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.

Effect of Propranolol on Portal Pressure and Systemic Hemodynamics in Patients with Liver Cirrhosis and Portal Hypertension: A Prospective Study

BACKGROUND/AIMS: Propranolol can prevent variceal bleeding by ameliorating portal hypertension. We conducted this study to determine the effect of propranolol on portal hypertension and the optimal required dose in Korean cirrhotic patients. METHODS: This study prospectively evaluated 50 patients with cirrhosis who exhibited variceal bleeding. The hepatic venous pressure gradient (HVPG), portal venous flow, heart rate (HR), and blood pressure were assessed both at baseline and at 3 months after the treatment. The initial dose of propranolol (20 mg) was subsequently adjusted until the target HR was reached. Patients in whom HVPG reduced by >20% or to less than 12 mmHg were defined as responders. RESULTS: Propranolol significantly (p<0.01) reduced the HVPG (-21+/-26%, mean+/-standard deviation), portal venous flow (-25+/-21%), HR (-20+/-13%), and blood pressure (-3+/-13%). Twenty-nine patients were responders, and the optimal required dose was 154.4 mg. The main complication was dizziness (24%), but this was not serious enough to require medication withdrawal. CONCLUSIONS: Propranolol is safe and effective at reducing portal pressure in Korean cirrhotic patients. An effective improvement in portal hypertension requires the dose to be increased until the target HR is reached.

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.

Health Behaviors and Health Perceptions among Medical and Law Students

BACKGROUND: Modern physicians' role as a model is very important in advocating health promoting behaviors for their patients. In this study, we compared health promoting behaviors and corresponding health perceptions between law students and medical students with evaluation of the association between health promoting behaviors and corresponding health perceptions. METHODS: The data of this survey, conducted among law students and medical students attending a university in a metropolitan city in June, 2004, were collected by self-administered questionnaire based on FANTASTIC lifestyle checklist adjusted to reflect Korean circumstances. RESULTS: Qestionnaires from 74 law students and 136 medical students were analysed. The medical students showed better health behaviors in terms of fastening seatbelt, leisure time, sleep, and salt intake reduction. The medical students showed better health perceptions in terms of exercise, activity, body weight, animal fat and salt intake reduction, smoking cessation. The law students showed better perceptions in being impatient. Significant association between health behavior and health perception was observed in relationship with family and friends, exercise, activity, breakfast, reduced intake animal fat, smoking cessation, reduced drug and drinking habits, sleep, fastening seatbelt, regular physical exam, positive thought, and school satisfaction in the law students. In the medical students, significant association was observed in relationship with family and friends, exercise, breakfast, reduced drinking, sleep, fastening seatbelt, coping skills for stress, regular physical exam, and positive thought. CONCLUSION: Even though the medical students were more concerned about and engaged in some health promoting behaviors, other factors affecting medical students' health promoting behaviors than health perception should be addressed further.

Design and Conduct of Randomized Controlled Trials (RCTs) / 대한간학회지

No abstract available.

A Case of Gastrointestinal Multiple Lymphomatous Polyposis with Conjunctival Involvement / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is a distinctive type of primary gastrointestinal lymphoma, characterized by multiple polyps involving long segments of the gastrointestinal tract. Because MLP has a high tendency toward extraintestinal involvement such as bone marrow, lymph node, spleen and liver, MLP can cause various clinical manifestations and has a poor prognosis. We report a case of gastrointestinal MLP, who had an unusual conjunctival involvement during the course of anti-cancer chemotherapy.

Effectiveness of Walking-exercise on Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. METHODS: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. RESULTS: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p<0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p<0.01). Age, history of abdominal surgery, constipation, obesity and walking- exercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walking- exercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. CONCLUSIONS: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.