Methotrexate (MTX) has been widely used in the treatment of psoriasis and rheumatoid arthritis. But prolonged use of MTX can induce hepatic fibrosis and even cirrhosis. To date, in Korea, there have been very few reports on hepatotoxicity due to MTX, and no report on biopsy-proven chronic active hapatitis. We report one patient who developed chronic acitve hepatitis while taking long-term daily dose of MTX(10mg per day) for psoriasis for a prolonged period.
Arthritis, Rheumatoid ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Korea ; Methotrexate* ; Psoriasis*

No abstract available.
Cardiac Catheterization* ; Cardiac Catheters* ; Child* ; Cineangiography* ; Heart Diseases* ; Heart* ; Humans ; Statistics as Topic*

In cervical spine disease patients, the authors performed awake intubation with a flexible fiberscope under local anesthetic preparation to avoid insult to the cervical spine during intubation, and had patients self pronate for positioning to prevent possible complications durings the turning from cart to operating table. We performed this method in 25patients(age15-68 years,19male female6). For oral anesthesia we used 15-20cc of 4% lidocaine in a divided dose. We injected 2 cc of 2% lidocaine for each superior laryngeal nerve block and injected 4-6 cc of 2 to 4% lidocaine through the cricothyroid membrane for transtracheal nerve block with a 22-gauge intravenous catheter. It took 5-10 minutes in 23 patients and over 10 minutes in 2 patients for local anesthetic preparation. It took less than 1 minute in 15 patients, 1-4 minutes in 6 patients and more than 4 minutes in 4 patients for fiberoptic awake intubation. We observed vocal cord movement in 6 patients and blood clot in the trachea in 7 patients. Seventeen patients did pronate without help, 5 patients needed some help and 3 patients needed full support. Among the 3 patients who needed full support, 2 patients were in a halo traction state and one was in deep sedation. Ten patients complained of pain or discomfort during intubation. This complaint may be related which the time taken for intubation and inadequate local anesthesia. There were no complications related to positioning. We concluded that fiberoptic awake intubation and self pronation for positioning is a safe and useful method for anesthetic mnagement in cervical spine disease patients.
Anesthesia ; Anesthesia, Local ; Catheters ; Deep Sedation ; Humans ; Intubation* ; Laryngeal Nerves ; Lidocaine ; Membranes ; Nerve Block ; Operating Tables ; Pronation* ; Spine* ; Trachea ; Traction ; Vocal Cords

PURPOSE: Intratracheal pulmonary ventilation (ITPV) is developed to decrease dead space ventilation. A reverse thrust catheter (RTC) is introduced into an endotracheal tube through an adapter. Bias gas through the RTC exits from the catheter tip. The flow of gas is redirected outward away from the lung. Gas is intermittently introduced into the lung as tidal volume (VT) by an expiratory valve. ITPV can be combined with pressure control mode, resulting in hybrid ventilation (HV). We hypothesized that HV might decrease VT, compared with volume controlled ventilation (VCV) or pressure controlled ventilation (PCV) alone. METHODS: HV was compared with VCV and PCV in 7 tracheostomized rabbits. We aimed at maintaining PaCO2 levels normal as the respiratory rates (RR) were set at 20, 40, 80, and 120/min. Blood pressure and airway pressures were monitored and dead space ratio was calculated. RESULTS: The dead spaces (VD) of VCV are 30+/-4 mL, 18+/-4 mL, 14+/-4 mL, and 12+/-5 mL and the VD of PCV are 24+/-6 mL, 16+/-3 mL, 15+/-4 mL and 12+/-4 mL at the respiratory rates of 20/min, 40/min, 80/min, and 120/min, respectively. The VD of HV are 13+/-6 mL, 9+/-3 mL, 7+/-2 mL, and 5+/-1 mL, respectively. The VT and PIP of HV are significantly lower than those of VCV and PCV at the same RR. CONCLUSION: It can be concluded that HV can be applied to minimize the airway pressures and dead space ventilation of VCV and PCV.
Bias (Epidemiology) ; Blood Pressure ; Catheters ; Lung ; Pulmonary Ventilation ; Rabbits* ; Respiratory Rate ; Tidal Volume ; Ventilation*

No abstract available.
Constriction, Pathologic*

Hypereosinophilic syndrome is a very rare disease characterized by marked peripheral eosinophilia and eosinophilic infiltration of organs such as the heart, nervous system, skin, liver, spleen, gastrointestinal tracts, lung and urinary system. Clinical manifestation depends on the organ involved and the severity of infiltration. The only hepatic involvement is a very rare clinical finding in hypereosinophilic syndrome. Clinical evidence of hepatic involvement typified by hepatomegaly, abnormality of liver function tests and radiologic findings such as multiple intrahepatic lesions detected in ultrasonography (USG) and computed tomography (CT). We reported a case of hypereosinophilic syndrome presenting as only hepatic involvement.
Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Heart ; Hepatomegaly ; Hypereosinophilic Syndrome* ; Liver ; Liver Function Tests ; Lung ; Nervous System ; Rare Diseases ; Skin ; Spleen ; Ultrasonography

BACKGROUND/AIMS: The prognosis of chronic liver disease is closely related to the development of hepatic fibrosis. Liver biopsy is the gold standard method to assess inflammatory activity and fibrosis stage, but this is associated with morbidity and mortality. This study aimed to evaluate the diagnostic value of serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis. METHODS: This study included 100 patients with chronic hepatitis B and cirrhosis. Liver biopsy and histopathologic classification were done. Serum hyaluronic acid and 7S domain of type IV collagen were measured by one step sandwich binding protein assay and radioimmunoassay using polyclonal antibody to 7S domain of type IV collagen, respectively. RESULTS: The serum concentrations of hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio in the cirrhosis group (139 +/- 98.4 ng/mL, 6.9 +/- 3.5 ng/mL, 1.6 +/- 1.5) were significantly higher (p<0.01) than those in the normal and fatty liver group (20.2 +/- 12.5 ng/mL, 3.5 +/- 0.5 ng/mL, 0.7 +/- 0.3), mild hepatitis group (32.3 +/- 52.7 ng/mL, 3.9 +/- 1.4 ng/mL, 0.7 +/- 0.4), and moderate to severe hepatitis group (68.2 +/- 72.3 ng/mL, 5.3 +/- 2.4 ng/mL, 0.8 +/- 0.4). At the cutoff value of 77 ng/mL for hyaluronic acid and 6.3 ng/mL for 7S domain of type IV collagen and 0.62 for AST/ALT ratio, the sensitivities were 81.8%, 63.6%, 90.9% and specificities were 87.3%, 88.6%, 53.1% for discriminating cirrhosis (fibrosis score: 4) from the mild to severe fibrosis (fibrosis score: 0-3). CONCLUSIONS: Serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio measurement may be clinically useful as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.
Adult ; Alanine Transaminase/*blood ; Aspartate Aminotransferases/*blood ; Biological Markers/blood ; Collagen Type IV/*blood ; Female ; Hepatitis B, Chronic/blood/*pathology ; Humans ; Hyaluronic Acid/*blood ; Liver/*pathology ; Liver Cirrhosis/blood/*pathology ; Male ; Prognosis ; Sensitivity and Specificity

BACKGROUND: To decrease homologuous transfusion and bleeding, Acute Normovolemic Hemodilution (ANH) may be combined with induced hypotension. Tissue oxygen balance may be in danger because of decreased tissue perfusion pressure by induced hypotension and reduced arterial oxygen content by ANH. Thus it is necessary to evaluate effects of induced hypotension combined with ANH on hemodynamics and systemic oxygen balance. METHODS: In 6 mongrel dogs anesthetized with N2O-O2-enflurane and paralyzed with vecuronium, ANH was performed up to half of initial level of hemoglobin with isovolemic pentastarch infusion, and then mean arterial pressure (MAP) was lowered by 30% of the initial value by intravenous administration of Sodium Nitroprusside (SNP). Various hemodynamic parameters were measured before and after ANH and 15, 30, 45 and 60 minutes after induction of hypotension and 15 minutes after the end of hypotension. RESULTS: Heart rate was not changed significantly throughout the study. Central venous pressure increased significantly after ANH but decreased to the initial value after induced hypotension. Systemic vascular resistance showed significant decrease after ANH, more significant decrease after induced hypotension and slight increase after discontinuation of SNP. Cardiac output increased markedly by ANH and maintained during induced hypotension. Oxygen flux decreased significantly after ANH but slightly increased after induced hypotension. Oxygen consumption and Oxygen extraction ratio were maintained throughout the study. There were no acidemia and hypoxemia throughout the study. CONCLUSION: The combined use of ANH and induced hypotension with SNP is safe in the aspect of cardiovascular system and systemic oxygen balance.
Administration, Intravenous ; Animals ; Anoxia ; Arterial Pressure ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Dogs* ; Heart Rate ; Hemodilution* ; Hemodynamics ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; Hypotension* ; Nitroprusside ; Oxygen Consumption ; Oxygen* ; Perfusion ; Sodium* ; Vascular Resistance ; Vecuronium Bromide

BACKGROUND/AIMS: Gastric variceal bleeding is difficult to treat endoscopically because the hemodynamics of the gastric varix are different from that of the esophageal varix. Transjugular intrahepatic portosystemic shunt (TIPS), which has been used widely, does not always result in the regression of gastric varix and it may aggravate the hepatic encephalopathy. Balloon occluded retrograde transvenous obliteration (BRTO) was introduced as a new procedure for gastric variceal bleeding with minimal invasiveness. The purpose of this study was to evaluate the therapeutic effects and complications on follow-up of BRTO as a new treatment option for gastric variceal bleeding. METHODS: Patients with gastric variceal bleeding, who were treated with BRTO form September, 2001 to April, 2003, were included in the study. After the definite confirmation of the shunts with abdominal CT, the sclerosing agent, 5% ethanolamine oleate, was injected into the gastric varix during occlusion through gastrorenal shunts. The procedurre was deemed a technical success when the clotting of the sclerosing agent was observed without leakage, and a clinical success when bleeding stopped and the varix decreased in size or was eradicated during the follow-up period (6-23 months, mean: 17.7). RESULTS: Technical success was achieved in 12 of 13 patients (92%) with gastric variceal bleeding. There were no significant side effects. In the one case of failure, the bleeding was controlled with TIPS. Eleven of the 12 patients who had technical success were shown to be clinically successful. The follow-up endoscopic exam showed some aggravation of pre-existing esophageal varices in four patients and a new development of esophageal varices in two patients. Endoscopic variceal ligation was done on one patient in whom esophageal variceal bleeding was present during the follow-up period. CONCLUSIONS: BRTO was proven to be a feasible, safe and less invasive procedure than TIPS and found to be an effective treatment of a gastric variceal bleeding. Considering the possible aggravation of pre-existing esophageal varices or the new development of esophageal varices, regular endoscopic examinations might be needed during the follow-up period.
Adult ; Aged ; *Balloon Occlusion ; English Abstract ; Esophageal and Gastric Varices/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged

Systemic amyloidosis results from the deposition of insoluble, fibrous amyloid proteins. It occurs mainly in the extracellular spaces of multiple organs and tissues including the kidney, heart, and liver. Although amyloid deposition in the liver is common in patients with systemic amyloidosis, clinically apparent liver disease is relatively rare. Indeed, most patients with systemic amyloidosis manifest only minimal to moderate hepatomegaly and trivial abnormalities in liver function tests. Recently, we experienced two cases of patients who presented with abnormalities in liver function tests and hepatomegaly as manifestations of systemic amyloidosis. We report these cases with a review of the relevant literatures.
Adult ; Amyloidosis/complications/*pathology ; Female ; Hepatomegaly/complications/*diagnosis/pathology ; Humans ; *Liver Function Tests ; Male ; Middle Aged