Gastric emptying in patients after several upper gastrointestinal surgeries was studied using the acetaminophen method. The subjects consisted of 23 gastric cancer patients, 2 duodenal ulcer patients, 5 periampullary cancer patients and 4 normal subjects. As an indicator of the gastric emptying rate, the serum acetaminophen concentration was measured by fluorescence polarization immunoassay, in units of g/ml, at 0, 30, 60, 120, and 180 minutes after ingestion of a liquid meal with 1.5 g of acetaminophen. In the normal subjects, the acetaminophen concentrations were 0, 16.35+/-5.06, 18.71+/-5.58, 16.38+/-4.82, and 11.09+/-3.62 g/ml at time 0, 30, 60, 120, and 180 min, respectively. The concentration peaked at 60 min after ingestion of the test meal in the normal subjects. We observed significant delayed gastric emptying after pancreas preserving pancreaticoduodenectomy (PPPD) and a standard Whipple's operation in the early postoperative period. In all patients with a subtotal gastrectomy, a truncal vagotomy was done. However, in patients with a pancreaticoduodenectomy, the vagus nerves were preserved. The gastric emptying pattern was different between the patients with a subtotal gastrectomy and the patients with a pancreaticoduodenectomy, despite similar reconstructions of the gastroenterostomy (Billroth I or Billroth II type reconstruction). There was more rapid gastric emptying in patients with a truncal vagotomy and pyloroplasty than in the normal subjects. Hence, we speculate that the truncal vagotomy was the main cause of the different gastric emptying between the patients with a pancreaticoduodenectomy and the patients with a subtotal gastrectomy.
Acetaminophen* ; Duodenal Ulcer ; Eating ; Fluorescence Polarization Immunoassay ; Gastrectomy ; Gastric Emptying* ; Gastroenterostomy ; Humans ; Meals ; Pancreas ; Pancreaticoduodenectomy ; Postoperative Period ; Stomach Neoplasms ; Vagotomy, Truncal ; Vagus Nerve

STUDY OBJECTIVE: determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a religious mass gathered ceremony. DESIGN: Standard charts and a four-tiered triage system(minor, moderate, urgent, and emergent) were developed before the event. The triage system was applied to each chart retrospectively by a single emergency physician. SETTING: Medical staff(10 physicians,13 nurses,1 pharmacist, and 54 first-aid attendants) were based in 8 advanced life support (ALS) clinics. INTERVENTIONS: First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue. Three ambulances were stationed at the venues. RESULT: 22 trauma patients were developed and 183 medical complaints were encountered. Only 7 urgent medical problems were encountered.
Ambulances ; Emergencies* ; Humans ; Pharmacists ; Retrospective Studies ; Triage

Hepatocyte growth factor (HGF) is a glycoprotein secreted from stromal fibroblasts which bind to the transmembrane Met receptor. This receptor is expressed from a variety of tumors, including gastric carcinomas. To look for a possible paracrine loop between gastric cancer cells and their surrounding fibroblasts in a gastric carcinoma, the effect of HGF on the morphology and expression of the cell- adhesion molecule E-cadherin was examined using fifty resected gastric carcinomas. The expression of Met and E-cadherin in primary gastric carcinoma was examined using immunohistochemical staining. The level of HGF in the tumor extracts was determined by using an Immunis HGF EIA kit (Institute of Immunology). The levels of HGF in the tumor extracts correlated significantly with the progression of the tumor stage (p<0.05). The mean level of HGF was significantly higher in the tumors of an undifferentiated type than in those of a differentiated type (p<0.05). Eighty-two percent (82%) of the tumors showed increased Met expression, but no significant correlation was found between Met expression and tumor progression or differentiation. Twenty-six (52%) tumors revealed a preserved E-cadherin expression similar to that of a normal gastric mucosa. Abnormal E-cadherin expression was found in twenty-four tumors (48%). There was a significant correlation between the degree of E-cadherin expression and the progression and differentiation of the tumor. The level of HGF in a tumor with cytoplasmic E-cadherin expression was significantly higher than that with membranous E-cadherin expression. In conclusion : we can conclude that HGF has the ability to modulate E-cadherin expression and induce intracellular translocation of E-cadherin in gastric carcinomas.
Cadherins* ; Cytoplasm ; Fibroblasts ; Gastric Mucosa ; Glycoproteins ; Hepatocyte Growth Factor ; Stomach Neoplasms

BACKGROUND: Hepatocyte growth factor (HGF) was first identified as a potent stimulator of hepatocyte growth. Later, it was shown that HGF can promote cell motility and cell proliferation in tumor cells as well as in endothelial cells. To look for the significance of HGF in patients with gastric cancer, we measured the serum levels of HGF in gastric cancer patients and followed the levels of HGF after resection of the tumors. METHODS: The serum levels of HGF were determined by using an Immunis HGF ELISA kit. The serum levels of CEA, CA125, and CA19-9 in the same serum sample were examined using the ELISA method. RESULTS: The mean levels of serum HGF in 212 healthy control subjects, 105 patients with primary gastric cancer, 54 patients after resections of the tumors, and 13 patients with recurrent gastric cancer were 0.20 +/- 0.07 ng/ml, 0.33 +/- 0.26 ng/ml, 0.20 +/- 0.19 ng/ml, and 0.58 +/- 0.26 ng/ml respectively. Of the 105 patients with primary gastric cancer, 35 (33.3%) showed an abnormal increase in the serum level of HGF. The increased HGF levels were significantly associated with the degree of tumor invasion, nodal metastasis, distant metastasis and stage. Also the HGF levels increased significantly with increasing tumor size. The HGF levels decreased to normal levels by one month after the resections of the tumors. The HGF levels in recurrent gastric cancer patients were significantly higher than those of nonrecurrent patients after resections of the tumors. Among several tumor markers including CEA, CA125, and CA19-9, HGF was revealed to be the one most correlated with the occurrence of gastric cancer. CONCLUSION: The serum levels of HGF were significantly correlated with the aggressiveness of the tumors, suggesting that HGF might play an important role in the tumor progression of gastric cancer. Furthermore, serum HGF levels should be studied as a tumor marker in patients with gastric cancer.
Biomarkers, Tumor ; Cell Movement ; Cell Proliferation ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Hepatocyte Growth Factor* ; Hepatocytes* ; Humans ; Neoplasm Metastasis ; Stomach Neoplasms*

PURPOSE: Hepatocyte growth factor (HGF) is a modulator of epithelial cell proliferation and motility. In this study, we measured the level of HGF in sera and tumor extracts of gastric adenocarcinoma using an enzyme-linked immunoassay and evaluated its association with tumor progression. MATERIALS AND METHODS: The level of HGF in the sera of seventy-five patients with gastric adenocarcinoma and in the tumor extracts of forty-two tumors were examined in this study. The level of HGF was determined by an Immunis HGF EIA kit (Institute of Immunology). RESULTS: The mean level of HGF in the sera of patients was 0.26+/-0.19 ng/ml, which was significantly higher than in those of healthy controls (0.14+/-0.07 ng/ml, p<0.05); the levels of HGF in the sera of patients increased according to the progression of the stage of cancer (p<0.05). The mean level of HGF in tumor extracts was 8.22+/-9.27 microgram/g protein, which was significantly higher than in those of healthy controls (1.95+/-1.45 microgram/g protein, p<0.05); the levels of HGF in the tumor extracts were correlated significantly with the progression of the tumor stage (p<0.05). The mean level of HGF in the tumors of diffuse type was 11.28+/-11.74 microgram/g protein, which was significantly higher than in those of intestinal type (5.16+/-4.31 microgram/g protein, p<0.05). CONCLUSION: HGF may play an important role in the progression and differentiation of gastric adenocarcinoma.
Adenocarcinoma* ; Epithelial Cells ; Hepatocyte Growth Factor* ; Hepatocytes* ; Humans ; Immunoassay

PURPOSE: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS: After the 2-year postoperative period, the mean range of motion was 131degrees in the CR-Flex group and 133degrees in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2+/-9.1 points) than in the PS-Flex group (11.9+/-9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.
Aged ; Arthroplasty, Replacement, Knee/*methods ; Female ; Humans ; Knee Prosthesis ; Middle Aged ; Posterior Cruciate Ligament/*surgery ; Postoperative Period ; Range of Motion, Articular/*physiology ; Recovery of Function/physiology ; Treatment Outcome

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.
Aneurysm, Infected ; Humans ; Iliac Artery ; Rupture ; Transplants

PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.
Compliance* ; Counseling ; Education ; Erectile Dysfunction ; Humans ; Male ; Prescriptions ; Sexual Behavior ; Telephone ; Sildenafil Citrate

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.
Absorption ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Laparoscopy ; Oxygen ; Pulmonary Gas Exchange* ; Urinary Bladder ; Ventilation ; Vital Signs*

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.
Absorption ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Laparoscopy ; Oxygen ; Pulmonary Gas Exchange* ; Urinary Bladder ; Ventilation ; Vital Signs*