PURPOSE: iNOS expression in vascular smooth muscle cells (VSMC) causes the development of septic shock, and multiple organ dysfunction syndrome (MODS). For the inhibition of iNOS expression, glucocorticoids are known to inhibit iNOS expression but immunosuppression decreases its clinical availability. Recently, aspirin was reported to inhibit iNOS expression, but the mechanism and effectiveness are still unclear. In this investigation, on aspirin, several non steroidal antiinflammatory drugs (NSAIDs) were applied to clarify the inhibitory mechanism of iNOS expression and NO production in lipopolysaccharide (LPS) treated VSMCs. METHOD: VSMCs were primarily cultured from rat aorta and confirmed by immunocytochemistry of anti-smooth muscle myosin antibody. LPS, an inducer of iNOS, and NSAIDs, such as aspirin, indomethacin, ketoprofen sodium salicylate and acetaminophen were used. The concentrations of nitrite in culture media following the addition of LPS with a 1-hour pretreatment of NSAIDs were measured by spectrophotometry with griess reaction. Western blot and RT-PCR for iNOS protein and iNOS mRNA, respectively, were performed. RESULT: Acetaminophen had no effect on the inhibition of nitrite production. NSAIDs, especially ketoprofen and sodium salicylate, showed a significant inhibitory effect on nitrite production. In their mechanism, all the NSAIDs in present study inhibited iNOS mRNA and protein expression. CONCLUSION: These results suggest that the inhibitory mechanism on iNOS expression of NSAIDs is due to the inhibition of iNOS mRNA expression and subsequent inhibition of iNOS protein expression.
Acetaminophen* ; Animals ; Anti-Inflammatory Agents, Non-Steroidal* ; Aorta ; Aspirin ; Blotting, Western ; Culture Media ; Glucocorticoids ; Immunohistochemistry ; Immunosuppression ; Indomethacin ; Ketoprofen ; Multiple Organ Failure ; Muscle, Smooth, Vascular* ; Myosins ; Rats ; RNA, Messenger ; Shock, Septic ; Sodium Salicylate ; Spectrophotometry

STUDY DESIGN: A retrospective study OBJECTIVES: To compare the radiological and clinical outcomes of three surgical methods SUMMARY OF LITERATURE REVIEW: There were many proposed surgical treatments for lumbar degenerative kyphosis but the best treatment is still controversial. MATERIALS AND METHODS: Thirty three patients (all female) had undergone surgery. The mean age at surgery was 61.2. The average follow-up period was 34.7 months. The patients were divided into three groups. Group A included 7 cases with a correction by a posterior osteotomy, Group B included 15 with a posterior correction without an osteotomy, and Group C included 11 with combined anterior-posterior surgery. The radiographic measurements of lumbar lordosis, upper lumbar lordosis, lower lumbar lordosis, and pelvic tilt were performed before surgery, after surgery, and at the final follow-up visit. The loss of correction, complication rates and the clinical results were also compared. RESULTS: Postoperative correction of the lumbar and lower lumbar lordosis were significantly higher in group A and C than group B. The correction of upper lumbar lordosis was significantly higher in group A than group C. On the final follow-up, there was no significant difference in the loss of correction and clinical results between the three groups. The number of cases with complications in groups A, B and C was 4 (57%), 2 (13.3%) and 2 (18.2%), respectively. Two patients in group A required additional surgery. CONCLUSIONS: Groups A and C were more effective than posterior-only correction. There was no significant difference in the clinical results between the three groups but complication rate was higher in Group A than the other groups. Combined anterior and posterior surgery can be a safe and effective method for correction.
Animals ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Osteotomy ; Retrospective Studies

In order to investigate the expression patterns of the transforming growth factor (TGF)beta isoforms in the internal ear, an immunohistochemical study of rat embryos was performed. Rat embryos were taken on the 13th, 15th, 17th, and 19th day after conception and their internal ears were immunohistochemically stained against TGF beta1, beta2, and beta3. As a result, the 13-day-old embryo showed a very weak positivity to TGF beta1. After the 15th day of pregnancy, no reactivity to TGF beta1 was defected. Immunoreactivity to TGF beta2 was observed from the 15th day of pregnancy throughout the rest of the period. The ampulla of the semicircular canal and the cochlear duct showed a notably strong immunohistochemical reaction. A strong reaction to TGF beta3 was observed on the 15th day of pregnancy. However, no positive reactions were observed thereafter. A strong immunoreactivity was observed especially on the apical cytoplasms, the surfaces of the epithelial cells, and basement membranes of the cochlear duct, as well as the semicircular canals of the developing internal ear of rat embryo.
Animals ; Ear, Inner/embryology/*metabolism ; Embryo/embryology/*metabolism ; Female ; Immunohistochemistry ; Male ; Rats ; Rats, Sprague-Dawley ; Time Factors ; Transforming Growth Factor beta/*biosynthesis

BACKGROUND: It was previously known that anuric acute kidney injury (AKI) is uncommon and its occurrence suggests complete ureteral obstruction, shock, or a major vascular event. As the epidemiology of AKI has significantly changed over the past decade, it is possible that the incidence, etiology, or clinical characteristics of anuric AKI have also changed. METHODS: A prospective cohort study was conducted that included all patients undergoing renal replacement therapy (RRT) for AKI during a 2-year period in a tertiary hospital. Patients were classified as having anuric, oliguric, or nonoliguric AKI based on their volume of urine when RRT started using the modified Acute Kidney Injury Network criteria. RESULTS: Of the 203 patients included in the study, 21.2% met the criteria for anuric AKI. Septic and postoperative AKI were the main causes of anuric AKI, with 60.5% of incidences occurring in hospital. Anuric AKI was associated with a younger age, a lower prevalence of pre-morbid chronic kidney disease and diabetes, more frequent continuous RRT requirement, and multi-organ dysfunction. In addition, patients with anuric AKI had a higher rate of in-hospital mortality and long-term dependence on RRT than patients with nonanuric AKI. CONCLUSION: Anuric AKI is common, with sepsis as the main etiological insult, and is associated with adverse outcomes among patients with AKI who require RRT.
Acute Kidney Injury* ; Anuria* ; Cohort Studies ; Epidemiology ; Hospital Mortality ; Humans ; Incidence ; Oliguria ; Prevalence ; Prospective Studies ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Sepsis ; Shock ; Tertiary Care Centers ; Ureteral Obstruction

PURPOSE: Cardiovascular diseases are a common cause of mortality in patients with end stage renal disease and are associated with vascular calcification (VC) and arterial stiffness. In addition to high turnover bone disease, there is substantial evidence that low levels of serum intact PTH (iPTH) are associated with vascular calcium deposition. The objective was to evaluate the association of iPTH levels with VC, arterial stiffness, and to identify risk factors contributing to VCs and arterial stiffness. METHODS: One hundred five hemodialysis (HD) patients were divided into three groups according to iPTH levels: A, <150 pg/mL; B, 150< or =and< or =400 pg/mL; and C, >400 pg/mL. The simple vascular calcification score (SVCS) was obtained by X-ray; the brachial ankle-pulse wave velocity (ba-PWV) and the serum fetuin-A level was mesured. RESULTS: Patients in group A were older and had a higher SVCS, a prevalence of diabetes, and an increased arterial stiffness. Severe VCs (SVCS> or =3) were associated with the low iPTH group (iPTH<150)/a higher CRP/a lower diastolic blood pressure (DBP)/diabetes/ increased arterial stiffness/older age and a lower serum fetuin-A level. The log [ba-PWV] had a positive correlation with age, systolic blood pressure (SBP)/DBP/PP/CRP/presence of diabetes and low iPTH and a negative correlation with serum albumin. Based on multivariate analysis, the low iPTH group and diabetes were identified as independent risk factors of severe VC and age/SBP/CRP and diabetes were risk factors for arterial stiffness. CONCLUSION: Low iPTH levels and/or diabetes had a greater risk of developing VCs and age/SBP/CRP/diabetes were associated with increased arterial stiffness in HD patients.
alpha-2-HS-Glycoprotein ; Blood Pressure ; Blood Vessels ; Bone Diseases ; Calcium ; Cardiovascular Diseases ; Humans ; Kidney Failure, Chronic ; Multivariate Analysis ; Parathyroid Hormone ; Prevalence ; Renal Dialysis ; Risk Factors ; Serum Albumin ; Vascular Calcification ; Vascular Stiffness

No abstract available.
Cervical Ripening* ; Cervix Uteri* ; Dinoprostone* ; Female ; Misoprostol* ; Pregnancy ; Pregnancy*

Signet ring cell carcinoma is a rare form of gallbladder cancer and has a worse prognosis. Since few cases have been reported, information regarding the behavior and prognosis of the gallbladder carcinoma is limited. About twenty four cases of gallbladder signet ring cell carcinoma have been reported so far. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented with epigastric pain. Abdominal computed tomography showed diffuse gallbladder wall thickening with enhancement, gallstones, and choledocholithiasis. After endoscopic treatment of choledocholithiasis, laparoscopic cholecystectomy was performed. Pathologic examination of the resected gallbladder revealed adenocarcinoma of signet ring cell type in the epithelium. Immunohistochemical stain for cytokeratin 7 was positive for tumor cells. The final pathologic diagnosis was primary signet ring cell carcinoma of the gallbladder. Lymph node metastasis was detected and he received chemotherapy and radiotherapy. After one year of follow-up, bone metastasis in the lumbar spine and malignant ascites were found. The patient is being provided with palliative care.
Adenocarcinoma ; Ascites ; Carcinoma, Signet Ring Cell* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Choledocholithiasis ; Diagnosis ; Drug Therapy ; Epithelium ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Keratin-7 ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Radiotherapy ; Spine

Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.
Abdominal Cavity ; Abdominal Pain ; Adult ; Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Contrast Media ; Drainage ; Early Diagnosis ; Humans ; Male ; Middle Aged ; Peritoneal Cavity ; Peritonitis ; Self Expandable Metallic Stents ; Sphincterotomy, Endoscopic ; Stents*

Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.
Abdominal Cavity ; Abdominal Pain ; Adult ; Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Contrast Media ; Drainage ; Early Diagnosis ; Humans ; Male ; Middle Aged ; Peritoneal Cavity ; Peritonitis ; Self Expandable Metallic Stents ; Sphincterotomy, Endoscopic ; Stents*

BACKGROUND: Although emerging evidence suggests that intra-abdominal hypertension (IAH) is a predictor of the development of acute kidney injury (AKI), it remains unclear whether the presence of IAH is a predictor of prognosis in patients with AKI. The purpose of this study was to assess whether the presence of IAH could predict prognosis in critically ill patients with AKI. The prognostic value of urinary biomarkers was also determined. METHODS: In this prospective observational study, we enrolled 57 patients with established AKI, who were admitted to the intensive care unit between February 2012 and June 2014. IAH was defined as a sustained elevation in intra-abdominal pressure of > or =12 mmHg, in three consecutive measurements performed daily on the first 3 days. Urinary neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein, and simplified acute physiology score II score at the time of admission were also examined. RESULTS: IAH was observed in 78.9% of patients. The in-hospital mortality was 21.1%, and renal recovery during hospitalization was achieved in 40.4% of patients. Although high urinary NGAL [odds ratio (OR), 1.015] and liver-type fatty acid-binding protein (OR, 1.003) were found to be independent predictors of renal recovery, IAH was not. High urinary NGAL (OR, 1.003) and a high simplified acute physiology score II score (OR, 1.102) were independent predictors of in-hospital mortality, while IAH or urinary liver-type fatty acid-binding protein was not. CONCLUSION: Although IAH is prevalent in critically ill patients with AKI, it did not predict AKI prognosis. However, urinary NGAL was found to be a useful predictor of both renal recovery and in-hospital mortality.
Acute Kidney Injury* ; Biomarkers ; Critical Illness* ; Hospital Mortality* ; Hospitalization ; Humans ; Intensive Care Units ; Intra-Abdominal Hypertension* ; Lipocalins ; Neutrophils ; Observational Study ; Physiology ; Prognosis ; Prospective Studies