T cell subsets in chronic hepatitis B and the effect of prednisolone withdrawal and interferon alpha-2b

OBJECTIVES: The evaluations of the pathogenetic roles of cell mediated immunity and of the preventive effect for disease progression with interferon(IFN) treatment in patients with chronic active hepatitis-B(CAH-B) are the objectives of this study. METHODS: Thirty-two patients with CAH-B were treated with interferon alpha-2b(IFN alpha-2b) with prednisolone withdrawal and 30 control patients were treated with conventional hepatotonics for 6 months. Peripheral total T cell fractions and T cell subsets of the patients with CAH-B, treated with IFN alpha-2b with prednisolone withdrawal, were examined 1 month before administration of prednisolone, and compared with 12 normal controls for assessing the potential role of cellular immunity in the development of CAH-B. To estimate the effectiveness of IFN therapy for the patients with CAH-B, levels of various liver function tests, HBsAg, anti-HBs, HBeAg, anti-HBe, HBV DNA, anti-HCV and others were assessed for the treatment group and compared with control patients at pre- and post-treatment period each. RESULTS: The value of CD4 was significantly lower in patients with CAH-B than normal controls (36.3 +/- 7.7% vs 42.1 +/- 5.7%, p < 0.05) and the value of CD8 was significantly higher in patients with CAH-B than normal controls (30.6 +/- 10.3% vs 24.3 +/- 5.2%, p < 0.05) before prednisolone administration. The patients in responder group (n = 26) had significantly lower CD4 cells compared with normal controls, but non-responders (n = 6) did not have. The levels of liver function test(LFT) in the patients with IFN alpha-2b treatment with prednisolone withdrawal were not different from the control patient group at pretreatment, but significantly lower than control patient group's after treatment, regardless of response to IFN alpha-2b treatment with prednisolone withdrawal. CONCLUSIONS: The cellular immunity of the host may have a potential role in the pathogenesis of chronicity of hepatitis B infection. IFN alpha-2b treatment with prednisolone withdrawal may be regarded as one of the effective treatment modalities for the inhibition of disease progression in patients with CAH-B.

The Effect of Slow Release Lanreotide in Korean Acromegalic Ratients / 대한내분비학회지

BACKGROUND: Previous studies have shown that somatostatin analogues such as octreotide are effective in suppressing GH and IGF-I levels in acromegaly. The recent availability of slow release lanreotide could avoid the inconveniences associated with either repeated subcutaneous injections or continuous infusions. We investigated the effects of the SR-lanreotide on clinical, biochemical and safety responses in five patients with acromegaly. And we investigated whether the response of the GH level to acute adrninistration of octreotide predicts the response after 12 weeks of treatment with the SR-lanreotide and whether the identification of gsp oncogene could be used as a therapeutic and prognostic clue in treatment with the SR-lanreotide. METHODS: We studied the effects of SR-lanreotide 30 mg administered intramuscularly biweekly for 12 weeks in five Korean acromegalic patients. Subjective improvements in the clinical symptoms of acromegaly and adverse reactions were recorded. During SR-lanreotide treatment, serum GH, IGF-I and IGFBP-3 concentrations were evaluated just before the next injection of the SR-lanreotide. Before the start of SR-lanreotide therapy the sensitivity of GH secretion to the octreotide was tested by measuring the effect of the acute response to 0.1 mg intravenously on plasma GH levels followed until 6 hours after administration of octreotide. Direct polymerase chain reaction sequencing of the gsp oncogene were performed. We compared the responses to SR-lanreotide in patients harboring gsp-positive and gsp-negative somatotroph adenomas. RESULTS: The treatment with SR-lanreotide for 12 weeks could suppress the GH level by more than 50% in four of five patients and normalize the IGF-I in two patients. No correlation was found between the GH level and IGF-I level at the end of the study. The IGFBP-3 level correlated with the IGF-I level in three of five patients. Although the initial GH response to octreotide tended to correlate with the IGF-I response after SR-lanreotide treatment, the results were statistically insignificant. The patients with gsp-positive tumor tended to show a better response to SR-lanreotide. During treatment, there was a reduction in the percentage of patients complaining of joint pain, fatigue, digital paresthesia, and hyperhydrosis. Changes in soft tissue swelling were documented by decreases in finger circumference. The common adverse events were abdominal discomfort, loose stool, and diarrhea. These events were decreased progressively. No patients discontinued the treatment of SR-lanreotide due to adverse events. CONCLUSION: This study showed that SR-lanreotide is effective in controlling acromegalic symptoms as well as GH and IGF-I hypersecretion. This treatment was well tolerated and more convenient for the patients. Further studies are required for clinical outcome of long-term SR-lanreotide treatment and cost-effective analysis.

A Carcinoid Tumor of the Stomach: A case report / 대한소화기내시경학회지

A carcinoid tumor of the stomach is uncommon, has no clinical symptoms, and is regarded as a benign. It is also incidentally found in most cases. 48-year-old woman with gastric carcinoid tumor was admitted. She had suffered from a anorexia and a dry mouth for 4-months. A gastroscopy revealed a polypoid mass on the greater curvature of the mid-body of the stomach which was subsequently thought to be an adenocarcinoma. An endoscopic mucosectomy revealed however, that it was a carcinoid tumor. A case of carcinoid tumor of the stomach is here by presented with a brief literature review.

Clinicopathologic Evaluation of 290 Cases Involving Endoscopic Gastric Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric polyps are recommended to be removed due to their premalignant potential. Endoscopic polypectomy has long been considered a safe and effective method for removal of gastric polyps. METHODS: The authors diagnosed and treated 290 gastric polyps using endoscopy on 210 patients who had been admitted to Chungnam National University Hospital from January, 1990 to August, 1996. The clinical endoscopic and pathologic findings were evaluated.

Clinical Implication of Gastric Leiomyosarcoma / 대한내과학회지

OBJETIVES: Gastric leiomyosarcomas are uncommon, represent 1 to 3% of primary malignant neoplasms of the stomach and variable in clinical outcomes. This paper is a retrospective study of the clinical behaviour, histopa thologic features and prognostic factors. METHODS: Between January 1990 and August 1996, the records of nine patients with primary gastric leio myosarcoma treated at Chung-Nam National University Hospital were reviewed for clinical presentations and histopathologic features. The statiscal analysis with SAS system was employed for evaluation of prognostic factors. RESULTS: 1) The median age of the patients was 53.4 years with even age distribution from 31 to 76 years. The male and female ratio was 1.25 to 1. 2) The common symptoms were abdominal pain(67%), bleeding(22%) and indigestion(11%). 3) The locations of the tumor was body(56%) and fundus(44%). The growth pattern of the tumor was mostly submucosal(67%). 4) The average size of tumors was 11cm (6-18cm). 5) The central ulcer on the tumor showed 100%. The endoscopically and preoperative diagnosed leiomyosar coma with endoscopic biopsy was 33% . 6) The low grade tumors were 7 cases and high grade was 1 in eight resected primary gastric leiomyosarcomas. 7) The overall resectability was 89%. The resected cases had no lymph node metastasis. Chemotherapy and radiotherapy was done 5 cases and 1 case, respectively in patients with high mitotic number, large size and distant metastases. 8) The follow-up period was 4 to 49 months and 3 patients were died. Two of 3 died patients were initially diagnosed stage IVA and 1 patient was stage II with very large size (18cm). The average survival time of 3 died patients was 37 months. 9) The two patients from surgically resected eight cases were recurred at liver and peritoneum and died 11 months and 31 months after recurrence, respectively. CONCLUSION: The advanced stage and recurred case has short survival time but the more many cases and longer follow-up periods should be need to identify for prognostic factors and the effective postoperative adju vant therapy should be studied for high risk patients.

A Case of Tuberculosis of the Duodenum / 대한소화기내시경학회지

The rate of tuberculosis has been significantly decreased due to development of effective antituberculosis chemotherapy. Tuberculosis of the duodenum is very rare and diagnosis is very difficult because of nonspecific symptoms and nonspecific duodenal lesions. A case of duodenal tuberculosis which was clinically diagnosed as malignancy of the duodenum was discovered. The diagnosis was confirmed by a subsequent operation and administration of antituberculous chemotherapy resulted in a positive response. Consequently, the following is a report on this case, review of related literature.

The Relationship between Biliary Calculi and Juxtapapillary Duodenal Diverticuli / 대한소화기내시경학회지

BACKGROUND/AIMS: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. METHODS: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. RESULTS: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diverticuli increased with age and more commomly in female patients. The prevalence of diverticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). CONCLUSIONS: We conclude that biliary stones are associated with juxtapapillary diverticuli.

The Cause and Complication of Liver Cirrhosis during the Reccent 5 Years / 대한간학회지

BACKGROUND/AIMS: The causes and complications of liver cirrhosis are varied and increasing prevalence of alcoholic liver disease has been suspected. We tried to categarize the causes and complications of liver cirrhosis. METHODS: We investigated the 159 patients who are diagnosed as liver cirrhosis at Chungnam National University Hospital during the recent 5 years. RESULTS: 1) HBV infection was the most common cause of liver cirrhosis (48.1%), alcohol was next (42.9%). 2) Alcoholic liver cirrhosis was the most common cause in male (54.2%), postnecrotic cirrhosis (HBV) was the most common cause in female (66.7%). The difference was considered to come from the fact that male drinks more, constantly or habitually. 3) Alcohol was the most common cause of liver cirrhosis above the fifth decade of age and HBV is under 40 yeats of age. 4) The complications of liver cirrhosis are variceal bleeding, most common, splenomegaly and ascites in order. Hepatocellular carcinoma occumd also especially in HBV induced liver cirrhosis. CONCLUSION: Alcoholic liver disease is a common cause of liver cirrhosis.

A Clinical Review of Ischemic Rowel Disease / 대한내과학회지

OBJECTIVE: Despite increased awareness of the fatality of mesenteric ischemia, the diagnosis seldom is made prior to the onset of gangrene. The multiplicity of etiologic factors, the many varied presentations, and splanchnic vasoconstriction all affect the extent of ischemic injury, adding to the complexity of the clinical problem. Extensive acute processes are still catastrophic illnesses with a high mrotality, but there is a potential for both better diagnisis and therapy with an improved outcome. Discussion of the pathophysiology, diagnosis, and treatment of this entity will be presented. METHODS: A Retrospective review of our experience with ischemic bowel disease was made. Ten consecutive clinical cases admitted in ChungNam National University Hospital from October 1990 to April 1994 were observed. RESULTS: 1) We experienced 5 patients with arterial embolic occlusion, 1 patient with venous thrombosis and 4 patients with colonic ischemia. 2) The peak ages were 6th decade and 8th decade. 3) The major clincal symptoms and signs were abdominal pain (100%), abdominal tenderness (70%), melena (70%), nausea (60%), fever (50%), vomiting (40%) and abdominal distension (30%). 4) On laboratory findings, there were leukocytosis (80%) and thrombocytopenia (20%) 5) In plain film, there were ileus (70%), edematous intestinal wall (50%), mucosal edema (30%), thumb printing (10%) and gasless abdomen (10%). Among the 5 cases performed abdominal CT, there were thickening of intestinal wall in 4 cases, narrowing of intestinal lumen in 2 case and ascites in 3 cases. 6) Bowel resections were perfomed in 7 cases and supportive care was performed in 3 cases. 7) The overall mortality rate was 30%, CONCLUSION: An oggressive approach in patients suspected of having ischemic bowel is indicated if the diagnosis is to be made before necrosis has occurred. A high index of suspicion, early angiography, correction of the underlying cardiac disease, treatment of splanchnic vasoconstriction, surgical revascularization, and resection of gangrenous bowel are necessery if there is to be a significant reduction in the high mortality rates associated with mesenteric ischemia.

A Comparison Between Savary - Gilliard and Balloon Dilatation in Benign Esophageal Stricture / 대한소화기내시경학회지

The balloon dilatation or Savary-Gilliard dilatation was performed in 59 patients with benign esophageal stricture in Chungnam National University Hospital from September 1990 to August 1995. We reviewed the effect and the safty of each therapeutic method and the results were as foillows: 1) The cause of stricture were corrosive stricture(28 cases, 49,4%), anastomotic stenosis after gastroesophageal surgery(26 cases, 44.1%), stricture after endoscopic variceal sclerotherapy(3 cases, 5.1%), esophageal web(1 case, 1.7%) or stricture complicated by reflux esophagitis(l case). 2) The overall cure rate of balloon dilatation was 50%(l2/24 cases) and that of Savary-Gilliard dilatation was 77.1%(27/35 cases). The Savary-Gilliard dilatation group had a better result than the balloon group. 3) The perforation after Savary-Gilliard dilatation occurred in 4 cases~(6.7%). One case was treated surgically and three cases wiere treated medically. But there was no fatal complication. 4) The overall cure rate of anastomotic stenosis was 84.6%(32/38 cases) and that of corrosive stricture was 46.4%(13/28 cases). 5) The cure rate of Savary-Gilliard dilatation in corrosive esophageal stricture was 64.7%(ll/17) and that of balloon dilatation was 18.1%(2/11). 6) According to site of stricture, the cure rate of dilatation was 84.2% (32/38) in thoracic esophagus, 42.8%(3/7) in cervical esophagus and 28,5%(4/14) in multiple or long segmented stricture.(continue...)

The Influence of EIS or EVL to Gastric Varices in Bleeding Esophageal Varices / 대한소화기내시경학회지

Background: Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated, and the fate of coexisting gastric varices after eradication of esophageal varices is not clearly known. Methods: EIS or EVL was preformed in 174 patients with variceal hemorrhage in CHUNG-NAM NATIONAL UNIVERSITY HOSPITAL from September 1990 to December 1993. Among the total 174 patients, 50 patients were followed for at least 1 year. Forty four patients were treated with EIS, and 6 witb EVL. We assesed the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in 50 patients.

Hemostatic Effect of Endoscopic Injection with Hypertonic Saline - Epinephrine (HS-E) Solution in Petic Ulcer Bleeding / 대한소화기내시경학회지

Peptic ulcer bleeding is the most common cause of upper gastromtestinal bleeding. The efficacy of local injection of hypertonic saline-epinephrine(RS-E)solutiom around the base of the bleeding vessels under endoscopy was assessed, During the period between January 1991 and August 1994, 83 patients with active bleeding or stigmata of recent hemorrhage in peptic ulcers were included to this study. The major cause of bleeding in this study consisted of gastric ulcers(60) and duodenal ulcers(23). Twenty patients rebled and seven required emergency surgery and two patients were died. Definitive hemoatasis was achieved in 74(89.3%). Two patients rebled due to mucosal ischemia induced by HS-E injection, other significant complication was not found. We conclude that the endoscopic injection with hypertonic saline-epinephrine solution is one of the effective and safe therapeutic modality in peptic ulcer bleeding.

Characterization of Cyclic AMP Response Element (CRE) in the Promoter of the Rat Thyrotropin Releasing Hormone (TRH) Gene / 대한내분비학회지

We investigated whether the two variant elements of CRE(TGcCGTCA[5'CRE], TGACcTCA[3'CRE]) in the 5'flanking region of the rat TRH gene, which are different from the CRE consensus sequence(5'-TGACGTCA-3') by one base pair, are responsive to cAMP, and whether the one base pair difference is responsible for the degree of cAMP responsiveness of the gene. When CA 77 cells were stimulated with forskolin and isobutylmethylxanthine for 4 hours, the level of TRH mRNA was increased by only two fold. The transient gene expression study using serial 5'deletion of the TRH gene in PC12 cells showed that the region between-113 and-77, which includes 5'CRE, was crucial for the cAMP resonsiveness. When the plasmid, which contains the 30 bp oligonucleotide including either 5'CRE or 3'CRE ligated to the enhancerless RSV promoter, was transfected into PC12 cells, it did not significantly affect not only the basal transcription but cAMP responsiveness. The 65 bp oligonucleotide including both 5'CRE and 3'CRE, however, increased both of the basal transcription and cAMP-stimulated transcription by 2-3 fold. When the sequence of 5'CRE was converted to that of the CRE consensus by replacing one base pair, the cAMP responsiveness was increased by two fold although the basal transcription was not increased. The one base pair mutant of 3'CRE increased both of the basal and cAMP-stimulated transcription by 3-4 fold. These results suggest that there are the two variant CREs in rat TRH gene, which are relatively weak CRE compared to the CREs of other neuropeptide genes and cooperative for the activation of both the basal and cAMP-stimulated transcription. The one base pair difference of the variant CREs from the CRE consensus sequence is responsible for the weak responsiveness to cAMP.

Expression of type 1?collagen mRNA of osteoblast like(MC3T3-E1) celss to sodium fluoride / 대한내분비학회지

No abstract available.

Expression of apolipoprotein C-II mRNA in cultured HepG2 cell / 대한내분비학회지

No abstract available.

Effect of fluoride and vandate on the osteoblast MC3T3-E1 function / 대한내분비학회지

No abstract available.