The value of ultrasonography and percutaneous transhepatic cholangiography in determining the site and etiology of biliary obstruction with surgical jaundice was studied in 30 patients. All diagnoses were subsequently made by surgery and pathology. The results were as follows; 1. In ultrasonography, the site of obstruction was delineated in 46%, while the etiology of the lesion was established in 40%, In comparison, percutaneous transhepatic cholangiography delineated the site in 100% and the etilogy in 93%. 2. Although the percutaneous transhepatic cholangiography is invasive to the human body, it is considered to be the single procedure of choicein the managment of the patient with biliary obstructive jaundice because of its diagnostic accuracy, technical simplicity and relative safety.
Cholangiography ; Diagnosis ; Human Body ; Humans ; Jaundice ; Jaundice, Obstructive ; Pathology ; Ultrasonography

BACKGROUND: Vimentin is the major intermediate-size filament in the cytoplasm of cells from mesenchymal origin. The HL-60 cell is a unique human leukemic cell line capable of terminal differentiation with several chemical inducers, and then the cell line becomes a fre#quently described model system for cell differentiation in vitro. Vimentin mRNA is reduced during all-trans retinoic acid (retinoic acid) -dependent differentication but increased by 12-0-tetradecanoylphorbol-13-acetate (TPA). In this paper, we have investigated on the mechanism of transcriptional repression of vimentin gene during retinoic acid-dependent differentication of HL-60 cell. METHODS: HL-60 cells were grown in RPMI 1640 medium supplemented with 10% heat-inactivated fetal bovine serum and antibiotics in a humidified 5% CO at 37C. Total RNA was prepared by a modification of the method of Karlinsey et al. Northern blot hybridization was performed by the method of Virca et al. EcoRI fragment of pVIM-GEM was used as probe for vimentin mRNA. DNA mobility shift assay was performed by the method of Lim et al. End labeled DNA probe (Upper strand, 5-CGCITGATGAGTCAGCCG-3) for AP-1 binding activity was mixed with nuclear extracts in a 20 pL reaction volume containing 300 mM KCI, 60 mM HEPES, pH 7.9, 25mM MgC1, 1mM EDTA, 1mM DTT, 60% glycerol, and 2 pg of poly[dI-dC]. RESULTS: The level of vimentin mRNA was decreased at 12 hours after retinoic acid treatment, and not detected at 48 hours. The level of vimentin mRNA was reduced in proportion to concentration of retinoic acid, Retinoic acid-reduced vimentin mRNA was no change in cells treated with cycloheximide. Retinoic acid-dependent decrease of vimentin mRNA was partially recovered by staurosporin pretreatment. In DNA mobility shift assay, AP-1 binding activity was reduced at 48 hr during retinoic acid-induced differentiation. CONCLUSION: These results suggest that the transcriptional repression of vimentin gene during retinoic acid-induced differentiation in HL-60 cells is correlated with reduction of DNA binding activity of AP-1.
Anti-Bacterial Agents ; Blotting, Northern ; Cell Differentiation ; Cell Line ; Cycloheximide ; Cytoplasm ; DNA ; Edetic Acid ; Electrophoretic Mobility Shift Assay ; Glycerol ; HEPES ; HL-60 Cells* ; Humans ; Hydrogen-Ion Concentration ; Repression, Psychology* ; RNA ; RNA, Messenger ; Transcription Factor AP-1 ; Tretinoin ; Vimentin*

