The Changes on the Duodenogastric Reflux after the Laparoscopic Cholecystectomy in Gallstone Patients

Although the "Duodenogastric reflux" was often developed in normal persons, it was more frequently developed in the majority of patients who had a gallstone disease or malfunctioned gallbladder. The "duodenogastric reflux" induced chronic gastritis, peptic ulcer, and esophagitis causing upper abdominal symptoms. After the cholecystectomy was performed, most patients have no further symptoms but a significant minority of patients still have persistent symptoms. Such symptoms was often explained with the "duodenogastric reflux". We examined the degree of duodenogastric reflux in the patients with gallstones and the changes of the degree of the duodenogastric reflux after the laparoscopic cholecystectomy in these patients. The study population consisted of 9 patients with gallstone disease. The clinical symptoms (upper abdominal pain, bloating, early satiety, nausea, vomiting, heartburn, dysphagia, indigestion, fat intolerance) were graded and all subjects had standard esophageal manometry to identify the location of the lower esophgeal sphincter and the 24 hour gastric pH monitoring to ascertain the duodenogastric reflux at before and 3 months after laparoscopic cholecystectomy. On the results of our study, the severity of clinical symptoms was decreased after operation and the time percentage above pH 7, longest time above pH 7, frequency above pH 7 and frequency persistent 5 min above pH 7 in supine and upright position were not significantly different after operation at statistical analysis. It is revealed that the degree of duodenogastric reflux was not changed on 24 hour gastric pH monitoring. We concluded that laparoscopic cholecystectomy did not affect on the duodenogastric reflux in the patients of gall bladder stone.

Assessment of sICAM-1 and sVCAM-1 in Patients with Chronic Renal Allograft Dysfunction / 대한이식학회지

AIMS: To examine the relationship between soluble adhesion molecules ICAM-1 and VCAM-1, and chronic renal allograft dysfunction METHODS: Serum samples taken on the day of renal biopsy from renal allograft recipients showing chronic graft dysfunction(n=31), at least one year after renal transplantation, were examined and compared with those from healthy control(n=20), or end stage renal failure patients(n=18), for the measurement of sICAM-1 and sVCAM-1. Specific enzyme-linked immunometric method were used. No pateints was experiencing concurrent infection. The indications of the biopsy were slow increment of serum creatinine, significant proteinuria(over 1 gram per day) or newly-developed microscopic hematuria with or without small amount of proteinuria. RESULTS: sVCAM-1 was increased in end stage renal failure patients as well as transplant recipients as compared with the healthy controls. However, sICAM-1 was not increased either in end stage renal failure patients or renal allograft recipients. The degree of chronic rejection and cyclosporine toxicity did not correlate with the serum level of sVCAM-1. The level of serum creatinine did not correlate with the serum levels of either sICAM-1 or sVCAM-1. CONCLUSION: Increase of sVCAM-1 but not of sICAM-1 may have some role in the mechanism of chronic renal allograft dysfunction.