Ameliorative Effects of Ombuoside on Dopamine Biosynthesis in PC12 Cells

This study investigated the effects of ombuoside, a flavonol glycoside, on dopamine biosynthesis in PC12 cells. Ombuoside at concentrations of 1, 5, and 10 µM increased intracellular dopamine levels at 1 – 24 h. Ombuoside (1, 5, and 10 µM) also significantly increased the phosphorylation of tyrosine hydroxylase (TH) (Ser40) and cyclic AMP-response element binding protein (CREB) (Ser133) at 0.5 – 6 h. In addition, ombuoside (1, 5, and 10 µM) combined with L-DOPA (20, 100, and 200 µM) further increased intracellular dopamine levels for 24 h compared to L-DOPA alone. These results suggest that ombuoside regulates dopamine biosynthesis by modulating TH and CREB activation in PC12 cells.

Effects of Gypenosides on Dopaminergic Neuronal Cell Death in 6-Hydroxydopamine-lesioned Rat Model of Parkinson's Disease with Long-term L-DOPA Treatment

The goal of this study was to determine whether gypenosides (GPS) exert protective effects against dopaminergic neuronal cell death in a 6-hydroxydopamine (OHDA)-lesioned rat model of Parkinson's disease (PD) with or without long-term 3,4-dihydroxyphenylalanine (L-DOPA) treatment. Rats were injected with 6-OHDA in the substantia nigra to induce PD-like symptoms; 14 days after injection, groups of 6-OHDA-lesioned animals were treated for 21 days with GPS (25 or 50 mg/kg) and/or L-DOPA (20 mg/kg). Dopaminergic neuronal cell death was assessed by counting tyrosine hydroxylase (TH)-immunopositive cells in the substantia nigra and measuring levels of dopamine, norepinephrine, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the striatum. Dopaminergic neuronal cell death induced by 6-OHDA lesions was ameliorated by GPS treatment (50 mg/kg). L-DOPA treatment exacerbated 6-OHDA-induced dopaminergic neuronal cell death; however, these effects were partially reversed by GPS treatment (25 and 50 mg/kg). These results suggest that GPS treatment is protective against dopaminergic neuronal cell death in a 6-OHDA-lesioned rat model of PD with long-term L-DOPA treatment. Therefore, GPS may be useful as a phytotherapeutic agent for the treatment of PD.

Inexplicable Abdominal Pain due to Thoracic Spinal Cord Tumor

Chronic, refractory abdominal pain without a metabolic or structural gastroenterological etiology can be challenging for diagnosis and management. Even though it is rare, it has been reported that such a recurrent abdominal pain associated with radicular pattern can be derived from structural neurologic lesion like spinal cord tumor. We experienced an unusual case of chronic recurrent abdominal pain that lasted for two years without definite neurologic deficits in a patient, who has been harboring thoracic spinal cord tumor. During an extensive gastroenterological workup for the abdominal pain, the spinal cord tumor had been found and was resected through surgery. Since then, the inexplicable pain sustained over a long period of time eventually resolved. This case highlights the importance of taking into consideration the possibility of spinal cord tumor in differential diagnosis when a patient complains of chronic and recurrent abdominal pain without other medical abnormalities.

Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst

Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg.

An Experience of Cyberknife Treatment in Patients with Advanced Pancreaticobilliary Malignancy / 대한소화기학회지

BACKGROUND/AIMS: CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies. METHODS: Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT. RESULTS: The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea. CONCLUSIONS: CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.

Interstitial Pneumonitis in a Patient with Chronic Hepatitis C and Chronic Renal Failure on Interferon Therapy / 대한소화기학회지

After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.

Diagnostic Agreement between Capsule Endoscopy and Double-balloon Enteroscopy of Small Bowel Disease / 대한소화기내시경학회지

BACKGROUND/AIMS: To evaluate the diagnostic agreement between capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in patients with suspected small bowel disease. METHODS: We retrospectively analyzed and compared the diagnostic yield and the diagnostic agreement between CE and DBE, in patients who initially underwent CE followed by DBE at a single tertiary referral center. RESULTS: Thirty patients (17 males, mean age 45+/-17) underwent both CE and DBE. Total small bowel examination was possible in 80% (24/30) with CE, and 20% (6/30) with DBE. Diagnostic yield was 56.7% (17/30) with CE, and 73.3% (22/30) with DBE. Overall diagnostic yield was 93.3% (28/30) after both examinations. The overall degree of concordance between CE and DBE for lesion description was a moderate agreement, with a calculated kappa index of 0.48 (95% CI 0.44~0.52, p<0.05). Both CE and DBE detected identical lesions relevant to the clinical presentation in 56.6% (17/30) of cases. A total of 36.7% (11/30) of cases changed diagnosis because different lesions were detected by each method. CONCLUSIONS: The overall degree of concordance between CE and DBE showed moderate agreement. Additional DBE examinations can improve the diagnostic yield of small bowel lesions in patients with no relevant findings or failed detection on CE, who are, however, clinically suspicious.

Changes in Indications and Diagnostic Rates of Capsule Endoscopy in a Single Center / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate changes with time in indications for capsule endoscopy examinations (CEs) and diagnostic rates. METHODS: We retrospectively reviewed medical records of 425 CEs (417 patients), which were done for several different indications between March 2003 and May 2009. Indications, bowel cleansing, complete CEs, and diagnostic rates were compared between the first half (2003~2005) and the second half (2006~2009) of the study period. RESULTS: Overt bleeding and occult bleeding, respectively, accounted for 31% and 5.8% in the first half; and 45.4% and 12.4% in the second half. The differences were significant (p<0.05). Other indications were significantly decreased in the second half compared to the first half (29.6% and 7.7% respectively). Bowel cleansing was considered "adequate" in 48% in the first half vs. 61.6% in the second half (p<0.05). No significant difference was found in complete CE rates. There was a significant difference in diagnostic rates between the first half and the second half (23.8% and 43.9%, respectively). CONCLUSIONS: Cumulative experience and knowledge with CEs has led to an increased number of CEs for obscure bleeding and a decreased number of CEs for other indications in which the role of CEs was unclear. Improved diagnostic rates of CEs were accompanied by these changes in CEs indications.

Characteristics of Lesions Misdiagnosed as Obscure Gastrointestinal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Double balloon enteroscopy (DBE) and capsule endoscopy (CE) are useful for evaluation of obscure gastrointestinal bleeding (OGIB). However, many bleeding sources within reach of conventional upper and lower endoscopes can be missed in patients who have undergone DBE and CE for OGIB. The aim of this study was to determine the incidence and characteristics of OGIB lesions within reach of a conventional endoscope in patients undergoing DBE and CE for the indication of OGIB. METHODS: This retrospective study included 134 patients who were evaluated for OGIB between March 2003 and May 2009 at Soonchunhyang University Hospital. RESULTS: Of the 134 patients, 76 underwent CE, 28 patients underwent DBE, and 30 underwent both CE and DBE. The incidence of OGIB lesions within reach of a conventional upper and lower endoscopy was 9.7% (n=13) and the mean age of patients was 51 years (range: 20 to 69 years). The most commonly missed lesion was duodenal ulcer (n=8). The other missed lesions were gastric ulcer (n=2), terminal ileal ulcer (n=2) and ileocecal valve ulcer (n=1). CONCLUSIONS: The duodenum should be observed closely in initial upper and lower endoscopy by experienced endoscopists. Performing a second EGD and ileocolonoscopy before DBE and CE may increase the diagnostic yield and improve cost-effectiveness in patients with OGIB.

A Case of Asymptomatic Aspiration of a Capsule Endoscope with a Successful Resolution

Aspiration is a very rare complication of capsule endoscopy, but it is potentially life-threatening and should be considered an emergency requiring immediate intervention since it can evolve into major airway compromise and obstructive pneumonitis. We experienced a case of asymptomatic aspiration of a capsule in a 75-year-old man. The aspirated capsule was diagnosed on routine chest and abdomen X-rays to confirm its position after ingestion. The capsule was removed via bronchoscopy using a net, without sequelae, after inducing the patient to cough. To prevent this complication, a thorough history of swallowing disorders is needed before capsule ingestion, and patients with swallowing difficulties should have the capsule placed in the duodenum endoscopically. Moreover, on capsule aspiration, cough induction is the most effective method of capsule removal.

A case of insulin autoimmune syndrome related to alpha-lipoic acid / 대한내과학회지

Insulin autoimmune syndrome is characterized by spontaneous hypoglycemia, high concentrations of serum immunoreactive insulin, and the presence of autoantibodies to insulin without previous insulin injection. A 71-year-old woman with diabetes, who had been treated with oral hypoglycemic agents, suffered from frequent hypoglycemia. High insulin levels and the presence of insulin autoantibodies were shown, so insulin autoimmune syndrome was diagnosed. Drugs containing sulfhydryl groups play an important role in the pathogenesis of insulin autoimmune syndrome. Alpha-lipoic acid, which contains a sulfhydryl group, was administered before the onset of hypoglycemia. The patient's human leukocyte antigen (HLA) type was HLA-Cw4 and DRB1*0406. There is a strong correlation between HLA-DRB1*0406 and insulin autoimmune syndrome. The patient was treated with prednisolone and has not had a hypoglycemic attack since. We report a case of insulin autoimmune syndrome, possibly associated with alpha-lipoic acid.

