JungWhan Lee

Depth of a central venous catheter tip: length of insertion guideline for pediatric patients

Background:  In pediatric patients, several studies have been undertaken to establish central venous catheter (CVC) tip optimal depth. Assessments of catheter tip position using chest radiographs may be misleading, whereas transesophageal echocardiography (TEE) has been shown to accurately monitor catheter tip placement at the superior vena cava–right atrial (SVC–RA) junction. The aim of this study was to issue a guideline for ideal catheter insertion depth, from the right internal jugular vein (IJV) using TEE to confirm the position of the catheter tip at the SVC–RA junction.

Effects of filter shapes on the capture efficiency of a superconducting high-gradient magnetic separation system

This paper reports experimental and analytical studies on the capture efficiency of a superconducting high-gradient magnetic separation (HGMS) system, employing ferromagnetic filters with various wire diameters and packing fractions. The magnetization force was inversely proportional to wire diameter because the magnetic field gradient increased with decreasing wire diameter. In addition, the capture efficiency of the HGMS system was increased with decreasing wire diameter and increasing packing fraction. The experimental results from the filtration tests via the superconducting HGMS system were in reasonably good agreement with the capture efficiency using the magnetization force obtained by magnetic field analysis.

Preparation of low-fat uptake doughnut by dry particle coating technique

Soybean hull-wheat flour composites were prepared and used a doughnut formulation in order to decrease fat uptake during deep-fat frying. Soybean hulls were microparticulated by jet milling, and wheat flour was air-classified into coarse and fine fraction by an air classifying system. The coarse fraction of wheat flour was dry-coated with the microparticulated soybean hulls by a hybridization system. To investigate the effect on fat uptake, 4 different types of composites were prepared, which contained 0%, 1%, 5%, and 10% of soybean hulls. Doughnuts containing 1%, 5%, and 10% of microparticulated hulls decreased fat contents of 11.5%, 13.6%, and 35.8%, respectively. As soybean hulls content increased, hardness and crispiness increased. However, sensory evaluations demonstrated that there were no significant differences in appearance, flavor, crispiness, taste, and general liking (P < 0.05). Inner crust structures of doughnut showed slight reductions in cell size and improved cellular integrity with shrinkage in the cell membrane as the content of soybean hulls increased. These results show that microparticulated soybean hulls may form a protective layer during frying process, and this process could be used by the food industry for preparing doughnuts with reduced fat uptake.

The Fundamental Characteristics of PPLP as Insulating Material for HTS DC Cable

A high- superconducting (HTS) dc cable system consists of an HTS conductor, cooling system, insulating materials, and high-voltage insulation. The insulating materials and high-voltage insulation at cryogenic temperature can be developed for longer life, reliability, and compactness of HTS dc cables. Polypropylene laminated paper (PPLP) has been widely used as an insulating material for HTS ac cables. However, the dc dielectric characteristics of PPLP in liquid nitrogen have not been revealed satisfactorily until now. In order to develop the HTS dc cable, it is important to understand the fundamental characteristics of PPLP. In this paper, we research the fundamental characteristics of PPLP for HTS dc cables and the volume resistivity, space charge, and the dc breakdown characteristics of PPLP in LN2. The findings of our research were studied under dc and lightning impulse voltage and imply that the PPLP may be used as an insulating material for HTS dc cables.

Thoracic epidural anesthesia for laparoscopic cholecystectomy in an elderly patient with severely impaired pulmonary function tests

Regional anesthesia for laparoscopic cholecystectomy has been reported in patients with severe respiratory disease and is a safe alternative to general anesthesia. Hemodynamic instability can occur on initiating pneumoperitoneum and the respiratory acidosis can last into the post‐operative period without careful monitoring and management. This case report describes such an episode in an elderly patient with severely impaired respiratory function who was given thoracic epidural anesthesia for laparoscopic cholecystectomy.

A Rare Cause of Abdominal Pain by Pancreatic Mass in a Young Female Patient. Carcinosarcoma of the Pancreas.

Gastroent Question: A 24-yearold woman presented with epigastric pain which began about 2 years ago and progressively worsened over the past 6 months. The pain occurred intermittently but usually began after a meal, lasted for about 1 hour, and radiated to the back. The patient said that she also had lost 4 kg during the past 3 months. Her past medical history was unremarkable and physical examination was positive only for mild epigastric tenderness. Laboratory test results at admission were as follows: amylase, 208 U/L; lipase, 261 U/L; total serum bilirubin, 0.48 mg/dL; direct serum bilirubin, 0.1 mg/dL; aspartate transaminase, 14 IU/L; alanine transaminase, 6 IU/L; alkaline phosphatase, 49IU/L; g-glutamyl transferase, 12 IU/L; carbohydrate antigen 19-9, 7.7 IU/mL; a-fetoprotein, 1.0 ng/mL; carcinoembryonic antigen, 1.0 ng/mL; and cancer antigen 125, 7.1 U/mL. To evaluate the cause of epigastric pain and weight loss, an abdominal CT was taken and revealed a 4.8-cm mass in the tail of the pancreas. On pre–contrast-enhanced image, the hypoattenuated central portion had a focal high attenuated lesion (white arrow), suggesting the presence of both hemorrhage and necrosis (Figure A). This pancreatic mass showed peripheral enhancement as it progressed from the arterial phase (Figure B) to the portal phase (Figure C). In addition, there was infiltration around the pancreatic mass (the splenic vein was also obstructed by the mass, evidenced by the presence of gastric fundal varix formation (black arrow; Figure D). Laparoscopic distal pancreatectomy and splenectomy was performed on this pancreatic mass. What is the diagnosis in this young female patient?

7191 Electron microscopic study of association between helicobacter pylori and gsatric epithelial cells.

Backgrounds: To study pathophysiologic roles of Helicobacter pylori, we investigate the ultrastructural relation of Helicobacter pylori to the gastric epithelial cells. Subjects and Methods: Endoscopic biopsy of gastric antrum and body were performed from thirty-one patients(18men and 13women) with chronic gastritis. These specimens were processed and observed by transmission and scanning electron microscope(Hitachi H-600, Hitachi S- 450). Results: 1) Helicobacter pylori were spiral, coccoid, and intermediate or un-defined forms. 2)Most of the Helicobacter pylori were present in the mucus gel layer, on the surface of gastric epithelium and were common at the area around the junctional complexes. 3)Coccoid forms were most common in the mucosal layer. 4)The gastric epithelial cells show increased cytoplasmic electron density, few microvilli, disruption of apical membrane, presence of cell fragments in intercellular space and mucosal layer. Junctional complexes were frequently observed deep in the intercellular space between the cytoplasmic elevation filled with secretory granules. Complete destruction of junctional complex was not common. Conclusions: Helicobacter pylori had variable relations to the gastric epithelial cells in human stomach. These features may contribute to the pathogenic action of the organism.

4728 Classification of gastric stromal tumor according to immunohistochemical phenotype.

Backgrounds: Gastrointestinal stromal tumor(GIST) is a mesenchymal tumor which originates from the GI tracts. Although recent immunohistochemical study has helped classifying mesenchymal tumor and forming diagnostic criteria for benign and malignant tumors according to cells origin and differentiation, it is yet to be settled. This study has classified gastric stromal tumor by using immunohistochemical staining. Materials and Methods: Immunohistochemical staining was performed on the gastric stromal tumor specimens attained by endoscopic resection and surgery. Smooth muscle actin, Desmin, Neuron-specific enolase, S-100, CD 34 and Vimentin has been used as immunohistochemical antibodies and the guideline for Ackermans surgical pathology has been used as criteria for diagnosing malignancy(Ackermans surgical pathology 8th ed, 1996). Smooth muscle type was classified as benign, borderline and malignant according to the size and number of mitosis. Neural type was classified as malignant, and combined smooth muscle-neural type and uncommitted type were classified as either potentially malignant or malignant. Results: Subjects consisted of 12 males and 26 females with average age being 53 ± 12.8 years old. 22 cases has been endoscopically resected, 16 surgically removed, with the mean length of tumor being 25.3 ± 18.1 mm. The results of immunohistochemical staining showed 12 cases(31.6%) of smooth muscle type, 7 cases(18.4%) of neural type, 1 case(2.6%) of combined smooth muscle-neural type and 18 cases(47.4%) of uncommitted type. On the basis of above immunohistochemical results and histologic findings, 12 cases(31.6%) were regarded as benign, 17 cases(44.7%) as potentially malignant or malignant, and 9 cases(23.7%) as malignant(Table). Conclusion: When classified by immunohistochemical staining, 68.4% of gastric stromal tumor proved to be potentially malignant or malignant.

⁎4727 Reassessment of usefulness of eus in differentiation of benign and malignant gastric stromal tumors which were diagnosed according to pathologic guidelines of ackerman's surgical pathology.

Backgrounds: GISTs originate from mesenchymal tissue within the GI tract, and it is difficult to differentiate between benign and malignancy by endoscopy. Although recent development of EUS allows a trial of differentiation from benign and malignant stromal tumors, its diagnostic accuracy is controversial. The aim of this study is to determine whether EUS can differentiate between benign and malignant gastric stromal tumors. Materials and Methods: EUS was performed prior to endoscopic resection or surgical resection of 38 gastric stromal tumors. EUS features such as tumor size(diameter>4 cm), irregular extraluminal border, echogenic foci, and cystic spaces, which were proposed by Chak A et al. as EUS findings of malignant GISTs(Gastrointest Endosc 1997) were evaluated. Pathologic diagnosis was based on guidelines of Ackermans surgical pathology (Ackermans surgical pathology 8th ed, 1996). Results: Subjects consisted of 12 males and 26 females. 22 cases has been endoscopically resected, 16 cases surgically removed. The results of immunohistochemical staining showed 12 cases of smooth muscle type, 7 cases of neural type, 1 case of mixed type and 18 cases of uncommitted type. On the basis of above immunohistochemical results and histologic findings, 12 cases were regarded as benign, 17 cases as potentially malignant or malignant, and 9 cases as malignant. Analyses of EUS features according to the criteria of Chak et al. are shown in the following table. Conclusion: When gastric stromal tumors were diagnosed with criteria from Ackermans surgical pathology, EUS features, which were proposed by Chak et al, were assessed to be less useful in differentiating between benign and malignant stromal tumors.