BACKGROUND/AIMS: It is essential to develop an in vitro culture model of primary hepatocytes for the study of hepatocellular function and the pathogenesis of hepatitis C virus (HCV) infection. In this study, we have established the immortalized primary human hepatocyte (IPHH) and performed in vitro culture of HCV derived from human patient. METHODS: Primary human hepatocytes were isolated from surgically resected liver tissue and then were immortalized by transfection with the SV40 large T antigen. The characterization of the IPHH during culture was analyzed by immunocytochemistry, RT-PCR, Western blot, ELISA, and soft agar assay. Next, sera and/or liver tissue homogenates from surgically resected liver tissues of patients with HCV infection were inoculated for the culture of HCV in IPHH. After HCV RNA extraction from IPHH and culture media, positive or negative stranded HCV RNA was examined by specific nest RT-PCR. RESULTS: IPHH expressed liver-associated proteins but did not express alpha-fetoprotein. Also IPHH showed ammonia removal activity. With regard to its malignant potential, colony formation in soft agar assay was not observed. Next, positive and negative stranded HCV RNAs in IPHH infected with patient's sera plus liver tissue homogenates were clearly detected whereas those in IPHH infected with only patient's sera were not detected. CONCLUSIONS: These results demonstrated the phenotypic characteristics of IPHH and the feasibility in vitro culture system of HCV infected human samples. This system might be useful for study of pathogenesis of HCV infection or hepatocyte-based applications.
Antigens, Viral, Tumor/genetics ; Base Sequence ; Carcinogenicity Tests ; Cell Culture Techniques ; Cells, Cultured ; Cells, Immobilized ; Hepacivirus/isolation & purification/*physiology ; Hepatocytes/metabolism/physiology/*virology ; Humans ; Liver Function Tests ; Models, Biological ; RNA Probes ; RNA, Viral/analysis ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Bupivacaine ; Catheters ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypotension ; Infant, Newborn ; Intracranial Hemorrhages ; Intubation ; Needles ; Neurologic Manifestations ; Pregnancy ; Pulmonary Edema ; Recovery Room

Patellar fractures in children occur rarely in approximately 1% of all pediatric fractures and 57% of these are osteochondral or cartilaginous avulsion fractures, a type of sleeve fracture. They may be missed in diagnosis due to small bony fragment on simple radiographs, and they always occur ipsilaterally; however, only a few cases of bilateral patellar fracture of the inferior pole have been reported. We experienced an 11 year-old patient an athlete, who suffered repetitive minor trauma, with a stress fracture, which occurred at the inferior pole of the patella bilaterally, and we report on this unusual case with a literature review.
Athletes* ; Child ; Diagnosis ; Fractures, Stress* ; Humans ; Patella*

Liver cirrhosis is one of the major complications of hepatitis C virus (HCV) infection, but the mechanisms underlying HCV-related fibrogenesis are still not clear. Although the roles of HCV core protein remain poorly understood, it is supposed to play an important role in the regulation of cellular growth and hepatocarcinogenesis. The aim of this study was to examine the role of HCV core protein on the hepatic fibrogenesis. We established an in vitro co-culture system with primary hepatic stellate cell (HSC) isolated from rats, and a stable HepG2-HCV core cell line which had been transfected with HCV core gene. The expressions of fibrosis-related molecules transforming growth factor beta1 (TGF-beta1), transforming growth factor b receptor II (TGF beta RII), alpha-smooth muscle actin (alpha-SMA) and connective tissue growth factor (CTGF) were analyzed via histological or molecular methods. In addition, the expression levels of matrix metaloprotinase-2 (MMP-2) and collagen type I (Col I) from the co-cultured media were measured by zymogram and ELISA, respectively. The expressions of alpha-SMA, TGF-beta1, Col I, TGF beta RII and MMP-2 were significantly increased in the co-culture of stable HepG2-HCV core with HSC. Moreover, the significant increases of CTGF and TGF-beta1 in the HCV core-expressing cells were observed by either Northern or Western blot analysis. These results suggest that HCV core protein may contribute to the hepatic fibrogenesis via up-regulation of CTGF and TGF-beta1.
Actins/metabolism ; Animals ; Cell Line, Tumor ; Cells, Cultured ; Coculture Techniques ; Collagen Type I/metabolism ; Gelatinase A/metabolism ; Immediate-Early Proteins/*biosynthesis ; Intercellular Signaling Peptides and Proteins/*biosynthesis ; Liver/metabolism/*pathology ; Liver Cirrhosis/*metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Receptors, Transforming Growth Factor beta/metabolism ; Research Support, Non-U.S. Gov't ; Transforming Growth Factor beta/*metabolism ; Up-Regulation ; Viral Core Proteins/genetics/*metabolism

Multiple myeloma is a plasma cell neoplasm mainly involving the bone marrow and skeletal system. Myelomatous pleural effusion is rare, accounting for less than 1%. In cases with high adenosine deaminase (ADA) activity, with lymphocytic exudate in the pleural fluid, tuberculous pleural effusion should be differentiated first. We report herein a rare case of a unilateral pleural effusion in a patient who was undergoing chemotherapy for multiple myeloma, with an ADA level of > 100 IU/L and lymphocytic exudate in the pleural fluid. An acid fast bacillus stain and polymerase chain reaction test for tuberculosis were negative. Consequently, the patient was diagnosed with myelomatous pleural effusion with elevated ADA activity.
Adenosine Deaminase ; Bacillus ; Bone Marrow ; Drug Therapy ; Exudates and Transudates ; Humans ; Multiple Myeloma ; Neoplasms, Plasma Cell ; Pleural Effusion* ; Polymerase Chain Reaction ; Tuberculosis

BACKGROUND: The medically unexplained symptoms present one of the most common problems in medical practice and the role of primary care physicians is becoming greater to manage them. Our goal was to investigate how the primary care physicians conceive and deal with patients complaining of medically unexplained symptoms (MUS). METHODS: A group of 840 primary care physicians, 524 internist and 316 family physicians in Seoul were surveyed. The questionnaire regarding the perception and the way of consultation about MUS was posted by mail. RESULTS: A total of 180 questionnaires were collected via mail and fax. Ten of them were uncompleted, and the response rate was 22%. Over half of the respondents felt that the consultation of MUS was difficult and they were concerned about the possibility of overlooking some of organic problems (57.6%). Average consultation rate of MUS in daily practice was 14%. The anxiety toward failure of treatment was the most common concern during the MUS consultation. Seventeen percent answered they knew the efficient method to deal with MUS patients. Respondents complained of the deficiency of contents and experiences to deal with MUS during the period of training (80%). More family physicians compared to internists perceived patients with MUS to have personality problems and they often tended to prescribe psychotropic drugs. Family physicians also answered that the training courses provided proper knowledge and contents regarding MUS consultation more than the internists. CONCLUSION: MUS consultation imposes a burden on primary care physicians. Therefore, continuing education not only for residency but for post graduates should be considered for effective management for MUS.
Animals ; Anxiety ; Surveys and Questionnaires ; Education, Continuing ; Humans ; Internship and Residency ; Mice ; Physicians, Family ; Physicians, Primary Care* ; Postal Service ; Primary Health Care* ; Psychotropic Drugs ; Seoul

Nitrous oxide (N2O) is a chemical used as a medical anesthetic supplement, industrial semiconductor cleaning agent, and food additive in the manufacture of whipping cream. Nitrous oxide causes hypoxemia and suffocation during repeated inhalation. In severe cases, it causes coma and death. Some of those who are not aware of the dangers still illegally obtain and abuse nitrous oxide even with the law enforcing its use, and some people seem to have abused nitrous oxide after purchasing large amounts in small containers before the law has taken effect. Deaths from misuse of nitrous oxide are extremely rare in South Korea compared to those from other addictions such as carbon monoxide poisoning. No autopsy or follow-up blood tests were performed in this case.However, this is a unique and rare case in which carbon monoxide inhalation due to the combustion of lightning coal at the last moment overlaps with continuous inhalation of large amounts of nitrous oxide for several days beyond simple hallucination use, and is included in this report with a simple literature review.

PURPOSE: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. METHODS: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. RESULTS: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (<60 mmHg in systolic) were related to high mortality (85.7%). In laboratory findings, decreased hemoglobin (<8 g/dL), and platelet count (<50,000/mm3), and increased creatinine level (>1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. CONCLUSION: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient's status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality.
Accidents, Traffic ; Blood Pressure ; Coma ; Creatinine ; Emergency Service, Hospital ; Equidae ; Humans ; Incidence ; Intestine, Small ; Intestines ; Jeollanam-do ; Liver ; Mesentery ; Mortality ; Multivariate Analysis ; Pancreas ; Platelet Count ; Postoperative Complications ; Resuscitation ; Risk Factors ; Shock ; Spleen ; Thoracic Injuries ; Violence ; Wound Infection

BACKGROUND/AIMS: The study of liver fibrogenesis by hepatitis C virus (HCV) has been limited due to the lack of an efficiency in vitro culture systems. In the present study, we investigated whether or not HCV core protein is directly related to liver fibrogenesis through stimulation of hepatic stellate cells (HSC). METHODS: Human and rat HSC were isolated and we established an in vitro co-culture system of a stable HepG2-HCV core cell line which was transfected with HCV core gene and primary HSC. We performed immunocytochemical staining and Western and Northern blot analysis in the stimulated HSC by HCV ocre protein to identify the expression of transforming growth factor beta1 (TGF-beta1), transforming growth factor beta receptor II (TGFbeta R II), alpha-smooth muscle actin (alpha-SMA) and connective tissue growth factor (CTGF). The expression of matrix metaloprotinase-2 (MMP-2) and collagen type I (Col I) in the culture media were measured by zymogram and ELISA, respectively. RESULTS: The expression of TGF-beta1 and CTGF was significantly higher in the stable HepG2-HCV core cell line than in HepG2 cells. Furthermore, the makers related to fibrosis such as alpha-SMA, TGF-beta1, Col I, TGFRII and MMP-2 were highly experssed in the co-culture of stable HepG2-HCV core with HSC. CONCLUSIONS: HCV core protein may play a direct role in the fibrogenesis of chronic liver disease with HCV infection.
Actins/metabolism ; Animals ; Cell Line, Tumor ; Coculture Techniques ; Connective Tissue Growth Factor ; Fibrosis ; Hepatitis C Antigens/*physiology ; Humans ; Immediate-Early Proteins/metabolism ; Immunoblotting ; Immunohistochemistry ; Intercellular Signaling Peptides and Proteins/metabolism ; Liver/metabolism/*pathology ; Protein-Serine-Threonine Kinases ; Rats ; Rats, Sprague-Dawley ; Receptors, Transforming Growth Factor beta/metabolism ; Transforming Growth Factor beta/metabolism ; Transforming Growth Factor beta1 ; Viral Core Proteins/*physiology

BACKGROUND/AIMS: The extent of hepatic fibrosis is important in chronic liver disease. Liver biopsy is essential for diagnosis of fibrosis. However, biopsy is invasive and may not represent the whole liver state. Serum hyaluronic acid (HA), a major component of connective tissues, was introduced as a useful non-invasive index of hepatic fibrosis. The aim of this study was to evaluate the relationship among HA, the degree of fibrosis, several hematologic and biochemical parameters in patients with chronic liver diseases or post state liver transplantation (PSLT). METHODS: Total 102 cases were divided into 4 groups: 57 chronic hepatitis (CH), 12 cirrhosis, 21 hepatocellular carcinoma (HCC), 12 PSLT. HA was measured by enzyme-linked binding protein assay and evaluated in relation the degree of fibrosis, several hematologic and biochemical parameters. RESULTS: Among four groups, HCC showed the highest HA and HA of HCC significantly higher than that of CH. The degree of fibrosis were correlated with HA. HA was correlated with age, platelet count and albumin but, not with ALT and PT. There is no significant relation between HA and the presence of acute rejection in liver transplantation. CONCLUSIONS: In chronic liver diseases, HA is a useful non-invasive index of hepatic fibrosis and disease severity.
Adolescent ; Adult ; Aged ; Biological Markers/blood ; Carcinoma, Hepatocellular/complications ; Chronic Disease ; Female ; Graft Rejection/diagnosis ; Hepatitis/complications ; Humans ; Hyaluronic Acid/*blood ; Liver/pathology ; Liver Cirrhosis/complications/*diagnosis/pathology ; Liver Neoplasms/complications ; Liver Transplantation ; Male ; Middle Aged