A case of myocardial infarction with antiphospholipid syndrome / 대한내과학회지

Antiphospholipid syndrome is a multi-system disorder characterized by arterial or venous thromboses and antiphospholipid antibodies, such as lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations are recurrent pregnancy losses and deep vein thromboses. Cardiac manifestations in antiphospholipid syndrome include valve abnormalities, occlusive arterial disease, intracardiac emboli, and ventricular dysfunction. Acute myocardial infarction is a rare manifestation of the primary antiphospholipid syndrome. We have experienced a case of myocardial infarction with antiphospholipid syndrome. A 35-year-old man with no cardiovascular risk factors, other than smoking, presented with chest pain. He was diagnosed with an acute myocardial infarction. Our evaluation for coagulapathy revealed elevated lupus anticoagulant antibody. The antiphospholipid syndrome should be considered early in the differential diagnosis as an important cause of unexplained thrombosis in young patients.

The Association Between History Of Disease And Psychometric Characteristics Among The Chronic Disease Patients

BACKGROUND: The chronic disease patients have various psychological problems during the treatment. Therefore, it is needed about understanding and support for chronic disease patients. The main purposes of this study are to identify the psychometric characteristics. METHODS: To evaluate the psychometric characteristics of chronic disease patients-liver cirrhosis, chronic pulmonary disease, etc. -a questionnaire(SCL-90-R) survey was performed toward 100 chronic disease patients in admission to 2 general hospital. 100 persons without any disease were investigated by the same questionnaire for comparison. The survey was performed from June to August 1996. RESULTS: The disease history among the patients, 31% of patients suffered from liver disease, 19% of patients suffered from chronic respiratory disease. 30% of patients reported that they were not expected a recovery from the disease. The patients have a significant higher score in the somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism than normal control (p<0.05). Most of the psychometric characteristics were associated with expectancy of the recovery, education about the disease, number of admission, duration of admission and type of disease(p<0.05). CONCLUSIONS: The chronic disease patients showed higher score psychological symptoms in various characteristics than normal control. Therefore it will be needed that is an proper treatment and psychological support continuously.

The Association Between History Of Disease And Psychometric Characteristics Among The Chronic Disease Patients

BACKGROUND: The chronic disease patients have various psychological problems during the treatment. Therefore, it is needed about understanding and support for chronic disease patients. The main purposes of this study are to identify the psychometric characteristics. METHODS: To evaluate the psychometric characteristics of chronic disease patients-liver cirrhosis, chronic pulmonary disease, etc. -a questionnaire(SCL-90-R) survey was performed toward 100 chronic disease patients in admission to 2 general hospital. 100 persons without any disease were investigated by the same questionnaire for comparison. The survey was performed from June to August 1996. RESULTS: The disease history among the patients, 31% of patients suffered from liver disease, 19% of patients suffered from chronic respiratory disease. 30% of patients reported that they were not expected a recovery from the disease. The patients have a significant higher score in the somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism than normal control (p<0.05). Most of the psychometric characteristics were associated with expectancy of the recovery, education about the disease, number of admission, duration of admission and type of disease(p<0.05). CONCLUSIONS: The chronic disease patients showed higher score psychological symptoms in various characteristics than normal control. Therefore it will be needed that is an proper treatment and psychological support continuously.

Clinicsl Evaluation of Guillain-Barre Syndrome / 대한마취과학회지

The Guillain-Barre syndrome is characterized by Bymmetrical rapidly, ascending paralysis that occasionally leads to respiratory embarrassment and death. We atudied 16 patients diagnosed as Guillain-Barre syndrome admitted to ICU at Severance Hospital from, January 1981 to April 1986. All patients were managed by respirators and 10 cases were tracheostomised. In addition to antibioticts with steroid therapy, rigid or fiheroptic bronchoscopy and plasma exchange were performed. The results were as follows ; 1) The 16 cases consist of 9 males and 7 females. 2) Prodromal symptoms were URI, fever, and gastrointestinal symptoms. 3) Diagnosis was 7ased on clinical symptoms, CSF studios and nerve conduction study. 4) Treatments included airway maintenance with ventilators, trachestomy, antibiotics with steroid therapy, rigid or fiberoptic bronchoscopy and plasma exchange. 5) Pulmonary complications (aspiration pneumonia, pneumoia, atelectasis, laryngeal ede-ma) and cardiovascular complications (hypertension, tachycardia, bradycardia, fever) were observed. However, there was no death in this group. ln conclusion, respiratory care and otter supportive therapy are of prime importance in the management of Guillain-Barre Syndorme.