Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

OBJECTIVE: Depending on genetic or environmental effects over adolescent development, typical behavioral responses come out in adolescence. Also, alteration of nitric oxide (NO) levels in the brain has been associated with modifications of stress related behavior. Present study was designed to investigate the possible influence of chronic stress from restraint on the generation of depression in adolescent mice, and also to evaluate whether NO has modulatory roles in the behavioral and biological reactions. METHODS: ICR mice exposed to stressful restraint, 2 h per day, was treated with NG-nitro L-arginine methyl ester (L-NAME) (10 mg/kg), a non-selective NO synthase (NOS) inhibitor. To evaluate depression-like behavior in the mice, forced swim test and open field test were performed after the last restraint. To investigate stress-induced changes in the expression level of glial cell-derived neurotrophic factor (GDNF), free-floating immunohistochemistry was performed. RESULTS: The results showed that stressed group has longer immobility time and less crossing number in forced swimming and open field test, and that these stress responses were significantly prevented by L-NAME. Furthermore, decreased GDNF expression in the hippocampus by stress was prevented to that of controls within the L-NAME treated group. CONCLUSION: The results suggest that stress and NO signaling could be involved in generation of depression in adolescence. It also suggested that GDNF might contribute to prevent stress-related behaviors.
Adolescent ; Adolescent Development ; Animals ; Arginine ; Brain ; Depression ; Glial Cell Line-Derived Neurotrophic Factor ; Hippocampus ; Humans ; Immunohistochemistry ; Mice ; Mice, Inbred ICR ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Swimming

No abstract available.
Lymphoma, Non-Hodgkin*

PURPOSE: Leptin has been considered a link between metabolic state and reproductive activity. Defective reproductive function can occur in leptin-deficient and leptin-excessive conditions. The aim of this study was to examine the effects of centrally injected leptin on the hypothalamic KiSS-1 system in relation to gonadotropin-releasing hormone (GnRH) action in the initial stage of puberty. METHODS: Leptin (1 microg) was injected directly into the ventricle of pubertal female mice. The resultant gene expressions of hypothalamic GnRH and KiSS-1 and pituitary LH, 2 and 4 hours after injection, were compared with those of saline-injected control mice. The changes in the gene expressions after blocking the GnRH action were also analyzed. RESULTS: The basal expression levels of KiSS-1, GnRH, and LH were significantly higher in the pubertal mice than in the prepubertal mice. The 1-microg leptin dose significantly decreased the mRNA expression levels of KiSS-1, GnRH, and LH in the pubertal mice. A GnRH antagonist significantly increased the KiSS-1 and GnRH mRNA expression levels, and the additional leptin injection decreased the gene expression levels compared with those in the control group. CONCLUSION: The excess leptin might have suppressed the central reproductive axis in the pubertal mice by inhibiting the KiSS-1 expression, and this mechanism is independent of the GnRH-LH-estradiol feedback loop.
Aluminum Hydroxide ; Animals ; Axis, Cervical Vertebra ; Carbonates ; Female ; Gene Expression ; Gonadotropin-Releasing Hormone ; Humans ; Leptin ; Luteinizing Hormone ; Mice ; Puberty ; RNA, Messenger

INTRODUCTION: Hiatal hernia (HH) is a well-known contributory factor of gastroesophageal reflux disease (GERD). However, studies on the clinical significance of simple small HH are lacking. We conducted a study to clarify the clinical significance of short segment HH (SSHH) in relation to GERD. METHODS: 4,592 consecutive cases (male/female: 2,076/2,516, median age: 49 years) examined with diagnostic esophagogastroduodenoscopy for the first time were enrolled. During the insertion of endoscope, presence of HH was determined and the length was measured, if present. The relationships between gender, age, presence of erosive esophagitis, and columnar-lined esophagus (CLE) and the lengths of HH were analyzed. RESULTS: Among 4,592 cases, HH was present in 428 cases (9.3%); SSHH was found in 255 cases (5.6%) and long segment HH (LSHH) in 173 cases (3.8%). HH was more frequent among males and patients with LSHH tended to be older. Erosive esophagitis was observed in 4.8%, 22.0%, and 37.0% of no HH, SSHH, and LSHH group, respectively (p <0.05). CLE was observed in 14.4%, 36.5%, and 24.3% of no HH, SSHH, and LSHH group, respectively (p <0.05). CONCLUSIONS: SSHH is not a clinically silent and "innocent entity," but rather a condition with a significant pathologic significance similar to LSHH in regard to GERD.
Endoscopes ; Endoscopy, Digestive System ; Esophagitis ; Esophagus ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Male

PURPOSE: To determine the accuracy of three-dimensional CT angiography(CTA) in the diagnosis of intracranialaneurysms. MATERIALS AND METHODS: 3D-CTA was performed in 46 consecutive patients with subarachnoid hemorrhage orsuspected intracranial aneurysm. Images were obtained using a helical CT scanner and the SSD techinque. 3D CTAfindings were reviewed retrospectively and independently in blind fashion by two neuroradiologists. Digitalsubtraction angiography(DSA) was used as the reference standard. RESULTS: DSA revealed, in 36 patients, 40aneurysms ranging from 2mm to 12mm in maximal diameter, and negative findings in 10 patients. For observer 1, theaccuracy of 3D-CTA for all aneurysms and all patients was 85.2% and 82.7%, respectively. For observer 2, therespective figures were 94.6% and 91.9%. The agreement rates between the two observers were 86% for all aneurysmsand 87% for all patients (Kappa value 0.58, 0.59). CONCLUSION: Three-dimensional CTA is a useful imagingtechnique for the diagnosis of intracranial aneurysms, with an accuracy of over 85%
Aneurysm ; Angiography* ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Retrospective Studies ; Silver Sulfadiazine ; Subarachnoid Hemorrhage ; Tomography, Spiral Computed

PURPOSE: To evaluate the preliminary results of endovascular coil treatment of acutely ruptured aneurysms. MATERIALS AND METHODS: Between August 1995 and December 1997, 18 patients with 20 ruptured aneurysms weretreated. They were classified as Hunt and Hess grade I (n=3), grade II (n=1), grade III (n=3), grade IV (n=10) orgrade V (n=1). Endovascular treatment was performed at mean 5.2 (range, 1-18) days. The first aneurysm was treatedwith mechanical detachable spirals (MDS) and the others with Guglielmi detachable coils (GDC). Aneurysm size wascategorized as small (n=17) or large (n=3). Ten aneurysms were located in the anterior circulation, and ten in theposterior circulation. Using the Glasgow outcome scale (GOS), clinical outcome was evaluated 5 to 27 months aftertreatment in 11 patients. Three patients had already died. RESULTS: In 14 of the 18 patients (16 of 20 aneurysms: 80%), treatment was successful. Four aneurysms failed due to unsuccessful catheter placement (n=2), smallaneurysm (n=1) or occlusion of the parent vessel (n=1). Total occlusion was observed in 13 aneurysms; 95-99%, orsubtotal occlusion, in two, and less than 95%, or incomplete occlusion, in one. Technical complications includedpassing of wire (n=1) and unintentional parent artery occlusion (n=1). There was a 7.1%(1/14) morbidity rate, butno mortality related to the technique. Six patients with Hunt and Hess grade I-III had good clinical outcome (3with GOS 1, and 2 with GOS 2). Four of the nine patients who were grade IV-V showed clinical improvement (GOS 3);two patients were clinically unchanged (GOS 4), and three died from the severity of primary hemorrhage. CONCLUSION: Endovascular coil treatment is a reasonable alternative for patients who are not candidates forconventional surgical treatment or in whom such treatment has failed.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Catheters ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Mortality ; Parents

Invasive gastric Candida infection in patient with co-morbidity can cause stenotic change if it is developed at anatomically narrowing portion, such as distal antrum, pylorus, or duodenal bulb. However, proper management of benign stenosis by diffuse gastric Candidasis is still under controversy and palliative bypass surgery has several shortcomings because high risk operative group may be included in this case. Palliative placement of self-expandable metallic stent has been settled as a standard management of malignant gastric pyloric obstruction and it is expected to be applied in benign stenotic lesions due to its gradual dilation effect. We described a case of stenosis by diffuse gastric Candidasis at anastomosis of subtotal gastrectomy, which was managed by temporary placement of self-expandable metallic stent.
Candida ; Candidiasis ; Constriction, Pathologic ; Gastrectomy ; Humans ; Pylorus ; Stents

OBJECTIVE: In the areas where intestinal metaplasia of the stomach is highly prevalent, diagnosing Barrett's esophagus solely by the presence of specialized columnar epithelium in the distal esophagus may lead to many false positive diagnoses. The aim of this study was to test validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett's esophagus in Korea. METHODS: During routine gastroscopy, the length of columnar-lined esophagus was measured and biopsy samples were taken from the mucosa immediately distal to the squamocolumnar junction. Under light microscopy, alcian blue-positive cells were identified. RESULTS: Prevalence of the specialized columnar epithelium in cases without the columnar-lined esophagus and with the short segment columnar-lined esophagus were 57.1% and 31.2%, respectively (P = 0.0281). The specialized columnar epithelium is frequently seen around the cardia in Koreans with or without the columnar-lined esophagus. CONCLUSION: Simple presence of the specialized columnar epithelium is not a valid criterion for a diagnosis of Barrett's esophagus. We propose that both the short segment Barrett's esophagus and the goblet cell metaplasia of the cardia might be grouped together under a title of "the specialized columnar epithelium around the gastroesophageal junction" as a potential preceding condition of adenocarcinoma around the cardia.
Adult ; Aged ; Barrett Esophagus/pathology* ; Biopsy, Needle ; Cardia/pathology* ; Epithelium/pathology ; Esophagoscopy ; Female ; Human ; Male ; Middle Age ; Reproducibility of Results ; Sensitivity and Specificity