The acid digestion method for extracting diatoms has been widely used to confirm death by drowning, but its reliability is still disputed because some diatoms can be destroyed during the extraction process due to treatment with strong acid and heat. There is a need to develop an efficient and reliable digestive method to overcome the limitation of the present analytical procedure. In this study, the reliability and efficacy of quantitative and qualitative diatom analysis from seawater by an enzymatic digestion method was evaluated. We confirmed the merit of the enzymatic method that used proteinase K instead of nitric acid in the conventional method. As a result, the enzymatic method showed a higher recovery ratio and better preservation of the diatom structure, which is essential for quantitative (diatom density) and qualitative (species) interpretation of diatom analysis. This result indicates that the enzymatic method can replace the conventional acid digestion method to confirm cases of death by drowning since it is more reliable and yields conclusive results.
Diatoms ; Digestion ; Drowning ; Endopeptidase K ; Hot Temperature ; Nitric Acid ; Plankton ; Seawater

No abstract available.

BACKGROUNDS/AIMS: Cholelithiasis is a prevalent diseases worldwide and it is known that its incidence is twice as common in cirrhotic patients compared with noncirrhotic patients. Liver cirrhosis is a critical factor contributing to morbidity and mortality in biliary tract surgery, as patient with cirrhosis are at particular risk of developing bleeding, infection and intractable ascites. Recently laparoscopic cholecystectomy has become the procedure of choice for cholelithiasis in the general population. This retrospective study was conducted to assess the effective treatment by comparing the results of open cholecystectomy versus laparoscopic cholecytectomy in cirrhotic patients. METHODS: Between January 1991 and December 1998, 53 patients with liver cirrhosis underwent cholecystectomy for cholelithiasis in the department of surgery at asan medical center. The patients were classified into two groups: one consisting of 18 patients who underwent open cholecystectomy and another consisting of 35 patients who underwent laparoscopic cholecystectomy. All cases that converse to an open cholecystectomy from a laparoscopic cholecystectomy were excluded from this analysis. RESULTS: No statistical difference was observed in the duration of surgery(OC: 110.6+/-32.6 vs. LC: 82.1 +/-26.7 min, p>0.05). Laparoscopic cholecystectomy was followed by a significantly smaller intraoperative blood loss(OC: 730.5+/-384.6 vs. LC: 324+/-168 ml, p<0.05), a earlier resumption of a normal diet(OC: 4.3+/-1.3 vs. LC: 1.3+/-0.4 days, p<0.05), and a shorter hospital stay(OC: 13.8+/-6.1 vs. LC: 4.7 +/-2.1 days, p<0.05) in comparison to open cholecystectomy. Postoperative complications in laparoscopic cholecystectomy group was significantly less(OC: 9 vs. LC: 4, p<0.05). There was no operative mortality in both group. CONCLUSIONS: Laparoscopic cholecystectomy can be safely performed in compensated cirrhotic patients and may be the procedure of choice whenever cholecystectomy is indicated in a cirrhotic patient because it may be associated with more advantages.
Ascites ; Biliary Tract ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Chungcheongnam-do ; Fibrosis ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Mortality ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Although heart rate variability (HRV) and blood pressure variability (BPV) arise from many different influences, probably the most consistent external modulator is respiration. At rest, the heart rate increases on inspiration and decreases on expiration, a phenomenon called respiratory sinus arrhythmia (RSA). Spectral analysis of heart rate offers good and reproducible estimate of RSA and BPV. Many studies have been conducted on the effects of respiration on HRV and BPV during awake subject breathing spontaneously. However, little is known as to whether respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. Here, we studied effects of respiratory rate on HRV and BPV during general anesthesia. METHODS: We studied 40 patients undergoing general anesthesia with mechanical ventilation. Maintaining anesthesia with isoflurane, we recorded R-R interval and systolic blood pressure at respiratory rate of 15, 10 and 6 breaths/minute. Data was analyzed by the power spectral analyses of HRV and BPV, which were divided into low frequency (LF) and high frequency (HF) band. RESULTS: Respiratory rate did not affect RR interval, systolic blood pressure, and total spectral power HRV and BPV. Compared with its value at 15 breaths/minute, HF-HRV was significantly increased at 6 breaths/minute. HF-and LF-BPV at 6 breaths/minute were significantly increased versus 15 breaths/minute. CONCLUSIONS: Respiratory rate modulates HRV and BPV during general anesthesia with mechanical ventilation. We suggest that respiratory rate should be considered and controlled in studies of cardiovascular variability during general anesthesia.
Anesthesia ; Anesthesia, General* ; Arrhythmia, Sinus ; Blood Pressure ; Heart Rate ; Humans ; Isoflurane ; Respiration ; Respiration, Artificial* ; Respiratory Rate*

BACKGROUND: In Korea, the number of patients enrolled in liver transplantation registry exceeds the supply of cadaveric donor. This donor shortage leads to living donor liver transplantation(LDLT). Due to wide prevalence of hepatitis B in Korea, many healthy donors for LDLT shows hepatitis B surface antigen-negative[HBsAg(-)] and core antibody-positive [HBcAb(+)]. However, the risk of using graft livers from HBsAg(-) and HBcAb(+) donors has not been clearly defined. The aim of this study is to identify the safety of using HBcAb(+) donor and the effectiveness of passive immunoprophylaxis with hepatitis B immunoglobulin(HBIG) in non-hepatitis B virus induced cirrhotic recipients. METHODS: From December 1994 to July 1998, 59 patients underwent living donor liver transplantation at the Asan Medical Center. Among them, 35 cases were non-hepatitis B virus induced cirrhotic recipients. Of these 35 recipients, 14 patients received liver graft from HBsAg(-) and HBcAb(+) donors and prophylactic passive immunoprophylaxis with HBIG. RESULTS: Eleven cases remained HBsAg(-) with HBIG immunoprophylaxis. Three of 14 recipients who were HBsAg(-) converted to HBsAg(+) serologically after receiving HBcAb(+) donor liver. All of these 3 cases did not receive HBIG therapy. CONCLUSIONS: Passive immunoprophylaxis with HBIG may prevent non-hepatitis B induced cirrhotic recipients from converting to HBsAg(+) status by using HBcAb(+) donor. Our experience suggests that HBcAb(+) donors can be accepted as potential donors in living donor liver transplantation.
Cadaver ; Chungcheongnam-do ; Hepatitis B* ; Hepatitis* ; Herpesvirus 1, Cercopithecine ; Humans ; Korea ; Liver Transplantation* ; Liver* ; Living Donors* ; Prevalence ; Tissue Donors* ; Transplants

Emphysema, a major component of chronic obstructive pulmonary disease (COPD), is a leading cause of human death worldwide. The progressive deterioration of lung function that occurs in the disease is caused by chronic inflammation of the airway and destruction of the lung parenchyma. Despite the main impact of inflammation on the pathogenesis of emphysema, current therapeutic regimens mainly offer symptomatic relief and preservation of lung function with little therapeutic impact. In the present study, we aimed to discover novel therapeutics that suppress the pathogenesis of emphysema. Here, we show that LJ-2698, a novel and highly selective antagonist of the adenosine A3 receptor, a G protein-coupled receptor involved in various inflammatory diseases, significantly reversed the elastase-induced destructive changes in murine lungs. We found that LJ-2698 significantly prevented elastase-induced airspace enlargement, resulting in restoration of pulmonary function without causing any obvious changes in body weight in mice. LJ-2698 was found to inhibit matrix metalloproteinase activity and pulmonary cell apoptosis in the murine lung. LJ-2698 treatment induced increases in anti-inflammatory cytokines in macrophages at doses that displayed no significant cytotoxicity in normal cell lines derived from various organs. Treatment with LJ-2698 significantly increased the number of anti-inflammatory M2 macrophages in the lungs. These results implicate the adenosine A3 receptor in the pathogenesis of emphysema. Our findings also demonstrate the potential of LJ-2698 as a novel therapeutic/preventive agent in suppressing disease development with limited toxicity.

Endocannabinoids can affect multiple cellular targets, such as cannabinoid (CB) receptors, transient receptor potential cation channel, subfamily V, member 1 (TRPV1) and peroxisome proliferator-activated receptor gamma (PPARgamma). The stimuli to induce adipocyte differentiation in hBM-MSCs increase the gene transcription of the CB1 receptor, TRPV1 and PPARgamma. In this study, the effects of three endocannabinoids, N-arachidonoyl ethanolamine (AEA), N-arachidonoyl dopamine (NADA) and 2-arachidonoyl glycerol (2-AG), on adipogenesis in hBM-MSCs were evaluated. The adipocyte differentiation was promoted by AEA whereas inhibited by NADA. No change was observed by the treatment of non-cytotoxic concentrations of 2-AG. The difference between AEA and NADA in the regulation of adipogenesis is associated with their effects on PPARgamma transactivation. AEA can directly activate PPARgamma. The effect of AEA on PPARgamma in hBM-MSCs may prevail over that on the CB1 receptor mediated signal transduction, giving rise to the AEA-induced promotion of adipogenesis. In contrast, NADA had no effect on the PPARgamma activity in the PPARgamma transactivation assay. The inhibitory effect of NADA on adipogenesis in hBM-MSCs was reversed not by capsazepine, a TRPV1 antagonist, but by rimonabant, a CB1 antagonist/inverse agonist. Rimonabant by itself promoted adipogenesis in hBM-MSCs, which may be interpreted as the result of the inverse agonism of the CB1 receptor. This result suggests that the constantly active CB1 receptor may contribute to suppress the adipocyte differentiation of hBM-MSCs. Therefore, the selective CB1 agonists that are unable to affect cellular PPARgamma activity inhibit adipogenesis in hBM-MSCs.
Adipocytes* ; Adipogenesis ; Dopamine* ; Endocannabinoids ; Ethanolamine ; Felodipine ; Glycerol ; Humans ; Mesenchymal Stromal Cells* ; PPAR gamma ; Receptor, Cannabinoid, CB1 ; Receptors, Cannabinoid* ; Signal Transduction ; Transcriptional Activation

