BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

BACKGROUND/AIMS: Hepatic fibrosis in rat induced by thioacet amide shares similar morphological and biochemical characteristics with human liver cirrhosis. Thioacetamide (T AA) initially induces accumulation of collagen in Disse space and eventually leads to macro- and micronodular cirrhos is. Ito cell was believed to play a main role in hepatic fibrosis. And it s activity was known to be regulated by the expression of various genes. But little has been discovered about the upstream signal trans duction pathway of these genes in hepatic fibrosis. The expression of genesrelated to Ito cell activity was regulated by many transcription factors , the activity of which was regulated by protein kinase C( PKC) is oforms. So it is s upposed that PKC could be as s ociated with fibrosis in liver. METHODS: We investigated the correlation of PKC is oforms and It ocell activity in the course of hepatic fibrosis using TAA induced rat liver cirrhosis model. We used six week- old male rats , and administered 0.03% TAA in drinking water. The animals were sacrificed at 9, 20, and 30 weeks after TAA administration. The degree of hepatic fibrosis was evaluated by measuring the total amount of collagen.-SMA immunohist ochemical st aining of liver tissue was done to determine the Ito cell activity. The expression pattern of PKC isoforms was investigated by West ern blotting. RESULTS: In TAA- treated group, collagen cont ent and Ito cell activity did not increase until 30 weeks and 20 weeks of treatment , respectively, while in control group collagen cont ent and Ito cell activity were not detected. Collagen content showed linear correlation with Ito cell activity. This implied that the proliferation of activated Ito cells was prior to the increase of collagen content. In view of expression pattern of PKC is oforms, PKC alpha showed no difference in TAA- treated group and control group. In TAA-treated group, PKCbeta1 exhibited increased level of expression in both particulate and cytosolic forms at 9 weeks, while PKCdelta and PKC epsilon showed striking shift to particulated form. After 20 weeks, all of the PKC beta1, delta, and epsilon degenerated and showed remarkably decreased level of expression. This suggested PKC alpha had no relation to hepatic fibrosis,while PKC beta1, delta, and epsilon, showing activity at 9 weeks, were related to fibrosis og liver. In response to fibrogenic factors, molecules engaged in intracellular signal transduction pathway like PKC beta1, delta, and epsilon, began to change prior to the increase of Ito cell activity, morphologic changes and alterations of collagen content. CONCLUSION: Our results strongly suggest that the activity of PKC isoforms play an important role in early step of hepatic fibrosis, while accompanying Ito cell activity do in later step.
Animals ; Collagen ; Cytosol ; Drinking Water ; Fibrosis ; Hepatic Stellate Cells ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Protein Isoforms ; Protein Kinase C-epsilon ; Protein Kinases ; Rats ; Signal Transduction ; Strikes, Employee ; Thioacetamide ; Transcription Factors

OBJECTIVE: We analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics. METHODS: We reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed. RESULTS: PARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6+/-2.9 and 5.4+/-6.4 in the unresected PARS group, 5.8+/-2.1 and 11.3+/-7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups. CONCLUSION: The large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.
Arthrodesis ; Body Mass Index ; Humans ; Neurologic Manifestations ; Spine

OBJECTIVES: The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. MATERIAL AND METHOD: A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. RESULTS: In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. CONCLUSION: It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
Age Distribution ; Basal Ganglia ; Cerebral Hemorrhage* ; Coma ; Geriatrics ; Hematoma ; Hemorrhage ; Humans ; Mortality ; Prognosis* ; Retrospective Studies ; Vascular Diseases

PURPOSE: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. MATERIALS AND METHODS: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. RESULTS: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). CONCLUSION: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.
Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support

PURPOSE: Thymidylate synthase (TS) is a critical enzyme in the DNA synthesis and an important target of cancer chemotherapeutic agents, such as 5-fluorouracil (5-FU). Recent studies suggest that TS expression is related to the prognosis of various cancers and the mechanism of chmotherapeutic drug resistance. This retrospective study was performed to determine whether TS expressions in primary colorectal tumors influence the overall survival and recurrence for patients with colorectal cancer. METHODS: Intratumoral TS expression was evaluated by immunohistochemical staining using TS-106 monoclonal antibody in primary colorectal cancers of 64 patients who had undergone surgery from July, 1995 to June, 1999. The relationship between TS expressions and patients' survival was evaluated statistically. The median follow-up period was 25.7 months. RESULTS: Overall positive TS expression rate was relatively high (54.7%) in colorectal cancers, and overall disease-free survival rate was significantly higher in the TS positive group (P=0.0204). But there was no statistically significant differences in overall survival rates (P=0.249) and tumor recurrence rates (P=0.732) between positive TS group and negative TS group. CONCLUSIONS: These results suggest that TS expression status in the colorectal cancer tissue is only related to the overall disease-free survival rates, not the overall survival rates and tumor recurrence rates. More objective method and long term follow up study will be required for accurate assessment of clinical importance of TS expression in colorectal cancers.
Colorectal Neoplasms* ; Disease-Free Survival ; DNA ; Drug Resistance ; Fluorouracil ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Thymidylate Synthase*