We retrospectively evaluated postoperative refraction of four patients(five eyes)who received intraocular lens implantation after excimer laser photorefractive keratectomy (PRK).The mean age of the patients was 44.8 years and 3 patients were female and 1 patient was male.The mean interval between PRK and cataract operation was 20.2 months (1 to 45 months)and the mean follow-up time after cataract operation was 16.2 months(2~43months).Phacoemulsification and PMMA-PCL(6.0~6.5 mm)implantation were made in all cases.SRK-II formula,the most popular empirical formula was used in first 3 cases(group I),but Idem-lens formula,a primitive theoretical formula was used in another 2 cases (group II)after occurrence postoperative refraction errors in group I .In group I and II,the mean postoperative refraction error was +3.00 diopters and +0.50 diopters and uncorrected visual acuity at postoperative 2 months was 20/60 and 20/24 respectively.The mean of calculated IOL-power was -3.75 diopter in group I and -0.625 diopter in group II.From these results,the empirical formula is definitely unsuitable for the calculation of IOL power in the cataract operation following excimer laser PRK. Moreover,although a primitive one,Idem-lens theory could be temporally useful for the IOL-power calculation in such cases.In conclusion,new formula is required for the cataract operation following excimer laser PRK.
Cataract* ; Female ; Follow-Up Studies ; Humans ; Lasers, Excimer* ; Lens Implantation, Intraocular ; Lenses, Intraocular* ; Photorefractive Keratectomy ; Retrospective Studies ; Visual Acuity

Background: Some working conditions may pose a higher physical or psychological demand to pregnant women leading to increased risks of pregnancy complications. Objectives: We assessed the association of woman's employment status and the industrial classification with obstetric complications. Methods: We conducted a national population study using the National Health Information Service database of Republic of Korea. Our analysis encompassed 1,316,310 women who experienced first-order live births in 2010–2019. We collected data on the employment status and the industrial classification of women, as well as their diagnoses of preeclampsia (PE) and gestational diabetes mellitus (GDM) classified as A1 (well controlled by diet) or A2 (requiring medication). We calculated odds ratios (aORs) of complications per employment, and each industrial classification was adjusted for individual risk factors. Results: Most (64.7%) were in employment during pregnancy. Manufacturing (16.4%) and the health and social (16.2%) work represented the most prevalent industries. The health and social work exhibited a higher risk of PE (aOR = 1.11, 95% confidence interval [CI]: 1.03–1.21), while the manufacturing industry demonstrated a higher risk of class A2 GDM (1.20, 95% CI: 1.03–1.41) than financial intermediation. When analyzing both classes of GDM, women who worked in public administration and defense/social security showed higher risk of class A1 GDM (1.04, 95% CI: 1.01, 1.07). When comparing high-risk industries with nonemployment, the health and social work showed a comparable risk of PE (1.02, 95% CI: 0.97, 1.07). Conclusion Employment was associated with overall lower risks of obstetric complications. Health and social service work can counteract the healthy worker effect in relation to PE. This highlights the importance of further elucidating specific occupational risk factors within the high-risk industries.

OBJECTIVES: Limited evidence is available regarding the impact of paternal occupation and its combined effect with maternal occupation on preterm birth. Therefore, we assessed the association of maternal and paternal occupations with preterm birth. METHODS: We used the national birth data of Korea between 2010 and 2020. Parental occupations were divided into 5 categories: (1) managers; (2) professionals, technicians, and related workers; (3) clerks and support workers; (4) service and sales workers; and (5) manual workers. A multinomial logistic regression model was used to calculate the adjusted odds ratios (aORs) of extremely, very, and moderate-to-late preterm births per occupational category considering individual risk factors. RESULTS: For the 4,004,976 singleton births, 40.2% of mothers and 95.5% of fathers were employed. Compared to non-employment, employment was associated with a lower risk of preterm birth. Among employed mothers, service and sales occupations were associated with a higher risk of preterm birth than managerial occupations (aOR, 1.06; 95% confidence interval [CI], 1.01 to 1.10 for moderate-to-late preterm births). The father’s manual occupation was associated with a higher risk of preterm birth (aOR, 1.09; 95% CI, 1.05 to 1.13 for moderate-to-late preterm) than managerial occupations. When both parents had high-risk occupations, the risk of preterm birth was higher than in cases where only the mother or neither of the parents had a high-risk occupation. CONCLUSIONS Paternal occupation was associated with preterm birth regardless of maternal employment and occupation and modified the effect of maternal occupation. Detailed occupational environment data are needed to identify the paternal exposures that increase the risk.

