A questionnaire survey was conducted to ask teaching staffs about the present activities and opinions of evaluation of faculty teaching from the students (EFS). One hundred and eighty-eight among 336 members (56.1%) responded. Among them sixty-four (34%) replied that they had tried at least once EFS of their lectures and/or practices. Approximately 70% had a opinion that EFS would benefit them for improving their lectures and practices, and/or for improving course planning. Fifty-four per cent of members supported EFS to be introduced, 34% depended upon how to evaluate, and remaining 5% did not support it. These results indicate that the staff members are highly concerned with EFS which should be provided for introduction after a full discussion how to evaluate.

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The effects of intravenous oxytocin on thoracic epidural pressure during cesarean section were studied in 90 parturients (American Society of Anesthesiologists physical atatus class I or II) after obtaining informed consent. The subjects were randomized to either a control (control group; n=30), bolus (bolus group; n=30) or drip treatment group (drip group; n=30). The subjects were anesthetized with 11∼12 mg of intrathecal isobaric bupivacaine (0.5%). An epidural catheter placed at Th 11/12 was connected to a pressure transducer to continuously monitor thoracic epidural pressure. Ten units of oxytocin were administered over 30 seconds in the bolus group and over 5 minutes in the drip group after fetus delivery. We analyzed epidural pressure, mean blood pressure, and heart rate, until 5 minutes after fetus delivery. Epidural pressures in both bolus and drip groups increased after fetus delivery compared with control group (P<0.0001). Epidural pressure immediately after placental delivery in the bolus group was higher than in the control group (p<0.0001) and epidural pressure at 5 minutes after fetus delivery in the drip group was higher than in the control group (p=0.0452). There were no significant differences in changes in blood pressure and heart rate among the three groups. We concluded that the increase in epidural pressure with intravenous administration of oxytocin 10 units over 5 minutes was lower than with intravenous administration of oxytocin 10 units over 30 seconds after fetus delivery.

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Objective: The aim of this study was to clarify the time course of plasma endothelin-1 levels and platelet counts after elective cesarean section in women with preeclampsia, and to investigate the relationship between them postoperatively. Methods: We studied 20 patients with preeclampsia and 25 healthy pregnant women without preeclampsia who underwent cesarean section and 20 women without preeclampsia who had vaginal deliveries. The plasma endothelin-1 and platelet counts were measured serially after cesarean section. Results: 1) In patients with preeclampsia, plasma endothelin-1 levels peaked on postoperative day 0 (p<0.05), and remained high, then fell to the preoperative level from day 5. The concentration was lower in healthy pregnant women undergoing cesarean section than in patients with preeclampsia before surgery, but showed a gradual significant increase from postoperative day 0 to postoperative day 3 (p<0.05) before falling. The women who underwent vaginal delivery showed a peak level of endtothelin-1 on the day of delivery but this fell rapidly between day 3. 2) Women with preeclampsia showed a negative correlation between plasma endothelin-1 levels and platelet counts after cesarean section (r=0.46, p<0.01), while women without preeclampsia undergoing cesarean and vaginal deliveries did not. Conclusion: Endothelin-1 production is stimulated after cesarean section, which is paralleled with postpartal thrombocytopenia only in patients with preeclampsia.

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Chymase, one of the proteases contained in human mast cells, promotes myocardial and renal interstitial fibrosis by converting angiotensin I to II (AII). We previously established a method for measuring chymase in liver tissue and examined the relationship between chymase and fibrosis in chronic hepatitis. In the present study, chymase was determined in liver specimens affected by autoimmune hepatitis (AIH, n=10) or primary biliary cirrhosis (PBC, n=12). To investigate spatial relationships between hepatic fibrosis and human chymase, mast cell distribution in the specimens was determined immunohistochemically using anti-chymase antibody. The mean amounts of chymase in livers with AIH and PBC were 11.56±10.64 and 11.67±9.96 ng/mg respectively. Hepatic chymase in AIH and PBC was significantly more abundant than in acute hepatitis (AH, 2.72±2.23 ng/mg, n=10; p<0.05). When sections from patients with AIH and PBC were immunostained for chymase, immunoreactive mast cells were detected in portal areas and sinusoidal walls, coinciding with zones of fibrosis. Thus chymase appears to be involved in hepatic fibrosis in AIH and PBC.

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Background: Recently, there is an increase in number of surgical treatments for the aortic stenosis caused by valvular sclerosis with aging. Whether valvular sclerosis are related to aortic atherosclerosis, the prevention therapy of arteriosclerosis may benefit the clinical treatment of the valvular dysfunction due to aging. Materials and Methods: Gross, histological and immunohistochemical studies were made on 159 autopsy cases (97 men, 62 women, mean age 65.1 years old). The degree of sclerotic change in aortic valve (AV), mitral valve (MV), aorta (Ao) and coronary artery (CA) was classified by gross examination to none, mild, moderate, and severe, scored as 0 to 3, respectively. The data were statistically analyzed by the correlation test. To observe the expression of bone related proteins in valve calcification, indirect immunostaining procedures were applied with antibodies to osteocalcin, osteopontin and osteonectin. Results: Grossly, there was a significant correlation in sclerotic change between Ao and AV, Ao and MV, AV and MV, CA and AV, and CA and MV, respectively (p<0.01). Also, the degree of sclerotic change in each tissue was correlated with patients'age. However, the grade of sclerotic change of each tissue was variant in each case. On gross observation, all valvular sclerosis showed yellowish thickening and/or calcification. Microscopically, hyalinous change of the fibrosa was observed in the yellowish lesion of the valves. Accumulations of foamy macrophages were found focally at the surface area of the fibrosa, but no atheromatous change was observed in the valves. Calcified deposits, if present, were found in the fibrous valvular ring or fibrosa with hyalinous degeneration. In MV, calcification was usually localized in the fibrous ring. However, in AV, valvular calcification extended diffusely in the fibrosa and caused stenosis in some cases. These lesions were similar to calcified area in the intima with fibrous thickening of Ao and/or CA, but were different from atheromatous lesion of these tissues. Immunohistochemically, calcified areas of valves showed stronger reaction for osteocalcin than that of vessels. Conclusion: Among sclerotic change of cardiac valves and arteriosclerosis, statistical correlations were found, but pathological features were different. Main causes of these differences are thought to be 1) not only the shear stress, but also intramural pressure and mechanical stress with opening and closing may interfere the sclerotic change of cardiac valves, and 2) mechanism of valvular sclerosis may be different from arteriosclerosis because medial smooth muscle cells are absent in the valves.

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Remnants of cardiomyocytes showing coagulation necrosis in the scars caused by myocardial infarction were histopathologically studied. Among 305 autopsy cases of acute and/or healed myocardial infarction, 8 cases (7 men, 1 woman, ages 62∼87 years, mean age 72.1) had masses of cardiomyocytes with coagulation necrosis at the center of the infarction scars more than 3 weeks (21 to 79 days) after the attack of myocardial infarction. All these cases had transmural infarction and more than 80% of the wall thickness of the left ventricle was involved in the infarction. No polymorphonuclear leukocytic infiltration or granulation tissue was found in the necrotic area, but macrophages were observed in the peripheral area adjacent to the scar tissue. Immunohistochemical staining for myoglobin showed no reaction in remnant necrotic cells or pericellular interstitium, which was similar to findings in the necrotic area more than 4 days after the infarction. These findings are important in the pathological diagnosis to distinguish remnant necrosis from acute necrosis, because 4 out of 8 present cases (50%) were misdiagnosed as acute myocardial infarction that superimposed on the previous old infarction.

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An unusual case involving an infected hepatic cyst in which the correct diagnosis was made without operation is reported. A 93-year-old woman presented with acute onset of right upper quadrant abdominal pain, mild left lower quadrant abdominal pain, diarrhea, and fever. On admission, computed tomography revealed a 15 cm solitary hepatic cyst in the anterior-superior segment of the liver with a thickened wall that enhanced with contrast media. Ultrasonography demonstrated a 15 cm anechoic lesion with a hypoechoic area in the dependent portion of the cyst and a thickened wall. The serum concentration of C-reactive protein was 24.3 mg/dL, and the white blood cell count was 13,800/μL. A diagnosis of infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. Milky yellow fluid was obtained and the patient's right upper quadrant abdominal pain resolved after drainage. Klebsiella pneumoniae was cultured from the drainage fluid. The patient was discharged 20 days after drainage. Infection has not recurred and the hepatic cyst has not enlarged after 18 months.

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Traumatic perilymph fistula is reported to be rare in infants because of the small size of the infant external meatus. We treated an infant with a traumatic perilymph fistula in the right ear. A metallic wire had penetrated the tympanic membrane. Horizontal-rotatory nystagmus was also observed. Computed tomographic images revealed dislocation of the ossicles. The perilymph fistula was closed under general anesthesia. The incus-stapes joint was separated and the footplate of the stapes was dislocated. Leakage of the perilymph fluid was apparent from the oval window and this fistula was closed with connective tissue. The perforation of the tympanic membrane was closed with temporal fascia. After surgery, the spontaneous nystagmus disappeared. The patient is under observation as an outpatient and is growing normally.

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Living-related liver transplantation is widely accepted as a treatment for patients with end-stage liver disease, with survival rates of up to 80%. Liver transplant recipients are at risk for the same postoperative complications as any patient undergoing a major intraabdominal operation, in addition to several complications specific to this procedure. Maintenance immunosuppression relies principally on administration of tacrolimus and methylprednisolone. Nevertheless, approximately 36% of liver transplant recipients suffer acute rejection in the early posttransplant period and require bolus steroid therapy as a rescue agent. Vascular complications, including hepatic arterial thrombosis and portal vein thrombosis, are additional major problems. When they occur in the immediate postoperative period, they can produce fulminant hepatic necrosis requiring retransplantation, so intensive anticoagulation therapy is needed as prophylaxis against these vascular complications. If thrombosis of the hepatic artery or portal vein is diagnosed early in the postoperative course, emergency thrombectomy with reanastomosis should be attempted. Outflow obstruction by hepatic vein stenosis sometimes causes liver dysfunction, pleural effusion, and hepatosplenomegaly. Percutaneous transhepatic or transjugular approached hepatic vein dilatation is very useful in case of hepatic vein stenosis. Recipients are generally immunocompromised secondary to immunosuppressive therapy and their poor clinical condition and are at high risk for postoperative infection. Infection is a major cause of morbidity and the most common cause of death in liver transplant recipients. Antibiotic, antifungal, and antiviral agents are used empirically, and serologic examinations and bacterial investigations of blood, sputum, stool, urine, and discharge from drains should be performed as well as antibiotic sensivity tests when necessary. Other complications related to the operation are intraabdominal bleeding, bile leakage, biliary anastomotic stenosis, and intestinal perforation. The postoperative course of liver transplant recipients with these complications depends on making an accurate diagnosis promptly and initiating appropriate management. Postoperative complications of living-related liver transplantation are protean, so it is very important to communicate with professionals in each specialized field to ensure optimal treatment.

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