The outcome of endoscopic management of bile leakage after hepatobiliary surgery

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

A Study on Choice Motives and Job Satisfaction about Nurses who Changed Jobs to Public Hospitals / 한국직업건강간호학회지

PURPOSE: This study was performed for the effective management of nursing organization as surveyed choice motives and job satisfaction about nurses who changed to public hospitals. METHODS: This study is a descriptive study. This study surveyed 214 nurses who changed jobs to public hospital in six Gyeonggi-do hospitals from October 23 to November 20, 2015. The collected data were analyzed for descriptive statistics, t-test, one-way ANOVA, sheffe test, multiple linear regression analysis using the SPSS/WIN 21.0 program. RESULTS: Most of the nurses chose public hospitals due to benefits correspond to public officials. They had worked in general hospitals located on provinces and changed jobs due to a heavy workload and low benefits. Of the participants 84.1% were satisfied with changing jobs to public hospitals and the advantages of public hospitals of their choice were job stability and good employee benefits(guaranteed maternity and paternity leave, etc). On the other hand there were complaints about low salaries compared to the workload after changing jobs to public hospitals. CONCLUSION: Hospitals need to enhance job stability and provide nurses with good employee benefits to reduce turnover rate.

The New Phytoformula Containing Morus alba, Schizandra sinensis and Asparagus cochinchinensis Inhibits Lung Inflammation in vitro and in vivo

A phytoformula containing the root barks of Morus alba, the fructus of Schizandra sinensis and the roots of Asparagus cochinchinensis (MSA) was prepared as a potential new herbal remedy, and its therapeutic potential for alleviating inflammatory lung conditions was examined. For in vivo evaluation, an animal model of lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice was used. With oral administration of 6 - 60 mg/kg, MSA potently and dose-dependently inhibited bronchitis-like symptoms in acute lung injury induced by intranasal treatment of LPS as judged by the number of cells in the bronchoalveolar lavage fluid (BALF) and histological observation. The inhibitory potency was comparable with that of dexamethasone. For in vitro assay, the effects on the production of proinflammatory molecules in lung epithelial cells and alveolar macrophages were examined. Although MSA inhibited IL-6 production in IL-1β-treated lung epithelial cells (A549) only at a high concentration (300 µg/ml), the formula strongly and concentration-dependently inhibited NO production in LPS-treated alveolar macrophages (MH-S) at 20 - 300 µg/ml. Based on all of these findings, the new phytoformula MSA is suggested to have the potential to control inflammatory lung diseases including bronchitis, at least in part, by inhibiting inducible nitric oxide synthase-catalyzed NO production.

Distribution of Elastic and Collagen Fiber in Uvular Tissue of Patients with Obstructive Sleep Apnea and Snorers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep related obstructive breathing disorders are frequently observed in adults. Despite extensive work of recent years, the essential pathophysiologic mechanism that mediates this process is still unclear. This study was conducted to determine whether distribution of connective tissue in the uvula is different among apneics, snorers and normal controls. MATERIALS & METHODS: Uvula was obtained by uvulopalatopharyngoplasty in 8 apneics, 6 snorers (mean apnea index: 17.1, 2.43 respectively) and by autopsy in 5 individuals not known to have snoring. The surgical specimen of uvula was fixed in 10% formalin and subsequently embedded in paraffin. Each specimen was cut into 5 micrometer-thick section and stained with hematoxylin-eosin for general appearance, Masson-Trichrome stain for collagen fiber, and Verhoeff stain for elastic fiber. Microscopic examination was performed by two pathologists who were blinded to the polysomnographic data. RESULTS: Infiltration of inflammatory cells and edema were significantly increased in the snorer and apneic groups compared with the control group (p<0.0001, p<0.05 respectively). Compared with the normal group, the density of elastic fibers and collagen fibers were significantly decreased in snorers and apneics (elastic fiber: p<0.0005, collagen fiber: <0.01). The distribution of elastic and collagen fiber showed significantly heterogeneous patterns in the snorer and apneic group compared to the control group (elastic fiber: p<0.001, collagen fiber: p<0.0005). CONCLUSION: Since connective tissue fibers have the supportive function in the body, this condition may result in increased collapsibility of upper airway and contributes to the development of obstructive sleep apnea.

The Immunohistochemical Localization of CD44 in Rabbit and Human Cornea

The CD44 protein has a functional domain for binding hyaluronic acid, maintaining the integrity and structure of the epithelium. The purpose of this study is to evaluate the presence and comparison of distribution of CD44 in human and rabbit corneas using immunohistochemical staining method. Immunostaining for CD44 was observed in the epithelium, endothelium and human stromal keratocytes. In particular, the strong positive deposition for CD44 can be seen in basal and limbal layers of the epithelium and in the endothelium. Immunodeposits for CD44 in rabbit cornea were detected in superficial parts of the epithelium, while they were localized in deep stromal keratocytes and the endothelium. In conjunctival tissue, immunostaining for CD44 was found in the epithelium, connective tissue, and vascular endothelium in human specimen but was faintly demonstrated only in the extracellular matrix of connective tissue in the rabbit conjunctiva. No immunostaining for CD44 was seen in control case. Our results suggest that CD44 protein can be seen both in human and rabbit corneas. However, there was different distribution of CD44 between two specimens.