BACKGROUND: Peritoneal fibrosis is one of the major causes of technical failure in patients on peritoneal dialysis. Epithelial-to-mesenchymal transition (EMT) of the peritoneum is an early and reversible mechanism of peritoneal fibrosis. Human peritoneal mesothelial cells (HPMCs) have their own renin-angiotensin-aldosterone system (RAAS), however, it has not been investigated whether aldosterone, an end-product of the RAAS, induces EMT in HPMCs, and which mechanisms are responsible for aldosterone-induced EMT. METHODS: EMT of HPMCs was evaluated by comparing the expression of epithelial cell marker, E-cadherin, and mesenchymal cell marker, alpha-smooth muscle actin after stimulation with aldosterone (1-100nM) or spironolactone. Activation of extracellular signal-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) and generation of reactive oxygen species (ROS) were assessed by western blotting and 2',7'-dichlorofluororescein diacetate staining, respectively. The effects of MAPK inhibitors or antioxidants (N-acetyl cysteine, apocynin, and rotenone) on aldosterone-induced EMT were evaluated. RESULTS: Aldosterone induced EMT in cultured HPMCs, and spironolactone blocked aldosterone-induced EMT. Aldosterone induced activation of both ERK1/2 and p38 MAPK from 1 hour. Either PD98059, an inhibitor of ERK1/2, or SB20358, an inhibitor of p38 MAPK, attenuated aldosterone-induced EMT. Aldosterone induced ROS in HPMCs from 5 minutes, and antioxidant treatment ameliorated aldosterone-induced EMT. N-acetyl cysteine and apocynin alleviated activation of ERK and p38 MAPK. CONCLUSION: Aldosterone induced EMT in HPMCs by acting through the mineralocorticoid receptor. Aldosterone-induced generation of ROS followed by activation of ERK, and p38 MAPK served as one of the mechanisms of aldosterone-induced EMT of HPMCs.
Actins ; Aldosterone* ; Antioxidants ; Blotting, Western ; Cadherins ; Cysteine ; Epithelial Cells ; Humans ; p38 Mitogen-Activated Protein Kinases ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritoneum ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Receptors, Mineralocorticoid ; Renin-Angiotensin System ; Spironolactone

PURPOSE: Laparoscopic colorectal procedures are widely used for benign disease but controversial for malignant disease. In early colorectal cancer, laparoscopic colectomy can be performed safely on the basis of oncologic principles. The purpose of this study is to evaluate the safety and effectiveness of laparoscopic-assisted colorectal resection for malignant polyps and benign disease. METHODS: Twenty five patients submitted to surgical treatment between Oct. 1996 to June 2000 were reviewed retrospectively. RESULTS: Malignant polyps comprized 7 cases whose resection margins were all positive for cancer cells after endoscopic polypectomy and benign diseases in 18 cases (benign polyp: 7, diverticular disease: 4, submucosal tumor: 4 etc.). The common sugical procedures were anterior or low anterior resection (7 cases) and segmental resection (6 cases). There was no conversion to an open surgery. In malignant polyps, pathologic results revealed early cancer with no lymph node metastasis. There was no operative mortality. Postoperative recovery was uneventful except 2 cases (9.0%) of complications, which were, prolonged ileus in one patient and subcutaneous emphysema in another patient. CONCLUSIONS: Laparoscopic-assisted resection can be recommended as a safe and effective procedure for treatment of colonic malignant polyps and benign disease.
Colectomy ; Colon ; Colorectal Neoplasms ; Humans ; Ileus ; Laparoscopy ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Polyps* ; Retrospective Studies ; Subcutaneous Emphysema

PURPOSE: Common bile duct (CBD) stone is a relatively common disease in elderly patients. There have been many reports about the efficacy and safety of LCBDE. But for elderly patients, only a few studies about its efficacy and safety exist. The aim of this study is to evaluate the efficacy, safety and the surgical outcome of LCBDE in patients who are 70 years or older and compare the results with those of the younger group. METHODS: From January 2000 to November 2009, 132 patients underwent LCBDE. We divided these patients into two groups according to age and conducted a retrospective analysis. The elderly group included patients who were 70 years old or older (n = 64), and the younger group included those who were younger than 70 (n = 68). The elderly group was compared to the younger group with respect to their clinical characteristics, operation time, postoperative hospital stay, open conversion rate, first meal time, postoperative complication, recurrence rate and mortality. RESULTS: The elderly group showed high American Society of Anesthesiologists score (2.2 vs. 1.9) (P = 0.003), preoperative morbidity (47 vs. 29) (P < 0.001), and previous abdominal operation (18 vs. 14) (P = 0.046). There were no significant differences in mean operation time, postoperative hospital stay, first meal time, recurrence rate, remnant stone, complication rates or mortality in both groups (P > 0.05). CONCLUSION: LCDBE is a safe and effective treatment modality for CBD stones not only for younger patients but also for elderly patients.
Aged ; Common Bile Duct ; Humans ; Length of Stay ; Meals ; Postoperative Complications ; Recurrence ; Retrospective Studies

A renin- or angiotensin-II responsive aldosterone producing tumor is a rare cause of primary hyperaldosteronism. This tumor can be identified by tests that show that the aldosterone producing adrenal tumor is not fully autonomous. In other words partially it is responsible for the stimulation of aldosterone secretion that results aldosterone levels in an increase in serum in response to the upright posture and spironolactone treatment. Furthermore, the urinary 18-hydroxycortisol level is within the normal range. Because of different responses to surgical removal, the differential diagnosis of the causes of primary aldosteronism can't be overemphasized even for rare causes of primary aldosteronism such as unilateral nodular hyperplasia or a renin-responsible aldosterone producing tumor. We should consider renin or angiotensin-II responsive adrenal adenoma in the differential diagnosis of primary aldosteronism when biochemical data shows atypical results. Here we present the first case in Korea of a renin-responsive aldosterone producing adrenal adenoma which was fully accessible and was successfully treated by surgical removal. Also, sampling for aldosterone secretion just above the insertion site in the left renal vein before surgery showed a suspiciously abberant left adrenal vein drainage into the IVC, This was very helpful information during adrenal vein ligation in laparoscopic adrenalectomy.
Adenoma* ; Adrenalectomy ; Aldosterone ; Diagnosis, Differential ; Drainage ; Hyperaldosteronism ; Hyperplasia ; Korea ; Ligation ; Posture ; Reference Values ; Renal Veins ; Renin ; Spironolactone ; Veins*

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.
Abdominal Abscess ; Appendectomy ; Appendicitis ; Child ; Humans ; Ileus ; Incidence ; Length of Stay ; Wound Infection

Patients with coronary artery disease and depressed ventricular function have better long- term benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from July 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction >or= 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EF group. The left internal thoracic artery was used less frequently in Low EF group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33% in Normal EF group, but without statistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit. Risk factor
Angina, Unstable ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Emergencies ; Humans ; Mammary Arteries ; Mortality ; Risk Factors* ; Ventricular Function

The nodular form of muscular sarcoidosis is a rare malady that is often confused with a soft-tissue neoplasm or other lesion. Here, we present a case of nodular muscular sarcoidosis in the arms and legs of a 59-year-old woman. She presented at our hospital with a painless nodule in her left arm. Excision was performed and she was diagnosed with sarcoidosis. One year later, nodular sarcoidosis recurred in her arms and legs. After 2 months of steroid medication, the nodules disappeared. The patient has been followed for 2 years and no evidence of recurrence has been observed.
Arm ; Female ; Humans ; Leg ; Middle Aged ; Recurrence ; Sarcoidosis

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass(CPB) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. The lesion was total(100%) occlusion of proximal right coronary artery (RCA) without any evidence of disease in the rest of coronary arteries. Percutaneous transluminal angioplasty(PTCA) was tried but unsuccessful. We herein report a case of successful CABG to right coronary artery without CPB on a patient with complete occlusion of RCA and symptomatic with minimal activity.
Arterial Occlusive Diseases ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Myocardial Revascularization ; Surgical Procedures, Minimally Invasive

Tumor lysis syndrome is a life-threatening complication of anti-cancer therapy that typically occurs in patients with large, rapidly growing and treatment-sensitive tumors such as high-grade lymphomas and acute leukemias. However, its incidence in solid tumors has been known to be very low. Tumor lysis syndrome in solid tumors has a high mortality rate owing to the lack of prophylactic therapy to prevent this complication. We report a case of fatal tumor lysis syndrome developed during chemotherapy in extensive-stage small cell lung cancer, along with a brief review of the relevant literature considering the rarity of this manifestation in solid tumor.
Humans ; Incidence ; Leukemia ; Lymphoma, Non-Hodgkin ; Small Cell Lung Carcinoma ; Tumor Lysis Syndrome

PURPOSE: To evaluate, using various port systems, the technique and complications of intra-arterial portimplantation in visceral (mainly hepatic) arteries for intra-arterial chemoinfusion. MATERIALS AND METHODS: Weretrospectively evaluated 30 cases of intra-arterial port implantation in 29 patients. Angiography was performedin all cases, and insertion of an implantable polyurethane port catheter was followed by angiographic exchangewhich, utilizing a .035" hydrophilic guide wire, targeted the artery. If a change in the direction of flow wasrequired, arterial flow control was performed, using an enbolie coil. In order to insert the subcutaneous portchamber, an incision approximately 4cm long was made at the puncture site and subcutaneous tissue was dissected.The port chamber was inserted into the subcutaneous pocket and fixed with a black-silk tagging suture. When thefemoral artery was punctured, the port chamber was inserted into the supra-or infrainguinal area; when the leftsubclavian artery was used, the port chamber was inserted into the lateral one third of the left clavicle. Theport systems used in the procedure were as follows : 5.8F Port-A-Cath (SIMS, Deltec, U.S.A.)(n=20) ; 5.2F A-Port(Therex, U.S.A.)(N=5); 5F PU-Anthron(Deny, Japan)(n=4) ; 5.2F R-Port(Therex, U.S.A.)(n=1). The subcutaneouschambers were inserted into the infrainguinal (n=22), suprainguinal (n=6) or subclavian area(n=2). RESULTS: Theprocedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic arteryproper(n=11), the right hepatic(n=9), gastroduodenal (n=6), common hepatic (n=2), inferior mesenteric (n=1) andinternal iliac artery(n=1). In 12 cases, flow was controlled using embolic coils. Follow-up study was performed in23 cases, with a mean follow up period of 55.8 (11-161) days. Complications were noted in four cases ; two wereprocedure related and two were catheter related. CONCLUSION: Intra-arterial port implantation is a safe procedureand can be performed easily by skilled radiologists; long-term observation is, however, still needed.
Angiography ; Arteries ; Catheters ; Clavicle ; Follow-Up Studies ; Humans ; Polyurethanes ; Punctures ; Subcutaneous Tissue ; Sutures ; Vascular Access Devices