. MCHC: 32.8 g/dL. The expected ranges were within +/-6% of their target values. Among the 20 batches obtained from expected range, there were no above +/-3% difference of red cell indices in both moving means. The comparison between % difference of Bull's mean and that of EAMM showed no difference. Total mean of (deltaEAMM/deltaBatch mean) was higher than that of (deltaBull's mean/deltaBatch mean). CONCLUSIONS: The % difference results of Bull's mean and EAMM were basically similiar within the expected range but EAMM method was more sensitive than Bull's mean method under the aspect of specimen effects, so EAMM was more detectable than Bull's mean on the quality control of red cell indices.
Erythrocyte Indices* ; Hematology ; Humans ; Quality Control

Objectives: ：Clozapine has been known to increase the possibility of developing cardio/cerebrovascular diseases, and the platelet activation has been deemed to be related to the occurrence of them. In author’s previous study, we observed the increase of platelet activity with short-term clozapine administration. This study was conducted, as a follow-up study, to investigate the effect of clozapine on the platelet activity when administered continuously for long-term period of time of 1 year. Methods: ：The medical records of the patients with schizophrenia or schizoaffective disorder who were treated with clozapine for 1 year were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results: ：Total of 24 patients were enrolled. 9 of them (37.5%) were male and 15 of them (62.5%) were female. In the Wilcoxon sign-ranks test, no significant change was observed between the mean platelet factor values at the beginning and at the end of one year. Conclusions ：No significant changes of mean platelet activity were observed after continued administration of clozapine for 1 year. Considering the author’s previous findings that observed a prominent decrease of mean platelet component after short-term clozapine administration, the result of this study suggests the possibility that the activity of the platelet may change depending on the duration of the clozapine administration.

We investigated the incidence, predictors, and long-term clinical outcomes of new-onset diabetes mellitus (DM) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). A total of 6,048 patients treated with DES were retrospectively reviewed and divided into three groups: 1) known DM (n = 2,365; fasting glucose > 126 mg/dL, glycated hemoglobin > 6.5%, already receiving DM treatment, or previous history of DM at the time of PCI); 2) non-DM (n = 3,247; no history of DM, no laboratory findings suggestive of DM at PCI, and no occurrence of DM during follow-up); and 3) new-onset DM (n = 436; non-DM features at PCI and occurrence of DM during follow-up). Among 3,683 non-DM patients, 436 (11.8%) patients were diagnosed with new-onset DM at 3.4 ± 1.9 years after PCI. Independent predictors for new-onset DM were high-intensity statin therapy, high body mass index (BMI), and high level of fasting glucose and triglycerides. The 8-year cumulative rate of major adverse cardiac events (a composite of cardiovascular death, myocardial infarction, stent thrombosis, or any revascularization) in the new-onset DM group was 19.5%, which was similar to 20.5% in the non-DM group (P = 0.467), but lower than 25.0% in the known DM group (P = 0.003). In conclusion, the incidence of new-onset DM after PCI with DES was not low. High-intensity statin therapy, high BMI, and high level of fasting glucose and triglycerides were independent predictors for new-onset DM. Long-term clinical outcomes of patients with new-onset DM after PCI were similar to those of patients without DM.
Body Mass Index ; Coronary Artery Disease ; Diabetes Mellitus* ; Drug-Eluting Stents* ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence* ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Retrospective Studies ; Stents ; Thrombosis ; Triglycerides

No abstract available.
Lutein* ; Lymphangioma, Cystic*

We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.
Abscess ; Adolescent ; Barium ; Fistula* ; Humans ; Inflammation ; Laryngoscopy ; Male ; Neck ; Pyriform Sinus* ; Soft Tissue Infections* ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Suppurative ; Tomography, X-Ray Computed

A 50 year old female presented unusual electrocardiographic changes including AV block, accelerated idioventricular rhythm, ventricular premature systole with severe fluctuation of blood pressure and clinical features of angina pectoris. Deep ST segment depression was demonstrated in spite of the normal coronary arteriogram and the negative coronary artery spasm study. Urinary excretion of catecholamines and their metabolites were elevated and a huge pheochromocytoma was found in the left adrenal glandd. After removal of the pheochromocytoma, the electrocardiographic abnormalities and the blood pressure were normalized and teh aptient became asymptomatic.
Accelerated Idioventricular Rhythm ; Angina Pectoris* ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Catecholamines ; Coronary Vessels ; Depression ; Electrocardiography* ; Female ; Humans ; Middle Aged ; Pheochromocytoma* ; Spasm ; Systole

BACKGROUND: Coronary artery disease(CAD) has been related to a number of factors, including diabetes, smoking,hypertension, blood lipids, and family history of CAD. However, a few studies have examined the correlation between these factors and severity of CAD. In the present study, we aimed to define the correlation between risk factors and the severity of CAD. METHODS: The study population was 309 consecutive patients who underwent coronary angiography in Kang Nam St. Marys hospital between Mar. 1992 and Aug. 1994. We analyzed risk factors of CA ; age, total cholesterol(TC), triglyceride, high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol cholesterol(LDL-C), the ratio of TC to HDL-C, Lp(a), uric acid, fibrinogen, diabetes, hypertension, smoking, and family history of CAD. All films were reviewed without specific knowledge of blood laboratory results. Significant occlusive disease was defined as >50% diameter obstruction of a major coronary vessel. Extent of disease was defined as the number of major coronalry arteries with significant occlusive disease. RESULTS: 1) Statistically significant risk factors between one vessel disease group and multivessel disease group are age, TC, LDL-C, and diabetes in total patients and age, LDL, and diabetes in male patients. But there is no significant difference in female patients. 2) In patients with multivessel disease, age, HDL-C level are significantly lowere, and TG level and the percentage of smkoing are significantly higher, in male than female. 3) There is increase in four major risk factors(diabetes, hypertension,smoking,hypercholesterolemia) with the increased number of diseasesd coronary arteries; normal coronary group has 1.07 risk factors, one vessel disease group 1.30, two vessel disease group 1.49, and three vessel disease group 1.78. 4) In total and male patients, three independent variables are significantly associated with severity of CAD. These variables are age, smoking, and diabetes. In female patients, diabetes in only significant independent risk factor. CONCLUSION: The significant independent risk factors associated with severity of CAD are age, diabetes, and smoking in total and male patients. Whereas in female patients, diabetes is only significant independent risk factor.
Arteries ; Cholesterol, LDL ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Female ; Fibrinogen ; Humans ; Hypertension ; Lipoproteins ; Male ; Risk Factors* ; Smoke ; Smoking ; Triglycerides ; Uric Acid