PURPOSE: To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). MATERIALS AND METHODS: 46 patients underwent PTBD in 52 occassions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general dondition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. RESULTS: Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. CONCLUSION: We PTBD using large neddie is a simple and safe procedure for prompt bile decompression.
Bile ; Decompression ; Drainage* ; Humans ; Needles*

No abstract available.
Female ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine*

OBJECTIVE: We compared patients with chronic schizophrenia and normal controls with respect to decision-making ability. Measures were implemented to control for the participants' intelligence levels as well as to ensure to use of a moderate sample size. The goal of this study was to confirm inconsistent results from previous studies which had stemmed from too small of a sample size, highly variable performance of normal controls, and not controlling for intelligence as a confounding factor. METHODS: Fifty-two chronic stable schizophrenic inpatients and 55 healthy controls participated in the study. We controlled for intelligence by including subjects with intelligence quotient's (IQ) between 80 and 120, examining any differences in decision-making performance between groups on the Iowa Gambling Task (IGT). We also addressed several issues relating to performance on the IGT, such as working memory and clinical symptoms. RESULTS: Schizophrenic patients were found to perform poorly on the IGT relative to normal controls (F(1,105)=17.73, p<0.001); however, more importantly, they also displayed the slow yet profitable shift from disadvantageous decks to advantageous decks over time. We also found that when compared with healthy controls, schizophrenic patients showed a poorer performance on the Wisconsin Card Sorting Test (WCST)(t=-5.48, p<0.001 for perseverative error) which was not related to their performance on the IGT. CONCLUSION: Based on previous literature and the results of this study, impaired sensitivity to both reward and punishment might be a more plausible explanation for the poor performance on the IGT in the schizophrenic group. We speculated that this impairment seemed related more to the different responsiveness to the magnitude than to the frequency of punishment, and to the different interpretation of less informative verbal cues in the context of the reinforcing schedule.
Appointments and Schedules ; Cues ; Dietary Sucrose ; Gambling ; Humans ; Inpatients ; Intelligence ; Iowa ; Memory, Short-Term ; Punishment ; Reward ; Sample Size ; Schizophrenia ; Wisconsin

PURPOSE: The purpose of the study is to investigate the correlation between the symptoms and the incidence of anatomical variant without mucosal abnormality. MATERIALS AND METHODS: Out of 892 patients with CT performed for the evaluation of sinus disease symptoms between March 1991 and March 1993, we observed the anatomic variations in 82 symptomatic patients without mucosal abnormality(male:female=43:39, mean age 36. 4 years). The control group included 88 patients with facial bone CT performed for the evaluation of trauma during the same period while patients with recent paranasal sinusitis were excluded. (male:female=76:12, mean age 22. 4 years). The scouis were performed with 5-ram section thickness from posterior margin of sphenoid sinus to anterior margin of posterior ethmoid and then with 3 mm thickness from anterior margin of posterior ethmoid to anterior margin of frontal sinus. The artatomic variations included nasoseptal deviation, concha bullosa, Hailer cells, Agger nasi cells, etc. RESULTS: The anatomic variations were demonstrated in 71 our of 82 symptomatic patients(86. 5%), whereas they were seen 26 of 88 patients(29. 5%) in control group. CONCLUSION: Our data suggest that there is a possible causal relationship between anatomic variations and symptomas. Even though without accompaning mucosal abnormalities, anatomic variations could contribute simply to its symptomas. ^natomic variants may obstruct or narrow the airway, leading to turbulating air flow or interrupting ucociliary movement, and finally may produce a series os symptoms.
Facial Bones ; Frontal Sinus ; Humans ; Incidence ; Sinusitis ; Sphenoid Sinus

Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Knee Joint ; Knee* ; Length of Stay ; Lidocaine ; Outpatients ; Respiratory Insufficiency ; Tourniquets

No abstract available.
Animals ; Bone Marrow Cells* ; Bone Marrow* ; Cyclosporine* ; Mice*

