No abstract available.
Trigger Points*

PURPOSE: Approximately 10% of the general population in western countries have gallstones. The compositions of gallstones, however, vary with location and ethnicity. The purpose of this study is to analyze the gallbladder stones of patients in Chungbuk and mainly to compare the compositions of the gallstones with those in other reports. METHODS: The patients in this study included gallbladder stone patients (N=318) who were operated on in Chungbuk National University Hospital from January 1992 to December 1997. By gross inspection of their cut surface structures, the gallstones were classified as pure cholesterol stones, mixed stones, brown stones, and black pigment stones. The chemical compositions of the stones (N=35) that were collected during January and February 1997 were analyzed using high- pressure liquid chromatography (HPLC). RESULTS: By inspection, 31 (9.7%) stones were classified as pure cholesterol stones, 54 (17%) as mixed stones, 27 (8.5%) as brown stones, and 206 (64.8%) as black pigment stones. The results of HPLC analysis were as follows; 5 (15%) stones had cholesterol contents higher than 90% of their composition, 5 (15%) stones 50 to 90%, and 25 (70%) stones less than 20%. CONCLUSION: Of the galldder stones of patients in Chungbuk 73.3% were pigment stones. This result was compatible with the HPLC results (70% of the stones have less than a 20% cholesterol content). The classification of the gallbladder stones of the patients in Chungbuk shows that the incidence of black pigment stones is very high while that of cholesterol stones is low. The difference is even greater when compared with the data in other papers published in Korea. The causes of the difference be remained to be clarified.
Cholesterol ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Chungcheongbuk-do* ; Classification ; Gallbladder* ; Gallstones ; Humans ; Incidence ; Korea

Nonparasitic liver cysts are usually asymptomatic and require treatment when they are symptomatic. Hence, many treatment methods, such as percutaneous aspiration, aspiration followed by injection of sclerosing agents into the cyst, excision of the liver cyst, and hepatic resection have been suggested. Recently, the laparoscopic cholecystectomy has become popular, and this method has been challenged as a treatment for symptomatic nonparasitic liver cysts. To evaluate the feasibility of using and the disadvantages of laparoscopic treatment, we reviewed the medical records of 10 patients with a symptomatic nonparasitic liver cyst who were treated by laparoscopic unroofing at the Department of Surgery, Chungbuk National University Hospital. All patients were diagnosed by USG and abdominal CT. All patients had vague abominal discomfort, abdominal distension, or indigestion. The sizes of the liver cysts varied from 7 cm to 20 cm, and half of them were located in the right lobe, the other half in the left lobe. In 5 patients, the cysts were multiple. The mean operative time was 99.5 minutes, and mean hospital stay was 8 days. The follow up period was from 3 to 37 months. Two patients required a reoperation because of cyst infection and a rapidly growing cyst. Remaining cysts were identified in 4 among 8 patients, but they did not have any symptoms. In conclusion, laparoscopic unroofing is feasible as a first choice for treatment of a symptomatic liver cyst. However, in liver cyst that are located at the dome of right side or in a thickened wall, incomplete unroofing and residual cysts can be anticipated. In this case, we suggest that open cyst excision or unroofing may be better than laparoscopic unroofing.
Cholecystectomy, Laparoscopic ; Chungcheongbuk-do ; Dyspepsia ; Follow-Up Studies ; Humans ; Length of Stay ; Liver* ; Medical Records ; Operative Time ; Reoperation ; Sclerosing Solutions ; Tomography, X-Ray Computed

Blunt chest trauma can cause various types of cardiac injuries such as myocardial contusion,cardiac ruptrue, valvular or papillary muscle injuries, and pericardial or coronary artery injuries. Complete rupture of both papillary muscles accompanied by left ventricular(LV) rupture following blunt chest trauma to our knowledge has not been previously reported. A 40-year-old female was referred because of severe dyspnea and anterior chest pain which occured immedicately after blunt chest trauma. Echocardiography demonstrated a moderate pericardial effusion as well as rupture of both papillary muscle with severe mitral regurgitation. Hemopericardium and a complets tear of the anterolateral papillary muscle at the mid portion were observed. The posteromedial papillary muscle was totally transected at the attachment site of LV wall and accompanied by external rupture of left ventricle at that site. Mitral valve replacement and primary repair of LV ruptrue was performed successfully. In the case we report, complete rupture of both papillary muscles developed after blunt chest trauma and LV rupture occurred as the papillary muscle was torn from the LV wall.
Adult ; Chest Pain ; Coronary Vessels ; Dyspnea ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Papillary Muscles* ; Pericardial Effusion ; Rupture* ; Thorax*

