Niclosamide Inhibits Aortic Valve Interstitial Cell Calcification by Interfering with the GSK-3β/β-Catenin Signaling Pathway

The most common heart valve disorder is calcific aortic valve stenosis (CAVS), which is characterized by a narrowing of the aortic valve. Treatment with the drug molecule, in addition to surgical and transcatheter valve replacement, is the primary focus of researchers in this field. The purpose of this study is to determine whether niclosamide can reduce calcification in aortic valve interstitial cells (VICs). To induce calcification, cells were treated with a pro-calcifying medium (PCM). Different concentrations of niclosamide were added to the PCM-treated cells, and the level of calcification, mRNA, and protein expression of calcification markers was measured. Niclosamide inhibited aortic valve calcification as observed from reduced alizarin red s staining in niclosamide treated VICs and also decreased the mRNA and protein expressions of calcification-specific markers: runt-related transcription factor 2 and osteopontin. Niclosamide also reduced the formation of reactive oxygen species, NADPH oxidase activity and the expression of Nox2 and p22 phox . Furthermore, in calcified VICs, niclosamide inhibited the expression of β-catenin and phosphorylated glycogen synthase kinase (GSK-3β), as well as the phosphorylation of AKT and ERK. Taken together, our findings suggest that niclosamide may alleviate PCM-induced calcification, at least in part, by targeting oxidative stress mediated GSK-3β/β-catenin signaling pathway via inhibiting activation of AKT and ERK, and may be a potential treatment for CAVS.

A Case of Lymphoepithelial Cyst of the Pancreas Showing Characteristic Findings on Endoscopic Ultrasonography / 대한소화기내시경학회지

Lymphoepithelial cyst of the pancreas is a rare benign cystic tumor which is histologically characterized by cyst containing keratin, lined by mature squamous epithelium surrounded by lymphoid tissue, often with prominent follicles. Cystic lesions of the pancreas are more often detected because sensitive abdominal imaging tests are used for multiple indications, but preoperative differential diagnosis is difficult despite the advancements of imaging technologies. We herein report a case of lymphoepithelial cyst incidentally found on routine abdominal ultrasonography which showed characteristic findings on endoscopic ultrasonography preoperatively and discuss the radiologic features of lymphoepithelial cyst.

Abdominal Pregnancy Presenting as Massive Lower Gastrointestinal Bleeding

An ectopic pregnancy in the abdominal organs is very rare. Primary intestinal pregnancy is considered the rarest form of extrauterine pregnancy, and only a few well-documented cases have been reported. Herein, a case of an abdominal pregnancy in a 25-year-old woman, with massive lower gastrointestinal bleeding, is reported. The source of bleeding could not be identified, despite gastroscopy, ultrasonography and angiography investigations. A diagnostic laparotomy disclosed an abdominal pregnancy, causing an erosion of the jejunal wall at the site of the pregnancy, with massive lower gastrointestinal bleeding. An abdominal pregnancy is seldom included in the differential diagnosis of lower gastrointestinal bleeding. The possibility of intestinal erosion in an abdominal pregnancy should be borne in mind in cases of lower gastrointestinal bleeding.

Clinical Study of Perforated Duodenal Ulcer

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.

Comparison Transilluminated Powered Phlebectomy with the Conventional Surgical Treatment of Primary Varicose Vein of the Lower Limbs

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.

Clinical Evaluation of Laparoscopic Appendectomy

BACKGROUND: This study was performed to evaluate our experience on laparoscopic appendectomy. METHODS: Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998. RESULTS: Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order. CONCLUSION: Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.