Since he liver is the central organ of uric acid metabolism, I investigated the utility of serum uric acid level as an indicator of the residual liver function and prediction of survival in patients with liver cirrhosis.

I measured the liver function test including uric acid level in the patients with chronic liver disease(41 patients with chronic hepatitis and 66 patients with liver cirrhosis). The serum uric acid level was analyzed for prognostic value.

The serum uric acid level was significant decreased in patients with Child-Pugh class B and C group(group III) compared with Child-Pugh class A(group II) or chronic hepatitis(group I)(p<0.001). There was no difference of the level of uric acid between alcoholic and nonalcoholic cirrhotic patients(p=0.09). The serum uric acid level was correlated inversely with serum bilirubin level in patients with cirrhosis. The sensitivity and specificity of hypouricemia in detecting liver function status in patients with liver cirrhosis were 62.5% and 100%, respectively.

The hypouricemia is one of sensitive factors to assess liver function and predictive value of survival in liver cirrhosis.

Diabetic patients develop hypoaldosteronism which frequently caused hyperkalemia and metabolic acidosis and diabetic hypoaldosteronism is associated with selective unresponsiveness of aldosterone to angiotensin II(A II), but mechanism of defect in A II stimulated aldosterone response still remain unclear.

To elucidate the mechanism of defect in A II stimulated aldosterone response and whether the defect was corrected by insulin treatment. author evaluated the responses of aldosterone production to A II, K⁺ and ACTH. I also evaluated the products of phospholipase C(PLC) and phospholipase D(PLD) activation important for increase of intracellular calcium and protein kinase C activation after A II activation in adrenal glomerulosa cells prepared from streptozotocin induced diabetic rats.

Two weeks after induction of diabetes by streptozotocin, rats were sacrificed by decapitation. The aldosterone production to A II, K⁺ and ACTH was measured by RIA. Inositol triphosphate(IP₃) and diacylglycerol(DAG) generated by activation of PLC and phosphatidic acid(PA), phosphatidylethanol(PEt) and DAG generated by activation of PLD were measured by anion exchange column and thin layer chromatography.

1) Plasma renin activity and aldosterone level were not different among control rats, untreated and insulin treated diabetic rats.

2) basal, ACTH and K⁺-stimulated aldosterone production were similar in cells from the three groups(p>0.05), but A II stimulated aldosterone production was significantly decreased in cells from untreated diabetic rats compared with control and insulin treated diabetic rats(p<0.05).

3) A II-induced IP₃, PA, PEt and DAG generation was similar among the three groups(p>0.05).

These results suggested that decreased A II-stimulated aldosterone response was present in glomerulosa cells from strepzptocin induced diabetic rats and reversed by insulin treatments. The main defect of altered A II response of zona glomerulosa might be located in the step distal to the activation of phospholipase.

This study was performed to evaluate the usefulness of quantitative measurement of C-reactive protein(C-RP) and ESR in the differentiation between Rotaviral and Salmonella gastroenteritis in children.

On admission quantitative C-RP measurement by nephelometry, stool culture for slmonella and shigella, stool latex agglutination test for rotavirus(slidex rota-kit 2), stool occult blood, stool WBC and CBC with ESR were performed.

Of sixty seven children, 40(59.7%) children had Rotaviral gastroenteritis, and 27(40.3%) had Salmonella gastroenteritis. The C-RP levels and ESR of the patients with Salmonella gastroenteritis differed significantly from the Rotaviral gastroenteritis. At the level of 0.8 mg/dL, C-RP gave the best balance of sensitivity(84.6%) and specificity(87.5%).

The quantitative measurement of C-RP levels may be a useful tool for predicting Salmonella gastroenteritis in children.

The purpose of this study is the evaluate the diagnostic accuracy of MRI, frequent location of injury site and injury type in meniscal injury, retrospective review of false positive cases.

From September 193 to January 1997 in our hospital, we analyzed a hundred cases of meniscal injury suggested by MRI. And we tried to correct operatively in meniscal injury by arthroscopic or open method of operation.

1)Diagnostic accuracy of MRI was 90%

2)Most common site of meniscal injury was medial meniscus posterior horn(54.4%).

3)Most common injury type was Bucket handle tearing(34.4%).

4)Cause of pitfall in false positive case was most common popliteal tendon sheath(30%).

MRI was effective method on diagnosis of meniscus injury and most common injury was medial meniscus posterior horn, And diagnostic fault was caused by popliteal tendon sheath, lateral inferior genicular artery, truncation artifect, meniscofemoral ligament, transverse geniculate ligament.

Tumors of the basal posterior fossa, especially the clivus or petrous apex area, are embarrasing lesions because surgical access to these areas remains a formidable challenge.

Numerous approaches for lesions at this deep-seated and vital location, have been utiliged, but disappointed in resuts. The author consider that the petrosal approach is the most suitable for tumors located at these areas. The surgical technique of this approach is described and reviewed its advantages.

The author review the 14 harboring benign nature via the petrosal approach form September 1992 to February 1994.

There was no mortalily in this series. Total removal was achieved in 8 patients. Morbidity included hemiparsis(4 patients), cerebeller sings(3 patients), 7th cranial nerve deficit(1 patient) and persistent CSF leakage(1 patient).

The petrosal approach for the following advantages : the cerebellum and temporal lobes are minimally retracted, the operative distance to the clivus is shortened, the surgeon has a direct line of sight to the lesion and the anterior and lateral aspects of the brain stem, the neural and otological structures including the cochlea, the labyrinth and the facial nerves are preserved, the transveres and sigmoid sinuses as well as the vein of Labbe and the basal occipital veins are preserved, the tumour's blood supply is intercepted early in the procedure, multiple axes for dissection are provided, and dissection is performed along alongitudinal axis.

It is suggested that the petrosal approach is the most suitable for tumors of the basal posterior fossa(at the petrous apex or clivus).

Cervical spine injury is a commonly encountered entity in most neurosurgical practice and is increasing with social environment. Universally accepted treatment modality for acute cervical spine injuries do not exist and several areas of controversy surround the issue of surgical intervention in the management of trauma to the cervical spine.

A retrospective study of 86 injured cervical spine patients who admitted and carried out a surgical treatment at Dong Dae Moon Hospital between Sep.92 and Aug.96 for the past four-year-period.

The author analyzed 86 patients with traumatic cervical spine injuries for the past 4 years. The incidence was highest in middle aged men(ratio : 6.8) and the traffic accident was the most common exclusive cause(68%). In 9 cases of C1-2 spine injury, they underwent posterior approach. In 74 cases of mid-lower(C3-7) cervical injury, the anterior approach was used in 57 patients, the posterior approach was used in 13 patients and the combined approach was used in 4 patients. The surgical complication rate was 15%(13 cases).

Internal fixation with variety of devices has become a popular procedure for cervical spine injuries.

In this study, the rate of re-operation and complications following initial surgical procedures were found to be higher than previous report of other authors. It could be concluded that choosing the most proper surgical approach for cervical spine injuries with minimal risks and adhering to stringent criteria are much important than simply selecting new fancy devices over the traditional one.

Improvements in microsurgical and neuroanesthesiological have resulted in an increasing number of operation for aneurysm clipping in elderly patients. It is the purpose of this article to evaluate surgical outcome of elderly patients(stand point of three groups), considering neurologic grade on admission, amount of subarachnoid hemorrhage(SAH) on computerized tomography(CT) findings and timing of surgery.

The subjects of the present study are 34 patients who were admitted to department of neurosurgery and treated surgically between 1991 and 1997 in Mok-Dong and Tongdaemun hospital. All the patients in this study were verified as having aneurysmal SAH on CT scanning followed b cerebral argiography. The patients were classified by age into three groups : 65 to 70 years(24 cases), 76 years(7 cases) and 76 years or older(3 cases). On admission, the clinical condition of patients was graded according to the scals of Hunt and Hess and the amounts of SAH was graded according to grading system of Fisher. The day 7 SAH was defined as Day O. the timing of operation was divided into three. 1-3 days ; 3-7 days; 8-days.

The surgical mortality according to the different age groups, Hunt-hess grade, grading system of Fisher and timing of operation was analised.

Overall, 11 of the 34 patients died, for a mortality rate 32%. The mortality rate by age groups was 21% for 65 to 70 years, 57% for 71 to 75 years and 20% for 76 years of older. The mortality rate by Hunt-Hess grade was 35%, in I-II, 33% in III and 20% in IV-V, and the mortality rate as related to grading system of Fisher was 0% in 1, 36% in 2, 36% in 3 and 25% in IV. The mortality rate according to timing of operation was 31% in 1-3 days, 25% in 3-7 days and 25% in over days.

In recent years, with improvement in surgical technique and neuroanesthesia, the number of operation for ruptured aneurysm have increased in elderly patient. A more aggressive treatment in elderly patients is justified.

Rastelli procedure for right ventricular outflow tract(RVOT) obstruction has many disadvantage especially for children. Instead of using the artificial valved conduit, we applied the REV procedure for preventing the valve re-replacement after growing and observed the fate of that patch.

We performed REV procedure for RVOT reconstruction with our own hand-made monocusp patch composed of porcine pericardial cusp and bovine pericardial patch in 7 young piglets(15.3±1.3kg) and raised till adult pig9about 70 kg). After sacrificed the pig we explored their pulmonary arteries, monocusp patch and hearts.

Without any stenotic residues in the pulmonary artery, we found the deformed monocusp patch with severe calcification, which deprived the adequate valve function, but kept the pig growing normally.

We are sure that this REV procedure with monocusp patch could be extendedly applied to the RVOT obstruction, but we need to develope the anti-calcification method for the heterograft patch.

The purpose of this study is to evaluate the therapeutic effect and clinical applicability of 5% sodium morrhuate sclerotherapy as primary surgical approach in cases of mucous systs.

15 cases of mucous cysts who were treated with 5% sodium morrhuate sclerotherapy were evaluated and 11 cases were followed up during 1994's. First, mucous cyst was incised, and washed out several times. 5% sodium morrhuate was infused slowly(More than 5 minutes) and throughly for maximal contact. Pressure dressing was done with elastic bandage for 2-3 days.

Age of patients were distributed form 12 year-old to 44 year-old. Involved sites were wrist97), thumb(2), ear(1), and hand(1). 5 cases among 11 cases(45%) were cured completely, but 6 cases(55%) were reoccurred, Timing of recurrences were distributed from 2-3 days till 4 months, and mean was 40 days. Patients assessed the satisfactions of therapy as excellent 2, good 1, fair 1, poor 7. complications were mild pain, hardening, and pigmentary change.

5% sodium morrhuate sclerotherapy might be useful as a primary surgical approach in cases of mucous systs because of simplicity. It is expected that therapeutic effects of sclerotherapy would be improved by repeated applications, changing to more potent sclerosants and meticulous pressure method.

Acute appendicitis is very rare in infancy and early childhood. Delayed diagnosis of appendicitis may result in catastrophic outcome with perforation. We performed a retrospective analysis of clinical and radiologic findings of acute appendicitis occurring in the first 2 years of life.

Nine patients of acute appendicitis who were are less than two years of age proved by surgery and pathology were analyzed in terms of clinical symptoms and signs, and findings on preoperative plain abdominal roentgenography(9 cases), barium or gastrografin enema(6 cases), ultrasonography(8 cases) and abdominal CT scan(1 case).

