PURPOSE: Transduodenal ampullectomy (TDA) has been reported in a limited number of cases and in a small number of case series. The aim of this study was to analyze perioperative and long-term oncological outcomes of patients with ampullary tumors who underwent TDA in a single large-volume center. METHODS: Through a retrospective review of data from 2004 to 2016, we identified 26 patients who underwent TDA at Asan Medical Center. RESULTS: Eleven of 26 patients underwent TDA for T1 and carcinoma in situ (high-grade dysplasia) cancer; these patients are still alive without recurrence. A major in-hospital complication (3.8%) occurred in 1 case, but there was no case of 90-day mortality. In addition, none of the patients was diagnosed as having newly developed diabetes mellitus after TDA. No significant differences were found between open and laparoscopic-TDA in terms of operation time, painkiller use, and hospital stay. CONCLUSION: TDA is a feasible and effective surgical procedure for the treatment of selected patients with ampullary tumors. It is an alternative treatment option in cases of ampullary tumors not amenable to endoscopic papillectomy or pancreaticoduodenectomy.
Ampulla of Vater ; Carcinoma in Situ ; Chungcheongnam-do ; Diabetes Mellitus ; Humans ; Length of Stay ; Mortality ; Pancreaticoduodenectomy ; Recurrence ; Retrospective Studies

OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of bone cement-augmented percutaneous short segment fixation for treating Kummell's disease accompanied by severe osteoporosis. METHODS: From 2009 to 2013, ten patients with single-level Kummell's disease accompanied by severe osteoporosis were enrolled in this study. After postural reduction for 1-2 days, bone cement-augmented percutaneous short segment fixation was performed at one level above, one level below, and at the collapsed vertebra. Clinical results, radiological parameters, and related complications were assessed preoperatively and at 1 month and 12 months after surgery. RESULTS: Prior to surgery, the mean pain score on the visual analogue scale was 8.5+/-1.5. One month after the procedure, this score improved to 2.2+/-2.0 and the improvement was maintained at 12 months after surgery. The mean preoperative vertebral height loss was 48.2+/-10.5%, and the surgical procedure reduced this loss to 22.5+/-12.4%. In spite of some recurrent height loss, significant improvement was achieved at 12 months after surgery compared to preoperative values. The kyphotic angle improved significantly from 22.4+/-4.9degrees before the procedure to 10.1+/-3.8degrees after surgery and the improved angle was maintained at 12 months after surgery despite a slight correction loss. No patient sustained adjacent fractures after bone cement-augmented percutaneous short segment fixation during the follow-up period. Asymptomatic cement leakage into the paravertebral area was observed in one patient, but no major complications were seen. CONCLUSION: Bone cement-augmented percutaneous short segment fixation can be an effective and safe procedure for Kummell's disease.
Follow-Up Studies ; Humans ; Osteonecrosis ; Osteoporosis ; Prospective Studies ; Spine

A Schmorl's node is defined as a simple endplate intravertebral herniation resulting from trauma or idiopathic causes. Although Schmorl's nodes have been considered clinically insignificant, they might indicate an active symptomatic process or cause serious complications. In this study, we report an interesting case of complete separation of a vertebral body caused by an untreated Schmorl's node accompanying severe osteoporosis. To our knowledge, this is the first clinical report in the published literature to evaluate the complete separation of a vertebral body associated with a Schmorl's node.
Osteoporosis*

PURPOSE: The purpose of this study was to evaluate the surface characteristics and response of osteoblast-like cell at SLA surface treated with NaOH. MATERIALS AND METHODS: Three kinds of specimens were fabricated for the experiment groups. Control group was a machined surface, SLA group was a conventionally SLA treated surface, and SLA/NaOH gorup was SLA surface treated with NaOH. To evaluate the surface characteristics, the surface elemental composition (XPS), surface roughness and surface contact angle were evaluated in each group. And the cytotoxicity, cell adhesion, cell proliferation and ATP activity of osteoblast-like cells (MG-63 cells) were compared in each group for evaluatation of the cell responses. Statistical comparisons between groups were carried out via one-way ANOVA using the SPSS software (SPSS Inc., Chicago, USA), and then performed multiple comparisons. The differences were considered statistically significant at P<.05. RESULTS: SLA surface treated with NaOH (SLA / NaOH group) was changed to hydrophilic surface. All groups did not show the cytotoxicity to the MG-63. In cell adhesion studies, SLA / NaOH group showed the higher degree of adhesion than anothers (P<.05), Up to 7 days of incubation, the proliferation was showed the increasing tendency in all groups but SLA / NaOH group showed the highest cell proliferation between the three groups (P<.05). At 7 days of incubation, there was no difference in ALP activities between the three groups, but at 14 days, SLA / NaOH group showed significant increase in ALP activities (P<.05). CONCLUSION: In this study, SLA surface treated with NaOH promoted cell adhesion, proliferation and differentiation. It means that SLA/NaOH group is possible to promote osseointegration of implants.
Adenosine Triphosphate ; Cell Adhesion ; Cell Culture Techniques ; Cell Proliferation ; Osseointegration

