OBJECTIVES: Hemodynamic measurements of chronic portal hypertension were done to study the mechanisms that maintain high portal pressure despite well developed collateral circulations. METHODS: A prehepatic portal hypertensive rat model was produced by partial portal vein ligation. Cardiac output, organ blood flow and porto-systemic shunt were measured by radioisotope labeled microsphere methods, and vascular resistance was calculated by standard equation. RESULTS: There was a significant reduction in the weight of the liver and increase in the weight of the spleen in the portal stenotic rats. Porto-systemic shunting, representing development of the collateral circulations, was 96.7+/-0.6% in the portal stenosis group compared with 0.9+/-0.2% in the control group (p<0.01). Portal pressure was significantly increased in the portal stenosis group compared with the control group(12.8+/-1.4 vs. 6.5+/-0.6mmHg; p<0.01). Mean arterial pressure was significantly decreased in portal stenosis group compared with control group(101.4+/-2.5 vs, 129.9+/-3.9mmHg; p<0.01). In the portal stenosis group, cardiac output(135.7+/-8.0 vs. 111.0+/-4.2ml/min; p<0.01) and splanchnic organ blood flow (28.97+/-2.03 vs. 17.90+/-1.27ml/min, p<0.01) were significantly increased, with concomitant decrease in total peripheral vascular resistance(58.0+/-3.3 vs. 88.2+/-4.8 dyne sec/cm5 X 105; p<0.01) and splanchnic vascular resistance(2.54+/-0.20 vs. 5.47+/-0.33 dyne sec/cm5 X 105; p<0.01), However, the portal venous resistance was not significantly different in both groups of rats (3.57+/-0.31 vs. 3.03+/-0.38 dyne sec/cm5 X 105; p>0.05). CONCLUSION: The hemodynamic results of this study indicate that hyperdynamic status of systemic and splanchnic circulation was present in chronic portal hypertension and that the primary factor contributing to the persistently elevated portal venous pressure was the markedly increased portal venous inflow.
Animals ; Arterial Pressure ; Cardiac Output ; Collateral Circulation ; Constriction, Pathologic ; Hemodynamics* ; Hypertension, Portal ; Ligation ; Liver ; Microspheres ; Models, Animal* ; Portal Pressure ; Portal Vein* ; Rats* ; Splanchnic Circulation ; Spleen ; Vascular Resistance

From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Constriction, Pathologic ; Diverticulum ; Gastric Bypass ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic

No abstract available.
Lung*

A study carried out to evaluate the bleeding control and prophylactic effect of rebleeding using emergency endoseopic sclerotherapy in patients with hleeding gastric varices. 42 patients with gastric variceal bleeding were admitted to the Yeungnam University Hospital from May, 1983 to August, 1992. Patients were randomly classified into control group, 20 patients treated with conservative management, and sclerotherapy group, 22 patients treated with emergency endoscopic sclerotherapy. The two group were analysed with age, sex, etiology of liver cirrhosis, nature of bleeding episode, hematocrit on admitting day, amount of sclercsants used, rebleeding episodes, complications, and mortality. There were no significant differences in the severity of underlying liver disease and hematocrit on admission between two groups. Blood transfusion were performed in 19 cases of control group and 21 cases in sclerotherapy group(p>0.05). The amounts of transfusion were 7. 7units in control group and 6.1 units in sclerotherapy group(p<0,05). Rebleeding were developed in 65% and 18% of the patiehts with control and sclerotherapy group, respectively(p<0.05). Chest pain and mild fever were observed after endoscopic sclerotherapy. These results suggest that the endoscopic sclerotherapy is effective method in hemostasis of bleeding gastric varices and short-term prevention of rebleeding, but mortality rate was not decreased compared to control group. Development of more effective methods to treat gastric variceal bleeding is required.
Blood Transfusion ; Chest Pain ; Emergencies ; Esophageal and Gastric Varices* ; Fever ; Hematocrit ; Hemorrhage* ; Hemostasis ; Humans ; Liver Cirrhosis ; Liver Diseases ; Mortality ; Sclerotherapy*

Bronchial carcinoid tumor was a low grade malignant and it was regarded as predictable clinical course and good survivality after surgical resection. But despite of its low grade malignant potentiality, bronchial carcinoid tumor was clearly capable of metastasizing and causing death. We present 2 cases of bronchial carcinoid tumors. One of them was typical carcinoid tumor in 44 year-old female and another was atypical carcinoid tumor in 53 year-old male patient. Currative therapeutic procedure was performed by lobectomy and wedge resection.
Carcinoid Tumor* ; Female ; Humans ; Male

To investigate the effect of bile acid on gastric mucosa, we performed biologic test using Sprague-Dawley rat. Mixture solution of TDCA 15mM and Hcl of pH 3 was given into stomach to one group and HCl of pH 3 was given into stomach to another group. The significant gastric mucosal change was vasodilation and edema, that was disappeared progressively. These findings suggest the bile acid and damage gastric mucosa.
Animals ; Bile* ; Edema ; Gastric Mucosa ; Hydrogen-Ion Concentration ; Rats ; Rats, Sprague-Dawley ; Stomach ; Vasodilation

BACKGROUND: The prevalence of acute viral liver injury is decreasing, but drug induced liver injury by herbal medicine and health foods is on an increasing trend after introduction of vaccination. Nevertheless, there is no consensus of diagnostic method and causality assessment for acute liver injury. Therefore, the cause, clinical features, prevalence and pattern of acute liver injury caused by herbal medicine and health foods in Gyeongju area were analyzed. Moreover, Council for International Organization of Medical Science (CIOMS) scale and Maria and Victorino (MandV) scale, clinical scales for causality assessment in hepatotoxicity were compared. METHODS: 78 patients in whom there was definite evidence of taking medicine and there was one more increase of over 2N (upper limit of the normal range) in alanine aminotransferase (ALT) or total bilirubin (TB) or alkaline phosphatase (ALP) and self-remitted after drug stop were selected excluding patients with previous liver disease history and history of alcohol, metabolic liver disease and hapatobiliary disease and viral, autoimmune, unknown origin hepatitis among 150 patients of admission due to acute liver injury, from April 1997 to March 2001. Each case was investigated retrospectively about taken medicine, the pattern of liver injury, recovery period after drug stop, history of alcohol, other hepatobiliary disease, pregnancy, recent hypotension, rechallenge and viral markers of hepatitis, aspartate aminotransferase (AST), ALT, TB, ALP. Also, herbal medicine and western medicine groups were compared and consistency with CIOMS scale and MandV scale were investigated. RESULTS: For four years, among 150 cases, drug-induced liver injury were 78 cases (52.0%), occurred the highest prevalence. In taken medicine, western medicine were 39 cases (50.0%), herbal medicine and health foods were 39 cases (50.0%), too. Among those cases, herbal medication were 23 cases (58.9%), pellet 5 cases (12.8%), In-jin-ssuk 3 cases (7.7%), deer extract 3 cases (7.7%), kitosan 2 cases (5%) and pumpkin extract, carp, plant roots was 1 case (2.5%) respectively. In the pattern of liver injury, hepatocellular liver injury were 48 cases (61.5%), occurred the highest prevalence. Between CIOMS and MandV scale, best correlation were only 2 cases (2.6%), therefore, their agreement was very low. CONCLUSION: The prevalence of drug induced liver injury is on an increasing trend in Gyeongju area and acute liver injury caused by herbal medicine and health foods had very high incidence was ascertained. Therefore, we should attend to indiscreet use of herbal medicine and health foods and should give a warning to our society. And a new clinical scale suitable for characteristic of our country that had high prevalence of liver injury caused by herbal medicine and health food is needed.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bilirubin ; Biomarkers ; Carps ; Consensus ; Cucurbita ; Deer ; Drug-Induced Liver Injury ; Gyeongsangbuk-do* ; Food, Organic ; Hepatitis ; Herbal Medicine ; Humans ; Hypotension ; Incidence ; Liver Diseases ; Liver* ; Plant Roots ; Pregnancy ; Prevalence ; Retrospective Studies ; Vaccination ; Weights and Measures

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.
Case Report ; Female ; Human ; Intestinal Diseases/therapy ; Intestinal Diseases/radiography ; Intestinal Diseases/pathology* ; Intestinal Diseases/microbiology ; Intestine, Small/radiography ; Intestine, Small/pathology ; Liver Diseases/therapy ; Liver Diseases/radiography ; Liver Diseases/pathology* ; Liver Diseases/microbiology ; Middle Age ; Mucormycosis/therapy ; Mucormycosis/radiography ; Mucormycosis/pathology* ; Mucormycosis/microbiology ; Tomography Scanners, X-Ray Computed

Stones in the common duct occur in 10% to 15% of patients with cholelithiasis. In our case, coexistent cholelithiasis and choledocholithiasis were diagnosed by endoscopic retrograde cholangiopancreatography. The stone basket was easily introduced into the gallbladder and common bile duct, then fortunately removed stones. However, endoscopic retrograde cholelithiasis removal is known to be difficult because of the anatomical approach. We herein present a rare case of cholelithiasis successfully treated by retrograde endoscopic removal.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledocholithiasis ; Cholelithiasis* ; Common Bile Duct ; Gallbladder ; Humans

BACKGROUND/AIMS: Pegylated interferon (peginterferon) and ribavirin combination therapy is less effective and associated with a higher frequency of serious complications in chronic hepatitis C patients with cirrhosis than in noncirrhotic patients. This study evaluated the efficacy and tolerability of peginterferon and ribavirin treatment in patients with hepatitis C virus (HCV)-related cirrhosis. METHODS: Eighty-six patients with clinically diagnosed liver cirrhosis were treated with either peginterferon alpha-2a (n=51) or peginterferon alpha-2b (n=35) plus ribavirin. The sustained virologic response (SVR) and adverse effects were analyzed retrospectively. RESULTS: Of the 86 patients (55 males), 48 patients (55.8%) had HCV genotype 1 infection and 38 (44.2%) had genotype non-1 infection. The overall SVR rate was 34.9% (30/86), and the rates of SVR in the genotype 1 and non-1 patients were 20.8% (10/48) and 52.6% (20/38), respectively. The multivariate analysis revealed that having HCV genotype 1 (P=0.003) and high baseline viral load (>8.0x10(5) IU/mL, P=0.012) were the independent predictive factors for SVR failure. In 20.9% (18/86) of the patients, treatment was not completed due to adverse events (27.8%), loss to follow-up (50.0%), and other reasons (22.2%). CONCLUSIONS: Peginterferon and ribavirin combination therapy was relatively effective and feasible for clinically diagnosed HCV patients, especially in those with genotype non-1 infection and low baseline viral load.
Adult ; Aged ; Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/complications/*drug therapy/virology ; Humans ; Interferon-alpha/*therapeutic use ; Liver Cirrhosis/*diagnosis/etiology/virology ; Male ; Middle Aged ; Polyethylene Glycols/*therapeutic use ; RNA, Viral/blood ; Recombinant Proteins/therapeutic use ; Retrospective Studies ; Ribavirin/*therapeutic use ; Viral Load