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.

BACKGROUND: beta-Bungarotoxin irreversibly changes the presynaptic membrane, hexamethonium acts on the presynaptic nicotinic receptor, and verapamil blocks the ion channels on the presynaptic membrane. The effect of these drugs on twitch height and train of four (TOF) ratio were investigated, as well as the reversal effects of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) on the partial neuromuscular blockade induced by these drugs. METHODS: Square wave, 0.1 Hz supramaximal stimuli or 2 Hz, 0.2 ms train of four stimuli, was applied to the phrenic nerve-hemidiaphragm preparation of the rat, and the twitch height response was recorded mechanomyographically. The cumulative concentration effects and TOF ratios at each point of twitch depression after beta-bungarotoxin, hexamethonium or verapamil were measured. TOF ratios were observed at 75, 50 and 25% of the control twitch height value during observation of the concentration effect. The EC50 and EC95 of beta-bungarotoxin, hexamethonium or verapamil were calculated using an inhibitory sigmoid Emax model. The reversal effect of some doses of neostigmine, pyridostigmine or 4-aminopyridine to the partial neuromuscular block produced by EC50 of beta- bungarotoxin, hexamethonium or verapamil was determined. RESULTS: The EC50 and EC95 of beta-bungarotoxin, hexamethonium and verapamil were 0.0695 and 0.1160 microgram/ml, 1267.0 and 2033.5 microgram/ml and 29.45 and 37.99 microgram/ml respectively. TOF fade was marked with hexamethonium or verapamil but small with beta-bungarotoxin. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by beta-bungarotoxin, hexamethonium or verapamil. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). CONCLUSIONS: beta-Bungarotoxin, hexamethonium and verapamil produced different degree of TOF fade, and this may be due to different sites of action of these drugs. 4-AP reversed effectively the partialneuromuscular block induced by beta-bungarotoxin, hexamethonium and verapamil, whereas, neostigmine and pyridostigmine did not.
4-Aminopyridine ; Animals ; Bungarotoxins* ; Colon, Sigmoid ; Depression ; Hexamethonium* ; Ion Channels ; Membranes ; Neostigmine ; Neuromuscular Blockade* ; Pyridostigmine Bromide ; Rats* ; Receptors, Nicotinic ; Verapamil*

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

BACKGROUND: This study was to access the hemostatic effectiveness of transcatheter arterial embolization (TAE) in a blunt splenic injury. We evaluated the efficacy of using detailed angiographic examnination and embolization for the nonsurgical management of patients with spleen injury. METHODS: Blunt splenic injuries diagnosed by Computed tomography (CT) between January 1997 and December 1997 were prospectively studied according to our management algorithm. The first group (G1) consisted of patients who were observed only, the second grourp (G2) with consisted of patients receving a TAE, and the third group (G3) consisted of those receving a laparotomy. The criteria for a TAE were: 1) Type III or IV injury and 2) extravasation of contrast material revealed by CT. RESULTS: Of the total 46 patients with blunt splenic injury, 17 underwent emergency laparotomies because of associated injuries or unstable vital signs after resuscitation. Fourteen of the 17 had splenectomies and the other three had splenorrhaphies. The remaining 29 patients were considered for nonoperative management (63%), and 13 of them were selected for a TAE. Splenic angiography showed active bleeding in 12 and minor bleeding in one. The bleeding was successfully controlled by TAE in all 13 patients. Abdominal CT and scintigraphy taken after TAE disclosed well functioning spleens. The total splenic salvage rate was 63% in our patients. CONCLUSION: We could reduce the laparotomy rate and could preserve more spleens after application of TAE. Our success rate for splenic salvage should encourage more extensive use of a TAE for splenic injury.
Angiography ; Emergencies ; Hemorrhage ; Humans ; Laparotomy ; Prospective Studies ; Radionuclide Imaging ; Resuscitation ; Spleen ; Splenectomy ; Tomography, X-Ray Computed ; Vital Signs