A Case of Management for Hepatocellular Carcinoma with Lung Metastasis

Liver cancer is the 2nd most common cause of cancer related death in Korea. Especially, patients who present extrahepatic spread of hepatocellular carcinoma (HCC) have a shorter life expectancy (50% survival at 1 year and less than 4 months of median overall survival). Molecular target agent like sorafenib was usually mentioned as a treatment for them, but that was still not firmly established. We present a 75 year-old who had expanding nodular type of HCC. The mass was removed by resection and radiofrequency ablation. However, lung metastasis were revealed shortly after surgery. That lesions were treated with lenvatinib and systemic chemotherapy.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

Enhanced Cardiomyogenic Differentiation of P19 Embryonal Carcinoma Stem Cells

BACKGROUND AND OBJECTIVES: We investigated the effects of different concentrations of serum, 5-azacytidine, and culture time on the cardiomyogenic differentiation of P19 embryonal carcinoma stem cells in the course of developing an efficient protocol for generating the cardiomyogenic lineage. MATERIALS AND METHODS: P19 cells were plated at a density of 1x10(6) cells on 10-cm bacterial dishes for 96 hours in the presence of 1% dimethyl sulfoxide to form embryoid bodies. The embryoid bodies were cultured in medium with 2% or 10% fetal bovine serum for an additional 10 or 15 consecutive days in the presence of 0, 1, or 3 microM 5-azacytidine. RESULTS: Quantitative real-time polymerase chain reaction (PCR) analysis showed that the messenger ribonucleic acid (mRNA) expression of cardiac muscle-specific genes, such as GATA4, alpha-actin, alpha-myosin heavy chain, and cardiac troponin T, were significantly higher in the 15-day culture groups than in the 10-day culture groups. Furthermore, the cardiac muscle-specific genes were expressed more in the high-serum groups compared to the low-serum groups regardless of the culture time. Cardiomyogenic differentiation of the P19 cells was most effective in 1 microM 5-azacytidine regardless of the serum concentrations. In addition, the stimulation effects of 5-azacytidine on cardiomyogenic differentiation were more significant under low-serum culture conditions compared to high-serum culture conditions. Cardiomyogenic differentiation of P19 cells was further confirmed by immunostaining with cardiac muscle-specific antibodies. CONCLUSION:Taken together, these results demonstrated that cardiomyogenic differentiation of P19 cells was enhanced by a combination of different experimental factors.

Beta-adrenergic Receptor Function and Anxiety in Patients with Irritable Bowel Syndrome / 신경정신의학

OBJECTIVES: Recently, irritable bowel syndrome (IBS) is known to be related with neurotransmitters. This study was designed to determine beta-adrenergic receptor function in patients with IBS and to compared with normal controls to examine the relationship between beta-adrenergic receptor function and anxiety in IBS patients. METHODS: Eighteen IBS patients were compared with the same number of age and sex-matched normal subjects in terms of beta-adrenergic receptor function and psychological variables reflecting anxiety levels. To assess beta-adrenergic receptor function, Chronotropic 25 dose (CD25) was calculated via isoproterenol stimulation test. RESULTS: CD25 values in the patient group were significantly lower than those in the control group, which reflected increased beta-adrenergic receptor function (2.19+/-1.08 versus 3.89+/-1.64, p<0.05). Patients with IBS showed higher HAM-A scores (8.88+/-4.88 versus 3.59+/-2.65, p<0.01), HAM-D scores (6.41+/-4.02 versus 2.47+/-2.40, p<0.01), BDI scores (9.00+/-6.21 versus 4.72+/-4.30, p<0.05), and STAI scores (STAI-S: 43.41+/-6.34 versus 33.83+/-8.18, p<0.01, STAI-T: 44.65+/-7.43 versus 38.17+/-8.45, p<0.05). In addition, HAM-A scores were negatively correlated with CD25 values in the patient group (r=-0.424, p<0.01). CONCLUSION: These results suggest that beta-adrenergic receptor function is increased in patients with IBS, which could affect increased anxiety levels in these patients.

Coronary vasospasm during esophagogastroduodenoscopy / 대한내과학회지

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.

Coronary vasospasm during esophagogastroduodenoscopy / 대한내과학회지

The incidence of serious cardiac complications associated with esophagogastro-duodenoscopic examination is very rare. An episode of cardiac arrest developed in 49-year-old during endoscopic examination. The patient had no history of pulmonary or ischemic heart disease. After cardiopulmonary resuscitation, he recovered completely. In this patient, we were able to demonstrate a focal spasm by coronary angiography.

A case of bleeding duodenal varix treated by endoscopic band ligation / 대한내과학회지

The occurrence of duodenal varices is rare. They are often overlooked as a source of upper gastrointestinal bleeding in patients with portal hypertension. Experience in control of bleeding duodenal varices is limited. Endoscopic variceal ligation (EVL) is generally considered a safer alternative than endoscopic injection sclerotherapy for treatment of bleeding esophageal varices. Recently EVL has been described as a successful treatment for ruptured duodenal varices. We present a case of bleeding duodenal varices in a 46-year-old man with liver cirrhosis and cholangiocarcinoma who presented with melena. Emergency endoscopy revealed no esophagogastric varices, but several nodular varices were found in the second portion of the duodenum. A punctate ulcer overlying the varix with intermittent bleeding was observed. The hemorrhagic lesion was successfully treated by endoscopic ligation after failure of hemostasis with ethanolamine injection theapy. Endoscopic ligation may be a therapeutic choice to arrest active duodenal variceal bleeding.

The Effects of Cisapride on Volume of Colonoscopy Lavage Solution / 대한소화기내시경학회지

BACKGROUND/AIMS: Polyethylene glycol (PEG) electrolyte lavage solution is now commonly used for peroral colonic preparation. However, the need to ingest a large volume reduces patient acceptance and may limit compliance, thereby resulting in improper preparation. This study was designed to assess whether adding of magnesium oxide or cisapride to PEG solution decreased the volume of PEG solution required without compromising the quality of the preparation. METHODS: One hundred thirty seven patients undergoing outpatient colonoscopy were randomly chosen to receive one of three preparations (Group A: 4 L PEG; Group B: 2 L PEG plus cisapride 20 mg; Group C: 2 L PEG plus magnesium oxide 2 g). Endoscopist was blinded as to the method of preparation and scored the degree of colonic preparation (1 to 4). RESULTS: Mean scores of preparation in group A, B, and C were 2.85, 2.69, and 2.20, respectively (p=0.001). There were significant differences of the degree of preparation between group A and group C, between group B and group C, but not between group A and group B. CONCLUSIONS: Two liters of PEG plus cisapride induced equally effective colonic preparation compared to four liter PEG solution. This results show that the addition of cisapride to PEG solution can reduce volume of PEG solution during colonoscopy preparation.

Impact of Hemodialysis on Left Ventricular Performance: A Doppler Echocardiographic Study / 영남의대학술지

BACKGROUND: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function, we performed M-mode and Doppler echocardiopraphic studies before and after hemodialysis. METHODS: The study population consisted of 30 patients(15 patients were male, mean age 45+/-10 years) with CRF on maintenance henodialysis. They have normal left ventricular systolic function(Fractional shortening > 30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction(EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity, peak A velocity, isovolumetric relaxaion time(IVRT), deceleration time(DT), and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance(IMP) was calculated from each of the Doppler velocity indices. RESULTS: The weight reduction after hemodialysis was 2.1+/-1.0kg(p<0.0001). After hemodialysiss, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF, peak A velocity, and DT. And significant in IVRT and IMP(p<0.05, p<0.0001) were noted. CONCLUSTION: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And and increased IMP suggests that diastolic function may be aggravated after gemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.