PURPOSE: Cyclooxygenase (COX) enzymes catalyze the ratelimiting step in arachidonate metabolism. COX-1 is expressed constitutively in many cell types. However COX-2 is an inducible enzyme responsible for prostaglandin production at site of inflammation. Recently, there has been increasing evidence that COX-2 involves in development and progression of human tumors. The aim of the present investigation is to evaluate the antiproliferative effect of NS-398, a selective COX-2 inhibitor, and its mechanism in a papillary thyroid cancer cell line, TPC-1. METHODS: We used TPC-1 cell line, NS-398 and EGF. COX-2 expression was detected by RT-PCR and western blot. We used MTT assay to evaluate antiproliferative effect of NS- 398. The mechanisms of growth inhibition were evaluated by apoptosis assay and cell cycle analysis using flow cytometry. RESULTS: COX-2 expression was identified by both RT-PCR and western blot in TPC-1 cells and it was upregulated by serum, EGF (10 ng/ml), and NS-398 (50 mM). NS-398 induced a dose-dependent inhibition of cell proliferation but did not increases apoptotic cell population significantly in the TPC-1 cell line. EGF treatment (10 ng/ml) for 72 hours did not seem to change the antiproliferative effect of NS-398. The proportion of G0/G1 cell cycle was increased by 10% compared with control after 36 hours of treatment with NS-398. CONCLUSION: TPC-1 cells expressed COX-2 constitutively and its expression was upregulated by serum, EGF, and NS-398. The selective COX-2 inhibitor, NS-398 inhibited cell proliferation in TPC-1 cell line rather by cell cycle arrest at G₀/G₁ phase than by inducing apoptosis.
Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line* ; Cell Proliferation ; Cyclooxygenase 2 ; Epidermal Growth Factor ; Flow Cytometry ; Humans ; Inflammation ; Metabolism ; Prostaglandin-Endoperoxide Synthases ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Several kinds of stents have shown their safety and efficacy to treat acute or subacute closure after balloon angioplasty as well as to reduce restenosis rate. However, one of the limitations of stents is difficult to deploy especially in tortuos vessels, lesions at a bend, and distal to previously deployed stents. The Micro stent II, which was one of the most recently developed stents, ia a rapid-exchage balloon expandable stainless steel stent with a zigzag design connected with a continuous single weld in each 3mm segments. It scores over excellent trackability and optimum radio-opacity. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report our experiences with Micro-II stent implanatation in the first 76 patients at Tonsei cardiovascular center to assess its safety and efficacy in patients with complex coronary anatomy and clinical results in the first months. METHODS: Between January 1996 and July 1996, eighty-six Micro-II stent were implanted in the coronary arteries of 76 patients(male 65.8%, age 59+/-10 year). Forty-five patients had unstable angina, the others had stable angina(17pts), acute myocardial infarction(14pts). RESULTS: 1) Indication of stenting was de novo 51(59.3%), suboptimal result 25(29.1%), restenosis 1(1.2%) and 9(10.4%) of lesions were stented in bail out situation. 2) Single stent were implanted in 76(88.4%)lesions, overlapping stent in 10(11.6%)lesions. Among overlapping stents, the second stent with Micro-II stent and with another kind of stent were 4.6%, 7.0%, respectively. 3) Procedure related complication including a subacute closure was occurred in 1(1.2%) patient who had distal dissection and 45% residual stenosis. In 12(14%) lesions, preistent dissection has been noticed after stent impantation. 4) Angiographic success(defined as a residual stenosis of <30% without major dissection) was achieved in 82 of 86 attempts(95.3%). The procedual success rate(defined as a residual stenosis of <30% without occurrence of major clinical events within 4 weeks after procesure) was 96.1%(73/76 patients). Angiographic success and procedural success rate in calcified lesion were 100% and 100%, respectively. Angiographic success and procedural success rate in more than 45` angulated lesion were 97% and 100%, respectively. 5) The mean minimal luminal diameter of the target lesions was increased from 0.42+/-0.40mm before stent implantation to 2.93+/-0.50mm(p<0.001). The percentage of diameter stenosis was reduced from 86.49+/-13.04% to 1.40+/-7.11%(p<0.001) after stent implantation. CONCLUSION: Coronary stenting with AVE Micro-II stent can be safety performed and is particularly beneficial in tortuous and calcified arteries. There was a high tendency for peristent dissection which need to special consideration to avoid. Follow-up data is needed to assess mid and term patency. Coronary artery disease . AVE Micro-II stent . Immediate results.
Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Phenobarbital ; Stainless Steel ; Stents*

