The empty sella syndrome is characterized by obesity, frequent pregnancy, headache and high blood pressure, but its exact cause remains unknown. Usually the incomplete diaphragmatic sella has been considered as the cause of the empty sella syndrome, but some authors recently have suggested that the antipituitary antibody way be related to development of pituitary atrophy and the pituitary empty sella syndrome, and thus it may be clinically useful as screening test for the empty sella syndrome. We experienced two empty sella syndromes associated Graves disease and applied the antipituitary antibody as the diagnostic tool of the empty sella syndrome. But none of this two patients had antipituitary antibody and we report these cases with reviews of literatures.
Atrophy ; Empty Sella Syndrome ; Graves Disease ; Headache ; Humans ; Hypertension ; Mass Screening ; Obesity ; Pregnancy

Background/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis.(continue..)
Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Diverticulum* ; Incidence

BACKGROUND AND AIMS: Bleeding from a peptic ulcer is one of the common and serious complications associated with the rate of reported mortality, which ranges from 5% to 10%. Endoscopic therapy is effective in controlling active bleeding and reducing the emer-gency surgery, the immediate mortality rate and the incidence of early rebleeding. But few recent studies have documented the long-term recurrent bleeding rate after discharge in patients with bleeding peptic ulcers. The aim of this study was to determine the long-term recurrent bleeding rate and factors predisposing to recurrent bleeding. METHODS: Eighty-eight patients with bleeding peptic ulcers discharged after medical treatment between Dec. 1990 and Jul. 1992 were included in this study and retrospectively followed up with medical records and telephone interviews. The end point of follow-up was recur-rent hemorrhage, surgery for treatment of ulcer complication, or death. RESULTS: By July 1997, retrospective follow-up was available in 76 patients. Recurrent bleeding occurred in 23 patients (30.3%) with bleeding peptic ulcers and the median follow-up period was 69 months (range, 1 ~79 months). The estimated cumulative recurrent bleeding rate after 1, 2, 3, 4, 5 and 6 years was 11.8%, 14.5%, 19.9%, 24.2%, 27.2% and 34.2%, respectively. There was no difference between the recurrent bleeding group and the non-recurrent bleed-ing group according to age, sex, prior NSAIDs use, previous history of bleeding or pepticulcer, site of ulcer, stigmata of recent hemorrhage at initial examination, method of treatment and amount of transfusion. CONCLUSION: Recurrent bleeding occurred in one-third of patients with bleeding peptic ulcers after 6 years of follow-up and one-third of recurrent bleeders rebled within 1 year. The factors predisposing to recurrent bleeding in the long-term follow-up could not be found. Therefore, further studies designed to identify factors predisposing to recurrent bleeding are needed and the evaluation of Helicobacter pylori status in bleeding peptic ulcer is needed because Helicobacter pylori is an important factor of peptic ulcer recurrence.
Anti-Inflammatory Agents, Non-Steroidal ; Christianity ; Follow-Up Studies ; Helicobacter pylori ; Hemorrhage* ; Humans ; Incidence ; Interviews as Topic ; Medical Records ; Mortality ; Peptic Ulcer* ; Recurrence ; Retrospective Studies ; Ulcer

PURPOSE: Chemokines are potent regulators of the host inflammatory or immune responses. Mucosal synthesis of chemokines may be important in the pathogenesis of mucosal inflammation in ulcerative colitis (UC). We performed this study to investigate the expression of C-X-C chemokine genes in UC. METHODS: Mucosal tissues were obtained from six normal controls and six UC patients by endoscopic biopsies. In patients with UC, mucosal tissues were separately obtained from both involved and uninvolved regions. RNA was extracted and mRNA levels of five C-X-C chemokines were determined by quantitative reverse transcription-PCR using internal RNA standards. RESULTS: Mucosal mRNA levels of all chemokines tested increased in the involved region of UC compared with the uninvolved region of UC or normal controls. CONCLUSION: Our data suggest that mucosal expression of C-X-C chemokines contributes to the pathogenesis of UC
Biopsy ; Chemokines ; Chemokines, CXC ; Colitis, Ulcerative* ; Colon* ; Humans ; Inflammation ; Mucous Membrane* ; RNA ; RNA, Messenger ; Ulcer*

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.
Adult ; Animals ; Blotting, Northern ; Gene Expression* ; Hepatocytes* ; Humans ; Liver ; Microscopy ; Rats ; RNA ; RNA, Messenger ; Spleen

BACKGROUND/AIM: Colonoscopy has been known as the best diagnostic and therapeutic modality for colorectal polyps. However, it has been difficult to assess its accuracy. METHODS: We studied the data from patients who had colonoscopic polypectomy within 30 days after the initial examination. RESULTS: From 218 patients, a total of 362 polyps were found, 51 (14.1%) of which were missed. There were 17 patients with missed polyps among 59 patients who had two or more polyps on the initial examination. According to the location, the missing rates were variable: the splenic and hepatic flexure had the highest missing rates, and the sigmoid colon had the lowest missing rate. In our study, there was no difference of missing rate according to the size and shape. CONCLUSIONS: There is a significant colonoscopic missing rate for colorectal polyps in routine clinical practice, especially in patients with multiple colonic polyps and at the site of the colonic flexure.
Colon ; Colon, Sigmoid ; Colonic Polyps ; Colonoscopy ; Humans ; Polyps*

BACKGROUND: Ampullary cancer is a malignant lesion in the pancreatobiliary system with a relatively good prognosis because of its slow growth, early appearance of symptoms and high resectability. Hndoscopic retrograde cholangiopancreaticography(ERCP) is an important and useful method in the diagnosis of ampullary cancer because it identifies the location of lesions endoseopically and by opacification of the bilio-pancreatic ducts and allows confirmation by biopsy, But the diagnostic accuracy of endoscopic forcep biopsy was variable according to the macroscopic appearance of ampullary cancer. In unexposed type ampullary cancer, biopsy after endoscopic sphincterotomy or intraluminal cannulatian biopsy has been recommended because the cancer tissue was either not visible at all or barely visible from the lumen of the duodenum. The purpose of this study was to evaluate the contribution of endoscopic sphincterotomy to the diagnosis of ampullary cancer and to compare the clinical eharasteristics of unexposed type ampullary cancer with those of exposed type ampullary cancer. METHOD: Thirty-one cases of the ampullary cancers over the past 5 years were reviewed. Macroscopically, thirty one ampullary cancers were classified into two types. The unexposed type ampullary cancer was defined normal ampullary mucosa with or without protruding. The exposed type ampullary cancer was defined abnormal ampullary mucosa including nodular, ulcerative, nodulo-ulcerative and polypoid appearance. Ampullary cancers were diagnosed preoperatively by forcep biopsy, biopsy after endoscopic sphincterotomy, or brushing cytology. RESULT: The proportion of unexposed type in ampullary cancer was 29%(9 cases). There were no differences of age, sex, diagnostic clue, distal common bile duct(CBD) shape and CBD dilatation by ERCP between unexposed and exposed type ampullary cancers. The serum bilirubin, alkaline phosphatase and GGT were lower in unexposed type comparting with exposed type. The unexposed ampullary cancers could be diagnosed with biopsy after endoscopic sphincterotomy except one case. Biopsy samples were successfully obtained immediately after sphincterotomy in 3 patients and a few days (3 days later-1 month later) after sphincterotomy in 5 patients. CONCLUSION: Weconsider the possibility of unexposed ampullary cancer in cases of jaundice or duct dilatation with normal ampullary cancer in cases of jaundice or duct dilatation with normal ampulla mucosa and should perform biopsy after endoscopic sphincterotomy.
Alkaline Phosphatase ; Bile ; Bilirubin ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Duodenum ; Humans ; Jaundice ; Mucous Membrane ; Prognosis ; Sphincterotomy, Endoscopic ; Surgical Instruments ; Ulcer

BACKGROUND: Photodynamic therapy with using 5-aminolevulinic acid (ALA) is a good noninvasive treatment modality that can treat several cutaneous diseases. Yet hydrophilic ALA is not able to easily penetrate the cellular membrane or the lipid layer of the skin. Thus, various ALA alkyl esters been developed. OBJECTIVE: We studied whether novel ALA unsaturated alkyl esters synthesize more protoporhyrin IX (PpIX) than does ALA in mouse skin tissues. METHODS: We applied 5, 10, 15% ALA and ALA esters ointment to the skin of shaved mice, respectively. We harvested the skin tissue, made a preparation and did quantitative analysis according to the fluorescent spectrum for determining the amount of PpIX synthesized in the skin after the elapse of 1 hour and 3 hours, respectively. RESULTS: No matter what the sort or the concentration of the ALA and ALA ester was, the amount of synthesized PpIX increased more after the elapse of 3 hours than that after 1 hour. ALA (hetenyl-, petenyl-, butenyl-, methyl-) esters tended to produce a much greater amount of PpIX than ALA. According to the results of the comparative study with using 5%, 10% and 15% of ALA and ALA esters ointment, the amount of synthesized PpIX was not proportional to the concentration of the ALA and the ALA esters, even though the ALA esters produced more PpIX than the ALA. CONCLUSION: We found that the ALA unsaturated alkyl esters are a good photosensitizer and they are similar to ALA-me, which is an ALA saturated alkyl ester that induces more PpIX, an actual photosensitizer, than ALA can.
Aminolevulinic Acid ; Animals ; Esters ; Membranes ; Mice ; Photochemotherapy ; Protoporphyrins ; Skin

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in a large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. METHOD: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. RESULTS: The incidence of SBP was 21.8%(68 cases) and showed 80.9% in male, 19.1% in female. Seventeen(25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrent SBP. CONCLUSON: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein < or =1.0 g/dl, prothrombin time < or =45% may not be a sensitive predictor of recurrent SBP.
Ascites ; Ascitic Fluid ; Female ; Fibrosis* ; Follow-Up Studies ; Humans ; Incidence ; Leukocytes ; Liver ; Liver Diseases ; Male ; Mononuclear Phagocyte System ; Mortality ; Peritonitis* ; Prevalence ; Prothrombin Time ; Recurrence

Castleman's disease or angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder. It may be appear as a local or generalized tumor-like condition, usually in chest or abdomen and may involve both lymph nodes and non-nodal tissues. Castleman's disease is an unusal entity which may at times mimic malignancy but is entirely benign in nature. It is topical as it has been noted to occur with AIDS and Kaposi's sarcoma. Careful interpretation of radiogram may help to distinguish Castleman's disease from other tumor condition, such as lymphoma, neurogenic tumor, or even angiofibroma, etc. But exact diagnosis must be made on the basis of histologic confirmation. In addition to histologic features, clinical distinction between the localized and multicentric form is important in selecting appropriate management. Surgical excision of an localized mass is the first choice of treatment. Partial resection, radiotherapy or observation alone may avoid the need for exessively aggressive therapy. Patients with multicentric disease don't benefit by surgical management because of systemic manifestation and rapid deterioration. Thus, antineoplastic agents and steroids may offer an alternative form of therapy. We report a case of female patient with Castleman's disease in oral and maxillofacial region, treated by surgical excision with good results.
Abdomen ; Angiofibroma ; Antineoplastic Agents ; Diagnosis ; Female ; Giant Lymph Node Hyperplasia* ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoproliferative Disorders ; Radiotherapy ; Sarcoma, Kaposi ; Steroids ; Thorax