BACKGROUND: The deleterious cardiopulmonary side effects immediately after positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy are well tolerated in healthy patients but can lead to serious morbidity and mortality in patients with a limited cardiopulmonary reserve. Using a continuous and non-invasive cardiac output monitor based on partial CO2 rebreathing method, we investigated the immediate cardiopulmonary changes caused by positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy, and assessed the applicability of the partial CO2 rebreathing method for the measurement of cardiac output in a laparoscopic cholecystectomy. METHODS: The investigation was carried out on 11 patients undergoing a laparoscopic cholesystectomy. The control values of cardiac index (CI), cardiac output (CO), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), systemic vascular resistance (SVR), dynamic compliance (Cdyn), airway resistance (Raw), peak inspiratory pressure (PIP) and end tidal CO2 partial pressure (PETCO2) were measured in the supine position after induction with target-controlled infusion of propofol (5 microgram/ ml). Five minutes after positioning in reverse Trendelenburg and CO2 insufflation, the same cardiopulmonay variables were measured and compared with the control values. RESULTS: CI, CO and CVP were reduced 33.3%, 31.9% and 29.0%, respectively (P < 0.05). MAP and SVR were increased 39.8% and 154.1%, respectively (P < 0.05). Cdyn was reduced 38.0% (P < 0.05). Raw and PIP were increased 22.8%, and 34.8%, respectively (P < 0.05), whereas HR and PETCO2 remained unchanged. CONCLUSIONS: The non-invasive cardiopulmonary monitor using partial CO2 rebreathing method, could be used with ease and safety in a laparoscopic cholecystectomy.
Airway Resistance ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Cholecystectomy, Laparoscopic ; Compliance ; Heart Rate ; Humans ; Insufflation ; Mortality ; Partial Pressure ; Propofol ; Respiratory System* ; Supine Position ; Vascular Resistance

The incidence of heterotopic gastric mucosa located in the submucosa in resected stomach specimens has been reported to be 3.0 to 20.1%. Heterotopic gastric mucosa is thought to be a benign disease, which rarely becomes malignant. Heterotopic gastric mucosa exists in the gastric submucosa, and gastric cancer rarely occurs in heterotopic gastric mucosa. Since tumors are located in the normal submucosa, they appear as submucosal tumors during endoscopy, and are diagnosed through endoscopic biopsies with some difficulty. For such reasons, heterotopic gastric mucosa is mistaken as gastric submucosal tumor. Recently, two cases of early gastric cancer arising from heterotopic gastric mucosa in the gastric submucosa were treated. Both cases were diagnosed as submucosal tumors based on upper gastrointestinal endoscopy, endoscopic ultrasound, and computed tomography findings, and in both cases, laparoscopic wedge resections were performed, the surgical findings of which also suggested submucosal tumors. However, pathologic assessment of the surgical specimens led to the diagnosis of well-differentiated intramucosal adenocarcinoma arising from heterotopic gastric mucosa in the gastric submucosa.
Adenocarcinoma ; Biopsy ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastric Mucosa ; Incidence ; Stomach ; Stomach Neoplasms

Carcinoma of uterine cervix is the most common malignant tumor in Korean women but the pathogeneeis of that is not well known. Recently human papillomavirus(HPV), especially type 16 and 18, ras and c-erb-B oncogenes and epiderma1 growth factor receptor(EGFR) have been knuwn to be implicated in the oncogenesis of cervical carcinoma. Fifty two women treated for invasive squamous cell carcinoma of uterine cervix and thirty three nomal controls were studiel to inveatigate the role of the infection of HPV type 16, 18 and the expression of EGFR in tumorigenesis and progression of cnvical cancer and to inveatigate the correlation behveen the infection of HPV and the exprression of EGFR in cervical cancer. The presence of HPV DNA was analysed using HPV amplification by polymerase chain reaction(PCR), abd tge expression of EGFR by immunohistochemical staining. The HPV 16/18 DNA were detected in 40 of 52(76.9%) cervical cancer tissue while in 6 of 33(18.2%) control tissues(p<0.05). The expression of EGFR was positive in 27 of 52(51.9%) cervical cancer while in none of control tissues (p<0.05%). The infection of HPV 16/18 and expression of EGFR were not significantly associatxl with the age, stage, histologic type., lymph nuxle metastases, tumor size, incasive depth of cervical wall and 5-year survival reate. Tere was no significant correlation between HPV positivity and EGFR expression in cervical cancer patients. These data suggest that HPV infection and EGRF expression might play a role in carcinogenesis but not in the progression of metastasis of cervical cancer.
Carcinogenesis ; Carcinoma, Squamous Cell ; Cervix Uteri ; DNA ; Epidermal Growth Factor* ; Female ; Humans* ; Neoplasm Metastasis ; Oncogenes ; Papillomavirus Infections* ; Receptor, Epidermal Growth Factor* ; Uterine Cervical Neoplasms

