Comparison between Wound Closure Methods in the Reversal of Diverting Ileostomy / 대한소화기학회지

Background/Aims@#The objective of this study was to determine the more appropriate wound-closure method by comparing the effectiveness of two methods in a group of patients who underwent ileostomy repair. @*Methods@#The study conducted after obtaining the approval of the Institutional Review Board (IRB) included 58 patients ≥19 years of age who underwent ileostomy at the Department of Surgery at the Presbyterian Medical Center. This was a retrospective, single-center trial. Patients who underwent ileostomy closure between January 2011 and September 2017 were assigned to the primary wound-closure (PC, n=25) group and the purse-string wound-closure (PSC, n=33) group. Post-repair complications, such as wound infection, delayed healing, and patient satisfaction related to wound management, were investigated and compared according to the wound-closure method. @*Results@#The PSC group had a significantly lower surgical site infection rate than the PC group (0% vs. 44%, p30 days was not significantly different (39% vs. 20%, p=0.114). In addition, there were no significant differences in the response to questionnaires on patient satisfaction between the two groups. @*Conclusions@#PSC has a lower surgical site infection rate and the wound-healing delay was not very different from that of PC. Therefore, if patients are at risk of wound infection, such as in severe wound contamination, long operating time, and immunocompromised conditions, we should consider PSC as a wound closure method of choice.

Clinical and microbiological factors associated with early patient mortality from methicillin-resistant Staphylococcus aureus bacteremia

BACKGROUND/AIMS: Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is a major bloodstream infection with a high mortality rate. Identification of factors associated with early mortality in MRSAB patients would be useful for predicting prognosis and developing new therapeutic options. METHODS: A prospective cohort of MRSAB patients was examined between August 2008 and June 2011. Early and late mortality was defined as death within 2 and 28 days of blood culture, respectively. The clinical and microbiological characteristics in the early and late mortality and survival groups were compared. Risk factors associated with severe sepsis or septic shock were also investigated. RESULTS: A total of 385 adult MRSAB patients whose S. aureus isolates were available were enrolled; of these patients, 25 patients (6.5%) and 50 (13%) died early and late, respectively. Compared with both the late-mortality group and the survival group, severe sepsis or septic shock was a statistically significant independent risk factor associated with early mortality. Rapidly or ultimately fatal McCabe and Jackson classification (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.25 to 3.02) and pneumonia (aOR, 2.04; 95% CI, 1.03 to 4.02) were independently associated with severe sepsis or septic shock. A vancomycin minimum inhibitory concentration (MIC) ≥ 1.5 μg/mL was associated with a reduced incidence of severe sepsis or septic shock (aOR, 0.53; 95% CI, 0.34 to 0.84). CONCLUSIONS: Severity of illness seems to be the most important risk factor associated with early mortality in MRSAB. Although vancomycin MIC was not independently associated with early mortality, reduced vancomycin susceptibility appears to be linked to reduced disease severity.

Rhabdomyolysis Following Colonoscopy: A Case Report

We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.

15-Hydroxyprostaglandin dehydrogenase as a marker in colon carcinogenesis: analysis of the prostaglandin pathway in human colonic tissue

BACKGROUND/AIMS: Cyclooxygenase-2 (COX-2), 15-hydroxyprostaglandin dehydrogenase (15-PGDH), and microsomal prostaglandin E synthase-1 (mPGEs-1) regulate prostaglandin E₂ (PGE₂) expression and are involved in colon carcinogenesis. We investigated the expression of PGE₂ and its regulating genes in sporadic human colon tumors and matched normal tissues. METHODS: Twenty colonic adenomas and 27 colonic adenocarcinomas were evaluated. COX-2 and 15-PGDH expression was quantified by real-time polymerase chain reaction. The expression of PGE₂ and mPGEs-1 was measured using enzyme-linked immunosorbent assay and Western blotting, respectively. RESULTS: The expression of COX-2, mPGEs-1, and PGE₂ did not differ between the adenomas and matched distant normal tissues. 15-PGDH expression was lower in adenomas than in the matched normal colonic tissues (P<0.001). In adenocarcinomas, mPGEs-1 and PGE₂ expression was significantly higher (P<0.001 and P=0.020, respectively), and COX-2 expression did not differ from that in normal tissues (P=0.207). 15-PGDH expression was significantly lower in the normal colonic mucosa from adenocarcinoma patients than in the normal mucosa from adenoma patients (P=0.018). CONCLUSIONS: Early inactivation of 15-PGDH, followed by activation of COX-2 and mPGEs-1, contributes to PGE₂ production, leading to colon carcinogenesis. 15-PGDH might be a novel candidate marker for early detection of field defects in colon carcinogenesis.

In Vitro Activity of Diphenyleneiodonium toward Multidrug-Resistant Helicobacter pylori Strains

BACKGROUND/AIMS: The increased resistance of Helicobacter pylori to antibiotics has increased the need to develop new treatments for this bacterium. The aim of our study was to identify new drugs with anti-H. pylori activity. METHODS: We screened a small molecule library—the library of pharmacologically active compounds (LOPAC), which includes 1,280 pharmacologically active compounds—to identify inhibitors of H. pylori growth. The minimal inhibitory concentrations (MICs) of antibiotics against multidrug-resistant H. pylori strains were determined using the agar dilution method. RESULTS: We identified diphenyleneiodonium (DPI) as a novel anti-H. pylori agent. The MIC values for DPI were <0.03 μg/mL against all tested H. pylori strains. DPI also exhibited strong antibacterial activity against common gram-negative and gram-positive pathogenic bacteria. CONCLUSIONS: DPI may be a candidate anti-H. pylori drug for future development.

Expression of MicroRNA in Host Cells Infected with Helicobacter pylori

BACKGROUND/AIMS: MicroRNAs (miRNAs) regulate gene expression. We assess miRNA regulation by Helicobacter pylori infection and elucidate their role in H. pylori-infected gastric epithelial cells. METHODS: The relationship between miRNA expression and DNA methylation was examined. Cells were treated with the nuclear factor-kappaB (NF-κB) inhibitor Bay 11-7082 to determine the relationship between miRNA expression and NF-κB signal transduction. RESULTS: In the negative control cells infected with H. pylori 26695, the expression of six miRNAs was increased, whereas the expression of five miRNAs was decreased. The expression of upregulated miRNAs was increased when the host cells were treated with H. pylori and an NF-κB inhibitor. miR-127-5p, -155, and -181 were associated with increased interleukin 6 (IL-6) secretion in H. pylori infected cells treated with anti-miRNA. The expression of miR-155, -127-5p, -195, -216, -206, and -488 increased by approximately 3-fold following treatment with the methylation inhibitor Aza. CONCLUSIONS: We found novel miR-NAs in H. pylori-infected negative control cells using miRNA microarrays. Upregulated miRNA expression was inversely related to the transcription of NF-κB. miR-195 and miR-488 appear to play a pivotal role in controlling IL-6 activity in H. pylori infection. miRNA expression in H. pylori infection was affected by methylation.

The Outcomes of Using Colistin for Treating Multidrug Resistant Acinetobacter Species Bloodstream Infections

Despite the identification of Acinetobacter baumannii isolates that demonstrate susceptibility to only colistin, this antimicrobial agent was not available in Korea until 2006. The present study examined the outcomes of patients with multidrug resistant (MDR) Acinetobacter species bloodstream infection and who were treated with or without colistin as part of their regimen. The colistin group was given colistin as part of therapy once colistin became available in 2006. The non-colistin group was derived from the patients who were treated with other antimicrobial regimens before 2006. Mortality within 30 days of the onset of bacteremia occurred for 11 of 31 patients in the colistin group and for 15 of 39 patients in the non-colistin group (35.5% vs 38.5%, respectively, P = 0.80). Renal dysfunction developed in 50.0% of the 20 evaluable patients in the colistin group, but in 28.6% of the 35 evaluable patients in the non-colistin group (P = 0.11). On multivariate analysis, only an Acute Physiological and Chronic Health Evaluation II score > or = 21 was associated with mortality at 30 days. This result suggests that administering colistin, although it is the sole microbiologically appropriate agent, does not influence the 30 day mortality of patients with a MDR Acinetobacter spp. bloodstream infection.

Ultrasound for Detecting Pleural Adhesion before Video-Assisted Thoracic Surgery / 대한흉부외과학회지

BACKGROUND: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. MATERIAL AND METHOD: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. RESULT: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. CONCLUSION: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.

Early Experience of Single Port Laparoscopic Cholecystectomy & Comparisons of Single Port and Three Port Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic cholecystectomy is a standard procedure for cholelithiasis. However, with the advance of minimal invasive surgery, much research has recently been performed into single port laparoscopic surgery (SPLS).1 The aim of this study is to evaluate single port laparoscopic cholecystectomy (SPLC) in comparison to the classical method (three port laparoscopic cholecystectomy, TPLC) through our initial experience. METHODS: This study was performed retrospectively by a review of medical charts and phone calls to patients. We checked for chronic calculous cholecystitis or cholesterol polyps in 56 patients who had undergone cholecystectomy between April 2009 and February 2010. We divided into two groups the patients who had undergone SPLC and TPLC. We then checked the sex, age, hospital day, operating time, mobilization time, pain scale, cosmetic satisfaction, surgical wound infection and BMI for each patient. RESULTS: Cosmetic satisfaction with SPLC was higher than with the classical method, but this was not significant. Hospital day and mobilization time of SPLC were shorter, but this was also not significant. There was no difference in patient age, hospital day, mobilization and BMI between SPLC and TPLC. The operating time and pain scale with TPLC were less than with SPLC. CONCLUSION: SPLC has the benefit of cosmetic satisfaction and relatively fewer complications. However, the operating time and pain scale of SPLC are higher than those of TPLC. Therefore, SPLC requires much concentration and effort from the surgeon to compensate for its deficiencies.

In vitro antimicrobial activity of cefditoren against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates / 대한내과학회지

BACKGROUND: The aim of this study was to determine the in vitro activity of cefditoren, an oral third-generation aminothiazolyl cephalosporin, against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates in a tertiary hospital. METHODS: We have studied the in vitro activities of cefditoren and other oral antibiotics against 120 S. pneumoniae isolates, including 80 penicillin non-susceptible isolates and 80 H. influenzae isolates from clinical specimens of patients at the Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. RESULTS: All S. pneumoniae strains tested were inhibited by 1 g/mL of cefditoren (MIC50/MIC90 0.25/1 microgram/mL; range 0.015~1 microgram/mL). The MICs were lower for penicillin-susceptible S. pneumoniae (MIC90 0.015 g/mL) as compared to penicillin-intermediate resistant (MIC90 0.5 g/mL) or penicillin- resistant strains (MIC90 1 microgram/mL). Cefditoren was active against all tested H. influenzae strains (MIC50/MIC90 0.015/0.03 microgram/mL; range <0.008~0.03 g/mL) and its activity was comparable to levofloxacin and cefixime. CONCLUSIONS: Cefditoren had an excellent activity against S. pneumoniae and H. influenzae irrespective of penicillin or ampicillin resistance, respectively. The results of this study suggest that cefditoren is a good choice of an antibiotic to use for empirical oral treatment of community-acquired respiratory tract infections.

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

The Expression of TGF-beta1 in Patients with Chronic Atrophic Gastritis / 대한소화기내시경학회지

BACKGROUND/AIMS: Mucosal atrophy is defined as the loss of appropriate glands in the gastric mucosa; such a finding suggests that this malady is associated with an excessive ratio of apoptotic cells to proliferating epithelial cells. However, exactly why the genesis and progression of the atrophic changes takes place in the gastric mucosa of some, but not all of the subjects infected with H. pylori, is seldom described. TGF-beta1 (transforming growth factor-beta1) is a potent growth inhibitor in epithelial tissues, and it also induces apoptosis of epithelial cells. We evaluated its role in the pathogenesis of atrophic gastritis by analyzing the expression of TGF-beta1. METHODS: The subjects were 14 patients with chronic atrophic gastritis and 43 patients with chronic gastritis. The exclusion criteria were as follows; those patients who had a previous history of gastrectomy, PPI, H. pylori eradication, NSAIDs, stomach cancer and/or a severe bleeding tendency. Biopsy specimens were obtained from the antrum, angle and body of the stomach, respectively and we performed RT-PCR for determining the expression of TGF-beta1 mRNA with using an additional angle specimen. RESULTS: The clinical parameters were similar in both groups. The rate of H. pylori infection was also similar in both groups. The TGF-beta1 levels were significantly higher for the chronic atrophic gastritis group than for the chronic gastritis group. CONCLUSIONS: The results that the TGF-beta1 levels are significantly higher in the chronic atrophic gastritis group suggest that TGF-beta1 is associated with the development of atrophic gastritis. The apoptotic process induced by TGF-beta1 may be linked to the development of atrophic gastritis.

In vitro Antimicrobial Activity of Cefcapene against Clinical Isolates / 감염과화학요법

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.

In vitro Antimicrobial Activity of Cefcapene against Clinical Isolates / 감염과화학요법

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.

The Close Relationship between Ciprofloxacin Resistance and Extended-Spectrum beta-Lactamase Production:Analysis of 154 Consecutive Nosocomially-Acquired Klebsiella pneumoniae Bacteremia / 감염과화학요법

BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

The Close Relationship between Ciprofloxacin Resistance and Extended-Spectrum beta-Lactamase Production:Analysis of 154 Consecutive Nosocomially-Acquired Klebsiella pneumoniae Bacteremia / 감염과화학요법

BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

Prophylactic Effect of Lactobacillus GG in Animal Colitis and Its Effect on Cytokine Secretion and Mucin Gene Expressions / 대한소화기학회지

BACKGROUND/AIMS: Lactobacillus rhamnosus GG (LGG) has been used in acute colitis treatment. However, it is unclear whether the LGG prevents chronic colitis. The aim of this study was to examine the prophylactic effect of LGG on animal colitis, cytokine secretion, and mucin gene expression. METHODS: BALB/c mice (n=64) were exposed to 5% dextran sulfate sodium (DSS) for 7 days followed by 10 days recovery period and repeatedly exposed for 4 days. Then, the mice were devided into three group; group of oral LGG adminstration throughout the recovery and repeated colitis period; PBS group of PBS administration; control group. Colon length, histologic score, tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10) levels, mucin gene expressions were determined at each period. RESULTS: In acute colitis period, the LGG group showed higher levels of disease activity index (DAI), histologic score, TNF-alpha, IL-10, but shorter colon length, lower levels of mucin gene expressions than the control group. However, in repeated colitis period, the LGG group showed markedly lower levels of DAI and IL-10 but significantly longer colon length than PBS group (p<0.05). There was no difference in the mucin gene expression. CONCLUSIONS: These results suggest that LGG prevents chronic murine colitis. It may be associated with cytokine modulation and competitive inhibition of pathogenic bacteria. However, it may not be related with gene expression.

Cytotoxicity and Apoptosis of Various Concentrations of Doxorubicin in Methylcholanthrene-induced Rat Fibrosarcoma(MCA) Cells / 대한흉부외과학회지

BACKGROUND: Although pulmonary resection is the standard approach for the management of pulmonary metastases from soft tissue sarcoma, most of them are unresectable and chemotherapy remains the only option. The effectiveness of the cytotoxic drugs may be limited by the toxicities that occur before the therapeutic dose is reached. The regional administration of doxorubicin using pulmonary arterial perfusion in a rodent model can produce 10 to 25 times higher concentrations in the lung than systemic administration with minimal systemic toxicities. However, it is unclear whether a high concentration of doxorubicin has beneficial effects for killing cancer cells. MATERIAL AND METHOD: We studied this to evaluate the dose-dependent cytotoxic and apoptotic effects of doxorubicin on methylcholanthrene-induced rat fibrosarcoma(MCA) cells. This study examined the cytotoxicity and apoptosis-related gene expressions(Fas, FasL, Bax, caspase 1, caspase 2, caspase 8, Bcl-2, Bcl-xL, Bcl-xS) in MCA cells after 24 hours exposure to various concentrations of doxorubicin such as 1, 5, 10, 50, and 100 micrometer. RESULT: Dose-dependent cytotoxicity was observed after 24 hours exposure to doxorubicin. However, peak apoptosis after 24 hours exposure was observed at 5 micrometer of doxorubicin. Above 5 micrometer, apoptotic activity was decreased with dose-increment. All mRNA levels of apoptosis-related genes after 24 hours exposure were up-regulated above the control level at 1 micrometer of doxorubicin and then decreased by doxorubicin dose-increment except caspase 8, which showed higher levels than the control level at 5 micrometer. Apoptosis-related protein levels were highest at 1 micrometer of doxorubicin and then decreased by doxorubicin dose-increment. However, Bax and Bcl-xL proteins steadily showed higher levels than the control throughout the different concentrations of doxorubicin. CONCLUSION: These results suggest that apoptosis is the main cytotoxic mechanism in low concentrations of doxorubicin in MCA cells and apoptosis-related genes, such as Bax, caspase 8, a can kill MCA cells, even when apoptosis is inhibited, and have its propriety for achieving much cytotoxicity against MCA cells.

Three Cases of Tracheal Stenosis after Using Airway Divices

Tracheal stenosis can be caused by various etiologies, such as infectious disease, trauma from previous prolonged incubation, airway surgery, or external blunt trauma, and neoplasm. Recently, the development of emergency and intensive care units leads to the primary cause of airway stenosis using airway devices. The stenotic lesions can be produced at any level between the vocal cord and the site of the tip of the tube. Laryngotracheal stenosis may be due to prolonged endotrachel intubation, especially with large tube, large tracheostomy stoma, too highly placed oacheostomy, erosion by local infection, the prying action of heavyweight equipment that connects the tracheostomy to the ventilator, excessive cuff pressure, or erosion by the tip of the tube. Prevention of tracheal stenosis is of key importance by understanding and attending to these causes. We experienced three cases of tracheal stenosis occurred after use of airway devices. In first and second cases, We performed end-to-end anastomosis artier resection of stenotic segment of the trachea in a 22-year-ol4 female and a 25-year-old male. They ha6 been treated with prolonged endotracheal incubation and emergency tracheostomy, respectively, for a ventilatory support for the respiratory failure after falling down from a height. The stenotic lesions occurred at the cuff site in the first case and at the stomal level in the second case. In third case, We performed one-stage laryngotracheoplastic procedure for subglottic stenosis in a 23-year-old male. He had been treated with emergence tracheostomy which had been placed too high for a ventilators support for the respiratory failure after traffic accident. The stenotic lesion occurred at the stomal level. The postoperative courses were uneventful.