Association of the myeloperoxidase-463G->A polymorphism with development of atrophy in Helicobacter pylori-infected gastritis / 대한내과학회지

BACKGROUND: Helicobacter pylori (H. pylori) infection is characterized by extensive infiltration of neutrophils and induces atrophic gastritis, however, the host factors governing the development of atrophy have not been defined. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential, thus MPO is suspected to play a role in H. pylori-induced gastric atrophy. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. METHODS: Biopsy specimens taken from the gastric mucosa were examined histologically in 127 patients. The PCR-RFLP assay was used to characterize MPO genotypes. RESULTS: The distributions of MPO genotypes were MPO (G/G) 81.9% and MPO (G/A) 18.1%. None of MPO (A/A) genotype was observed in 127 patients studied. The degree of active inflammation increased with the increase in H. pylori colonization. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy was found only in MPO (G/G) but not in MPO (G/A) genotype. CONCLUSION: MPO G/G genotype may be a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection.

Eosinophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain. Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract. She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures.

Accuracy of GenediaTM H. pylori ELISA for the Diagnosis of Helicobacter pylori Infection in Korean Population / 대한내과학회지

BACKGROUND: GenediaTM H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of GenediaTM H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. METHODS: GenediaTM H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with GenediaTM H. pylori ELISA. H. pylori infection was determined by rapid urease test, histology, culture or 13C-urea breath test in adults. In children, the subject was considered to be H. pylori positive if 13C-urea breath test was positive. RESULTS: In adults, the sensitivity and specificity of GenediaTM H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of GenediaTM H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of GenediaTM H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%; plt;0.005 and 92.5% vs 71.4%; p<0.005, respectively). CONCLUSION: GenediaTM H. pylori ELISA is a relatively accurate method for the serodiagnosis of H. pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of GenediaTM H. pylori ELISA for epidemiological studies of H. pylori infection in Korea.

The relationship of bacterial and Helicobacter infection to composition of bile acid in biliary tract diseases / 대한내과학회지

BACKGROUND: Bacterial and Helicobacter gene were commonly detected in diseased human bile, although the meaning of the presence of Helicobacter in biliary tract is still unclear. The aim of this study was to evaluate the changes of bile acid composition in bacterial and Helicobacter infected bile, and to determine whether Helicobacter pylori might grow in human bile or not. METHODS: Thirty bile samples were obtained by percutaneous transhepatic biliary drainage or gallbladder puncture during cholecystectomy. According to the polymerase chain reaction analysis using bacterial 16S rRNA and Helicobacter genus specific 16S rRNA primers, 3 groups were divided; Group I; no presence of any bacterial DNA, Group II; positive bacterial DNA only, Group III; positive bacterial and Helicobacter DNA. Bile acid analysis for deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) was performed by high performance liquid chromatography. And then Helicobacter pylori was tried to culture in broth mixed with human bile at a final bile concentration of 50%. RESULTS: The concentrations of DCA in group II and III were very low and significantly reduced compared to group I (p<0.01, respectively). The concentrations of LCA or UDCA were not shown any relationships between groups. Helicobacter pylori has grown actively in the broth mixed with human bile containing both of less than 0.1 gm/L of DCA and CDCA, compared to no growth in media mixed with human bile containing more than 3.0 gm/L of DCA and/or CDCA. CONCLUSION: DCA seems to have the strongest antibacterial effect. Helicobacter pylori is likely to grow in human bile containg very low concentrations of CDCA and DCA.

Features of Malignant Biliary Obstruction Affecting the Patency of Metallic Stents: A Multicenter Study / 대한소화기내시경학회지

BACKGROUND/AIMS: Although metalic stents are established therapeutic options for the palliation of malignant biliary obstruction, it remains unclear which stricture or stent related factors affect the stent patency. METHODS: Metallic Wallstents (Microvasive, Boston-Scientific, MA, U.S.A.) were inserted endoscopically in 68 patients (mean age; 70.2+/-8.5, M:F=38:30) with malignant biliary obstruction. Patency rates were prospectively analyzed according to the characteristics of malignant strictures including length, morphologic type and degree of stricture. Furthermore, patient age, initial serum bilirubin level, the length of stent, the adequate expansion time, and the location of the distal stent end were evaluated as possible factors affecting the stent patency. Stent patency was assessed using the survival analysis of the Kaplan-Meier estimation and Cox regression analysis. RESULTS: Median overall stent patency was 231 days and overall rate of stent occlusion was 41.2% (28/68). The causes of stent blockage were tumoral ingrowth in 23 patients (33.8%), distal overgrowth of the cancer in 3 (4.4%), proximal overgrowth in 1 (1.5%) and sludge incrustation in 1 patient (1.5%). No significant differences in metallic stent patency rates according to primary tumor type, length and morphologic type of stricture, and length and location of distal end of the stent were found. Log-rank test and multivariate regression analysis, however, demonstrated that the degree of stricture assessed by cannula or guidewire passage and the adequate expansion time of the stent are independent factors associated with long-term metallic stent patency. CONCLUSIONS: Our study showed that early expansibility of the stent and easy passage of larger-caliber instruments over the stricture were favorable factors for long-term patency of the metallic stent.

A Case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms / 대한내과학회지

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.

Topographic expression of p21WAF1/SDI1/CIP1, bcl2, and p53 is altered at the early stage of colorectal carcinogenesis

We analyzed the expression of p21, bcl2, and p53 in normal and different pathologic mucosa of the human colorectum using immunohistochemistry and cold polymerase chain reaction-single strand conformation polymorphism. The topography of normal mucosa showed; bcl2 and p53 expression restricted to basal epithelial cells and p21 expressed only in superficial epithelial cells. This topographic expression was altered in hyperplastic polyps and adenomas. Hyperplastic polyps revealed absence of or weak bcl2 expression and strong p21 expression without topography. In adenomas, whereas bcl2 expression increased and extended to parabasal and superficial dysplastic epithelium, the increase of p21 expression was limited to surface dysplastic epithelium. p53 was weakly expressed throughout the full thickness of dysplastic epithelium. Bcl2 expression in adenomas was stronger than in carcinomas; p53 expression was converse and p21 expression was variable. In carcinomas, this topographic expression was largely abrogated but p53 mutation (36%) was more frequent than in adenomas (2%). In carcinomas, p21 and p53 expression correlated inversely, but there was no relationship with bcl2. These results suggest that there is precisely ordered topographic pattern of p21, bcl2, and wild p53 expression in normal colorectal cells, but this becomes disordered during the early stage of colorectal carcinogenesis.

Effect of Rebamipide (Mucosta(R)) in Eradication of Helicobacter pylori / 대한소화기내시경학회지

BAKGROUND/AIMS: Eradication of Helicobacter pylori infection is highly efficacious in preventing the recurrence of peptic ulcer. Rebamipide (Mucosta(R)) is known to have the ability to inhibit neutrophil activity, to reduce the production of inflammatory cytokines, to scavenge oxygen radical, and to stimulate prostaglandin production. This study was designed to evaluate the effect of rebamipide on the eradication of H. pylori, and decrease of the infilatration of inflammatory cells. METHODS: Eighty two patients with gastric or duodenal ulcers with H. pylori infection were allocated to two treatment groups. The patients were treated either with omeprazole 40 mg, clarithromycin 1.0 g, amoxicillin 2.0 g, rebamipide 300 mg (OCAR group) or omeprazole 40 mg, clarithromycin 1.0 g, amoxicillin 2.0 g (OCA group) for two weeks. RESULTS: H. pylori was eradicated 56 out of 62 patients (90%) in OCAR group and 16 out of 20 patients (80%) in OCA group. The infiltration of inflammatory cells decreased in both treatment groups. No significant side effects had been noticed. CONCLUSIONS: The results of the present study suggest that rebamipide may be useful to decrease gastric mucosal inflammation in peptic ulcer disease. However, further detailed study will be reqiured to determine the potentially beneficial effect whether rebamipide can prevent the recurrence of peptic ulcer diseases with H. pylori infection.

A Study on Normal Structures, Variations, and Anomalies of the Korean Pancreaticobiliary Ducts: Cooperative Multicenter Study / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was designed to evaluate normal Korean pancreaticobiliary ducts and to assess the prevalence and pattern of variations and anomalies of theses structures. METHODS: We performed this multicenter study in which 7 university hospitals in Korea participated from March 1997 until June 1999. Total 10,243 ERCP cases were reviewed during this study period. RESULTS: 1) Maximal and midportion diameters of common bile ducts were 6.4+/-1.8 mm and 5.5+/-1.7 mm, respectively. Maximal and midportion diameters of pancreas head were 3.2+/-1.1 mm and 2.7+/-1.0 mm, respectively. Pancreaticobiliary duct diameters of subjects above the age of 40 were greater than those of subjects below the age of 40 (p<0.05). 2) The prevalence of choledochal cyst was 0.32%. The prevalence of gallbladder anomalies and anomalous union of pancreaticobiliary duct was 4.2% and 4.1%, respectively. The prevalence of pancreas divisum and annular pancreas was 0.49% and 0.05%, respectively. The most common type of pancreaticobiliary duct union was V shape (60.2%), followed by U shape (23.7%) and Y shape (16.1%). CONCLUSIONS: Understanding normal pancreaticobiliary structures and being aware of the prevalence and pattern of variations and anomalies of pancreaticobiliary structures will be helpful to diagnose and treat patients with pancreaticobiliary problems.

A Case of Complete Agenesis of Dorsal Pancreas / 대한소화기내시경학회지

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.

Identification of Helicobacter in diseased human bile / 대한내과학회지

BACKGROUND: Several studies have been reported that the presence of Helicobacter DNA in human bile sample, although its pathological role is not clear. The purpose of this study was to evaluate the presence and identification of Helicobacter species in human bile samples obtained from patients with biliary tract diseases. METHODS: 58 bile samples (35 intrahepatic duct stones, 10 bile duct cancer, 13 pancreatic cancer) were obtained by percutaneous transhepatic biliary drainage (PTBD). DNA was isolated from bile sample. The primers were designed to amplify region of Helicobacter genus specific 16S rRNA. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was developed to differenciate the presence of H. pylori, H. bilis, H. rappini and H. muridarum. RESULTS: Forty-two of 58 (72.4%) bile samples obtained from patients with biliary tract disease showed positive PCR band for Helicobacter genus specific 16S rRNA. H. pylori was found in 83.3% of positive samples. Either H. bilis or H. rappini was in 16.7%. H. muridarum, however, was not detected. CONCLUSION: Helicobacter genus was detected in human bile samples obtained from patients with biliary tract diseases using PCR method, and the major species was H. pylori. In addition, RFLP technique was used successfully to identify Helicobacter species.

Risk factors of Helicobacter pylori infection in asymptomatic Korean population / 대한내과학회지

BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection varies between countries and between social classes. The aim of this study was to identify risk factors for with Helicobacter pylori infection in asymptomatic Korean population. METHODS: Sera were collected from 2,687 females and 3,049 males (mean age, 29.1 y; range, 1 m-79 y) in Korea from Mar 1998 through Oct 1998. All asymptomatic subjects completed assessment questionnaires. An enzyme-linked immunosorbent assay was performed to detect IgG antibody to H. pylori. RESULTS: The overall seroprevalence observed was 46.6% and showed nostatistical diffrerence between female (45.9%) and male (47.2%). The seroprevalences in children (neonate-15 y) and adult (16-79 y) were 17.2% and 66.9%, respectively. According to multivariate analysis, variables such as sex, age, geographic area, crowding (number of person per room) in childhood, economic status in childhood, and types of housing in childhood were significantly and independently associated with H. pylori seroprevalence of adults. In children, age, geographic area, income, mother's education, and drinking water source were significant risk factors of H. pylori infection. CONCLUSION: Socioeconomic condition and close person to person contact in childhood are the significant determinants for H. pylori infection in adult. Drinking water source is an another important risk factor for H. pylori infection in children, suggesting the fecal to oral transmission in Korea.

Seroprevalence of Helicobacter pylori ingection in asymptomatic people in Korea / 대한내과학회지

BACKGROUND: Helicobacter pylori infection occurs throughout the world and causes various gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies among countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in healthy people in Korea. METHODS: From March 1998 to October 1998, 5,732 asymptomatic subjects responded to the self-assessment questionnaires from 54 hospitals were enrolled. Serum level of anti-H. pylori IgG was measured by ELISA test. RESULTS: The overall prevalence of H. pylori infection was 46.6% and showed no significant difference between male (47.2%) and female (45.9%). According to the geographic areas, the highly prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Jeonra provinces (50.6%), while Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was the highest at 40's (78.5%). The characteristic feature of this study was that the infection rate increased steeply in three age groups (10-12, 16-19 years old and 30's). In Seoul, there was no different prevalence rate among the districts studied. CONCLUSION: The nation-wide seroprevalence of H. pylori infection in Korea is higher than that of the developed countries. We hope that this study provides the landmark for the study of H. pylori infection in Korea.

Diagnostic p53 expression in gastric endoscopic mucosal resection

Endoscopic mucosal resection (EMR) has been standardized for the treatment of intestinal type of intramucosal gastric carcinomas, and careful histological examination of the resected specimen is important for further treatment. To evaluate the diagnostic utility of p53 expression in gastric EMR samples, using immunohistochemical staining, we examined 24 gastric carcinomas (22 intestinal types and two diffuse types) and 20 adenomas removed by EMR. Intestinal type of adenocarcinomas revealed strong p53 expression in 13 cases (59%), weak in four cases (18%), and negative in five cases (23%). Resection margins of 11 carcinomas were involved in the carcinoma cells, which showed the same p53 expression pattern with main carcinoma cells. Squeezed carcinoma cells, remaining in resection margins, were definitely identified by strong p53 expression in seven cases of which the main tumor strongly expressed p53. Microscopic in situ carcinoma could be easily detected in p53 immunostaining. Multifocal involvement and submucosal invasion of carcinomas could be demarcated easily and definitely by strong p53 expression of carcinoma cells. All adenomas showed diffuse weak p53 expression. The difference of p53 expression (p< 0.001) could be used as a differential diagnosis between adenomas and carcinomas. According to these results, we propose that for careful histological examination in hospital diagnosis, both histological evaluation and p53 immunostaining are important diagnostic parameters in EMR samples of the intestinal type of gastric carcinomas.

Changes in the evolution of the antigenic profiles and morphology during coccoid conversion of Helicobacter pylori

OBJECTIVES: The significance of the coccoid forms of H. pylori is still controversial and the questions of whether these forms are viable and infective or degenerative are still open. We induced conversion from rod to coccoid forms and studied morphological changes and antigenic evolutions during this conversion and, thereby, elucidated the viability of coccoid forms. METHODS: The H. pylori strain (C001) used for Western blotting was isolated from the patient with gastric cancer. The antigenic evolution during coccoid conversion of H. pylori was studied by Western blotting, using different sera from thirty patients known to be culture positive. These sera were used to reveal the total antigens of the strain cultured for 2 days (100% rod) and 15 days (> 99% coccoid). After SDS-PAGE, with 10% separating gel of total antigens (rod and coccoid), transblotting (Trans-Blot electrophoretic cell, Bio-Rad) was taken onto a nitrocellulose membrane (Bio-Rad). Then, the blots, with human sera diluted at 1/100, were developed with color reaction by goat serum anti-human IgG with alkaline phosphatase and BCIP. RESULTS: The antigenic profiles were not changed in 46.7% (14/30 cases) and were changed in 53.3% (16/30 cases) during coccoid conversion. Antigenic fractions changed during coccoid conversion were protein band at 120 kDa and band at 35 kDa, and were not detected in coccus forms. The rest of the profiles were identical between rod and coccoid forms. The protein which disappeared include CagA (120 kDa) and porin, or adhesin (35 kDa). The morphological changes during coccoid conversion were U shaped at day 7, doughnut shaped at day 9 and full coccoid at day 15. CONCLUSIONS: The results showed that coccoid forms of H. pylori retain cellular structures similar to rod form, and some of the antigens (CagA and porin) disappeared during coccoid conversion. Therefore, coccoid form might be viable and represent one of the stages of H. pylori biological cycle.

Detection of Helicobacter DNA in bile from bile duct diseases

Several species of Helicobacter colonize the hepatobiliary tract of animals and cause hepatobiliary diseases. The aim of this study is to investigate Helicobacter found in the biliary tract diseases of humans. Thirty-two bile samples (15 from bile duct cancer, 6 from pancreatic head cancer, and 11 from intrahepatic duct stone) were obtained by percutaneous transhepatic biliary drainage. Polymerase chain reaction analysis using Helicobacter specific urease A gene and 16S rRNA primers, bile pH measurement, and Helicobacter culture were performed. Helicobacter DNA was detected in 37.5%, and 31.3% by PCR with ureA gene, and 16S rRNA, respectively. The bile pH was not related to the presence of Helicobacter. The cultures were not successful. In conclusion, Helicobacter can be detected in the bile of patients with bile duct diseases. The possibility of pathogenesis of biliary tract diseases in humans by these organisms will be further investigated.

Is It Necessary to Examine Precisely about Extrahepatic Duct in Patients with Normal Liver Function Showing EHD Dilatation Alone on Abdominal Ultrasonography? / 대한소화기내시경학회지

BACKGROUND AND AIMS: It is necessary to study about extrahepatic bile duct (EHD) lesions in cases with abnormal liver function test (LFT) and clinical symptoms, even though abdominal ultrasonography could not find out the bile duct lesions. It is unclear however, whether the precise examination of EHD lesions are necessary in asymptomatic patients with normal liver function showing EHD dilatation without any lesions on abdominal ultrasonography (US). METHODS: We examined prospectively about EHD using endoscopic ultrasonography (EUS), followed by endoscopic retrograde cholangiopancreatography (ERCP) in fifty-three patients with normal LFT showing only EHD dilatation on US. The mean EHD diameter on US was 9.1 1.4 mm. RESULTS: The EHD dilatations alone on EUS were 41.5% and the EHD dilatations with lesions were 58.5%. The observed lesions of EHD by EUS were bile duct stones in 32.1%, thickening or stricture of distal bile duct in 17.0%, ampullary mass in 5.7% and CBD polyps in 3.8%. Three cases of ampullary mass were confirmed as 2 cases of T1 ampullary cancer and 1 case of papillitis. Examination by ERCP revealed EHD dilatation alone in 49.1% and bile duct lesions in 50.9%. ERCP could not detect the 2 cases of CBD polyp and 2 cases of distal bile duct thickening. CONCLUSIONS: In patients with normal LFT showing only EHD dilatation on abdominal US, EHD lesions can be detected in high frequency. Therefore, further examination about dilatated EHD should be conducted and for this purpose, EUS is be recommended as a useful tool.

Detection of Helicobacter DNA in the Bile from the Obstructed Bile Duct / 대한내과학회지

