Proteomic analysis of pancreas in miniature pigs according to developmental stages using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time of flight mass spectrometry / 한국실험동물학회지

Organ transplantation is limited by the shortage of human organs. Many studies have sought to overcome this hurdle by using animal organs. Porcine organs, especially from miniature pigs, have been used for organ xenotransplantation rather than nonhuman primates. While the molecular profiling for transplantation is well known in humans and rodents, the situation for pigs is almost completely unknown. The present study examined protein regulation of the developing stages of the pancreatic proteome (4 day-old miniature neonate, 19 day-old miniature piglet, and 14 month-old miniature adult pigs) using two-dimensional gel electrophoresis and matrix assisted laser desorption/ionization-time of flight mass spectrometry. Thirteen different expressed spots were observed and nine were identified. The data presented within this study provides critical direction relating to the development of pancreas of miniature pigs, which will assist future proteome analysis of the pancreas, and advance our understanding of the hurdles facing xenotransplantation.

Proteomic analysis of liver in miniature pigs according to developmental stages using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time of flight mass spectrometry / 한국실험동물학회지

Due to the shortage of human organ donors for transplant, various studies of xenotransplantation, or the use of animal organs instead of human organs, have been carried out. The organs of porcine are thought to be safer and of a more suitable size for xenotransplantationthan those of nonhuman primates. Understanding the levels of expression of proteins, and their post-translational regulation, would be very practical between different species and among developing stages, though the molecular profiling for xenotransplantation has been rarely studied for porcine, while that of human and rodent is well known. Here, in this present study, we report protein regulation of the developing stages of liver (4-day old neonate, 19-day old piglet and 14-month old adult miniature pigs) using 2-DE and MALDI-TOF. From images of the three different stages, a total of 8 spotswhich were differently regulated were identified, and 5 spots were identified with MALDI-TOF MS. The data presented within this study provides critical direction relating to the development of livers of miniature pigs, which will assist future proteome analysis of the liver, and advance our understanding of the hurdles facing xenotransplantaion.

The Role of Macrophages in Transplant Rejection / 대한이식학회지

Macrophage accumulation has been recognized as a feature of allograft rejection, however, the role of macrophages in rejection remains underappreciated. Macrophages are present within graft tissues throughout the lifespan of the graft, including acute rejection episodes. Recent advances in macrophage biology have demonstrated that different types of macrophages in grafts serve a range of functions, including promotion or attenuation of inflammation, participation in innate and adaptive immune responses, and mediation of tissue injury, fibrosis, and tissue repair. Macrophages contribute to both the innate and acquired arms of the alloimmune response, and, thus, may be involved in all aspects of acute and chronic allograft rejection. Macrophages are also involved in hyperacute and acute vascular rejection of xenografts. A deeper understanding of how macrophages accumulate within grafts and of the factors that control differentiation and function of these cells could lead to identification of novel therapeutic targets in transplantation.

The Prevalence and Clinical Characteristics of Reflux Esophagitis in Koreans and Its Possible Relation to Metabolic Syndrome

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44+/-10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m2 (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol > or =160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride > or =150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose > or =110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusiosn, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.

Sigmoid Diverticular Bleeding Detected by Capsule Endoscopy / 대한소화기내시경학회지

Colonic diverticulosis is small outpouching from the lumen of the colon, and this caused by mucosal herniation. Most patients are asymptomatic, but 5~15% of those affected manifest diverticular bleeding. Because most of them stop bleeding spontaneously, the source of the bleeding can not be found by colonoscopy in 15% of these cases. We report here on a case of sigmoid diverticular bleeding that detected by capsule endoscopy in a 68-year old woman who presented with acute obscure gastrointestinal bleeding.

Emerging Need for Vaccination against Hepatitis A Virus in Patients with Chronic Liver Disease in Korea

Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.

A Case of Lower Gastrointestinal Bleeding with Ileal Ulceration in Scrub Typhus / 대한소화기내시경학회지

Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi-induced vasculitis, is common in Korea, Asia and Pacific Islands. Endoscopic mucosal lesions or mucosal damages have rarely been reported in Scrub typhus. However, four cases of upper gastrointestinal bleeding, controlled by hemoclipping, in Tsutsugamushi-infected patients have been reported in Korea; although, no case of lower gastrointestinal bleeding in Scrub typhus has been reported. We experienced massive hematochezia in a 77-year-old female patient with Scrub typhus. Special studies, including upper gastroduodenoscopy, colonoscopy, abdominal CT scan, and SMA angiography were performed, but the focus of the bleeding could not be found. An RBC scan showed suspicious small bowel bleeding, but a capsule endoscopy could not reveal the focus of the bleeding focus; however, a colonoscopy showed active bleeding at the terminal ileum, with multiple ileal ulcerations. After conservative therapy, the patient's condition was stable and the hematochezia disappeared.

A Case of Duodenal Obstruction Induced by the Short-term Use of a Nonsteroidal Anti-inflammatory Drug / 대한소화기내시경학회지

Giant duodenal ulcer can be defined as a variant of peptic ulceration that exceeds 2 cm at the greatest diameter. The high mortality and morbidity of giant duodenal ulcer are directly related to the resultant perforation, obstruction and massive hemorrhage. The patient usually has a long history of an inadequately treated or neglected peptic ulcer, but this malady is rarely induced by nonsteroidal anti-inflammatory drugs (NSAIDs). A 60-year-old man was referred to us due to epigastric pain. He underwent appendectomy 1 week ago, and he was administered ketorolac (tarasyn(R)) for 5 days to control the postoperative pain. Esophagogastroduodenos copy (EGD) revealed a giant duodenal ulcer encircling the lumen from the pylorus to the postbulbar portion of the duodenum, and he was then treated with proton pump inhibitor. Two weeks later, the follow-up EGD showed complete duodenal obstruction at the bulb. He was treated by laparoscopic gastrojejunostomy. We report here on this case of duodenal obstruction that was induced by the short-term use of NSAIDs.

Clinical Features of Ischemic Colitis: A Comparision with Colonoscopic Findings / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the relationships between the clinical manifestations and the colonoscopic findings of ischemic colitis. METHODS: From March 2000 to June 2005, the data of 69 patients diagnosed with ischemic colitis were analyzed retrospectively. Statistical analysis was done by dividing the patients into two groups according to involved segments and also by again dividing the patients into two groups according to the mucosal findings that were gangrenous or not. RESULTS: The most common involved segment was the sigmoid colon (82.6%). The levels of total protein and albumin were significantly lower in the multisegmented group than in the non-multisegmented group (p=0.012, p=0.030, respectively), but there was no significant difference in the operation rate between the two groups. The WBC count and the level of serum glucose were significantly higher in the gangrenous group than in the non-gangrenous group (p=0.007, p=0.048, respectively). The operation rate was also higher in the gangrenous group (33.3%) than in the non-gangrenous group (3.5%) (p=0.011). CONCLUSIONS: Evaluating the severity of mucosal damage by colonoscopy may be helpful in predicting the clinical status and prognosis of the patients with ischemic colitis.

Clinical characteristics and predisposing factors for complication of caustic injury of the upper digestive tract / 대한내과학회지

BACKGROUND: Accidental or suicidal ingestion of caustic agents is not uncommon. The caustic injury of upper digestive tract can lead to severe stenotic sequelae. We attempt to investigate clinical characteristics, endoscopic findings and predisposing factors of development of complications of caustic injury. METHODS: The medical records of 77 patients admitted to our department for caustic ingestion from March, 1993 to June, 2004 were reviewed. All patients underwent initial endoscopic examinations and caustic lesions were graded according to Zargar's classification (Grade 0~III). RESULTS: Strictures of the esophagus and the stomach occurred in 12 patients (15.6%) and 3 patients (3.9%), respectively. The development of esophageal or gastric stricture was more frequent when the grade of caustic injury of the esophagus or the stomach was more severe. Hemorrhage from exposed vessels of the injured esophagus and stomach was seen in one patient and so was jejunal hemorrhage. Two patients (2.6%) died of multiple-organ failure. All cases of hemorrhage and death resulted from grade III lesions of the esophagus, stomach and duodenum. The type or amount of the caustic agent, duration between ingestion and endoscopic examination, and initial treatment with steroid and/or antibiotics did not correlate with the development of stricture. CONCLUSIONS: Caustic injury of the esophagus and the stomach was significantly associated with esophageal stricture. Early endoscopic examination was very useful for predicting the development of complications and prognosis after caustic injury.

A Case of Polypoid Arteriovenous Malformation Treated by Polypectomy with Detachable Snare / 대한소화기내시경학회지

Arteriovenous malformations are degenerative lesions of the gastrointestinal tract that occur with a frequency that increases with increasing age. Although the bleeding caused by arteriovenous malformations is typically chronic, slow, intermittent and recurrent, 15% of patients with arteriovenous malformations present with massive bleeding. Any part of the gastrointestinal tract can be involved and arteriovenous malformations usually appear on endoscopy as either flat or elevated discrete bright red mucosal lesions. There are a few cases of colonic arteriovenous venous malformations with a polypoid appearance with some of their endoscopic treatments resulting in profuse bleeding from the remnant stalk. We encountered a case of a polypoid arteriovenous malformation in the colon of a 69-year-old patient with active gastrointestinal bleeding. The patient was treated successfully by an endoscopic polypectomy with a detachable snare.

A Case of Bleeding Meckel's Diverticulm Diagnosed by Wireless Capsule Endoscopy / 대한소화기내시경학회지

Meckel's diverticulum is a remnant of the vitelline duct located in the distal ileum, and it is the most common cause of small bowel bleeding in patients who are under the age of 25 years. The ectopic gastric mucosa in Meckel's diverticulum causes ulceration and acute gastrointestinal bleeding. Capsule endoscopy is now a valuable tool for diagnosing obscure gastrointestinal bleeding. However, the identification of a Meckel's diverticulum by wireless capsule endoscopy has rarely been reported on. An 18-year-old man was admitted for recurrent melena and anemia. He underwent a small bowel series that showed a jejunal diverticulum, and capsule endoscopy then revealed a jejunal diverticulum with multiple ulcerations. After 2 months, he had fresh hematochezia and so he underwent small bowel segemental resection that included the jejunal diverticulum. The operation revealed Meckels' diverticulum at 180 cm distant from the ileocecal valve at the mesenteric side. We report here on a case of bleeding Meckel's diverticulum that was diagnosed by wireless capsule endoscopy, and we include a review of the relevant literature.

A Case of Cap Polyposis Treated by Conservative Management / 대한소화기내시경학회지

Cap polyposis is a rare intestinal disease that is characterized by the presence of inflammatory polyps consisting of elongated, tortuous and distended crypts that are covered by a 'cap' of granulation tissue. The pathogenesis and proper treatment of cap polyposis are still unclear. We experienced a case of cap polyposis, that was treated successfully by conservative management without the need for a pharmacotherapy or resection.

A Case of Bleeding Meckel's Diverticulm Diagnosed by Wireless Capsule Endoscopy / 대한소화기내시경학회지

Meckel's diverticulum is a remnant of the vitelline duct located in the distal ileum, and it is the most common cause of small bowel bleeding in patients who are under the age of 25 years. The ectopic gastric mucosa in Meckel's diverticulum causes ulceration and acute gastrointestinal bleeding. Capsule endoscopy is now a valuable tool for diagnosing obscure gastrointestinal bleeding. However, the identification of a Meckel's diverticulum by wireless capsule endoscopy has rarely been reported on. An 18-year-old man was admitted for recurrent melena and anemia. He underwent a small bowel series that showed a jejunal diverticulum, and capsule endoscopy then revealed a jejunal diverticulum with multiple ulcerations. After 2 months, he had fresh hematochezia and so he underwent small bowel segemental resection that included the jejunal diverticulum. The operation revealed Meckels' diverticulum at 180 cm distant from the ileocecal valve at the mesenteric side. We report here on a case of bleeding Meckel's diverticulum that was diagnosed by wireless capsule endoscopy, and we include a review of the relevant literature.

A Case of Cap Polyposis Treated by Conservative Management / 대한소화기내시경학회지

Cap polyposis is a rare intestinal disease that is characterized by the presence of inflammatory polyps consisting of elongated, tortuous and distended crypts that are covered by a 'cap' of granulation tissue. The pathogenesis and proper treatment of cap polyposis are still unclear. We experienced a case of cap polyposis, that was treated successfully by conservative management without the need for a pharmacotherapy or resection.

A Case of Crohn's Disease Confined to the Appendix / 대한소화기내시경학회지

Crohn's disease is a condition of chronic inflammation involving potentially any location in alimentary tract, but it is worldwide the rare when primary lesion with its extent is confined to the appendix alone. Because clinical manifestations of the Crohn's disease of the appendix dose not differ from those of acute appendicitis, it is difficult to diagnose preoperatively or intraoperatively, so it is usually diagnosed by postoperative pathologic examination. Because Crohn's disease confined to the appendix has favorable prognosis than typical Crohn's disease, it is considered a separate disease entity from Crohn's disease, and a new diagnostic term-"idiopathic granulomatous appendicitis"-has gained wide acceptance in recent years. We experienced a case of Crohn's disease confined to the appendix or idiopathic granulomatous appendicitis and review, we reported the care with review of the literatures.

A Case of Cardiac Metastasis to Left Atrium from Large Cell Carcinoma of the Lung

Metastatic tumors to the heart are far more frequent than primary tumors of the heart. Cardiac metastasis may be detected up to 30 percent of patients with fatal lung cancers. Metastatic cancer to the heart is difficult to suspect. Where cardiac metastasis is diagnosed ante-mortem, signs and symptoms of the primary cancer are usually the presenting features and the presence of cardiac involvement is often incidentally detected. We experienced a case of 35-year-old woman with metastatic lung cancer invading the left atrium via pulmonary vein, which was not proved pathologically. She presented with hemoptysis and chest pain. Transthoracic echocardiography demonstrated massive cardiac infiltration with tumor and decreased cardiac wall motion, correlating with the chest CT findings, which were also remarkable for the presence of intracardiac mass and direct invasion to adherent pericardium, pulmonary vein and left atrium. We suggest that careful examination of 2D echocardiography can be noninvasive and valuable tool for diagnosis of metastatic cancer to the heart.