A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.
Alkaline Phosphatase ; Bilirubin ; Biopsy ; Eosinophilia ; Graves Disease ; Humans ; Hyperthyroidism ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Methimazole* ; Middle Aged ; Prednisolone ; Propylthiouracil*

BACKGROUND: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. MATERIAL AND METHOD: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was 66+/-8 years (range, 47~81 years). Gender ratio was 37:3 (male:female). RESULT: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was 33.2+/-23.2 months (range, 3.8~90.2 months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. CONCLUSION: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.
Amputation ; Arteries ; Atherosclerosis* ; Endarterectomy ; Extremities ; Follow-Up Studies ; Humans ; Lower Extremity* ; Retrospective Studies

A 65 year-old male had chest pain which was diagnosed as unstable angina needing urgent coronary artery bypass surgery. Physical examination demonstrated signs of severe anemia and hemoglobin level was 5.7 g/dL. Gastrofiberscopy showed a 4 cm sized fungating mass at the lesser curvature with active bleeding. The mass was adenocarcinoma by pathologic examination. Simultaneous coronary artery bypass surgery and total gastrectomy were planned due to bleeding of the mass. Off-pump coronary bypass grafting was done first, followed by total gastrectomy. The postoperative course was smooth. He was discharged from the hospital after 12 days and was on surveillance for 9 months. We report a rare case of simultaneous surgery for angina and gastric cancer.
Adenocarcinoma ; Aged ; Anemia ; Angina, Unstable ; Chest Pain ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Gastrectomy* ; Hemorrhage ; Humans ; Male ; Physical Examination ; Stomach Neoplasms ; Transplants

OBJECTIVE: Using Lee et al (1996) model, we assessed the effect of opioid within the PAG on the manifestations of the neuropathic pain, and we studied the effects of naloxone on the analgesic effects of opioid. METHOD: Under pentobarbital anesthesia, male Sprague-Dawley rats were implanted with cannula in the ventral (n=10) and dorsal (n=6) PAG after the unilateral tibial and sural nerves were ligated and cut, leaving the common peroneal nerve intact. Pain sensitivity was assessed using the von Frey filament (8 mN) and acetone applied to the sensitive area for 1 week postoperatively. Rats with neuropathic pain were intracerebrally microinjected with DAMGO (0.1microgram/5microliter) and enkephaline (20microgram/5microliter) into the ventral and dorsal PAG and the pain sensitivity was assessed. Naloxone was injected to assess the observed change of pain sensitivity. RESULTS: Intracerebral microinjection of DAMGO and enkephaline into the ventral PAG, but not the dorsal PAG, increased the pain threshold which was reversed by naloxone. CONCLUSION: The results suggest that stimulation of the ventral PAG in neuropathic rats may reduce neuropathic pain via opioid-mediating pathway of the descending pain inhibition system.
Acetone ; Anesthesia ; Animals ; Catheters ; Enkephalin, Ala(2)-MePhe(4)-Gly(5)- ; Enkephalins ; Humans ; Male ; Microinjections ; Naloxone ; Neuralgia* ; Pain Threshold ; Pentobarbital ; Periaqueductal Gray* ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Sural Nerve