OBJECTIVE: Several newly recognized Helicobacter spp. such as H. hepaticus, H. bilis, H. cholecystus, H. rappini, H. pullorum, can cause persistent hepatitis, hepatoma, cholangiopancreatitis, and cholecystitis in animals. Recently some studies have been reported that Helicobacter DNA can be found in the bile from the patients with diseased bile duct, although its clinical significance is still unclear. The aim of this study is to investigate the existence, and character of Helicobacter in the bile from the obstructed bile duct, and the relationship with pH and the other bacteria found in the bile. METHODS: Twenty-eight bile samples (15 from bile duct cancer, 6 from pancreatic head cancer, 7 from bile duct stones) were obtained from the PTBD route. Bile pH measurement, and Helicobacter culture in microaerophil uric and anaerobic conditions were performed. The primers chosen for polymerase chain reaction (PCR) amplification for detection and characterization were ureA (411 bp) and cagA gene (298 bp), respectively. And primer of 16s rRNA for all known bacteria including Helicobacter was used, and the kinds of bacteria were identified by RFLP. RESULTS: Helicobacter DNA was detected in 39.3%. The bile pH was not related with presence of Helicobacter (7.83 +/-0.41 vs 7.78+/-0.48). The prevalence of cagA was 35.7%, and 16s rRNA was found in 46.4%. The specific 16s rRNA band for Helicobacter was observed in 14.3%. All the culture were not successful. CONCLUSION: Although the Helicobacter spp. were not cultured, Helicobacter exists obviously in the bile from the diseased bile duct, and coexist with other bacteria. These results should stimulate studies to ascertain whether these Helicobacter play a role in the pathogenesis of bile duct diseases in human.

In vivo Assessment for the Antioxidant Activity of the Calcium Channel Blocker Nicardipine in 3% Sodium-Taurocholate-induced Acute Pancreatitis

BACKGROUND: Although several pathophysiological sequences, such as protease activation, free radical generation, and inflammatory mediator release, have been described in acute pancreatitis, the precise mechanism by which acute pancreatitis is initiated is unkown. Cellular calcium, a key function and also a crucial pathological intracellular messenger in cell injury, appears to be involved in the initiation and development of acute pancreatitis. The aim of this study is to evaluate the role of cellular calcium and therapeutic effect of administering the Ca++ channel blocker nicadipine as an antioxidant. METHOD:Nicardipine, known to be a calcium channel blocker and a most potent antioxidant, was wed as a pretreatment 1 hour before induction of pancreatitis by intraductal infusion of 3% sodium taurocholate or as a post-treatment 1 hour after induction of aucte pancreatitis by retrograde infusion of sodium taurocholate. The net weight of the pancrease, the amounts of s-amylse, GSH and MDA in the pancreatic tissue, and the histologic damage were examined 12 hours after the induction of pancreatitis. RESULTS: Nicardipine administration ameliorated pancreatic edema and reduced the amount of s-amylase compare to untreated necrotizing pancreatitis group. Also, pre- or post-treatment with nicardipine had beneficial protective effect with respect to free radical-induced injury; in particular, pre-treatment with nicardipine was much better. With respect to the histologic findings, pancreatic necrosis, hemorrhage, and neutrophil infiltration were prominent in the necrotizing group, however, in the group treated with nicardipine, the necrosis and hemorrhage were ameliorated remarkably. CONCLUSION:The free oxygen radicals and the intracellular calcium influx were major elements in the pathogenesis of acute pancreatitis, and nicardipine ameliorated pancreatic necrosis and hemorrage and exerted an antioxidant effect. The administration of nicardipine should be considered in the early stage of pancreatitis or in case of risk of pancreatitis.

A Case of Primary Gastric Tuberculosis Diagnosed as a Submucosal Tumor / 대한소화기내시경학회지

Gastric tuberculosis is a rare disease and is usually secondary to pulmonary or intestinal tuberculosis. Only a few cases of gastric tuberculosis have been reported in the literature. In most cases, gastric tuberculosis exists as an ulcerating lesion, whereby the clinical symptom is non-specific and similar to that of a peptic ulcer. The diagnosis af gastric tuberculosis is based on either positive histological or bacteriological study. Submucasal tumors resembling gastric tuberculosis has been reported extremely rare in incidence. In this study we report a case of a young woman admitted with intermittent abdominal pain due to gastric tuberculosis presenting as submucosal tumor in the greater curvature of the lower body. After gastric resection, a histological examination revealed chronic granulomatous inflammation with caseation necrosis which is consistent with tuberculosis. There was no evidence of the tuberculous lesion anywhere else. The patient was put on antituberculosis medications. The patient's follow-up observation in the clinic was uneventful.