The Feasibility and Safety of the Endoscopic Submucosal Dissection of Superficial Gastric Neoplastic Lesions in Patients with Compensated Liver Cirrhosis: A Retrospective Study

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

Duodenal Carcinoid Tumor Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Duodenal carcinoid tumors are rare, and they represent only 2.0~8.9% of all gastrointestinal carcinoid tumors in the western countries. Duodenal carcinoid tumors have previously been treated by surgical resection. The recently recommended treatment for a carcinoid tumor smaller than 1 cm in diameter is endoscopic resection. We experienced a case of a duodenal carcinoid tumor in a 56 year-old man who presented with upper abdominal pain. On the endoscopic examination, a 6 mm sized polypoid lesion with a central depression was noticed on the duodenal bulb. The biopsy confirmed the diagnosis of carcinoid tumor. The endoscopic ultrasound probe showed a hypoechoic tumor that was confined to the submocosal layer. The tumor was completely resected by an endoscopic mucosal resection technique and using a transparent cap.

A case of superior mesenteric artery thrombosis associated with antiphospholipid syndrome / 대한내과학회지

Antiphospholipid syndrome (APS) has received considerable attention due to its association with a thrombophilic disorder. Thrombotic events associated with this syndrome most often involve the venous system and occasionally the arterial system such as the cerebral, coronary, renal, and retinal arteries. Few reports on mesenteric artery thrombosis associated with APS are documented. We report a case of a 45 year old male diagnosed with superior mesenteric artery thrombosis associated with APS. The patient had symptoms of chronic mesenteric ischemia including postprandial abdominal pain, weight loss and diarrhea, and was positive for lupus anticoagulant antibody. An abdominal CT showed superior mesenteric arterial thrombosis and luminal narrowing. Symptoms were improved after anticoagulant therapy.

Improved Imaging of the Cervico-Thoracic Junction in Computed Tomography

PURPOSE: To reduce beam hardening artifacts caused by the shoulder joint, we explored new and unique methods to improve the quality of images, such as varying the injection site and changing the position of patients (swimmers position). MATERIALS AND METHODS: Fifth-four patients underwent neck CT examinations performed in routine and swimmers position and with a 64-slice MDCT scanner in spiral scanning. To examine the difference due to the injection sites of contrast material, subjects were divided into right- and left-side groups. For the evaluation of images, we carried out a subjective and objective assessment based on radiologists' ratings and noise measurement. RESULTS: Images of the lower neck in the swimmers position exhibited less hardening and streak artifacts. The subjective and objective evaluations showed that the swimmers position received higher rating by radiologists and had lower noise level than that of routine position. The swimmers position was the most effective for the diagnosis of the cervico-thoracic junction area. As for the injection site, we obtained better images by an injection of contrast material in the right arm than in the left. CONCLUSION: CT examination of the lower neck in the swimmers position may improve the quality of image and the effectiveness of diagnosis. The injection of a contrast material to the right side rather than the left side reduced foreign body artifacts.

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).

A case of valproic acid-induced hyperammonemic encephalopathy with normal liver function / 대한내과학회지

Valproic acid is an effective anticonvulsant used in neurology and psychiatry. Valproic acid-induced hyperammonemic encephalopathy is an unusual complication characterized by a decreasing level of consciousness, the development of progressive confusional states and, sometimes, a coexisting increase in the frequency of seizures after the onset of valproic acid treatment. It can lead to death, but can be reversed if a swift diagnosis is made. We report the case of a 58-year-old woman with an intracerebral hemorrhage and normal liver function who presented with valproic acid-induced hyperammonemic encephalopathy. After valproic acid treatment, she developed encephalopathy and became comatose, with seizures and a markedly elevated serum ammonia level. Her neurologic manifestations and hyperammonemia improved after discontinuing the valproic acid.

Suppressed Production of Pro-inflammatory Cytokines by LPS-Activated Macrophages after Treatment with Toxoplasma gondii Lysate

During Toxoplasma gondii infection, macrophages, dendritic cells, and neutrophils are important sources of pro-inflammatory cytokines from the host. To counteract the pro-inflammatory activities, T. gondii is known to have several mechanisms inducing down-regulation of the host immunity. In the present study, we analyzed the production of proand anti-inflammatory cytokines from a human myelomonocytic cell line, THP-1 cells, in response to treatment with T. gondii lysate or lipopolysaccharide (LPS). Treatment of THP-1 cells with LPS induced production of IL-12, TNF-alpha, IL-8, and IL-10. Co-treatment of THP-1 cells with T. gondii lysate inhibited the LPS-induced IL-12, IL-8 and TNF-alpha expression, but increased the level of IL-10 synergistically. IL-12 and IL-10 production was down-regulated by anti-human toll-like receptor (TLR)-2 and TLR4 antibodies. T. gondii lysate triggered nuclear factor (NF)-kappaB-dependent IL-8 expression in HEK293 cells transfected with TLR2. It is suggested that immunosuppression induced by T. gondii lysate treatment might occur via TLR2-mediated NF-kappaB activation.

Involvement of MAPK activation in chemokine or COX-2 productions by Toxoplasma gondii

This experiment focused on MAPK activation in host cell invasion and replication of T. gondii, as well as the expression of CC chemokines, MCP-1 and MIP-1 alpha , and enzyme, COX-2/prostaglandin E2 (PGE2) in infected cells via western blot, [3H]-uracil incorporation assay, ELISA and RT-PCR. The phosphorylation of ERK1/2 and p38 in infected HeLa cells was detected at 1 hr and/or 6 hr postinfection (PI). Tachyzoite proliferation was reduced by p38 or JNK MAPK inhibitors. MCP-1 secretion was enhanced in infected peritoneal macrophages at 6 hr PI. MIP-1 alpha mRNA was increased in macrophages at 18 hr PI. MCP-1 and MIP-1 alpha were reduced after treatment with inhibitors of ERK1/2 and JNK MAPKs. COX-2 mRNA gradually increased in infected RAW 264.7 cells and the secretion of COX-2 peaked at 6 hr PI. The inhibitor of JNK suppressed COX-2 expression. PGE2 from infected RAW 264.7 cells was increased and synthesis was suppressed by PD98059, SB203580, and SP600125. In this study, the activation of p38, JNK and/or ERK1/2 MAPKs occurred during the invasion and proliferation of T. gondii tachyzoites in HeLa cells. Also, increased secretion and expression of MCP-1, MIP-1 alpha , COX-2 and PGE2 were detected in infected macrophages, and appeared to occur via MAPK signaling pathways.

A cephalometric study of cleft lip and palate patients with a class III malocclusion

The general characteristics and states of family of chemical-abusers in an adolescent jail

BACKGROUND: The drug abuse has become one of social problems especially in the adolescents. It has been well known that the drug abuse is concerned with interaction of biopsychosocial factors and farnily relation factors. So I have studied the general characteristics and rearing attitude and family state of the adolesents who were in a jail because of drug abuse and have intended to give some help for establishing effective strategies for family education and therapy. METHODS: The study was done for adolescents who were in a jail because of violation the illegal drug control law. The group was total 55 men and the age distribution was frorn 15 to 20 years. The Questionnaire was used in Mar 1996 for study and I analyzed 53 cases excluding 2 cases because they were nearly illiterate. The FACES III(Family Adaptability and Cohesion Evaluation Scales), family APGAR score and PBI(Parental Bonding Instrument) were used for evaluating the characteristics of family function and the parental rearing attitude. Statistical management with SAS was executed for data analysis. RESULTS: The average age of the group was 6.9+/-1.4. 48.1% of them lived in the metropolitan area, 40.4% lived in the middle-sized cities and 11.5% lived in the small country towns. The education level of 91.8% was under middle-school graduate. They have use drugs since the age of 14.6+/-1.8, they began to use glue sniffing at the first time in 78.8% and butane gas inhalation in 17.3%. The state of family showed the death of father in 28.9% and the death of mother in 13.5 % and 76.9% of deaths occured before they have become 13 years. Their parents divorced in 25 %. The mean APGAR score was 4.56+/-2.6, which means moderately dysfunctional state of family. In FACES III adaptability score was 20.3+/-5.7 and cohesion score was 26.2+/-6.9. According to the family type by FACES III, there were 5 cases(9.4%) in balanced, 19 cases(35.9%) in midrange, and 29 cases(54.7%) in extreme. In PBI mother overprotection score was 16.24+/-4.59, mother care score was 22.5+6.8, father overprotection score was 16.71+/-5.1 father care was 21.94+/-6.24. CONCLUSIONS: The drug abused adolescents in a jail were in hadicapped family because of deaths and divorce of parents. Their family function score was low and more than half of them had the extreme type of family. Therefore it is wise for us to have a concern for the family problem when understanding and managing drug abused adolescents.