BACKGROUND/AIMS: Transforming growth factor-a(TGF-a) is a polypeptide cytokine related to cell proliferation and transformation. TGF-a binds to EGF receptor and stimulating DNA synthesis in liver cell. The hepatitis B virus (HBV) by itself is also believed to play a role in the hepatic carcinogenesis. Recently, it was reported that TGF-a and HBV were synergistic in action with rapid appearance of hepatocelluar carcinoma in bitransgenic mice. Although TGF- a is thought to play an important role in hepatocarcinogenesis, its expression during the natural history of HBV hepatitis was poorly understood. This investigation was performed to elucidate the dynamic changes and istinct immunohistochemical staining patterns in the course of chronic HBV hepatitis with specific reference to hepatocelluar carcinoma and to explain the role of TGF-a in the pathogenesis of hepatocelluar carcinoma. MATERIALS/METHODS: Employing TGF-a monoclonal antibody, signal detection was carried out by peroxidase-conjugated streptavidin in deparaffinized liver tissue sections taken from HBsAg positive patients. All of the liver tissue sections were proven HBV DNA positive by in situ hybridization. Immunohistochemical staining was performed in the tissue sections obtained from four normal controls, six from patients with chronic persistent hepatitis, five with chronic active hepatitis, eight with liver cirrhosis and eleven with hepatocellular carcinoma. RESULTS: The patterns of TGF-a immunoreactivity were cytoplasmic-grain types in normal controls and chronic persistent hepatitis, honeycomb types in chronic active hepatitis, occasional cytoplasmic-flooding types in liver cirrhosis, and cytoplasmic-grape types in hepatocellular carcinoma. A Shapiro-Wilk W test for frequency table analysis for the expression of TGF-a in these different disease groups was statistically significant. CONCLUSION: These data suggest that step-wise distinct expression of TGF-a enhancement in HBV associated chranic liver diseases which eventually resulted in the development of hepatocellular carcinoma were conceivably due to dysregulation of liver cell cycles by both HBV and TGF-a during the persistent repetition of cell cycles.
Animals ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Cell Cycle ; Cell Proliferation ; DNA ; Hepatitis ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis, Chronic* ; Humans ; In Situ Hybridization ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Mice ; Natural History ; Receptor, Epidermal Growth Factor ; Streptavidin

Gallstone diseases include gallbladder stones, extrahepatic bile duct stones and intrahepatic duct stones. In the past, the main treatment modality was a surgical operation. With the development of endoscopic treatment, the main treatment modality is shifting towards endoscopic treatment. After the development of endoscopic sphincterotomy, endoscopic stone removal using a basket or balloon has been the major treatment modality for extrahepatic bile duct stones. For huge extrahepatic bile duct stones, mechanical or laser lithotripsy are used as ancillary equipment. Direct peroral cholangioscopic methods using a slim endoscopy or a Spyglass system now being rapidly developed instead of the "mother and baby" scope. If extrahapatic bile duct stones fail to be removed with peroral endoscopic treatment, then the stones can be treated via a percutaneous route (a percutaneous transhepatic route or a percutaneous transabdominal route). For intrahepatic duct stones, the location of stones, the site and degree of bile duct stricture and the existence of parenchymal atrophy are important factors to decide the treatment modality. The treatment modality is usually decided on according to the Tsunoda classification. Gallbladder stones usually need cholecystectomy because of recurrence. Endoscopic treatment is an indication for treating inoperable calculous cholecystitis patients. Endoscopic treatment for gallstone disesae will continue to rapidly develop in the future to the benefit of both the patients and endoscopists.
Atrophy ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholecystectomy ; Cholecystitis ; Constriction, Pathologic ; Endoscopy ; Gallbladder ; Gallstones ; Humans ; Lithotripsy, Laser ; Recurrence ; Sphincterotomy, Endoscopic

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor

BACKGROUND/AIMS: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. METHODS: Nine B6C3F1 mices were given I.p. injection of ENU (60 ug/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. RESULTS: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15+112.39 p m (Mean+ SD), but that of randomly selected 104 points was 291.73+157.98pm (Mean+5D) (Students t-test, p<0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85+149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87+145.79 pm (Mean+SD)(Students t-test, p<0.0005). CONCLUSION: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins.
Animals ; Appointments and Schedules ; Basophils ; Cholestasis ; DNA ; Eosine Yellowish-(YS) ; Ethylnitrosourea ; Fluconazole ; Hematoxylin ; Hepatic Veins ; Hepatocytes ; Liver ; Metabolism ; Mice* ; Portal Vein ; Veins

No abstract available.
Acinetobacter calcoaceticus* ; Acinetobacter* ; Pneumonia*

Palliative treatment of malignant biliary obstructions represent the principal indications of endoscopic or percutaneous transhepatic implantation of endoprostheses. Many kinds of biliary stents have been used to maintain patency of the bile ducts obstructed by benign or malignant strictures. However, the biliary stent in current use, has a tendency to become blocked. In order to maintain a long-term stent patency before clogging, biliary stents with large diameters are needed and some kinds of expandable metal stents are proposed. The Hanaro stent (Sooho medi-tech Co. LTD, Seoul, Korea) is a modified Gianturco Z biliary stent, made of 0,01-inch stainless steel wire with a zigzag pattern. It has a spiral, cylindrical configuration and is 10 mm in expanded diameter. It hes been used only with the percutaneous transhepatic technique. In this article, we describe a new method for endoscopic retrograde placement of a modified Gianturco Z biliary stent. This report describes our experience on endoscopic application of a modified Gianturco Z biliary stent in a patient with malignant obstruction of the distal common bile duct.
Bile Ducts ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Palliative Care ; Seoul ; Stainless Steel ; Stents*

We report two cases of mucinous ductal ectasia of the pancreas which showed characteristic pancreatoscopic findings. They also showed characteristic duodenoscopic findings such as patulous ampullary orifice and mucus leakage from the papilla, and underlying pathology was hyperplasia in one case and adenoma in the other case, The insertions of pancreatoscope into the main pancreatic duct were easy without previous sphincterotomy and whitish frog egg-like mucosa was noted in one case and finger-like papillary projection was noted in the other case.
Adenoma ; Dilatation, Pathologic* ; Hyperplasia ; Mucins* ; Mucous Membrane ; Mucus ; Pancreas* ; Pancreatic Ducts ; Pathology

Objectives: The sphincter of Oddi(SO) manometry via transpapillary route is performed usually for a period of several minutes. To investigate whether there is a considerable variation in the manometric measurements of SO over a longer period of time, we have performed long-term manometry of SO via transpapillary(n=5) as well as percutaneous(n=7) route. Methods: Transpapillary manometry of SO was carried out by conventional low- compliant continuously perfused techni~que. The location of the manometric catheter was maintained at the same level by observing the video monitor. SO manometry and the duodenal migrating motor complex(MMC) was simuitaneously measured with specially designed catheter via pereutaneous route. Results: The mean recording time was 41 minutes(range 11-72 minutes). The frequency of phasic contractions of SO varied from 0 to 12/min. Throughout the whole recording period, high-frequency contractians(over 8/min) were noted in 14.9 % of the time. In the eases of percutaneous transductal SO manometry, the periods of high-frequency contractions coincided with the phase III of duodenal MMC. The interval between the first high-frequency contractions and the second was 47 minutes. The mean duration of high-frequency contractions was 6 minutes and 4~2 seconds. There as no significant change in the amplitude, basal pressure and contraction sequence among the various periods of frequencies. Conclusions: Long-term continuous recording of SO manometry via transpapillary and percutaneous route showed that the contraction frequency of SO was not constant and tachyoddia appearde periodically. In the interpretation of tachyoddia, it is necessary to consider the period of phase III of the duodenal MMC.
Catheters ; Manometry* ; Sphincter of Oddi*

BACKGROUND: Peroral intubation of a self-expanding metal stent is usually difficult in malignant antral obstruction in patients with unresectable gastric cancer, due to the curved gastroduodenal structure. METHODS: The delivery catheter of a self-expanding nickel-titanium coil stent was modified, which was originally used in obstructive esophagocardial cancer. Peroral intubation of the coil stent was attempted in patients suffering from intractable vomiting due to unresectable gastric cancer with antral obstruction. RESULTS: Fifteen of 18 patients (83.3%) were successfully managed without immediate complications such as stent migration, serious bleeding, bowel perforation, and procedure- related mortality. One patient, who failed the peroral intubation, was managed by percutaneous intubation of the coil stent via the route of percutaneous endoscopic gastrostomy. After insertion of the coil stent, food ingestion and symptomatic improvement of vomiting was achieved in 15 (93.8%) of 16 patients. The mean survival time was 3.7 months (range, 1-10 months). No delayed stent migration and occlusion by tumor overgrowth occurred. Stent occlusion by food materials occurred in one patient during the follow-up period, which was corrected by endoscopic flushing. CONCLUSION: These results suggest that peroral intubation of a self-expanding coil stent is a safe and effective palliation for unresectable gastric cancer with antral obstruction.
Catheters ; Eating ; Flushing ; Follow-Up Studies ; Gastrostomy ; Hemorrhage ; Humans ; Intubation* ; Mortality ; Stents* ; Stomach Neoplasms* ; Survival Rate ; Vomiting

To assess the reproducibility of Sphincter of Oddi(SO) manometry, percutaneous manometry of SO was performed repeatedly in 10 subjects with biliary diseases(9 intrahepatic stone cases and 1 bile duct cancer case). Time interval for measurement of SO manometry was 3 to 7(mean 5) days. Mean manometric parameters of SO phasic contraction in the 1st and 2nd studies were not significantly different. However, as a result of manometric records, a diagnosis of dyskinesia was made in the 1st study from 4 patients(tachyoddia in 3 cases and increased retrograde propagation in one case). Among them, the diagnosis was reproduced in the 2nd study from 2(tachyoddia in 2 cases) out of 4 patients. In conclusion, abnormal manometric findings were poorly reproducible. Thus, more prolonged measurement of SO manometry or a dynamic test which stimuli or inhibit the SO activity may be necessary for accurate diagnosis of biliary dyskinesia and better reproducibility of SO manometry.
Bile Duct Neoplasms ; Biliary Dyskinesia ; Diagnosis ; Dyskinesias ; Humans ; Manometry* ; Sphincter of Oddi*