Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29.year.old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC
Colitis, Ulcerative ; Colon ; Duodenitis ; Duodenum ; Humans ; Incidence ; Inflammation ; Mucous Membrane ; Rectum ; Stomach ; Ulcer

The term of giant hydronephrosis in adults, is applied when the collecting system contains more than 1,000 mL of fluid. The commonest cause of asymptomatic giant hydronephrosis in early adult life is congenital ureteropelvic stenosis. Giant hydronephrosis in adults is uncommon and often clinically misdiagnosed, because clinical characteristics are vague and generalized symptom. We presented a giant hydronephrosis associated with ureter stricture on 31 years old male.
Adult* ; Constriction, Pathologic ; Humans ; Hydronephrosis* ; Male ; Ureter

BACKGROUND/AIMS: Renal dysfunction commonly develops in patients with established liver disease. The assessment of renal function is of clinical importance in patients with cirrhosis and ascites. Renal function indices such as glomerular filtration rate and the plasma renin activity (PRA) could be better predictors of survival than the parameters usually used to estimate liver function including Child-Pugh score. This study was designed to find whether renal function indices are useful in determining the prognosis concerned with the survival of patients with liver cirrhosis. METHODS: A total of 110 patients was selected and followed for 89 weeks. As indices reflecting renal function, creatinine clearance rate, PRA, aldosterone concentration, and the pulsatility index (PI) and resistive index (RI) by Doppler ultrasonography were measured. The prognostic values of these indices were determined by comparison and analysis according to survival or death of the patients. For the statistics, univariate and multivariate analysis was done. RESULTS: Child-Pugh score (> or =10), creatinine clearance rate (<80 mL/min), plasma alodosterone concentration (> or =15 ng/dL), PRA (> or =8 ng/mL/hr), renal PI (> or =1.15) and RI (> or =0.7) were prognostic indicators in univariate analysis (p<0.05). Multivariate analysis disclosed two independent survival predictors of creatinine clearance rate (<80 mL/min) (OR:5.37, 95% CI: 2.09-13.82) and plasma aldosterone concentration (> or =15 ng/dL) (OR: 3.65, 95% CI: 1.09-12.18). CONCLUSION: Various renal function indices are closely related to the survival of patients with liver cirrhosis. Creatinine clearance rate and plasma aldosterone concentration are especially important prognostic factors in predicting the survival of patients with liver cirrhosis.
Aldosterone ; Ascites ; Creatinine ; Fibrosis ; Glomerular Filtration Rate ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Multivariate Analysis ; Plasma ; Prognosis* ; Renin ; Ultrasonography, Doppler

BACKGROUND/AIMS: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. METHODS: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. RESULTS: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. CONCLUSIONS: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension.
Ascites ; Hemorrhage ; Hepatic Encephalopathy ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Prospective Studies ; Renal Artery ; Ultrasonography, Doppler ; Venous Pressure

BACKGROUND: Several studies have shown in animal models that remote ischemic preconditioning (rIPC) has a neuroprotective effect. However, a randomized controlled trial in human subjects to investigate the neuroprotective effect of rIPC after cardiac surgery has not yet been reported. Therefore, we performed this pilot study to determine whether rIPC reduced the occurrence of postoperative cognitive dysfunction in patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery. METHODS: Seventy patients who underwent OPCAB surgery were assigned to either the control or the rIPC group using a computer-generated randomization table. The application of rIPC consisted of four cycles of 5 min ischemia and 5 min reperfusion on an upper limb using a blood pressure cuff inflating 200 mmHg before coronary artery anastomosis. The cognitive function tests were performed one day before surgery and again on postoperative day 7. We defined postoperative cognitive dysfunction as decreased postoperative test values more than 20% of the baseline values in more than two of the six cognitive function tests that were performed. RESULTS: In the cognitive function tests, there were no significant differences in the results obtained during the preoperative and postoperative periods for all tests and there were no mean differences observed in the preoperative and postoperative scores. The incidences of postoperative cognitive dysfunction in the control and rIPC groups were 28.6% (10 patients) and 31.4% (11 patients), respectively. CONCLUSIONS: rIPC did not reduce the incidence of postoperative cognitive dysfunction after OPCAB surgery during the immediate postoperative period.
Blood Pressure ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Humans ; Incidence ; Ischemia ; Ischemic Preconditioning* ; Models, Animal ; Neuroprotective Agents ; Pilot Projects* ; Postoperative Period ; Random Allocation ; Reperfusion ; Thoracic Surgery ; Transplants* ; Upper Extremity

BACKGROUNDS/AIMS: Doppler ultrasongraphy is used to evaluate hemodynamic alternations in patients with liver cirrhosis. Purpose of this study was to determine the interequipment variability of Doppler indices in portal and splenic vein in cirrhosis. METHODS: Blood velocity, diameter, flow and congestive index in portal and splenic vein were measured by Doppler ultrasonography in 30 patients with cirrhosis using two different machines. RESULTS: Portal venous velocities measured by HDI-5000 and SSD-5000 were 8.72+/-3.69 cm/sec, 12.21+/-2.84 cm/sec, respectively which showed significant difference (P<0.001). Measured portal blood flows and congestive indices also had significant difference between HDI-5000 and SSD-5000 (P<0.01). Splenic venous velocity by HDI-5000 was 8.55+/-2.71 cm/sec, which was lower than that of 12.32+/-3.11 cm/sec by SSD-5000 (P<0.001). Splenic blood flows measured by HDI-5000 and SSD-5000 were 390.73+/-260.98 mL/min, 595.01+/-346.53 mL/min, respectively, showing significant difference (P=0.015). However, no differences were in the diameters of portal and splenic vein between HDI-5000 and SSD-5000. CONCLUSION: Doppler indices in portal and splenic vein showed significant interequipment variability. Therefore, in liver cirrhosis, hemodynamic investigations using different Doppler ultrasonographic machines is inappropriate.
Adult ; Aged ; Blood Flow Velocity ; Female ; Humans ; Liver Cirrhosis/*ultrasonography ; Male ; Middle Aged ; Ultrasonography, Doppler/*instrumentation

BACKGROUNDS AND AIMS: Angiotensin receptors are found on hepatic stellate cells, which participate in hepatic fibrosis. Therefore, it is presumed that angiotensin has a role in hepatic fibrosis. The aim of this study was to evaluate the effects of angiotensin blockade on inhibition of hepatic fibrosis in cirrhotic rat model. Material and METHODS: Cirrhosis with portal hypertension was produced by common bile duct ligation (BDL) in the adult Sprague-Dawley rats. They were classified into 4 groups (each group n=6) as follows; G1: BDL without drug, G2: BDL+captopril 100 mg/kg/day beginning 2 weeks after BDL, G3: BDL+captopril 100 mg/kg/day, starting just after BDL, G4: BDL+losartan 10 mg/kg/day, starting just after BDL. After 4 weeks following BDL, hepatic fibrosis was histomorphologically analyzed by Batts & Ludwig score. Alpha smooth muscle actin by immunohistochemical stain, hydroxyproline contents of liver tissue by spectrophotometry and expression of collagen, procollagen, and TGF-beta by real-time PCR were measured. RESULTS: Batts & Ludwig score were 3.8, 3.0, 2.6,and 2.6 in G1, G2, G3, and G4, respectively. The expression of alpha-SMA was significantly lower in G3 and G4 than in G1; 11.9%, 10.9%, 2.6%, and 1.1% in G1, G2, G3, and G4, respectively (p<0.05). The concentration of hydroxyproline (microgram/g liver tissue) was lower in G3 and G4 compared with G1 (p<0.05). Also, the administration of angiotensin blockade just after BDL significantly reduced the expression of collagen, procollagen, and TGF-beta mRNA. CONCLUSIONS: Angiotensin blockades are effective in the prevention of hepatic fibrosis in BDL rats.
Actins/metabolism ; Angiotensin II Type 1 Receptor Blockers/administration & dosage/*therapeutic use ; Animals ; Bile Ducts/pathology/surgery ; Captopril/administration & dosage/*therapeutic use ; Fibrosis ; Hydroxyproline/metabolism ; Ligation ; Liver/drug effects/metabolism/pathology ; Liver Cirrhosis, Experimental/*drug therapy/etiology/metabolism ; Losartan/administration & dosage/*therapeutic use ; Male ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta/metabolism

Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl ). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and gamma-GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patient's symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a few lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug-induced hepatitis was diagnosed with a typical clinical course; the exclusion of all possible causes of acute hepatic dysfunction; and a positive response to accidental readministration of drug. We report this case with a review of the literature.
Adult ; Alkaline Phosphatase ; Asthma ; Bilirubin ; Biopsy ; Cholestasis ; Drug-Induced Liver Injury ; Eosinophils ; Hepatitis* ; Hepatitis, Autoimmune ; Humans ; Internal Medicine ; Jaundice ; Liver ; Liver Function Tests ; Lymphocytes ; Pruritus ; Pulmonary Disease, Chronic Obstructive ; Theophylline