Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

PURPOSE: To compare the success rates, complications and cost effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URS) using a Holmium: YAG laser to establish the more effective treatment for upper and mid ureter stones. MATERIALS AND METHODS: This retrospective study included 83 and 286 patients treated with URS and ESWL, respectively, for upper and mid ureter stones. URS was performed with a 7.5Fr semi-rigid ureterorenoscope and Holmium: YAG laser. ESWL was performed with Stonelith V.5 (PCK, Turkey). The stone sizes, success rates, postoperative complications and cost effectiveness were analyzed for each group. RESULTS: The overall success rates of the URS and ESWL were 97.6 and 82.5%, respectively. Success rates of URS were 98.4 and 95.2% when the stones were smaller and larger than 10mm, respectively. In the ESWL group, the success rates after the third session were 86.3 and 65.4% with stones smaller and larger than 10mm, respectively. The complication rates associated with URS and ESWL were 6 and 4.2%, respectively. The average cost of URS was lower than that of ESWL. CONCLISIONS: In our study, URS with Holmium: YAG laser was more efficacious than ESWL. Considering both the success rate and cost effectiveness, URS should remain the recommended first-line treatment for upper and mid ureter stones.
Cost-Benefit Analysis ; Holmium* ; Humans ; Lasers, Solid-State* ; Lithotripsy* ; Postoperative Complications ; Retrospective Studies ; Shock* ; Ureter* ; Ureteroscopy

We investigated the effects of isoflurane-induced hypotension on global cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO,), and the balance between cerebral oxygen supply and demand in 8 mongrel dogs. After endotracheal intubation, anesthesia was maintained with nitrous oxide (50%)-oxygen (50%)-fentanyl (2u/kg/hour). Ventilation was controlled to normocapnia. Mean arterial pressure (MAP) was lowered to 60 mmHg with inhalation of isoflurane. CBF was measured directly using sagittal sinus outflow method before (prehypotension), during (hypotension), and after (posthypotension) isoflurane-induced hypotension. Concomitantly, arterio-sagittal sinus venous oxygen content differen- ce was measured to calculate CMRO2. During hypotension, CBF and CMRO, were measured at 20 minutes after MAP was lowered to 60 mmHg and maintained stably. The time to induce hypotension was 8.6+/-6.1 (mean+/-SD) min. Mean inspired isoflurane concentra tion to induce desired hypotension was 3.1+/-0.9 vol%. The time to recover from hypotension was 28.6+/-7.7 min. MAP and heart rate were reduced significantly during hypotension (p<0.05, respectively) and returned to prehypotensive values during posthypotension. CBF was not changed between three peroiods. CMRO2 was reduced significantly during hypotension (6.5+/-1.2 vs 4.3+/-0.8ml/100/g/min, mean+/-SD, p<0.05) and returned to prehypotensive values during posthypotension. The percentage of CMRO2 reduction from prehypotension to hypotension (% CMRO2 reduction) was 32.5+/-12.9%. CBF/CMRO2 ratio was increased significantly during hypotension (12.8+/-3.3 vs 18.2+/-6.1, mean+/-SD, p<0.05) and lowered to prehypotensive values during posthypotension. Isoflurane-induced hypotension maintained CBF and reduced CMRO2 and therefore favorably influenced the balance between the global cerebral oxygen supply and demand. In conclusion, isoflurane induced-hypotension may be a safe and effective technique in view of the balance of the global cerebral oxygen supply and demand.
Anesthesia ; Animals ; Arterial Pressure ; Dogs* ; Heart Rate ; Hypotension* ; Inhalation ; Intubation, Intratracheal ; Isoflurane* ; Nitrous Oxide ; Oxygen* ; Ventilation

We recently experienced an unexpected episode of bilateral vocal cord paralysis following endotracheal extubation after uvulopalatopharyngoplasty and tonsillectomy in 64-year-old man. The patient had no any other clinical manifestations regarding larynx or vocal cord except sleep apnea syndrome prior to this operation. The surgical procedure lasted almost 120 minutes and surgery and anesthesia was uneventful. After restoration of his spontaneous respiration, we tried extubation as usual method. Regardless his effort of spontaneous respiration for several times, he was suddenly apneic and showed declining of arterial oxygen saturation on the pulse oximeter (SpO2). Then we tried reintubation as a decision of laryngeal spasm. This alternative episode of extubation and reintubation was tried again and the causative factor of this respiratory impairment was confirmed as bilateral vocal cord paralysis by fiberoptic bronchoscopic examination in the operating room. Almost two thirds of vocal cord function was restored after six months of operation.
Airway Extubation* ; Anesthesia ; Humans ; Intubation ; Laryngismus* ; Larynx ; Middle Aged ; Operating Rooms ; Oxygen ; Respiration ; Sleep Apnea Syndromes ; Tonsillectomy ; Vocal Cord Paralysis* ; Vocal Cords*

The mutation of p53 tumor suppressor gene is the most common genetic variation of primary malignant tumors. The occurrence, progression and reaction for medical management of cancers can be different according to the characteristics of p53 gene, even if they are same kinds of malignant tumors. In this study, the property of p53 gene in 4 kinds of squamous cell carcinoma cell lines were investigated by using immunocytochemistry, PCR-SSCP, sequencing and Western blot methods. As a result, p53 mutation detected in 3 kinds of squamous cell carcinoma cell lines. Namely, it is found that T in codon 176 changed to A, and G in codon 281 changed to A in KUMA3 cell lines; CC in codon 241 changed to TT in KUMA4 cell lines; G in codon 266 changed to T in KUMA6 cell lines. In single nucleotide polymorphism of codon 72 of p53 gene, the genetic variations are Arg/Pro heterozygote in KUMA3 and KUMA4 cell lines; Arg/Arg homozygote in KUMA5 cell lines; Pro/Pro homozygote in KUMA6 cell lines. These results will provide useful data for p53 gene researches of various squamous cell carcinomas.
Blotting, Western ; Carcinoma, Squamous Cell* ; Cell Line* ; Codon ; Genes, p53* ; Genes, Tumor Suppressor ; Genetic Variation ; Heterozygote ; Homozygote ; Immunohistochemistry ; Polymorphism, Single Nucleotide

No abstract available.
Humans

Purpose: The use of an ostomy for urination and defecation leads to reduced quality of life. Although many ostomy management strategies are needed, such strategies are often implemented by patients. Thus, there is a need for a home health care service platform that can be used in ostomy patient management. Methods: We developed an ostomy patient management platform by identifying the needs of patients and medical staff through the Chronic Care Ostomy Self-Management Training Program in the United States and from studies conducted in Korea. Results: The platform encompassed physical management, psychological management, maintenance of social function, spiritual stability, and home medical care. These components were implemented through monitoring, self-care guidance, and a community platform. For the monitoring function, patients entered their health status in a mobile application (app); the medical staff at the affiliated hospital then monitored the stoma status through a web interface. Conclusion Our platform allows medical staff to monitor ostomy patients through a web interface and help such patients to fully manage their ostomy at home using an app. We expect that the continued development of patient-oriented functions in our app will allow ostomy patients to experience quality-of-life improvements.

PURPOSE: To investigate whether the up-regulation of Bcl-2 gene expression may be associated with chemotherapy resistance and malignant progression in human renal cell carcinomas (HRCC). MATERIALS AND METHODS: The HRCC cell line, SN12C, was cultured in MEM medium, supplemented with 10% FBS. Full length of Bcl-2 cDNA was obtained using the sense primer (5'-ATGGCGCACGCTGGGAGAACGG-3') and the antisense primer (5'-TCACTTGTGGCTCAGATAGG-3') and inserted into SN12C cells to establish stable cells expressing the Bcl-2 gene (SN12C/smcb2). To investigate the response to doxorubicin in orthotropic organs, SN12C/smcb2 and parental cells were implanted into the subcapsular renal tissue of nude mice (n=5). The mice were treated with doxorubicin (8mg/kg) on days 8 and 15 following tumor cell implantation. Tumor tissues, obtained from the kidneys and lungs, were ex vivo cultured (SN12C/smcb2-kidney and SN12C/smcb2-lung, respectively). To compare the metastatic potential in these cell lines, the gelatinolytic activity was measured by zymogram and the expression of type IV collagenase (MMP-9) examined by western blot. RESULTS: In the in vitro study, the SN12C/smcb2 was more resistant to doxorubicin than the parental cells, and treatment and those cells produced a higher rate of tumor formation and metastasis. The SN12C/ smcb2-kidney showed higher gelatinolytic activity than the parental cells. Higher expression levels of type IV collagenase were detected in the SN12C/smcb2-lung and SN12C/smcb2-kidney, but barely detected in SN12C. CONCLUSIONS: The up-regulation of Bcl-2 gene expression in HRCC cells induces drug resistance to doxorubicin and increases the metastatic potential. Although the drug resistance induced by Bcl-2 over-expression enhances distant metastasis (lung), the up-regulation of Bcl-2 may enhance the malignant potential of tumor cells and produce distant metastasis.
Animals ; Blotting, Western ; Carcinoma, Renal Cell* ; Cell Line ; Collagenases ; DNA, Complementary ; Doxorubicin ; Drug Resistance* ; Drug Therapy ; Genes, bcl-2* ; Humans* ; Kidney ; Lung ; Mice ; Mice, Nude ; Neoplasm Metastasis ; Parents ; Up-Regulation

INTRODUCTION AND AIM: Acute pancreatitis is an inflammatory process of varying severity, ranging from a mild, self-limiting form to severe acute pancreatitis, which leads to complications such as necrosis, pseudocyst formation, and organ failure. This highly lethal condition should be differentiated from acute abdomen caused by other diseases as early as possible so appropriate management can be carried out. PATIENTS AND METHODS: A survey was carried out to determine the current status of management for this particular disease in Korea. A total of 269 patients were collected from 13 university hospitals during a four and a half year period (January 2000 to June 2004). RESULTS: Of the 269 patients, 103 (38.3%) were managed with surgery, and 166 (61.7%) were managed with conservative treatment. The most commonly performed surgical procedure was debridement of necrotic tissue with closed drainage. The most common etiology was alcohol, with 143 cases (53.4%), followed by gallstones, with 48 cases (17.9%). E. coli was the most commonly cultured bacterium. The mortality rate in surgically managed patients was 9.7%. The mortality rate in conservatively treated patients was 7.2% . CONCLUSION: Patients with infected pancreatic necrosis should be managed with surgical necrosectomy and drainage. However, patients with sterile necrosis should be managed conservatively unless organ complications or severe clinical deterioration develops despite intensive therapy. Patient survival is improved through early diagnosis, followed by adequate drainage in combination with intensive care.
Abdomen, Acute ; Debridement ; Drainage ; Early Diagnosis ; Gallstones ; Hospitals, University ; Humans ; Korea ; Necrosis ; Pancreatitis

BACKGROUND: Systemic hypertension produces varying degree of LVH which is associated with increased cardiovascular morbidiity. Previous studies have documented regression of LVH with various antihypertensives including calcium channel blockers, except diuretics and vasodilators. Recently echocadiographic assessment of the change of left ventricular mass(LVM) after antihyertensive therapy have been reported to offer prognostic cardiovascular information. The aim of this echocardiographic study is determining the influence of nicardipine, a calcium channel blocker, on the change of LVM in patients with essential hypertenison. METHODS: Left ventricular mass(LVM) and left ventricular mass index(LVMI) were measured by M-mode echocardiography in 15 patients with essential hypertension. Nicardipine, a calcium channel blocker, was administered for 6 months and two echocardiographies were done before and after administering, respectively. RESULTS: In the 15 patients treated for 6 months, systolic and diastolic pressure remained very significantly decreased compared with pressure before before therapy(135+/-15mmHg vs 168+/-26mmHg, and 86+/-7mmHg vs 105+/-16mmHg, both p<0.01). Concomitantly both LVM and LVMI decreased significantly(209+/-49g vs 235+/-71g, and 116+/-6g/m2 vs 131+/-38g/m2,both p<0.05). And no change was noted in left ventricular cavity size, demonstration that LVM reduction was due to regression of hypertrophy. CONCLUSION: This study showed that nicardipine produced a significant decrease in blood pressure, LVM, and LVMI over the 6 months period. And large and longterm controlled studies are needed for the clarification of the association between nicardipine and regression of LVH in hypertensive patients.
Antihypertensive Agents ; Blood Pressure ; Calcium Channel Blockers ; Calcium Channels ; Diuretics ; Echocardiography ; Humans ; Hypertension ; Hypertrophy ; Nicardipine* ; Vasodilator Agents