In anesthetized cats the effects of lactate-activated muscle spindle upon the group Ia muscular afferent fibers were studied. Laminectomy was done from L5 to Sl spinal cord level. Extracellular recording was done at dorsal root to record the impulse discharge from group Ia muscular afferent fibers. 1) Muscle spindle of Gastrocnemius-Soleus muscle were activated by lactate injection and exhibited increased impulse discharge through group Ia muscular afferent fibers. 2) There was latency of 7-12 seconds before muscle spindle is activated by lactate injection. But the whole response was not dose related. 3) The response pattern after lactate injection was divided into three groups which were excitation, inhibition and inhibition with preceding excitation. 4) Some responses were similar to those of bradykinin, sympathetic stimulation (adrenaline injection) and succinylcholine injection. 5) It was suggested that muscle spindle has characteristics of polymodal receptor which has responses to not only mechanical stimulation but also chemical stimulation.
Animals ; Bradykinin ; Cats ; Lactic Acid ; Laminectomy ; Muscle Spindles ; Spinal Cord ; Spinal Nerve Roots ; Stimulation, Chemical ; Succinylcholine

Endoscopic injection sclerotheraphy(EIS) was an effective method for treatment of bleeding esophageal varices. However, it might be associated with some undesirable complications. Endoscopic variceal ligation(EVL) is a recently developed method for control of active variceal bleeding and eradicating esophageal varices with similar efficacy and minimal risk of complications compare to EIS. We performed EVL in 40 patients who had recently bled from esophageal varices. Total 198 variceal ligations were performed during 64 separate EVL session. Control rate of acute bleeding was 90%(36 of 40patients) and 4 patients died after EVL because of failure of bleeding control. Rebleeding following initiation of EVL occured in 5 patients-three patients were successfully controlled by EVL, one patient was controlled but eradication was impossible and one patient died. Varices were eradicated or reduced to grade I in 31(86.1%) of 36 survivors by 1-9 ligation(mean 5.0) in l-4 EVL sessions(mean 1.6). After EVL, there were mild complications-mild substernal discomfort in 4 patients, mild dysphagia in 2 patients and fever in 2 patients. These results suggest that EVL is a safe and effective method for treatment of bleeding and eradication of esophageal varices with less complication.
Deglutition Disorders ; Esophageal and Gastric Varices* ; Fever ; Hemorrhage* ; Humans ; Ligation* ; Survivors ; Varicose Veins

BACKGROUND: Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE. METHODS: Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis. RESULTS: All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively. CONCLUSIONS: This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.
Agar ; Ampicillin ; Busan ; Colon ; Diffusion ; DNA ; DNA Fingerprinting ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium ; Epidemiologic Studies ; Epidemiology ; Genotype ; Hand Disinfection ; Humans ; Hygiene ; Infant, Newborn ; Intensive Care, Neonatal* ; Intestines ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Skin ; Teicoplanin ; Vancomycin

Xanthogranulomatous pyelonephritis is an atypical form of severe chronic parenchymal infection and usually occurs in associated with urinary tract infection, obstruction and/or calculi. An accurate preoperative diagnosis is difficult because of its clinical and radiological similarities to various other renal lesions. We experienced two cases of xanthogranulomatous pyelonephritis, so we report with review of some literatures.
Calculi ; Diagnosis ; Pyelonephritis, Xanthogranulomatous* ; Urinary Tract Infections

PURPOSE: The purpose of this study was to evaluate the utility of the CT cholangiography by using helical CT with multiplanar reformation in patients with extrahepatic biliary obstruction. MATERIALS AND METHODS: Helical CT was performed in 36 patients of extrahepatic biliary obstruction confirmed by operation or invasive cholangiography(percutaneous transhepatic cholangiography or endoscopic retrograde cholagiopancreatography). The cause of obstructions were 18 benign diseases(11 common bile duct stones, four choledochal cysts, three pancreatitis) and 18 malignant diseases(seven common bile duct carcinomas, seven pancreatic head carcinomas, three ampullary carcinomas, one periampullary duodenal carcinoma). After helical scanning through the extrahepatic bile duct, retrospective reconstruction of the helical data was performed. And then, CT cholagiogram was obtained with multiplanar reformation. We evaluated the technical success rate and the accuracy in determinating the level and the cause of the obstruction. We compared findings of the CT cholangiogram with that of operation or invasive cholangiography. RESULTS: In 100%(36/36) of cases, CT cholangiography could be obtained successfully. The accuracy of the CT cholangiography in determinating the level of the obstruction was 100%(11 cases of suprapancreatic duct, 13 cases of intrapancreatic duct, 13 cases of infrapancreatic duct and ampulla), and the accuracy in determinating the cause of the obstruction was 91.7%(all cases of 18 benign diseases, and 15 cases of 18 malignant diseases). CONCLUSION: In evaluating the obstruction of extrahepatic bile ducts, the CT cholangiography by using helical CT with multiplanar reformation is an useful noninvasive method in determinating the level.and the cause of biliary obstruction and therefore could replace t~e invasive cholangiography.
Bile Ducts, Extrahepatic ; Cholangiography* ; Choledochal Cyst ; Common Bile Duct ; Head ; Humans ; Retrospective Studies ; Tomography, Spiral Computed*

The gastrointestinal polyp is a premalignant lesion in varying degree. According to the size, the pathology and the location of polyps, it should be removed. Polyps in the gastrointestinal tract can be removed by surgical excision, electrosurgery, cryotherapy, regional radiotherapy and laser therapy with some limitations. Considerable advance in therapeutic endoscopy as well as in diagnostic endoscopy along with newly developed instruments has now made it possible to excise gastrointestinal polyps by means of high frequency generator. We have underwent endoscopic polypectomy, strip biopsy and "O" ring ligation on gastric polyps in 112 patients who visited in this hospital from July l988 to January 1994, and the clinical characteristics including histopathology has been evaluated. Removed polyps were variable in size from less than 0.5 cm up to 4cm. Finally, we concluded that endoscopic polypectomy is a safe and relativly simple procedure and postpolypectomy complication can be considerably reduced by conservative antiulcer therapy.
Biopsy ; Cryotherapy ; Electrosurgery ; Endoscopy ; Gastrointestinal Tract ; Humans ; Laser Therapy ; Ligation ; Pathology ; Polyps* ; Radiotherapy

PURPOSE: A standardized colonoscopy training program surgical residents is still unestablished. The aim of this study was to assess the current status of colonoscopy training for surgical residents and collect the opinions on the direction for future colonoscopy education. METHODS: A questionnaire survey containing 24 items was conducted by sending an email to 310 colorectal surgeons in 84 training hospitals across the country. RESULTS: One hundred fifteen staff surgeons (115 of 310, 37%) of 84 institutions returned fully completed questionnaires. Most surgeons were working at tertiary hospitals with more than 5 years of clinical experience. About half of the responding surgeons answered that they perform colonoscopy in clinical practice and the main purpose of colonoscopy was follow-up after colorectal resection. Only 9 of 84 hospitals (10.7%) had a regular program on colonoscopy training for surgical residents. Most of colonoscopy education was conducted irregularly in a form of staff lecture, conferences or hands-on workshops. According to the future directions, 72 of 115 surgeons (62.6%) answered judging competency in colonoscopy should be needed for professional qualification of the surgeon. About 50 cases of colonoscopy seem appropriate during the 4-year-training of surgical residency, especially during the third- and fourth-year. CONCLUSION: This survey shows colonoscopy education for surgical residents is still insufficient in Korea and that most surgeons feel that regular colonoscopy training is needed during the surgical residency period. There needs to be efforts to standardize the education program as well as various institutional and academic societal supports to achieve this goal.
Colonoscopy* ; Colorectal Surgery ; Congresses as Topic ; Education* ; Electronic Mail ; Follow-Up Studies ; Internship and Residency ; Korea* ; Surgeons ; Tertiary Care Centers

Rheumatoid arthritis patients have an increased risk of subclinical cardiovascular disease, and they also have a high prevalence of carotid disease and peripheral arterial disease as a form of vasculitis. Rheumatoid arthritis patients have an increased cardiovascular mortality rate and an increased premature death rate, and they have a higher incidence of atherosclerosis. Myocardial infarction due to vasculitis is a rare complication for patients with rheumatoid vasculitis. We report here on a case of a patient with multiorgan involvement who developed myocardial infarction, right carotid artery occlusion and left renal artery occlusion secondary to his rheumatoid vasculitis.
Arthritis, Rheumatoid ; Atherosclerosis ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Stenosis ; Humans ; Incidence ; Mortality ; Mortality, Premature ; Myocardial Infarction* ; Peripheral Arterial Disease ; Prevalence ; Renal Artery ; Rheumatoid Vasculitis* ; Vasculitis

BACKGROUND AND OBJECTIVES: The use of drug-eluting stent implantation for in-stent restenosis (ISR) has shown some promising results. This study investigated the clinical and angiographic results of performing sirolimuseluting stent (SES) implantation for the treatment of patients with ISR as compared with treatment with cutting balloon angioplasty (CBA). SUBJECTS AND METHODS: Forty one patients with ISR (43 lesions) were treated with SES implantation and they were retrospectively compared with a group of patient with matched lesions that were treated with CBA (57 patients with 61 lesions). Routine angiographic follow-up was obtained at about 6 months after treatment and the incidence of major adverse cardiovascular events was evaluated. RESULTS: The baseline clinical characteristics, the patterns of ISR and the minimal luminal diameters (MLD) were not different between the two groups. There was no procedural failure and no immediate major cardiovascular adverse events (MACE) in the two groups. There were two target lesion revascularizations during the clinical follow-up in the CBA group and no MACE was found in the SES group (4% vs. 0%, respectively p<0.001). On the follow-up angiogram, the MLD and the stenosis diameter were significantly lower in the SES group than in the CBA group (2.82+/-0.33 vs. 1.80+/-0.82 mm, p<0.001; and 11.3+/-9.6 vs. 41.2+/-24.8%, p<0.001, respectively). The acute gain was significantly higher and the late loss was significantly lower in the SES group than in the CBA group (2.64+/-0.38 vs. 2.02+/-0.44 mm, p<0.001; and 0.21+/-0.28 vs. 0.71+/-0.73, p<0.001, respectively). CONCLUSION: The sirolimuseluting stent was safe, feasible and highly effective for treating the patients suffering with in-stent restenosis as compared with cutting balloon angioplasty.
Angioplasty ; Angioplasty, Balloon* ; Constriction, Pathologic ; Coronary Restenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Incidence ; Phenobarbital ; Retrospective Studies ; Sirolimus ; Stents*

PURPOSE: To observe MR findings of vascular abnormality in Sturge-Weber syndrome and to determine the value of MRI in diagnosis. MATERIALS AND METHODS: Ten patients with Sturge-Weber syndrome (age : 3 months-32 years)were evaluated by MR imaging ; in six and four cases, respectively, the results were correlated with those of CT and angiography. We retrospectively analysed changes in the cortical vein and deep venous system, including the medullary and subependymal vein, as well as an largement of the choroid plexus, leptomeningeal enhancement, and changes in diploic space. RESULTS: In all cases except one, in which non-contrast enhanced study had been performed, varying degrees of leptomeningeal enhancement were seen. In nine cases the cortical vein became smaller; enlargement of the choroid plexus was seen in eight cases, change in the diploic space in seven (including three in which there was angiomatous involvement), and enlargement of the deep venous system in seven. In younger patients, collateral pathways were less developed and leptomeningeal angiomatous changes were more pronounced than in those who were older. CONCLUSION: MRI is a useful modality for the evaluationn of vascular changes in Sturge-Weber syndrome. These changes vary according to a patient's age and the duration of the disease.
Angiography ; Choroid Plexus ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Sturge-Weber Syndrome* ; Veins