BACKGROUND: Total spinal anesthesia (TSA) after injections of local anesthetics into the intrathecal space during epidural anesthesia is not rare. TSA anesthetizes cranial nerves and peripheral nerves, causes specific circulatory disturbances related to autonomic imbalance. Spectral analysis of heart rate variability (HRV) and blood pressure variability (BPV) provide a dynamic assessment of sympathetic and parasympathetic tone. Cross-spectral analysis has been used to emphasize this dynamic baroreflex control of HR as a frequency-dependent phenomenon and allows an assessment of baroreflex function. To examine the effects of TSA on the autonomic nervous system, we used spectral and cross-spectral analytic METHODS. METHODS: We investigated 14 rats before and after TSA. Power spectral densities of blood pressure (BP) and heart rate (HR) were estimated by fast Fourier transform. To evaluate the effect of TSA on baroreflex function, the cross spectral gain, phase, and coherence between beat-to-beat BP and HR signals were calculated by using transfer function analysis. RESULTS: With the onset of TSA, BP and HR significantly decreased. TSA significantly decreased the low frequency (LF) and high frequency (HF) components of HRV and BPV. Baroreflex sensitivity (BRS) obtained from transfer function gain between these variables was significantly decreased. CONCLUSIONS: TSA reduces the LF and HF components of HRV and BPV. These suggest that TSA in rats decreases both parasympathetic and sympathetic drive. Moreover, the decrease in BRS suggests impairment of cardiac baroreflex buffering function during TSA.
Anesthesia, Epidural ; Anesthesia, Spinal* ; Anesthetics, Local ; Animals ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Cranial Nerves ; Fourier Analysis ; Heart Rate ; Peripheral Nerves ; Rats*

Four cases of congenital coronary arteriovenous fistula were diagnosed using coronary angiography. Three cases had fistula-related chest pain and the remaining case showed no symptoms but displayed electrocardiographic changes suggesting myocardial ischemia. As he was elderly and had a potential for future complications, we decided to close the fistulas of all cases. Three cases were closed with transcatheter coil embolization and one with surgical ligation due to a suspicious accompanying pericardial cyst. None of the patients demonstrated periprocedural or perioperative complications and all were relieved from symptoms during the 2 year follow-up period. We concluded that transcatheter coil embolization and surgical ligation are effective methods for use in the management of coronary arteriovenous fistula.
Aged ; Arteriovenous Fistula* ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Electrocardiography ; Embolization, Therapeutic ; Fistula ; Follow-Up Studies ; Humans ; Ligation ; Mediastinal Cyst ; Myocardial Ischemia

PURPOSE: The majority of carcinomas of the biliary tract are often diagnosed at an advanced stage, despite improved diagnostic capabilities. Aggressive surgery is generally recommended in an attempt to cure the advanced disease because only complete resection of the tumor can provide a chance to improve the survival rate. Thus, the purpose of this research was to assess the effectiveness of a hepatopancreato duodenectomy (HPD) in patients with both advanced gallbladder cancer directly invading adjacent organs and diffuse bile-duct cancer by analyzing the long term results of an HPD. METHODS: Forty patients underwent an HPD at Asan Medical Center from December 1993 to May 1999, and their cases were retrospectively reviewed. Gallbladder cancers was present in 14 of the patients and bile-duct cancers in 24 cases; the other 2 cases were benign. Cancers were classified by using the criteria of the American Joint Commission on Cancer (AJCC). Survival curves were calculated by using the Kaplan-Meier method. The median follow-up was 35 months. RESULTS: Hepatectomies varied from a right trisegmentectomy to an S4aS5 subsegmentectomy. There were 19 (47.5%) major postoperative complications, including intraabdominal bleeding, intestinal obstruction, liver abscess, and others. Of the 14 patients experiencing tumor recurrence, 7 (50%) cases involved the remnant liver. There were 4 (10%) perioperative mortalities. The 5 (22.7%) patients who with stage IVa and IVb cancer (22 cases) survived more than 3 years are all still alive and without tumor recurrence. The 1-and 3-year cumulative survival rates for gallbladder cancer were 83.3% and 48.5%, respectively, and those for bile-duct cancer were 83.3% and 49.7%. The differences in survival between the groups was not statistically significant, excluding perioperative deaths. The median survival was 13.7 months. CONCLUSION: An HPD is indicated for either advanced gallbladdercancer or diffuse bile-duct cancer because complete resection through this surgical procedure can provide a chance to improve survival. It is necessary to decrease perioperative mortality and morbidity by complete preoperative evaluation, meticulous operative manipulation, and intensive postoperative care.
Biliary Tract ; Chungcheongnam-do ; Follow-Up Studies ; Gallbladder Neoplasms ; Hemorrhage ; Hepatectomy ; Humans ; Intestinal Obstruction ; Joints ; Liver ; Liver Abscess ; Mortality ; Postoperative Care ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate