PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard procedure for gallbladder disease. LC is associated with bile duct injury, which can cause serious complications. We evaluate the treatment, results and the relation with cholangiopancreatography for bile duct injury during LC. METHODS: 860 cases of LC were performed from April 2000 to August 2005. Among them, 7 cases of bile duct injury were reviewed for the diagnosis, management and operation findings. RESULTS: According to the Strasberg classification, there were 5 cases of type E, 1 case of type C and 1 case of type D. All of them were identified at operation and they were immediately managed. Among the type E cases, the type E1 was managed by CBD end-to-end anastomosis with internal drainage, type the E2 and type E3 were managed by Roux-en-Y hepaticojejunostomy, the type C were managed by primary repair with T-tube drainage and the type D were managed by primary repair. Although all of cases were visible at the cystic duct on preoperative cholangiopancreatography, we could not identify the type E on the operation findings. CONCLUSION: In this study, although the cystic duct was identified on cholangiopancreatography preoperatively, the possibility of bile duct injury increases if there was severe inflammation and adhesion. For the management of bile duct injury, we recommend CBD end-to-end anastomosis for type E1, Roux-en-Y hepaticojejunostomy for type E2 and E3, and primary repair and/or drainage for type C and D.
Bile Ducts* ; Bile* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Classification ; Cystic Duct ; Diagnosis ; Drainage ; Gallbladder Diseases ; Inflammation ; Laparoscopy

Adrenal cysts are a rare disease, and its prevalence is reported to be 0.06~0.18%. Its frequency of being recognized is increasing due to the widespread use of ultrasonography and computed tomography (CT) scans. We report here on a case of adrenal cyst that was mistaken as biliary cystadenoma prio-ocation and features. Laparoscopic exploration was performed via the transabdominal approach and this revealed a right adrenal cystic mass in the retroperitoneum beneath the liver (segment IV). We present here a case of adrenal cyst with endothelial lining along with a review of the literature to address the clinical presentation, histology, imaging features and differential diagnosis of this interesting and rare entity.
Cystadenoma* ; Diagnosis, Differential ; Laparoscopy ; Liver ; Prevalence ; Rare Diseases ; Ultrasonography

Although hemodialysis using heparin bound Hemophan(HBH-HD) has been reported to be a possible modality that can be used in patients at high risk of bleeding, the efficiency of HBH-HD is not certain. To investigate the efficiency of HBH- HD, we compared the total blood compartment volume(TBCV), Kt/V and urea clearance of dialyzer(K) of HBH-HD with those of routine hemodialysis with systemic heparinization(R-HD) in the same patients. HBH-HD was switched to R-HD as soon as the bleeding risk had ceased. Before each HBH-HD, heparin solution(1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1 hour while removing saline solution(700ml/hr) by applying transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. Then we performed 10 HBH-HD on 10 patients at risk of bleeding. The dilayzer had to be changed due to severe clotting in one patient during HBH-HD so the comparison of above parameters was possible in 9 patients. The duration of each dialysis was possible in 9 patients. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. During HBH-HD, there was a slight increase in activated partial thromboplastin time(aPTT)(45.02.6 sec) at 15 min after initiation of dialysis from predialysis level (35.81.3 sec), but no increase in aPTT was observed at 60min, 120min, and the end of dialyses. The loss of TBCV(%) of dialyzers was greater in HBH-HD (174%) than in R-HD(51%). The Kt/V and K of HBH-HD, however, were 1.25+/-0.10 and 143+/-3ml/ min, respectively, which did not differ from those of R-HD which were 1.28+/-0.07 and 145+/-4ml/min, respectively. We conclude that the use of heparin bound Hemophan can be an efficient hemodialysis technique in patients at high risk of bleeding, but clotting of the dialyzer should be observed carefully during hemodialysis(values are mean+/-SE).
Dialysis* ; Hemorrhage ; Heparin* ; Humans ; Renal Dialysis* ; Sodium Chloride ; Thromboplastin ; Urea

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) serves as an extracellular signal triggering apoptosis in tumor cells. To characterize the molecular events involved in TRAIL-induced apoptotic signaling, we investigated the role of extracellular signal-regulated kinase 1/2(ERK1/2) in the apoptosis using HeLa cells. Here we show that TRAIL pronounced ERK1/2 activation through a tyrosine kinase-dependent mechanism, subsequently elevated anti-apoptotic Bcl-2 protein levels. Pretreatment with Genistein, an inhibitor of tyrosine kinase, significantly attenuated ERK1/2 activation and enhanced cell death. Moreover, inhibition of ERK1/2 with PD98059 promoted apoptotic cell death through the down-regulation of ERK1/2 activity and Bcl-2 protein levels. Taken together, our results suggest that the activation of ERK1/2 via tyrosine kinase pathway plays a protective role as the mechanism of cellular defense through the up-regulation of Bcl-2 protein levels in TRAIL-induced apoptosis.
Apoptosis* ; Cell Death ; Down-Regulation ; Genistein ; HeLa Cells* ; Humans ; Necrosis ; Phosphotransferases ; Protein-Tyrosine Kinases* ; Tyrosine* ; Up-Regulation

Various factors such as senescence, stress, neurodegenerative diseases including Alzheimer's disease (AD) contribute to the impairments of organs, especially brain. Also, they should be negative factors on normal brain function, like as memory and cognition. In this study, the neuroprotective role of BF-7, extracted from Bombyx mori, was examined agaist scopolamine-induced neurotoxicity in SK-N-SH cells. In order to know if the BF-7 has positive role on the cognition and memory, we examined using SD rat model and human. Scopolamine-induced memory impairments were observed, as measured by the passive avoidance and water maze tests, but treatment with BF-7 significantly improved memory and cognitive function. Moreover, the memory index and memory preservation of clinical experiments using MMSE-K tests were significantly improved memory and cognitive function. This results strongly represent that the BF-7 play effectively positive role in the improvement of brain function including learning and memory. Taken together, our results suggested that the BF-7 should be useful for developing strategies protecting nervous system and improving brain function.
Aging ; Alzheimer Disease ; Bombyx ; Brain ; Cognition ; Humans ; Learning ; Memory* ; Models, Animal ; Nervous System ; Neurodegenerative Diseases ; Scopolamine Hydrobromide