We demonstrate herein that silibinin, a polyphenolic flavonoid compound isolated from milk thistle (Silybum marianum), inhibits LPS-induced activation of macrophages and production of nitric oxide (NO) in RAW 264.7 cells. Western blot analysis showed silibinin inhibits iNOS gene expression. RT-PCR showed that silibinin inhibits iNOS, TNF-alpha, and IL1beta. We also showed that silibinin strongly inhibits p38 MAPK phosphorylation, whereas the ERK1/2 and JNK pathways are not inhibited. The p38 MAPK inhibitor abrogated the LPS-induced nitrite production, whereas the MEK-1 inhibitor did not affect the nitrite production. A molecular modeling study proposed a binding pose for silibinin targeting the ATP binding site of p38 MAPK (1OUK). Collectively, this series of experiments indicates that silibinin inhibits macrophage activation by blocking p38 MAPK signaling.
Adenosine Triphosphate ; Binding Sites ; Blotting, Western ; Gene Expression ; Macrophage Activation* ; Macrophages* ; MAP Kinase Signaling System ; Milk Thistle ; Models, Molecular ; Nitric Oxide ; p38 Mitogen-Activated Protein Kinases* ; Phosphorylation ; Tumor Necrosis Factor-alpha

Here, we show that radicicol, a fungal antibiotic, resulted in marked inhibition of inducible nitric oxide synthase (iNOS) transcription by the pancreatic beta cell line MIN6N8a in response to cytokine mixture (CM: TNF-alpha, IFN-gamma, and IL-1beta). Treatment of MIN6N8a cells with radicicol inhibited CM-stimulated activation of NF-kappaB/Rel, which plays a critical role in iNOS transcription, in a dose-related manner. Nitrite production in the presence of PD98059, a specific inhibitor of the extracellular signal-regulated protein kinase-1 and 2 (ERK1/2) pathway, was dramatically diminished, suggesting that the ERK1/2 pathway is involved in CM-induced iNOS expression. In contrast, SB203580, a specific inhibitor of p38, had no effect on nitrite generation. Collectively, this series of experiments indicates that radicicol inhibits iNOS gene expression by blocking ERK1/2 signaling. Due to the critical role that NO release plays in mediating destruction of pancreatic beta cells, the inhibitory effects of radicicol on iNOS expression suggest that radicicol may represent a useful anti-diabetic activity.
Flavonoids ; Gene Expression ; Imidazoles ; Insulin-Secreting Cells ; Macrolides ; Negotiating ; Nitric Oxide Synthase Type II ; Pyridines ; Tumor Necrosis Factor-alpha

PURPOSE: To analyze the stress distribution of the implant and its supporting structures through 3D finite elements analysis for implants with different hexagon heights and to make the assessment of the mechanical stability and the effect of the elements. MATERIALS AND METHODS: Infinite elements modeling with CAD data was designed. The modeling was done as follows; an external connection type Phi 4.0 mm x11.5 mm Osste(R) USII (Osstem Co., Pusan, Korea) implant system was used, the implant was planted in the mandibular first molar region with appropriate prosthetic restoration, the hexagon (implant fixture's external connection) height of 0.0, 0.7, 1.2, and 1.5 mm were applied. ABAQUS 6.4 (ABAQUS, Inc., Providence, USA) was used to calculate the stress value. The force distribution via color distribution on each experimental group's implant fixture and titanium screw was studied based on the equivalent stress (von Mises stress). The maximum stress level of each element (crown, implant screw, implant fixture, cortical bone and cancellous bone) was compared. RESULTS: The hexagonal height of the implant with external connection had an influence on the stress distribution of the fixture, screw and upper prosthesis and the surrounding supporting bone. As the hexagon height increased, the stress was well distributed and there was a decrease in the maximum stress value. If the height of the hexagon reached over 1.2 mm, there was no significant influence on the stress distribution. CONCLUSION: For implants with external connections, a hexagon is vital for stress distribution. As the height of the hexagon increased, the more effective stress distribution was observed.
Dental Implants ; Molar ; Plants ; Prostheses and Implants ; Titanium

Primary neuroendocrine carcinoma of the gallbladder is extremely rare because normal gallbladder mucosa does not contain neuroendocrine cells. Neuroendocrine cells can be detected at sites of intestinal metaplasia induced by chronic inflammation, which may be the initial step in the development of neuroendocrine tumor of the gallbladder. Anomalous union of the pancreaticobiliary duct (AUPBD) is an uncommon congenital anomaly that is frequently associated with choledocholithiasis, cholangitis, pancreatitis, and cancer of the gallbladder or bile duct. In AUPBD, cancers of the gallbladder and bile duct can be induced by chronic inflammation. We report herein a case of large-cell neuroendocrine tumor of the gallbladder associated with AUPBD.
Bile Ducts ; Carcinoma, Neuroendocrine ; Cholangitis ; Choledocholithiasis ; Gallbladder ; Gallbladder Neoplasms ; Inflammation ; Metaplasia ; Mucous Membrane ; Neuroendocrine Cells ; Neuroendocrine Tumors ; Pancreatitis

A 35-year-old man, previously hepatitis B surface antigen (HBsAg) carrier, presented with gross hematuria and heavy proteinuria that he had been suffering from for 1 month. Serum creatinine was 4.4 mg/dL. Renal biopsy showed pauci-immune crescentic glomerulonephritis. He received plasmapheresis and was treated with high-dose steroids and cyclophosphamide. Lamivudine was started for the prevention of hepatitis B virus (HBV) activation. Serum creatinine and proteinuria were ameliorated one week after the treatment. There was no sign of HBV activation after six months of treatment. We report a case of rapidly progressive glomerulonephritis in a HBV carrier successfully treated with high dose immunosuppressive therapy and prophylactic lamivudine.
Adult ; Biopsy ; Creatinine ; Cyclophosphamide ; Glomerulonephritis ; Hematuria ; Hepatitis ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Lamivudine ; Plasmapheresis ; Proteinuria ; Steroids ; Stress, Psychological

PURPOSE: This study was performed to determine the natural history of histologically confirmed IgA nephropathy in pediatric patients who presented with hematuria and proteinuria. PATIENTS AND METHODS: We reviewed the clinical course of 57 patients diagnosed with IgA nephropathy at the age of 15 years or younger from 1981 to 2000. All patients presented with hematuria or minimal proteinuria(<40 mg/m2/day) and had normal renal function and blood pressure at the time of renal biopsy. Based on the clinical and pathological findings at the time of diagnosis, we sought for complications of IgA nephropathy such as heavy proteinuria(> or =40 mg/m2/day), hypertension, and chronic renal failure. RESULTS: The mean age at presentation was 9.5+/-2.8 years(4 to 15 years) and 42(74%) were male. Isolated gross hematuria was observed in 20 patients(35%), microscopic hematuria in 3(5%), minimal proteinuria in 4(7%), both gross hematuria and minimal proteinuria in 15(26 %), and both microscopic hematuria and minimal proteinuria in 15(26%). During a median follow-up of 7.0+/-3.5 years, 38(67%) had complete resolution of hematuria and proteinuria, 12(21%) had persistently abnormal urinalysis without development of adverse events. Only 7(12%) developed adverse events:4(7%) developed severe proteinuria, 1(2%) became hypertensive, and 2(3%) developed impaired renal function. By univariate analysis using the chi-square test, the age at presentation(>10 years)(P<0.01) and poor histological classes of the Lee or Haas classification at onset(P<0.05) were significantly correlated with adverse events, whereas sex and clinical signs at onset were less concordant. CONCLUSION: We can conclude that the prognosis of IgA nephropathy diagnosed in early childhood is better and a good correlation exists between the clinical manifestations of this disease and the histological classes.
Biopsy ; Blood Pressure ; Child* ; Classification ; Diagnosis ; Follow-Up Studies ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Male ; Natural History ; Prognosis* ; Proteinuria ; Urinalysis