PURPOSE: To investigate the immunologic effect of the gasless laparoscopic procedure, we compared it with an immunologically effective, gas insuffulated (pneumoperitoneal) laparoscopic procedure. METHODS: The temporal immune responses in two similar groups of patients randomized to gas vs gasless laparo scopic cholecystectomy were analyzed. The patients were matched by age, weight, and operation time. Immune parameters, including serum white blood cell count and TNF-alpha, INF-gamma, IL-6, IL-8, cortisol and ESR levels, were assessed preoperatively and on postoperative days 1 and 3 between the two groups. Also during the operations, cytokines were checked in cultured peritoneal macrophages. RESULTS: The results were as follows: 1) Serum cortisol and ESR levels were not statistically different between the two groups. White blood cell counts were also not statistically different. 2) The preoperative and postoperative day 1 and days 3 serum TNF-alpha, INF-gamma, IL-6, and IL-8 levels in the two group were not statistically different. However, an immediate decrease cytokine levels was significant in both groups after postoperative day 1. 3) Especially cytokine levels were more increased in cultured peritoneal macro phages than in serum, but difference between the two groups was not statistically significant. CONCLUSION: From our results the beneficial effects of immunology in a gasless laparoscopic procedure were not different from those in a gas laparoscopic procedure. Rather, immediate preservation of the immune function during the postoperative period was detected in both groups.
Allergy and Immunology ; Bacteriophages ; Cholecystectomy ; Cytokines ; Humans ; Hydrocortisone ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Leukocyte Count ; Macrophages, Peritoneal ; Postoperative Period ; Tumor Necrosis Factor-alpha

Although technological advances and clinical studies on stem cells have been increasingly reported in stroke, research targeting hemorrhagic stroke is still lacking compared to that targeting ischemic stroke. Studies on hemorrhagic stroke are also being conducted, mainly in the USA and China. However, little research has been conducted in Korea. In reality, stem cell research or treatment is unfamiliar to many domestic neurosurgeons. Nevertheless, given the increased interest in regenerative medicine and the increase of life expectancy, attention should be paid to this topic. In this paper, we summarized pre-clinical rodent studies and clinical trials using stem cells for hemorrhagic stroke. In addition, we discussed results of domestic investigations and future perspectives on stem cell research for a better understanding.

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

BACKGROUND: Tumor markers have been used in diagnosis, predicting the extent of disease, monitering recurrence after therapy and prediction of prognosis. But the utility of markers in lung cancer has been limited by low sensitivity and specificity. TPA-M is recently developed marker using combined monoclonal antibody of Cytokeratin 8, 18, and 19. This study was conducted to evaluate the efficacy of new tumor marker, TPA-M by comparing the estabilished markers 8CC, CEA, Cyfra2 I - I in hmg cancer. METHODS: An immunoradiometric assay of serum CEA, SCC, Cyfra2l-I, and TPA-M was performed in 49 pathologically confirmed lung cancer patients who visited Keimyung University Hospital from April 1996 to August 1996, and 29 benign lung diseases. Commercially available kits, Ab bead CM (Eiken) to CEA, SCC RIA BEAD (DAINABOT) to SCC, CA21-1 (TEE) to Cyfra21-1, arid TPA-M (DAIICHI) to TPA-M were used for this study. RESULTS: The mean serum values of lung cancer group and control group were 10.05 +/- 38.39 micro/L, l.59+/-0.94 micro/L in CEA, 3.04+/-5.79 micro/L, 1.58+/-2.85 micro/L in SCC, 8.27+/-11.96 micro/L, 1.77+/-2.72 micro/L in Cyfra21-1, and 132.02+/-209.35 U/L, 45.86+/-75.86 U/t in TPA-M respectively. Serum values of Cyfra21-1 and TPA-M in lung cancer group were higher than control group (p<0.05). Using cutoff value recommended by the manufactures, that is 2.5 micro/L, in CEA, 3.0 micro/L in Cyfra21-1, 70.0 U/L in TPA-M, arid 2.0 micro/L in SCC, sensitivity and specificity of lung cancer were 33.3%, 786% in CEA, 50.0%, 89.7% in Cyfra2l-l, 52.3%, 89.7% in TPA-M, 23.8%, 89.3% in SCC. Sensitivity and specificity of nonsmall cell lung cancer were 36.1%, 78.1% in CIA, 50.1%, 89.7% in Cyfra2l-1, 53.1%, 89.7% in TPA-M, 33.8%, 89.3% in SCC. Sensitivity and specificity of small cell king cancer were 25.0%, 78.5% in CEA, 50.0%, 89.6% in Cyfra2l-1, 50.0%, 89.6% in TPA-M, 0%, 89.2% in SCC. Cutoff value according to ROC(Receiver operating characteristics) curve was l.25 micro/L in CEA, 1.5 micro/L in Cyfra2l-1, 35 U/L in TPA-M, 0.6 micro/L in SCC. With this cutoff value, sensitivity, specificity, accuracy and kappa index of Cyfra21-1 and TPA-M were Letter than CEA and SCC. SCC only was related with statistic significance to TNM stages, dividing to operable stages(TNM stage I to IIIA) and inoperable stages (IIIB and IV) (p<0.05). But no tumor markers showed any correlation with significance with tumor size(p>0.05). CONCLUSION: Serum TPA-M and Cyfra21-1 shows higher sensitivity and specificity than CEA and SCC in overall lung cancer and nonsmall cell lung cancer those were confirmed pathologically. SCC has higher specificity in nonsmall cell lung cancer. And the level of serum SCC are significantly related with TNM staging.
Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Humans ; Immunoradiometric Assay ; Keratin-8 ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Neoplasm Staging ; Prognosis ; Recurrence ; Biomarkers, Tumor

BACKGROUND/AIMS: Portal hypertension in cirrhosis is associated with a hyperdynamic circulation, which is characterized by hypervolemia, high cardiac output, arterial hypotension and low peripheral vascular resistance. These circulatory abnormalities are thought to be secondary to a splanchnic arteriolar vasodilation related to the increase in portal pressure. Studies assessing regional hemodynamics in patients of cirrhosis with ascites have shown vasoconstriction in the renal circulation and in peripheral vascular territory. This study was designed to assess the cerebral vascular resistance in cirrhotic patients with ascites. METHODS: The resistive index in the middle cerebral artery and in a renal interlobar artery were measured by Doppler ultrasonography in 12 cirrhotic subjects without ascites, 23 cirrhotic subjects with ascites, and 8 healthy subjects. The arterial blood pressure and plasma renin and norepinephrine concentration, which reflect the activity of the renin-ngiotensin and sympathetic nervous systems respectively, were also measured. RESULTS: The resistive index in the middle cerebral artery were significantly higher in cirrhotic patients with ascites (0.58 +/- 0.04, mean +/- standard deviation) than in cirrhotic patients without ascites (0.53 +/- 0.02, p<0.01) and in control subjects (0.50 +/- 0.05, p<0.01). The resistive index in the middle cerebral artery showed direct correlation with renal resistive index (r = 0.52, p<0.01), plasma renin activity (r = 0.44, p<0.01) and norepinephrine (r = 0.33, p<0.05). The resistive index in the middle cerebral artery showed an inverse correlation with mean arterial pressure (r = -.59, p<0.01). CONCLUSION: The results suggest that in patients of cirrhosis with ascites, independent of the amount of ascites, there is a cerebral vasoconstriction which is related with the arterial hypotension and the overactivity of vasoconstrictor systems.
Arterial Pressure ; Arteries ; Ascites* ; Cardiac Output, High ; Fibrosis ; Hemodynamics ; Humans ; Hypertension, Portal ; Hypotension ; Liver Cirrhosis* ; Liver* ; Middle Cerebral Artery ; Norepinephrine ; Plasma ; Portal Pressure ; Renal Circulation ; Renin ; Sympathetic Nervous System ; Ultrasonography, Doppler ; Vascular Resistance ; Vasoconstriction ; Vasodilation

Lymph node metastasis is found in 10-15% of patients with early gastric cancer; however, metastatic nodes forming giant abdominal masses or distant metastases are extremely rare. A 51-year-old male, HBs Ag-positive patient presented with an incidentally found huge upper abdominal mass. Imaging studies showed a 7 cm-sized epigastric mass consistent with hepatocellular carcinoma. His serum -fetoprotein level was also significantly elevated (330.6 ng/ml). Endoscopic studies revealed a suspicious early gastric carcinoma located on the lesser curvature and the anterior wall of the antrum. He was operated on with a preoperative diagnosis of hepatocellular carcinoma coexisting with an early gastric carcinoma. However, the actual abdominal tumor was a metastatic lymph node resulting from a gastric carcinoma which was located around the hepatic artery. Accordingly, he underwent a subtotal gastrectomy with the D2 lymph node dissection and the removal of the metastatic node. Postoperatively, he did well without any complications. His serum -fetoprotein level decreased to 49.3 ng/ml one week after the surgery and was completely normalized 3 months later. To date, one year and 4 months after the operation, he is in good conditions without evidence of recurrence on endoscopic and imaging studies.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Gastrectomy ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Male ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms*

OBJECTIVES: The aim of this study was to investigate whether verbal and spatial working memory functions were impaired not only in patients with schizophrenia but also in people at ultra-high risk for first-episode psychosis. METHODS: Twenty-five patients (M 13, F 12) with schizophrenia (SPR), 21 people at ultra-high risk for psychosis (UHR)(M 10, F 11) and 19 normal controls (NC)(M 10, F 9) were recruited. The working memory was assessed by using the verbal and spatial n-back test. The working memory load increased incrementally from the 0-back to the 3-back condition. RESULTS: SPR performed significantly lower than NC and UHR in terms of hit rates of verbal and spatial n-back test. UHR subjects conducted significantly lower than NC and higher in trend-level than SPR in terms of hit rates of verbal and spatial n-back test. These differences were derived from the high working memory load (2-back and 3-back), not from the low working memory load (0-back and 1-back). There was no significant difference between the verbal and spatial n-back test across the three groups. CONCLUSION: These findings suggest that verbal and spatial working memory dysfunction may be general rather than differential in terms of stimuli modality, and this working memory deficit may be an important trait factor in schizophrenia.
Humans ; Memory, Short-Term ; Psychotic Disorders ; Schizophrenia

OBJECTIVE: The purpose of this study was to determine the changes of mandibular anterior alveolar bone thickness with age. METHODS: Cephalometric radiographs of 160 skeletal class I patients (male 80, female 80) with normal vertical growth pattern was investigated by measuring the buccolingual thickness of mandibular alveolar bone on the basis of root axis. RESULTS: As the age increases, both male and female showed a significant decrease in buccolingual width of the mandibular anterior alveolar bone and in the width of mandibular anterior lingual alveolar bone except the CEJ area of females. However, there was no significant difference in the thickness of mandibular anterior buccal alveolar bone and in the width of maximum prominence of mandibular symphysis with age. CONCLUSION: From the above results, it is concluded that Korean children whose growth pattern is sagittally skeletal class I with a vertical normal growth pattern have a greater mandibular anterior lingual alveolar bone width than Korean adults; therefore, lingual movement of mandibular incisors, which is usually accompanied in extraction treatment, is considered to be more preferable in younger patients.
Adult ; Axis, Cervical Vertebra ; Child ; Female ; Humans ; Incisor ; Male ; Tooth Cervix

PURPOSE: The aim of this study was to correlate patients 'satisfaction with the objective measurement of the knee stability after a ACL reconstruction using a patellar tendon autograft. MATERIALS AND METHODS: Contact was made with 120 patients who a ACL reconstruction using a patellar tendon autograft on unilateral ACL rupture between January 1995 and April 2002 by single surgeon. Assessment was made by the KOOS score, Tegner score, Lysholm score, patients 'satisfaction, IKDC score, manual physical examination, one leg hop test and radiologic AP translation. Paired t-test, Pearson product moment correlation(PPMC) and Spearman 's rank correlation test were used to test the correlation between the parameters. RESULTS: Radiologic AP translation showed a statistically significant correlation with manual lachman and pivot shift tests. The Lysholm score had a high correlation with the patients 'satisfaction and one leg hop test. The final IKDC evaluation system showed the highest correlations with the Lysholm score, the patients 'satisfaction, the Tegner score, the manual lachman test, one leg hop test. Resumption of sports and work according to the Tegner score correlated with the patients 'satisfaction but had a very low correlation with manual lachman test. The knee laxity measurement using manual lachman test correlated with neither one leg hop test nor the patients 'satisfaction. The one leg hop test correlated with the Lysholm score, the patients 'satisfaction, the final IKDC evaluation system. CONCLUSION: We conclude that the final IKDC evaluation system is a very reliable tool and the patients 'satisfaction is important for evaluating the results after ACL reconstructiuon. And the one leg hop test also appear to be a reliable way of evaluating the functional outcome of the ACL reconstruction.
Anterior Cruciate Ligament ; Autografts ; Humans ; Humulus ; Knee ; Leg ; Patellar Ligament ; Patient Satisfaction ; Physical Examination ; Rupture ; Sports

Villous adenomas of the stomach are rare, although they more frequently occur in the colon and rectum. Clinical symptoms are similar to gastric polyps, but acute or chronic bleeding with anemia occurs frequently. The size of tumors varies between 4 and 6 cm, and the malignant potential is greater when the tumor is larger. Complete resection with surgery or endoscopic resection is the treatment of choice. Endoscopic findings revealed a dome-like or pedunculated appearance. Microscopically, the tumor was composed of long fronds and papillations covered by columnar epithelia with a reduced number of goblet cells. We report a case of polyps with chronic intermittent and acute bleeding for 6 months, which was alleviated by endoscopic mucosal resection and was confirmed as a villous adenoma.
Adenoma ; Adenoma, Villous ; Anemia ; Colon ; Gastrointestinal Hemorrhage ; Goblet Cells ; Hemorrhage ; Polyps ; Rectum ; Stomach