No abstract available.
Doxorubicin* ; Membrane Potentials* ; Membranes* ; Papillary Muscles*

Wolff-Parkinson-White(WPW) syndrome is characterized by electrographic evidence of ventricular preexcitation, which predisposes to supraventicular arrhythmias. Familial occurrence of WPW syndrome is uncommon. We observed two affected siblings in a family. Five members of the family underwent 12-lead electrocardiography and echocardiography. Although known genetic abnormality of the 7q34-q36(PRKAG2) for the familial WPW syndrome was evaluated, the mutation was not detected in this family. Other unknown mutations responsible for this familial WPW syndrome were suggested.
Arrhythmias, Cardiac ; Echocardiography ; Electrocardiography ; Humans ; Siblings ; Wolff-Parkinson-White Syndrome*

A biliary cystadenoma (BC) and a cystadenocarcinoma (BCA) are rare neoplasms of the liver. Among 178 patients with primary liver neoplasms who underwent surgery during the last two years at our department, there were only one case of BC and three cases of BCA. The BC case was a 57-year-old female with 15-cm-sized multilocular cystic mass containing mucin. That patient, who had undergone a simple excision of a liver cyst 6 years earlier under the diagnosis of a cystadenoma, received a repeated wedge resection and is still doing well, no recurrence, 41 months after the resection. One BCA case was a 59-year-old female with an 8-cm-sized multilocular cystic mass. She underwent an extended left lobectomy and is still alive, without recurrence, 55 months later. Another BCA case was 77-year-old female with multiple multilocular masses which had degenerated due to sclerotherapy; the masses were removed by a wedge resection. She has been alive 35 months without recurrence. The other BCA case was a 37-year-old female with a 10-cm-sized unilocular mass with lung metastasis. She underwent an extended left lobectomy and survived 22 months. Malignant transformation of a BC to a BCA is well documented, and recurrence is the rule following incomplete resection. Complete resection of a BC and radical resection of a BCA seem to offer a chance for long-term survival.
Adult ; Aged ; Cystadenocarcinoma* ; Cystadenoma* ; Diagnosis ; Female ; Hepatectomy ; Humans ; Liver ; Liver Neoplasms ; Lung ; Middle Aged ; Mucins ; Neoplasm Metastasis ; Recurrence ; Sclerotherapy

BACKGROUND/AIMS: In patients with advanced biliary malignancies, a chance of curability is obtained by only performing extended liver resection with concomitant pancreatoduodenectomy. This hepatopancreatoduodenectomy(HPD) is known to carry high risk of hepatic failure. We evaluated the effect of pancreatoduodenectomy on liver regeneration and the risk of hepatic failure in patients having undergone HPD to prevent complications associated with liver function. METHODS: Sixteen cases of HPD with extended liver resection were reviewed in the aspects of liver regeneration and hepatic failure. Twenty cases of extended right hepatectomy were selected as a control group(ERL group) for comparison of liver regeneration. Liver volumes were measured by computed tomogram volumetry. RESULTS: Resection rates of the liver and the pancreas in the HPD group were more than 51% and about 40%, respectively. Right portal vein embolization was performed in 66% of cases and all cases with obstructive jaundice underwent percutaneous biliary drainage. Rate of liver regeneration at postoperative 1 month in HPD group was 162%, and that of the ERL group was 169%, resulting in no statistical difference. There was no occurrence of hepatic failure in the HPD group. CONCLUSIONS: Forty percent resection of pancreatic parenchyme following concomitant pancreatoduodenectomy may not compromise liver regeneration after extended liver resection. Complete external drainage of obstructive jaundice and preoperative portal vein embolization are recommended as preoperative procedures for patients undergoing extended liver resection with pancreatoduodenectomy.
Drainage ; Hepatectomy ; Humans ; Jaundice, Obstructive ; Liver Failure ; Liver Regeneration* ; Liver* ; Pancreas ; Pancreaticoduodenectomy* ; Portal Vein ; Preoperative Care

