Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain &thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I(p=0.04). 2. ncidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during emodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group II(3.1+/-0.8) than GroupI(2.8+/-0.8) and III (2.9+/-0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, 0.05+/-0.12, 0.41+/-0.24 and 0.22+/-0.29 respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
Blood Pressure* ; Blood Urea Nitrogen ; Creatinine ; Dialysis ; Dialysis Solutions ; Fasting ; Hemodynamics* ; Humans ; Hypotension ; Incidence* ; Osmolar Concentration ; Potassium ; Renal Dialysis* ; Sensation ; Sodium ; Thirst* ; Ultrafiltration* ; Weight Gain*

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

Background/Aims: This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. Methods: This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. Results: Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. Conclusions Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

BACKGROUND AND OBJECTIVES: The p53 protein is a 53 kD phosphoprotein. It is also one of the early recognition markers of malignancy and can be used to predict the aggressive behaviors of tumor. The human papilloma virus (HPV) is a species-specific, epitheliotrophic, double-stranded DNA virus. The purpose of this study was to evaluate the expression rate of p53, and to investigate whether a correlation exists between the rate of recurrence and the severity of lesion. We also investigated whether p53 expression rate and HPV affect recurrence and carcinogenesis of inverted papilloma. MATERIALS AND METHODS: Twenty-two cases of the inverted papilloma and 6 cases of squamous cell carcinoma arising in the inverted papilloma were used for the study. We used immunohistochemical staining for p53 and performed the molecular study of HPV DNA with in situ hybridization (ISH) on the paraffin embedded materials. RESULTS: 1) The overall expression rate of p53 was 39% (11/28). A significant correlation was observed between p53 protein accumulation and the severity of the lesion (p=0.0015). 2) Seven of 11 patients who tested positive for p53 showed recurrence, whereas two of the 12 patients who tested negative for p53 showed recurrence. There was a correlation between the rates of p53 expression and recurrence (p=0.029). 3) The HPV was detected in four cases (13%) of inverted papilloma. There was no statistical significance between HPV and the rate of recurrence(p=0.147). CONCLUSION: The results demonstate that p53 mutations and HPV may play a role in the oncogenesis of inverted papilloma.
Carcinogenesis ; Carcinoma, Squamous Cell ; DNA ; Humans ; In Situ Hybridization ; Papilloma ; Papilloma, Inverted* ; Paraffin ; Recurrence

BACKGROUND AND OBJECTIVES: Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents. SUBJECTS AND METHODS: We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin and high sensitive C reactive protein. RESULTS: The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents. CONCLUSION: These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.
Adiponectin ; Adipose Tissue ; Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Echocardiography ; Humans ; Insulin ; Interleukin-6 ; Intra-Abdominal Fat ; Leptin ; Linear Models ; Magnetic Resonance Imaging ; Obesity ; Obesity, Abdominal ; Tumor Necrosis Factor-alpha ; Waist Circumference

Sorafenib (Nexavar) has been regarded as a treatment for unresectable hepatocellular carcinoma (HCC), with side effects that include hand-foot skin reaction, diarrhea, rash, fatigue, hypertension, nausea, anorexia, weight loss, and alopecia. Thyroid disorder, such as endocrine side effect, has also been reported. However no case involving adrenal insufficiency has been reported. Here, we report a case of adrenal insufficiency which occurred after taking sorafenib in a patient with HCC. A 56-year-old man visited our hospital due to right upper quadrant abdominal pain and he was diagnosed as multiple disseminated and unresectable HCCs with portal vein invasion; therefore transarterial chemoembolization was performed and sorafenib administration was started. Two months later, he was admitted to the hospital complaining of severe fatigue. The laboratory results showed cortisol of <0.2µ g/dL and adrenocorticotropic hormone of <1.00 pg/mL. The patient had no history of taking steroids or herbal medications. Secondary adrenal insufficiency was diagnosed and prednisolone 10 mg per day was started immediately; as a result, fatigue remarkably improved. This may be the first report indicating a possible association between sorafenib and adrenal insufficiency and it implies that the possibility of adrenal insufficiency should be considered in patients taking sorafenib who complain of severe fatigue.
Abdominal Pain ; Adrenal Insufficiency* ; Adrenocorticotropic Hormone ; Alopecia ; Anorexia ; Carcinoma, Hepatocellular* ; Diarrhea ; Exanthema ; Fatigue ; Humans ; Hydrocortisone ; Hypertension ; Middle Aged ; Nausea ; Portal Vein ; Prednisolone ; Skin ; Steroids ; Thyroid Gland ; Weight Loss

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.
Carbon ; Cystectomy ; Cystoscopy ; Humans ; India ; Ink ; Laparoscopy ; Length of Stay ; Muscles ; Needles ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Tattooing ; Urachal Cyst ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Catheterization ; Wound Healing

OBJECTIVE: To evaluate the efficacy and side effects of cispaltin and carboplatin each in combination with paclitaxel in recurrent epithelial ovarian cancer who had not taken paclitaxel-based chemotherapy. MATERIALS AND METHODS: Between January 1994 and October 1999, in department of obstetrics and gynecology, Asan medical Center, 42 recurrent ovarian cancer patients who had initial platinum-based chemotherapy except paclitaxel were treated with paclitaxel-based chemotherapy. One group was 14 patients treated with paclitaxel-cisplatin and the other group was 28 patients treated with paclitaxel-carboplatin. Disease free interval before recurrence was 6 months at least. Patients received paclitaxel 135mg/m2 followed by either cisplatin 75mg/m2 or carboplatin 300mg/m2. The schedule was repeated every 3 weeks for at least 6 cycle. Response was evaluated by physical examination, serial serum CA 125 measurement, chest PA before each cycle, and abdomino-pelvic CT scan every 3 cycles. RESULTS: As paclitaxel-cisplaitin group, with a median follow-up of 34.5 months (range, 9-60 months), 1 patient had complete response, 6 patients had partial response, 3 patients had stable disease and 4 patients had persistent disease, overall response rate was 50%, mean survival duration was 40 months. As paclitaxel-carboplatin group, with a median follow-up of 25.5 months (7-36 months), 4 patients had complete response, 11 patients had partial response, 6 patients had stable disease, and 7 patients had persistent disease, overall response rate was 53.4%, mean survival of 24 months. As grade of side effects in each group, we evaluated leukopenia, anemia, thrombocytopenia, nausea, vomiting, fever, neurological abnormality, and renal abnormality. The rate of grade 3 to 4 leukopenia was 11% in paclitaxel-cisplatin arm and 17% paclitaxel-arboplatin, in arm. CONCLUSION: These results demonstrate that the combined chemotherapy of paclitaxel followed by cisplatin or carboplatin is highly effective and safe in recurrent epithelial ovarian cancer who had taken no previous paclitaxel-based chemotherapy.
Anemia ; Appointments and Schedules ; Arm ; Carboplatin ; Chungcheongnam-do ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination* ; Fever ; Follow-Up Studies ; Gynecology ; Humans ; Leukopenia ; Nausea ; Obstetrics ; Ovarian Neoplasms* ; Paclitaxel ; Physical Examination ; Recurrence ; Thorax ; Thrombocytopenia ; Tomography, X-Ray Computed ; Vomiting

OBJECTIVE: To evaluate the outcomes of laparoscopico-vaginal (modified) radical hysterectomy and to compare surgical parameters and recurrence rate of these with those of conventional abdominal radical hysterectomy. METHODS: From October 1997 to March 2002, we have performed 37 cases of LVMRH (laparoscopico- vaginal modified radical hysterectomy) +PLND (pelvic lymph node dissection) and 47 cases of LVRH (laparoscopico-vaginal radical hysterectomy) with paraaortic lymph node sampling +PLND. Inclusion criteria for laparoscopic group were patients with FIGO stage IA1 to IB1 which exocervical mass size was less than 2 cm clinically. As a control group, we selected 46 cases for the MRH group and 96 cases for the RH group. These groups had the same FIGO stage and the same tumor size less than 2 cm or tumor volume calculated by MRI being less than 4.2 cm3, while the age for each group were identically matched with the laparoscopic group. RESULTS: The mean duration of surgery, the number of lymph nodes and the rate of perioperative and postoperative complications were similar in both the laparoscopic and the conventional laparotomy group. The mean duration of hospital stay was significantly shorter in patients treated by laparoscopic surgery (LVMRH vs. MRH; 9 vs. 15, LVRH vs. RH; 13 vs. 21 days). No lymph node metastasis was reported in both LVMRH and MRH group. No recurrences but only one patient in MRH group were found in both groups during the median follow up of 34.5 and 43.5 months, respectively. The positive rates of pelvic lymph node metastasis in both RH groups were similarly 6.4%. Four (8.5%) of 47 LVRH patients and two (2.1%) of 96 RH patients had recurrences. However, in patients who had tumor volume being less than 4.2 cm3, recurrence rate was 2.5% (1/40) and 42.9% (3/7) in those with tumor volume larger than 4.2 cm3. There was one death in a patient with pulmonary metastasis who took LVRH in spite of vigorous chemotherapy. Three year progression free survival rates were 96.7% in LVRH group (tumor volume<4.2 cm3) and 97.9% in RH group (p=0.81). CONCLUSION: Laparoscopic surgery for treatment of early small volume cervical cancer, especially stage IA is safe and effective alternatives in terms of operative morbidity and mortality. However, patients with large volume disease (>4.2 cm3) who were treated by LVRH had higher recurrence rate compared to those by conventional RH. It is concluded that laparoscopic surgery for the treatment of cervical cancer would be better to be limited to patients with early disease who have the largest tumor diameter less than 2 cm or tumor volume less than 4.2 cm3 carefully measured by MRI.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Magnetic Resonance Imaging ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Tumor Burden ; Uterine Cervical Neoplasms*

PURPOSE: Metabolic syndrome (MS), characterized by obesity and insulin resistance, elicits risk factors such as hyperlipidemia, hypertension, and glucose intolerance with additive effects on atherosclerosis, leading to cardiovascular diseases. The purposes of this study were to evaluate the prevalence of MS among overweight and obese adolescents and to investigate the impact of obesity on the cardiovascular system. METHODS: tal cholesterol, triglyceride, low-density-lipoprotein (LDL)-cholesterol, high-density-lipoprotein (HDL)-cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitive C-reactive protein (hs-CRP) were measured in the patients with a BMI of >85 percentile. Brachial-ankle pulse wave velocity (BaPWV) and ankle brachial index were measured using Vascular Profiler (VP)-1000. RESULTS: MS was confirmed in 19.5% of the overweight and obese adolescents and 50.8% of the obese adolescents. The systolic and diastolic blood pressure, height, weight, fat mass, %fat, BMI, obesity index, and waist circumference were higher in the overweight and obese adolescents with MS. Moreover, the triglyceride, AST, ALT, and hs-CRP levels were higher, whereas HDL-cholesterol level was significantly lower in this group. The overweight and obese adolescents with MS showed shorter diastolic and systolic times, higher heart rate and BaPWV, and longer E-wave deceleration time by echocardiography. CONCLUSION: Overweight and obese adolescents showed characteristic MS features such as hypertension and hyperlipidemia. Thus, obese adolescents predisposed to MS should be provided early treatment for obesity.
Adolescent ; Alanine Transaminase ; Ankle Brachial Index ; Aspartate Aminotransferases ; Atherosclerosis ; Blood Pressure ; C-Reactive Protein ; Cardiovascular Diseases ; Cardiovascular System ; Cholesterol ; Deceleration ; Glucose Intolerance ; Heart Diseases ; Heart Rate ; Humans ; Hyperlipidemias ; Hypertension ; Insulin Resistance ; Obesity ; Overweight ; Prevalence ; Pulse Wave Analysis ; Risk Factors ; Waist Circumference