BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
Arteries ; Blood Pressure ; Catheters ; Coronary Vessels ; Deferoxamine* ; Electrocardiography ; Heart Atria ; Heart Rate ; Heart Ventricles ; Hydroxyl Radical ; Iron ; Ischemia ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Oxygen ; Rabbits ; Reperfusion ; Transducers, Pressure

BACKGROUND/AIMS: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. METHODS: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). RESULTS: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). CONCLUSIONS: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.
Bile Ducts* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Humans ; Inflation, Economic ; Lithotripsy ; Sphincterotomy, Endoscopic

BACKGROUND: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status. METHODS: A total of 1,926 women were studied and divided into three groups according to their menstrual stage (premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III criteria. RESULTS: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause (r = 0.56, P < 0.01) and perimenopause (r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted (odds ratio (OR) 1.517 [95% confidence interval (CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndromeincreased in accordance with elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels. CONCLUSION: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause.
Adult ; Alanine Transaminase ; Cholesterol ; Estrogens ; Female ; gamma-Glutamyltransferase ; Humans ; Menopause ; Obesity, Abdominal ; Perimenopause ; Postmenopause ; Premenopause ; Prevalence ; Waist Circumference

Sedation, defined as the depressed level of consciousness, induced by drug administration, is widely used for gastrointestinal endoscopy to relieve a patient’s anxiety and discomfort. In addition, successful procedure is anticipated with control of unintended movements. Endoscopic sedation, however, cannot be free from the risk of serious adverse events, e.g., cardiopulmonary compromise. Therefore, principles on personnel, facility and equipment, as well as performance itself, should be followed to prevent unfavorable incidents. In this article, sedation guidelines for the Accreditation of Qualified Endoscopy Units, issued by the Korean Society of Gastrointestinal Endoscopy, are presented.
Accreditation ; Anxiety ; Consciousness Disorders ; Endoscopy ; Endoscopy, Gastrointestinal ; Oximetry

OBJECT: Surgery for aneurysms at non-branching sites of an internal carotid artery (ICA) is considered based on the size, shape, direction and site of the aneurysm. In this study, we analyzed characteristics of aneurysms that have arisen from non-branching sites of an ICA from the viewpoint of surgery. METHODS: From 2003 to 2007, 346 intracranial aneurysms were treated at our institute. 19 (5.5%) aneurysms were non-branching site aneurysms of an ICA. Surgery for these aneurysms was retrospectively analyzed in view of the treatment strategy according to the site, size, and configuration of the aneurysms in videos obtained during surgery. RESULTS: There were 13 cases of a ruptured aneurysm (68.4%) and six cases of an unruptured aneurysm (31.6%). There were ten cases of a saccular type of aneurysm (52.6%) and nine cases of a blood blister-like aneurysm (47.4%). There were seven aneurysms that arose from the dorsal wall of an ICA (36.8%), six aneurysms that arose from the ventral wall (31.6%), four aneurysms that arose from the lateral wall (21.1%) two aneurysms that arose from the medial wall (10.5%). Three patients with unruptured blood blister-like aneurysms underwent simple wrapping and wrapping with the use of clip. Three unruptured saccular aneurysms could be clipped perpendicular to an ICA or at a slant to an ICA. Three out of six (50%) ruptured blood blister-like aneurysms were ruptured during surgery. These aneurysms were clipped with the partial wall of an ICA, resulting in ICA stenosis. We treated 15 (84%) of 19 cases by only clipping, one case (5.2%) was treated by clipping with bypass surgery and three cases (15%) were treated by wrapping. CONCLUSION: Ruptured aneurysms of nonbranching sites of an ICA such as blister-like or dorsal saccular aneurysms have a high risk of rupture and can be difficult to clip. If clipping of the aneurysms is possible, preoperative balloon test occlusion should be performed to avoid ICA stenosis after clipping of the aneurysm neck with the arterial wall. Clipping after bypass or trapping can vary the treatment strategy and improve patient outcome. For small-unruptured aneurysms from nonbranching sties of an ICA, wrapping with the use of clip may be a useful method for treatment regardless of the clipping direction.
Aneurysm ; Aneurysm, Ruptured ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Intracranial Aneurysm ; Neck ; Retrospective Studies ; Rupture

A 22-month-old male infant visited at our hospital with stuporous mentality. Brain CT angiography revealed right M1 aneurysm with subarachnoid hemorrhage and intraventricular hemorrhage. After one month from ictus, aneurysmectomy and neck clipping was done. We report here on an extremely rare case of ruptured intracranial aneurysm under the age of 5 years.
Aneurysm ; Angiography ; Brain ; Hemorrhage ; Humans ; Infant ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Neck ; Rupture ; Stupor ; Subarachnoid Hemorrhage

Gastric ulcer bleeding is commonly encountered in emergency situations for gastroenterologist. Usually depth of gastric ulcer does not exceed the muscle layer. We report a case of a 67-year-old male with massive gastric ulcer bleeding caused by direct connection to the splenic artery. Bleeding control was not effectively performed by endoscopy due to massive bleeding with unstable vital sign. Angiography for embolization was performed. Active extravasation of contrast agents at the splenic artery stenosis was noted on splenic arteriogram. Bleeding stopped after embolization with histoacryl and lipiodol was successfully performed. After 1 month, complete ulcer healing was confirmed by follow up endoscopy. There was no evidence of invasive disease on biopsy.
Aged ; Angiography ; Biopsy ; Constriction, Pathologic ; Contrast Media ; Emergencies ; Enbucrilate ; Endoscopy ; Ethiodized Oil ; Follow-Up Studies ; Hemorrhage* ; Humans ; Male ; Splenic Artery* ; Stomach Ulcer* ; Ulcer ; Vital Signs

BACKGROUND: The presence of axillary lymph node metastases (ALNM) and tumor size are two most important prognostic factors in breast cancer. An axillary lymph node dissection (ALND) is usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. However this procedure results in lymphedema of the affected upper extremity, increased axillary drainage, sensory abnormality, and pain. If the axillary lymph node status could be predicted accurately prior to an ALND, selected patients with a low probability of ALNM could be spared the procedure. The purpose of this study was to determine the association between the incidence of ALNM and 14 clinico-pathologic factors by using univariate and multivariate analysis and to investigate the possibility of using those factors as predictors for ALNM. METHODS: We reviewed data from 253 patients with breast cancer who had undergone at least a level I/II axillary dissection between 1991 and 1998. The association between the incidence of ALNM and 14 clinico-pathologic factors (age, menstruation, tumor size, palpability of tumor, tumor site, pathologic type, nuclear grade, estrogen receptor status, progesteron receptor status, p53, c-erbB-2, Ki67, Cd34, and Cathepsin D) were analyzed by using univariate and, when significant, multivariate analysis. RESULTS: Approximately 38.7% of the 253 patients with breast cancer had ALNM. Univariate analysis showed that ALNM were associated with tumor size (P<0.01), pathologic type (P<0.001), palpability (P<0.01), and nuclear grade (P<0.01). However, independent predictors of ALNM in the multivariate analysis were tumor size and pathologic type. Among the patients with smaller than 1.0 cm in the tumor size and DCIS in the pathologic type, the ALNM was not founded. CONCLUSIONS: We conclude that the characteristics of primary breast cancer can help assess the risk for ALNM. Selected patients, who are assessed to be minimal risk, might be spared a routine ALND, if the treatment decision would not be influenced by the lymph node status.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsins ; Drainage ; Estrogens ; Female ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes* ; Lymphedema ; Menstruation ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

PURPOSE: Children under 3 years old with medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (SPNET) have a poor prognosis. They are more susceptible to the deleterious effects of craniospinal radiation (CSR). This study was undertaken to determine the survival rates and prognostic factors of currently used treatment. METHPDS: Retrospective review of 19 children (MB 16, SPNET 3) who were newly diagnosed as MB or SPNET at Seoul National University Children's Hospital from April 1996 to August 2000 was done. Eligible Patients were treated with postoperative induction chemotherapy using Children's Cancer Group (CCG) 9921A or 9931. Patients over 3 year of age received CSR as well. RESULTS: Three Patients with SPNET are all alive without disease. However, 6 patients under 3 years old at diagnosis with MB were all dead whereas only one patient had an event among 10 patients over 3 years old at diagnosis. Among patients with MB, age under 3 years at diagnosis or residual tumors after induction chemotherapy correlated with poor outcome. Metastasis at diagnosis, postoperative residual disease or extent of excision did not have a significant effect on survival statistically. Three-year event-free survival (EFS) of patients with MB was 53%. Three-year EFS of patients over 3 years old at diagnosis with MB was 85.7% and 1-year EFS of under 3 years old at diagnosis with MB was 16.7%. CONCLUSION: The combined use of chemotherapy and CSR in the treatment of MB and SPNET improved survival in children over 3 years old, whereas any treatment failed to improve survival in children under 3 years old. So, there's a need for a new treatment modality to improve survival of children under 3 year of age.
Child ; Child, Preschool ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Induction Chemotherapy ; Medulloblastoma* ; Neoplasm Metastasis ; Neoplasm, Residual ; Neuroectodermal Tumors, Primitive* ; Prognosis ; Retrospective Studies ; Seoul ; Survival Rate*

PURPOSE: There have been few studies of the direct effect of a drug overdose on the gastrointestinal (GI) mucosa. This study evaluated the frequency of GI mucosal injury and the necessity for esophagogastroduodenoscopy (EGD) in patients with non-caustic drug ingestion (DI). METHODS: Patients who presented to the emergency department with non-caustic DI from January 2001 to December 2003 were enrolled in this study. EGD was performed on the patients after acute toxicologic management. Those who did not consent to EGD were excluded. The EGD findings were analyzed according to the non-caustic drug that had been ingested. RESULTS: Among the 37 patients, 24 (65%) had significant endoscopic lesions. Endoscopic findings were gastric erosion (n=17), ulcers (n=5), esophageal erosion (n=1), and a gastric hemorrhage (n=1). Pesticides, rodenticides, salicylates, and high dose doxylamine (>5 g) were associated with drug-induced gastropathy. CONCLUSION: This study suggests that GI mucosal injury has been underestimated in DI patients and that a treatment for gastromucosal protection should be performed when the non-caustic ingested drug is a pesticides, a rodenticides, a salicylates or high-dose doxylamine.
Doxylamine ; Drug Overdose ; Eating* ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Mucous Membrane ; Pesticides ; Poisoning ; Rodenticides ; Salicylates ; Ulcer