A case of ulcerative duodenitis accompanying ulcerative colitis / 대한내과학회지

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29.year.old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC

Non-invasive Doppler ultrasonography for assessment of the portal hypertension of liver cirrhosis: A prospective study / 대한내과학회지

BACKGROUND/AIMS: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. METHODS: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. RESULTS: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. CONCLUSIONS: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension.

Inhibitory Effect of Angiotensin Blockade on Hepatic Fibrosis in Common Bile Duct-ligated Rats / 대한간학회지

BACKGROUNDS AND AIMS: Angiotensin receptors are found on hepatic stellate cells, which participate in hepatic fibrosis. Therefore, it is presumed that angiotensin has a role in hepatic fibrosis. The aim of this study was to evaluate the effects of angiotensin blockade on inhibition of hepatic fibrosis in cirrhotic rat model. Material and METHODS: Cirrhosis with portal hypertension was produced by common bile duct ligation (BDL) in the adult Sprague-Dawley rats. They were classified into 4 groups (each group n=6) as follows; G1: BDL without drug, G2: BDL+captopril 100 mg/kg/day beginning 2 weeks after BDL, G3: BDL+captopril 100 mg/kg/day, starting just after BDL, G4: BDL+losartan 10 mg/kg/day, starting just after BDL. After 4 weeks following BDL, hepatic fibrosis was histomorphologically analyzed by Batts & Ludwig score. Alpha smooth muscle actin by immunohistochemical stain, hydroxyproline contents of liver tissue by spectrophotometry and expression of collagen, procollagen, and TGF-beta by real-time PCR were measured. RESULTS: Batts & Ludwig score were 3.8, 3.0, 2.6,and 2.6 in G1, G2, G3, and G4, respectively. The expression of alpha-SMA was significantly lower in G3 and G4 than in G1; 11.9%, 10.9%, 2.6%, and 1.1% in G1, G2, G3, and G4, respectively (p<0.05). The concentration of hydroxyproline (microgram/g liver tissue) was lower in G3 and G4 compared with G1 (p<0.05). Also, the administration of angiotensin blockade just after BDL significantly reduced the expression of collagen, procollagen, and TGF-beta mRNA. CONCLUSIONS: Angiotensin blockades are effective in the prevention of hepatic fibrosis in BDL rats.

Interequipment Variability of Doppler Ultrasonographic Indices in Patients with Liver Cirrhosis / 대한간학회지

BACKGROUNDS/AIMS: Doppler ultrasongraphy is used to evaluate hemodynamic alternations in patients with liver cirrhosis. Purpose of this study was to determine the interequipment variability of Doppler indices in portal and splenic vein in cirrhosis. METHODS: Blood velocity, diameter, flow and congestive index in portal and splenic vein were measured by Doppler ultrasonography in 30 patients with cirrhosis using two different machines. RESULTS: Portal venous velocities measured by HDI-5000 and SSD-5000 were 8.72+/-3.69 cm/sec, 12.21+/-2.84 cm/sec, respectively which showed significant difference (P<0.001). Measured portal blood flows and congestive indices also had significant difference between HDI-5000 and SSD-5000 (P<0.01). Splenic venous velocity by HDI-5000 was 8.55+/-2.71 cm/sec, which was lower than that of 12.32+/-3.11 cm/sec by SSD-5000 (P<0.001). Splenic blood flows measured by HDI-5000 and SSD-5000 were 390.73+/-260.98 mL/min, 595.01+/-346.53 mL/min, respectively, showing significant difference (P=0.015). However, no differences were in the diameters of portal and splenic vein between HDI-5000 and SSD-5000. CONCLUSION: Doppler indices in portal and splenic vein showed significant interequipment variability. Therefore, in liver cirrhosis, hemodynamic investigations using different Doppler ultrasonographic machines is inappropriate.

A Giant Hydronephrosis in Adult / 대한신장학회잡지

The term of giant hydronephrosis in adults, is applied when the collecting system contains more than 1,000 mL of fluid. The commonest cause of asymptomatic giant hydronephrosis in early adult life is congenital ureteropelvic stenosis. Giant hydronephrosis in adults is uncommon and often clinically misdiagnosed, because clinical characteristics are vague and generalized symptom. We presented a giant hydronephrosis associated with ureter stricture on 31 years old male.

Renal Function Indices Predicting the Prognosis of Patients with Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Renal dysfunction commonly develops in patients with established liver disease. The assessment of renal function is of clinical importance in patients with cirrhosis and ascites. Renal function indices such as glomerular filtration rate and the plasma renin activity (PRA) could be better predictors of survival than the parameters usually used to estimate liver function including Child-Pugh score. This study was designed to find whether renal function indices are useful in determining the prognosis concerned with the survival of patients with liver cirrhosis. METHODS: A total of 110 patients was selected and followed for 89 weeks. As indices reflecting renal function, creatinine clearance rate, PRA, aldosterone concentration, and the pulsatility index (PI) and resistive index (RI) by Doppler ultrasonography were measured. The prognostic values of these indices were determined by comparison and analysis according to survival or death of the patients. For the statistics, univariate and multivariate analysis was done. RESULTS: Child-Pugh score (> or =10), creatinine clearance rate ( or =15 ng/dL), PRA (> or =8 ng/mL/hr), renal PI (> or =1.15) and RI (> or =0.7) were prognostic indicators in univariate analysis (p or =15 ng/dL) (OR: 3.65, 95% CI: 1.09-12.18). CONCLUSION: Various renal function indices are closely related to the survival of patients with liver cirrhosis. Creatinine clearance rate and plasma aldosterone concentration are especially important prognostic factors in predicting the survival of patients with liver cirrhosis.

A Case of Theophylline-Induced Hepatitis / 대한간학회지

Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl ). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and gamma-GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patient's symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a few lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug-induced hepatitis was diagnosed with a typical clinical course; the exclusion of all possible causes of acute hepatic dysfunction; and a positive response to accidental readministration of drug. We report this case with a review of the literature.