Although our present knowledge of the etiology of peptic ulcer is incomplete, the presence or absence of peptic ulcer is determined by the delicate interplay between aggressive factors (secreted gastric acid and pepsin) and defensive factors (mucosal resistance). Peptic ulcer is produced when the aggressive effects of acid-pepsin dominate the protective effects of gastric or duodenal mucosal resistance by predominance of aggressive factors or interruption of defensive factors. KU-54 enhances mucosal resistance to tissue injury by the increase of gastric mucosal blood flow, the stimulation of gastric mucosal metabolism, the increase of glycoprotein of gastric mucus, and the increase of ATP of gastric mucosa. We have treated 38 cases of gastric ulcers with KU-54 300 mg daily for 4-12 weeks for the evaluation of the therapeutic efficacy. Endoscopic, clinical, and laboratory assessments were undergone before and after 4 ~ 12 weeks of the treatment. Major symptoms of gastric ulcer have been improved in 83.3% after the medication with KU-54. The healing rate of gastric ulcer evaluated by endoscopy was observed in 33.3% after 4 weeks, 73.3% after 8 weeks, 76.6% after 12 weeks of the medication with KU-54. The utility rate of KU-54 was 86.7%. We could conclude that KU-54 is the utilizable drug for gastric ulcer.
Adenosine Triphosphate ; Endoscopy ; Gastric Acid ; Gastric Mucosa ; Glycoproteins ; Metabolism ; Mucus ; Peptic Ulcer ; Stomach Ulcer*

Acid ingestion causes a coagulative necrosis of the surface epithelium of the upper gastromtestinal tract. Its late sequence is luminal stenosis which frequently requires surgical repair. Nevertherless, in many cases, non-operative dilatation of luminal stenosis have been applicated, such as bouginations, balloon dilatations, endoscopic laser therapy, endoscopic electrocoagulation, endescopic microwave coagulation. These methods may give some considerable benefits in unoperable cases. Recently, we experienced a case of a 60-year-old man who had severe corrosive esophageal and gastric angular strictures by accidentally ingested hydrochloric acid and after many tiems of application of non-operative dilatation was able to have normal diet without dysphagia. So, we report this case with a review of literatures.
Constriction, Pathologic* ; Deglutition Disorders ; Diet ; Dilatation* ; Eating ; Electrocoagulation ; Epithelium ; Humans ; Hydrochloric Acid ; Laser Therapy ; Microwaves ; Middle Aged ; Necrosis ; Phenobarbital

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.
Bile ; Bile Ducts ; Bilirubin ; Cholangitis ; Decompression ; Diagnosis ; Drainage* ; Jaundice, Obstructive ; Pancreatitis ; Parasites

No abstract available.
Animals* ; Hypertension, Portal* ; Models, Animal*

PURPOSE: This study focused on in vitro cell differentiation and surface characteristics in a magnesium coated titanium surface implanted on using a plasma ion source. MATERIALS AND METHODS: 40 commercially made pure titanium discs were prepared to produce Ti oxide machined surface (M) and Mg-incorporated Ti oxide machined surface (MM). Surface properties were analyzed using a scanning electron microscopy (SEM). On each surface, alkaline phosphatase (ALP) activity, alizarin red S staining for mineralization of MC3T3-E1 cells, and quantitative analysis of osteoblastic gene expression, were evaluated. Actin ring formation assay and gene expression analysis of TRAP and GAPDH performing RT-PCR were performed to characterize osteoclast differentiation on mouse bone marrow-derived macrophages (BMMs). RESULTS: MM showed similar surface morphology and surface roughness with M, but was slightly smoother after ion implantation at the micron scale. M was more hydrophobic than MM. No significant difference between surfaces on ALP activity at 7 and 14 days were observed. Real-time PCR analyses showed similar levels of mRNA expression of the osteoblast phenotype genes; osteopontin (OPN), osteocalcin (OCN), bone sialoprotein (BSP), and collagen 1 (Col 1) in cell grown on MM at 7, 14 and 21 days. Alizarin red S staining at 21 days showed no significant difference. BMMs differentiation increased in M and MM. Actin ring formation assay and gene expression analysis of TRAP showed osteoclast differentiation to be more active on MM. CONCLUSION: Both M and MM have a good effect on osteoblastic cell differentiation, but MM may speed the bone remodeling process by activating on osteoclast differentiation.
Actins ; Alkaline Phosphatase ; Animals ; Bone Remodeling ; Cell Differentiation ; Collagen ; Gene Expression ; Integrin-Binding Sialoprotein ; Macrophages ; Magnesium* ; Mice ; Microscopy, Electron, Scanning ; Osteoblasts* ; Osteocalcin ; Osteoclasts* ; Osteopontin ; Phenotype ; Plasma ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Surface Properties ; Titanium*

Recently the syndrome of mitral valve prolapse with associated auscultatory and other clinical findings has generated considerable interest. Although this syndrome was originally described as benign, more recent observations have demonstrated that the patients are subject to sudden death, life threatening arrhythmias, bacterial endocarditis or hemodynamically significant mitral regurgitation. It is therefore important to identify such patients so that appropriate antibiotic prophylaxis and antiarrhythmic therapy may be instituted. Since earlier reports of this syndrome by Barlow et al. in 1963, various names or descriptions have been applied to the condition based upon pathologic findings, on cinical investigators has stressed different aspects of the entity. Now it is well known that the syndrome is no longer a benign condition. We have recently had the opportunity to study 15 cases of mitral valve prolapse, which was confirmed by left ventricular cineangiography. Among them 9 cases had associated other cardiac anomalies, most frequently secundum type of atrial septal defect. Among 15 cases 8 were female and the ages ranged from 20 to 52. Selective cine-coronary arteriography was also performed in 2 cases who complained of severe chest pain. We discussed generally the clinical features including hemodynamic and angiocardiographic findings, and pertinent literature published until recently were reviewed.
Female ; Humans

No abstract available.

Death by drowning is a major cause of unnatural death worldwide. It is therefore important to conduct forensic examination of immersed bodies following drowning, in order to determine the diagnosis of drowning, because no specific methods have been established thus far. Therefore, we performed a series of rat experiments to compare autopsy findings between seawater and fresh water drowning cases, which included the presence of pleural effusion and histologic findings of the lung. The results showed that the volume of pleural effusion increased in the seawater drowning group compared to the fresh water drowning group, and the total weight of lung was affected by the type of drowning medium and postmortem interval. However, histologic findings of the lung showed no significant difference between the 2 types of drowning mediums.
Animals ; Autopsy ; Drowning ; Fresh Water ; Lung ; Pleural Effusion ; Rats ; Seawater

Electrocardiography has been long an important tool in cardiac diagnosis and, with advances in electrocardiography, the accuracy of the electrocardiographic diagnosis has been greatly increased. Though the most accurate methods for quantitative diagnosis of mitral valvular disease are cardiac catheterization and ventriculography, these procedures are time consuming, expensive, and not without risk, thus, it would be helpful if routine catheterization of the heart could be avoided in patients who are potential condidates for mitral valvulotomy. This could be done if reliable electrocardiographic criteria could be found for estimating the amount of obstrcution and leak at the mitral valve. As mitral valvular dysfunction progress, changes (hypertrophy and/or dilation) in the left atrium and both ventricles are inevitable. Many authors attempted to characterize the electrocardiographic findings of such changes according to the specific lesion of the mitral valve. In addition to atrial fibrillation, characteristic P wave changes and their diagnostic significance have been reported (Macruz et al., 1958; Arevalo et al., 1963: Morris et al., 1964). The diagnostic importance of QRS voltage difference in precordial leads has been stressed in the differential diagnosis of specific lesions of mitral valvular disease (Janton et al., 1954: Bateman and January, 1955: Wierum and Glenn, 1957: Bentivoglio et al., 1958: Imperial et al., 1960). Semle and Pruitt(1960) reported that a mean QRS electrical axis of +91degrees or more degrees was the most frequent positive single index of increased total pulmonary resistance in mitral stenosis, and Fowler et al. (1955) stated that precordial lead V1 was very helpful in evaluating the degree of pulmonary hypertension. In Korea there are only a few reports on the electrocardiographic changes in mitral valvular disease and the correlation of electrocardiographic findings and hemodynamics (Oh et al., 1961: Kim, 1970: Kim, 1971). It would be evident that the various electrocardiographic findings noted in western races can't be applied to Koreans. The main objectives of this study are: 1. To determine the electrocardiographic characteristics of pure mitral valvular disease and the differentiation between the specific lesions of pure mitral stenosis, pure mitral insufficiency and combined lesions of mitral stenosis and insufficiency. 2. To know whether the characteristic electrocardiographic changes of mitral stenosis are directly related to the narrowed valve area or to the hemodynamic abnormalities secondary to obstruction. SUBJECTS AND METHODS: 139 cases of isolated mitral valvular disease were reviewed: of these 93 were cases of pure mitral stenosis, 18 were pure mitral insufficiency, and 28 were combined mitral stenosis and insufficiency. Of the total patients, 68 were male and 71 were female. The ages ranged from 10 to 54 years with an average of 35.6 years. Diagnosis was based on cardiac catheterization and supplemented by cienangiocardiography. The conventional 12 lead electrocardiogram was taken at normal sensitivity and at a paper speed of 25mm/sec. The mitral valve area was estimated according to the Gorlin's formula and cardiac output was determined by the direct Fick's principle. The electrocardiograms were analyzed with respect to: 1. Rhythm (atrial fibrillation and sinus rhythm) 2. Presence or absence of P-mitrale 3. Terminal P force in lead V1 (by the method of Morris et. al., 1964) 4. Mean QRS electrical axis in frontal plane 5. QRS voltage in percordial leads(V1S, V5R, V6R & V1S+V(5-6)R) 6. R/S ratio in lead V1 7. Conduction disturbance of right bundle branch block In patients with pure mitral stenosis the electrocardiographic findings of atrial fibrillation P-mitrale, terminal P force in lead V1 were correlated with the hemodynamic data of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure and mitral valve area. An attempt was made to ascertain whether or not a quantitative correlation could be found. A patient showing electrocardiographic pattern of right bundle branch block was excluded in the evaluation of QRS voltage in lead V1 and mean QRS electrical axis in frontal plane. RESULTS AND SUMMARY: 1. P wave abnormality, which was noted in most (131/139) cases, is apparently a characteristic and most frequent electrocardiographic finding in mitral valvular disease. Of the P weve abnormalities the development of atrial fibrillation and P-mitrale were thought to be related to the duration of the illness rather than to the types of lesion or hemodynamic abnormalities secondary to valvular dysfunction. However, the terminal P force in lead V1 was thought to be related to the mean pulmonary arterial wedge pressure rather than to narrowing of the valve. 2. 15 patients showed the electrocardiographic pattern of right bundle branch block. In patients with mitral stenosis this electrocardiographic pattern was noted at almost all levels of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure, mitral gradient and mitral valve area. 3. Mean QRS electrical axis and QRS voltage in precordial leads; There was no case which deviated leftward more than +30degrees even among cases with a predominant or pure mitral insufficiency. Although the difference of mean value in mean QRS electrical axis and QRS voltage in precordial leads according to the types of the lesion was significant, this difference was generally not helpful in the differential diagnosis in individual patients because of much overlapping among cases. 4. There was no definite electrocardiographic criteria to differentiate clearly the types of mitral valvular disease. However, the following aspects of electrocardiogram may be useful in differential diagnosis. a. Difference of QRS voltage in precordial leads: The volage of V1S and V1S+V(5-6)R in all patients with pure mitral insufficiency was over 1mm and 11mm respectively. That of V1S+V(5-6)R in all patients with pure mitral stenosis was below 39mm. b. R/S ratio in lead V1: There was no case showing "R wave only" in lead V1 among patients with pure or predominant mitral insufficiency. c. Mean QRS electrical axis in frontal plane: The mean QRS electrical axis of all patients with pure mitral stenosis deviated rightward more than +60degrees in all except one case. None of the patients with pure mitral insufficiency deviated rightward more than +110degrees. 5. Relationship between hemodynamics and electrocardiography in paitents with mitral stenosis: Among the hemodynamic abnormalities, mean pulmonary artery pressure showed a close relationship with the following aspects of the electrocardiogram. a. R/S ratio in lead V1:The mean value of mean pulmonary artery pressure (45.9+/-3.8mmHg) in groups showing R/S>1 was significantly elevated as compared with that (34.8+/-1.5mmHg) of groups showing R/Sdegrees1. b. Mean QRS electrical axis in frontal plane: There was a weak positive correlation (r=+0.53) between mean pulmonary artery prersure and QRS electrical axis in the frontal plane. The QRS axis of all patients with a mean pulmonary artery pressure of 41mmHg or more was +91degrees or more except for one case. c. Terminal P force in lead V1: The difference of mean value in mean pulmonary artery pressure according to the size of terminal P force in lead V1 was significant in all cases.
Atrial Fibrillation ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Catheterization ; Catheters ; Continental Population Groups ; Diagnosis ; Diagnosis, Differential ; Electrocardiography* ; Female ; Heart ; Heart Atria ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Korea ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Artery ; Pulmonary Wedge Pressure