A series of experiments on various factors which induce optimal in vitro excystation of the metacercariae of Metagonimus yokogawai isolated from the fish, Plecoglossus altivelis was conducted and the following results were obtained. The metacercariae used in this experiment were isolated by the digestion technique therefore all of them were pretreated with the acid-pepsin solution before being applied to the various tests. No excystation occurred when the metacercariae were placed in a salt solutions such as physiological saline, Tyrode solution and Veronal, Tris buffers alone or in combination. The metacercariae underwent complete excystation in the trypsin and pancreatin solution in Tris buffer within an hour at 38 degrees C. The best results were obtained in 0.8-0.9% trypsin solutions, pH 8.0-8.6 and at 38-40 degrees C, approximately one hundred per cent excystation occurred in 40 minutes. Not only temperature but also hydrogen ion concentration played an important role causing excystation of the metacercariae in trypsin-Tris buffer solution. However, bile salts were not responsible for the excystation. Agitation effect on the excystation was tested as a mechanical stimulus and it was found that the shaking stimulus accelerated the excysting mechanism, compared with the metacercariae on which it was not imposed. It is concluded that the metacercariae pretreated in the acid pepsin solution demonstrates an essential requirement for the enzyme solution such as trypsin or pancreatin, provided with the optimum conditions of temperature and hydrogen ion concentration in excysting medium.
parasitology-helminth-trematoda-Metagonimus yokogawai ; metacerecaria-excystation ; bioloygy ; physiological saline ; Tyrode solution ; Veronal buffer ; Tris buffer ; trypsin ; pancreatin ; trypsin-Tris buffer

Post-traumatic tricuspid insufficiency is a rare condition and may be clinically silent and imprecise. The diagnosis may be difficult when it progreses slowly and other acute lesions exist concomittantly. Two-dimenstional Doppler echocardiography appears to be an essential procedure in diagnosting the rupture of chordae tendineae or papillary muscle following traumatic injury. We report a case of tricuspid insufficiency of which symptom developed 8 years later following a blunt chest trauma. The patient was operated by tricuspid vlave repair with chordal replacement and ring annuloplasty successfully. We would like to emphasize that patients sustaining major thoracic trauma should be carefully examine for possible blunt chest trauma including cardiac valve rupture or tear.
Chordae Tendineae ; Diagnosis ; Echocardiography, Doppler ; Heart Valves ; Humans ; Papillary Muscles ; Rupture ; Thorax*

BACKGROUND: Recently-developed equipment based on bioelectrical impedance analysis (BIA) not only measures total body fat but also displays several estimated indicators that reflect intra-abdominal fat, such as waist circumference (WC) and waist-to-hip ratio (WHR). This study examined the usefulness of these indicators in the diagnosis of metabolic syndrome (MS). METHODS: A total of 632 people over 20 years of age (355 men and 277 women, mean age 48.61+/-11.08 years, mean BMI 23.62+/-3.00 kg/m2, 117 MS patients) were enrolled in the study. Measurements of WC and hip circumference were measured by one individual, and WHR was calculated. BIA was performed to estimate waist circumference (BIAWC) and waist-to-hip ratio (BIAWHR). Receiver operating characteristic (ROC) curve analysis was used to examine the usefulness of BIAWC and BIAWHR in diagnosing MS. RESULTS: The areas under the curve (AUCs) were 0.836 (95% CI 0.805-0.864) for WC, 0.814 (95% CI 0.782-0.844) for BIAWC, 0.815 (95% CI 0.782-0.844) for WHR, and 0.805 (95% CI 0.772-0.835) for BIAWHR. The difference between the AUCs of WC and BIAWC (0.022, 95% CI -0.004 to 0.048) and the difference between the AUCs of WHR and BIAWHR (0.010, 95% CI -0.015 to 0.034) were not significant. CONCLUSIONS: The indices for central obesity estimated by BIA had high agreement with the direct method, and they were not inferior to direct measured indices for predicting metabolic syndrome.
Adipose Tissue ; Area Under Curve ; Electric Impedance ; Female ; Hip ; Humans ; Intra-Abdominal Fat ; Male ; Obesity, Abdominal ; ROC Curve ; Waist Circumference ; Waist-Hip Ratio

No abstract available.
Accidents, Traffic* ; Fistula*

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

No abstract available.
Rhinomanometry*

Congenital diverticulum of the left ventricle is a very rare disease. Ventricular diverticulum is usually associated with other anomalies including intracardiac and midline thoracoabdominal defect. We describe a case with congenital left ventricular diverticulum presenting as an isolated lesion. A 37-year-old man presented with 4-year history of chest pain. Diverticulum was diagnosed by echocardiography and left ventriculogram.
Adult* ; Chest Pain ; Diverticulum* ; Echocardiography ; Heart Ventricles ; Humans ; Rare Diseases

