Therapeutic effects of traditional herbal medicine on cerebral ischemia: a perspective of vascular protection / 中国结合医学杂志

Although many agents for acute ischemic stroke treatment have been developed from extensive preclinical studies, most have failed in clinical trials. As a result, researchers are seeking other methods or agents based on previous studies. Among the various prospective approaches, vascular protection might be the key for development of therapeutic agents for stroke and for improvements in the efficacy and safety of conventional therapies. Traditional medicines in Asian countries are based on clinical experiences and literature accumulated over thousands of years. To date, many studies have used traditional herbal medicines to prove or develop new agents based on stroke treatments mentioned in traditional medicinal theory or other clinical data. In the current review, we describe the vascular factors related to ischemic brain damage and the herbal medicines that impact these factors, including Salviae Miltiorrhizae Radix, Notoginseng Radix, and Curcumae Rhizoma, based on scientific reports and traditional medical theory. Further, we point out the problems associated with herbal medicines in stroke research and propose better methodologies to address these problems.

Increased Serum Activity of Matrix Metalloproteinase-9 in Patients with Acute Variceal Bleeding

BACKGROUND/AIMS: Matrix metalloproteinases (MMP)-2 and -9 can degrade essential components of vascular integrity. The aim of this study was to investigate the association between those MMPs and variceal bleeding (VB). METHODS: Fifteen controls, 12 patients with acute ulcer bleeding (UB) group, 37 patients with varix (V group), and 35 patients with acute VB group were enrolled. Serum was obtained to measure MMP-2 and -9 activity by zymogram protease assays. RESULTS: The activity levels of these compounds were compared with the controls' median value. The median MMP-9 activity was 1.0 in controls, 1.05 in the UB group, 0.43 in the V group, and 0.96 in the VB group. The level of MMP-9 activity was higher in the VB group than in the V group (p<0.001). In the VB group, there was a signifi cant decrease in MMP-9 activity over time after bleeding (p<0.001). The median MMP-2 activity level was 1.0 in controls, 1.01 in the UB group, 1.50 in the V group, and 1.55 in the VB group. The level of MMP-2 activity was similar in the VB and V groups. CONCLUSIONS: The level of MMP-9 activity increased in association with VB. The role of MMP-9 in the pathogenesis of VB should be verified.

Influence of Transforming Growth Factor-beta1 Gene Polymorphism at Codon 10 on the Development of Cirrhosis in Chronic Hepatitis B Virus Carriers

Transforming growth factor (TGF)-beta1 is a key cytokine producing extracellular matrix. We evaluated the effect of TGF-beta1 gene polymorphism at codon 10 on the development of cirrhosis in patients with chronic hepatitis B. One hundred seventy eight patients with chronic hepatitis (CH, n=57) or liver cirrhosis (LC, n=121), who had HBsAg and were over 50 yr old, were enrolled. The genotypes were determined by single strand conformation polymorphism. There were no significant differences in age and sex ratio between CH and LC groups. HBeAg positivity and detection rate of HBV DNA were higher in LC than in CH groups (P=0.055 and P=0.003, respectively). There were three types of TGF-beta1 gene polymorphism at codon 10: proline homozygous (P/P), proline/leucine heterozygous (P/L), and leucine homozygous (L/L) genotype. In CH group, the proportions of P/P, P/L, and L/L genotype were 32%, 51%, and 17%, respectively. In LC group, the proportions of those genotypes were 20%, 47%, and 33%, respectively. The L/L genotype was presented more frequently in LC than in CH groups (P=0.017). Multivariate logistic regression analysis confirms that detectable HBV DNA (odds ratio [OR]: 3.037, 95% confidence interval [CI]: 1.504-6.133, P=0.002) and L/L genotype (OR: 3.408, 95% CI: 1.279-9.085, P=0.014) are risk factors for cirrhosis.

A Comparison of Patient Acceptance and Preferences Between CT Colonography and Conventional Colonoscopy in Colorectal Cancer Screening

BACKGROUND/AIMS: Colorectal cancer, one of the most common cancers in developed countries, is curable when diagnosed at an early stage. However, for better screening, both a test that patients will tolerate and diagnostic accuracy are required. We compared patient experiences and preferences between computed tomographic (CT) colonography and conventional colonoscopy (CC) under conscious sedation. METHODS: Patients referred to the gastrointestinal clinic for CC were enrolled to also undergo CT colonography prior to CC. After each procedure, patients completed a questionnaire in which variables, such as abdominal pain, abdominal discomfort, and loss of dignity, were assessed using a 7-point Likert scale, with the highest score representing the worst experience. To verify response stability, a telephone questionnaire followed within 24 h after each procedure. Patients were then asked about their preference for CT colonography or CC. RESULTS: Data were collected from 51 patients who fulfilled all requirements, including CT colonography, CC, the two questionnaires after each procedure, and a follow-up questionnaire. Severity of abdominal pain, abdominal discomfort, and a loss of dignity were reported to be higher in CT colonography than in CC (p<0.01). In addition, the preference for CC was significantly higher than that for CT colonography (p<0.01). CONCLUSIONS: Although CT colonography is a safe and noninvasive screening test for colorectal cancer, further study is required to increase patient acceptance.

Usefulness of liver stiffness measurement for predicting the presence of esophageal varices in patients with liver cirrhosis / 대한간학회지

BACKGROUND/AIMS: Bleeding from esophageal varices (EV) is a major cause of death in patients with liver cirrhosis. Endoscopic screening is recommended for diagnosing EV, but various noninvasive parameters can also be used to predict EV. The liver stiffness measurement (LSM), a noninvasive technique for estimating liver fibrosis, was recently reported to be strongly correlated with the hepatic venous pressure gradient. This study evaluated the usefulness of LSM for predicting the presence and size of EV in patients with cirrhosis. METHODS: The relationships of LSM with the presence and size of EV were analyzed in 112 patients with liver cirrhosis. Liver cirrhosis was diagnosed histologically or clinically. The presence and size of EV were assessed by endoscopy, and LSM was determined by the Fibroscan(R) technique. RESULTS: LSM was strongly correlated with the presence of EV (P<0.0001): the LSM value was 42.7+/-21.9 kPa (mean+/-standard deviation) in patients with EV (n=82) and 19.1+/-12.6 kPa in patients without EV (n=30). The area under the receiver operating characteristic curve was 0.818 (95% CI, 0.732-0.904) for predicting the presence of EV, and an LSM value of 19.7 kPa was predictive of the presence of EV with a sensitivity of 87%, a specificity of 70%, a PPV of 89%, and a NPV of 66%. However, there was a weak correlation between LSM and the size of EV. CONCLUSIONS: LSM is useful for predicting the presence of EV in patients with cirrhosis but not their size.

The significance of anti-HBc and occult hepatitis B virus infection in the occurrence of hepatocellular carcinoma in patients with HBsAg and anti-HCV negative alcoholic cirrhosis / 대한간학회지

BACKGROUND/AIMS: Alcohol and the hepatitis B virus (HBV) exert synergistic effects in hepatocelluar carcinogenesis. We aimed to elucidate the clinical significance of the antibody to hepatitis B core antigen (anti-HBc) and occult HBV infection on the development of hepatocellular carcinoma (HCC) in patients with alcoholic liver cirrhosis (LC). METHODS: Patients with alcoholic LC alone (n=193) or combined with HCC (n=36), who did not have HBsAg or antibody to hepatitis C virus were enrolled. Clinical data and laboratory data including anti-HBc were investigated at enrollment. The polymerase chain reaction was applied to HBV DNA using sera of patients with HCC or LC after age and sex matching. RESULTS: Patients with HCC were older (60+/-11 years vs. 53+/-10 years, mean+/-SD, P<0.001), more likely to be male (100% vs. 89%, P=0.03), and had a higher positive rate of anti-HBc (91.2% vs. 77.3%, P=0.067), and a higher alcohol intake (739+/-448 kg vs. 603+/-409 kg, P=0.076) than those with LC. Age was the only significant risk factor for HCC revealed by multiple logistic regression analysis (odds ratio, 1.056; P=0.003). The positive rate of anti-HBc and alcohol intake did not differ in age- and sex-matched subjects between the LC (n=32) and HCC (n=31) groups. However, the detection rate of serum HBV DNA was higher in the HCC group (48.4%) than in the LC group (0%, P<0.001). CONCLUSIONS: Anti-HBc positivity is not a risk factor for HCC. However, occult HBV infection may be a risk factor for HCC in patients with alcoholic LC.

Clinical Features of Acute Viral Hepatitis A Complicated with Acute Renal Failure / 대한간학회지

BACKGROUND: Most patients with acute viral hepatitis A (AVHA) spontaneously recover, but a few patients experience complications. This study was carried out to examine clinical features of AVHA complicated with acute renal failure (ARF). METHOD: Medical records of 404 patients with AVHA were reviewed. Clinical features of AVHA patients with ARF (group A) were compared with those of AVHA patients without ARF (group B). RESULT: ARF complication was present in 11 patients (3%). There were no differences between group A and B in sex ratio and age. Microscopic hematuria (7 cases), proteinuria (7 cases), metabolic acidosis (4 cases), oliguria (4 cases), pulmonary edema (3 cases) and hyperkalemia (2 cases) were found in group A. The prevalence of heavy alcohol drinking (64% vs 3%, p<0.001) and diabetes mellitus (18% vs 1%, p=0.01) was higher in group A than B. The peak value of ALT (median: 4,290 IU/L vs 1,266 IU/L, p=0.006) and total bilirubin (median: 10.8 mg/dL vs 6.0 mg/dL, p=0.001) was higher in group A than B. Duration of admission was longer in group A than B (median: 14 days vs 5 days, p<0.001). Four patients of group A recovered with renal replacement therapy, while 7 patients recovered with conservative treatment. CONCLUSIONS: The AVHA patients with ARF experienced more severe hepatitis than those without ARF, but they had a good prognosis with the proper treatment.

A Case Intestinal Mucormycosis Healing of Ulcer after Only Amphotericin B Treatment / 대한소화기내시경학회지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection and usually occur in immunocompromised patients. Rhinocerebral and pulmonary disease are the common forms but intestinal infection is an extremely rare form of the disease. Invasive intestinal mucormycosis is usually fatal, therefore, few cases reported survival after early diagnosis and surgical resection combined with antifungal treatment. Because of high mortality after surgery, the healing of ulcers caused by intestinal mucormycosis has not previously observed in immunocompromised host. We reported a case of the intestinal mucormycosis that had been healed the ulcer and symptomatic improvement after only amphotericin B.

A Case of Synchronous Double Primary Cancer with Esophageal Small Cell Carcinoma and Lung Squamous Cell Carcinoma / 대한소화기내시경학회지

Double primary cancer means that more than two cancers with different origin exist independently in an individual. The diagnosis of double primary cancer was determined by following criteria. Each of the tumors must present a definite picture of malignancy, each must be distance, and the probability of one being a metastasis of the other must be excluded. Primary small cell carcinoma in the esophagus is relatively rare, and rarer when it is combined with other malignant disease. A review of the Korean medical literature failed to reveal any previously described the case of syn-chronous double primary cancer of primary esophageal small cell carcinoma and squamous cell carcinoma of lung. Recently, we have experienced a case of double primary cancer, a 65-year-old man with primary esophageal small cell carcinoma and squamous cell carcinoma of lung, which were diagnosed by endoscopic biopsy and bronchoscopic biopsy.

Two Cases of Microscopic Polyangiitis with Honeycomb Lung / 결핵

Microscopic polyangiitis is a systemic small-vessel vasculitis that is associated primarily with necrotizing glomerulonephritis and pulmonary capillaritis. A recurrent and diffuse alveolar hemorrhage due to pulmonary capi llaritis is the main clinical manifestation of lung involvement. Recently, an interstitial lung disease that mimics idiopathic pulmonary fibrosis was reported to be rarely associated with microscopic polyangiitis. Here we report two patients with microscopic polyangiitis who showed a honeycomb lung at the time of the initial diagnosis with a brief review of relevant literature.