The purpose of this study was to investigate the morphologic changes of the bile canaliculi and its associated structures of the liver induced by common bile duct ligation(CBDL) in the rat. The canalicular surface and lateral surface of the dry-fractured hepatocytes was studied with scanning electron microscopy at 1~6 weeks post ligation. The first week after CBDL, the bile canaliculi were dilated. The microvilli were increased in number and the lumens contained granular materials After 2 weeks or more, the bile canaliculi were dilated to a variable degree, and with irregularity, measuring from 1.5 to 5 micrometer in diameter, and in the advanced stage, the canaliculi showed blunting and the disappearance of microvilli. Some canaliculi had sprouting side branches. At 4~6 weeks post-ligation, the lateral surface of the hepatocytes also showed some irregularity and a tortuous appearance, and numerous small sized microvillous projections were formed. The tubular structures of the proliferated SER distributed adjacent to the lateral surface of the hepatocytes, and the direct connection of a tubular structure and the cytoplasmic membrane was observed. These results suggest that the deformity and loss of microvilli of bile canaliculi reflect the disturbance of bile secretion from the hepatocytes. And prolonged obstruction of bile flow may result in bile excretion via the lateral surface of hepatocytes.
Rats ; Animals

BACKGROUND: The protease inhibitor aprotinin reduces blood loss and homologous blood usage after a cardiac operation. The aim of the present study was to investigate the effect of low- and high-dose aprotinin on thromboelastography (TEG) variables and to examine the relationship between the clinical effect of aprotinin and the TEG variables in coronary artery bypass grafting surgery (CABG). METHODS: Twenty-three patients scheduled for an elective CABG were randomly assigned to receive either high does (group H, n = 12) or low does (group L, n = 11) aprotinin. TEG variables, and a coagulation profile test at baseline and arrival in ICU were performed. Amount of blood loss, homologous blood transfusion and heparin requirements were measured. RESULTS: In group L, there were significant increases in r time and k time and significant decreases in MA and alpha angle after aprotinin administration. In group H, just k time after aprotinin administration was significantly increased compared with baseline data. There were no significant differences in amount of blood loss and allogenic blood transfusions between the two groups. There was not a significant correlation between TEG variables and amount of blood loss in both groups. Interestingly a siginificant negative correlation between the length of cardiopulmonary bypass and MA was noted in group H (r = -0.63; P < 0.05). CONCLUSIONS: In CABG patients, aprotinin preserves platelet function more significantly in the high-dose aprotinin group. In addition, TEG variables indicated a later clot formation in the low dose aprotinin group.
Aprotinin* ; Blood Platelets ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Heparin ; Humans ; Protease Inhibitors ; Thrombelastography*

BACKGROUND: Dendritic cells (DCs) play an important role in immune reactions. This study was designed to identify the distribution patterns of DCs and regulatory T-cells (Tregs) in cutaneous lymphomas. METHODS: Immunohistochemistry was used to determine langerin expression on Langerhans cells, CD11b on inflammatory DCs, CD209 and CD11c on dermal DCs, CD303 on plasmacytic DCs, and Foxp3 on Tregs in 81 cases of cutaneous lymphomas. RESULTS: Various DCs and Tregs were identified in most cutaneous lymphomas. Plasmacytic DCs, inflammatory DCs and Tregs were identified mainly in tumor areas, whereas dermal DCs were distributed both in the tumor and stromal areas. Among DCs, dermal DCs were most prominently identified in the cutaneous lymphomas not only in the tumor area but also in the stroma. The intense stromal infiltration of dermal DCs was consistent finding in T-cell lymphomas. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified also showed intense stromal infiltration of dermal DCs, but stromal infiltration in DLBCL, leg type was relatively scant. CONCLUSIONS: The results suggest that all types of DCs and Tregs are involved in cutaneous lymphoma tumor immunity. Among them dermal DCs may play a dominant role.
Dendritic Cells ; Immunohistochemistry ; Langerhans Cells ; Leg ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; T-Lymphocytes, Regulatory

We experienced a case of eisenmenger syndrome treated by simple surgical intervention. Eisenmenger syndrome refers to patients with congenital heart defects who have a systemic level of pulmonary arterial pressure and high pulmonary vascular resistance, with right-to-left or bidirectional shunting. Because a progressive rise in pulmonary vascular resistance may be better tolerated with an intracardiac communication, surgical repair in such patients may shorthen their life. But, urgent surgical intervention should be undertaken to reverse process if the pulmonary vascular disease is of recent origin. Patients who respond to vasoilator therapy, such as oxygen, are subjected to surgery. We reported a case of PDA with eisenmenger syndrome whose pulmonary vascular resistance fall following vasodilator, 100% oxygen, and closure of defect during cardiac catheterization, preoperatively, and who may faborable after simple surgical repair.
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent* ; Eisenmenger Complex* ; Heart Defects, Congenital ; Humans ; Ligation* ; Oxygen ; Vascular Diseases ; Vascular Resistance

Background: Remifentanil can be used as adjuvants during remimazolam induction without neuromuscular blockade. We evaluated the 95% effective concentration (EC) of remifentanil effect-site concentration (Ce) for the successful insertion of an i-gel using the biased-coin up-and-down method in adult patients during remimazolam induction. Methods: Forty 19–65 year-old patients scheduled to undergo surgery using i-gel were enrolled. Anesthesia was induced using remimazolam infusion (12 mg/kg/h). Simultaneously, remifentanil was infused at a predetermined Ce. After 5 min of anesthesia induction, the i-gel was inserted. The 95% EC (EC95) of remifentanil in each patient was determined using a biased-coin up-and-down method based on a successful insertion in a preceding patient. The step size of remifentanil Ce was 0.4 ng/ml. If the insertion failed, remifentanil Ce was increased in the next patient. Following successful insertions, the corresponding concentration decreased in subsequent patients with a probability of 1/19 or was maintained with a probability of 18/19. The time from remimazolam infusion initiation to a bispectral index (BIS) < 60 (time to BIS60) and hemodynamic variables were measured and recorded. Results: The EC95 (95% CI) of Ce was 2.07 (1.94, 2.87) ng/ml. The overall time to BIS60 was 154.0 ± 39.9 s. No patient experienced significant hypotension or bradycardia during remimazolam induction. Conclusions The EC95 of remifentanil Ce was 2.07 (1.94, 2.87) ng/ml for successful i-gel insertion during remimazolam induction at 12 mg/kg/h without hemodynamic instability in adult patients. Future studies should measure remifentanil Ce in elderly patients or using remimazolam at various infusion doses.

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) occasionally fails due to surgically altered anatomy, difficult cannulation, or poor general condition. This study evaluated the safety and effectiveness of percutaneous transhepatic papillary balloon dilatation (PTPBD) for managing extrahepatic bile duct stones. METHODS: Between 2001 and 2010, 17 out of 509 patients with extrahepatic bile duct stones and acute cholangitis were enrolled retrospectively. After PTPBD of the sphincter, the stones were extracted using an occlusion balloon to push the stone over a guidewire into the duodenum. The procedure success was evaluated based on residual stones. In addition, the size and number of stones and complications were analyzed. RESULTS: Of the 17 patients, nine had a previous gastrectomy, four had poor general condition, and four had unsuccessful cannulation. The stone diameter ranged from 8 to 25 mm. Seven, five, and five patients had one, two, or three or more stones, respectively. The results were successful in 16 out of 17 patients, with no residual stones. Treatment failed in one patient, who was then treated with the rendezvous technique with endoscopy. No procedure-related major complication occurred. Three patients had mild transient elevations of the serum amylase levels. CONCLUSIONS: PTPBD was safe and effective for managing extrahepatic bile duct stones in patients with unsuccessful or contraindicated ERCP.
Amylases ; Bile Ducts, Extrahepatic ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Dilatation ; Duodenum ; Endoscopy ; Gastrectomy ; Humans ; Retrospective Studies

Carcinoid tumors originate from the enterochromaffin cells that are located in the gastrointestinal mucosa. Most of these tumors are asymptomatic and gastric carcinoid with massive gastrointestinal bleeding is found rarely. We experienced a case of gastric carcinoid admitted to our hospital due to melena and dizziness. The esophagogastroduodenoscopic examination revealed an ulcerofungating mass in the lower body which was thought to be a Borrmann type III adenocarcinoma. Microscopic examination of the biopsy specimens showed benign gastric ulcer without malignant cells. Repeated endoscopic biopsy revealed the same results. A computed tomographic scan of the abdomen showed a gastric mass with multiple perigastric enlarged lymph nodes. Histopathological examination of the operative specimen showed gastric carcinoid. We report a case of gastric carcinoid with massive bleeding mimicking advanced gastric cancer.
Abdomen ; Adenocarcinoma ; Biopsy ; Carcinoid Tumor* ; Dizziness ; Enterochromaffin Cells ; Hemorrhage* ; Lymph Nodes ; Melena ; Mucous Membrane ; Stomach Neoplasms ; Stomach Ulcer

We report herein a case of intestinal amyloidosis with grave prognosis that caused intractable diarrhea and intestinal pseudo-obstruction, alternately in spite of intensive conservative treatment. A 44-year-old woman was admitted for fever, diarrhea, and crampy abdominal pain which had been continuned during 6 months. Abdomen CT scan showed edematous wall thickening of the small bowel and right colon, and colonoscopic biopsy revealed amyloid deposition in the mucosa. Monoclonal light chains in serum and/or urine were not detected and highly elevated serum amyloid A was shown. In spite of intensive treatment including oral prednisolone and colchicine, diarrhea and intestinal pseudo-obstruction developed alternately, general status rapidly got worsened and died after two months.
Administration, Oral ; Adult ; Amyloidosis/complications/*diagnosis/drug therapy ; Anti-Inflammatory Agents/therapeutic use ; Colchicine/therapeutic use ; Colonoscopy ; Diarrhea/*etiology ; Female ; Humans ; Intestinal Mucosa/pathology ; Intestinal Pseudo-Obstruction/*diagnosis/etiology ; Prednisolone/therapeutic use ; Serum Amyloid A Protein/metabolism ; Tomography, X-Ray Computed ; Tubulin Modulators/therapeutic use

BACKGROUND: Arterial stiffness is a strong indicator of cardiovascular risk. Increased visceral fat confers greater risks of metabolic syndrome and cardiovascular events. The aim of this study was to elucidate the relationships between arterial stiffness and regional distribution of abdominal adiposity (i.e. subcutaneous and visceral adipose tissue). METHODS: Thirty obese participants (M:F=17:13, mean age=53.6+/-12.0 years) underwent anthropometric measurements, laboratory procedures such as serum lipid levels and abdominal computed tomography scan. The aortofemoral pulse wave velocity was measured by foot to foot method using two continuous Doppler waves. RESULTS: Pulse wave velocity was positively associated with age, hip circumference (P<0.01), visceral to subcutaneous abdominal fat ratio and body weight (P<0.05), but independent of the total abdominal, visceral, and subcutanous fat. Although not positively associated, the mean pulse wave velocity tended to be higher in patients with history of hypertension or diabetes. CONCLUSIONS: The site of abdominal fat distribution contribute to the prediction of arterial stiffness and visceral adiposity is associated with increased risk of cardiovascular events.
Abdominal Fat ; Adiposity* ; Body Weight ; Foot ; Hip ; Humans ; Hypertension ; Intra-Abdominal Fat ; Methods ; Pulse Wave Analysis ; Vascular Stiffness*

OBJECTIVES: We evaluated nailfold capillary abnormalities in patients with hand-arm vibration syndrome using nailfold capillary microscopy. METHODS: Fifty workers who underwent a special health examination because of exposure to hand-arm vibration at Ulsan University Hospital in 2012 (exposed group) and a control group of 50 white-collar employees were evaluated through a questionnaire survey regarding their present tasks, types of tools used, vibration exposure duration, use of protective wear, and medical history. Then, an occupational physician performed a physical examination for any hand deformities, skin problems, or motor and sensory dysfunctions of the upper extremities. The nailfold capillary morphologies (tortuous, crossing, bushy, meandering, branching, hemorrhage, avascular area, enlarged, and giant), capillary dimensions (afferent, top, venous, total width, and length), and specific counts (crossing and branching) on both fourth fingers were determined by a rheumatologist. Thereafter, the exposed subjects were assessed according to the Stockholm workshop classification scale. In total, 8 and 6 subjects in the exposed and control groups, respectively, were excluded from the study because of poor capillary microscopic image quality. In addition, 24 subjects in the exposed group with Stockholm vascular stage 0 were excluded. Finally, capillary morphology, dimensions, and specific counting were compared between the exposed (n = 18) and control groups (n = 44). RESULTS: The exposed group had significantly greater crossing capillaries and abnormal capillary numbers that included crossing capillaries (crossing, branching, bushy, and meandering) but smaller branching and abnormal capillary numbers that excluded crossing capillaries (branching, bushy, and meandering) than the control group did. No significant difference in capillary dimensions was observed between the two groups. Despite the adjustment for age, smoking status, and underlying diseases, the statistical significance was unchanged. In the specific counting of the type of capillaries, the exposed group had a significantly higher total crossing count but fewer total branching count than the control group did. However, no statistical significance resulted after adjustment for age, smoking status, and underlying diseases. CONCLUSIONS: In this study, the exposed group had significantly more crossing capillaries and a higher crossing count than the control group did.
Capillaries* ; Classification ; Education ; Fingers ; Hand Deformities ; Hand-Arm Vibration Syndrome* ; Hemorrhage ; Humans ; Microscopy* ; Physical Examination ; Skin ; Smoke ; Smoking ; Ulsan ; Upper Extremity ; Vibration