To identify the developmental characteristics of intermediate filaments, the expressions of various cytokeratines (CK), desmin and vimentin in fetal (14032 weeks of gestations) and adult epidermis were studied immunohistochemically. The primary antibodies used were CK7, 8, 10, 14, 18, AE8, 5D3, and MNFl16 for cytokeratins, D33 for desmin, and V9 for vimentin. At 14 weeks of gestation, the epidermis consisted of basal cells and periderm. The periderm exhibited positive staining for CK8 and AE8, and weak staining for MNF116 and D33. The basal cells showed positive staining for MNF116 and D33. The epidermis did not reacted for CK7, 10, 14, 18, 5D3, and V9 at this period. At 16-20 weeks of gestation, the epidermis was composed of basal, intermediate, and periderm layers. The periderm was positive for CK8, 18, AE8, MNF116, and D33. The intermediate cells were positive for CK10 and the basal cells CK14, MNF116, and D33. Few cells were stained positively with V9 among the basal cells. At 24-32 weeks of gestation, the epidermis exhibited no longer positive reactions for CK8, 18, AE8 and D33. The intermediate cells were positive for CK10. Immunoreactivity for MNF116 was noted in intermediate layer just above the basal layer. CKl4, MNFl16, D33, and often V9 were expressed in basal cells. The expressions of CK7 and 5D3 were not observed at any period of gestation. In adult epidermis, basal cells exhibited positive staining for CKl4, MNFl16, and D33. The intermediate cells were strongly positive for CK10, and weakly positive for CK7, 8, and MNFl16. The cells positive for V9 were often present among the basal cells. These results indicate that CK8 and 18 may serve as useful markers for periderm, CK10 for intermediate cells, CKl4 for basal cell, and suggest that the vimentin immunoreactive cells in basal cell layer are Langerhans cells.
Adult ; Antibodies ; Desmin ; Epidermis* ; Fetus* ; Humans* ; Immunohistochemistry ; Intermediate Filaments ; Keratins* ; Langerhans Cells ; Pregnancy ; Vimentin

Wegener's granulomatosis is a systemic necrotizing vasculitis of unknown cause. The disease is characterized by the involvement of the upper airway, the lung, and the kidney. Skin lesions are frequent and the most common lesion is purpura distributed on the limbs and trunk. A 34-year-old female showed recurrent purpuric macules on the both lower extremities and buttocks. The patient. showed nasal septal perforation with saddle nose deformity and C-ANCA positivity. Histopathologic findings of purpuric lesion revealed the features of necrotizing vasculitis. The histologic specimen from the nasal cavity showed chronic inflammation with granuloma formation and kidney showed focal necrotizing glomerulonephritis. Therefore, we treated the patient with prednisolone and cyclophosphamide having diagnosed Wegener's granulomatosis.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Buttocks ; Congenital Abnormalities ; Cyclophosphamide ; Extremities ; Female ; Glomerulonephritis ; Granuloma ; Humans ; Inflammation ; Kidney ; Lower Extremity ; Lung ; Nasal Cavity ; Nasal Septal Perforation ; Nose ; Prednisolone ; Purpura ; Skin ; Vasculitis ; Wegener Granulomatosis

BACKGROUND: In the Far East, it is well known that hepatic resection is a best form of treatment for complicated intrahepatic stones (IHS). However, many investigators have reported that the associated intrahepatic biliary stricture is the main cause of treatment failure, requiring additional management because of recurrent cholangitis. PURPOSE: A retrospective comparative study was undertaken to clarify the long term efficacy of hepatic resection in IHS and to investigate the clinical significance of intrahepatic biliary stricture affected on treatment failure after hepatic resection. Patient and METHOD: The clinical records of 44 among 51 consecutive patients with symptomatic IHS who underwent hepatic segmentectomy or lobectomy between July 1986 and October 1996 were reviewed. We excluded 7 patients from study group because of postoperative death or incomplete follow- up. Patients were divided into two study groups: group A with intrahepatic biliary stricture (n=28) and group B without stricture (n=16). Residual or recurrent stones, recurrence of intrahepatic biliary stricture, late cholangitis, and final outcomes were analyzed and compared statistically between group A and B. Patients were followed up for a median duration of 65 months after hepatectomy. RESULTS: The overall incidence of residual or recurrent stones were 36% and 11%, respectively. The initial treatment failure rate was 50% in group A and 31% in group B. Intrahepatic biliary stricture was recurred in 46% of group A, but in none of group B (P=0.001). More than two thirds of restrictures were identified on the primary site. The incidence of late cholangitis was higher in group A (54%) than in group B (6%)(p=0.002). The late cholangitis was severe, recurrent and related to stones and strictures in 11 of the 15patients in group A. Twelve patients (ten in group A and two in group B) needed additional secondary multiple procedures at a median of 12 months after hepatectomy. These consisted of percutaneous fluoroscopic stone retrieval (n=6), postoperative cholangioscopy (POC) or percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL)(n=3), balloon dilatation (n=7)choledochotomy (n=3), S4 segmentectomy (n=1), Sphincteroplasty (n=1), drainage of the delayed subphrenic or liver abscess (n=2), and repair of prolonged biliary fistula (n=1). The final outcomes after hepatectomy with or without secondary management were good in 80%, fair in 16%, and poor in 4% of the cases. CONCLUSION: The majority of the recurrent cholangitis after hepatectomy in IHS were related to recurrent intrahepatic ductal strictures. Therefore, hepatic resection should be included the strictured duct. However, with hepatectomy alone, it is difficult to clean the IHS and relieve the ductal strictures completely, particularly in cases of bilateral IHS, so a perioperative team approaches, including both radiologic and cholangioscopic interventions, should be used for effective management of IHS.
Biliary Fistula ; Cholangitis ; Constriction, Pathologic* ; Dilatation ; Drainage ; Far East ; Hepatectomy ; Humans ; Incidence ; Lithotripsy ; Liver Abscess ; Mastectomy, Segmental ; Recurrence ; Research Personnel ; Retrospective Studies ; Treatment Failure