BACKGROUND: Color Doppler echocardiography is sensitive in detecting mitral regurgitation and useful in quantitating its severity. The presence of an eccentric regurgitant jet suggests that regurgitation is caused by prolapsing or flail leaflet of mitral valve. Until recently the direction of regurgitant jet in mitral valve prolapse has been examined in a single(parasternal short axis view) or orthogonal plane using color Doppler echocardiography, and few in the apical rotation method of a transducer. The purpose of this study was to clarify the usefullness of the apical rotation method of a transducer in detection of the direction of mitral regurgitant jet and diagnosis of the sites of mitral valve prolapse. METHODS: Twenty four patients(8 men and 16 women, mean age:47.3+/-18.8 years) with mitral valve prolapse with eccentric regurgitant jet were examined by two-dimensional and color Doppler echocardiograply using conventional parasternal long and short axis views, and four apical longitudinal planes(four chamber, vertical, two chamber and transverse views) obtained by the apical retation method of a transducer. RESULTS: Thirty one regurgitant jets were detected in twenty four patients, eighteen patients had anterior, nine patints posterior, and three patients bi-leaflet(anterior and posterior) prolapse. In eighteen patients with anterior leaflet prolapse, ten had medial, eight had middle, three had lateral, and three had two portions(two, medial and middle; one, middle and lateral) prolapse. In nine patients with posterior leaflet prolapse, five had medial, three had middle, two had lateral, and one had two(medial and middle) scallop prolapse. CONCLUSION: Color Doppler echocardiography by the apical rotation method of transducer is useful in assessment of the site of prolapse in patients with mitral valve prolapse with eccentric regurgitation.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Echocardiography, Doppler, Color ; Female ; Humans ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prolapse* ; Transducers*

PURPOSE: There is no reliable method for predicting which patient with a T1G3 bladder tumor will progress and possibly benefit from an early cystectomy. The prognostic significance of p53, pRb, and p21(waf1) expression was evaluated in patients with a T1G3 bladder tumor. MATERIALS AND METHODS: Of the 787 patients with a newly diagnosed bladder tumor, 485 were superficial. Of these patients, 57 had a T1G3 transitional cell carcinoma. Overall, a total of 30 patients were included in this study. A tumor with nuclei staining more than 10% with either p53 or p21(waf1) antibodies were defined as having altered p53 or p21(waf1) expression. The relationship between recurrence and progression and the results of immunostaining in a T1G3 bladder cancer was analyzed. RESULTS: A pathological diagnosis consisted of 14 papillary and 16 non-papillary including 2 mixed transitional cell cancers. An associated carcinoma in situ was noted in 3 patients. Of the 30 patients, 11 had a recurrence. A progression to muscle invasive bladder cancer had developed in 6 cases at a mean interval of 10.2 months. Each separate expression of p53, p21(waf1) and pRb did not correlate with tumor recurrence or progression. However, patients with combination of a positive p53 with a negative p21(waf1) and a negative pRb test had a significantly higher rate of progression to muscle invasive disease. CONCLUSIONS: A combination of altered immunostaining for a positive p53 with a negative p21(waf1) and a negative pRb test correlated with progression of a T1G3 TCCa of the bladder but not with a recurrence. Therefore, early cystectomy should be considered in a T1G3 bladder tumor with an altered expression of p53 with either p21(waf1) or with pRb.
Antibodies ; Carcinoma in Situ ; Carcinoma, Transitional Cell ; Cystectomy ; Diagnosis ; Humans ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: There is no reliable method for predicting which patient with a T1G3 bladder tumor will progress and possibly benefit from an early cystectomy. The prognostic significance of p53, pRb, and p21(waf1) expression was evaluated in patients with a T1G3 bladder tumor. MATERIALS AND METHODS: Of the 787 patients with a newly diagnosed bladder tumor, 485 were superficial. Of these patients, 57 had a T1G3 transitional cell carcinoma. Overall, a total of 30 patients were included in this study. A tumor with nuclei staining more than 10% with either p53 or p21(waf1) antibodies were defined as having altered p53 or p21(waf1) expression. The relationship between recurrence and progression and the results of immunostaining in a T1G3 bladder cancer was analyzed. RESULTS: A pathological diagnosis consisted of 14 papillary and 16 non-papillary including 2 mixed transitional cell cancers. An associated carcinoma in situ was noted in 3 patients. Of the 30 patients, 11 had a recurrence. A progression to muscle invasive bladder cancer had developed in 6 cases at a mean interval of 10.2 months. Each separate expression of p53, p21(waf1) and pRb did not correlate with tumor recurrence or progression. However, patients with combination of a positive p53 with a negative p21(waf1) and a negative pRb test had a significantly higher rate of progression to muscle invasive disease. CONCLUSIONS: A combination of altered immunostaining for a positive p53 with a negative p21(waf1) and a negative pRb test correlated with progression of a T1G3 TCCa of the bladder but not with a recurrence. Therefore, early cystectomy should be considered in a T1G3 bladder tumor with an altered expression of p53 with either p21(waf1) or with pRb.
Antibodies ; Carcinoma in Situ ; Carcinoma, Transitional Cell ; Cystectomy ; Diagnosis ; Humans ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Transitional cell carcinoma such as renal cell carcinoma is the relatively common urinary tract cancer in patients who are on dialysis. A 66-year-old male patient, who had been on maintenance hemodialysis for 5 years, was suffering from gross hematuria. The subsequent image studies revealed multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder. We performed cystoscopy to evaluate the multiple bladder papillary masses and their blood clots. The patient then underwent bilateral radical nephroureterectomy and radical cystectomy. Histological examination revealed the papillary urothelial carcinoma. Our case may imply that dialysis patients have an increased susceptibility to urological malignancies. Physicians should always raise the possibility of urological malignancy when encountering a dialysis patient with gross hematuria. Because of the high recurrence rate, a more extensive operation and aggressive follow-up protocols should be done for these patients on dialysis.
Male ; Humans

PURPOSE: The aim of this study was to demonstrate OK- 432 sclerotherapy efficacy for treatment of simple renal cysts. MATERIALS AND METHODS: Twenty patients with 25 symptomatic or large simple cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of OK-432 (8 men and 12 women, mean age 63.6 years, SD 9.5). Six patients presented with flank pain, 14 presented with renal mass; renal cyst location was right, left, or bilateral sided in 9, 8, and 8 kidneys, respectively. Patients were evaluated by clinical assessment, US, or CT scan 3 months following the procedure. Complete and partial success was defined as symptom resolution with either total cyst ablation or greater than 70% reduction, respectively. Failure was defined as 30% of cyst size recurrence and/or persistent symptoms. RESULTS: Average reduction was 93.0%. Complete and partial resolution occurred in 11 (44.0%) and 13 (52.0%) cysts, respectively. One case was defined as failure, with a 64.2% size reduction from 10.9cm to 3.9cm (volume reduction rate 95.4%). Renal pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 3 patients, 2 developed leukocytosis and 1 had mild fever (< 38.5 degrees C) following aspiration and sclerotherapy. Successful treatment was achieved with conservative measures and NSAID therapy. CONCLUSION: Percutaneous treatment of simple renal cysts with OK-432 sclerotherapy was found to be a safe, effective and minimally invasive procedure.
Treatment Outcome ; *Sclerotherapy/adverse effects ; Picibanil/*therapeutic use ; Middle Aged ; Male ; Kidney Diseases, Cystic/pathology/*therapy ; Humans ; Functional Laterality ; Female ; Aged ; Adult

BACKGROUND: Core hypothermia after the induction of general anesthesia results largely from core-to- peripheral redistribution of body heat and anesthetic-induced inhibition of tonic thermoregulatory vasoconstriction. Because most metabolic heat is lost via the skin surface, covering the skin surface with an insulator is a way of minimizing heat loss. We therefore evaluated core and peripheral temperature changes with and without wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia. METHODS: Eighty-five patients of ASA physical status 1 or 2 who underwent open abdominal surgery under general anesthesia were investigated in this study. They were randomly assigned based on wrapping of the lower extremity in cotton and elastic bandages (group 2, n = 37) or not (group 1, n = 48). Anesthesia in both groups was induced with propofol and maintained with enflurane and 50% nitrous oxide in oxygen. The temperatures of the nasopharynx, forehead, chest, back, palm and sole were measured before and 10, 30, 60, 90, 120, 150 and 180 min after induction. RESULTS: Core temperature decreased significantly after the induction of anesthesia in both groups (P <0.05), but no significant difference was found between the groups in terms of core, palm, back and forehead skin temperature changes. However, the core and chest temperatures of group 2 at 150 and 180 min after induction were significantly lower than those of group 1 (P <0.05), and sole temperature changes were significantly different between the groups (P <0.05). CONCLUSIONS: Wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia was not effective at preventing the core temperature from decreasing. It is possible that wrapping the lower extremity causes peripheral vasodilation before anesthesia, stimulating the barorecepter, and shifting the body core temperature threshold for hypothermia inducing peripheral vasoconstriction to lower the body core temperature.
Anesthesia ; Anesthesia, General* ; Body Temperature Regulation ; Compression Bandages ; Enflurane ; Forehead ; Hot Temperature ; Humans ; Hypothermia ; Lower Extremity* ; Nasopharynx ; Nitrous Oxide ; Oxygen ; Propofol ; Skin ; Skin Temperature ; Thorax ; Vasoconstriction ; Vasodilation

Venous air embolism(VAE) can occur by the entry of air into open veins, being facilitated if the operative field is above the level of the heart. Among the many diagnostic methods, precordial ultrasonic Doppler is currently the more sensitive. Thus we have attempted to define the incidence of VAE using this device. 103 ASA physical status 1 or 2 parturients undergoing Cesarean section with general anesthesia in 73 parturients and epidural anesthesia in 30 parturients were studied with the ultrasonic Doppler transducer placed parasternally over the 4th right intercostal space. Total incidence of venous emboli was 31%(32/103) during surgery. In some parturients, embolism occurred more than once during operation and leaded to total 45 episodes of venous emboli. The incidence of venous emboli was 26%(19/73 ) during general anesthesia and 43.3%(13/30 ) during epidural anesthesia. No statistical difference existed in the incidence of venous emboli detected related to the type of anesthesia. Among the 45 episodes of venous emboli, 19 episodes(42.2%) were detected during repair of the hysterotomy. As even small air bubbles in the circulation are potentially harmful especially in patent foramen ovale and emboli events may occur at risk cases involving profound hypovolemia, abruptio placenta, or placenta previa, clinically insignificant venous air emboli, although low, is still worrisome. Thus above the cases, the use of additional precordial Doppler monitoring may be considered during cesarean section to detect VAE promptly, efficiently.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Cesarean Section* ; Embolism ; Embolism, Air* ; Female ; Foramen Ovale, Patent ; Heart ; Hypovolemia ; Hysterotomy ; Incidence* ; Placenta ; Placenta Previa ; Pregnancy ; Transducers ; Ultrasonics* ; Veins

BACKGROUND: Although used for obtund pain, bupivacaine may itself initially produce pain on injection. This study was designed to evaluate the effect of diluting bupivacaine with normal saline, lactated Ringer's solution, 5% dextrous in water and distilled water on perception of pain associated with intramuscular injection. METHODS: Twenty-five healthy volunteers were involved in this study. Each subject received 4 injections in random order: 0.25% bupivacaine in normal saline, lactated Ringer's solution, 5% dextrous in water and distilled water. Both upper trapezius muscles were used for the intramuscular injection site. Needle size (25-gauge), injection depth (1.5-2 cm), injection volume (2.5 ml), administration speed (0.5 ml/sec), and temperature (room) were controlled for each of the four injections. The intensity of pain was rated on a 0 to 10 visual analogue scale (VAS) score at the point of needle insertion and injecting solutions. RESULTS: There was no statistical difference among each solution in VAS score. However, the VAS scores of drug administration were higher than those of needle insertion in all diluting solutions (P<0.05). CONCLUSIONS: There was no difference in the intensity of pain of an intramuscular injection of bupivacaine between four different kinds of solutions. However, it might be suggested that more effort and investigation will be needed to reduce pain with an intramuscular injection.
Bupivacaine* ; Healthy Volunteers ; Injections, Intramuscular* ; Needles ; Superficial Back Muscles ; Water

BACKGROUND AND OBJECTIVES: Fibroblasts play an indirectly augmenting effector role in allergic inflammatory response by releasing different proinflammatory cytokines, including RANTES, GM-CSF, IL-8 after stimulation by other inflammatory cytokines such as IFN-gamma, TNF-alpha. The aim of this study was to investigate expression of RANTES in allergic and non-allergic nasal fibroblasts after stimulation with IFN-gamma and TNF-alpha, and to study the effect of dexamethasone on the RANTES expression of nasal fibroblast cell. MATERIALS AND METHODS: Using the 3rd passage of fibroblasts taken from the inferior turbinates of allergic and non-allergic patients, we evaluated the RANTES expression of fibroblasts after the IFN-gamma, TNF-alpha stimulation in the presence or in the absence of dexamethasone by ELISA. RESULTS: The expression of RANTES in allergic nasal fibroblasts stimulated by cytokines was stronger than in non-allergic nasal fibroblasts stimulated by cytokines. And dexamethasone suppressed the RANTES expression in allergic nasal fibroblasts stimulated by IFN-gamma. However, dexamethasone did not affect the RANTES expression in allergic fibroblasts stimulated by TNF-alpha and non-allergic fibroblasts stimulated by IFN-gamma and TNF-alpha. CONCLUSION: This study shows different responses of the RANTES production in nasal fibroblasts to dexamethasone, perhaps reflecting heterogeneity of nasal fibroblasts.
Chemokine CCL5* ; Cytokines ; Dexamethasone* ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-8 ; Population Characteristics ; Tumor Necrosis Factor-alpha ; Turbinates

BACKGROUND: Protection against ischemia-reperfusion injury is crucial for successful transplantation of the lung. It has been known that nitric oxide has many favorable effects on the donor lungs but at the same time, has some potential side effects of cytotoxicity. In this regards, we investigated whether the administration of nitroglycerin could decrease ischemia-reperfusion injury in isolated rat lung reperfusion model for the confirmation of the effect of nitroglycerin, a donor of nitric oxide, on lung transplantation. MATERIAL AND METHOD: 35 Sprague-Dawley species male white rats were used for this experiment. For nitroglycerin group (n=18), nitroglycerin was administered intravenously followed by mixed in flushing solution for preservation. As a control group (n=17), we used the same amount of normal saline. To evaluate the effect of nitroglycerin on the lung, heart-lung block was obtained, weighed and stored in University of Wisconsin Solution at 10oC for 24 hours. In each group of the isolated lungs, reperfusion was carried out with Krebs-Hensleit-diluted human blood for 60 minutes. As parameters of the state of the isolated lung, peak inspiratory and pulmonary arterial pressures were continuously recorded. Oxygen and carbon dioxide tension of reperfusing blood were measured before and after 30, 60 minutes of reperfusion. After sixty minutes of reperfusion, protein content in bronchoalveolar lavage fluid was measured also for the evaluation of the degree of alveolar flooding. Lung myeloperoxidase activity was determined to verify the accumulation of neutrophils. RESULTS: Although statistically significant differences were not noted in peak inspiratory and pulmonary arterial pressure between control and nitroglycerin group, latter group showed lowering tendency of pulmonary arterial pressure during the entire reperfusion period. Oxygen tension was higher (p<0.05) in nitroglycerin group compared with that of the control group, in contrast, there were no differences in carbon dioxide tension, protein content in bronchoalveolar lavage fluid and myeloperoxidase activity between the groups. In the examination of ultrastructural changes, nitroglycerin denoted the protective effect on the pulmonary architecture compared with that of control group. CONCLUSION: Collectively, on the bases of these experimental results, prior treatment of donor lung with nitroglycerin could result in better preservation of the lung. Consequently, these nitroglycerin preserved lungs are thought to be more suitable for successful transplantation of the lung.
Animals ; Arterial Pressure ; Bronchoalveolar Lavage Fluid ; Carbon Dioxide ; Flushing ; Humans ; Lung Transplantation ; Lung* ; Male ; Neutrophils ; Nitric Oxide ; Nitroglycerin* ; Organ Preservation ; Oxygen ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Wisconsin