PURPOSE: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. RESULTS: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 6.8%. CONCLUSION: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.
Abdominal Abscess ; Gastrectomy* ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Pancreatic Fistula ; Retrospective Studies ; Spleen ; Stomach Neoplasms* ; Survival Rate

Changes of bone turnover with aging are responsible for bone loss and play a major role in osteoporosis. Among the early postmenopausal women, as are known by previous study, there are about 35% ""fast bone losers and bone turnover is more uncoupled in osteoporotic group than in normal control. So, early detection of such fast losers"" and women who have high turnover rate is important to prevent postmenopausal osteoporosis and spontaneous fracture. Dual-energy X-Ray absorptiometry (DEXA), however, cannot reflect current bone loss because changes in bone mineral density (BMD) are only seen after 1 or more years of bone densities declining. In this study, we have measured a battery of new sensitive and specific markers of bone turnover which reflect current bone loss. To investigate the changing pattern of those markers, 674 healthy women including 451 postmenopausal women were classified, according to their menopausal period (less than 5 years, 5-10 years, more than 10 years). Bone formation was assessed by serum osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and bone resorption by the urinary excretion of deoxypyridinoline (DPD), cross-linked N-telopeptide of type I collagen (NTX). All Biochemical markers, except OC, significantly increased after menopause (p < 0.05). NTX and BSAP remained elevated after 10 years of menopause. These data indicated that the overall rates of both bone formation and bone tesorption increased after menopause and remained high in elderly women.
Absorptiometry, Photon ; Aged ; Aging ; Alkaline Phosphatase ; Biomarkers ; Bone Density ; Bone Resorption ; Collagen Type I ; Female ; Fractures, Spontaneous ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal

Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.
Ankle ; Dislocations* ; Humans ; Talus* ; Tendons*

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve Insufficiency*

BACKGROUND: Internet use is taking place as a necessary part in modern life. Recently, internet use among adolescents has bocome a prominent social problem. In accordance with assessment of internet using pattern and addiction, this study analyzed addiction, this study analyzed addiction-relating factors. According to analysis of intimate relating factor, this study attempted to provide appropriate countermeasure. METHODS: The author had performed physical examination on the subjects on May, 2001. The subjects were elementary, middle, and high school students. Among them, 913 students were surveyed with questionnaires. Among the 193 students, elementary school students were 222, middle school 369, high school 291, and 31 did not complete the survey. Addiction-relating factors were sex, age, frequency, mostly connected web-site, time, and place. Young's scale was used as internet addiction assessment, 70 points, and above were used as criteria for internet addiction. RESULTS: There were 32 addicted students among the subjects. By sex, male students were 7, female students 25. By age, elementary school student was 1, middle school students 9, and high school students 22. In frequency, 424 students used the internet more than 5 times per week among all subjects. 30 students used the internet more than 5 times per week among addicted students. CONCLUSION: Internet use of chatting sire is an intimate addiction-relating factor. Therefore, substitute activity which can reduce computer using time, and frequency should be encouraged. Especially, avoiding chatting site is considered a preventive methive of addiction during the computer using time.
Adolescent* ; Factor Analysis, Statistical* ; Female ; Humans ; Internet* ; Korea* ; Male ; Physical Examination ; Social Problems ; Surveys and Questionnaires

The purpose of this study was to determine the effect of reperfusion about infarct size and infarct expansion by different duration of ischemic time. Temporary coronary ligation was performed in rats for 30min, 60min, 90min and 120min, followed by reflow. Rats with permanent ligation were used for comparison. After 7 days, transverse histologic heart sections were prepared for structual analysis. The results were as follows ; 1) Reperfusion after 30 min ischemic time 1.Infarct size of reperfusion (method 1 ; 16.5+/-8.3%, method 2 ; 20.9+/-8.0%) was smaller than that of permanent ligation (method 1 ; 29.8+/-8.9%, method 2 ; 33.5+/-12.1%)(p<0.01, p<0.05). 2. Expansion index of reperfusion (46.9+/-19.6) was smaller than that of permanent ligation (88.0+/-34.9)(p<0.01). 3. The infarct thickness of reperfusion (1.59+/-0.40mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 4.The viable left ventricular tissue area of reperfusion (28.8+/-2.90mm2) was larger than that of permanent ligation (24.2+/-3.10mm2)(p<0.01). 2) Reperfusion after 60 min ischemic time 1. There was no difference in infarct size between reperfusion and permanent ligation. 2. Expansion ratio (27.2+/-5.9%) and expansion index (51.8+/-24.6) of reperfusion were smaller than those of peremanent ligation (35.7+/-7.4%, 88.0+/-34.9)(p<0.05, P<0.05). 3. The infarct thickness of reperfusion (1.48+/-0.32mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 3) Reperfusion after 90~120 min ischemic time reduced neither infarct size nor infarct expansion. The results of this study in the rat preparation suggest a beneficial effect of reperfusion even in late on infarct expansion independent of myocardial salvage.
Animals ; Heart ; Ligation ; Myocardial Infarction* ; Rats* ; Reperfusion*

BACKGROUND: Hemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB) is mainly attributed to impaired filling and diastolic dysfunction. An elevated ratio of the mitral velocity to the early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively new indicator of diastolic function, and this was reported to be associated with impaired hemodynamics during OPCAB. We investigated the efficacy of milrinone on the perioperative hemodynamics and short term outcomes of patients with an E/e' > 15 and who underwent OPCAB. METHODS: The patients were randomly allocated into either group C (control, n = 31) or group M (n = 31) and they were treated with the same amount of either normal saline or milrinone (0.5 microg/kg/min) without bolus loading after completion of internal mammary artery harvest until the end of operation. Hemodynamic measurements were recorded after the induction of anesthesia (T1), 5 min after starting each distal anastomosis of the left anterior descending artery (T2), left circumflex artery (T3) and right coronary artery (T4), and 5 min after sternum closure (T5). RESULTS: The mixed venous oxygen saturation (SvO2) was lower through T2-T4 compared to the baseline value in both groups, while the degree of the decrease was significantly less in group M than that in group C. The other hemodynamic variables, the operative data and the postoperative outcomes were similar between the two groups. CONCLUSIONS: Intraoperative infusion of milrinone did not significantly improve the perioperative hemodynamics and the subsequent short term outcomes for the patients with preexisting diastolic dysfunction as represented by an elevated E/e' value, although it reduced the degree of decrease of the SvO2 during OPCAB.
Anesthesia ; Arteries ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Hemodynamics ; Humans ; Mammary Arteries ; Milrinone ; Oxygen ; Sternum

PURPOSE: Nitric oxide (NO) exerts the relaxant effect in vascular smooth muscle cells (VSMC) by activating soluble guanylate cyclase (sGC), which produces cyclic guanidine monophosphate (cGMP) in the cell. This study was undertaken to investigate the mechanism of the inhibitory actions of sGC inhibitors, LY 83583 and methylene blue in the VSMC. METHODS: VSMC was primarily cultured from rat aorta and confirmed by immunocytochemistry of anti-smooth muscle myosin antibody. Bacterial lipopolysacchride (LPS), an inducer of inducible nitric oxide synthase (iNOS) and sodium nitroprusside (SNP), an NO donor, were uesd to increase NO within VSMC. The changes in concentrations of nitrite in culture media by an addition of LPS or SNP with a pretreatment of LY 83583 or methylene blue were measured by the spectrophotometry with griess regent and absorbance at 550 nm. Western blot and RT-PCR for iNOS and iNOS mRNA, respectively were performed. RESULTS: LPS and SNP increased nitrite concentration. LY 83583 potentiated the increase in nitrite concentration by LPS and SNP. LY 83583 also increased expressions of iNOS protein and mRNA induced by LPS. Methylene blue has no effect on nitrite concentration increased by LPS or SNP, and it did not affect the expressions of iNOS protein or mRNA induced by LPS. CONCLUSION: These results suggest that the mechanism of inhibitory actions of LY83583 and methylene blue on sGC are different each other: LY83583 interferes the interaction of sGC and NO resulting positive feedback increase in iNOS gene expression, but methylene blue eliminates NO from cytosol inducing no compensatory effect.
Animals ; Aorta ; Blotting, Western ; Culture Media ; Cytosol ; Gene Expression ; Guanidine ; Guanylate Cyclase* ; Humans ; Immunohistochemistry ; Methylene Blue ; Muscle, Smooth, Vascular* ; Myosins ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Nitroprusside ; Rats ; RNA, Messenger ; Spectrophotometry ; Tissue Donors

Permanent electrostimulation is the therapy of choice for syncope due to bradycardic rhythm disturbance. In maintaining optimal hemodynamic function, the role of atrial systole has been well recorgnized and the time relationship between atrial and ventricular systole have great relation with cardiac output. Assessment of optimal mode of cardiac pacing by nonivasive method is very important for the best hemodynamic effect. To evaluate the usefulness of systolic time interval for optimal pacing mode, we calculated systolic time interval by using ventricular pacing spike on electrocardiogram to aortic opening time/left ventricular ejection time by aortic pressure curve (invasive PEP/LVET) in various modes of cardiac pacing and measured cardiac output by thermodilution method simultaneously in 9 mongrel dogs. Basal pacing cycle length were 300 msec, and the atrioventricular (AV) and ventriculoatrial (VA) interval during AB & VA sequential pacing were set at 30 msec, 60 msec and 90 msec. The result were as follows: 1) The cardiac output at AV interval of 90 msec (1.65+/-0.23 L/min) is significantly higher than 30 msec (1.38+/-0.19 L/min) in AV sequential pacing. 2) The cardiac output in ventricular pacing is higher than VA sequential pacing, but no significant changes noted among VA interval 90 msec, 60 msec and 30 msec. 3) The invasive PEP/LVET at VA interval of 90 msec (0.85+/-0.17) is significantly lower than 60 msec (0.97+/-0.16) and 30 msec (1.01+/-0.16) in AV sequential pacing. 4) The invasive PEP/LVET among VA sequential pacing with 90 msec, 60 msec, 30 msec interval and ventricular pacing did not show any significant difference. 5) When AV interval changes from 90 msec to 30 msec during AV sequential pacing, cardiac output decreased and invasive PEP/LVET increased. 6) In VA sequential pacing, there were no changes of cardiac output and invasive PEP/LVET when VA interval changes from 90 msec to 30 msec. In conclusion, systolic time interval can be used for estimation of hemodynamic changes during AV sequential pacing considering our results and other authors' results of high correlation between invasive & noninvasive PEP/LVET.
Animals ; Arterial Pressure ; Cardiac Output ; Dogs ; Electrocardiography ; Hemodynamics ; Syncope ; Systole* ; Thermodilution

Hemoglobin M (HbM) is a group of abnormal hemoglobin variants that form methemoglobin, which leads to cyanosis and hemolytic anemia. HbM-Milwaukee-2 is a rare variant caused by the point mutation CAC>TAC on codon 93 of the hemoglobin subunit beta (HBB) gene, resulting in the replacement of histidine by tyrosine. We here report the first Korean family with HbM-Milwaukee-2, whose diagnosis was confirmed by gene sequencing. A high index of suspicion for this rare Hb variant is necessary in a patient presenting with cyanosis since childhood, along with methemoglobinemia and a family history of cyanosis.