PURPOSE: The pathophysiological role of detrusor overactivity (DO) in the bladder, which is commonly observed in various bladder diseases, is not well understood. DO appears in bladder outlet obstruction (BOO), and may continue even after subsequent deobstruction. DO therefore provides an excellent opportunity to observe molecular biological changes. METHODS: In this study, to understand the molecular effects of persistent DO after BOO induction and deobstruction, we performed awake cystometry on female Sprague-Dawley rats divided into 4 groups: a sham group, a BOO group, a deobstructed group with DO after BOO (DDO), and a deobstructed group without DO after BOO (non-DDO). Total RNA was extracted from the bladder samples, and gene expression profiles were compared between the sham and model groups. RESULTS: DO was observed in 5 of the 6 rats (83%) in the BOO group, and in 6 of the 13 rats (46%) in the deobstructed group. The non-DDO group showed a significantly greater residual volume than the DDO group. Through a clustering analysis of gene expression profiles, we identified 7,532 common upregulated and downregulated genes, the expression of which changed by more than 2 fold. In the BOO group, 898 upregulated and 2,911 downregulated genes were identified. The non-DDO group showed 3,472 upregulated and 4,025 downregulated genes, whereas in the DDO group, only 145 and 72 genes were upregulated and downregulated, respectively. CONCLUSIONS: Abnormal function and gene expression profiles in bladders after BOO were normalized in the BOO rats with DO after deobstruction, whereas in those without DO, abnormal function persisted and the gene expression profile became more abnormal. DO may play a protective role against the stress to the bladder induced by BOO and deobstruction as a form of adaptive neuroplasticity.
Animals ; DNA ; Female ; Gene Expression Profiling ; Gene Expression* ; Humans ; Microarray Analysis ; Neuronal Plasticity ; Rats* ; Rats, Sprague-Dawley ; Residual Volume ; RNA ; Transcriptome* ; Urethral Obstruction ; Urinary Bladder Diseases ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Bladder, Overactive

OBJECTIVE: To explore the association of the phase II glutathione S-transferase mu (GSTM1), theta (GSTT1) gene null polymorphisms with endometriosis in a Korean population. METHODS: One hundred forty eight women with surgically diagnosed endometriosis of stage I-IV were recruited. And 130 patients with no evidence of endometriosis by laparoscopy or laparotomy served as controls. Genomic DNA was extracted from peripheral blood and analyzed for GSTM1, GSTT1 null polymorphisms. RESULTS: GSTM1 null genotype (GSTM1 0/0) was found more frequently in patients with endometriosis than in controls (61.5% in endometriosis vs. 49.2% in control, p=0.040). And the association was found only in moderate to severe endometriosis (stage III IV) (63.7% vs. 49.2%, p=0.027: odds ratio: 1.812), not in minimal or mild endometriosis (p=0.395). There was no significant difference between endometriosis patients and controls in the frequency of the GSTT1 null genotype (51.4% vs. 54.6%, p>0.1). CONCLUSION: These results suggest that GSTM1 null genotype is associated with the risk of endometriosis but GSTT1 null genotype is not in the Korean population.
DNA ; Endometriosis* ; Female ; Genotype ; Glutathione Transferase ; Humans ; Laparoscopy ; Laparotomy ; Odds Ratio

OBJECTIVE: To explore the association of the estrogen receptor PvuII and XbaI polymorphism with endometriosis. METHODS: One hundred sixty women with surgically or histologically diagnosed endometriosis of stages I-IV, and 142 patients with no evidence of endometriosis by laparoscopy or laparotomy served as control. Frequency and distribution of PvuII and XbaI polymorphisms for estrogen receptor gene were evaluated. RESULTS: There was no statistically significant difference in the allele distribution of PvuII polymorphism between the patients and the controls (pp of 35%, pP of 51%, PP of 14% vs. 42%, 44%, 15%, p>0.1); or in the frequency of the positive PvuII allele (0.61 vs. 0.63, p>0.1). And no significant difference was also observed in the allele distribution of XbaI polymorphism between the patients and the controls (xx of 66%, xX of 29%, XX of 5% vs. 68%, 30%, 1%, p>0.1); or in the frequency of the positive XbaI allele (0.80 vs. 0.83, p>0.1). CONCLUSION: These results suggest that the PvuII or XbaI polymorphism of the estrogen receptor gene is not associated with the risk for endometriosis in the Korean population.
Alleles ; Endometriosis* ; Estrogens* ; Female ; Humans ; Laparoscopy ; Laparotomy