BACKGROUND AND AIMS: The objective of this paper is to compare the effectiveness of com-mon bile duct stone extraction by conditions and methods. METHODS: Endoscopic sphinc-terotomies with stone extraction were practiced in 71 patients with common bile duct stones by basket extraction, balloon extraction and mechanical lithotripsy. RESULTS: 1) In 71 patients with CBD stone, sex distribution showed predominence in females (56.3%) and most of the cases were over 60 years old. 2) After sphincterotomy, the overall success rate of the stone extraction was 87.3% (with balloon and basket or mechanical lithotrispy). The removal methods of the stone extractions were varied, but the most commonly used method was basket extraction (50.7%). 3) The complications of sphicterotomy were noted in 10 cases and in 8 cases minor bleeding was stopped with a hypertonic saline epinephrine injection. 4) After the stone extraction, counts and levels of leukocyte, aspartate transami-nase, alanine transaminase, alkaline phosphatase and total bilirubin were significantly improved (p <0.05). 5) Removal methods according to stone size did not show a signifi-cant difference, but the mean size of the stones was different. According to the several methods, the mean diameter of stones were different. The stone size was 1.1 cm in the case of spontaneous removal, 1.4 cm in balloon or basket removal, 1.9 cm in mechanical lithotripsy and 2.0 cm in surgical removal. CONCLUSIONS: Endoscopic stone extraction was effective and safe method with low rate of complications. However there were some significant difficulties in removing large or impacted stones, therefore EHL, ESWL or operation should be considered.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartic Acid ; Bile Ducts ; Bilirubin ; Common Bile Duct* ; Epinephrine ; Female ; Hemorrhage ; Humans ; Leukocytes ; Lithotripsy ; Middle Aged ; Sex Distribution

BACKGROUND AND AIMS: Various gastric and duodenal lesions with gastrofiberscopy were observed in patients with obstructive biliary disease. METHODS: A clinical analysis of the endoscopic findings was carried out on 88 patients with obstructive biliary disease, from February 1994 to January 1998, in the department of Internal Medicine, Chungnam National University Hospital. RESULTS: 1) In the 88 patients, sex distribution showed predominance in the males (47/41) and most of the cases involved those in their 60's. 2) The obstructive biliary diseases were included, common bile duct stones (53.4%), common bile duct cancer (18.2%), pancreatic cancer (18.2%), Klatskin tumor (4.5%) and common hepatic duct cancer (3.4%). 3) The gastroduodenal lesions involved in the obstructive biliary diseases were, erosive gastritis (22.7%), duodenal ulcer (8.0%), gastric ulcer (5.7%), and acute duodenitis (3.4%) in orders. CONCLUSIONS: Significant upper gastrointestinal lesions were found in obstructive biliary disease.
Chungcheongnam-do ; Common Bile Duct ; Duodenal Ulcer ; Duodenitis ; Gastritis ; Hepatic Duct, Common ; Humans ; Internal Medicine ; Klatskin's Tumor ; Male ; Pancreatic Neoplasms ; Sex Distribution ; Stomach Ulcer

BACKGROUND: Type 2 diabetes develops because of defects in both insulin secretion and action. The half-life of insulin in uremia is prolonged because the metabolic clearance rate of insulin in diabetic end stage renal disease (ESRD) patients is reduced with consequence that the dose of insulin and/or oral hypoglycemic agent (OHA) administered in normal renal function make them increase the risk of hypoglycemia. Therefore, we should usually reduce the dose of insulin and/or OHA, or stop administration of insulin and/or OHA if type 2 diabetic patients are progressed to ESRD. But in some patients, that is not true. The aim of this study was to test the hypothesis that insulin resistance plays an important role in (re)evaluation of optimal insulin and/or OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD. METHODS: Insulin resistance was examined in 23 type 2 diabetic ESRD patients with tight control of glycemia using the K index of the insulin tolerance test (Kitt). We divided 23 patients into three groups. Group 1 (n=10) was defined as patients who were administered neither insulin nor OHA after ESRD. Group 2 (n=9) was defined as patients who were changed from insulin to OHA as drug for glycemic control after ESRD. Group 3 (n=4) was defined as patients in whom insulin or OHA was continuously administered after ESRD without a change of them for glycemic control. We compared the degree of insulin resistance among these three groups. RESULTS: Insulin resistance determined by Kitt was significantly different between group 1 (Kitt, 2.1422/0.94-4.01%/min), group 2 (Kitt, 1.3811/0.79- 3.90%/min) and group 3 (Kitt, 0.8550/0.44-1.81%/min) by using Kruskal-Wallis test (p=0.048). Kitt in group 3 was significantly lower than in group 1 by using Mann-Whitney test (p=0.016). CONCLUSION: Although metabolic clearance of insulin is reduced by renal failure, demand of insulin/ OHA for optimal glycemic control is not reduced in higher insulin-resistant type 2 diabetic ESRD patients on hemodialysis. Insulin resistance plays an important role in determination of optimal insulin/ OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD.
Half-Life ; Humans ; Hypoglycemia ; Insulin Resistance* ; Insulin* ; Kidney Failure, Chronic* ; Metabolic Clearance Rate ; Renal Dialysis* ; Renal Insufficiency ; Uremia

BACKGROUND: The impact of the immune response on cancer gene therapy using viral vectors to deliver a "suicide gene" is currently unclear. A vigrous immune response targeted at viral proteins or transgene may enhance the efficacy of tumor destruction and even augment responses to tumor antigens. These responses may involve the release of cytokines and stimulation of tumor specific cytotoxic T-lymphocytes that enhance therapeutic efficacy. On the other hand, a vigorous rapid cellular immune response may destroy cells expressing the therapeutic gene and attenuate the response to therapy. Furthermore, development of neutralizing antibody responses may prevent readministration of virus, a potentially significant limitation. Evaluating the significance of these limitations in animal models and developing solutions are therefore of obvious importance. METHODS: After retroviral transduction of mouse mesothelioma cell line(AB12) with Herpes Simplex Virus thymidine kinase (HSVtk) gene in vitro, subcutaneous flank tumors were established. To study the effect of intact immune system on efficacy of tumor erradication, the ability of the HSVtk/ganciclovir system to inhibit tumor growth was compared among normal Balb/c mice, immunodeficient Balb/c-nude and SCID mice, and Balb/c mice immunosuppressed with cyclosporin. RESULTS: Ganciclovir treatment resulted in greater inhibition of tumor growth in Balb/c mice compared with immunodeficient Balb/c-nude mice and SCID mice(in immunodeficient mice, there were no growth inhibition by ganciclovir treatment). Ganciclovir treatment resulted in greater inhibition of tumor growth in non-cyclosporin (CSA) treated Balb/c mice compared with CSA treated Balb/c mice. On day 8, mean ganciclovir-treated tumor volume were 65% of control tumor volume in Balb/c mice versus 77% control tumor volume in CSA-treated Balb/c mice. This effect was still evident during therapy (day 11 and 13). On day 13, non-CSA treated tumor volume was 35% of control tumor volume versus 60% of control tumor volume in CSA treated Balb/c mice. Duration of expression of HSVtk was not affected by the immunosuppression with CSA. CONCLUSION: These results indicate that the immune responses against retrovirally transduced cells enhance the efficacy of the HSVtk/ganciclovir system. These findings have important implications for clinical trials using currently available retrovirus vectors as well as for future vector design.
Animals ; Antibodies, Neutralizing ; Antigens, Neoplasm ; Cyclosporine ; Cytokines ; Ganciclovir ; Genes, Neoplasm ; Genetic Therapy* ; Hand ; Herpes Simplex* ; Immune System* ; Immunity, Cellular ; Immunosuppression ; Mesothelioma ; Mice ; Mice, SCID ; Models, Animal ; Phosphotransferases* ; Retroviridae ; Simplexvirus* ; T-Lymphocytes, Cytotoxic ; Thymidine Kinase ; Transgenes ; Tumor Burden ; Viral Proteins ; Zidovudine

OBJECTIVES: To investigate the effect of the occupational exposure to organic solvent on the olfactory function of shipyard painters; we measured the prevalence of olfactory function impairment between the exposure group and the controls by using the Korean Version of the Sniffin'Stick (KVSS) test through smell, and by analyzing factors related to olfactory alteration. METHODS: The olfactory function of 245 painters exposed to organic solvents was compared to that of 122 unexposed controls. A total of 367 shipyard subjects underwent questionnaire study and the olfactory function test was performed by KVSS test I from April to August 2007. Suspected subjects of abnormal findings were referred to an otorhinolaryngologist. In addition, the Biologic Exposure Index (BEI) and industrial hygiene laboratory data were collected as well as analyzed by job title in the exposure group. RESULTS: The difference in the result of KVSS test I was significantly different from the exposure group and the controls (P<0.05). For the exposure group, reduced olfaction and exposure group were correlated with statistical significance when compared to the controls (P<0.01). Adjusting for work duration, smoking, rhinitis or sinusitis history, exposure of the organic solvent (OR 1.76, 95% CI=1.05-2.96) had a statistically meaningful relationship with decreased olfaction. The data on BEI for the exposure group were collected; the difference in methylhippuric acid was significant between spray workers and others, but did not correlate well with decreased olfaction. CONCLUSION: Occupational exposure to organic solvents in shipyard painters may affect the olfactory function. Therefore, shipyard painters should be monitored on a periodic bases by the quantitative test such as KVSS test. There is no other quantitative testing method or standardized procedure that can objectively diagnose the neurotoxic effect, further enhanced quality research in this field is necessary.
Occupational Exposure ; Occupational Health ; Paintings ; Prevalence ; Questionnaires ; Rhinitis ; Sinusitis ; Smell ; Smoke ; Smoking ; Solvents

PURPOSE: Ductal carcinoma in situ (DCIS) is a high-risk disease for the development of invasive tumors. Although it is associated with excellent prognosis, many patients undergo extensive treatment with surgery, radiation, and endocrine therapy. This study evaluated the clinical and pathologic factors associated with invasive recurrence, particularly locoregional, distant disease after breast-conserving surgery (BCS). METHODS: This study included 431 patients diagnosed with pure DCIS after BCS between January 2000 and December 2008. The clinicopathological characteristics, margin status, adjuvant therapy, and duration of endocrine therapy were evaluated in hormone receptor-positive DCIS patients. RESULTS: The median duration of follow-up was 115 months. During this period, 37 cases (8.5%) of recurrence were observed (12 in situ and 23 invasive recurrence and 2 unknown cases). There was no distant metastasis as first event. Similarly, none of the initial in situ recurrence cases developed distant metastasis while eight (32%, 8/23) developed distant metastasis after invasive recurrence. Overall recurrence was associated with young age (≤40 years) (HR: 3.60, 95% confidence interval [CI]: 1.77–7.32) and hormone receptor negativity (HR: 3.33, 95% CI: 1.52–7.29). Invasive local recurrence was independently associated with young age (≤40 years) (HR: 3.86, 95% CI: 1.50–9.96), high nuclear grade (HR: 4.46, 95% CI: 1.62–12.27) and omission of adjuvant radiotherapy (HR: 6.45, 95% CI: 1.82–22.82). Notably, duration of endocrine treatment among the hormone receptor positive patient group, was numerically shorter for recurred patients, though not statistically significant. CONCLUSION Young age, high nuclear grade and absence of adjuvant radiotherapy were independently associated with an increased risk of invasive recurrence. Moreover, invasive locoregional recurrence as a first event was associated with worse outcomes, yet in situ recurrence didn't affect overall survival. Further studies with larger sample sizes are warranted to confirm the prognostic indicators of recurrence and the optimal strategy for adjuvant therapy in this setting.

BACKGROUND: With increasing industrial development, opportunities are growing to contact electricity in the workplace or home. Therefore, the risk of electrical accident has been increased gradually. In general, electrical injuries involve the extremities and result in amputation or severe disability of limbs. Delayed spinal cord injury and peripheral neuropathies following electrical accidents are extremely rare. CASE REPORT: A 32-year-old man with 10 years working experience at a CRT-monitor manufacturer with repetitive exposures to high voltage current visited our hosipital. He complained of left leg weakness and atrophy, and intermittent pain. The symptoms were progressive. Other symptoms occurred such as nocturia, hesitancy, and weak urinary stream. We examined the patient and conducted EMG, L-spine MRI, neurometer test, isokinetic strength test, and physical examination. The results showed neural injuries due to anterior horn lesions or compression of the left femoral nerve pathway, with a consequent diagnosis of neurogenic bladder.
Adult ; Amputation ; Animals ; Atrophy ; Diagnosis ; Electricity ; Extremities ; Femoral Nerve ; Horns ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscular Atrophy ; Nocturia ; Peripheral Nervous System Diseases* ; Physical Examination ; Rivers ; Spinal Cord Injuries ; Urinary Bladder, Neurogenic

OBJECTIVE: To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. METHODS: Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. RESULTS: All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. CONCLUSION: The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.
Evoked Potentials, Motor ; Evoked Potentials, Somatosensory* ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Posture

Absorptiometry, Photon ; Adult ; Aged ; Bone Density ; Chungcheongbuk-do ; Female ; Humans ; Ilium ; Male ; Middle Aged ; Osteoporosis ; Tibia ; Tissue Donors ; Transplants ; Volunteers

Branchioma ; Carotid Body Tumor ; Diagnosis ; Diagnosis, Differential ; Head ; Hemangioma ; Hodgkin Disease ; Humans ; Lymph Nodes ; Lymphangioma, Cystic ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neck ; Neoplasm Metastasis ; Oropharynx ; Parotid Gland ; Parotid Region ; Rare Diseases ; Retrospective Studies ; Tongue