Fourtyone patients fo gallbladder and bile duct diseases were studied clinically and sonographically.Tweentynine (Seventyone percent) patients were distributed between age fourty to fiftynine and male to femaleratio was 1:1.4. The order of frequency of biliary tract disease was cholelithiasis, acalculous cholecystitis, CBDstone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faintinternal echoes without shadowing, gallbladder wall thickneing and anechoicity of the gallbladder wall. Instead ofsmall proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seenin ten of nineteen cases of cholelithiasis. On choledocholithiasis, meniscus sign at the junction of the stone andgallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degreeof CBD dilatation was more severe in malignancy than in CBD stones and ascaris in CBD. Sonographic examination wasuseful in detection of gallbladder and bilicary tree pathology and the cause of biliary tract obstruction could beidentified.
Acalculous Cholecystitis ; Ascaris ; Bile Duct Diseases ; Biliary Tract Diseases ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Gallbladder ; Humans ; Male ; Pathology ; Shadowing (Histology) ; Trees ; Ultrasonography

In this paper, we present some results from an experimental web-based Problem-Based Learning(PBL) course, which was offered to 64 medical students in the first grade at Konkuk university for 7 weeks. For the course, we developed a web-based PBL module, which is composed of three sections. The first section includes the 8 stages of problem probing and solving in patient's care. In every stage, the students can browse all the data for the problem solving. The second section contains some problems for evaluating the academic achievement of the students who successfully passed in the first section. In the third section, some questionnaires are presented to survey the students response. The followings are the results. 1. Average score of the first section was 64.1+/-13.2. Most students participated in the course with integrity, and especially seven students(11%) were remarkable in their clinical reasoning. 2.The student's computer skill did not largely affect their academic achievements. However, it is desirable for the students to learn basic computer usage in advance. 3.A few students attended to the discussion through bulletin board facilities. Considering the importance of discussion in PBL, we need to devise a new way of attracting students in the discussion. 4. The survey showed that sixty five percent of the students thought that the lecture was effective and ninety one percent of them that it would be better if it is offered as a regular course during summer or winter vacations. Seventy five percent of students became to realize the importance of basic sciences such as biochemistry and physiology after this course. 5. There were many students who complained about the malfunctioning of the system. The system should be modified to be more reliable and robust. In conclusion, the web-based PBL course provided an effective way of learning in medical education. It also turned out to be used as an alternative of traditional PBL and especially useful for self study.
Biochemistry ; Education, Medical ; Humans ; Learning ; Physiology ; Problem Solving ; Problem-Based Learning* ; Students, Medical ; Surveys and Questionnaires

PURPOSE: Anatomy and morphology of superficial veins vary from patient to patient. Thorough assessment of variations is mandatory for successful treatment of primary varicose vein. Alos in complex case clinical examination alone is unable to achieve diagnostic goals. Duplex scan is a highly accurate, noninvasive technique that can provide both anatomic and physiologic information. METHODS: Thirty-eight legs in 30 patients with primary varicose veins were examined clinically first then with portable doppler. Patients then underwent duplex scanning by surgical team and results of tests were compared with other clinical examinations. RESULTS: On duplex scanning, 25 legs (66%) had saphenofemoral junction (SFJ) incompetence, 9 legs (24%) had saphenopopliteal junction (SPJ) incompetence and 4 legs (10%) had perforator incompetence. The respective sensitivity of clinical examination with portable doppler in SFJ, SPJ was 91.6%, 81.8%. CONCLUSION: Clinical and doppler assessment was unreliable. Routine preoperative duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.
Humans ; Leg ; Recurrence ; Varicose Veins* ; Veins

PURPOSE: Gallstone disease has been presumed to be a sequellae of gastrectomy. To know correlation between gallbladder disease and gastrectomy, we check anatomical and functional status of gallbladder with ultrasonogram in our study. METHODS: Gallbladder motility after gastrectomy was studied by means of measuring fasting and postprandial gallbladder volume using real time ultrasonography in 50 gastrectomized patients and in 28 controls (healthy but not operated gastric cancer patients) were selected as study subjects. RESULTS: Mean fasting and postprandial gallbladder volume was significantly increased in gastrectomized patient group (FV: 37.63+/-20.70 ml, PV: 11.50+/-10.26 ml) than control group (FV: 22.17+/-10.35 ml, PV: 5.44+/-3.67 ml, p<0.01). The ejection fraction of gallbladder in gastrectomized patient group (69.05+/-14.57%)was significantly smaller than control group (75.57+/-10.26%, p<0.05). CONCLUSION: The risk of gallbladder disease was independent of age, sex, and post-operative duration in our study. Gastrectomy may have the possibility of increasing the risk of gallbladder disease by causing gallbladder dysmotility and bile stasis. So, gallbladder motility evaluation would be helpful for prevention and understanding gallstone formation. Further study will be needed about the clinical benefits of prophylactic cholecystectomy during gastrectomy.
Bile ; Cholecystectomy ; Fasting ; Gallbladder Diseases ; Gallbladder* ; Gallstones* ; Gastrectomy* ; Humans ; Stomach Neoplasms* ; Ultrasonography

BACKGROUND: COPA (cuffed oropharyngeal airway) is a convenient device for airway management in patients undergoing general anesthesia for elective surgery in supine position. It causes less pharyngeal trauma than LMA (Laryngeal mask airway). The purpose of this study was to compare the effect of COPA with and without muscle relaxant. METHODS: Forty patients with ASA physical status I and II for elective surgery were randomly assigned to two groups. Anaesthesia was induced with propofol (2 mg/kg) and vecuronium (1.5 mg/kg) and was administered intravenously in Group I but not in Group II. Mask ventilation was done for 5 min with O2 5 L/min. COPA was placed and heart rate, and systolic, mean, diastolic blood pressure and peak inspiratory pressure were measured at 1 min interval for 5 min. Anaesthesia was maintained with propofol 150 microgram/kg/min, fentanyl 1 microgram/kg/hr, O2 2 L/min and N2O 2 L/min. RESULTS: There were no significant differences between Group I and Group II in heart rate, systolic, mean and diastolic blood pressure. PIP (Peak inspiratory pressure) was increased and hiccups occurred significantly (p < 0.05) in Group II. Complete airway obstruction occurred in one patient of Group I and severe coughing, body movements and gagging occurred during induction and insertion in Group II. CONCLUSIONS: With the use of appropriate muscle relaxant, we can use COPA without increased inspiratory pressure or significant complication.
Airway Management ; Airway Obstruction ; Anesthesia, General ; Blood Pressure ; Cough ; Fentanyl ; Gagging ; Heart Rate ; Hiccup ; Humans ; Masks ; Propofol ; Supine Position ; Vecuronium Bromide ; Ventilation

BACKGROUND: We designed this study to evaluate the antinociceptive effect and changes in amounts of substance P in the spinal cord after perineural application of capsaicin to the injured nerve in rats in neuropathic pain. METHODS: Male Sprague-Dawley rats (200-250 g) were prepared with the tight ligation of the left L5, 6 spinal nerves or with the sham operation. They were divided into 3 groups according to the solution treated to the left sciatic nerve and pre-treated condition, group I (capsaicin treatment after ligation; n = 10), group II (solvent treatment after ligation; n = 10), group III (capsaicin treatment after sham operation; n = 10). The withdrawal threshold to touch with von Frey filaments and the withdrawal time to thermal stimulus by plantar tester were measured and percent maximum possible effects (%MPE) were calculated, respectively, at 1, 2, 3 and 4 weeks after treatment. The area and integrity optical density (IOP) of substance P stained immunohistochemically in the lumbar dorsal horn were quantified with an image analyzer in group I. RESULTS: In the capsaicin-treated groups (I, III), withdrawal time to thermal stimulus was prolonged significantly during the 4 weeks as compared with baseline values before treatment (P < 0.05), but withdrawal time to touch didn't change. The %MPE of capsaicin to thermal stimulus in group I was significantly higher than that in group III (P < 0.05). In group II, withdrawal responses to touch and thermal stimulus didn't change. The area and IOP of substance P in the left lumbar dorsal horn at the 1st and 4th week didn't change, compared with the baseline before capsaicin treatment, except for theIOP at the 4th week in group I. CONCLUSIONS: Perineural application of capsaicin to the injured nerve in neuropathic rats does not inhibit hypersensitivity to touch but inhibit reaction to thermal stimulus. Its effect does not depend on the changes in amounts of substance P in the ipsilateral lumbar dorsal horn.
Animals ; Capsaicin* ; Horns ; Humans ; Hypersensitivity ; Ligation ; Male ; Neuralgia ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve ; Spinal Cord ; Spinal Nerves ; Substance P

BACKGROUND/AIMS: Oxidative stress may contribute to gastric epithelial damage and mutagenesis caused by Helicobacter pylori (H. pylori). H. pylori induces recruitment and activation of inflammatory cells, which produces reactive oxygen species. H. pylori extract directly induces the synthesis of reactive oxygen species in gastric epithelial cells and causes DNA damage. The aim of this study was to investigate the association between the levels of glutathione (GSH) and H. pylori density, histological findings, endoscopic findings, clinical variables, and virulence factors. METHODS: Gastric biopsy specimens were obtained from 73 consecutive patients. The 5,5'-dithiobis-(2-nitrobenzoic acid) reaction was used to determine GSH levels. RESULTS: The infection rate of H. pylori was 68.5%. The GSH level was not related to age, sex, alcohol intake, and endoscopic findings. The GSH level was lower in patients infected with H. pylori. GSH levels were not correlated significantly with the grades of neutrophil, intestinal metaplasia, and atrophy. However, the GSH levels were significantly correlated with H. pylori density (r=-0.296, p=0.01) and monocyte grade (r=-0.257, p=0.02). The GSH levels were not related to CagA, VacA, and UreA. CONCLUSIONS: This study suggests that H. pylori causes oxidative stresses which deplete GSH in gastric mucosa of patients infected with H. pylori.
Adolescent ; Adult ; Aged ; Female ; Gastric Mucosa/*metabolism/pathology ; Glutathione/*metabolism ; Helicobacter Infections/*metabolism/pathology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Stomach Diseases/*metabolism/microbiology/pathology

BACKGROUND/AIMS: Oxidative stress may contribute to gastric epithelial damage and mutagenesis caused by Helicobacter pylori (H. pylori). H. pylori induces recruitment and activation of inflammatory cells, which produces reactive oxygen species. H. pylori extract directly induces the synthesis of reactive oxygen species in gastric epithelial cells and causes DNA damage. The aim of this study was to investigate the association between the levels of glutathione (GSH) and H. pylori density, histological findings, endoscopic findings, clinical variables, and virulence factors. METHODS: Gastric biopsy specimens were obtained from 73 consecutive patients. The 5,5'-dithiobis-(2-nitrobenzoic acid) reaction was used to determine GSH levels. RESULTS: The infection rate of H. pylori was 68.5%. The GSH level was not related to age, sex, alcohol intake, and endoscopic findings. The GSH level was lower in patients infected with H. pylori. GSH levels were not correlated significantly with the grades of neutrophil, intestinal metaplasia, and atrophy. However, the GSH levels were significantly correlated with H. pylori density (r=-0.296, p=0.01) and monocyte grade (r=-0.257, p=0.02). The GSH levels were not related to CagA, VacA, and UreA. CONCLUSIONS: This study suggests that H. pylori causes oxidative stresses which deplete GSH in gastric mucosa of patients infected with H. pylori.
Adolescent ; Adult ; Aged ; Female ; Gastric Mucosa/*metabolism/pathology ; Glutathione/*metabolism ; Helicobacter Infections/*metabolism/pathology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Stomach Diseases/*metabolism/microbiology/pathology

We performed three kinds of problem-based learning (PBL) formulas in all of forty-one 3rd grade students after the final examination of the first semester from June 28, 1999 to July 9, 1999 at Konkuk University College of Medicine to investigate which formula is the most efficient and helpful in medical education and polyclinic course. The PBL formulas applied were the typical face-to-face PBL accompanied by mini-lecture (Type I) or by distribution of the guidelines without lecture (Type II) and cyber PBL using web-based module and discussion over cyber space (Type III). Response of students was surveyed using some questionnaires and the evaluation results of each PBL were analyzed with Pearson's correlation test. All participating students were satisfied with the face-to-face PBL especially in applying time of PBL, using discussion to solve the problem, and studying with tutors. In cyber PBL, in spite of excellency of the contents, limitations in discussion over cyber space and computer skills, misunderstanding of computer system, and additional cost for private PC rent seemed to decrease the satisfaction with this PBL. Experience in Type II PBL was turned out to be the most helpful and discussion among fellow students in PBL to be the most useful experience for incoming polyclinic course. There were no significant correlations between the evaluation results of face-to-face PBL and cyber PBL or between the evaluation results of each type of PBL and the average credit of that semester, suggesting that evaluation of the newly acquired knowledge through PBL using tools such as Triple Jump, OSCE (objective structured clinical examination), and MEQ (modified essay question) should be included in assesment of academic achievement in addition to the evaluation of activities during PBL.
Computer Systems ; Education, Medical ; Equidae ; Humans ; Problem-Based Learning* ; Surveys and Questionnaires

Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion.
Adenocarcinoma, Papillary* ; Adenoma* ; Biliary Tract ; Biopsy ; Dilatation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucins ; Papilloma ; Recurrence ; Tomography, X-Ray Computed