Cases report of unicentric Castleman's disease: revisit of radiotherapy role

Castleman's disease or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder. Complete surgical resection was recommended in unicentric Castleman's disease. Radiotherapy was considered alternative therapeutic option. However, there have been consistent favorable responses to radiotherapy. We also experienced two cases of uncentric Castleman's disease salvaged successfully with radiotherapy. This paper described these cases and reviewed the literature about Castleman's disease treated with radiotherapy. Reviewed cases showed that radiotherapy is a successful treatment option in unicentric Castleman's disease. Furthermore, our report confirms the radiotherapy role in uncentric Castleman's disease.

Surgical Treatment of Inferior Vena Cava Tumor Thrombus in Patients with Renal Cell Carcinoma

Radical nephrectomy with inferior vena cava (IVC) thrombectomy remains the most effective therapeutic option in patients with renal cell carcinoma and IVC tumor thrombus. Cephalic extension of the thrombus is closely related to perioperative morbidity. We purposed to design a safe and successful surgical strategy through a review of our surgical experience and treatment results in 35 patients (male:female=28:7, mean age=56 yr [32-77]) who underwent IVC thrombectomy with radical nephrectomy between January 1997 and December 2006. The limit of tumor extension was level I in 10 patients (28.6%), level II in 17 (48.6%), and level III and IV in 4 patients each (11.4%). Liver mobilization with hepatic vascular exclusion was performed in 12 patients and cardiopulmonary bypass in 7. Thirty-two primary closures, 2 patch closures, and 1 graft interposition were performed. One patient underwent simultaneous pulmonary embolectomy because of an operative pulmonary embolism. There was no operative mortality, and the overall survival at 5-yr was 50.8%. Complete thrombus removal without tumor fragmentation under long venotomy on fully exposed involved IVC is recommended for successful result in a bloodless operative field. The applicability of liver mobilization, hepatic vascular exclusion, and cardiopulmonary bypass, can be determined by the level of thrombus.

The Effective Steroid Dose of Caudal Epidural Injection with Unilateral Epidural Catheter Position in Patients with Symptomatic Herniated Nucleus Purposus / 대한마취과학회지

BACKGROUND: The epidural steroid injection is commonly used in the management of chronic low back pain and radiating pain. We compared the efficacy of 40, 60, and 80 mg of methylprednisolone acetate in patients with lumbar herniated disc disease treated with caudal epidural block. METHODS: Seventy-two patients with lumbar herniated nucleus purposes on magnetic resonance imaging were included.All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle.After confirming the catheter tip position at the affected nerve root, contrasts were injected until patients felt discomfort in their site of pain.24 patients in each group received 40 mg, 60 mg, 80 mg of methylprednisolone acetate, respectively.We evaluated the improvements by pain relief scale (0-100%) after 2 weeks. RESULTS: There are no significant differences in the pain improvement between three groups (P = 0.537 ). CONCLUSIONS: Sixty and 80 mg methylprednisolone acetate injection during caudal epidural block showed no further benefit compared to 40 mg injection.

Effects of ascorbic acid on coagulation during living donor liver transplantation in adults / 대한마취과학회지

BACKGROUND: Prompt correction of hemostatic and thrombotic derangements during liver transplantation can play a key role in preventing excessive blood transfusion or thrombotic complications. It is well known that reactive oxygen species can affect coagulant and anticoagulant systems. Therefore, we investigated whether ascorbic acid (AA), one of potent antioxidant agents, can improve the coagulation during living donor liver transplantation (LDLT). METHODS: Thirty three adult patients undergoing LDLT were enrolled in this study. The blood samples of these patients were collected at 90 minutes after the beginning of operation and at 150 and 300 minutes after reperfusion. At each time period, blood samples were categorized into hypocoagulation, normal, and hypercoagulation. Within each category, the samples were further divided into three groups: whole blood (WB) (0.36 ml of native WB), AA (0.33 ml of native WB mixed with 0.03 ml of AA solution), and normal saline (NS) groups (0.33 ml of native WB mixed with 0.03 ml of NS), and these samples were analyzed using thromboelastogram (TEG). We compared the parameters of TEG (gamma time, K time, alpha angle, maximum amplitude (MA), and LY60) in each coagulation status. RESULTS: AA did not significantly affect TEG parameters in hypocoagulation or normal coagulation during LDLT. However, AA significantly decreased gamma time, alpha angle and MA at 150 minutes, and, K time and alpha angle at 300 minutes after reperfusion in the blood samples of hypercoagulation category. CONCLUSIONS: We may conclude that ascorbic acid inhibits hypercoagulation after reperfusion period during living donor liver transplantation.

A Case of Olfactory Neuroblastoma in Sphenoid Sinus / 대한이비인후과학회지

Olfactory neuroblastoma is a relatively uncommon malignant tumor originating from neuroectoderm and it usually arises from the superior portion of the nasal cavity, such as superior turbinate, superior part of septum, or cribriform plate. Cases of olfactory neuroblastoma from sphenoid sinus, in which olfactory epithelium rarely exists, have been rarely reported. Although nasal obstruction and epistaxis are the most common presenting symptoms of olfatory neroblastoma, our patient presented with headache and dizziness. The most common cause of isolated sphenoid lesion is inflammation, but the possibility of tumorous conditions should not be excluded without thorough evaluation. The authors experienced a rare case of olfactory neuroblastoma from sphenoid sinus that had been confused as isolated sphenoid sinusitis. So we report our unusual case with a brief review of literature.

The Effect of H1-Receptor Antagonist on Hemodynamic Change during Anesthesia / 대한마취과학회지

baseline for safe use of a drug. RESULTS: SVR and PVR failed to show statistically significant changes. Heart rates were increased only at 2 minute after administration of chlorpheniramine maleate. Blood pressures were increased but returned to basal level within 4 minutes. Cardiac output showed statistically significant increase until 8 minutes. However, the changes of hemodynamic values were maintained within 20% of basal levels. CONCLUSIONS: Chlorpheniramine maleate is observed to cause statistically significant hemodynamic change after intravenous administration during anesthesia. But the changes were within 20% of basal levels, and we can safely use chlorpheniramine maleate 8 mg IV in the view of hemodynamic changes.

The Determination of Optimal Intramuscular Injection Time of Midazolam as a Premedication Agent for Minimizing Decrease of Serum Potassium / 대한마취과학회지

BACKGROUND: Pre-operative anxiety is known to cause an increase in plasma catecholamine levels, which, in turn, attributes to the decrease in serum K+ concentration. Midazolam is one of the most commonly used premedication agent for the purpose of anxiolysis in the pre-operative period. In this study, by measuring serum K+ concentration, we investigated the optimal intramuscular injection time for midazolam which maximally prevents the reduction of serum K+ concentration. METHODS: One hundred twenty three patients undergoing breast surgery were randomly assigned to one of 5 groups. Control group (n = 24) had no premedication. 30-minute group (n = 30), 60-minute group (n = 25), 90-minute group (n = 22) and 120-minute group (n = 22) received IM injection of midazolam (0.05 mg/kg) at 30, 60, 90, and 120 minutes before induction of anesthesia, respectively. Anxiety level, serum K+ concentrations, blood pressures and heart rates of all patients were measured at 7:00pm of the day before surgery and immediately before induction of anesthesia. RESULTS: Serum K+ concentrations of all groups showed significant decrease in the preinduction time compared with those values at 7:00 pm of the day before surgery. There were no significant changes of heart rates in all groups. Blood pressures immediately before induction of anesthesia elevated compared with those at 7"00 pm of the day before surgery in all groups. Immediately before induction of anesthesia, the K+ levels of 60-minute and 90-minute groups were higher than those of the control group. At this time, the rates of hypokalemia (K+ <3.5 mEq/L) of 60-minute and 90-minute groups were lower than those of the control group. 30-minute and 60-minute groups had significantly lower anxiety levels than the control group. CONCLUSIONS: When we consider anxiety and serum potassium levels, the optimal intramusculr injecting time of midazolam was 60 minutes before induction of anesthesia.

Changes of Coagulation Status and Implication for the Use of Epidural Catheter after Donor Right Hepatectomy / 대한마취과학회지

BACKGROUND: Living donors for liver transplantations may have a low pain threshold and should be given effective postoperative pain control. However, epidural catheterization has been the subject of intense debate because of the possibility of severe coagulation derangement after a right hepatectomy. This study examined the changes in the coagulation status in right lobe donors. METHODS: The charts and computerized hospital data of 261 consecutive living donors who had undergone right hepatectomy were retrospectively reviewed. The coagulation profile including the platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) was analyzed at the preoperative period, immediately after surgery, and 5 days after surgery. RESULTS: The platelet count decreased significantly from immediately after surgery until postoperative day (POD) 5 (P 2.0 INR in only 4 donors (1.5%). The aPTT immediately after surgery showed severe prolongation (P < 0.001), but recovered rapidly on POD 1. CONCLUSIONS: Right lobe donors showed postoperative coagulation derangement but the changes appear to be acceptable for the maintenance and removal of the epidural catheters. These results suggest that careful epidural catheterizations are relatively safe in right lobe donors.

Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.

Comparative Analysis of Sextant and Extended Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: To investigate whether the extended-core (eight- or ten-core) biopsy incorporating far lateral peripheral zone can increase the rate of prostate cancer detection compared to traditional sextant biopsy. MATERIALS AND METHODS: We retrospectively analyzed the results of prostate needle biopsies of 770 men with elevated serum prostate specific antigen (PSA) ranging from 4.1 to 20ng/ml. Ten-core, eight-core, and sextant biopsies were performed in 584, 111, and 75 men, respectively. There were no significant differences in age, mean level of serum PSA, prostate volume, and PSA density between extended biopsy group and sextant biopsy group. The cancer detection rate was compared between the two groups according to the range of PSA and finding of digital rectal examination (DRE). RESULTS: Overall cancer detection rate was 12.0% in sextant biopsy group and 18.3% in extended-core biopsy group (p>0.05). In men with abnormal DRE, there was no significant difference between the two groups in terms of the cancer detection rate (35.0% in sextant biopsy group versus 30.2% in extended biopsy group). However, significantly higher cancer detection rate was noted in extended-core biopsy group with normal findings of DRE (3.6% versus 12.7%). No significant difference of the cancer detection rate was observed between eight-core and ten-core biopsy groups. CONCLUSIONS: In men with an elevated PSA and a normal DRE, extended- core biopsy appears to enhance cancer detection compared to the traditional sextant biopsy, whereas sextant biopsy may be sufficient to detect the cancer in men with abnormal findings of DRE.

A Case of Juxtaglomerular Cell Tumor / 대한신장학회잡지

The juxtaglomerular cell tumor is a rare benign tumor which causes surgically correctable hypertension. We report a case of hypertension caused by juxtaglomerular cell tumor in a 17-year old man. He presented with hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism. Renal angiography showed no evidence of renal artery stenosis. Though no mass was suspected in renal angiography, CT scan showed a well demarcated mass, 3 cm in diameter, in the upper portion of left kidney, which was resected and diagnosed to be a juxtaglomerular cell tumor. After resection of the tumor, blood pressure was normalized with resolution of hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism.

Effects of Alpha 1 Adrenoceptor Antagonist Tamsulosin on Sexual Function in Patients with Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: We evaluated the effectiveness of alpha 1 adrenoceptor antagonist tamsulosin on erectile function in the treatment of the patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We recruited 268 patients who had BPH with lower urinary tract symptoms in the period of June 2003 to September 2003. The study utilized an open-label approach. Patients were evaluated by physical examination, transrectal ultrasonography (TRUS), serum prostate specific antigen (PSA), uroflowmetry, international prostatic symptom score (IPSS), quality of life (QOL) assessment, voiding diary for 3 days, brief international index of erectile function (IIEF)-7 score, and the global efficacy assessment questionnaire (GEAQ)-2. All evaluations were performed before medication, and again at 4 and 12 weeks of treatment. The patients suspected to have prostatic carcinoma based on the digital rectal examination and/or PSA level above 4 ng/ml underwent transrectal ultrasonography guided biopsy of the prostate. The patients found to have prostate cancer were not included in the study. RESULTS: A total of 165 patients completed the study. Total IIEF scores did not change significantly. Question 10 of IIEF was significantly different between 4 and 12 weeks. There was a statistically significant difference in GEAQ-2 between 4 and 12 weeks of medication. Ejaculation volume decreased 14% and 22% at 4 and 12 weeks, respectively. However, orgasmic function significantly improved between 4 and 12 weeks. CONCLUSIONS: In patients with BPH, tamsulosin therapy improved sexual and orgasmic function, although it decreased ejaculation volume. We need a longer follow-up period and more patients to establish the effects of tamsulosin on erectile function in the patients with BPH.

A New External-landmark Technique of Right Internal Jugular Vein Cannulation / 대한마취과학회지

BACKGROUND: Central venous cannulation is one of the important parts of anesthetic management. Because general anesthesia causes external-landmarks (e.g. sternocleidomastoid muscle, carotid artery pulse) indistinct, we developed a new external landmark for internal jugular vein cannulation that can be easily detected under general anesthesia. METHODS: We cannulated the right internal jugular vein of 110 patients under general anesthesia. We used the external jugular vein and cricoid cartilage as a landmark. RESULTS: Cannulation of the right internal jugular vein was successful in 108 out of 110 patients (98.2%). Patients required an average 1.48+/-0.63 attempts. There were 2 carotid punctures (1.8%), 3 discomforts (2.7%) and no brachial plexus irritation. CONCLUSIONS: This new landmark technique has a high success rate and few complications.

The Clinical Significance of Hormonal Receptors in Breast Cancer

PURPOSE: Clinically, the detection of steroid hormone receptors, estrogen receptor (ER) and proges terone receptor (PR), has been used not only as a prognostic marker but also as a predictor of hormone response in breast-cancer patients. We performed this study to evaluate the clinical significance of hormone receptors in breast cancers in Korea. METHODS: We have collected data about hormonal receptors from breast-cancer patients of Kangnam St. Mary's Hospital, The Catholic University of Korea, since 1984. A total of 544 patients were followed up and their clinicopathological results were analyzed retrospectively by using medical records. The survival analysis was performed by using the Kaplan-Meier method. RESULTS: The mean age of the patients was 47.3 years, and the peak of age distribution was noted in the 5th decade. The premenopausal patients were 358 (65.8%), and the postmenopausal patients were 186 (34.2%). The median follow-up period was 4.5 years. The results of ER/PR status were as follows: (+)/(+) in 191 patients (35.1%), (+)/(-) in 82 patients (15.1%), (-)/(+) in 74 patients (13.6%), and (-)/(-) in 197 patients (36.2%). The positive rates of ER and PR were 52% or 55% in premenopausal patients and 46% and 36% in postmenopausal patients, respectively. In the univariate analysis of the overall survival by the Log-rank test, the significant variables were stage (p=0.0004), node metastasis (p=0.0000), lymphatic invasion (p=0.0000), vein invasion (p=0.0558), ER (p=0.0397), PR (p=0.0538), adjuvant hormone therapy (p=0.0010), the duration of hormone therapy (p=0.0004). In the multivariate analysis of the overall survival by using the Cox regression test, the significant variables were ER (p=0.0070), adjuvant hormone therapy (p=0.0234), adjuvant chemotherapy (p=0.0493) and mean ingful results were noted in the duration of hormonal therapy (p=0.0629), lymphatic invasion (p=0.0752) and tumor size (p=0.1726). CONCLUSION: The results of this study suggest that the pattern of hormonal receptor status according to menopause status might be different from that of western patients and confirmed hormonal receptors as prognostic markers and predictors of hormone therapy in breast cancer.

Chest Wall Muscle Changes after a Mastectomy: Findings of Chest CT

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons and radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether modified radical mastectomy (MRM) was properly performed or not. METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT findings to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 yeras, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Patey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muslce atrophies were noted at the m. subscapularis in 3 patients (100 %), the m. serratus anterior in 2 patients (66.7%) and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However, there was no muscle atrophy in patients who received scanlon operation. CONCLUSIONS: These results suggests that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in MRM. The scanlon operation which preserves the nerve by dividing of pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.

Two-dimensional Ultrasound-guided Cannulation of the Internal Jugular Vein / 대한마취과학회지

BACKGROUND: Internal jugular vein access is an essential part of patient management in many clinical settings and is usually achieved with a blind, anatomical landmark-guided technique. The purpose of this study is to evaluate whether a 2-dimensional ultrasound technique can improve on the traditional method. METHODS: Eighty patients undergoing elective open heart surgery were randomly assigned to an anatomical landmark group or ultrasound group (each n = 40). With the patient in the supine position, the head was rotated 30o to the contralateral side and triangle formed by the clavicle and both heads of the sternocleidomastoid muscle were identified. We accessed the internal jugular vein from the apex of the triangle toward the ipsilateral nipple in the anatomical landmark group. The internal jugular vein and carotid artery were visualized with two-dimensional ultrasound. We compared the number of advances made with the central venous cannulation needle, the time to blood aspiration, complications and failure rate. RESULTS: The failure rate was 22.5% using the anatomical landmark technique and 5% using the ultrasound technique. The vein was entered on the first attempt in 60% of patients using the landmark technique and in 63% using ultrasound (P>0.05). Mean attempts for puncture were 1.9 (anatomical) vs 1.6 (ultrasound-guided) (P>0.05). Complications occurred in 20% of cases using anatomical landmarks and in 5% using ultrasound (P>0.05). The average access time was 26.5 seconds by the anatomical approach and 56 seconds by the ultrasound approach (P< 0.05). CONCLUSIONS: Ultrasound-guided cannulation of the internal jugular vein did not significantly decrease failure rate, access time, complications, and attempts for puncture, nor did it increase the amount of successful first attempts. However an investigation using a larger number of patients will be needed.

Telomerase Activity in Breast Cancer and Benign Breast Disease of Korea / 한국유방암학회지

BACKGROUND: Telomerase is an RNA-dependent DNA polymerase that compensates for the telomere shortening that occurs in its absence. Reactivation of telomerase is thought to be an important step in cellular immortalization, and recent studies have indicated that telomerase activity is often detected in primary human malignancies. The purpose of this study is to identify telomerase activity in breast cancer. MATERIALS & METHODS: Telomerase activities were analyzed in the samples of 12 breast cancer tissues and 11 benign breast disease tissues by TRAPeze ELISA detection kit (Oncor, Gaithersburg, USA). All samples were obtained from the excised mass at the time of specimen removal in the operating room and stored in liquid-nitrogen tank. RESULTS: Telomerase activity was detected in 10 of 12 (83.3%) breast cancer samples and 4 of 11 (36.4%) benign breast disease samples. The detection of telomerase activity in diagnosis of breast cancer has validity: 83.3% sensitivity rate, 63.6% specificity rate, 71.4% (+) predictability rate, 77.8% (-) predictability rate. The telomerase activity correlates with the estrogen receptor status (p=0.009). CONCLUSION: The telomerase activity can be detected in breast cancer sensitively. Further study with sufficient samples is needed to establish detection of telomerase activity as diagnostic tool in breast cancer.

Chest Well Muscle Changes after A Mestectomy Findings of Chest CT / 한국유방암학회지

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons an radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether the modified radical mastectomy (MRM) was properly performed or not. MATERIALS AND METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT finding to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total of 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 years, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Petey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muscle atrophies were noted at the m, subscapularis in 3 patients (100%), the m. serratus anterior in 2 patients (66.7%), and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However. there was no muscle atrophy in patients who received Scanlon operation. CONCLUSIONS: These results suggest that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in a MRM. The Scanlon operation which preserves the serve by dividing the pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.

The Effect of Erythropoietin on the Production of Endothelin in Human Glomerular and Umbilical Endothelial Cells / 대한신장학회잡지

The administration of erythropoietin for renal failure patients is frequently associated with a mild-to-marked rise in arterial blood pressure. The erythropoietin-induced hypertension has been variably attributed to the rise in erythrocyte concentration and/or a direct or indirect pressor action of erythropoietin on vascular smooth muscle. Especially erythropoietin-induced hypertension may be mediated by increased production of the potent vasoactive peptide endothelin. This study was designed to determine the effect of erythropoietin to the production of endothelin in human glomerular endothelial cells and human umbilical vein endothelial cells. ELISA method was used to measure the endothelin- 1, after 4 X 10(4) endothelial cells were grown to confluency on 24-well plates, in which erythropoietin 25u/ml was incubated for 24 hours. The results showed that the endothelin production in human glomerular endothelial cells was insignificant (116.0+/-14.0%, P>0.05, mean+/-S.E., n=5, each n means the mean of duplicate experiments), but the endothelin production in human umbilical endothelial cells was increased after 25u/ml erythropoietin treatment(126.5+/-15.2%, P<0.05, mean+/-S.E., n=4). In glomerular endothelial cells, TGF-beta(0.5ng/ml) increased the production of endothelin(218.8+/-57.2%, P<0.01, mean+/-S.E., n=5), also it looks like that TNF-alpha and thrombin might increase the production of endothelin according to the concentration. In conclusion, the responsiveness of endothelial cells to erythropoietin may be different according to the cell type, and glomerular endothelial cells could increase the production of endothelin, if appropriate stimuli were given.

Comparative Study of the Lacrimal Dacryocyscintigraphy and Contrast Dacryocystography in Epiphora

PURPOSE: The purpose of this study was to compare contrast dacryocystography with lacrimal dacryo-scintigraphy in correlation with epiphora, superiority in localization of the site of obstruction and discomfort of partient during procedures. MATERIAL AND METHODS: Lacrimal dacryoscintigraphy and contrast dacryocystography were performed in 200 lacrimal drainage systems in 100 patients who were referred to our hospital with epiphora since January, 1993. RESULTS: Lacrimal dacryoscintigraphy showed 88% in correlation with epiphora, 90% in positive predictive value and 74% in negative predictive value. Contrast dacryocystography showed 72% in correlation with epiphora, 97% in positive predictive value and 60% in negative predictive value. Contrast dacryocystography was superior to lacrimal dacryoscintigraphy in localization of the site of the obstruction because of limitation of resolution of 6mm pin hole collimator. But discomfort of patient was variable and severe on contrast dacryocystography. CONCLUSION: When obstruction is suspected, we recommend the lacrimal dacryoscintigraphy as initial radio-graphic study. If adequate information is not available and confirmation is necessary, contrast dacryo-cystography should be done in next step. Inspite of patient symptom, if finding of contrast dacryocystography is normal, lacrimal dacryoscintigraphy should be performed to exclude functional obstruction.