Prevalence and associated factors of nonalcoholic fatty liver disease in the health screen examinees / 대한내과학회지

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a kind of most common hepatic disease having wide pathologic spectrum and has been increasingly recognized as an important disorder because it may progress to end stage of liver disease. In spite of several foreign reports about clinical aspects of NAFLD, there are not enough reports analyzing large group for long times in Korea. We have examined the prevalence and associatd factors for NAFLD in health screen examinees from January 1997 to June 2003. METHODS: The results of 29,781 health screen examinees were analyzed retrospectively. Prevalence of alcoholic and nonalcoholic fatty liver was computed and associating factors were analyzed statistically. RESULTS: Overall prevalence of NAFLD was 18.6% and higher in the groups of age over 50 years. NAFLD was more preponderant in male. Age, body mass index, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and abnormal serum low density lipoprotein, high density lipoprotein, ALT level were independently associated factors with presence of NAFLD in logistic regression analysis. CONCLUSIONS: The prevalence of NAFLD and tendency of associated factors were similar to Western world. To prevent development of this common hepatic disorder which may results in end stage liver disease, prevention and control of obesity, diabetes, hyperlipidemia must be important.

Factors Associated or Related to with Pathological Severity of Nonalcoholic Fatty Liver Disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been more and more often regarded as a serious disorder, because nonalcoholic steatohepatitis (NASH), a part of NAFLD, may progress to the end stage of liver disease. Though an advanced age, obesity, diabetes mellitus (DM) etc. being not infrequent conditions in Korea, are known to exacerbate the severity of this disease, there are only a few Korean reports on this subject. The purpose of this study is to identify possible factors that might add up to the pathological severity of this disorder in Korean patients. METHODS: Of 60 patients with steatosis found at liver biopsy, 43 NAFLD patients were reviewed retrospectively after exclusion of other liver diseases. RESULTS: The cases of steatosis were mild, moderate, and severe in 9, 10, and 24 patients, respectively. The degree of necroinflammatory activity was mild, moderate, and severe in 33, 9, and 1 patients, respectively. There were no established factors directly related to these classes. As to fibrosis, the cases were classified as none, mild, moderate, severe, and cirrhotic in 9, 11, 16, 7, and 0 patients, respectively. The stage of fibrosis correlated with the age (p< 0.001), BMI (body mass index) (p=0.032), and the platelet count (p=0.009), but the presence of NASH was associated only with BMI (p=0.002) and obesity (p=0.001). CONCLUSION: It seems that there are no factors that are directly related to the degree of steatosis or necroinflammatory activity. BMI seems to be a unique factor directly related to both the severity of fibrosis and the presence of NASH. The age and the platelet count are factors that are directly related to the degree of fibrosis but not to the presence of NASH.

Protective Effect of Melatonin on the Nephrotoxicity by Cisplatin / 대한신장학회잡지

BACKGROUND: Cisplatin (CP), an antitumor agent widely used in the treatment of cancers, has nephrotoxicity. This side effect is closely related to oxidative stress. In the present study, we attempted to reduce CP-induced nephrotoxicity in rats by administering melatonin, an antioxidant. METHODS: Male Sprague-Dawley rats were divided into different groups and were treated as follows: (1) saline control; (2) CP (16 mg/kg, i.p.); (3) CP plus melatonin (10 mg/kg, i.p.). The rats were sacrificed at the 6th day after CP treatment. To evaluate renal damage, BUN, serum creatinine, creatinine clearance and microscopic examination were done. Hydrogen peroxide which is one of the oxygen free radicals, and malondialdehyde which is known as a marker of the oxygen free radical mediated injury, and the activities of the antioxidant enzymes such as superoxied dismutase, catalase, and glutathione peroxidase were also measured. RESULTS: CP-treated rats showed the increase of BUN, serum creatinine, malondialdehyde, hydrogen peroxide and superoxide dismutase (SOD) in kidney. And CP-treated rats also showed the decrease of creatinine clearance and catalase levels. CP-treated rats showed severe tubular necrosis in proximal convoluted tubules under the light microscopic examination. The light microscopic finding and all of the parameters except SOD were restored in the rats injected with CP plus melatonin than those with CP alone. SOD level was higher in the rats injected with CP plus melatonin than that with CP alone. CONCIUSION: These results suggest that melatonin suppresses CP-induced nephrotoxicity by suppressing the production of reactive oxygen species via the activation of SOD and catalase.

A Case of Duodenal Fistula Caused by Intestinal Tuberculosis / 대한소화기내시경학회지

Intestinal hemorrhage, fistula formation, and intestinal obstruction are the common complications associated with intestinal tuberculosis. However, duodenal fistula due to intestinal tuberculosis is very rare. We experienced a case of 26-year-old woman with a fistula in the duodenum referred to our hospital due to abdominal pain. Esophagogastroduodenoscopy showed a fistula at the duodenum with lymph node. After 2 months of anti-tuberculous medication, abdominal pain was improved and fistula size decreased. We report a case of fistula caused by duodenal tuberculosis.

A Case of Primary Small Cell Carcinoma in the Common Bile Duct / 대한소화기학회지

Extrapulmonary primary small cell carcinoma comprises approximately 4% of all small cell carcinoma. In the common bile duct, small cell carcinomas are extremely rare. We experienced a 60-year-old woman with small cell carcinoma arising in the common bile duct. Abdominal CT scan revealed an intraluminal mass in the proximal common bile duct and multiple lymphadenopathies. Microscopic examination of the tumor revealed proliferation of small monotonous anaplastic cells, which were characterized with hyperchromatic nuclei, high nuclear to cytoplasmic ratio, and frequent mitosis. By immunohistochemical stain, the tumor cells were strongly positive for chromogranin, synaptophysin, and CD56. We report this case with a review of literatures.

Effect of Cyanate on the Carbamylation and Biological Activity of Superoxide Dismutase / 대한신장학회잡지

The patients with end stage renal disease show several complications such as artherosclerosis, anemia and increased susceptibility to infection by damage due to oxygen free radicals. Superoxide dismutase(SOD) is directly linked to the fate of the highly reactive oxygen metabolites. If there is an alteration in the activity of SOD, this alteration may contribute to the complications by reactive oxygen species in patients with end stage renal disease. In this experiment, SOD activity and the effect of cyanate on the activity of SOD was studied to understand the mechanism of several complications mediated by oxygen free radicals in patients with end stage renal disease. SOD activity in the plasma and erythrocytes from patients with end stage renal disease was significantly lower than those from healthy controls. It is known that underproduction of SOD leads to excess production of superoxide and reduced iron favoring hydroxyl radical formation. The results in this experiment suggest that there is an overproduction of superoxide anion in patients with end stage renal disease. The overproduction of superoxide anion may contribute the patients with end stage renal disease susceptible to oxidant damages. To evaluate if cyanate could carbamylate SOD, SOD was incubated with cyanate. The level of carbamylated SOD increased as the time of exposure to cyanate increased from 0 hour to 72 hours. Furthermore, the degree of carbamylation of SOD increased as cyanate concentration in the incubation media rose from 20mM to 1M. There appears to be a maximum degree of carbamylation at a concentration of 1,000mM cyanate. To test the hypothesis that in vitro carbamylation of SOD alters its biological activity, SOD activity was measured after incubation with cyanate. The activity of carbamylated SOD decreased as the time of exposure to cyanate increased from 0 hour to 72 hours. Furthermore, the activity of carbamylated SOD decreased as cyanate concentration in the incubation media rose from 20mM to 1M and when albumin was added to the reaction mixture, the loss of SOD activity was prevented. These results are consistent with the hypothesis that SOD is also carbamylated and lost biological activity in end stage renal disease patients by cyanate, and that the degree of carbamylation depends on both the concentration of cyanate and the length of exposure. Also, these suggest that albumin may prevent carbamylation of SOD at least in vitro condition.

Tuberculous Intestinal Perforation Following Renal Transplantation / 대한이식학회지

The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.

Herpes Simplex Esophagitis Following Cadaveric Renal Transplantation / 대한이식학회지

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.

Factors Contributing to the Outcome in Adult Patients with Idiopathic Membranous Glomerulonephritis: Single Center Study in Korea / 대한신장학회잡지

The 70 adult patients with idiopathic membranous glomerulonephritis(IMGN), in whom renal biopsy has been performed at Keimyung University Dongsan Hospital, between January 1982 and December 1995 were studied for the clinical evolution of the disease and factors which might be involved in the development of chronic renal failure. There was 41 males and 29 females with a mean age of 41 years. Mean time from the onset to the renal biopsy was 13 months. The clinical presentations at the time of diagnosis were nephrotic syndrome(61.4%), asymptomatic urinary abnormality(21.4%), acute nephritic syndrome(14.3%), and recurrent gross hematuria(2.9%). During the mean follow-up period of 40+/-31 months, eleven(15.7%) of the patients developed chronic renal failure and five of them had end-stage renal disease. Five and ten years renal survival were 81.2% and 66.4%, respectively. In univariate analysis of clinical prognostic factors for progression to renal failure using Kaplan-Meier method, four parameters ; serum creatinine >or=1.4mg/ dL(p=0.011), hypoalbuminemia 2.5g/dL(por=10.0g/day(p=0.036) and remission of proteinuria < 2.0g/24hr (p<0.01) were found to have predictive value. No effect was observed in the age, sex, steroid and/or immunosuppressive therapy, hypertension and serum total cholesterol concentration on prognosis. In univariate analysis of pathologic prognostic factors, interstitial fibrosis(p=0.036) and inflammation(p=0.011) were significant for predictive value.