Carcinoma of uterine cervix is the most common malignant tumor in Korean women but the pathogeneeis of that is not well known. Recently human papillomavirus(HPV), especially type 16 and 18, ras and c-erb-B oncogenes and epiderma1 growth factor receptor(EGFR) have been knuwn to be implicated in the oncogenesis of cervical carcinoma. Fifty two women treated for invasive squamous cell carcinoma of uterine cervix and thirty three nomal controls were studiel to inveatigate the role of the infection of HPV type 16, 18 and the expression of EGFR in tumorigenesis and progression of cnvical cancer and to inveatigate the correlation behveen the infection of HPV and the exprression of EGFR in cervical cancer. The presence of HPV DNA was analysed using HPV amplification by polymerase chain reaction(PCR), abd tge expression of EGFR by immunohistochemical staining. The HPV 16/18 DNA were detected in 40 of 52(76.9%) cervical cancer tissue while in 6 of 33(18.2%) control tissues(p<0.05). The expression of EGFR was positive in 27 of 52(51.9%) cervical cancer while in none of control tissues (p<0.05%). The infection of HPV 16/18 and expression of EGFR were not significantly associatxl with the age, stage, histologic type., lymph nuxle metastases, tumor size, incasive depth of cervical wall and 5-year survival reate. Tere was no significant correlation between HPV positivity and EGFR expression in cervical cancer patients. These data suggest that HPV infection and EGRF expression might play a role in carcinogenesis but not in the progression of metastasis of cervical cancer.
Carcinogenesis ; Carcinoma, Squamous Cell ; Cervix Uteri ; DNA ; Epidermal Growth Factor* ; Female ; Humans* ; Neoplasm Metastasis ; Oncogenes ; Papillomavirus Infections* ; Receptor, Epidermal Growth Factor* ; Uterine Cervical Neoplasms

Castleman's disease or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder. Complete surgical resection was recommended in unicentric Castleman's disease. Radiotherapy was considered alternative therapeutic option. However, there have been consistent favorable responses to radiotherapy. We also experienced two cases of uncentric Castleman's disease salvaged successfully with radiotherapy. This paper described these cases and reviewed the literature about Castleman's disease treated with radiotherapy. Reviewed cases showed that radiotherapy is a successful treatment option in unicentric Castleman's disease. Furthermore, our report confirms the radiotherapy role in uncentric Castleman's disease.
Giant Lymph Node Hyperplasia ; Lymphoproliferative Disorders

The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.
Amputation ; Arteries ; Decompression ; Drainage ; Ear* ; Hyperemia ; Leeching ; Replantation* ; Veins

The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.
Amputation ; Arteries ; Decompression ; Drainage ; Ear* ; Hyperemia ; Leeching ; Replantation* ; Veins

PURPOSE: Chronic prostatitis (CP) does not yet have a universally successful therapy. Alternative treatments including thermotherapy have been adopted in the multimodal management of pain and voiding dysfunction. We retrospectively analyzed the therapeutic efficacy of bipolar radiofrequency thermotherapy for patients who were unsatisfied with conventional medication for CP. MATERIALS AND METHODS: A retrospective study between October 2009 and September 2010 of 26 patients who were under 50 years old and diagnosed with CP (National Institutes of Health [NIH]-category III) was performed. Twenty patients were diagnosed with inflammatory CP (NIH-category IIIa) and the rest with noninflammatory CP (NIH-category IIIb). We used the Tempro system at an intraprostatic temperature of 55degrees C for 50 minutes with a medium heating rate. All patients also completed the NIH-Chronic Prostatitis Symptom Index (CPSI) before and after treatment. RESULTS: In the patients diagnosed with CP, the mean serum prostate-specific antigen (PSA) level was 0.9+/-0.3 ng/ml, the prostate volume was 27.1+/-5.5 g, and the average score for all 3 domains on the NIH-CPSI significantly decreased. The total scores decreased from 19.8+/-7.1 to 11.1+/-7.0, the pain domain decreased from 8.6+/-3.1 to 4.8+/-3.1, the voiding symptom domain decreased from 5.1+/-1.8 to 2.9+/-1.8, and the effect on the quality of life decreased from 6.1+/-2.2 to 3.4+/-2.2 (p<0.05). CONCLUSIONS: Bipolar radiofrequency thermotherapy for patients with CP intractable to conventional medication can provide significant improvement in the NIH-CPSI. Large, randomized controlled trials will also be required to confirm the efficacy of this therapy.
Academies and Institutes ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Quality of Life ; Retrospective Studies

PURPOSE: Changes in the balance between MMP and TIMP can have a profound effect on the composition in the extracellular matrix (ECM) and affect various cellular functions including adhesion, migration, differentiation of cells, and fibrosis and invasion and metastasis of cancer cells. Radiation therapy is a popular treatment modality for benign and malignant tumor, but the study for radiation effect on MMP and TIMP is scarce. In the current study, we have examined the expression of TIMP in fibrosis-prone (C57BL/6) mice after radiation. METHODS AND MATERIALS: Adult female mice of 10~12 weeks were used. The whole body were irradiated using a Varian CL-4/100 with 2 and 10 Gy. Immunohistochemical staining was performed according to Avidin Biotin complex method and evaluated by observing high power field. For TIMP-1, TIMP-2 antibodies, reactivity was assessed in the parenchymal cell and in the stromal cell. The scale of staining was assessed by combining the quantitative and qualiative intensity of staining. RESULTS: TIMP-1 immunoreactivity did not change in lung. But, in liver, TIMP-1 immunoreactivity was localized in cytoplasm of hepatocyte and Kupffer cell. In kidney, TIMP-1 immunoreactivity was localized in cytoplasm of some tubular cell. Temporal variations were not seen. Dose-response relationship was not seen except kidney. TIMP-2 immunoreactivity in lung was a score (++) at 0 Gy and elevated to a score (+++) at 2 Gy. TIMP-2 immunoreactivity was a score (++) in liver at 0 Gy. TIMP-2 immunoreactivity was localized in cytoplasm of hepatocyte and Kupffer cell as same as patterns of TIMP-1 immunoreactivity. The TIMP-2 immunoreactivity in liver was elevated to (+++) at 2 Gy. Immunoreactivity to TIMP-2 in kidney was a score (+++) at 0 Gy and was not changed at 10 Gy. The score of TIMP-2 immunoreactivity was reduced to (++) at 2 Gy. TIMP-2 immunoreactivity was confined to tubules in kidney. Temporal variation of TIMP-2 immunoreactivity was irregular. Dose-response relationship of TIMP-2 immunoreactivity was not seen. CONCLUSIONS: Differences between intensity of expression of TIMP-1 and TIMP-2 in each organ was present. Expression of TIMP was localized to specific cell in each organ. Irradiation increased TIMP-1 immunoreactivity in the liver and the kidney. Irradiation increased TIMP-2 immunoreactivity in the lung. But, in the liver and the kidney, TIMP-2 expression to radiation was irregular. Temporal variation of TIMP-2 immunoreactivity was irregular. Dose-response relationship of TIMP-2 immunoreactivity was not seen. In the future, we expect that the study of immunohistochemical staining of longer period of postirradiation and quantitative analysis using western blotting and northern blotting could define the role of TIMP in the radiation induced tissue fibrosis.
Adult ; Animals ; Antibodies ; Avidin ; Biotin ; Blotting, Northern ; Blotting, Western ; Cytoplasm ; Extracellular Matrix ; Female ; Fibrosis ; Hepatocytes ; Humans ; Immunohistochemistry ; Kidney* ; Liver* ; Lung* ; Mice* ; Neoplasm Metastasis ; Radiation Effects ; Stromal Cells ; Tissue Inhibitor of Metalloproteinase-1* ; Tissue Inhibitor of Metalloproteinase-2*

BACKGROUND: This study was performed to assess the effect of fentanyl and ketorolac in intravenous patient-controlled analgesia (IV-PCA) on postoperative nausea and vomiting and the antiemetic effect of prophylactic ondansetron after a total abdominal hysterectomy. METHODS: Of 115 women having general anesthesia for a total abdominal hysterectomy, a non-PCA group (n = 52) didn't receive IV-PCA and a PCA group (n = 39) and ondansetron group (n = 24) received IV fentanyl 1 - 1.5 microgram/kg and IM ketorolac 30 mg as a loading dose and IV-PCA with a mixture of 60 ml with fentanyl 25 - 30 microgram/kg and ketorolac 4 - 5 mg/kg. In addition, the ondansetron group received IV ondansetron 4 mg before an IV-PCA was started. We assessed nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. RESULTS: During the first 24 hours postoperation, there were no significant differences in the incidence of nausea, vomiting and the need for rescue antiemetics among the groups. CONCLUSIONS: Intravenous patient-controlled analgesia with fentanyl and ketorolac didn't increase postoperative nausea, vomiting and the need for rescue antiemetics during the first 24 hours postoperation. Also, prophylactic ondansetron didn't significantly reduce the chance of postoperative nausea, vomiting and rescue antiementics.
Analgesia, Patient-Controlled* ; Anesthesia, General ; Antiemetics ; Female ; Fentanyl* ; Humans ; Hysterectomy ; Incidence ; Ketorolac* ; Nausea ; Ondansetron* ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting* ; Vomiting