The prognosis of hilar cholangiocarcinoma is very poor due to its location and complicated anatomical characteristics. The bile duct cancer arising in the hilum easily invades the vascular structures and spreads along the bile duct. Complete curation could only be expected when curative resection of the hilar cholangiocarcinoma had been achieved. For the operability to be decided, the evaluation of longitudinal and vertical tumor extensions are important. Preoperative endoscopic staging work-up could be performed using endoscopic retrograde cholangiography (ERC), choledochoscopy, endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS). ERC and choledochoscopic examinations have an advantage that these could take biopsy specimens. However ERC is not superior to either magnetic resonance cholangiography or percutaneous transhepatic cholangiography to make a better evaluation of the extent of the disease. Major problem of ERC is procedure-induced cholangitis, especially in Bismuth-Corlette type III and IV hilar cholangiocarcinoma. Percutaneous transhepatic choledochoscopic examination has an advantage that the stricture site could be examined directly with the availability of biopsy specimens. The diagnostic accuracy rates are different according to the morphological types of cholangiocarcinoma. EUS or IDUS could provide an information about the nodal involvement, the relationship with portal vein and the vertical extension of bile duct cancer. However, further study about the usefulness of EUS or IDUS would be needed in hilar cholangiocarcinoma. Above mentioned endoscopic examinations could be of help to decide the proximal margin of hilar cholangiocarcinoma. Each examination has its own limitations and advantages. Therefore appropriate combination of diagnostic modalities could be helpful to decide the best treatment option.
Bile Duct Neoplasms/*diagnosis ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis ; Cholangiopancreatography, Endoscopic Retrograde ; *Endoscopy, Digestive System ; Endosonography ; Humans

Chronic pancreatitis is an ongoing inflammatory disorder characterized by irreversible destruction of the pancreas associated with disabling chronic pain and permanent loss of exocrine and endocrine function. Fibrosis and loss of acinar cell mass in the pancreas are characteristic findings in chronic pancreatitis, and pancreatic fibrosis is suggested to contribute to the irreversibility of the disease Over the past several decades, several theories have emerged to explain the pathogenesis and evolution of pancreatitis. These models provide conceptual frameworks that are not mutually exclusive, but at times are mutually contradictory. The role of pancreatic fibrogenesis in response to various forms of pancreatic injury and the relationship of fibrogenesis in response to the progression from acute to chronic form is emphasized within the sentinel acute pancreatitis event (SAPE) model of chronic pancreatitis. Studies on pancreatic fibrogenesis have been given new impetus, largely because of the identification and characterization of stellate-shaped cells in the pancreas. In the normal pancreas, pancreatic stellate cells (PSC) exist in a quiescent state. However in pancreatic injury, the PSCs are activated so that they exhibit increased proliferation, transformation onto myofibroblast-like cells and synthesize increased amounts of the extracellular matrix proteins that form fibrous tissues. Therefore, the PSCs have a central role in pancreatic fibrogenesis. Over the past several decades, the pathogenesis of chronic pancreatitis has been studied. However, the pathogenesis of chronic pancreatitis is unclear. Therefore, further studies would be needed to clarify the pathogenesis of chronic pancreatitis..
Acinar Cells ; Chronic Pain ; Extracellular Matrix Proteins ; Fibrosis ; Pancreas ; Pancreatic Stellate Cells ; Pancreatitis ; Pancreatitis, Chronic*

We have experienced a case of occult hepatocellular carcinoma metastasized to the heart in a 41 year old female. The hepatocellular carcinoma invaded the hepatic vein, grew in a snakelike fashion up the inferior vena cava and reached the right atrium. Ultrastural examination in this case confirmed the hepatocellular origin of the tumor.
Female ; Humans ; Carcinoma, Hepatocellular

Endoscopic therapy has been increasingly recognized as the effective therapy in selected patients with chronic pancreatitis. Utility of endotherapy in various conditions occurring in chronic pancreatitis is discussed. Its efficacy, limitations, and alternatives are addressed. For the best management of these complex entities, a multidisciplinary approach involving expertise in all pancreatic specialties is essential to achieve the goal.
Bile Ducts/surgery ; Enteral Nutrition ; Humans ; Pancreatic Ducts/surgery ; Pancreatic Pseudocyst/surgery ; Pancreatitis, Chronic/*surgery ; Sphincterotomy, Endoscopic/*methods ; Stents

PURPOSE: Recently, analytical studies of the various parameters of rectoanal inhibitory reflex were reported and revealed that many of the parameters showed significant differences according to the anal continence function. The standardization of these studies is, however, not yet sufficient enough to apply to use those parameters in reflex test for clinical practice. The aim of this study was to check how the parameters react differently to various degrees of rectal distention and to determine the efficacy of each parameter in clinical applications of rectoanal inhibitory reflex. METHODS: Thirty-two subjects underwent repeated manometries for rectoanal inhibitory reflex with different volumes (40, 60, 80 cc) of rectal ballooning. Latencies, amplitudes, slopes, durations, and areas under the reflex curves of the reflexes were measured, and the differences among them according to the ballooning volume in each subject were analyzed statistically. RESULTS: The area under reflex curve, the amplitude, the duration, and the slope did not differ statistically with the ballooning volume (P values were 0.3959, 0.2142, 0.2080, 0.1453, respectively, by repeated measures two way ANOVA). However, the latencies did differ significantly (P=0.0131). CONCLUSIONS: Most of the parameters except latency were stable against different volumes of rectal ballooning. Among the stable parameters, the area under the reflex curve seemed to be the most useful in clinical applications of rectoanal inhibitory reflex.
Manometry ; Reflex*

Arotinolol, a now alpha and beta bloking agent, was administered orally in 32 hypertensive patients for 8 weeks in order to evaluate the antihypertensive effects and side effects. The doses were from 20mg to 30mg a day. The serum chemistries and chest X-ray were taken before and after Arotinolol administration. The results were as follows; 1) Blood pressure which was measured in sitting, supine and standing position was 176.37+/-4.73/116.54+/-4.34, 170.14+/-5.35/103.12+/-3.67, 156.37+/-7.54/104.31+/-3.34mmHg in control and 144.63+/-2.78/94.41+/-2.87, 146.47+/-5.41/89.12+/-4.34, 140.71+/-4.47/89.73+/-3.71mmHg in the treatment group. The differences between both blood pressure were statistically significant(P<0.001). 2) There was no significant change in pulse rate before and after medication. 3) There was no significant change in the laboratory findings such as CTR, GOT, GPT, alkaline phosphatase, CPK, creatinine, BUN, uric acid, cholesterol, fasting blood sugar and triglyceride before and after treatment. 4) The side effects of arotinolol were observed in 6 of 32 cases(18.7%), which were not required discontinuing the medication or decreasing the dose.
Alkaline Phosphatase ; Blood Glucose ; Blood Pressure ; Cholesterol ; Creatinine ; Fasting ; Heart Rate ; Humans ; Hypertension ; Thorax ; Triglycerides ; Uric Acid

C-fos protein is a gene regulatory third messenger involved in long-term responses of cells to various stimuli. Kainic acid(KA), a powerful excitatory analogue, induces seizures and damages the hippocampus and other limbic regions in rats. KA treatment induces c-fos protein production in the hippocampus. This study was undertaken to investigate the expression of c-fos protein in the hippocampus according to seizure stage induced by systemic injection of KA. Twenty-three adult male Sprague-Dawley rats experienced convulsions by a single intraperitoneal injection of convulsive dose (20-40 mg/Kg) of KA. Seven control rats received normal saline. Animals were sacrificed 3 hr after KA treatment. The expression of c-fos protein was tested in the hippocampus by immunohistochemical staining using polyclonal anti-Fos. Most of the rats exhibited limbic motor epileptic activity. C-fos protein immunoreactivity increased in the CA1, CA3 and dentate gyrus at stage 1-2, and not only in the CA1, CA3 and dentate gyrus but also in the CA4 at stage 3-4. At stage 5, c-fos protein immunoreactivity increased in all areas of the hippocampus. C-fos protein immunoreactivity increased progressively with increasing severity of convulsions. These results show that KA produces limbic motor seizure associated with a rise in the c-fos protein in the hippocampus, and that the expression of c-fos protein may has some relevance to the progressive and permanent brain changes occurring during epilepsy.
Adult ; Animals ; Brain ; Dentate Gyrus ; Epilepsy ; Genes, vif ; Hippocampus* ; Humans ; Injections, Intraperitoneal ; Male ; Rats* ; Rats, Sprague-Dawley ; Seizures*

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*