A Case of Pulmonary Sarcoidosis with Elevated Carcinoembryonic Antigen (CEA) / 결핵및호흡기질환

Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology. The characteristic pathological finding is the presence of non-caseating granulomas. The lungs are primarily affected, however other organs may be involved causing various symptoms and ambiguous laboratory findings can be present. There are a few reported cases of sarcoidosis with elevated tumor markers. We describe a 68-year-old woman presenting with sarcoidosis showing elevated serum carcinoembryonic antigen (CEA). The possibility of cancer arising from serum CEA such as gastrointestinal cancer, breast cancer and lung cancer was excluded. A transbronchial lung biopsy demonstrated a non-caseating granuloma without necrosis. As a result prescribed 30 mg prednisolone daily to the patient and serum CEA was decreased after 1 month of treatment. We report a case of pulmonary sarcoidosis with elevated serum CEA.

A Case of Pulmonary Sarcoidosis with Elevated Carcinoembryonic Antigen (CEA) / 결핵및호흡기질환

Sarcoidosis is a multi-systemic granulomatous disorder of unknown etiology. The characteristic pathological finding is the presence of non-caseating granulomas. The lungs are primarily affected, however other organs may be involved causing various symptoms and ambiguous laboratory findings can be present. There are a few reported cases of sarcoidosis with elevated tumor markers. We describe a 68-year-old woman presenting with sarcoidosis showing elevated serum carcinoembryonic antigen (CEA). The possibility of cancer arising from serum CEA such as gastrointestinal cancer, breast cancer and lung cancer was excluded. A transbronchial lung biopsy demonstrated a non-caseating granuloma without necrosis. As a result prescribed 30 mg prednisolone daily to the patient and serum CEA was decreased after 1 month of treatment. We report a case of pulmonary sarcoidosis with elevated serum CEA.

Changes in the Rate of Renin Secretion During Cell Cycle of As 4.1 Cells / 대한신장학회잡지

BACKGROUND: Renin is secreted from the juxtaglomerular (JG) cells in response to a wide variety of extracellular stimuli. To study the underlying mechanism of regulation of renin secretion at molecular level, pure JG cell lines (As 4.1) cloned from renal JG tumor was used. In this study, to explore the feasibility of As 4.1 cells as an in vitro model for renin secretion, the changes of renin secretion from As 4.1 in culture during cell cycle were characterized. METHODS: To address this issue, As 4.1s were synchronized in G0, G1, S, G2, early M and late M phase during experiment. RESULTS: The rate of renin secretion was above 1 ng AI/well/hr in G0, G2/M and early mitotic phase and 0.5 ng AI/well/hr in G1, G1/S, S and late mitotic phase. ML-7 (6x10(-5) M), an inhibitor of MLCK which is known to stimulate renin secretion, increased the rate of renin secretion much greater in G1, G1/S, S and late M phase than the other phases; in particular, in early mitotic phase it had no stimulation. On the other hand, the rate of renin secretion was not influenced through out cell cycles by calyculin A, an inhibitor of type 1 protein phosphatase. Forskolin, an activator of adenlyate cyclase resulting in an elevation of intracellular cyclic AMP, stimulated renin secretion only in S phase in a concentration dependent manner. CONCLUSION: The present study demonstrated that As 4.1 cells in culture secrete active renin in much the similar manner to JG cells in situ but its rate varies during each phase of the cell cycle. Thus As 4.1 cells can be utilized as an in vitro model for renin secretion. But, changes in the rate of renin secretion and the secretory responses to stimulators or inhibitors during cell cycle must be considered in conducting experiments to elucidate the cellular and molecular mechanism of the renin secretion.

Vesicular transport as a new paradigm in short-term regulation of transepithelial transport

The vectorial transepithelial transport of water and electrolytes in the renal epithelium is achieved by the polarized distribution of various transport proteins in the apical and basolateral membrane. The short-term regulation of transepithelial transport has been traditionally thought to be mediated by kinetic alterations of transporter without changing the number of transporters. However, a growing body of recent evidence supports the possibility that the stimulus-dependent recycling of transporter-carrying vesicles can alter the abundance of transporters in the plasma membrane in parallel changes in transepithelial transport functions. The abundance of transporters in the plasma membrane is determined by net balance between stimulus-dependent exocytic insertion of transporters into and endocytic retrieval of them from the plasma membrane. The vesicular recycling occurs along the tracts of the actin microfilaments and microtubules with associated motors. This review is to highlight the importance of vesicular transport in the short-term regulatory process of transepithelial transport in the renal epithelium. In the short-term regulation of many other renal transporters, vesicular transport is likely to be also involved. Thus, vesicular transport is now emerged as a wide-spread general regulatory mechanism involved in short-term regulation of renal functions.

Role of Ca2+ in the stimulation of glucose transport by insulin in adipocytes

We investigated the role of Ca2+ and protein kinases/phosphatases in the stimulatory effect of insulin on glucose transport. In isolated rat adipocytes, the simple omission of CaCl2 from the incubation medium significantly reduced, but did not abolish, insulin-stimulated 2-deoxy glucose (2-DG) uptake. Pre-loading adipocytes with intracellular Ca2+ chelator, 5,5'-dimethyl bis (o-aminophenoxy)ethane-N,N,N'N' tetraacetic acetoxymethyl ester (5,5'-dimethyl BAPTA/AM) completely blocked the stimulation. Insulin raised intracellular Ca2+ concentration ((Ca2+)i) about 1.7 times the basal level of 72+/-5 nM, and 5,5'-dimethyl BAPTA/AM kept it constant at the basal level. This correlation between insulin-induced increases in 2-DG uptake and (Ca2+)i indicates that the elevation of (Ca2+)i may be prerequisite for the stimulation of glucose transport. Studies with inhibitors (ML-9, KN-62, cyclosporin A) of Ca2+-calmodulin dependent protein kinases/phosphatases also indicate an involvement of intracellular Ca2+. Additional studies with okadaic acid and calyculin A, protein phosphatase-1 (PP-1) and 2A (PP-2A) inhibitors, indicate an involvement of PP-1 in insulin action on 2-DG uptake. These results indicate an involvement of Ca2+-dependent signaling pathway in insulin action on glucose transport.

A Case of Bronchocentric Granulomatosis Associated with Aspergillus / 결핵

Bronchocentric granulomatosis(BCG), first defined in 1973, consists of granulomatous replacement of bronchial mucous membrane, often with heavy eosinophilic reaction within and about the involved bronchi. Etiologic factors are from hypersensitivity reaction for aspergillus, most often from idiopathic form, and in others from being associated with mycobacterium, ecchinococcus, rheumatoid disease, ankylosing spodylitis, and glomerulonephritis. Diagnosis is responsible only for pathologic findings and, in many cases, is confirmed in postoperative findings with misleading for tumor, tuberculosis, infectious or Wegener's granulomatosis. We report a case of bronchocentric granulomatosis associated with aspergillus.

Swelling of the vesicle is prerequisite for PTH secretion

Unlike most secretory cells, high extra cellular calcium inhibits rather than stimulates hormonal secretion in several cells such as parathyroid cells, Juxtaglomerular cells and osteoclast. To gain further insight into the common but unique stimulus-secretion coupling mechanism in these cells, bovine parathyroid slices were incubated in various conditions of Krebs-Ringer (KR) solution containing essential amino acids. Parathyroid cells showed the inverse dependency of secretion on extra cellular calcium concentration as we expected. Ammonium acetate overcame the inhibitory effect of 2.5 mM of calcium and the maximum effect was as much as the five times of the basal value, while there was a little additive effect under 0 mM CaCl2. PTH secretion was biphasic according to the change of extra cellular osmolarity and the lowest response was observed at 300 mOsm/l. In Na-rich KR solution, high concentration of nigericin (> 10(-4)M) completely overcame the inhibitory effect of 2.5 mM CaCl2 and the maximum stimulatory effect was 8 times greater whereas it was only 2 times greater without CaCl2. In K-rich KR solution that abolished the K-gradient between the extra cellular solution and the cytoplasm, the rate of PTH secretion increased, and furthermore the addition of nigericin increased the rate of secretion significantly. The results above suggested that the osmotic swelling of the secretory vesicle in parathyroid cells might promote exocytosis as in Juxtaglomerular cells. We propose that the swelling of the vesicle is also prerequisite for secretion in several cells inhibited paradoxically by Ca++, whatever the signal transduction pathway for swelling of the secretory granules induced by the lowering of Ca++ in cytoplasm are.

Vesicular transport with emphasis on exocytosis

The eukaryotic cell is compartmentalized by a series of vesicular organelles which constitute the endocytic and exocytic transport pathways. Each vesicular compartment has distinct sets of membrane proteins, structures and functions. Despite continuous vesicular transport, each vesicular compartment maintains its structure and function by use of retention and retrieval signal for its own resident proteins. Proteins in transit along the endocytic and exocytic pathway are transported without admixing with cytoplasmic constituents by successive steps of budding from the donor vesicles, formation of intermediate transport vesicles, transport, targeting to and fusion with acceptor vesicles. Specificity and fidelity of the vesicular transport are conferred by vesicular membrane proteins and small molecular weight GTP-binding proteins of the Rab subfamily. Proteins for export are packaged into specific vesicles for their final destinations. Insertion into and retrieval from the plasma membrane of transport proteins in response to cellular stimulus are a new paradigm of cellular regulatory mechanism. Secretion of neurotransmitters, hormones and enzymes by exocytosis involves a complex set of cytosolic proteins, G-proteins, proteins on the secretory granule membrane and plasma membrane. Much progress has been recently made in identifying proteins and factors involved in the exocytosis. But the molecular interactions among identified proteins and regulatory factors are unknown and remain to be elucidated. Finally our chemiosmotic hypothesis which involves the H+ electrochemical gradient across the secretory granule membrane generated by an ATP-dependent electrogenic H(+)-ATPase as the potential driving force for fusion and release of granule contents will be discussed.

A case of congenital diaphragmatic hernia associated with endocardial cushion defect / 대한주산의학회잡지

No abstract available.

Further Analysis of Various Renal Functions in the Korean III. Urinary Excretion of Phosphate, Ammonia and Titratable Acid

In an attempt to investigate the pattern of the urinary acidification process in the Korean, the urinary excretion of phosphate, ammonia, and the titratable acid were measured in 20 medical students (A group) and in 15 psychiatric patients (B group) under regular Korean diets, while the effects of high protein diets on them were studied in 4 subjects. In addition, TmPO4 was also determined in 11 subjects. The urinary excretions of phosphate, titratable acid, and ammonia under regular Korean diets were markedly lower as compared to those of the Europeans. However, there was no difference in the plasma concentration of phosphate between the Korean and the European. Upon administration of high protein diets, the urinary excretions of phosphate and titratable acid increased while the urine pH and the ammonia excretion were little affected. Thus, the correlations between urinary nitrogen and titratable acidity were 0.50 and 0.65, respective1y, showing a linear relationship. However, the correlation between urinary nitrogen and ammonia excretion was slight. The value of TmPO4 ranged from 74 to 355 muM/min with the mean of 193 muM/min, which is considerably higher than that of the European. On the basis of these findings, the overall pattern of the urinary acidification processes in the Korean is discussed.

Further Analysis of Various Renal Functions in the Korean I. Studies on Water Metabolism of the Korean

A typical pattern of daily water exchange was determined in 10 medical students during three different seasons: summer, autumn and winter. The daily water intake was averaged to 3,810ml of which 1,256ml was from liquids, 2,055ml from the water contained in food and 500ml from the water of oxidation. On the other hand, the daily water output was 1,844ml by urinary loss, 144ml by fecal loss and 1,819ml by evaporative loss. The above quantitative pattern of daily water exchange in the Korean remained unchanged throughout the year. The daily urinary output of NaCl and urea-nitrogen was in the order of 20gm and 10gm, respectively. Furthermore, the magnitude of daily water intake was well correlated to the daily urinary output of NaCl but little correlated to that of urea-nitrogen. A comparison of these data with the corresponding figures obtained from the occidental indicates that the daily water intake and the daily urinary output of NaCl were significant1y greater in the Korean than those in the occidental. On the basis of these results, the greater water intake in the Korean was attributed to their high salt intake.

Further Analysis of Various Renal Functions in the Korean II. Effect of High Protein Diet on Water Metabo1ism and Renal Functions

Effects of high protein diet on water metabolism and on various renal functions were studied in 4 medical students. The daily water intake during the high protein intake was averaged to 3,000ml of which 39% was from liquids, 49% from the water contained in food and 12% from the water of oxidation. Of the daily water output, 53% was by urine, 3% by feces and 44% by the evaporation. As compared to the occidental, this average daily water intake of 3,000ml on high protein diet was greater in the Korean. Moreover, the daily water intake for a given caloric intake or body weight was still significantly greater in the Korean. Moreover, the quantitative pattern of daily water exchange was not modified by the protein content in the diet. On the other hand, the urine osmolarity as well as the urea concentration increased when the protein intake was augmented. However, the urinary concentrations of Na+, Cl- and K+ were not affected by the amount of protein intake. When high protein diet was given, the values of CIN and CPAH showed only a slight increase but renal concentrating ability as judged by the magnitude of maximal negative free water clearance (T H20) showed a significant increase. From these results, it is evident that the lower renal concetrating ability of the normal Korean is most likely due to low protein intake. However, greater water intake in the Korean is independent of the changes in the renal concentrating ability. On the basis of these facts, it is again suggested that greater water intake in the Korean is attributable to greater salt intake.

The Relation of Urine Specific Gravity to Its Composition and Osmolality in the Normal Korean

A random urine sample was obtained from each of 155 normal Koreans and its specific gravity (S.G.), the total osmolality (Uosm) and the concentration of chloride (UCl) and urea (Uurea) were determined. The Uosm, 2 X UCl and Uurea were then plotted as a function of the S. G., and the following regression equations were obtaind: Uosm (in mOsm/kg) = 34,500 (S.G.-1,000), 2xUCl (in mOsm/kg) = 20,000 (S.G. 1,000), and Uurea (in mOsm/kg) = 10,000 (S.G.-1,000). the analysis of these data indicated that 58.5% of the Uosm could be accounted for by NaCl and 28.8% by urea while 41.0% of the S. G. of urine could be accounted for by NaCl and only 14.5% by urea. A comparison of these data with corresponding figures obtained from occidentals suggests that, in the Korean, the contribution of NaCl to both the Uosm and S.G. of urine is considerably higher, while that of urea is significantly lower than that in the occidental. This peculiarity of the urinary composition in Koreans is attributed to their ingestion of a lowprotein, high-salt diet.