A sensitive and simple liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of ticagrelor and its active metabolite, AR-C124910XX from 50 µL human plasma using tolbutamide as an internal standard as per regulatory guidelines. Analytes in plasma were extracted by simple protein precipitation using acetonitrile, followed by chromatographic separation with an Acclaim™ RSLC 120 C₁₈ column (2.2 µm, 2.1 × 100 mm) and a gradient acetonitrile-water mobile phase containing 0.1% formic acid within 8 min. Mass spectrometric detection and quantitation were conducted by selected reaction-monitoring on a negative electrospray ionization mode with the following transitions: m/z 521.11 → 361.10, 477.03 → 361.10, and 269.00 → 169.60 for ticagrelor, AR-C124910XX, and tolbutamide, respectively. The lower limit of quantifications was 0.2 ng/mL with linear ranges of 0.2–2,500 ng/mL (r² ≥ 0.9949) for both analytes. All validation data, including selectivity, cross-talk, precision, accuracy, matrix effect, recovery, dilution integrity, stability, and incurred sample reanalysis, were well within acceptable limits. This assay method was validated using K₂-EDTA as the specific anticoagulant. Also, the anticoagulant effect was tested by lithium heparin, sodium heparin, and K₃-EDTA. No relevant anticoagulant effect was observed. This validated method was effectively used in the determination of ticagrelor and its active metabolite, AR-C124910XX, in plasma samples from patients with myocardial infarction.
Heparin ; Humans ; Lithium ; Mass Spectrometry ; Methods ; Myocardial Infarction ; Pharmacokinetics ; Plasma ; Tolbutamide

OBJECTIVE: Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. METHODS: Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the beta-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). RESULTS: The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA beta-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). CONCLUSION: During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.
Blood Glucose ; Body Weight ; Cholesterol ; Cotinine ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Lipoproteins ; Male ; Plasma ; Smoke ; Smoking ; Smoking Cessation

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp.
Abdominal Pain ; Appendicitis ; Cecum ; Colonoscopy ; Hemorrhage ; Intussusception ; Polyps ; Rare Diseases

BACKGROUND/AIMS: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS. METHODS: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed. RESULTS: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps. CONCLUSIONS: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features.
Abdominal Pain ; Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cohort Studies ; Constriction, Pathologic ; Follow-Up Studies ; Hand Strength ; Humans ; Pancreatitis, Chronic ; Plastics ; Stents

OBJECTIVE: Patients with lung cancer have a relative high risk of developing secondary primary lung cancers. This study examined the additional value of autofluorescence bronchoscopy (AFB) for diagnosing synchronous lung cancers and premalignant lesions. METHODS: Patients diagnosed with lung cancer from January 2005 to December 2005 were enrolled in this study. The patients underwent a lung cancer evaluation, which included white light bronchoscopy (WLB), followed by AFB. In addition to the primary lesions, any abnormal or suspicious lesions detected during WLB and AFB were biopsied. RESULTS: Seventy-six patients had non-small cell lung cancer (NSCLC) and 23 had small cell lung cancer (SCLC). In addition to the primary lesions, 84 endobronchial biopsies were performed in 46 patients. Five definite synchronous cancerous lesions were detected in three patients with initial unresectable NSCLC and in one with SCLC. The secondary malignant lesions found in two patients were considered metastatic because of the presence of mediastinal nodes or systemic involvement. One patient with an unresectable NSCLC, two with a resectable NSCLC, and one with SCLC had severe dysplasia. The detection rate for cancerous lesions by the clinician was 6.0% (6/99) including AFB compared with 3.0% (3/99) with WLB alone. The prevalence of definite synchronized cancer was 4.0% (4/99) after using AFB compared with 2.0% (2/99) before, and the staging-up effect was 1.0% (1/99) after AFB. Since the majority of patients were diagnosed with advanced disease, the subjects with newly detected cancerous lesions did not have their treatment plans altered, except for one patient with a stage-up IV NSCLC who did not undergo radiotherapy. CONCLUSIONS: Additional AFB is effective in detecting early secondary cancerous lesions and is a more precise tool in the staging workup of patients with primary lung cancer than with WLB alone.
Biopsy ; Bronchoscopy* ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Prevalence ; Radiotherapy ; Small Cell Lung Carcinoma

BACKGROUND: Autofluorescence bronchoscopy (AFB), when used as an adjunct to conventional white light bronchoscopy (WLB) improves the bronchoscopist's ability to localized small intraepithelial lesions. Current study was undertaken to evaluate prevalence of preinvasive intraepithelial lesions (dysplasia II-III and CIS) and efficacy of additional AFB system to WLB in comparison with WLB alone. METHODS: In patients with suspicion of lung cancer or follow-up ones with known lung cancer, WLB (Pentax; BP 3500, Japan) and AFB (Richard Wolf, Germany) were done and all subjects with endoscopic abnormalities underwent biopsies from January 2005 to December 2005. RESULTS: 169 patients (134 suspected to have lung cancer radiologically, 18 with known lung cancer, and 17 with initial abnormal WLB visual findings) were enrolled. Overall preinvasive intraepithelial lesions were detected in 6.5% (11 persons). Biopsy based sensitivity of WLB+AFB and WLB alone for detecting preinvasive intraepithelial lesions was 77.8% compared with 22.2% (relative ratio 3.5, 95% CI 0.93-13.24). Corresponding specificity was 56.9% compared with 89.2% (relative ratio 0.64, 95% CI 0.54-0.75). The positive predicitve value was 6% and 3%, and the negative predictive value was 94% and 87%, respectively, for WLB+AFB and WLB alone. CONCLUSIONS: WLB+AFB was superior to WLB alone in detecting preinvasive intraepithelial lesions, but general use of AFB as a screening tool seems to be limited in suspected or known lung cancer group because of low prevalence. It is necessary of further study for precise indication for AFB among the lung cancer risk groups.
Biopsy ; Bronchoscopy* ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Mass Screening ; Prevalence ; Sensitivity and Specificity ; Wolves

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies

No abstract available.
Aortic Aneurysm* ; Aortic Valve* ; Bicuspid*

A 55 years old female was admitted for nausea, vomiting and right upper quadrant pain. On the admission physical examination revealed icteric sclera and right upper quadrant tenderness. She had no history of surgery and alcoholic intake. The levels of bilirubin and liver enzyme(ALT, AST) were elevated without evidence of viral hepatitis. After abdominal sonography, CT and ERCP, diagnosis was cholelithiasis. The laparoscopic cholecystectomy was done under enflurane anesthesia for 90 minutes without transfusion of blood and blood products. On the 9th postoperative day, she was discharged with symptomatic improvement and almost normal laboratory data. On the 20th postoperative day, she was admitted for follow up study and elevated liver enzyme were found. On the 30th postoperative day, she had suffered from acute hepatitis with symptoms of nausea, vomiting, chilling and jaundice and marked elevation of ALT, AST and eosinophilia. There were no evidence of viral hepatitis and remnant stone. The liver function was more aggravated and more advanced parenchymal damage of liver was shown by liver scan and sonography but liver function was improved gradually after 55th postoperative day. She recovered gradually and went home in good health on the 105th postoperative day. Postoperative hepatotoxicity might be developed as a result of many causes and we had suspected enflurane but the exact causes in this case were still unknown.
Alcoholics ; Anesthesia ; Anesthesia, General* ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Diagnosis ; Enflurane* ; Eosinophilia ; Female ; Follow-Up Studies ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Physical Examination ; Sclera ; Vomiting

In the anesthesia for the Cesarean section, the anesthetists should select the agent and technique carefully which is safe for both the mother and baby. If a light plane of general anesthesia is chosen for fetal safety and rapid recovery, there may be increased incidence of maternal recall and intraoperative pain perception. We studied the effect of nalbuphine(N group) and fentanyl(F group) used as main analgesics in balanced anesthesia in 60 full term parturients, ASA physical status class I or II, scheduled for elective Cesarean section. The patients were questioned for recall, pain perception and unpleasant dreams during anesthesia. The results were as follows, 1) The 12 patients had positive reactions. Among them, 3 patients(10%) were in the N group and 9 patients(30%) in the F group. 2) The sedation was more in the N group(30%) than in the F group(6.6%). We concluded that the balanced anesthetic technique using nalbuphine caused less maternal recall and pain perception with more sedation than using fentanyL.
Analgesics ; Anesthesia ; Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Cesarean Section* ; Dreams ; Female ; Fentanyl* ; Humans ; Incidence ; Mothers ; Nalbuphine* ; Pain Perception ; Pregnancy