BACKGROUND/AIMS: ErbB receptor proteins are transmembrane tyrosine kinase receptors; when they are activated by interaction with ligands, they generate diverse cellular responses, especially during lesion development and progression to cancer. In this study the expression of ErbB receptors and TGF-alpha were investigated using an experimental cirrhosis rat model giving rise to hepatocellular neoplasms, similar to human liver diseases. METHODS: Fifty three male rats received intraperitoneal injection of diethylnitrosamine (DEN, 50 mg/kg), weekly for 18 weeks. Until the eighth week, two rats were sacrificed every two weeks and from the tenth to the eighteenth week, five rats were sacrificed weekly. Grossly, dyschromatic and dysmorphic nodules were counted and categorized into three groups: N1/N2/N3: 3 mm < or = x < 5 mm/5 mm < or = x < 10 mm/x > or = 10 mm in diameter. All nodules were examined, histologically. Antibodies for GSTp, TGF-alpha, EGF-R, ErbB2, ErbB3 and ErbB4 were used for immunohistochemistry. RESULTS: The onset of cirrhoses was noted from the twelfth week. Preneoplastic foci, hepatocellular adenomas (HCA) and hepatocellular carcinomas (HCC) were noted from the second, eleventh and fifteenth week, respectively. The nodules (N1/N2/N3: 397/258/64) included regenerating nodule; RN (N1/N2/N3: 72.3%/15.9%/0%), HCA (N1/N2/N3: 27.2%/82.2%/7.6%) and HCC (N1/N2/N3: 0.5%/ 1.9%/92.4%). EGF-R was expressed in 12.5% of RN, 64.7% HCA and 75.2% HCC. TGF-alpha was expressed in 92.4% of RN, 91.3% HCA and 93.2% HCC. Sixty eight percent of TGF-alpha expressing nodules showed concurrent EGF-R expression. ErbB2 was expressed in 83.6% of RN, 72.9% HCA and 88.7% HCC. ErbB4 was expressed in 95.2% of RN, 86.3% HCA and 62.5% HCC. CONCLUSIONS: Increased expression of EGF-R and decreased expression of ErbB4, might be related with tumor progression during DEN-induced hepatocarcinogenesis.
Adenoma, Liver Cell/chemically induced/metabolism/pathology ; Animals ; Carcinoma, Hepatocellular/chemically induced/*metabolism/pathology ; Diethylnitrosamine ; Glutathione Transferase/metabolism ; Immunohistochemistry ; Liver Neoplasms, Experimental/chemically induced/*metabolism/pathology ; Male ; Rats ; Rats, Wistar ; Receptor, Epidermal Growth Factor/*metabolism ; Receptor, erbB-2/*metabolism ; Transforming Growth Factor alpha/*metabolism

Human membranous nephropathy (MN) is morphologically characterized by subepithelial immune complex deposits and progressive thickening of glomerular basement membranes (GBM). Studies have suggested that the enhanced secretion of classical and novel type IV collagen chains in MN contributes to spike formation and the novel type IV collagen chain is particularly related to thickening of GBM. It is unclear whether the increased accumulation of extracellular matrix (ECM) proteins in GBM is due to the increased mRNA expression for type IV collagen in glomerular visceral epithelial cells (GECs). To answer this question, we analyzed seven renal biopsies of patients with idiopathic MN using in situ hybridization. In MN, the number of GECs expressing mRNA for alpha1(IV) collagen was 2.82+/-1.80/glomerular cross section (gcs), and the number expressing mRNA for alpha4(IV) collagen was 8.42+/-2.85/gcs. The number of GECs expressing mRNA for alpha4(IV) collagen was significantly larger than that of alpha1(IV) collagen mRNA. The expression of mRNA for these ECM proteins in normal controls was negligible. These results suggest that subepithelial immune complexes stimulate the gene expression of alpha1(IV) collagen and alpha4(IV) collagen in glomerular GECs which, in turn, increase the secretion of ECM proteins and contribute to the thickening of GBM in MN.
Antigen-Antibody Complex ; Biopsy ; Collagen ; Collagen Type IV* ; Extracellular Matrix ; Gene Expression ; Glomerular Basement Membrane ; Glomerulonephritis, Membranous* ; Humans* ; In Situ Hybridization ; Podocytes ; RNA, Messenger*

BACKGROUND: There were many studies about the changes of cognitive or non-cognitive domain and behavioral and psychological symptoms with the progression of Alzheimer's disease. But they assessed the changes individually so could not explain comprehensively the global change of disease progression. Also they studied by clinical dementia rating scale(CDR) which could not successfully explain the latest stage. So we have evaluated the cognitive, non-cognitive domain and behavioral and psychological symptoms at the same time and evaluated the changes with the expanded clinical dementia rating scale. Also we evaluated the relationship of each scale and assessed sensitivity change at the different stage of disease. METHODS: Twenty-three mild cognitive impairment(MCI) subjects and eighty-seven patients with Alzheimer's disease were recruited. The Korean version of Mini-Mental State Examination(K-MMSE), the Korean version of the neuropsychiatric inventory(NPI), the Extended version of the Korean Clinical Dementia Rating Scale(CDR), the Activity of Daily Living(ADL), the Severe Dementia Scale(SDS) and the Short form of Samsung Dementia Questionnaire(S-SDQ) were performed. RESULTS: It was found that all of them were well correlated each other(r>-0.73 and p<0.05) except NPI. Physical activity of daily living(P-ADL) was most related to Korean version of instrumental activity of daily living(K-IADL) (r=0.86 and p<0.01), SDS to K-MMSE(r=0.93 and p<0.01) and S-SDQ to K-IADL(r=0.86 and p<0.01). P-ADL and S-SDQ revealed the ceiling effect at CDR 4 and K-IADL at CDR 3. CONCLUSION: The cognitive and non-cognitive function were declined according to disease progression. The changes of behavioral and psychological symptoms were relatively independent of cognitive function. SDS, P-ADL and CDR were proved to be more sensitive in advanced stage of dementia and K-IADL, S-SDQ were more adequate in milder stage of dementia or MCI.
Alzheimer Disease ; Dementia ; Disease Progression ; Humans ; Motor Activity

No abstract available.