BACKGROUND/AIMS: Treatmant for hepatolithiasis is characterized by high failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but the development of percutaneous transhepatic cholangioscopy and lithotripsy has played an important role in the treatment of these patients. Therefore, we undertook this prospective study to assess the role of surgery in the treatment of bilateral intractable hepatolithiasis in new era of the endoscopy. METHODS: We evaluated our results of 12 patients with bilateral intrahepatic stones treated by preoperative percutaneous transhepatic cholangioscopic approach and new definitive surgical approach (suprahilar approach and hilar cholangiotomy). RESULTS: The rate of complete stone removal was 100%. There was no incidence of procedure and operative mortality. CONCLUSIONS: In this new endoscopic era, we carefully foresee that the major role of surgical treatment may be concentrated in the intractable cases of hepatolithiasis. Therefore, we suggest that more definitive surgery must be tried in the treatment of intractable bilateral hepatolithiasis.
Endoscopy ; Humans ; Incidence ; Lithotripsy ; Mortality ; Prospective Studies ; Recurrence

PURPOSE: To study whether preoperative fasting would influence postoperative prognosis and to measure the variation of the ketone body amount and ketone body ratio, kidney function during the postoperative period in the model of 90% hepatectomy. MATERIALS AND METHODS: Total of 180, seven weeks old, male, specific pathogen free Sprague-Dawley rats, divided into two groups of the fasted and the fed. First, 80 rats were divided into two groups of 40 each; 40 of that were denied food for 48 hours before the operation, other 40 were fed. Following 90% hepatectomy they were investigated by Kaplan-Meier method, drawing a survival curve. Secondly, 100 rats were divided into two groups of 50 each, 50 of that were denied food for 48 hours before the operation, and the other 50 were fed. Following 90% hepatectomy, they were investigated by the method of Student's T-test and Mann-Whitney test on the following: the amount of arterial ketone body in the blood in the blood sampled from abdominal aorta, reading at preoperative 48 hours, at the time of operation, postoperative 6 hours, 12 hours, 24 hours, 48 hours periods. RESULTS: The mean survival time after operation: the fasted group was 53.0+/-3.7 hours and the fed group was 34+/-1.7 hours and it had the statistical significance(p=0.0008). Rats which had long term survival over 72 hours were 14(35%) in fasted group, but only 2(5%) in fed group. In preoperative fasted group arterial ketone body ratio was recovered earlier than fed group and ketone body amount elevated, but in preoperative fed group, there was no significant change in ketone body amount. Blood glucose level lowered in both groups. Blood ammonia was severely increased in preoperative fed group, suggested bad liver function and destruction of muscle. BUN and blood creatinine was elevated in preoperative fed group, suggested lowered kidney function. CONCLUSION: Preoperative fasting has a positive influence on survival of the rats which has acute liver failure induced by 90% hepatectomy, because it could be caused by increased ketone body amount by preoperative fasting.
Ammonia ; Animals ; Aorta, Abdominal ; Blood Glucose ; Creatinine ; Fasting* ; Hepatectomy* ; Humans ; Kidney ; Liver ; Liver Failure ; Liver Failure, Acute ; Male ; Postoperative Period ; Prognosis ; Rats* ; Rats, Sprague-Dawley ; Specific Pathogen-Free Organisms ; Survival Rate

BACKGROUND: Purified major allergens of house dust mite are essential for evaluation of the allergic mechanism in molecular basis and development of new modalities of immunemodulation. OBJECTIVE: In this study, we aimed to purif group 1 and group 2 allergens from Dermatophagoides pteronyssinus (Dp). In addition, cDNAs corresponding to Der pI and II in Korean Dp were isolated and recombinant Der p1 and Der pII were synthesized. MATERIALS AND and METHOD: Der pI allergen was purified by ammonium sulfate precipitation, anion -exchange column chromatography, and gel filtrat,ion chromatography. Der pII allergen was purified by anion exchange chromatography, gel filtration chromatography, and a preparative isoelectric focusing method. RESULTS: Eight hundred ug of Der pI and 50 ug of Der pII were obtained from 100 g of culture medium and 1 g of mite bodies, respectively. The purities of these allergens were confirmed by SDS PAGE and the strong reactivity to the patient sera was identified. In order to produce a recombinant allergens, poly(A) RNA from house dust mites were isolated and used for cDNA synthesis by RT PCR. The cDNA was inserted into prokaryotic expression vector and the vectors were transformed into E. coli. A little amount of recombinant Der pI protein was produced due to the low solubility, and 1.2 mg of recombinant Der pII was produced from 1 L of E. coli culture medium. The antigenicity of Der pI was relatively weak, however, Der pII showed a strong antigenicity. Amino acid sequence of the amplified cDNA deduced from DNA sequences of Der pII showed 6 different variants. The variation of amino acid sequences suggests the possibility of high incidence of mutation of Der pII protein. CONCLUSION: A simplified method for the purification of Der pI and Der pII was developed. Recombinant allergens will be useful for the diagnosis and treatment of allergy with lower costs.
Allergens* ; Amino Acid Sequence ; Ammonium Sulfate ; Base Sequence ; Chromatography ; Chromatography, Gel ; Dermatophagoides pteronyssinus* ; Diagnosis ; DNA, Complementary ; Electrophoresis, Polyacrylamide Gel ; Humans ; Hypersensitivity ; Incidence ; Isoelectric Focusing ; Mites ; Polymerase Chain Reaction ; Pyroglyphidae* ; RNA, Messenger ; Solubility

Acral persistent papular mucinosis has been thought to be a distinct for of cutaneous mucinosis not associated with systemic diseases. It was recently classified as one of five subtypes of localized lichen mixedematosus. A 64-year-old man presented with a 15-year history of flesh-colored to translucent papules and a few round hypopigmented patches on his wrists, back of the hands, and distal forearms. Biopsy from the papular lesions revealed focal mucin accumulation in the upper reticular dermis. The clinical and histopathological features were consistent with acral persistent papular mucinosis.
Biopsy ; Dermis ; Forearm ; Hand ; Humans ; Lichens ; Middle Aged ; Mucinoses ; Mucins ; Scleromyxedema* ; Wrist

No abstract available.
Blotting, Southern*

No abstract available.
Cytogenetics* ; Korea* ; Oncogenes* ; Stomach Neoplasms*

PURPOSE: To evaluate the surgical results and clinical effectiveness of silicone tube intubation through Hasner's valve under intranasal endoscopic guidance in children with congenital nasolacrimal duct obstruction (CNDO). METHODS: The present study enrolled a total of 58 eyes of 46 children over 12 months of age diagnosed with CNDO in the Department of Ophthalmology, Inje University College of Medicine from 2003 to 2010. Patients who had previously undergone ineffective probing or had a combination of an anatomical abnormality such as secondary nasolacrimal duct obstruction were also included. The silicone tube was intubated through the Hasner's valve and observed with intranasal endoscopy; tube retention time was planned for at least 12 weeks. RESULTS: A total of 20 eyes were previously probed preoperatively (mean 1.7 times). After the average follow-up period of 13.5 months, the overall success of silicone intubation was 57 of 58 eyes (98%). In one failed eye, nasolacrimal obstruction was already combined preoperatively, and unintentional tube removal by the patient occurred within one week. Silicone tube reintubation was performed after four months, and CNDO symptoms improved. CONCLUSIONS: Intranasal endoscopic observation to ensure the passage of a silicone tube through Hasner's valve decreases anatomical injury. When considering patient age and former treatment, silicone tube intubation with intranasal endoscopic observation could produce desirable results with a higher success rate.
Child ; Dietary Sucrose ; Eye ; Follow-Up Studies ; Humans ; Intubation ; Nasolacrimal Duct ; Ophthalmology ; Retention (Psychology) ; Silicones

BACKGROUND/AIMS: It is well known that N-nitrosobis(2-oxopropyl)amine(BOP)-induced pancreas cancer and cholangiocarcinoma in Syrian hamster is similar to that of humans in morphological, biological and immunological aspects. The cyclic administration of BOP and ethionine, choline-deficient diet and methionine is known to rapidly induce the ductal type of carcinoma in pancreas and bile duct. Authors studied whether the rapid production of this cancer can occur in Syrian hamster and what its features are. METHODS: Sixteen Syrian hamsters aged 6-7 weeks and weighing 100 gm were used. All hamsters received 70 mg/kg body weight of BOP followed by three cycles of dl-ethionine, choline-deficient diet, l-methionine and 20mg/kg BOP. Hamsters were killed 9, 10 and 11 weeks after the beginning of the experiment and their gross and histologic features were observed. RESULTS: Nine cases, killed withan 10weeks after the begining of experiment, showed no development of cancer. Of seven Syrian hamsters, killed more than 10weeks after the begining of experiment, the incidences of BOP-induced cancer included one case(14.3%) of pancreas cancer and five cholangiocarcinomas( 71.4%). The morphological change of pancreas carcinogenesis was shown at first in cell mitosis and atypia(6 weeks) and then in atypical ductal hyperplasia(9 weeks) and carcinoma in situ(10 weeks). The change in cholangiocarcinoma, first progressed with ductular proliferation and surrounding fibrosis(6 weeks) followed by focal cholangiocarcinoma(10 weeks) and multiple invasive cholangiocarcinomas( 11 weeks). CONCLUSION: Pancreas cancer and intrahepatic cholangiocarcinomas can be induced rapidly within 10 weeks by cyclic injections of carcinogens in Syrian hamsters initiated with Nnitrosobis( 2-oxopropyl)amine and the morphologic changes can be observed.
Animals ; Bile Ducts ; Body Weight ; Carcinogenesis ; Carcinogens* ; Cholangiocarcinoma* ; Cricetinae* ; Diet ; Ethionine ; Humans ; Incidence ; Mesocricetus ; Methionine ; Mitosis ; Pancreas* ; Pancreatic Neoplasms*

BACKGROUND : Anomalous pancreaticobiliary ductal union (APBDU) is a congenital defect defined as a union of the pancreatic and the biliary ducts located outside the duodenal wall. Accordingly, this anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cysts, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose is to analyze combined disease, especially biliary neoplasm, and to evaluate biliary tract microscopic changes in the biliary tract. METHODS : To study the clinical characteristics of APBDU, we reviewed 21 APBDU cases which were treated from June 1994 to January 1998. We studied the associated diseases, the surgical treatment, histological findings and the PCNA expression. We also analyzed the gallbladder epithelium in 10 control patients without APBDU. RESULTS : Among the 21 cases, 12 cases were accompanied by a choledochal cyst. A gallbladder carci noma occurred in 5 cases. Of the 13 operations, 4 involved a cholecystectomy only, and 9 involved a cholecystectomy, bile duct resection and hepaticojejunostomy. The histologic findings were reviewed in 13 cases. Bile duct metaplasia was found in 8 of the 9 cases with a bile duct resection, and gallbladder metaplasia was found in 8 of the 12 cases whereas metaplasia was detected in 1 of the 10 control patients. The PCNA expression was significantly high in APBDU group. CONCLUSIONS : The patients with APBDU showed a high incidence of gallbladder carcinoma and meta plasia in the epithelium of the gallbladder and the bile duct. This metaplasia in the gallbladder and the bile duct was thought to be related to the cancerous change.
Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Biliary Tract ; Biliary Tract Diseases ; Cholangitis ; Cholecystectomy ; Choledochal Cyst ; Common Bile Duct ; Congenital Abnormalities ; Epithelium ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Incidence ; Metaplasia ; Noma ; Pancreatic Ducts ; Pancreatitis ; Proliferating Cell Nuclear Antigen

PURPOSE: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. MATERIALS AND METHODS: Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PlCC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5- French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. RESULTS: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5%), acute thrombosis of the subclavian vein in 3(0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. CONCLUSION: The PICC system is an excellent option for medium-duration cen- tral venous access. Patients were able to carry on normal activities with the catheters in place.
Arm* ; Catheters* ; Heart Atria ; Humans ; Ocimum basilicum ; Punctures ; Radiology, Interventional ; Silicones ; Subclavian Vein ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior