No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

PURPOSE: The purpose is to correlate computed tomographic findings classified according to the degree of disease severity(grading A-E) with clinical course of acute pancreatitis. MATERIALS AND METHODS: in a retrospective review of 42 patients with acute pancreatitis, computed tomographic scans were classifed according to the degree of disease severity, and were correlatd with the clinical course. RESULTS: Pancreatic abscesses were seen in 14.3% and occured in 35.7% of grade D and E patients. Three patients with abscess died. Fatty infiltration of the liver was noted in 16.7%, pleural effusion in 21.4%.. stones and thickened wall of the gallbladder were present in 7.1% and in 9.5%, respectively. CONCLUSION: Our data indicate that phlegmonous extrapancreatic spread on initial CT scan had a high predictive value of the patients, prognosis.
Abscess ; Cellulitis ; Gallbladder ; Humans ; Liver ; Pancreatitis* ; Pleural Effusion ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study is to evaluate the normal anatomy of the lymphatic system draining the biliary trees and the prevalence of variable lymphatic spread of primary biliary carcinoma into these extrahepatic planes. MATERIALS AND METHODS: We reviewed 46 pathologically confirmed among 116 cases underwent abdominal CT. RESULTS: Of 17 patients with gallbladder cancer, nodal metastsis was proved in 10(59%) cases, direct organ invasion in 3(18%) cases, and peritoneal spread in 2(12%) cases. After a radicaloperation, nodal invasion was developed in 4 patients and peritoneal spread in 5 patients. Of 11 patients with hilar cholangiocarcinoma, nodal metastasis was proved in 6(55%) patients. Four patients developed paritoneal dissemination later. Of 18 patients with extrahepatic cholangiocarcinoma, however, nodal metastasis was proved in only 6(33%), but 5 among 12 patients who took a radical operation showed recurrence. CONCLUSION: The lymph node of the foramen of Winslow and pancreaticoduodenal lymph node were prevalent sites in the nodal metastasis of biliary carcinoma and CT was helpful in the indentification of this lymphadenopathy and extrabiliary spread on both initial and follow-up studies.
Cholangiocarcinoma ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphatic System ; Neoplasm Metastasis* ; Prevalence ; Recurrence ; Tomography, X-Ray Computed

BACKGROUND: Oral beta-blocker is initially used to prevent the symptons in patients with vasovagal syncope or presyncope. But, beta-blocker treatment may actually cause worsening of symptoms in some patients. The purpose of the present study was to evaluate the efficacy of oral beta-blocker in preventing symptoms during repeat head-up tilt test in patients who had a positive response in initial head-up tilt test. METHOD: Patients. Among the 150 patients with unexplained syncope or presyncope who underwent head-up tilt from October 1994 to January 1996, forty-three patients, who were taking beta-blocker and underwent repeat head-up tilted test, were included in this study. Initial head-up tilt test. Each patients was tilted to the 70 degree upright position for 30 minutes. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 (micro)g/min and then increased by 1 (micro)g/min every three minutes to al maximum of 5 (micro)g/min while maintaining 70 degree upright position. Repeat head-up tilt test. The test was repeated while each patients was taking atinolol. The repeat test was continued until reaching at the stage where each patient had a positive response in initial test. RESULTS: 1) In initial head-up tilt test, most (91%) of a positive response occured during isoproterenol provocation. 2) In repeat head-up tilt test on atenolol, thirty-four patients(79%) had a negative response. But nine patients(21%) still had a positive response. 3) Nonresponsive group showed younger age and shorter time period to a positive response in initial head-up tilt test than responsive group. CONCLUSION: It may be useful to assess the effectiveness of beta-blocker by repeat head-up tilt before deciding long term treatment, especially younger age group.
Adult* ; Atenolol ; Humans ; Isoproterenol ; Syncope* ; Syncope, Vasovagal*

OBJECTIVE: To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. MATERIALS AND METHODS:From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. RESULTS: The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 +/- 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. CONCLUSION: Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Angiography ; Arteries ; Disseminated Intravascular Coagulation/etiology ; Embolization, Therapeutic ; Female ; Gastrointestinal Hemorrhage/*radiography/surgery ; Hemodynamics ; Humans ; Male ; Middle Aged ; Recurrence

BACKGROUND: Many reports with hypnotics and opiates have been published for nonrelaxant tracheal intubation.In addition to its immediate onset and short duration time, remifentanil can well prevent responses against short and strong stimulation like tracheal intubation.However, the high concentration of remifentanil for nonrelaxant tracheal intubation can cause hemodynamic instability, thus we tried to estimate the predicted effect-site concentration of remifentanil for smooth intubation and provoking hypotension. METHODS: Forty three ASA I and II patients were randomly selected to receive an effect-site-controlled infusion of remifentanil 0, 2, 4, 6 ng/ml and propofol 2 mg/kg.Trachea was intubated after 3 minutes of manual breathing support with desflurane 6 vol%. The vital signs, end-tidal concentration of desflurane and responses of patients were recorded before intubation for 3 minutes and until 2 minutes after intubation every minute.The effective effect-site concentration (ECe) was calculated at 95% successful rate of smooth intubation and at 50% of provoking hypotension (equal to or under 55 mmHg). RESULTS: The estimation results of the logistic regression stated that 95% ECe of remifentanil for smooth intubation was 8.0 (5.0-14.3) ng/ml and 50% ECe for provoking hypotension equal to or under 55 mmHg before intubation was 5.0 (2.6-9.7) ng/ml. CONCLUSIONS: Remifentanil at 8.0 ng/ml provided good conditions for smooth intubation without muscle relaxants but could provoked hypotension.Consequently, we recommend the careful observation of the blood pressure with the use of remifentanil and the evaluation of the suitable measures to maintain the blood pressure for nonrelaxant tracheal intubation.
Anesthesia ; Blood Pressure ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Hypotension ; Intubation ; Isoflurane ; Logistic Models ; Muscles ; Piperidines ; Propofol ; Respiration ; Vital Signs

BACKGROUND: Vasovagal syncope is a common cause of syncope. In some cases, syncopal episode is recurrent, resulting in physical injury. Head-up tilt test with or without isoproterenol provocation has been a tool to diagnose vasovagal syncope. But the protocol of head-up tilt test has not been settled. In this study, we evaluate the usefulness of a head-up tilt test with isoproterenol provocation in patients with syncope or presyncope of unexplained origin. METHODS: Head-up tilt test was performed with patients in the fasting state in the morning. After supine heart rate and blood prewwure were obtained, each patient was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 microg/min and then increased by 1 microg/min every three minutes to a maximum of 5 microg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance of isoproterenol, heart rate>150 beats/min, and completion of the protocol. When an end point reached, the patient was rapidly returned to the horizontal position. RESULTS: 1) Of 122 patients with syncope or presyncope, 113 patients(93%) had prodromal symptoms. 2) 23 patients(19%) had physical injury during episode. 3) 93 patients(76%) experienced episodes while they were standing or sitting. 4) A total of 83 patients(68%) had a positve response during head-up tilt test ; 7 patients(8%) of these 83 patients had a positive response during the baseline tilt. But, 76 patients(92%) required isoproternol provocation to elicit this response. 5) The pattern of positive response showed vasodepressive pattern in 55 patients(67%), mixed pattern in 26 patients(31%), and cardioinhibitory pattern in 2 patients(2%). 6) No significant side effect of isoproterenol was noted. 7) There were no significant differences between positive response group and negative response group in terms of clinical characteristics and hemodynamic findings during head-up tilt test. CONCLUSION: A head-up tilt test with isoproterenol provocation could be an useful tool for diagnosing vasovagal syncope or presyncope in adults.
Adult* ; Fasting ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Isoproterenol ; Prodromal Symptoms ; Syncope* ; Syncope, Vasovagal

BACKGROUND AND OBJECTIVES: It has been well known that the Braunwald classification is an appropriate clinical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the classification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. MATERIALS AND METHOD: 148 patients (M 85, F 63, age 61+/-10) with suspected unstable angina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. RESULTS: Unstable angina was diagnosed in 95 patients (64%). Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75%) and 2 (2%) deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1%) myocardial infarction/death and 12 (13%) revascularizations occurred. Cardiac event rate (death, myocardial infarction or revascularization) was not different during hospitalization and 6 months follow-up period among subgroups of severity class. CONCLUSION: Clinical outcome should be reevaluated after early coronary intervention to predict cardiac event in patients with unstable angina.
Angina, Unstable* ; Classification ; Diagnosis ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Ratio

BACKGROUND: The analysis of ACE gene expression in vital to study the role of angiotensin conveting enzyme(ACE) in the pathogenesis of cardiovascular disease. Traditionally, levels of individual mRNA expression have been analyzed by semiquantitative Northern blotting, which requires a large quantity of tissue. Therefore, gene expression of a little biopsy specimen from the human heart or atherectomy specimen from the blood vessel cannot be measured easily. Reverse transcription-polymerase chain reaction(RT-PCR) is very effective, sensitive and rapid method of detecting the method of quantitative RT-PCR(QRT-PCR) using recombinant RNA template as internal standard to measure the expression of ACE. METHOD: Recombinant RNA(rcRNA) was designed to yield PCR product which differs in size by about 200bp from that of the target RNA. Initially, spacer gene, which was composed of ACE sense primer, antisense primer, T7 promotor and poly(dT) tail with glutathione transferase(GSTM) gene of 180bp in the middle, was constructed. Then, standard rcRNA was obtained by in vitro transcription. Target RNA was mixed with rcRNA and amplified by PCR, togather with P-dCTP. PCR products were analyzed by gel electrophoresis. For quantitation, either gel was cut and radioactivity was counted or gel was dried and exposed to X-ray film and density was measured using image densitometer. We carried out semiquantitative RT-PCR to study the modulation of ACE expression in vascular smooth muscle cell(VSMC) by dexamethasone and basis FGF(bFGF). RESULT: The size difference of PCR products from the standard RNA and the extracted target RNA was matched as designed. By using QRT-PCR, there was 1.7*10(8) ACE mRNA molecules in 1 ng of rat lung total RNA. bFGF and dexamethasone upregulated ACE mRNA expression in cultured VSMC. CONCLUSION: These results suggest that RT-PCR using rcRNA as internal standard is a very useful method for quantitation or semiquantitation of ACE mRNA from a small amount of tissue or cultured cells. Expression of ACE in VSMC can be modulated by various stimuli such as basic FGF and dexamethasone. QRT-PCR could be widely used in the studies of expression of specific human genes.
Angiotensins* ; Animals ; Atherectomy ; Biopsy ; Blood Vessels ; Blotting, Northern ; Cardiovascular Diseases ; Cells, Cultured ; Dexamethasone ; Electrophoresis ; Gene Expression ; Glutathione ; Heart ; Humans ; Lung ; Muscle, Smooth, Vascular ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Radioactivity ; Rats ; RNA ; RNA, Messenger* ; X-Ray Film

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/surgery/*therapy ; Death, Sudden, Cardiac/etiology ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Thrombosis/etiology