Development of a Broadband Telemedical Network Based on Internet Protocol in the Asia-Pacific Region

Objectives : To promote the exchange of knowledge and standardization of medical procedures and medical systems in the Asia-Pacific region, we established a medical networkwith high-quality moving images over broadband Internet lines in February 2003.

Methods : Real-time teleconferences and live demonstrations with medical-qualityvideos, broadcastvia the Digital Video Transport System, have been used t teach surgical techniques and other medical procedures across national borders.

The Asia-Pacific Advanced Network (APAN) committee in August 2005 formally approved our proposal to establish a medical working group within APAN. The networkwas expanded by the launch of the Trans- Eurasia Information Network 2 in 2006. By the end of 2006, we had conducted 82 events, in 10 countries in the Asia-Pacific region. The multi-station event has increased everyyear.

Results : There have been no serious transmission problems or ethical conflicts so far. With these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific.

Conclusion : This system is a promising and very useful tool for the standardization of medical system and procedures across national borders. Drawing upon these experiences and current achievements, we hope to extend this advanced network system to the entire Asia- Pacific region.

Development of a broadband telemedical network based on internet protocol in the Asia-Pacific region

OBJECTIVES

To promote the exchange of knowledge and standardization of medical procedures and medical systems in the Asia-Pacific region, we established a medical network with high-quality moving images over broadband Internet lines in February 2003.

METHODS

Real-time teleconferences and live demonstrations with medical-quality videos, broadcast via the Digital Video Transport System, have been used to teach surgical techniques and other medical procedures across national borders. The Asia-Pacific Advanced Network (APAN) committee in August 2005 formally approved our proposal to establish a medical working group within APAN. The network was expanded by the launch of the Trans-Eurasia Information Network 2 in 2006. By the end of 2006, we had conducted 82 events, in 10 countries in the Asia-Pacific region. The multi-station event has increased every year.

RESULTS

There have been no serious transmission problems or ethical conflicts so far. With these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific.

CONCLUSION

This system is a promising and very useful tool for the standardization of medical system and procedures across national borders. Drawing upon these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific region.

The influence of gastrectomy on the change of bone metabolism and bone density

OBJECTIVES

Abnormalities of bone metabolism could be followed in gastrectomized patients as a late complication. Nowadays, many biochemical and radiologic measurements are applied to detect these abnormalities. The aim of our study is to determine the valuable parameter as an appropriate screening test during long-term follow-up periods and define the usefulness of new biochemical markers for bone metabolism by comparing with traditional markers.

METHODS

Fifteen patients who had undergone partial gastrectomy were chosen randomly and fifteen healthy controls were compared. Then, several biochemical and radiologic tests were measured. We excluded subjects who proved to have other causes of bone metabolism abnormalities. Ten patients and 10 controls were finally selected.

RESULTS

Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography (QCT) was statistically significantly lower in the patient group (p < 0.01). The urinary deoxypyridinoline, a biochemical marker for bone resorption, was statistically higher in the patient group (p < 0.025). Osteocalcin, Procollagen I C-terminal peptide (PICP) and Type I collagen C-terminal telopeptide (ICTP) were slightly but not significantly higher in the patient group. The serum parathyroid hormone (PTH) and 25-hydroxy vitamin D levels were similar in both groups.

CONCLUSION

We could suggest that urinary deoxypyridinoline and QCT are appropriate parameters as screening tests for the detection of bone metabolism abnormalities in gastrectomized patients during long-term follow-up. Urinary deoxypyridinoline may be a simple and rapid test which could replace cumbersome 24-hour urinary hydroxyproline.

Gallbladder motility change in late pregnancy and after delivery

OBJECTIVES

The incidence of gallstone disease has increased recently in Korea and there seems to be an increased prevalence of gallstones when in association with pregnancy. Although the pathogenesis is incompletely defined, and altered motility of the gallbladder may contribute to the increased risk of gallstones during pregnancy.

METHODS

We measured gallbladder volume using real-time ultrasonography to find out the mechanism for the changes of gallbladder motility during late pregnancy. Eighteen pregnant women took the gallbladder ultrasonography during their last trimester of pregnancy and after delivery; gallbladder volume and ejection fraction were calculated in each patient.

RESULTS

Fasting gallbladder volumes increased significantly in the last trimester of pregnancy (25.28 +/- 14.26ml) compared with postpartum (17.44 +/- 5.82 ml) (p < 0.05). Gallbladder volumes measured after fatty meals showed more increment in pregnant women (10.13 +/- 7.19 ml) than in those after delivery (4.34 +/- 3.36 ml) (p < 0.005). A significantly reduced gallbladder ejection fraction was found in the pregnant group (60.56 +/- 18.80%) compared with those after delivery (77.48 +/- 13.37%) (p < 0.005).

CONCLUSION

Gallbladder motility in late pregnancy shows significant impairment compared with that in postpartum. Thus, we suggest that gallbladder hypomotility may occur during late pregnancy, and this impairment of gallbladder motility may play an important role in gallstone formation.

Gallbladder motility in diabetes mellitus using real time ultrasonography

OBJECTIVES

Diabetes mellitus is one of the risk factors in cholesterol gallstones. Individuals with diabetes mellitus are reported to have a 2-fold to 3-fold increase in the incidence of cholesterol gallstones. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes.

METHODS

We compared the gallbladder volume and ejection fraction of 24 diabetics with those of 19 age-matched and weight-matched controls using real-time ultrasonography. Blood sampling for biochemical study of all the subjects were performed.

RESULTS

No significant differences in any physiochemical parameters between the diabetic group and control group could be found. Fasting gallbladder volume increased significantly in the diabetic group (21.90 +/- 9.53 cm3) compared with the control group (16.99 +/- 5.97 cm3). Gallbladder volume measured after a fatty meal were greater in the diabetic group (10.76 +/- 7.19 cm3) than in the control group (4.22 +/- 3.31 cm3) (p < 0.04). When the diabetic group was divided according to the presence or absence of autonomic neuropathy, a significant reduction of ejection fraction was found in diabetics with autonomic neuropathy (42.75 +/- 19.37%) in comparison with diabetics without autonomic neuropathy (61.75 +/- 17.63%) (p < 0.02).

CONCLUSIONS

Gallbladder volume in diabetics was significantly greater compared with that of the control. Moreover, in diabetics with autonomic neuropathy, gallbladder motility was markedly reduced in comparison to diabetics without autonomic neuropathy. Thus, we suggest that impairment of gallbladder motility complicated with autonomic neuropathy causes stasis and results in cholesterol gallstone crystal formation and gallstone growth.

Pharmacological effects of metronidazole+tetracycline+bismuth subcitrate versus omeprazole+amoxycillin+bismuth subcitrate in Helicobacter pylori-related gastritis and peptic ulcer disease

PURPOSE

Two 4-week triple-therapy treatment regimens, metronidazole+tetracycline+bismuth subcitrate and omeprazole+amoxycillin+bismuth subcitrate, were compared in a randomly allocated double-blind trial for their efficacy in eradicating Helicobacter pylori from the gastric mucosa of patients with gastritis and/or peptic ulcer disease.

PATIENTS AND METHODS

The presence of gastritis and/or peptic ulcers was confirmed by endoscopy in all patients included in the study. To evaluate drug effects, we used the urease test on gastric mucosa, and haematoxylin-eosin and specific Giemsa stains on biopsy tissues obtained by endoscopic procedures; we also evaluated the improvement in clinical symptoms before and after the 4-week treatments.

RESULTS

Among 164 patients with gastritis and/or peptic ulcers, H. pylori infection was confirmed in 93.9% (154 patients) by the urease test and in 87.8% (144 patients) by haematoxylin-eosin stain. Following 4 weeks of treatment with both combination regimens, negative conversion rates by the urease test and haematoxylin-eosin staining and rates of recovery from clinical symptoms were similar in both regimens (metronidazole+tetracycline+bismuth subcitrate: 82.3, 72.9 and 73.9%; omeprazole+amoxycillin+bismuth subcitrate: 89.6, 83.4 and 76.1%, respectively). Also, the extent of inflammatory activity and the H. pylori score by the Giemsa method indicated high rates of recovery, with improvements to grade 0 (lowest grade) from higher grades with both combination regimens (60.4 and 66.7% of patients taking metronidazole+tetracycline+bismuth subcitrate and 64.6 and 83.3 of those taking omeprazole+amoxycillin+bismuth subcitrate). However, the prevalence of side effects during the 4 weeks of treatment was doubled in the former group compared to the latter (25.5 versus 12.5% of patients).

CONCLUSIONS

Significant improvements in biochemical and histopathological findings and in the clinical symptoms of gastritis and/or peptic ulcer disease in patients with a high rate of H. pylori infection were observed equally with both regimens. However, there were notably fewer side effects in patients treated with omeprazole+amoxycillin+bismuth subcitrate. We therefore recommended this regimen in preference to metronidazole+tetracycline+bismuth subcitrate for the treatment of H. pylori-related gastritis and peptic ulcer disease.

Right atrial mass associated with hepatoma--2 case reports

Hepatoma has a tendency to spread into the venous system, but intracavitary cardiac extension or metastasis of hepatocellular carcinoma is an uncommon form of cardiac malignancy. When the carcinoma grows from the hepatic vein into the right atrium, the right atrial tumor thrombis may hinder the blood flow. Therefore, these patients have the risk of sudden death. In the past, antemortem diagnosis of right atrial tumor thrombi in patients with primary hepatocellular carcinoma was difficult. But, echocardiography allowed easy detection of the intracardiac tumor thrombi. We describe two cases of hepatocellular carcinoma with right atrial tumor thrombi. In these cases, the right atrial tumor thrombi was detected by two-dimensional echocardiography. Recently, successful surgical removal of the right atrial tumor thrombi are reported in several cases. We advocate performing echocardiographic examination in patients with hepatoma who have cardiac symptoms and signs.

Ionization and self-association of unconjugated bilirubin, determined by rapid solvent partition from chloroform, with further studies of bilirubin solubility

Our studies of equilibrium solubilization of crystals of unconjugated bilirubin (UCB) in buffered aqueous NaCl (1988. J. Lipid Res. 29: 335-348) suggested that the two carboxylic pKa values were 6.8 and 9.3 and the solubility of UCB diacid was 0.1 microM. These data, however, were not ideal, due to possible effects of crystal size, metastability, 96-h incubation times with formation of polar derivatives, impurities in the bilirubin, and imprecision of analyses at low concentrations of UCB ([UCB]). In the present study, designed to determine the pKa values and self-association of UCB, these problems were minimized by solvent partition of UCB from solution in CHCl3 into buffered aqueous NaCl. There was no crystal phase. Equilibrium was attained rapidly (10 min); UCB and CHCl3 were highly purified; and accurate diazo assay of low [UCB] in the aqueous phase, [Bw], was achieved by concentrating the UCB through back-extraction into a small volume of CHCl3. By determining effects on partition rations of varying the [UCB] in the CHCl3 phase, [Bc], we could assess also the self-association of UCB species in the aqueous phase. Partition ratios (P = Bw/Bc) did not differ between initial and repeat extractions, indicating insignificant concentrations of polar UCB derivatives. Similar P ratios were obtained when equilibrium was approached from a supersaturated aqueous phase. At 21-25 degrees C, mu = 0.15, the data (n = 76) fit the equation: log P = log Po + log[1 + 10(pH-A) + 10(2pH-B) + Bc.10(4pH-D)]; the bracketed terms reflect P for H2Bo (diacid), HB- (monoanion), B= (dianion), and (B=)2 dimer, respectively. Computer-fitted values for constants (+/- SD) were: Po = P for H2Bo = 5.79 x 10(-5); A = pK1 = 8.12 +/- 0.23; B = pK1 + pK2 = 16.56 +/- 0.10; pK2 = 8.44 +/- 0.33; D = pk22 + 2(pK1 + pK2) -log(2Po) = 37.64 +/- 0.07, and k22 = 0.26 microM-1 [formation constant of (B=)2 dimer]. In ancillary studies, multiple cycles of direct dissolution of UCB crystals revealed a progressive decrease in aqueous solubility of UCB as fine crystals were removed; this effect was minimal in CHCl3. Unlike in water, moreover, varied UCB crystal forms had similar solubilities in CHCl3, with [Bc] = 1.14 mM at saturation. As determined from [Bc]sat.Po, the aqueous solubility of H2Bo was 66 nM.(ABSTRACT TRUNCATED AT 400 WORDS)

Biliary proteins in patients with and without gallstones

BACKGROUND

Nucleation from supersaturated bile of calcium salts of cholesterol and bilirubinate is essential in the formation of gallstone. Nucleation requires gallbladder mucin and its main component, glycoprotein, may contribute to gallstone formation by providing a nidus or matrix for precipitation of lipid components. However, biliary protein patterns of patients with gallstones have not been completely explored.

METHODS

We have tried to extract, isolate and characterize the proteins in patients with gallstones and without gallstones. 21 bile samples were obtained from patients with different types of gallstones and with no stones at cholecystectomy. Biliary protein concentrations were measured by Lowry and Bensadoun methods, and individual glycoproteins from each of the patients were compared by silver staining and densimetric quantification of Sodium Dodesyl Sulfate Polyacrylamide Gel Electrophoresis.

RESULTS

1) Among 16 gallstones, 5 were cholesterol stones, 5 were calcium bilirubinate stones, and 6 were black pigment stones. 2) The mean protein concentration was highest in bile with cholesterol stones (47.6 mg/ml), 24.2 mg% in bile without gallstones, and 15.9 mg/ml in brown pigment stones. 3) Cholesterol gallstones were found to have 14.2 KD glycoproteins, whereas pigment stones were found to have 66 KD glycoproteins.

CONCLUSIONS

Gallbladder proteins from both cholesterol and pigment stones play an important role in the nucleation and growth of calcium salt crystals.

Isoextraction studies of partition of UCB between chloroform and aqueous solution

Bilirubin is a major component of gallstones and the solubility of unconjugated bilirubin (UCB) has been shown to play an Important role in gallstone formation. The mechanism of gallstone formation and solubilization of UCB is, however, still unknown. Several investigators have attempted to determine the chemical nature of bilirubin which are thought to be closely related to its solubility. However, there is some controversy over the ionization constants and pK values of carboxyl groups of UCB. In the present study, the effect of pH, the type and concentration of bile salt on UCB solubility were studied and the pK values of bilirubin were calculated. The first ionization censtants of the carboxyl group of UCB (pk₁) were 7.2 in saline, 6.7 in TC (Taurocholic acid), and 6.6 in TDHC (Taurodehydrocholic acid). The pK₂ was 9.2 in 50 m M TC. Thus, UCB monoanion (BH⁻) accounted for over 90% of the ionized UCB at physiologic pH values. Our results suggest that: 1. With the isoextraction method of UCB from chloroform, crystal surface effects are avoided and the partition equilibrium could also be attained rapidly. 2. There are more solubilities with higher bile salt concentrations and with increasing pH, and bile salt plays an important role in solubilizing UCB in bile. 3. Bile salt monomers, dimers and micelles are equally effective in solubilizing bilirubin. 4. The bilirubin in bile is almost entirely in the monoanion (BH⁻) form at physiological pH values.