BACKGROUND: Sympathetic blocking agent, esmolol (selective beta 1 blocker) or labetalol ( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. METHODS: Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control (n=10), Group II:esmolol (n=11) and Group III: labetalol (n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure (RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. RESULTS: Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation ( p<0.05). Esmolol reduced the heart rate and the rate-pressure product than labetalol, but statistically there were no significance (P > 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups ( p<0.05). But there were no difference among groups (P>0.05). The side effects of esmolol and labetalol did not appear at all. CONCLUSION: 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation.
Adult ; Anesthesia, Inhalation ; Blood Pressure ; Catecholamines ; Dopamine ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Norepinephrine ; Operating Rooms ; Plasma ; Tachycardia

Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.
*APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers ; Calcitonin/*blood ; Comparative Study ; Female ; Human ; Ketone Bodies/*blood ; Male ; Middle Aged ; Multiple Organ Failure/blood/diagnosis/*mortality ; Predictive Value of Tests ; Protein Precursors/*blood ; Sepsis Syndrome/blood/diagnosis/*mortality ; Survival Analysis

Acute renal cortical necrosis is an anuric form of acute renal failure. We experienced a case of renal cortical necrosis complicated by tranexamic acid administration. To our knowledge, only three cases of renal cortical necrosis have been reported worldwide. A 49-year-old man was referred with hemothorax and multiple bone fractures following a traffic accident. Tranexamic acid, and hemocoagulase were injected three times a day. After the 4th dose of hemostatics, anuria developed abruptly, the platelet count decreased to 84,000 /microL, and the serum creatinine was increased to 2.56 from 1.06 mg/dL. On the 4th Intensive Care Unit (ICU) day, computed tomography (CT) showed bilateral renal cortical necrosis with normal renal arteries and aorta. The oliguria persisted for 14 days and temporary hemodialysis was performed. The serum creatinine had decreased to 2.12 mg/dL 8 months after discharge.
Accidents, Traffic ; Acute Kidney Injury ; Anuria ; Aorta ; Batroxobin ; Creatinine ; Fractures, Bone ; Hemostatics ; Hemothorax ; Humans ; Intensive Care Units ; Kidney Cortex Necrosis ; Middle Aged ; Oliguria ; Platelet Count ; Renal Artery ; Renal Dialysis ; Tranexamic Acid

PURPOSE: Follicular neoplasms (FNs) such as follicular adenoma and carcinoma (FTC), nodular hyperplasia (NH) and follicular variant of papillary carcinoma (FVPC) share cytological features. In the present study, we investigate whether review of sonographic findings in patients with thyroid nodules suspicious of FN spares diagnostic thyroidectomies (DTs) by excluding benign diseases such as NH or not. METHODS: From June 1999 to May 2007, DTs were performed on 98 patients who had nodules suspicious of FN. High resolution sonographic findings are available for 53 patients. According to the final histologic diagnosis: Group I (23 patients) consisted of 20 FNs (11 FTCs), 1 Hurthle cell adenoma, 2 FVPC; Group II (30 patients) consisted of all others (23 NHs, 4 Hashimoto's thyroiditis, 3 papillary carcinomas (PTCs). Sonographic features were compared between the two groups. RESULTS: Three differential sonographic findings (DSF) i.e. irregular margin, absence of peripheral halo or marked inhomogeniety were identified more often in Group II than Group I (P<0.05). If we spared DTs for patients who have at least one DSF, 18 patients (34.0%) would have been selected for clinical follow-up whose final diagnoses were 14 NHs and 4 PTCs (including 1 FVPC). Sparing DTs by DSFs shows sensitivity, 56.7%; specificity, 95.7%; positive predictive value, 94.4%; negative predictive value, 62.9%; and accuracy, 73.6%, respectively. CONCLUSION: In patients with thyroid nodules suspicious of FN, sonographic findings such as irregular margin, absence of peripheral halo or marked inhomogeneity might spare DTs with the help of other diagnostic modalities such as cytogenetic or immunohistochemical studies.
Adenoma ; Carcinoma, Papillary ; Cytogenetics ; Factor IX ; Follow-Up Studies ; Humans ; Hyperplasia ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis