Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. METHODS: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. RESULTS: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. CONCLUSIONS: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability.
Aminocaproic Acid ; Blood Platelets ; Fibrinolysis ; Heparin ; Humans ; Liver Transplantation* ; Liver* ; Plasma ; Platelet Transfusion ; Reaction Time ; Reperfusion ; Thrombelastography ; Transplantation

Recently, in Korea, imported malarial infections are increased and occasionally domestic infections are reported. But the malarial infected pregnant women are seldom cases and we have experienced second trimester infected one. She had no traveling and transfusion history. She delivered a healthy baby at term by repeated cesarean section and her baby had no evidence of congenital malarial infection. We treated her with hydroxychloroquine at antepartum and primaquine at postpartum. We present this case with a brief review of literatures.
Cesarean Section ; Female ; Humans ; Hydroxychloroquine ; Korea ; Malaria ; Postpartum Period ; Pregnancy Trimester, Second ; Pregnancy* ; Pregnant Women ; Primaquine

PURPOSE: The pro-inflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha), is a central mediator of the immune response involved in a wide range of immuno-inflammatory and infectious diseases. There is increasing evidence that TNF-alpha may promote the development and spread of the cancer. Polymorphisms in the TNF-alpha promoter have been related to TNF-alpha production. Therefore, we investigated the potential association of TNF-alpha genotypes with gastric cancer in the Korean population. METHODS: The study included 66 patients with gastric adenoma, 75 patients with gastric carcinoma, and 551 healthy controls. The -308 and -238 polymorphisms in the TNF-alpha promoter were analyzed by PCR- restriction fragment length polymorphism (RFLP). Distributions of TNF-alpha promoter polymorphisms were compared between groups by chi2 test. P values smaller than 0.05 were considered to be significant. RESULTS: The proportion of individuals carrying the TNF-alpha -308A allele was higher in the carcinoma group compared to controls and adenomas, but the differences were not significant (P=0.124). However, the TNF-alpha -308A allele was significantly associated with advanced gastric carcinoma (P=0.026), serosa invasion (P=0.004), neural invasion (P= 0.021), and lymph node metastasis (P=0.005). On the other hand, the TNF-alpha -238G/A polymorphism was not associated with the development of gastric adenoma and carcinoma and the severity of gastric carcinoma. CONCLUSION: These results suggest that the TNF-alpha -308A allele is associated with the severity of gastric carcinoma in terms of invasion and metastasis in the Korean population. Therefore, TNF-alpha promoter polymorphism could be used as a predictive marker of the severity of gastric carcinoma.
Adenoma ; Alleles ; Communicable Diseases ; Genotype ; Hand ; Humans ; Lymph Nodes ; Necrosis* ; Neoplasm Metastasis ; Polymorphism, Restriction Fragment Length ; Serous Membrane ; Stomach Neoplasms ; Tumor Necrosis Factor-alpha

PURPOSE: The aim of this study was to assess the short-term results of conventional open distal gastrectomy (ODG) and laparoscopy-assisted distal gastrectomy (LADG) in obese patients with early gastric cancer. METHODS: This study included 28 consecutive patients who underwent LADG and 33 patients who underwent ODG for early gastric cancer. The patients were divided into two groups: obese (body mass index, BMI> or =25) and non-obese (BMI<25). Patient characteristics, operative details, and postoperative outcomes were analyzed and compared between the two groups. RESULTS: The operation time was longer in LADG patients than in ODG patients. In the LADG group, the high BMI subset required significantly longer operative time than the low BMI subset. The number of retrieved lymph nodes, average perioperative hemoglobin concentration, serum albumin, first flatus, and postoperative WBC count were similar between the two groups. Regarding ODG patients, the mean perioperative decrease in hemoglobin concentration was significantly greater in the high BMI subset. The difference in operative time between the ODG/high BMI subset and the ODG/low BMI subset was not statistically significant. CONCLUSION: Obesity has differing effects on LADG and on ODG, and this should be considered when deciding what procedure to utilize in patients with early gastric cancer. Further research is needed to better elucidate the relationship between obesity and gastrectomy for early gastric cancer.
Flatulence ; Gastrectomy ; Hemoglobins ; Humans ; Lymph Nodes ; Obesity ; Operative Time ; Serum Albumin ; Stomach Neoplasms

PURPOSE: A technique of cerclage wire fixation in comminuted fracture of the clavicle shaft is thought to interfere the fracture healing, so authors studied radiographically and clinically about the cases of cerclage wiring of the fracture fragments with the plate and screws fixation in the comminuted fracture of the shaft of the clavicle. MATERIALS AND METHODS: According to following inclusion criteria, total 18 patients (male: 15, female: 3) were investigated; Patients who visited hospital due to clavicle shaft comminuted fracture from February 2005 to April 2009, who underwent surgery utilizing more than 2 cerclage wire fixation for the fragments when open reduction and plate fixation were operated and who could be follow-up over one year. The duration for fracture union, functional outcome and complications were investigated retrospectively. RESULTS: Radiological bone union was accomplished in average 13.3 weeks (12~16 weeks) and there was no complication such as nonunion, delayed union or infection. Range of motion of ipsilateral shoulder joint was recovered in all patients except one at the final follow-up. CONCLUSION: The clinical and radiographical results of the plate and screws fixation with cerclage wiring of the fragments in comminuted clavicle shaft fracture showed that the cerclage wiring does not interfere the fracture healing, so authors think that this method is a good alternative operation if it is performed carefully to minimize soft tissue dissection.
Clavicle ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Humans ; Range of Motion, Articular ; Shoulder Joint

OBJECTIVE: To evaluate the efficacy of color Doppler ultrasound in diagnosis and management of placenta previa with accreta. METHODS: Hospital records were reviewed all cases of placenta previa from December 1999 to June 2002, and seventy-four patients with placenta previa underwent color Doppler ultrasound in their second and third trimester. Four diagnostic criteria of placenta accreta were diffuse lacunar flow pattern, exhibiting diffusely dilated vascular channels throughout the whole placenta: focal lacunar flow pattern showing irregular sonolucent vascular lakes, regionally or focally within the intraparenchymal placental area: absence of subplacental vascular signals in the areas lacking the peripheral subplacental hypoechoic zone: interphase hypervascularity with abnormal blood vessels linking the placenta to the bladder. RESULTS: Twenty-four of the seventy-four patients diagnosed placenta previa with accreta according to the above criteria and thirteen of these have proven to placenta accreta histopathologically. In ten cases hysterectomy were done under the group of suspicious placenta accreta. The sensitivity, specificity, positive predictive value and negative predictive value were 100%, 83%, 56% and 100%. CONCLUSION: The color Doppler ultrasound was effective method for the diagnosis of placenta previa with accreta, so proper diagnosis will be helpful to management of placenta previa with accreta patients.
Blood Vessels ; Diagnosis* ; Female ; Hospital Records ; Humans ; Hysterectomy ; Interphase ; Lakes ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Third ; Sensitivity and Specificity ; Ultrasonography* ; Urinary Bladder

PURPOSE: The lack of reliable in vitro infection systems or convenient animal models has hindered the progress of hepatitis B virus (HBV) research and the development of new treatment options. We established an in vitro model of hepatitis B, using recombinant HBV encoding baculovirus, which provided HBV replication and antigens expression in HepG2 cells. The objectives of this study were to characterize the magnitude of HBV expression and the level of replication obtainable in HepG2 cells, to establish the optimum infection and culture conditions of HBV expression and replication. METHODS: Replication of a competent HBV genome encoding the baculovirus, RC-HBV-Bac, was generated for delivering the HBV genome to HepG2 cells. HBV replication and antigens expression were determined in relation to the infection and culture conditions. RESULTS: In RC-HBV-Bac infected HepG2 cells, HBsAg, HBeAg and HBcAg were expressed in the cytoplasm and nuclei, and secreted into the medium. HBV replication was evidenced by the presence of a replication complex and covalently closed circular (ccc) DNA in the cytoplasmic fraction of infected cells. The level of HBV expression was directly proportional to the multiplication of RC-HBV-Bac infection. Polyethylene glycol was able to enhance the infection efficiency of the baculovirus to HepG2 cells. High levels of HBV replication were achieved under culture conditions supplemented with dimethyl sulfoxide and a low serum concentration. CONCLUSION: This in vitro model of hepatitis B, generated by baculovirus gene delivery, represents a simple and flexible system for the study of HBV replication and drug testing.
Baculoviridae* ; Cytoplasm ; Dimethyl Sulfoxide ; DNA ; Gene Transfer Techniques* ; Genome ; Hep G2 Cells ; Hepatitis B Core Antigens ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Models, Animal ; Polyethylene Glycols

Phospholipase C (PLC) plays a role in ligand-mediated signal transduction for cellular activity such as proliferation and differentiation. A recent observation that PLC- gamma1 is highly expressed in some kinds of human cancer tissue supports the view that PLC-gamma1 may be involved in proliferation and carcinogenesis. PLC-gamma2 is known to be involved in B cell differentiation and maturation. However, there have been few studies about the expressions of PLC-gamma1 and gamma2 in human lymphoid malignancy. In the present study, we examined the contents of PLC-gamma1 and gamma2 in 10 cases of B cell, 10 cases of T cell non-Hodgkin's lymphoma and 5 cases of Hodgkin's lymphoma to find out whether these enzymes play any role in the carcinogenesis by immunohistochemistry and immunoprecipitation. Immunoprecipitation analysis revealed that in contrast to increased expression of PLC-gamma2 only in B cell lymphoma, a considerably higher level of PLC-gamma1 was detected in both B and T cell lymphoma. Immunohistochemical finding confirmed this observation. PLC-gamma1 and PLC-gamma2 were expressed in the cytoplasm of most tumor cells. PLC-gamma2 was also expressed in mature B cells, while PLC-gamma1 was not expressed in reactive non-tumor cells. These results suggest that PLC-gamma1 mediated signal transduction implicates a significant role in the carcinogenesis of all types of lymphoid tissue, and PLC-gamma2 may play a role in the carcinogenesis of B cell lymphoma as well as B cell differentiation.
B-Lymphocytes ; Carcinogenesis ; Cell Differentiation ; Cytoplasm ; Hodgkin Disease* ; Humans ; Immunohistochemistry ; Immunoprecipitation ; Lymphoid Tissue ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell ; Phospholipases* ; Signal Transduction ; Type C Phospholipases

OBJECTIVE: To determine that epidural anesthesia need not increase Cesarean delivery rates and prolong labor. METHODS: From December 1999 to May 2002, 1,585 deliveries were in Ilsan Paik Hospital. We selected 70 (epidural group) and 87 (non-epidural group) singleton, nulliparous, term, cephalic presentation without antenatal complications. We compared duration of labor, rates of Cesarean delivery and perinatal outcomes between these two groups. RESULTS: The duration of active and second stage of labor were not prolonged in the epidural group. Cesarean delivery rates was 8.6% (n=70) in the epidural group and 9.2% (n=87) in the non-epidural group, so there was no significant difference. Perinatal outcomes was no significant difference between the two groups. CONCLUSION: Epidural anesthesia during labor provides the best pain relief and does not increase the Cesarean delivery rates. The duration of the active, second stage of labor and perinatal outcomes was not different between these two groups.
Anesthesia, Epidural*

A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo-scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Constriction, Pathologic ; Duodenal Neoplasms* ; Duodenum ; Esophagus* ; Gastrectomy ; Humans ; Intestines* ; Laparotomy ; Lymph Node Excision ; Lymph Nodes ; Male ; Mucous Membrane ; Nausea ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Stomach Neoplasms* ; Stomach* ; Ulcer ; Vomiting