The Effects of High Glucose, Angiotensin II and ACE Inhibitor on the Expression of TGFbeta mRNA in Cultured Human Mesangial Cells / 대한신장학회잡지

OBJECTIVE: Diabetic nephropathy is an important cause of end stage renal disease in Korea and associated with major morbidity and mortality. The precise pathogenic mechanism of this disease is still controversial, but it has been considered that multiple factors are contribute to the development and progression of diabetic nephropathy. One of these factors, renin-angiotensin system has been proven to be a major mediator of this disease via activation of angiotensin II, which has multiple functions such as induction of production of extracellular matrix protein and various intraglomerular cells, tubulointerstital component and increment of intraglomerular pressure. Transforming growth factor(TGFbeta) is a multifunctional cytokine with major profibrotic character, which stimulates the production of extracellular matrx(ECM) protein, inhibit the degradation of ECM and induce the interaction of mesangial cells with ECM via integrin receptors. This study was done to evaluate the role of angiotensin II and angiotensin converting enzyme inhibitor in expression of TGFbeta mRNA which is a main mediator in the pathogenesis of diabetic nephropathy. METHODS: Human mesangial cells(MCs) were cultured by standard culture techniqne. For this study, cells in the 5th to 7th passage were used. To make a different glucose concentration in culture medium, normal(100mg/dl) or high glucose(450mg/dl) concentrations of D-glucose were added, and cultured in 17% heat inactivated fetal bovine serum. Angiotensin II and ACE inhibitor(captopril) were administered to the culture medium at final concentration of 10-6M. After 72 hours, MCs were harvested to measure the expression of TGFbeta mRNA. To measure the mRNA expression of TGFbeta in each condition, semi quantitative PCR was done and all results were corrected by beta-actin gene. RESULTS: mRNA expression of TGFbeta was significantly increased in the high glucose medium(30 mM) compared to normal glucose medium(5.5mM) (3.82+/-0.465 vs 2.27+/-0.13, p<0.05). Administration of angiotensinII(10-6M) in high glucose medium induced a further increase in the TGFbeta expression to 4.29+/-0.476(p<0.05). AngiotensinII(10-6M) in normal glucose medium also showed a significant increase in TGFbeta expression as 3.40+/-1.88(p<0.05). Administration of ACE inhibitor(Captopril, 10-6M) in high glucose medium prevented the increse of TGFbeta expression(1.20+/-0.18 vs 3.82+/-0.465, p<0.05). CONCLUSION: From these findings, it suggest that angiotensinII is an important mediator in the pathogenesis of diabetic nephropathy. ACE inhibitor may have a role in the progress of this disease via direct suppression of TGFbeta system as well as beneficial intraglomerular hemodynamic effect.

A Case of Spindle Cell Carcinoma of the Esophagus / 대한소화기내시경학회지

Spindle cell carcinoma of the esophagus containing both carcinomatous and sarcomatous elements is rare, accounting for approximately 1- 2% of all esophageal neoplasms. Terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous squamous cell carcinoma and spindle cell variant of squamous cell carcinoma. Spindle cell carcinomas were originally classified as carcinosarcomas or pseu- dosarcomas, depending on the morphology and bilologic behavior of the particular lesian. However, pseudosarcoma and carcinosarcoma appear to be the same pathologic entity with varying degrees of anaplastic spindle cell metaplasia of the carcinomatous portion of the tumor. Thus, these lesions have been clsssified together as spindle cell carcinomas. A 59 year-old man who experienced weight loss for 4 months was hospitalized as a result of suffering from dysphagia for 2 months. A diffuse bulky protruding mass with superficial ulceration and easy friability on 25 to 35 cm from the incisors, which invaded the right intermediate bronchus and involved the right paratracheal and subcarnial lymph nodes, were obsetved in esophagogram, endoscopy and chest CT. Pathologic finding, including immunoreactivity to cytokeratin and vimentin, was consistent with spindle cell carcinoma. We report a case of spindle cell carcinoma of the esophagus.

A Case of Gastric Anisakiasis Causing Mallory - Weiss Syndrome / 대한소화기내시경학회지

Anisakiasis is an infection in humans caused by larval nematodes of the family Anisakidae and is encountered in people who eat inadequately prepared raw, salt-water fish or "sashimi". This clinical syndrome is characterized by severe cramping abdominal pain, nausea, and vomiting. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but the incidences of upper gastrointestinal bleeding caused by anisakiasis has been very rare. The present case is a 30 year-old male Admitted with an episode of hematemesis. A gastrofibroscopy revealed a mucosal laceration and the larva of Anisakis on the esophagogastric junction. We report one case of Mallory-Weiss Syndrome due to gastric Anisakis larva, confirmed by an endoscopy.

A Case of Strongyloides Stercoralis Infection Associated with Long-term Adminstration of Steroid in a Patient with Alcoholic Liver Disease / 대한소화기내시경학회지

Strongyloides stercoralis is distinguished by a capacity, unusual among helminths to replicate within the human host, thereby permitting on going cycle of autoinfection due to internal production of internal larvae. It has a worldwide distribution but is much more common in tropical climates where the warm, moist soil offers an environment suited to the development of the larvae. In immunocompromised hosts who receiving corticosteroids, immunosupressive drugs, or radiotherapy in these with AIDS, large numbers of invasive strongyloides larvae can disseminate widely and be fatal. The presents case is a 76 year-old-woman presenting with vomiting and epigastric pain. The patient had a long history of adminstration of steroid and alcohol. A gastrofibroscopic biopsy and stool examination revealed rhabditoid larvae. The patient seems to have suffered from autoinfection with S. stercoralis. We report this case with the review of literatures.

A Case of Lung Abscess in an Achalasia Patient / 대한소화기내시경학회지

Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of peristalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia.