Effects of Red Liriope platyphylla on NGF secretion ability, NGF receptor signaling pathway and gamma-secretase components in NSE/hAPPsw transgenic mice expressing Alzheimer's Disease / 한국실험동물학회지

Liriope platyphylla (LP) has long been regarded as a curative herb for the treatment of diabetes, asthma, and neurodegenerative disorders. To examine the therapeutic effects of Red LP (RLP) manufactured by steaming process on neurodegenerative disorders, significant alteration of the key factors influencing Alzheimer's Disease (AD) was detected in NSE/hAPPsw transgenic (Tg) mice after RLP treatment. The concentration of nerve growth factor (NGF) in serum increased in RLP-treated NSE/hAPPsw Tg mice compared with vehicle-treated Tg mice. However, downstream effectors of the NGF receptor signaling pathway, including TrkA and p75NTR proteins, were suppressed in RLP-treated NSE/hAPPsw Tg mice. Especially, Tg mice showed decreased levels of TrkA, p75NTR, and RhoA expression. Production of Abeta-42 peptides was lower in RLP-treated NSE/hAPPsw Tg mice than in vehicle-treated Tg mice. Further, analysis of gamma-secretase components showed that Abeta-42 peptide expression was downregulated. Of the four components, the expression of APH-1 and Nicastrin (NCT) decreased in RLP-treated NSE/hAPPsw Tg mice, whereas expression of PS-2 and Pen-2 was maintained or increased within the same group. Overall, these results suggest that RLP can help relieve neurodegenerative diseases, especially AD, through upregulation of NGF secretion ability, activation of NGF signaling pathway, downregulation of Abeta-42 peptide deposition, and alteration of gamma-secretase components.

The Prevalence of Barrett's Esophagus and the Comparison of Barrett's Esophagus with Cardiac Intestinal Metaplasia in the Health Screening at a Secondary Care Hospital / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.

Effects of Steaming Time and Frequency for Manufactured Red Liriope platyphylla on the Insulin Secretion Ability and Insulin Receptor Signaling Pathway / 한국실험동물학회지

In oriental medicine, Liriope platyphylla (LP) has long been regarded as a curative herb useful for the treatment of diabetes, asthma, and neurodegenerative disorders. The principal objective of this study was to assess the effects of steaming time and frequency for manufactured Red LP (RLP) on insulin secretion ability and insulin receptor signaling pathway. To achieve our goal, several types of LPs manufactured under different conditions were applied to INS cells and streptozotocin (STZ)-induced diabetic ICR mice, after which alterations in insulin concentrations were detected in the culture supernatants and sera. The optimal concentration for the investigation of insulin secretion ability was found to be 50 ug/mL of LP. At this concentration, maximum insulin secretion was observed in the INS cells treated with LP extract steamed for 3 h (3-SLP) with two repeated steps (3 h steaming and 24 h air-dried) carried out 9 times (9-SALP); no significant changes in viability were detected in any of the treated cells. Additionally, the expression and phosphorylation levels of most components in the insulin receptor signaling pathway were increased significantly in the majority of cells treated with steaming-processed LP as compared to the cells treated with LP prepared without steaming. With regard to glucose transporter (GLUT) expression, alterations of steaming time induced similar responses on the expression levels of GLUT-2 and GLUT-3. However, differences in steaming frequency were also shown to induce dose-dependent responses in the expression level of GLUT-2 only; no significant differences in GLUT-3 expression were detected under these conditions. Furthermore, these responses observed in vitro were similarly detected in STZ-induced diabetic mice. 24-SLP and 9-SALP treatment applied for 14 days induced the down-regulation of glucose concentration and upregulation of insulin concentration. Therefore, these results indicated that the steaming processed LP may contribute to the relief of diabetes symptoms and should be regarded as an excellent candidate for a diabetes treatment.

Usefulness of Endoscopic Ultrasonography for Diagnosing Choledocholithiasis in Patients with Gallbladder Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: CBD stones (CBDS) are generally thought to originate from the gallbladder. Recently, EUS appears to be the best imaging method for making the diagnosis of CBDS. We conducted this study to evaluate the role of EUS for detecting CBDS in patients with gallbladder stones (GBS) and to determine the parameters for predicting CBDS. METHODS: From April 2003 to March 2005, 117 GBS patients were enrolled. The patients' clinical and laboratory findings and the radiologic findings of US, EUS, CT and ERCP were reviewed. The sensitivity, specificity, PPV and NPV of EUS for detecting CBDS were evaluated by using ERCP and intraoperative CBD exploration as the gold standard for diagnosing CB. RESULTS: A total 117 patients received EUS and no complications were encountered. After performing ERCP and/or intraoperative exploration, 62 of the patients were examined for determining the presence or absence of CBDS. EUS shows 95% sensitivity and 95% specificity for identifying CBDS. The overall agreement between EUS and ERCP was 94.8%. The patients with CBDS were older than those without CBDS. Fever, jaundice and cholangitis were more prevalent in the patients with CBDS. The results of liver function tests were elevated more frequently in the patients with CBDS (p<0.05). CONCLUSIONS: EUS is an accurate and minimally invasive method for diagnosing CBDS. Evaluating CBD in patients with gallstones is selectively recommended according to clinical and laboratory findings.

Conscious Sedation with Midazolam Combined with Propofol for Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: There is increasing interest in the use of propofol as a sedative agent for colonoscopy. We evaluated the safety and efficacy of the synergistic sedation with midazolam combined with low-dose propofol versus that of midazolam alone. METHODS: A total of 56 patients from among those who underwent total colonoscopy between August 2004 and October 2004 were randomly assigned to one of three medication treatment groups. Group A (n=18) received low-dose midazolam (0.03 mg/kg IV) plus propofol, group B (n=19) received high-dose midazolam (0.07 mg/kg IV) plus propofol, and group C (n=19) received high-dose midazolam alone. The patients' vital signs were monitored throughout the course of the study. The recovery time and quality as well as the patients' comfort level were also assessed. RESULTS: There were no significant differences in baseline characteristics among the treatment groups. There were also no differences in the duration and insertion time of the colonoscopy among the three groups. The patients' comfort level and cardiorespiratory parameters during colonoscopy were similar among the three groups. The sedation efficacy and recovery times were also similar among the three groups. CONCLUSIONS: Midazolam combined with low-dose propofol as a sedative for colonoscopy exhibits similar effects on safety, patient' comfort level and recovery time to those of midazolam alone.

A Case of Double Pylorus Accompanied by Duodenal Ulcer / 대한소화기내시경학회지

Double pylorus is a rare abnormality of the gastrointestinal tract and it presents as two openings between the gastric antrum and the duodenal bulb. The acquired type is more common than the congenital one and this acquired type arises secondary to peptic ulcer disease. A 68-year-old man visited the gastrointestinal clinic and he presented with chronic epigastric pain and dyspepsia. Upper endoscopy showed double pylorus with an accessory channel on the lesser curvature side of the prepyloric antrum and also an active duodenal ulcer. Upon review of the patient's past history and examination, the findings of the upper endoscopy that was done 7 years previously were within the normal limits. The patient was diagnosed as having a double pylorus secondary to duodenal ulcer and he treated conservatively with anti-ulcer therapy. We report here on a case of double pylorus along with the brief review of the literature.

A Case of Double Pylorus Accompanied by Duodenal Ulcer / 대한소화기내시경학회지

Double pylorus is a rare abnormality of the gastrointestinal tract and it presents as two openings between the gastric antrum and the duodenal bulb. The acquired type is more common than the congenital one and this acquired type arises secondary to peptic ulcer disease. A 68-year-old man visited the gastrointestinal clinic and he presented with chronic epigastric pain and dyspepsia. Upper endoscopy showed double pylorus with an accessory channel on the lesser curvature side of the prepyloric antrum and also an active duodenal ulcer. Upon review of the patient's past history and examination, the findings of the upper endoscopy that was done 7 years previously were within the normal limits. The patient was diagnosed as having a double pylorus secondary to duodenal ulcer and he treated conservatively with anti-ulcer therapy. We report here on a case of double pylorus along with the brief review of the literature.

Comparison of CTP, MELD, and MELD-Na Scores for Predicting Short Term Mortality in Patients with Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: MELD-Na (model for end-stage liver disease with incorporation of serum sodium) was suggested to provide better survival prediction than MELD alone for patients with end stage liver disease. However, there is no data verifying the usefulness of MELD-Na for predicting short term mortality of cirrhotic patients in Korea. This study was aimed to determine whether MELD-Na would be more accurate in predicting short term mortality than other scoring systems such as Child-Turcotte-Pugh (CTP) or MELD. METHODS: Data from 355 patients admitted due to liver cirrhosis were retrospectively reviewed. The cumulative survival rates were obtained. Prediction of mortality rate for three months and one year were analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: One hundred patients (28%) died during the study period. All of the three systems showed significant differences in the cumulative survival rate according to the scores on admission (p0.05), and the AUC of each score system for death within one year were 0.792, 0.800, and 0.831, respectively (p>0.05). The AUC of MELD-Na in predicting short term death were the highest, although it was not statistically significant. Multivariate analysis showed that only MELD-Na was significantly related to three-month mortality (p=0.012). CONCLUSIONS: MELD-Na is more appropriate in predicting short term mortality, but larger scale studies are needed to confirm the superiority of MELD-Na to MELD and CTP in patients with liver cirrhosis.

Clinical Features of Pseudoaneurysms Complicating Pancreatitis: Single Center Experience and Review of Korean Literature / 대한소화기학회지

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.

A Case of Peripheral Ischemic Complication after Terlipressin Therapy / 대한소화기학회지

Hepatorenal syndrome is a severe complication of cirrhosis, leading to death in more than 90% of cases in the absence of liver transplantation. Several treatments have been attempted as a bridge to liver transplantation. Among such treatments, terlipressin is a nonselective V1 vasopressin agonist. When comparing with ornipressin, it is known to have a similar vasoconstricting potency, but much less ischemic complication. We report a case of gangrene on toes and necrosis on the infusion site of left hand which developed after the use of terlipressin due to hepatorenal syndrome in a 41-year-old-man with liver cirrhosis. Ischemic complication of terlipressin is rare and there has been no case report in Korea. Although it is rare, we must pay attention to the peripheral ischemic complication of terlipressin.

A case of adenocarcinoma, signet ring cell type, in 2nd portion of duodenum associated with neurofibromatosis type I / 대한내과학회지

The neurofibromatoses are a rare group of hereditary diseases of autosomal dominant fashion with the overall incidence of one in 3,000~4,000 and with two distinct forms, type I (Von Recklinghausen's neurofibromatosis) characterized by skin lesions including multiple cutaneous neurofibromas, axillary and groin freckling, and cafe-au-lait spots and type II by the presence of bilateral vestibular schwannomas. The neurofibromatosis type I is associated with the mutation of NF-I gene on chromosome 17q 11.2, which has a tumor suppressive role and with resultant development of the wide variety of tumors with the malignant incidence of about 2~16 %. Although the cases of malignant tumors in the neurofibromatosis type I have been reported in various tumors with the neural origin, lymphoma, pheochromocytoma and some cases of gastrointestinal tumors, the gastrointestinal tumors were found in only hepatobiliary system and large and small bowels and the cases of the malignant tumors of upper GI origin in duodenum and stomach have not been reported yet in Korea. We report a case of a 64-year-old man admitted with epigastric pain and diagnosed to adenocarcinoma, signet ring cell type, in 2nd portion of duodenum associated with neurofibromatosis type I.

Clinical Efficacy of Cervicovaginal Fetal Fibronectin in Induction of Labor / 대한산부인과학회잡지

OBJECTIVE: To determine whether the presence of fetal fibronectin in the cervicovaginal secretion could be used as a clinical marker to predict the outcome of labor induction. METHODS: The study group comprised 58 term pregnant women with intact amnionic membranes, 44 without labor and 14 with irregular labor. All patients had been admitted for induction of labor during Sept. 1, 1999 to Dec. 31, 1999 at the Department of Obstetrics and Gynecology of Yeungnam University Hospital. Fetal fibronectin was assayed with the cervicovaginal secretion. We analyzed the variables of labor outcome by the presence (positove) or absence (negative) of fetal fibronectin and the modified Bishop score. RESULTS: Cervicovaginal fetal fibronectin was detected in 75.0% (33/44) of the women without labor and 85.7% (12/14) with irregular labor, and 76.3% (29/38) with Bishop score 4 or less and 80.0% (16/20) with score 5 or above. There was no statistical differences in the positive rate of fetal fibronectin between the women without labor and those with irregular labor, and the women with Bishop score 4 or less and those with Bishop score 5 or above, respectively. The mean oral PGE2 tablets used for cervical ripening, the mean time interval from the beginning of labor induction to delivery, and the mean cesarean delivery rate were 1.97+/-2.56 tabs and 3.12+/-2.42, 10.12+/- 6.56 hours and 13.88+/-6.14, and 20.0% and 38.4%, in the women with positive fetal fibronectin and those with negative respectively, and 1.83+/-2.50 and 2.42+/-2.60, 10.11+/-7.17 hours and 11.28+/-6.26 hours, and 10.0% and 31.6% in the women with Bishop score 5 or above and those with Bishop score 4 or less, respectively. There were no statistical differences in the mean values between the women with positive and negative fetal fibronectin, and between Bishop score 5 or above and Bishop score 4 or less, respectively. There were no statistical differences in the mean oral PGE2 tablets used for cervical ripening (2.00+/- 2.65 vs. 4.40+/-1.82) and the mean time interval from the beginning of labor induction to delivery (10.11+/- 7.53 vs. 16.17+/-5.38), between the women with positive fetal fibronectin and Bishop score 5 or above and those with negative fetal fibronectin and Bishop score 4 or less, respectively. However, the cesarean delivery rate was significantly lower in the women with positive fetal fibronectin and Bishop score 5 or above than those with negative fetal fibronectin and Bishop score 4 or less (6.3% vs 44.4%, p=0.040). CONCLUSION: The assesment of cervicovaginal fetal fibronectin and Bishop score could be useful in predicting the success or failure of labor induction. But it was not helpful to predict the easiness of labor induction by the presence or absence of fetal fibronectin in the cervicovaginal secretion and/or modified Bishop score.

A Nocardial infection in a patient with systemic lupus erythematosus / 대한내과학회지

Nocardiosis is a rare opportunistic infection and only sporadic cases were reported in systemic lupus erythematosus (SLE). We report a case of a nocardial infection in a patient with SLE. A 37-year-old woman was admitted to our hospital because of general weakness and edema. She had been diagnosed as SLE in 1995 and was diagnosed as lupus nephritis (class IV, diffuse proliferative glomerulonephritis) in 1999, but had refused the treatment for SLE. After admission, she was diagnosed as active SLE with lupus nephritis based on clinical and laboratory findings. She was treated with methylprednisolone pulse (1 gx3 days) and cyclophosphamide pulse (750 mg) therapy followed by daily high dose oral prednisone (60 mg) and plasmapheresis (7 times). On 32 days after admission, chest radiograph revealed a massive pleural effusion. The pleural fluid was exudate and cultures for bacteria, fungi and tubercle bacilli were negative and pleural biopsy showed mesothelial thickening. The thoracentesis was done (1 L), but the effusion recurred within 3 days. Further four thoracentesis and thoracostomy were performed due to recurrent massive pleural effusion. On 60 days after admission, thoracostomy tube was removed, but 4 days later, fever occurred and Nocardia asteroides was cultured in pleural fluid. Treatment with oral trimethoprim/sulfamethoxazole (TMP-SMX, 160~800 mg) was started. After treatment with TMP-SMX, the pleural effusion decreased. On 76 days after admision, she was discharged and maintained on TMP-SMX (80~400 mg) for another 12 months. At present, her SLE activity is on control and has no pleural effusion.

Usefulness of Circumsporozoite Protein Genotype-Specific PCR (Polymerase Chain Reaction)-Hybridization Assay for Diagnosis of Vivax Malaria / 감염

BACKGROUND: Molecularornucleicacid-based method has been developed for diagnosis as well as epidemiological studies of malaria infection recent years. We developed and evaluated a polymerase chain reaction (PCR)-hybridization assay for its usefulness in diagnosis and genotyping of vivax malaria resurged in South Korea. METHODS: Blood samples were collected from 30 patients diagnosed as vivax malaria and 48 patients with other diseases. The circumsporozoite protein (CSP) gene fragment of Plasmodium vivax was amplified by PCR and hybridized with genotype (VK210 or VK247)-specific oligonucleotide probes. The performance of the assay was evaluated and compared with that by a commercially available immunochromatographic test (ICT; AMRAD, Australia). RESULTS: Twenty-five out of thirty P. vivax-positive blood samples were positive for the PCR-hybridization assay. All products amplified were hybridized only with the VK210-specific probe and showed size polymorphism with approximately 900~ and 865 bp, suggesting of genetic variations of CSP gene. Based on the results of Giemsa-stained blood smear, comparative analysis of test performance demonstrated that sensitivities of the PCR-hybridization assay and ICT were 83.3% and 73.3%, respectively and no false positive results were found. The ktest ratio of two tests yielded results of 0.91 with excellent correlation. CONCLUSOIN: The study suggested that vivax malaria resurged in South Korea has the VK210 genotype of CSP with presence of genetic variants, and that the PCR-hybridization assay is useful for diagnosis as well as genotyping of vivax malaria.

Effect of Pyrimethamine on DNA Synthesis of Germ Cells in Mice Testis / 대한비뇨기과학회지

Pyrimethamine(PYR) produces reversible infertility in mice. The antifertility effect of PYR is due to its antifolate action. PYR causes male infertility in Balb C mice in a dose dependent manner. The present study was performed to determine DNA synthesis of germ cell in mice treated with PYR. For 6-8 weeks adult Balb C mice were administered a PYR dose of 100mg- 200mg/ kg/day suspended in vegetable oil.10 control mice received only vegetable oil without PYR. After 7 weeks administration 28.6% of mice(4/14) administered a PYR dosage of 100mg/kg were infertility, whereas all of those(4/4), 200mg/kg/day were infertile. Morphologic changes of the testis induced by orally administered PYR were spermatogenic arrest and depopulation of germ cell. The incorporation of thymidine into DNA of germ cells was studied by using autoradiography after intraperitoneal injection of 15 Ci of methyl-3H-thymidine. Synthesis of DNA takes place in interphase and early prophase of mitotic phase of germ cell. The synthesis of DNA in spermatogonia reduced in all stage of spermatogenesis in mice treated with PYR due to spermatogenic arrest, compared with that of control mice. These results suggest that reduced synthesis of DNA in spermatogonia by PYR administration caused hypospermatogenesis. PYR represents further approach toward development of male contraceptive.

A Case of Primary Carcinoid Tumor of the Rete Testis / 대한비뇨기과학회지

Testicular carcinoid tumor is uncommon and most of these tumors occur in fourth decade' of life. A 33-year-old man presented with intrascrotal painless mass, which was initially misdiagnosed as epididymal tumor. Epididymectomy including the mass was performed and pathologic examination revealed a carcinoid tumor confined to the rete testis. There was no evidence of carcinoid syndrome. The 24 hour urinary 5-HIAA level was normal. Abdominal CT scan and GI contrast study showed no evidence of carcinoid in other organ including the gut. Radical orchiectomy and hemiscrotectomy were undergone as a curative therapy. He has been well for 40 months without recurrence.

Torsion of the appendix testis: 3 cases / 대한비뇨기과학회지

Torsion of the appendix testis ranks second in causes of acute scrotal swelling in children Prompt surgical exploration in children with torsion of the appendix testis is necessary if scrotal swelling obscures diagnosis or induces persistent scrotal pain. Exploration of both testes at the first operation adds little trouble to the operation and eliminates the possibility of Further torsion.