PURPOSE: The purpose of this study was to explore the meaning of pregnant women's experiences with drinking alcohol during first trimester of pregnancy METHODS: The data were collected through in-depth interviews of 7 pregnant women who drank alcohol in the first trimester. Giorgi's phenomenological method was used for data analysis. RESULTS: Findings included 6 main themes and 14 themes. The main themes concerning pregnancy and drinking were: ‘Open attitude in drinking, History of drinking in family or spouse, Seeking information in how drinking affects pregnancy, Regret not doing planned pregnancy and not quitting drinking before pregnancy, Willing to stop drinking until the child birth, Awareness about importance of preconception care. CONCLUSION: The results of this study provide a deeper understanding of pregnant women's experiences of drinking alcohol during the first trimester of pregnancy. These results can be used in the development of strategies to prevent drinking alcohol during first trimester and to support preconception care and prenatal care.
Binge Drinking ; Child ; Drinking* ; Family Planning Services ; Female ; Humans ; Methods ; Parturition ; Preconception Care ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy* ; Pregnant Women* ; Prenatal Care ; Spouses ; Statistics as Topic

Almost all colorectal carcinomas have been thought to develop from pre-existing adenomas. However, some colorectal carcinomas can arise directly from normal flat mucosa, and usually form infiltrative mass at the early stage. The carcinogenesis of this infiltrative carcinoma may be different from the well-known adenoma-carcinoma sequence, which usually forms a polypoid mass. The purpose of this study is to investigate the different expression of various oncogenes in polypoid carcinoma and infiltrative carcinoma. We performed immunohistochemical staining on p53, bcl-2, c-erbB-2 and MIB-1 in 29 polypoid carcinomas arised from adenomas, and 21 infiltrative carcinomas. The average tumor size of infiltrative carcinomas (5.5 cm) was larger than that of polypoid carcinomas (3.1 cm), and the polypoid carcinomas were differentiated more than the infiltrative carcinomas. The results of p53, bcl-2, c-erbB-2, and MIB-1 antisera immunoreactivity in the polypoid carcinoma were 79%, 17%, 21%, and 100%, and those in the infiltrative carcinoma were 71%, 29%, 29%, and 100%, respectively. However the diffuse positivities of p53 and MIB-1 antisera were slightly higher in the infiltraive carcinomas (62%, 76%) than in the polypoid carcinomas (55%, 41%) (p=0.63, 0.01). And the results of p53 and c-erbB-2 immunoreactivity in the adenomas were 52% and 17%, respectively, which is significantly lower than that in the polypoid carcinoma(p=0.03, 0.74). The immunoreactivty of bcl-2 in the adenoma was 72%, which was significantly higher than that in the polypoid carcinoma (17%) (p<0.01). In summary, we did not show the significant difference in expression of p53, bcl-2, c-erbB-2, and MIB-1 proteins between polypoid and infiltrative carcinomas. However, the tendency of infiltrative carcinomas having a more aggressive nature suggests another carcinogenetic mechanism is involved in the colorectal carcinogenesis.
Adenoma ; Carcinogenesis ; Colorectal Neoplasms* ; Immune Sera ; Ki-67 Antigen ; Mucous Membrane ; Oncogenes

BACKGROUND/AIMS: Acute suppurative cholangitis (ASC), a severe form of acute cholangitis, is a life-threatening condition that must be treated with appropriate and timely management. The purpose of this study was to identify the factors that predispose patients to ASC. METHODS: We retrospectively investigated 181 patients (100 men, 81 women; age, 70.66+/-7.38 years, mean+/-SD) who were admitted to Wonkwang University Hospital between January 2005 and June 2007 for acute cholangitis with common bile duct (CBD) stones. All patients underwent endoscopic retrograde cholangiopancreatogram to remove the stones. Variables and factors that could be assessed upon admission were analyzed to identify the risk factors for the development of ASC. RESULTS: Of the 181 patients, 44 (24.3%) presented with ASC. On multivariate analysis, the followings were found to be independent risk factors for the development of ASC: impacted common bile duct stone (p=0.010), current smoker status (p=0.008), advanced age (>70 years; p=0.002), and gallstone (p=0.016). The most commonly isolated organisms in bile culture were Enterococcus species, Escherichia coli, and Klebsiella species. CONCLUSIONS: Impacted bile-duct stones, current smoking, advanced age, and gallstones were identified as independent risk factors for the development of ASC in patients with CBD stones. These results suggest that emergency biliary drainage is beneficial in patients with these risk factors.
Bile ; Cholangitis ; Common Bile Duct ; Drainage ; Emergencies ; Enterococcus ; Escherichia coli ; Gallstones ; Humans ; Klebsiella ; Male ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

