Endoscopic metal stent insertion has been widely performed to palliatively treat gastrointestinal (GI) tract obstruction in patients with cancer. The use of metal stents for benign strictures of the GI tract is increasing due to the low risk of major complications other than stent migration. The incidence of acute pancreatitis after placing a GI tract metal stent is rare. Herein, we report a case of acute pancreatitis caused by a covered metal stent that was initially inserted for a benign stricture of a gastroduodenal anastomosis that developed after the operation, then distally migrated, bent into a U-shape, and impacted into the second portion of the duodenum in a 56-year-old female who underwent a Billroth-I gastrectomy due to gastric cancer.
Constriction, Pathologic ; Duodenum ; Female ; Gastrectomy ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Incidence ; Middle Aged ; Pancreatitis ; Stents ; Stomach Neoplasms

Clinical heterotopic liver transplantation(HLT) has been carried out in the several institutions since 1962. Recently, Rotterdam group reported a successful clinical series of HLT in spite of several negative viewpoints against orthotopic liver transplantation. Among the successful HLT cases till now, several occurrences of hepatocellular carcinoma in the native liver had been reported. In the current study, a thirty percent liver was transplanted heterotopically in the dimethylnitrosoamine(DMN)-induced cirrhotic rats and the feasibility of host-hepatectomy after regeneration of the graft was tested, and we are going to introduce the concept of host liver resection(HR) to the clinical auxiliary liver transplantation. Of the thirty syngeneic partial HLT with portal blood input only, 16 rats died following transplantation and three rats dies after HR. The DMN-induced cirrhotic liver specimen showed a microscopic finding of nodular cirrhosis with thick intralobular fibrous septa. Grafts examined at three posttransplant weeks appeared architecturally normal and well regenerated and the atrophied host livers were small hard showing micronodularity on the surface. Of all the animals examined, no host liver tissues were regrowing after one month following near total HR. We conclude that HLT can be performed in the clinically relevant cirrhotic rats and HR is feasible after graft regeneration and expect that this experimental model can be used for the study of cirrhosis and HLT.
Animals ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatectomy* ; Liver Transplantation* ; Liver* ; Models, Theoretical ; Rats* ; Regeneration ; Transplants

PURPOSE:Preconditioning due to activation of AMPK might reduce ischemia-reperfusion (I/R) injury in the kidney, based on the key role of AMPK in preserving ATP. To evaluate this possibility, the effect of preconditioning with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), AMPK activator, before sustained ischemia was investigated. METHODS:Adult male Sprague-Dawley rats weighing approximately 220-250 g were used. To induce renal ischemia, a laparotomy was performed under ketamine and xylazine hydrochloride, and the blood supply to both kidneys was interrupted by placement of vessel clamps at the level of the renal pedicles. Reflow was initiated by removing the clamps. The following experimental groups were defined 1. Acute renal ischemia 0 sec, 10 min, 15 min, 2. AICAR treatment, 3. Sham group (S), 4. Ischemia/ Reperfusion group (I/R), 5. AICAR+I/R group (A+I/R), 6. AraA (Adenine-9-b-D-arabinofuranoside, an AMPK) inhibitor+AICAR+I/R group (AraA+A+I/R) RESULTS:There was only faint AMPK phosphorylation in the sham group. After 10 minutes of ischemia, or AICAR preconditioning however, Thr172 phosphorylation of AMPK was increased (p<0.05). The serum levels of BUN and creatinine were significantly decreased in AICAR preconditioning group (A+I/R). (128.0+/-7.33 mg/dL, 4.18+/-0.27 mg/dL vs. 90.2+/-11.13 mg/dL, 2.58+/-0.7 mg/dL, p<0.05), but these effects were attenuated by AMPK inhibitor, AraA (AraA+A+I/R group). In quantitative analysis of tubular injury, tubular injury score in AICAR preconditioning group significantly decreased (p<0.05). CONCLUSION:The AMPK activator AICAR has a protective effect against renal I/R injury.
Adenosine Triphosphate ; Aminoimidazole Carboxamide ; AMP-Activated Protein Kinases ; Creatinine ; Glycosaminoglycans ; Humans ; Ischemia ; Ketamine ; Kidney ; Laparotomy ; Male ; Phosphorylation ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Ribonucleotides ; Salicylamides ; Xylazine

We report a case of somatostatinoma, which manifested as insulinoma after liver metastasis. A 74-year-old man suffered from diabetes mellitus and jaundice. The abdominal CT scan of this patient showed a mass in the pancreas head, which obstructed biliary duct. He underwent Whipples procedure. Immunohistochemical staining of postoperative specimen disclosed that this tumor was strongly positive for somatostatin. After 4 months, follow up CT scan showed multiple metastatic lesions in the liver. We performed transarterial chemoinfusion two times, but the response was disappointing. After 2 months, he suffered from altered mentality, which was relieved by intake of sugar. Biochemical laboratory findings and immunohistochemical staining of liver biopsy disclosed that the metastatic lesion in this patient was insulinoma. We performed embolization of hepatic artery with gelform. The biochemical response was dramatic, but he died of septic shock, which was caused by gas forming liver abscess. In summary, we report a case of somatostatinoma which manifested as insulinoma after metastasis to the liver.
Aged ; Biopsy ; Diabetes Mellitus ; Follow-Up Studies ; Head ; Hepatic Artery ; Humans ; Insulinoma* ; Jaundice ; Liver Abscess ; Liver* ; Neoplasm Metastasis ; Pancreas ; Shock, Septic ; Somatostatin ; Somatostatinoma* ; Tomography, X-Ray Computed

Hemophagocytic syndrome is a rare syndrome characterized by fever, weight loss, profound pancytopenia, lymphadenopathy, hepatosplenomegaly and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissue. This syndrome can be associated with viral infections and lymphoid neoplasia, bacteria, fungus and drugs. Hyperproduction of cytokines, including interferon-gamma, tumor necrosis factor-alpha, may play a role in the pathogenesis of hemophagocytosis. Authors experienced a rare case of hemophagocytic syndrome associated with tuberculosis in a 40-year- old female who had undergone renal transplantation 12 years ago and received triple immunotherapy. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and clinical symptoms improved. Tuberculosis is a common infection in Korea. Therefore, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, hepatosplenomegaly and pancytopenia in immunosupressive patients.
Bacteria ; Biopsy ; Bone Marrow ; Cytokines ; Erythrocytes ; Female ; Fever ; Fever of Unknown Origin ; Fungi ; Humans ; Immunotherapy ; Interferon-gamma ; Kidney Transplantation ; Korea ; Leukocytes ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic* ; Macrophages ; Pancytopenia ; Transplantation* ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Weight Loss

BACKGROUND: Monocyte chemoattractant protein- 1 (MCP-1) is an important mediator for monocyte/ macrophage infiltration in various inflammatory renal diseases and is produced by renal cells. In the process of renal diseases, endothelin-1 (ET-1) is known to play an active role in cell growth, inflammation and fibrosis. The aim of this study was to investigate whether three isoforms of endothelin regulate MCP-1 expression in cultured mesangial cells. METHODS: Mesangial cells were incubated with or without various doses of ET-1, ET-2 or ET-3. To determine the monocyte chemotactic activity, chemotaxis assay was performed in modified Boyden chambers using freshly isolated human monocytes. MCP-1 mRNA expression in mesangial cells was measured by Northern blot analysis. RESULTS: ET-1, ET-2 and ET-3 stimulated monocyte chemotactic activity released from mesangial cells in a dose-dependent manner. ET-1, ET-2 and ET-3 also stimulated MCP-1 mRNA expression in a time-dependent manner, which was seen as early as 4 hours and was maintained up to 24 hours. CONCLUSION: These data suggest that ET-1, ET- 2 and ET-3 stimulate MCP-1 expression in mesangial cells and may contribute to the monocyte/ macrophage infiltration in inflammatory renal diseases.
Animals ; Blotting, Northern ; Chemokine CCL2* ; Chemotaxis ; Endothelin-1* ; Endothelin-2* ; Endothelin-3* ; Endothelins ; Fibrosis ; Humans ; Inflammation ; Macrophages ; Mesangial Cells* ; Monocytes* ; Protein Isoforms ; Rats* ; RNA, Messenger

The hemolytic uremic syndrome (HUS) is clinically characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The unique cause has not been determined but some bacteria such as E. coli was regarded as the causative agent of HUS in infant. A 30-year-old male patient was admitted due to acute abdomen. In operating field, the periappendiceal abscess was found, so the appendectomy with the drainage of abscess was performed. Initial hemoglobin level was 16.2g/dL but abruptly developed anemia (12.6g/dL) and thrombocytopenia (27000/mm3) was detected at hospital day 3. The urinary outflow was totally absent, the serum creatinine was 12.8mg/dL and the LDH was 3,650IU/L. The peripheral blood smear showed strong evidence of microangiopathic hemolysis. We performed total plasma exchange and hemodialysis under the diagnosis of HUS. The patient's renal function was markedly improved and the last creatinine was 1.9mg/dl. To our knowledge, this is the first report of HUS associated with periappendiceal abscess in Korea. We present a case and the review of literature.
Abdomen, Acute ; Abscess* ; Acute Kidney Injury ; Adult ; Anemia ; Anemia, Hemolytic ; Appendectomy ; Bacteria ; Creatinine ; Diagnosis ; Drainage ; Hemolysis ; Hemolytic-Uremic Syndrome* ; Humans ; Infant ; Korea ; Male ; Plasma Exchange ; Renal Dialysis ; Thrombocytopenia

A persistent left superior vena cava(SVC) is found in about 0.3% of healthy individuals and 4.3% of patients with congenital heart disease. This anomaly is most frequently found in conjunction with a right-sided SVC, but may also be solitary. Recently, we experienced a case of persistent left SVC in patient with chronic renal failure. He required subclavian catheterization for hemodialysis due to leakage of peritoneal dialysate into external genitalia and pleural cavity. Because he had had a history of right subclavian catheterization for hemodialysis 3 months ago, the hemodialysis catheter was inserted in the left subclavian vein without any complication. Chest X-ray after insertion of the catheter showed that the distal tip of the catheter seemed to be within the aorta. Venography showed that the catheter was located within the left SVC and MRI showed isolated two SVC. He is receiving hemodialysis through the left subclavian catheter which is positioned within the left SVC without any problem.
Aorta ; Catheterization ; Catheters* ; Genitalia ; Heart Defects, Congenital ; Humans ; Kidney Failure, Chronic* ; Magnetic Resonance Imaging ; Phlebography ; Pleural Cavity ; Renal Dialysis* ; Subclavian Vein ; Thorax ; Vena Cava, Superior*

A 33-year-old man was admitted with macroscopic hematuria and systemic edema appearing after an acute upper respiratory tract infection. On admission, hypertension, nephrotic syndrome were evident together with a decreased renal function. Renal biopsy showed markedly increased mesangial cells acompanied with increase of endocapillary cells including neutrophils. Immunofluorescence microscopy showed granular deposits of C3 and IgA. Electron Microscopy revealed so-called "hump" on the subepithelial area. These features were consistent with the coexistence of IgA nephropathy (IgAN) and post-infectious glomerulonephritis. It is not clear about the prognosis and the therapeutic regimen in the patient who develop above situation. Although the patient showed still persistent proteinuria, high dose steroid therapy was probably useful for improving the disease.
Adult ; Biopsy ; Edema ; Glomerulonephritis* ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Mesangial Cells ; Microscopy, Electron ; Microscopy, Fluorescence ; Nephrotic Syndrome ; Neutrophils ; Prognosis ; Proteinuria ; Respiratory Tract Infections

BACKGROUND: Monocyte chemoattractant protein- 1 (MCP-1) is produced by renal cells and an important mediator for monocyte/macrophage infiltration in various inflammatory renal diseases. In the process of renal disease, endothelin-1 is known to play an active role in cell growth, inflammation and fibrosis. The aim of this study was to investigate whether endothelin-1 regulates MCP-1 expression in cultured human proximal tubular epithelial cells. METHODS: Primary cultured human proximal tubular epithelial cells (PTEC) were incubated with or without various dose of endothelin-1. MCP-1 concentration in PTEC conditioned medium was measured by sandwich ELISA. MCP-1 mRNA expression was analyzed by Northern blotting. The NF-kB or AP-1 activity in response to endothelin-1 was measured by electrophoretic mobility shift assay. RESULTS: Endothelin-1 (10(-7) M) stimulated MCP- 1 production in PTEC, which was significant at 48 hours and various doses of endothelin-1 (10(-8)-10(-6) M) increased MCP-1 production from PTEC in a dose-dependent manner. Northern blot analysis revealed that endothelin-1 stimulated MCP-1 mRNA expression. Endothelin-1 (10(-7) M) stimulated both AP-1 binding activity and NF-kB binding activity up to 8 hour. Supershift analysis showed that p65 and p50 are major NF-kB subunit bound to the DNA probe and that c-Fos and c-Jun are major AP-1 subunit bound to the DNA probe. CONCLUSION: Our results suggest that endothelin- 1 may stimulate MCP-1 expression in proximal tubular epithelial cells through the activation of NF- kB and AP-1 binding activity.
Blotting, Northern ; Chemokine CCL2* ; Culture Media, Conditioned ; DNA ; Electrophoretic Mobility Shift Assay ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Fibrosis ; Humans* ; Inflammation ; Monocytes* ; NF-kappa B ; RNA, Messenger ; Transcription Factor AP-1