Background/Aims: The optimal duration and interval of follow-up for cystic lesions of the pancreas (CLPs) is not well established. This study was performed to investigate the optimal duration and interval of follow-up for CLPs in clinical practice. Methods: Patients with CLPs without worrisome features or high-risk stigmata underwent followup with computed tomography at 6, 12, 18, and 24 months and then every 12 months thereafter. A retrospective analysis of prospectively collected data was performed. Results: A total of 227 patients with CLPs detected from 2000 to 2008 (mean initial diameter, 1.3±0.6 cm) underwent follow-up for a median of 120 months. Twenty-two patients (9.7%) underwent surgery after a median of 47.5 months. Malignancies developed in four patients (1.8%), one within 5 years and three within 10 years. One hundred and fourteen patients (50.2%) were followed up for more than 10 years. No malignancy developed after 10 years of follow-up. During surveillance, 37 patients (16.3%) experienced progression to surgical indication. In patients with CLPs less than 2 cm in diameter, development of surgical indications did not occur within 24 months of follow-up. Conclusions CLPs should be continuously monitored after 5 years because of the persistent potential for malignant transformation of CLPs. An interval of 24 months for initial follow-up might be enough for CLPs with initial size of less than 2 cm in clinical practice.

OBJECTIVE: To investigate the antiproliferative activity of Salvia miltiorrhiza Bunge. (SM) on the castration-resistant prostate cancer (CRPC) cell line DU-145, in vitro and in vivo. METHODS: Prostate cancer cell line (DU-145) and normal prostate cell line (RWPE-1) were treated with SM at different concentrations (3.125, 12.5, 25 and 50 μg/mL) to investigate the antiproliferative effects. DNA laddering analysis was performed to investigate the apoptosis of DU-145 cells. Molecular mechanism was investigated by Western blot analysis of p53, Bcl-2, prostate specific antigen (PSA), and androgen receptor (AR). Six-week-old male BALB/c nude mice were randomly divided into normal control group (n=101) and treated group (n=101) which administered 500 mg/kg SM for 2 weeks. Tumor volumes were measured. RESULTS: Treatment with SM resulted in a dose-dependent decrease in cell number of DU-145 cells in comparison with RWPE-1. DNA laddering analysis indicated the apoptosis of DU-145 cells. Treatment with SM increased the expression of p53 and reduced the expression of Bcl-2 proteins. The levels of PSA were considerably reduced in SM-treated group compared to the controls, and a decrease in AR expression was observed when cells were treated with SM in the same pattern as a reduction in PSA. In the tumour xenograft study, SM given once a day for 2 weeks significantly inhibited tumour growth. CONCLUSION SM might contribute to the anticancer actions such as induction of apoptosis and inhibition of proliferation of prostate cancer cells.

BACKGROUND/OBJECTIVES: Recent living condition improvements, changes in dietary habits, and reductions in physical activity are contributing to an increase in metabolic syndrome symptoms including diabetes and obesity. Through such societal developments, humankind is continuously exposed to metabolic diseases such as diabetes, and the number of the victims is increasing. This study investigated Cordyceps militaris water extract (CMW)-induced glucose uptake in HepG2 cells and the effect of CMW treatment on glucose metabolism. MATERIALS/METHODS: Colorimetric assay kits were used to determine the glucokinase (GK) and pyruvate dehydrogenase (PDH) activities, glucose uptake, and glycogen content. Either RT-PCR or western blot analysis was performed for quantitation of glucose transporter 2 (GLUT2), hepatocyte nuclear factor 1 alpha (HNF-1α), phosphatidylinositol 3-kinase (PI3k), protein kinase B (Akt), phosphorylated AMP-activated protein kinase (pAMPK), phosphoenolpyruvate carboxykinase, GK, PDH, and glycogen synthase kinase 3 beta (GSK-3β) expression levels. The α-glucosidase inhibitory activities of acarbose and CMW were evaluated by absorbance measurement. RESULTS: CMW induced glucose uptake in HepG2 cells by increasing GLUT2 through HNF-1α expression stimulation. Glucose in the cells increased the CMW-induced phosphorylation of AMPK. In turn, glycolysis was stimulated, and glyconeogenesis was inhibited. Furthermore, by studying the mechanism of action of PI3k, Akt, and GSK-3β, and measuring glycogen content, the study confirmed that the glucose was stored in the liver as glycogen. Finally, CMW resulted in a higher level of α-glucosidase inhibitory activity than that from acarbose. CONCLUSION: CMW induced the uptake of glucose into HepG2 cells, as well, it induced metabolism of the absorbed glucose. It is concluded that CMW is a candidate or potential use in diabetes prevention and treatment.
Acarbose ; alpha-Glucosidases* ; AMP-Activated Protein Kinases ; Blotting, Western ; Cordyceps* ; Food Habits ; Glucokinase ; Glucose Transport Proteins, Facilitative ; Glucose* ; Glycogen ; Glycogen Synthase Kinase 3 ; Glycolysis ; Hep G2 Cells* ; Hepatocyte Nuclear Factor 1-alpha ; Hypoglycemic Agents ; Liver ; Metabolic Diseases ; Metabolism* ; Motor Activity ; Obesity ; Oxidoreductases ; Phosphatidylinositol 3-Kinase ; Phosphoenolpyruvate ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; Pyruvic Acid ; Social Conditions ; Water*

BACKGROUND AND PURPOSE: Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis worldwide, and it remains fatal even when optimal antiviral therapy is applied. There is only a weak consensus on the clinical outcomes and prognostic factors in patients with HSE. This study examined whether the radiological and electrophysiological findings have a prognostic value in patients with HSE. METHODS: We retrospectively analyzed patients who were diagnosed with HSE by applying the polymerase chain reaction to cerebrospinal fluid and who received intravenous acyclovir at our hospital from 2000 to 2014. We evaluated the clinical outcomes at 6 months after onset and their correlations with initial and clinical findings, including the volume of lesions on MRI, the severity of EEG findings, and the presence of epileptic seizures at the initial presentation. RESULTS: Twenty-nine patients were enrolled (18 men and 11 women). Univariate analysis revealed that the presence of severe EEG abnormality and epileptic seizures at the initial presentation were significant correlated with a poor clinical outcome at 6 months (p=0.005 and p=0.009, respectively). In multivariate analysis, the presence of severe EEG abnormality was the only independent predictor of a poor outcome at 6 months (p=0.006). CONCLUSIONS: In cases of HSE, the initial EEG severity and seizure presentation may be useful predictive factors for the outcome at 6 months after acyclovir treatment.
Acyclovir ; Cerebrospinal Fluid ; Consensus ; Electroencephalography* ; Encephalitis ; Encephalitis, Herpes Simplex* ; Epilepsy ; Herpes Simplex* ; Humans ; Magnetic Resonance Imaging* ; Male ; Multivariate Analysis ; Polymerase Chain Reaction ; Retrospective Studies ; Seizures ; Simplexvirus

Pulmonary aspiration of gastric contents is one of the most frightening complications during anesthesia. Although pulmonary aspiration of gastric contents in general surgical patients is not common and resulting long-term morbidity and mortality are rare, severe hypoxemia and other sequelae of pulmonary aspiration continue to be reported. We report a case of massive aspiration of gastric contents during induction of general anesthesia, resulting in cardiac arrest due to severe pulmonary hypertension and myocardial infarction. Sustained cardiac arrest and shock that did not respond the conventional resuscitation was successfully treated using milrinone. The patient was discharged without complications in 20 days.
Anesthesia ; Anesthesia, General ; Anoxia ; Heart Arrest ; Humans ; Hypertension, Pulmonary ; Milrinone* ; Mortality ; Myocardial Infarction ; Respiratory Aspiration of Gastric Contents ; Resuscitation ; Shock ; Shock, Cardiogenic*

BACKGROUND: The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. METHODS: One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. RESULTS: The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 +/- 6.9 min, 13.6 +/- 4.5 min, 16.7 +/- 4.6 min, and 16.5 +/- 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). CONCLUSIONS: In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.
Anesthetics, Local ; Horner Syndrome ; Humans ; Mepivacaine ; Nerve Block

No abstract available.
Dantrolene ; Malignant Hyperthermia

PURPOSE: Lower urinary tract symptoms (LUTS) can be caused by abnormal detrusor activity, bladder outlet obstruction (BOO), or numerous other factors. These factors must be evaluated with scrutiny, especially when prostate volume is small and the patient is about to have invasive treatment. We evaluated the urodynamic findings of patients with LUTS and small prostate volumes. MATERIALS AND METHODS: From January 2006 to December 2008, a total of 140 men with LUTS underwent urodynamic study. Of these 140 men, 51 patients with prostate volume < or =30 ml and an International Prostate Symptom Score (IPSS) > or =8 were evaluated. RESULTS: The average age of the patients was 65.5+/-7.4 years (range 46~86), mean prostate volume was 24.5+/-5.1 (range 13.0~30.0), mean IPSS was 15.5+/-7.7 (range 8~34), and quality of life (QOL) score was 3.4+/-1.5 (range 3~6). BOO was the most common finding, affecting 21 (41.2%) patients. The patients with BOO were significantly older than the unobstructed patients (70.1+/-5.9 and 62.4+/-6.7 years, respectively; p<0.001) and had larger prostates (27.5+/-3.1 and 22.4+/-5.1, respectively; p<0.001). Furthermore, they had higher IPSS, but the difference was not significant (p=0.074). Eighteen (35.5%) patients had normal findings, while detrusor underactivity (DU) was found in 15 (29.4%) and detrusor overactivity (DO) in 3 (5.9%) patients. There was no significant difference in age, prostate volume, or IPSS between men with and without DU. CONCLUSIONS: The most common finding of LUTS with small prostate volume is BOO, even though it accounts for less than half of the patients. However, patients with normal finding or DU on urodynamic study account for majority of cases, emphasizing the value of urodynamic study before invasive treatments.
Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Quality of Life ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics

PURPOSE: We examined changes in the clinicopathologic characteristics of renal cell carcinoma (RCC) in the past 25 years and aimed to obtain indicators for its diagnosis and treatment. MATERIALS AND METHODS: The medical records of 563 patients with confirmed primary RCC after surgical treatment from 1985 to 2010 at Seoul St. Mary's Hospital were retrospectively reviewed. Patient and tumor characteristics were compared over 3 time periods (period 1: 1985-1994, period 2: 1995-2004, period 3: 2005-2010). RESULTS: Period 1 included 65 patients, period 2 included 183 patients, and period 3 included 315 patients, showing an exponential growth in the number of patients. Frequency was highest in the late 50s age group. The review of clinical symptoms showed that incidental diagnosis increased significantly. The tumor size at diagnosis gradually decreased and the proportion of small tumors less than 4 cm increased remarkably. Concerning tumor spread, organ-confined tumors (T1-2N0M0) increased and distant metastasis decreased. Histologically, the clear cell type made up the greatest proportion, about 90% in each period, but subtypes besides the clear cell type increased over the study period. The rate of nephron-sparing surgery increased, and exophytic masses were the most common. CONCLUSIONS: Our review of the recent 25 year's worth of data on RCC from Seoul St. Mary's Hospital showed that the incidental diagnosis of RCC increased over the study period in accordance with the development of screening tests. Tumor size decreased in accordance with the progress in imaging modalities. In the future, multicenter research will be needed to analyze the characteristics of whole renal cancer in Korea.
Carcinoma, Renal Cell ; Humans ; Kidney Neoplasms ; Korea ; Mass Screening ; Medical Records ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies

No abstract available.