Efficacy of Fine Needle Aspiration Biopsy and Frozen Section Biopsy in Salivary Gland Malignancies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the efficacy of fine needle aspiration biopsy (FNAB) and frozen section biopsy in salivary gland malignancies. SUBJECTS AND METHOD: From January 1995 through December 2004, 462 patients underwent operation for salivary gland mass. Of these patients, FNABs and frozen section biopsies were performed in 262 and 241 patients, respectively. The medical and pathologic reports were reviewed retrospectively. Malignancies were found in 57 patients. RESULTS: The sensitivity and the specificity of FNAB to detect salivary gland malignancies were 50.9% and 94.1%, respectively. For the frozen section biopsy, the sensitivity and specificity rose to 90.7% and 99.0%, respectively. When the examination period was divided into period 1 (Jan, 1995-Dec, 1999) and period 2 (Jan, 2000-Dec, 2004), sensitivity showed a significant increase from 33.3% to 57.1%. With respect to pathologic types of the tumors, the sensitivity of FNAB was high in adenocarcinoma (88.9%, 8/9) but low in mucoepidermoid carcinoma (30%, 3/10) and carcinoma ex pleomorphic adenoma (33.3%, 3/9). CONCLUSION: FNAB alone cannot guarantee accurate diagnosis of salivary gland malignancies. Therefore, intraoperative frozen section biopsy is recommended to make an adequate decision for surgical extent. The clinical experience of pathologists is also an important factor in improving the accuracy of fine needle aspiration biopsy.

Pharmacokinetics of Glutathione and Its Metabolites in Normal Subjects

To determine the loading and maintenance dosage of glutathione (GSH) for patients suffering from reactive oxygen species (ROS) injury such as acute paraquat intoxication, a kinetic study of reduced GSH was performed in synchrony with that of cysteine (Cys), cystine (Cys2), and methionine (Met). Human subject's porticipitation was voluntary. The effective dose of Cys, Cys2, and Met against ROS in fibroblast cells generated by paraquat was assessed using laser scanning confocal microscopy. Both Cys and Met suppressed ROS in a dose-dependent manner at concentrations of 1-1,000 micrometer; the concentration required to suppress ROS by 50% was 10 micrometer for Cys and 50 micrometer for Met. Using metabolite kinetics with the assumption that Cys and Met are the metabolites of GSH, expected concentrations of Cys and Met of above 20 and 50 micrometer were estimated when GSH was administered at 50 mg/kg body weights every 205.4 min for Cys and 427.4 min for Met.

Effect of High-Dose Intravenous N-acetylcysteine on the Concentration of Plasma Sulfur-Containing Amino Acids

BACKGROUND: The purpose of this study was to determine the adequate loading and maintenance doses of N-acetylcyseteine (NAC) for patients suffering from acute ROS-induced injury. METHODS: Concentrations of extra cellular NAC, cysteine (Cys), cystine (Cyst2), and methionine (Met) were measured in vitro, at which more than 50% of the intracellular ROS raised by paraquat were suppressed using Swiss 3T3 fibroblasts. An in vivo pharmacokinetic study followed on a healthy subject to determine the proper loading and maintenance doses of reduced NAC following intravenous administration of 25 mg/kg NAC. RESULTS: In vivo, NAC suppressed ROS in a dose dependant manner. 10 mM of NAC suppressed about 50% of ROS, and was comparable to 10 micro M of Cys and Met and 400 micro M of Cys2. In vitro, the elimination of half-life was achieved at 2.88+/-1.14 h for NAC and at 3.68+/-1.84 h for total NAC. The body clearances were 1.23+/-0.77 L h (-1) kg (-1) and 0.56+/-0.27 L h (-1) kg (-1) and the volumes of distribution were 3.07+/-0.10 L kg (-1) and 3.00+/-0.11 L kg (-1), respectively. The loading and maintenance NAC doses used to reach the target concentration of 10 mM, were 5010 mg. kg (-1) and 2250 mg min (-1) kg (-1), respectively. CONCLUSION: NAC provides an antioxidant effect on ROS produced by paraquat in vivo. However, in vitro, our results showed that the intravenous NAC dose could not be estimated from NAC plasma concentration or its metabolites.

Propofol as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. METHODS: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. RESULTS: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p<0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p<0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p<0.01). CONCLUSIONS: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

Four Cases of Gastric Mucosal Tear after Blunt Abdominal Trauma / 대한소화기내시경학회지

The incidence of abdominal trauma has increased in recent decades as the frequency of traffic accidents increased. Early symptoms and signs of blunt abdominal trauma may be absent and associated injuries frequently detract physicians from early diagnosis of abdominal trauma. Delayed diagnosis has been shown to be associated with higher morbidity and mortality. Gastrointestinal tract is the third most commonly injured organ from blunt abdominal trauma. Gastric ruptures after blunt abdominal trauma were reported occasionally, but reports of upper gastrointestinal bleeding by gastric mucosal tear were very rare. Four cases of upper gastrointestinal bleeding due to gastric mucosal tear after blunt abdominal trauma are herein reported with a review of related literatures.

A Case of Budd-Chiari Syndrome with IVC Web Treated by Balloon Dilatation / 대한간학회지

Budd-Chiari syndrome is acute or subacute occlusion of the hepatic vein and IVC, The occlusion of hepatic veins often reveals dramatic illness characterized by abdominal pain, ascites, hepatomegaly and a poor prognosis. Several recent reports have suggested that balloon dilatation may be effective in Budd-Chiari syndrome. We experienced a case of Budd-Chiari syndrome with IVC web which was successfully treated with balloon dilatation. We report the case here with a brief review of literature,