A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.
Alkaline Phosphatase ; Bilirubin ; Biopsy ; Eosinophilia ; Graves Disease ; Humans ; Hyperthyroidism ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Methimazole* ; Middle Aged ; Prednisolone ; Propylthiouracil*

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

No abstract available.
Bromodeoxyuridine* ; Hep G2 Cells* ; Kinetics* ; Tretinoin*

Cholangiocarcinoma is a form of adenocarcinoma arising from the intrahepatic or extrahepatic biliary epithelium. Apparent predisposing factors include some chronic hepatobiliary parasitic infsttations, congenital anomalies with ectatic ducts, sclerosing cholangitis and chronic ulcerative colitis and occupational exposure to possible biliary tract carcinogens. Patients with cholangiocarcinoma usually present with biliary obstruction, painless jaundice, pruritus, weight loss and acholic stools. Because the obstructing process is gradua1, the cholangiocarcinoma is often far advanced by the time it presents clinically. The diagnosis is most frequently made by cholangiography following ultrasound demonstration of dilated intrahepatic bile ducts. We report a case of common bile duct cancer spreading to gallbladder and common hepatic duct along the biliary mucosal epitherium and submucosal tissue in 68-year-old female patient along with a review of literature.
Adenocarcinoma ; Aged ; Bile Ducts, Intrahepatic ; Biliary Tract ; Carcinogens ; Causality ; Cholangiocarcinoma ; Cholangiography ; Cholangitis, Sclerosing ; Colitis, Ulcerative ; Common Bile Duct* ; Diagnosis ; Epithelium ; Female ; Gallbladder* ; Hepatic Duct, Common* ; Humans ; Jaundice ; Occupational Exposure ; Pruritus ; Ultrasonography ; Weight Loss

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Promthombin, gamma GT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.
Adult ; Aged ; Carcinoma, Hepatocellular/*complications ; Female ; Hepatitis B/*complications ; Humans ; Liver Cirrhosis/*complications ; Liver Cirrhosis, Alcoholic/complications ; Liver Neoplasms/*complications ; Male ; Middle Aged ; Prognosis ; *Severity of Illness Index

A Case of double pylorus, in 56 year old man, was diagnosed by fiberoptic gastroscopy and upper gastrointestinal series. Two ovoid large openings of pyloric canal divided by smooth thickened septum were observed endoscopically And the relevant literatures on tihe subject were reviewed.
Gastroscopy ; Humans ; Middle Aged ; Pylorus*

Focal nodular hyperplasia (FNH) is a rare, benign hepatic tumor which was usually discovered incidentally by imaging procedure performed for some other reasons. FNH is typically asymptomatic and, it seldom bleeds. There is no evidence to support any relation with primary liver cancer. Accordingly, the preferred management is conservative, and excision is reserved for large symptomatic and complicated lesion, or when the diagnosis remains uncertain. Although many cases of FNH has been described to date in the other countries, only four cases of FNH has been reported in Korean literature. In the present report we describe a 7 cm sized asymptomatic lesion of FNH in a 23-year-old woman, that was disclosed by various kinds of imaging procedure. The left lateral segmentectomy was performed. The mass was firm and showed areas of localized growth of mature hepatocytes and septal fibrosis accompanied with marginal ductal proliferation, consistent with FNH. It also displayed an incomplete stellate architectual configration consisted of a central fibrous scar.
Cicatrix ; Diagnosis ; Female ; Fibrosis ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Neoplasms ; Liver* ; Mastectomy, Segmental ; Young Adult

No abstract available.
Decompression* ; Head* ; Osteonecrosis*

BACKGROUND/AIMS: NAD glycohydrolase (NADase) is abundantly expressed in the liver. This expression is prominent in Kupffer cells. Since it was recognized that reticulendothelial function is impaired in liver cirrhosis, we assessed how these enzyme activities were altered in patients with liver cirrhosis. METHODS: Serum samples were obtained from 61 patients with liver cirrhosis (according to the criteria of Child-Pugh 15 were classified A, 24 were classified B, and 22 were classified C) and 16 healthy subjects. NADase activities were measured fluorometrically with [adenine-14C] NAD. The reaction mixture contained [adenine-14C] NAD and enzyme (patient serum). The reaction was stopped after a 30 to 480 min incubation by the addition of 50 L of 25% trichloroacetic acid. RESULTS: Serum NADase activities in 61 patients with liver cirrhosis were significantly lower than those in healthy subjects (33+/-14 vs. 55.6+/-13 p<0.001). Serum NADase activities in severe cirrhotic patients were significantly lower than those in mild to moderate cirrhotic patients (criteria of Child-Pugh, A: 40.6+/-6.4 vs. B: 38.6+/-13 vs. C: 21.8+/-14, p<0.001). NADase activities were correlated to prothrombin time (r = 0.69), and Apo A1 (r = 0.58) that were useful in identifying high-risk subjects for severe liver disease, but not asparate aminotransferase (AST) and alanine aminotransferase (ALT). Also, NADase activities reciprocally correlated with PGAA index (r = -0.78), Child-Pugh's score (r = -0.48), and serum alpha-2-macroglobulin (r = -0.72). CONCLUSIONS: NADase activities could be used as a single diagnostic marker for liver cirrhosis in addition to the Child-Pugh's score and PGAA index.
Alanine Transaminase ; Apolipoprotein A-I ; Humans ; Kupffer Cells ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; NAD* ; NAD+ Nucleosidase* ; Prothrombin Time ; Trichloroacetic Acid