BACKGROUND: We examined whether increases of intra-abdominal pressure would decrease compliance (C) of both lung and chest wall. METHODS: We measured airway and esophageal pressure in 10 anesthetized/paralyzed tracheally intubated patients during mechanical ventilation at the respiratory rate of 10 freq/min and the tidal volume of 10 ml/kg undergoing laparoscopic cholecystectomy. Measurements were made at 0 mmHg intra- abdominal pressure the (Pab) in supine position and at 15 mmHg Pab in 10 head-up (reverse Trendelenburg) position at 0, 5, 10 and 15 min. after CO2 insufflation. RESULTS: We found that abdominal carbon dioxide insufflation caused a marked increase in peak airway pressure, plateau pressure and esophageal pressure (p<0.05); a reduction in compliance of respiratory system and chest wall (p<0.05). CONCLUSION: These changes should be considered in patients such as those with pulmonary disease, undergoing laparoscopic cholecystectomy where increase in impendance may be critical.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Compliance* ; Humans ; Insufflation ; Lung ; Lung Diseases ; Respiration, Artificial ; Respiratory Rate ; Respiratory System* ; Supine Position ; Thoracic Wall ; Tidal Volume

BACKGROUND: Propofol (2,6-diisopropylphenol) is a widely used intravenous anesthetic, and the effects of propofol on several ion channels have been studied at the whole cell and single-channel levels. However, in general there is no report on the effect of propofol on outward K+ currents in canine colonic myocytes, in which there are two types of outward K+ currents, a large-conductance Ca2+-activated K+ current and a classical delayed rectifier K+ current. We examined the effects of propofol on the two types of outward K+ currents the kinetics involved. METHODS: Experiments were performed on freshly dispersed smooth muscle cells from the circular muscle layer of the proximal canine colon. Outward currents were recorded using the patch clamp technique in the whole cell configuration. RESULTS: The application of propofol (600 nM-600microM) decreased net outward current in a dose-dependent manner. Propofol (6-60microM) also decreased peak delayed rectifier K+ currents. Pretreatment with TEA abolished propofol effects on delayed rectifier K+ currents. However, propofol still decreased delayed rectifier K+ currents in the presence of 4-AP. CONCLUSIONS: These data suggest that propofol decrease net outward K+ currents primarily by inhibiting large-conductance Ca2+-activated K+ currents and 4-AP resistant delayed rectifier K+ currents. These results suggest that propofol action on outward currents may depend on the different blocking mechanisms of the different types of K+ channels. If propofol cannot induce contraction, Ca2+ currents in colonic myocytes warrant further study.
Colon* ; Ion Channels ; Kinetics ; Muscle Cells* ; Myocytes, Smooth Muscle ; Propofol* ; Tea

Methods: We enrolled 40 patients who underwent either MISS (M group, 20 patients) or open posterior instrumentation surgery (O group, 20 patients) for the treatment of traumatic unstable burst fractures. Clinical outcomes were evaluated based on postoperative back pain, operation time, blood loss, hospital stay duration, and perioperative complications. For radiologic evaluation, preoperative magnetic resonance imaging and plain radiography were performed before and after the surgery to evaluate the changes in the kyphotic angle and fracture union. Results: The change in the kyphotic angle was −8.2°±5.8° in the M group and −8.0°±7.8° in the O group. No significant difference was noted in terms of the change in the kyphotic angle (p=0.94, t-test) after 12 months of surgery. The Visual Analog Scale score was 1.5±0.7 points in the M group, while it was 5.2±1.4 points in the O group. In the M group, back pain has significantly decreased (p<0.01, t-test). The estimated blood loss was 195.5 mL in the M group and 1,077.5 mL in the O group; the operation time was significantly decreased in the O group from 290.7 to 120.7 minutes in the M group (p<0.05, t-test) (p=0.36, t-test). The average duration of hospital stay was 36.0 days in the M group and 41.9 days in the O group (p=0.36, t-test). Conclusions For the treatment of unstable burst fractures, MISS showed significant differences in terms of postoperative back pain, operation time, and blood loss as compared to open posterior instrumentation surgery.