All patients presented with nonspecific clinical symptoms and signs, such as vomiting and fever. All were complicated with perforation. Six were associated with periappendiceal abscess, and four with appendicolith. Plain abdominal roentgenogram showed generalized paralytic ileus and increased density on right lower quadrant in all cases, and diffuse for right lower abdominal wall bulging in some cases. Most cases of perforated appendicities and periappendiceal abscess were diagnosed by ultrasound and some cases by contrast enema or abdominal CT scan.

When the patients less than 2 years of age have nonspecific acute abdominal symptom with the roentgenographic findings of aggravating ileus and haziness in the right lower abdomen, ultrasonography might be considered as a helpful diagnostic tool for the early diagnosis of appendicitis. CT and contrast enema also might be helpful.

Paclitaxel(Taxol) si a chemotherapeutic agent with potent microtubule stabilizing activities that arrests cell cycle in G2-M. Since D2-m is the most radiosensitive phase of the cell cycle, paclitaxel has potential as a cell cycle-specific radiosensitizer. This study was designed to investigate the effects of paclitaxel to radiotoxicity in normal rat liver.

A single intraperitoneal infusion of paclitaxel(10mg/kg), and a single irradiation(8Gy, x-ray) to the whole abdomen, and combination of irradiation(8Gy,x-ray)24 hours after paclitaxel infusion were done in Sprague-Dawley rats. The incidence of mitosis, apoptosis and parenchymal changes of the liver were evaluated at 6 hours, 24 hours, 3 and 5 days, respectively.

Paclitaxel and irradiation significantly increased mitosis at 6 hours and apoptosis was increased by irradiation at 6 and 24 hours. Increased numbers of apoptosis at 3 days by paclitaxel alone was not significantly different from control. Combination of paclitaxel and irradiation showed significantly increased numbers of mitosis and apoptosis at 6 hours. The degree of necrosis of hepatocyte was not significantly different between 3 groups.

Since the incidence of mitosis, apoptosis and hepatocyte necrosis were not increased by paclitaxel infusion 24 hours before irradiation, paclitaxel did not show radiosensitizing effect in this experimental condition. Studies with conditions similar to clinical situation will be the next stop to define the radiosensitizing effects of paclitaxel.

Elevated serum lgE and pheripheral blood eosinophilia are immunologic hallmark in helminthic infections. Recently, these responses are known to be regulated by Th2-specific cytokine IL-4 and IL-5, respectively. And also, the antagonistic effects of IFN-γ on Th2 cell proliferation were shown in vitro. However, few studies on the effect of IFN-γ on Th2 cytokine responses in Paragonimus westermani infection are reported, In this study, effects of rIFN-γ on serum lgE production and the number of pheripheral blood eosinophils in mice infected with P.westermani were examined.

5-6week old male BALB/c mice treated with IFN-γ were divided into 3 groups. All the mice were inoculated orally with 20 metacercariae of P.westermani. GroupImice(0-14days) were treated intraperitoneally with 2×10³ unit of rIFN-γ at daily intervals from the time of the infection to 4th day infection, group II mice(5-14 days) were treated with rIFN-γ from the 5th to the 14th day of infection and group III mice(8-14 days) were treated from the 8th to the 14th of infection. Total serum lgE and the number of pheripheral blood eosinophils were examined in infected mice treated with rIFN-γ.

The serum lgE levels in groupIand II were decreased compared with those of infected mice with no treatment with rIFN-γ, but not significantly. The number of pheripheral blood eosinophils in group I and II were decreased compared with those of infected mice with no treatment with rIFN-γ, especially significant(p<0.05) reduction was shown in group I. However, the serum lgE levels and number of pheripheral blood eosinophils in group III were similar to those of infected mice with no treatment with rIFN-γ.

These results suggest that IFN-γ decreases Th2 cytokine response in P.westermani-infected mice. However, IFN-γ treatment has less of an effect once the production of Th2-associated cytokines has become established.