The antihypertensive effect of captopril was evaluated in 15 patients with mild to moderate essestial hypertension(Mean age : 55, Mean blood pressure : 171/102mmHg). Captopril was administered 25 to 50mg twice daily with or without hydrochlorothiazide by mouth according to our protocol which was presented in the text. All the patients were followed up to 12 weeks. Captopril with or without hydrochlorothiazide significantly lowered the systolic and diastolic pressure in almost all patients. The mean systolic and diastolic pressure were reduced to 134/86mmHg(-37/-16mmHg ; -22/-16%)(p<0.001). Heart rate did not change significantly. No unwanted effects were observed. We conclude captopril has exellent antihypertensive effect in most patients with mild to moderate essential hypertension.
Blood Pressure ; Captopril* ; Heart Rate ; Humans ; Hydrochlorothiazide ; Hypertension* ; Mouth

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.
APACHE ; Blood Gas Analysis ; Blood Pressure ; Heart Rate ; Humans ; Nutritional Status ; Respiration, Artificial ; Respiratory Rate ; Ventilation* ; Weaning*

PURPOSE: Although the diagnostic accuracy of thyroid cancer by fine needle aspiration cytology (FNAC) is increasing, there are some nodules for which ultrasonography and FNAC show indeterminant. The purpose of this study was to determine the usefulness of thyroid ultrasonography by the surgeon prior to operation METHODS: Forty-nine patients who underwent thyroid operations between June 2006 and January 2007 were selected for this study. Thyroid ultrasonography was performed on each patient.And we recorded and analyzed the shape and the margin of the nodule, internal echogeneiety, heterogeneiety, the presence of microcalcification, height versus width, and the presence of level VI lymph node larger than 3 mm, assigning each a score of 1, 2 or 3. RESULTS: The average score was 17.1. Assuming an average score over 14 is considered to be malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.6%, 88.9%, 91.7%, 94.1% respectively. Statistically significant characteristics of malignancy were the shape and the margin of the nodule, internal echogeneiety, microcalcification, taller than wide shape and the presence of enlarged VI lymph nodes. The heterogeneiety had no significant P value. CONCLUSION: When malignancy cannot be confirmed even after repeated FNAC, preoperative ultrasonograpy performed by surgeons can be a reliable test and helpful for operations.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Sensitivity and Specificity ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography*

In contrast to the intrinsic feedback inhibition defect of primary hyperparathyroidism (HPT), secondary HPT is caused by chronic extrinsic overstimulation of otherwise normal parathyroid glands. This condition is very common in patients with end stage renal disease (ESRD), and secondary HPT develops as a complex sequence of interactions. As the glomerular filtration rate falls, the renal production of 1,23- dihydroxy-vitamin D3 decreases. Moreover, this causes a reduction in intestinal calcium absorption, which creates the parathyroid hormone (PTH) secretion. This secretion increases serum calcium levels by mobilizing calcium from bones. Lastly, the PTH secretion is further stimulated by hyperphosphatemia (via a phosphorous-specific receptor) and a decrease in ionized calcium (from reduced solubility caused by hyperphosphatemia). Intact PTH levels of 500 to 1,500 pg/ml are common (normal: 10~65 pg/ml) in ESRD patients. Long-standing hyperphosphatemia contributes to the alteration of the parathyroid cells, which affect feedback inhibition, due to an increase in ionized calcium. Secondary HPT is mainly controlled by the restriction of phosphate, the inhibition of phosphorous absorption and the supplementation of calcitriol. Secondary HPT, which is unresponsive to medical treatment, it is well known that a total parathyroidectomy and autotransplantation has good results. This report documents our experience with secondary HPT, treated with a total parathyroidectomy and autotransplantation.
Absorption ; Accidental Falls ; Autografts ; Calcitriol ; Calcium ; Glomerular Filtration Rate ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperphosphatemia ; Kidney Failure, Chronic* ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Solubility ; Transplantation, Autologous

Bilateral chylothorax as a complication of modified radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. Early diagnosis and proper management is very important. We report here on a case of bilateral chylothorax following left modified radical neck dissection that was successfully treated with conservative management.
Chylothorax* ; Early Diagnosis ; Lymph Node Excision* ; Lymph Nodes* ; Neck Dissection ; Neck* ; Thyroid Neoplasms

No abstract available.
Abortion, Habitual* ; Female ; Immunization* ; Lymphocytes* ; Pregnancy

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.
Academic Medical Centers ; Biopsy ; Cecum ; Diagnosis ; Drug Therapy ; Gastrointestinal Tract* ; Humans ; Ileum ; Incidence ; Lymph Nodes ; Lymphoma* ; Prednisone ; Radiography ; Retrospective Studies ; Stomach ; Survival Rate ; Ultrasonography ; Vincristine ; Weight Loss

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.
Clinical Clerkship ; Clinical Competence ; Decision Making ; Education, Medical ; Emergency Medicine ; Humans ; Internal Medicine ; Internship and Residency* ; Learning ; Malpractice ; Motivation ; Organization and Administration ; Pediatrics ; Program Development* ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

The colostomy may cause considerable discomfort as well as surgical, psychological and esthetic problems. The ostomates probably suffer most from fecal incontinence, even though many attempts have been made to eliminate the problems related to the spontaneous colonic emission. Hence the aims of this study are to survey ostomates' satisfaction with colostomy irrigation. METHODS: This medical survey attempts to assess the degree of satisfaction that ostomates are satisfied with the quality of their lives and the extent to which they are affected in doing their jobs and sexuality. The survey was conducted for 146 ostomates, who responded to the questionnaire at the 3rd & 4th Workshop for Stoma Rehabilitation for Ostomates in 1998 and 1999 developed by the Department of Surgery, Kyung Hee University Hospital. The irrigation group was formed with 66 cases (45.2%) and the non-irrigation group 80 cases (54.8%). In assessment of the satisfaction of sexuality, the irrigation group was composed of 37 cases (male: 22 cases, female: 15 cases) and the non-irrigation group 48 cases (male: 30 cases, female: 18 cases). RESULTS: It is found out that the ratio of male to female is 1.5:1 (97:59) and by the age distribution, the ostomates in their 50's and 60's constitute 67.1%: by the cause of stoma operation, malignancy consists of 133 cases (91.1%), Inflammatory Bowel Disease (IBD) 6 cases, the others 7 cases. As for the degree of the satisfaction of ostomates for their life quality, it is found that 52 cases (78.9%) of the irrigation group and 71 cases (88.8%) of the non-irrigation group (p<0.05) reveal dissatisfaction. As for the degree of the satisfaction of the ostomates for the extent to which they are affected in doing their social activities, dissatisfaction is revealed in 52 cases (78.9%) in the irrigation group and in 64 cases (80.0%) in the non-irrigation group (p>0.05). As for the degree of the satisfaction of the ostomates for the sexuality in male, dissatisfaction is revealed in 13 cases (59.1%) of the irrigation group and in 23 cases (76.7%) of the non-irrigation group (p<0.05). In the case of female, the dissatisfaction is observed in 8 cases (53.3%) of the irrigation group and in 13 cases (72.2%) of the non-irrigation group (p<0.05). CONCLUSIONS: This medical survey clearly shows high dissatisfaction rates especially in the non-irrigation group, and the better significant satisfaction was shown in the quality of life and sexuality between the male and the female in the irrigation group. Therefore, colostomy irrigation may be an effective method for the management of colostomy.
Age Distribution ; Colon ; Colostomy* ; Education ; Fecal Incontinence ; Female ; Humans ; Inflammatory Bowel Diseases ; Male ; Quality of Life ; Surveys and Questionnaires ; Rehabilitation ; Sexuality

PURPOSE: The laparoscopic cholecystectomy has increasingly been accepted as the procedure of choice for treatment of symptomatic gall stones and chronic cholecystitis. However, its role and its timing in the management of patients with acute cholecystitis remain controversial. This retrospective study was undertaken to compare on early laparoscopic cholecystectomy with a delay one for patients with acute cholecystitis. METHODS: Between January 1995 and June 1999, 15 patients were operated on within 72 hours of symptom onset. Those patients were classified as the early laparoscopic cholecystectomy group. The 18 patients who underwent a delayed laparoscopic cholecystectomy after a percutaneous transhepatic cholecystostomy (PTCS) and conservative management were classified as the delayed laparoscopic cholecystectomy group. RESULTS: No significant differences were seen in the conversion rate (1 case in the delayed group), the operation time (early group 107.3 min., delayed group 118.6 min.), postoperative complications (early group 20.0%, delayed group 16.7%), and the postoperative hospital stay (early group 4.7 days, delayed group 7.1 days). The early group had significantly more frequent operation modifications and decreased total hospital stays than the delayed group: 86.7% and 7.0 days, for the early group and 44.4% and 22.8 days for the delayed group. CONCLUSION: Early laparoscopic cholecystectomy for acute cholecystitis did not increase the operation time, the morbidity, or the conversion rate. Although this study was not a randomized study and the sample size was small, an early laparoscopic cholecystectomy seems to be safe and feasible for patients with acute cholecystitis, having the benefit of a decreased total hospital stay.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Cholecystostomy ; Gallstones ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Sample Size