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking. This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.
Adolescent ; Coronary Artery Disease ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Food Habits ; Humans ; Incidence ; Korea ; Male* ; Myocardial Infarction* ; Perfusion ; Risk Factors ; Smoke ; Smoking ; Stents ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography

Aerophagia is a disorder caused by abnormal accumulation of air in the gastrointestinal tract as a result of repetitive and frequent inflow of air through the mouth. For the diagnosis of this condition, it is difficult to objectively measure the air swallowing. However, multichannel intraluminal impedance monitoring facilitates the differential diagnosis between normal air swallowing and pathologic aerophagia, and can aid in the determination of the frequency and amount of air swallowed. In this report, in addition to a literature review, we describe a case of 36-year-old man with abdominal distension who was diagnosed with aerophagia using esophageal impedance monitoring and was treated with clonazepam.
Adult ; Aerophagy/*diagnosis/diagnostic imaging/drug therapy ; Anticonvulsants/therapeutic use ; Clonazepam/therapeutic use ; Diagnosis, Differential ; Electric Impedance ; Humans ; Male ; Mental Disorders/complications ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to determine the optimal length of time to observe patients with contrast media anaphylaxis in the Emergency Department. METHODS: This study included the patients of all age groups who presented with anaphylaxis due to contrast media to the ED of Pusan National University Hospital from January 2006 to August 2009. The medical records were retrospectively reviewed. We analyzed the 100 patients who met the inclusion criteria. Their median age was 55 (46-62), and 38 out of the 100 patients (38%) were male. RESULTS: The most common symptom of patients was urticaria. Corticosteroid and H1 antihistamine were given to most of the patients in the ED. All were discharged after observation in the ED and none were admitted to the ward. The average time from injection of the contrast media to the onset of symptom was 31 minutes (24-39) and the average time to symptom recovery was 127 minutes (89-188). The mean observation time in the ED was 93 minutes (59-153). Biphasic reactions were reported in only one case (1/100, 1%). CONCLUSION: These results suggest that patients who present with an anaphylactic reaction after radiologic studies that use intravenous contrast media can be safely discharged early from the ED because the symptom recovery time is not long and a biphasic reaction is rare.
Anaphylaxis ; Contrast Media ; Emergencies ; Humans ; Male ; Medical Records ; Retrospective Studies ; Urticaria

BACKGROUND: Carcinoma of the ampulla of Vater is rare and its pathogenesis is unclear. The role of epigenetic changes in the APC or CDH1, in the Wnt pathway, has not been reported in ampullary carcinomas. METHODS: We performed immunohistochemistry on 73 sporadic ampullary carcinomas to identify Wnt-related molecules (APC, beta-catenin, E-cadherin, c-erbB2, cyclin D1) and examined mutations in the CTNNB1, loss of heterozygosity of 5q21, and the methylation status of the CpG island of APC and CDH1. RESULTS: Thirteen tumors (17.8%) showed abnormal nuclear localization of beta-catenin; this was more prominent in the intestinal type than in the pancreaticobiliary type (p=0.01). The loss of APC correlated with the loss of beta-catenin or c-erb B2 (p<0.01). The prognosis was worse in the group with APC loss than when APC was maintained (p<0.05). There was no mutation identified in CTNNB1. Six (24%) out of 25 informative cases had 5q21 allelic loss. CpG island methylation in APC and CDH1 was detected in 33 (45.2%) and 29 (31.5%) cases, respectively. CONCLUSIONS: The absence of mutations in CTNNB1 and the epigenetic alteration of APC and CDH1, might be characteristic changes in the Wnt/beta-catenin signaling pathway during the carcinogenesis of ampullary carcinomas.
Ampulla of Vater* ; beta Catenin ; Cadherins ; Carcinogenesis ; CpG Islands ; Cyclins ; Epigenomics* ; Immunohistochemistry ; Loss of Heterozygosity ; Methylation ; Prognosis ; Wnt Signaling Pathway