Bartha strain of pseudorabies virus[PRV-Ba] was utilized as a tracer to identify the neuronal axis of rat tongue muscles ; intrinsic muscles and extrinsic muscles, styloglossus, genioglossus, and hyoglossus muscle. After injection of 10 microliter of PRV-Ba into tongue muscles and 48-96 hours survivals, rats were perfused with 4% paraformaldehyde lysine periodate and brains were removed. PRV-Ba were localized in neural circuits by immunohistochemistry employing rabbit anti PRV-Ba as a primary antibody and ABC method. Injection of PRV-Ba into the tongue muscles resulted in uptake and retrograde transport of PRV-Ba in the rat brain. The result showed a circuit specific connection of many nerve cell groups along the time sequence : PRV-Ba immunoreactive cells appeared in hypoglossal nucleus and motor trigeminal nucleus ipsilaterally as seen with conventional tracers. Raphe nucleus, prepositus hypoglossal nucleus, spinal trigeminal nucleus, Al, A5 and facial nucleus of rhombencephalon showed immunoreactivity bilaterally. There were positive neurons in parabrachial nucleus, locus ceruleus, mesencephalic trigeminal nucleus, periaqueductal gray and A7 of mesencephalon and paraventricular nucleus, suprachiasmatic nucleus, organum vasculosum of lamina terminalis of diencephalon. Also positive reactions were showed in amygdala, insular cortex, frontal cortex and subfornical organ in telencephalon. Early immunoreactivity was appeared in hypoglossal nucleus and motor trigeminal nucleus, and there were positive neurons in the nuclei of the medulla oblongate, midbrain, pons, hypothalamus, cerebellum and medial preoptic area at middle stage. Subsequently the viral antigens were found in forebrain cell groups, paraventricular nuclei, suprachiasmatic nucleus, lateral hypothalamic area and primary motor cortex in frontal lobe bilaterally at 80-90hrs postinjection. These data demonstrate that the PRV-Ba can across synapses in the central nervous system with projection specific pattern, and this virus defines many elements of the neural network governing tongue. Therefore PRV-Ba are proved as a excellent neurotracer in the tract-tracing researches.
Amygdala ; Animals ; Antigens, Viral ; Axis, Cervical Vertebra ; Brain ; Central Nervous System ; Cerebellum ; Diencephalon ; Frontal Lobe ; Hypothalamic Area, Lateral ; Hypothalamus ; Immunohistochemistry ; Locus Coeruleus ; Lysine ; Mesencephalon ; Motor Cortex ; Muscles ; Neural Pathways* ; Neurons ; Paraventricular Hypothalamic Nucleus ; Periaqueductal Gray ; Pons ; Preoptic Area ; Prosencephalon ; Pseudorabies ; Raphe Nuclei ; Rats* ; Rhombencephalon ; Subfornical Organ ; Suprachiasmatic Nucleus ; Synapses ; Telencephalon ; Tongue* ; Trigeminal Nuclei ; Trigeminal Nucleus, Spinal

For evaluating the reproductive performances of GTD patients, we found 115 cases of GTD patients, 77 HM and 38 GTT, who became pregnant after the completion of treatments and follow-up period. The results of this study suggest subsequent pregnancies after the completion of treatments may promise normal reproductive outcomes regardless of the chemotherapy.
Drug Therapy ; Follow-Up Studies ; Gestational Trophoblastic Disease* ; Humans ; Pregnancy

No abstract available.
Catheterization* ; Catheters* ; Fallopian Tube Diseases* ; Fallopian Tubes* ; Female

A 32 year-old man was transferred to our hospital due to blood-tinged sputum for 15 days. He had been treated at a private hospital for recurrent pneumonia. The chest X-ray showed an atelectasis on the right middle lobe. Computed tomography of the chest demonstrated a broncholith on right middle lobar bronchus with lobar atelectasis of the right middle lobe. We tried to remove the broncholith through fiberoptic bronchoscopy, but could not remove it. Therefore, we performed surgical removal of broncholith and the right middle lobectomy. The cause of broncholith was identified as actinomycosis by pathologic examination. The broncholith caused by actinomycosis is rare. We report a rare case of broncholithiasis with recurrent obstructive pneumonia caused by actinomycosis, which was treated by surgical operation.
Actinomycosis* ; Adult ; Bronchi ; Bronchoscopy ; Hospitals, Private ; Humans ; Pneumonia ; Pulmonary Atelectasis ; Sputum ; Thorax

PURPOSE: The purpose of this study was to identify the correlation between communication skills for emotional empathy and academic achievement on the Clinical Performance Examination (CPX). METHODS: One hundred twelve medical school students were observed to determine the extent to which they applied communication skills for emotional empathy (preparation stage: interview attitude, respect; rapport stage: encouragement, active listening, will for support; empathy stage: verbal expression empathy, nonverbal expression empathy, acceptance) to the CPX, as well as their level of understanding of these skills to calculate the Pearson r, which can be used to determine the correlation between communication skills and academic achievement (hematochezia, fatigue, abnormal menstruation, chest pain, alcohol problems). RESULTS: Male students had higher scores than females for all communicational skills except verbal expression empathy. Fourth-year students had statistically more significant correlations than third-year students with regard to the rapport stage 'active listening' and empathy stage 'nonverbal expression' and abnormal menstruation and chest pain. Correlations were also more significant for hematochezia in the preparation stage 'interview attitude,' rapport stage 'encouragement,' and empathy stages 'verbal and nonverbal expression' and 'acceptance.' The empathy stage 'nonverbal expressions' was more significant for fourth-year students with alcohol problems. Third-year students largely had negative correlations between emotional empathy communication skills and CPX academic achievement, especially between the preparation stage 'respect' and abnormal menstruation, and between the rapport stage 'encouragement' and hematochezia. CONCLUSION: There was a significant correlation between hematochezia, wherein MS students deliver bad news to patients, and communication skills for emotional empathy.
Achievement ; Chest Pain ; Clinical Competence ; Empathy ; Fatigue ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Menstruation ; Schools, Medical

No abstract available.
Radiotherapy*