Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

PRF001 is a fragmented DNA polymer extracted from the testes of salmon. The purpose of this study was to assess the anti-inflammatory effect of PRF001 in vitro as well as the protective effect of PRF001 intake against arthritis in a rat model. In vitro, cell survival and inflammatory markers after H₂O₂ treatment to induce cell damage were investigated in CHON-001 cells treated with different concentrations of PRF001. In vivo, osteoarthritis was induced by intra-articular injection of monosodium iodoacetate (MIA) into the knee joints of rats. After consumption of PRF001 (10, 50, or 100 mg/kg) for 4 weeks, inflammatory mediators and cytokines in articular cartilage were investigated. In vitro, the levels of inflammatory markers, IL-1β, TNF-α, COX-2, iNOS, and PGE2, were significantly suppressed by PRF001 treatment. In vivo, the inflammatory mediators and cytokines, IL-1β, p-Erk1/2, NF-κB, TNF-α, COX-2, and PGE2, as well as MMP3 and MMP7, which have catabolic activity in chondrocytes, were decreased in the MIA-induced osteoarthritic rats following intake of PRF001. Histological analysis revealed that PRF001 had a protective effect on the articular cartilage. Altogether, these results demonstrated that the anti-inflammatory property of PRF001 contributes to its protective effects in osteoarthritis through deregulating IL-1β, TNF-α, and subsequent signals, such as p-Erk1/2, NF-κB, COX-2, PGE2, and MMPs.

Corrigendum to: Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

The authors note that on pages 167 (Fig. 2A), 168 (Fig. 3A), and 169 (Fig. 4A), the figure label “RPF-001” should instead appear as “PRF-001.”

Synchronous multicentric small hepatocellular carcinomas: defining the capsule on high-frequency intraoperative ultrasonography with pathologic correlation

PURPOSE: The aim of this study was to define the capsules of synchronous multicentric small hepatocellular carcinomas (HCCs) with use of high-frequency intraoperative ultrasonography (IOUS). METHODS: Among the 131 consecutive patients undergoing hepatic resection and high-frequency IOUS for HCC, 16 synchronous multicentric small HCCs in 13 patients were histologically diagnosed in the resected specimens. High-frequency IOUS and pathologic findings of these lesions were compared, with particular focus on the presence and appearance of the capsule in or around each lesion. RESULTS: Synchronous multicentric small HCCs were pathologically classified into distinctly nodular (n=12) or vaguely nodular (n=4) types. All 12 distinctly nodular HCCs including six subcentimeter lesions showed detectable capsules on high-frequency IOUS and pathology. The capsules appeared as a hypoechoic rim containing hyperechoic foci (n=6), hypoechoic rim (n=5), or hyperechoic rim (n=1) with varying degrees of coverage around each lesion. Histologically, the capsules were composed of a combination of one to four layers consisting of a fibrous capsule, peritumoral fibrosis, prominent small vessels, and entrapped hepatic parenchyma. CONCLUSION: Synchronous multicentric small HCCs with distinctly nodular type, even at subcentimeter size, can show capsules with varying coverage and diverse echogenicity on high-frequency IOUS.

Incidental gallbladder cancer after routine cholecystectomy: when should we suspect it preoperatively and what are predictors of patient survival?

PURPOSE: In about 1% of cases, incidental gallbladder cancers (iGBC) are found after routine cholecystectomy. The aim of this study is to compare clinical features of iGBC with benign GB disease and to evaluate factors affecting recurrence and survival. METHODS: Between January 1998 and March 2014, 4,629 patients received cholecystectomy and 73 iGBC patients (1.6%) were identified. We compared clinical features of 4,556 benign GB disease patients with 73 iGBC patients, and evaluated operative outcomes and prognostic factors in 56 eligible patients. RESULTS: The iGBC patients were older and concomitant diseases such as hypertension and anemia were more common than benign ones. And an age of more than 65 years was the only risk factor of iGBC. Adverse prognostic factors affecting patients' survival were age over 65, advanced histology, lymph node metastasis, and lymphovascular invasion on multivariate analysis. Age over 65 years, lymph node involvement, and lymphovascular invasion were identified as unfavorable factors affecting survival in subgroup analysis of extended cholecystectomy with bile duct resection (EC with BDR, n = 22). CONCLUSION: Prior to routine cholecystectomy, incidental GB cancer should be suspected especially in elderly patients. And advanced age, lymph node metastasis, and lymphovascular invasion are important prognostic factors in EC with BDR cohorts.

Living-donor Sequential ABO-incompatible Kidney Transplantation after Liver Transplantation in a Patient with Alcoholic Liver Cirrhosis and End-stage Renal Disease / 대한이식학회지

A 47-year-old man developed chronic alcoholic liver cirrhosis and end-stage renal disease. He underwent blood-type-compatible liver transplantation with a graft from his daughter. After 8 months, sequential ABO-incompatible (ABOi) kidney transplantation was performed, with his brother as the donor (A to O). The patient had anti-A antibody titers (1:256). We performed pretransplant desensitization, including administration of rituximab, mycophenolate mofetil, tacrolimus, and prednisolone 2 weeks before the scheduled transplantation, and plasmaphresis (PP) and administered an intravenous immunoglobulin injection. The patient underwent PP before kidney transplantation until the anti-A antibody titer was <1:8. The patient achieved normal renal function within 4 posttransplantation days. Postoperative bleeding (diffuse hemorrhage) requiring additional blood transfusions and radiological intervention (drainage procedure) occurred 9 days after transplantation. The patient was discharged on day 20 of hospitalization. Nine months after the kidney transplantation, the recipient's and donor's liver and kidney functions were normal. ABOi renal transplantation after liver transplantation can be successfully performed in patients with high baseline anti-ABO antibody titers after preconditioning with rituximab and PP, and quadruple immunosuppressive therapy. However, caution is required regarding an increased risk of bleeding complications.

A case of Zollinger-Ellison syndrome with MEN-1 / 대한내과학회지

Zollinger-Ellison syndrome (ZES) is a clinical syndrome caused by excessive gastric acid secretion by gastrinoma, characteristically causing peptic disease and/or gastroesophageal reflux disease. Approximately one third of patients with gastrinoma have multiple endocrine neoplasia type 1 (MEN-1). A 56-year-old man was admitted for abdominal pain and diarrhea lasting for 2 weeks. The endoscopic findings revealed severe reflux esophagitis and multiple ulcers at the bulb and second portion of the duodenum. He was diagnosed as ZES based on typical clinical features such as markedly elevated fasting gastrin level (> or =1,263 pg/mL) and findings from a CT scan and somatostatin receptor scan. Pathologic findings after the operation revealed malignant gastrinoma. He was confirmed to have parathyroid adenoma and MEN-1. Despite antisecretory therapy with proton pump inhibitors, an esophageal stricture developed, and we performed esophageal balloon dilatation and stent insertion.

A Patient with Mixed Squamous Cell and Papillary Thyroid Carcinoma

Mixed squamous cell carcinoma and papillary carcinoma in the thyroid gland is a very rare malignant tumor. Primary squamous cell carcinoma of the thyroid may develop from squamous metaplasia of the follicular epithelium in a variety of pathologic conditions, such as other differentiated carcinomas of the thyroid. A 70-year-old man presented with a palpable mass on the right side of the thyroid gland. The patient underwent a right lobectomy without neck lymph node dissection. Histopathological findings revealed primary squamous carcinoma mixed papillary thyroid carcinoma. He underwent a completion thyroidectomy and radioactive iodine therapy. Adjuvant radiotherapy and chemotherapy were not performed.

Intramural and Intraluminal Hematoma of the Small Bowel as the Lead Point of Intussusception in an Adult Patient with Warfarinization

We report a case in which an intramural and intraluminal hematoma of the jejunum served as the lead point of intussusception in a 77-year-old man with warfarinization. The patient presented with cramping abdominal pain and vomiting. Palpation of the abdomen revealed periumbilical tenderness. Abdominal computed tomography revealed a circular mass with a concentric ring, consistent with an intussuscepted jejunum. Because of warfarinization, which was due to atrial fibrillation and lacunar infarction, the patient's prothrombin time was prolonged. Laparotomy revealed reducible jejuno-jejunal intussusception, and we performed a segmental resection of the intussuscepted jejunum. We identified an intramural and intraluminal jejunal hematoma as the lead point. Upon histopathological examination, angiodysplasia of the intussuscepted jejunum was found to be the bleeding focus. No similar case was found in the literature.

Laparoscopic versus Open Primary Repair for Perforated Peptic Ulcer / 대한내시경복강경외과학회지

PURPOSE: Simple closure, regardless of using an omental patch, continues to be the preferred option for many surgeons. It is a easy, quick and safe operation, and it can be applied to all situations by every surgeon. The purpose of this study was to investigate the feasibility of routinely using laparoscopic repair for treating perforated peptic ulcer. METHODS: A retrospective review was carried out on 68 consecutive patients who underwent patch repair for a perforated peptic ulcer; 11 underwent laparoscopic repair and 57 underwent open repair. Laparoscopic repair was performed by one surgeon at the same hospital between March, 2006 and February, 2009. Both groups were compared according to the Mann-Whitney U-test. A p value <0.05 was considered to be significant. RESULTS: Statistical significance (p<0.05) between two groups (laparoscopic vs. open) was present regarding to the postoperative morbidity (0 vs. 16 cases, respectively), the hospital stay (4.8 vs. 12.7 days, respectively), the postoperative day of resuming an oral diet (3 vs. 5.7 days, respectively). The mean operative time of laparoscopic repair (78 minutes) was shorter than that of open repair (82 minutes) but this was not statistically significant (p=0.81). We excluded using a pain scale or assessing the use of analgesics in this study because of the popularity of IV PCA (intravenous patient-controlled analgesia). CONCLUSION: Laparoscopic primary repair is a safe emergency procedure for treating perforated peptic ulcer patients.

Clinical Analysis for the Postoperative Complications of Pancreaticoduodenectomy in the Recent 5 Years

PURPOSE: Pancreaticoduodenectomy (PD) is known to have high morbidity and mortality rates among the various abdominal operations, but there have been few reported current series of pancreaticoduodenectomy from large volume medical centers. The purpose of this study is to analyze the postoperative complications of PD and to assess the risk factors for postoperative morbidity. METHODS: A total of 398 cases of PD were performed by two surgeons from January 2003 to December 2007 at our institution and we retrospectively reviewed the medical records of these cases. RESULTS: 186 (46.7%) of 398 patients underwent pylorus preserving pancreaticoduodenectomy (PPPD) and 212 patients (53.3%) underwent a classic Whipple procedure. The most common indication for this procedure was pancreatic cancer (151 cases, 37.9%) and the second most common was intraductal papillary mucinous tumor (78 cases, 19.6%). The mean age was 57.2 years, ranging from 12 to 81. The mean postoperative hospital stay was 24.7 days. The most common complication was delayed gastric emptying (11.8%) and next was pancreatic fistula (10.3%), bleeding (6.5%) and new onset diabetes mellitus (DM) (4%). Four patients (1%) died of hospital mortality. The patients' age, gender, DM history, hypertension history and serum bilirubin level had no significant influences on the postoperative morbidity rate. CONCLUSIONS: Pancreaticoduodenectomy can be performed safely with an acceptable complication rate and minimal mortality if the surgeon has sufficient surgical experiences and with the advance in anesthesia and postoperative care.

Low-grade Mucinous Cystic Tumor Associated with Endo-metriosis in the Cecum

We report here on an unusual case of mucinous cystic tumor that was associated with endometriosis in the cecum. A 45-year-old woman was admitted to the hospital due to her 5 day history of right lower quadrant abdominal pain with a mild fever. A laparotomy was performed under the clinical impression of the tubo-ovarian abscess. A relatively well defined a multi-locular cystic mass (8.0x8.0x7.0 cm) filled with white-to-yellow thick mucoid material was found in the wall of the cecum. The right ovary and fallopian tube showed marked fibrous adhesion to the external surface of the cecal mass. A right hemicolectomy and salpingo-oophorectomy were performed. Histologically, the tumor was similar to those of ovarian borderline mucinous tumor, the intestinal type, and the mucinous epithelium of the tumor was merged with the endometriotic epithelium and stroma. On immunostaining, the CK20 positive mucinous epithelium was well demarcated from the CK7 endometriotic epithelium. This is the first case of low-grade mucinous cystic tumor intimately associated with intestinal endometriosis in the cecum.

Inguino-Femoral Hernia in Women

PURPOSE: Inguino-femoral hernias in women are less common than that in a man, and we have had limited experience for hernia repair in women. The purpose of this study was to evaluate the characteristics of inguino-femoral hernias in females and to establish the choice of specific treatment for inguino-femoral hernia in females. METHODS: This retrospective study was based on the medical records of 566 patients who underwent 657 cases of herniorrhaphies for treating inguino-femoral hernia in adult females from January 1998 to June 2006. We evaluated the incidence of hernia, the operative technique and the length of the operation, the complications and the postoperative recurrence rate. The operative findings and median time to reoperation for a recurrent hernia were also evaluated. RESULTS: During the 8.5-year period, we performed 2,931 herniorrhaphies in 2,274 patients. Of these, 657 herniorrhaphies were done in females (22.4%). The types of hernia in females were indirect inguinal hernia (67.3%), direct inguinal hernia (10.2%), the pantaloon type (10%) and femoral hernia (14.9%). Femoral hernia was more frequent in females (14.9%) compared to males (3.5%) (P<0.001). The overall rate of reoperation due to incarceration in the females was higher (2.5%) than that in the men (1.1%)(P<0.001). Femoral hernias in females was found at reoperation in 39.7% compared with 17.2% in the males (P<0.001). CONCLUSION: The incidence of inguino-femoral hernia in females was higher than the results of most published studies and the reoperation rate was higher in females. The increased frequency of femoral hernia at reoperation in females suggests avoiding injuries to the posterior wall of the inguinal canal and the need for exploration of the femoral canal at the time of the primary operation.

Cervical Bronchogenic Cyst

Head and neck surgeons see many congenital cysts of the neck. Most of these cysts are thyroglossal duct cysts and branchial cleft cysts. Bronchogenic cysts are rare congenital malformations of the ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions. Cervical bronchogenic cysts are unusual. Only 70 cases of bronchogenic cysts in the head and neck regions have been reported on and the majority of cases have been found in the pediatric population. We describe here a 61-year-old female who presented a palpable left neck mass. The preoperative diagnostic studies included chest X-ray and sonography-guided fine needle aspiration. The neck sonography showed the mass, but it could not rule out a pathologic lymph node. Aspirated material contained no cellular content. The mass was excised. The neck mass of the patient was diagnosed as a bronchogenic cyst. We suggest that the clinical observation of a lateral neck mass in an adult includes the possibility of a bronchogenic cyst in the differential diagnosis.

Composite Neuroendocrine Carcinoma with Adenocarcinoma of the Stomach Mimicking Double Primary Cancer

A 67-year-old man presented with a 3-month history for intermittent epigastric pain and postprandial discomfort. Upper gastrointestinal endoscopy and contrast-enhanced axial computed tomographic scan demonstrated two separate tumors of the gastric antrum and the duodenal second portion, suggestive of the preoperative diagnosis of a double primary cancer. Pancreaticoduodenectomy with lymph node dissection was performed, and the microscopic features and immunohistochemical profiles of the resected specimen confirmed the diagnosis of the composite neuroendocrine carcinoma with adenocarcinoma of the stomach (mixed exocrine-endocrine carcinoma).

Delayed Perforation of the Gallbladder after Blunt Abdominal Trauma

Isolated injury of the gallbladder rarely occurs after blunt abdominal trauma and, if so, is usually associated with damage to other intra-abdominal organs clearly necessitating surgical intervention. Blunt abdominal trauma is often overlooked because there may be no visible signs on the abdominal wall. It is important to closely follow patients and look for early signs of organ damage, as isolated injury of the gallbladder often follows a vague and insidious clinical course. A combination of special investigations may be required to confirm the diagnosis of this relatively rare but serious injury. Our case was a 38-year-old female, admitted to the hospital with a history of blunt abdominal trauma secondary to a fall. Initial computed tomographic scan demonstrated an edematous gallbladder; a follow-up computed tomographic scan showed a 5-cm collection of fluid around the gallbladder, suspicious for gallbladder perforation. Diagnostic laparoscopy followed by laparoscopic cholecystectomy was performed without complications. The postoperative course was uneventful and the patient was discharged on postoperative day three.

Spontaneous Rupture of a Primary Splenic Cyst Causing Hemoperitoneum

A 14-yr-old male presented with a hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst. The laparotomy showed a ruptured spleen at the lower pole from one of the multiple cyst-like lesions, measuring approximately 2 cm in diameter. After the splenectomy, a microscopic examination confirmed the diagnosis of a primary splenic cyst lined with a mature, well-differentiated squamous epithelium. A hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst is a rare but potentially lethal complication, because most patients with a splenic rupture present with some degree of hypovolemia.

Computed Tomographic Findings of Anomalies of Intestinal Rotation in Adult Patients

Anomalies of the intestinal rotation mainly produce clinical manifestations in infants and children, but are uncommon in adults. We report three adult patients who presented with a surgical abdomen and the characteristic computed tomographic findings associated with anomalies of the intestinal rotation. Two patients presented with acute appendicitis, and one presented with an intestinal obstruction caused by colon cancer. In all patients, the computed tomographic findings were suggestive and were helpful for making a preoperative diagnosis of the anomalies of intestinal rotation: (1) a left-sided colon and/or (2) mesenteric vascular inversion. A computed tomographic scan is useful not only for providing an accurate diagnosis of a suspected surgical abdomen but also for detecting associated rotational anomalies, which may require a separate surgical correction.

Posterior Tibial Artery Aneurysm: A Case Report

Aneurysms of the infrapopliteal arteries are rare and they are commonly associated with trauma. We report here on a rare case of a true aneurysm of the posterior tibial artery in a sixty-year-old female. There was no history of trauma, and the serologic tests for the possibility of vasculitis were all negative. The color Doppler ultrasound examination and the multi-detector computed tomographic scan confirmed the diagnosis of a posterior tibial artery aneurysm and these tests revealed no evidence of aneurysms or occlusive lesions in the other arteries. Aneurysmectomy and end-to-end microvascular anastomosis were performed successfully. Preoperative multi- detector computed tomographic scanning is a valuable, noninvasive diagnostic tool to delineate not only the state of the aneurysm, but also that of the distal arterial tree.

Celiac Artery Aneurysm Associated with Chronic Pancreatitis: Case Report

Celiac artery aneurysms are extremely rare. Among the numerous conditions that can lead to a celiac artery aneurysm, acute or chronic pancreatitis has been described as one of the less common causes. A 54-year-old alcoholic man with a 7-year history of recurrent pancreatitis and iron deficiency anemia presented with a 15-day history of gastrointestinal bleeding. The contrast-enhanced axial CT scan and abdominal arteriography demonstrated that a 3-cm sized aneurysm had developed on the celiac artery and there were multiple calcified densities in the pancreas; these findings were suggestive of a diagnosis of celiac artery aneurysm with gastrointestinal bleeding that was caused by chronic pancreatitis. Aneurysmectomy without revascularization was performed successfully. We report here on a rare case of celiac artery aneurysm that was caused by chronic pancreatitis.

Primary Splenic Tuberculosis Presenting as a Large Solitary Mass

Tuberculosis may be difficult to diagnose when it presents in an uncommon extrapulmonary site. Although there has been a resurgence of abdominal tuberculosis in immunocompromised patients, which is largely due to the extensive use of immunosuppressive drugs and the increasing incidence of a human immunodeficiency virus infection, splenic tuberculosis is rare, particularly in the immunocompetent patients. Almost all cases of splenic tuberculosis present as multiple hypoechoic foci on sonography or multiple focal hypodense lesions on contrast enhanced computed tomographic scan. To our knowledge, splenic tuberculosis is an extremely rare condition. An 80-year-old man was found to have a large solitary splenic mass mimicking a splenic neoplasm on sonography and contrast enhanced computed tomographic scan. A diagnostic splenectomy revealed a large solitary mass in the spleen, which was consistent with splenic tuberculosis microscopically. We report a rare case of splenic tuberculosis in an elderly man presenting as a large solitary splenic mass on sonography and contrast enhanced computed tomographic scan.