BACKGROUND: Many Studies regarding hemodynamic changes by various vasodilators, such as nitroprusside, nifedipine, and hydralazine have been reported, however little data are available upon acute hemodynamic change due to captopril, an angiotensin converting enzyme inhibitor especially in chronic regurgitant valvular heart disease. Therefore the aim of this study is to evaluate the acute hemodynamic effects of sublingual captopril in patients with regurgitant valvular heart diseases. METHODS: Among the 9 patients enrolled in this study, 5 patients mitral regurgitation, 2 had aortic regurgitation, and 2 had both. Five had patients were male and 4 were female. Before, 15 minutes and 30 minutes after administration of 25mg of captopril via sublingual route, forward cardiac output was measured three times using Swan-Ganz catheter. Right and left cardiac catheterization were also done at each phase and measurement of pulmonary capillary wedge pressures, pulmonary artery pressures, right atrial pressures, aortic pressures, left ventricular pressures were done. RESULTS: 1) Heart rate, pulmonary capillary wedge pressures, cardiac output and cardiac indices left ventricular end-diastolic pressure, diastolic and mean aortic pressures, and diastolic pulmonary artery pressure showed no significant change after administration of sublingual captopril. 2) Systolic aortic pressure decreased significantly from basal value(130+/-35) to 15 minute value(126+/-39). 3) Systemic vascular resistance at 15 minute showed significant reduction as compared with basal value(from 1743+/-551 to 1642+/-491). Pulmonary vascular resistance at 30 minutes(254+/-193) was significantly lower than basal value(282+/-229). CONCLUSIONS: Reductions of systemic and pulmonary vascular resistance occurred relatively rapidly, however, acute effects on cardiac output and pulmonary capillary wedge pressures were not evident. Clinical implication of sublingual captopril in patients with regurgitant valvular heart diseases is worth evaluationg by more extensive hemodynamic studies.
Aortic Valve Insufficiency ; Arterial Pressure ; Arteries ; Atrial Pressure ; Blood Pressure ; Capillaries ; Captopril* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Catheters ; Female ; Heart Rate ; Heart Valve Diseases* ; Hemodynamics* ; Humans ; Hydralazine ; Male ; Mitral Valve Insufficiency ; Nifedipine ; Nitroprusside ; Peptidyl-Dipeptidase A ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Vascular Resistance ; Vasodilator Agents ; Ventricular Pressure

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.
Adolescent ; Cytoplasm ; Eosinophils ; Ependymoma ; Female ; Frozen Sections ; Giant Cells ; Humans ; Intranuclear Inclusion Bodies ; Mitosis ; Necrosis

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Circle of Willis ; Glycosaminoglycans ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Middle Cerebral Artery ; Ophthalmic Artery ; Optic Nerve ; Subarachnoid Hemorrhage

We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest T1-201 SPECT and 2nd day 24 hour delay T1-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease(24) or having chest pain(3). Stress and rest Tc-99m- sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system(0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale(0 to 3 for normal to dyskinesia) in the lst day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments(20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT:i.e. 1-1: 23 segments, 2-2: 29 segments, 3-3: 3 segments. Re-maining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SFECT. Twenty one segments with wall motion abnormality had normal perfusion(rest:15 segments, 24 hour delay: 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality(persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT(transient prolonged stunning). These 6 segments had normal perfusion at rest(n=4) or at 24 hour delay(n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning(P value<0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to assess rest wall motion.
Coronary Vessels ; Dipyridamole* ; Humans ; Myocardial Stunning ; Perfusion ; Thorax ; Tomography, Emission-Computed, Single-Photon*

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.
Adenosine ; Asthma ; Bronchial Provocation Tests ; Hand ; Histamine ; Hyperventilation ; Inflammation ; Mannitol ; Methacholine Chloride ; Methods ; Myocytes, Smooth Muscle ; Respiratory Hypersensitivity ; Sensitivity and Specificity