BACKGROUND: The aim of the present study was to detect and quantify auto-positive end-expiratory pressure (auto-PEEP) in anesthetized patients using a Laser-Flex endotracheal tube (Mallincrodt, ID, 6.0 mm), by comparing the effects of changes in tidal volume and respiratory rate. METHODS: All patients (n = 30) undergoing elective surgery were anesthetized, paralyzed and intubated with a ID 8.0 mm endotracheal tube (n = 10, control), ID 6.0 mm endotracheal tube (n = 10, group S), or ID 6.0 mm Laser-Flex endotracheal tube (n = 10, group L), respectively. After anesthetic induction, ventilator settings using a Siemens Servo 900C were changed for a tidal volume of 8, 10 ml/kg, respiratory rates of 10, 12 or 14 breaths/min. Peak airway pressure was measured and auto-PEEP was quantified using an end-expiratory occlusion method. Data recorded on the Bicore CP-100 pulmonary monitor was transfered to a PC and analyzed by processing software (ANADAT). RESULTS: In group S and L, peak airway pressure and auto-PEEP were higher than control group and increased during an increase in tidal volume (P < 0.05). But they were increased significantly during an increase of respiratory rate, only when the tidal volume was 10 ml/kg (P < 0.05). CONCLUSIONS: There was an increase of auto-PEEP in anesthetized patients using a Laser-Flex endotracheal tube during incremental changes of tidal volume and respiratory rates.
Humans ; Positive-Pressure Respiration, Intrinsic* ; Respiratory Rate* ; Tidal Volume* ; Ventilators, Mechanical

PURPOSE: Although there has been recent progress in surgical techniques, such as perioperative management, immunosuppresive regimen and intervention radiology, a liver retransplantation remains as the only therapeutic option for patients with a failing liver allograft. The purpose of this study was to review our clinical experiences of liver retransplantation, performed at the Asan Medical Center. METHODS: Between August 1992 and March 2001, 400 cases of liver transplantations, including 331 in adults and 69 in pediatrics, were performed. Of the 331 adult cases, 10 cases of liver retransplantation, during the same period, were retrospectively analyzed. RESULTS: In the 331 cases of adult liver transplantation, 232 cases of living donor and 99 of cadaveric liver transplantations were carried out. The 331 adult cases also included 10 liver retransplantations. Therefore, the overall liver retransplantation rate was 3%. Primary non-function (PNF) was the leading cause of retransplantation. The conversion of living donor liver transplantation to a cadaveric liver retransplantation was the most common type of retransplantaion, with a cadaveric to cadaveric type the second most common. The in-hospital mortality was 40%. The causes of in-hospital mortality were hepatic artery pseudoaneurysm rupture, Aspergillus pneumonia, and multiple organ failure, initiated by jejuno-jejunostomy site bleeding and massive hepatic necrosis. CONCLUSION: In the current era of extreme organ shortage, retransplantation is the only therapeutic alternative for irreVersible graft failure, especially if the patient has no multiple organ failure (MOF) prior to the operation. Therefore, the careful selection of patients for a retransplantation is required. They should be given superurgent priority if the circumstances permit, and living donor liver transplantation (LDLT) offer a promising alternative.
Adult ; Allografts ; Aneurysm, False ; Aspergillus ; Cadaver ; Chungcheongnam-do ; Hemorrhage ; Hepatic Artery ; Hospital Mortality ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Massive Hepatic Necrosis ; Multiple Organ Failure ; Pediatrics ; Pneumonia ; Retrospective Studies ; Rupture ; Transplants

Patients with hepatocellular carcinoma are often combined with liver cirrhosis, which limits the extent of liver resection. We evaluated the effect of preoperative portal vein embolization (PVE) on perioperative course of major hepatectomy of cirrhotic livers. A case-controlled study categorized by PVE and liver cirrhosis was perfomed in 63 cases undergone right lobectomy for hepatocellular carcinoma. The cirrhotic PVE group showed the following changes before and after PVE, respectively; indocyanine green 15 minutes retention rate of 7.5% and 9.1%, left lobe volume of 433.8 ml and 461.5 ml, and portal pressures of 13.0 mmHg and 18.8 mmHg. The non-cirrhotic PVE group showed a smaller increase in the portal pressure after PVE. There were no PVE-related complications. Postoperative changes in the remnant liver volume at 2 weeks and 3 months showed no significant differences between the cirrhotic PVE and the cirrhotic non-PVE groups. Postoperative bleeding and hepatic failure occurred in 5.3% versus 22.7% and additional hepatic decompensation at postoperative 3 months was found in 10.5% versus 18.2% of the cirrhotic PVE and the cirrhotic non-PVE groups, respectively. The mean size of the tumor in mortality cases was 3.8 cm, and there was no mortality in PVE cases with a tumor less than 5 cm. PVE of a functionally preserved cirrhotic liver was a safe procedure and lowered liver function-related complications, which may be at least partially due to atrophy-hypertrophy of the liver parenchyme and to the attenuated portal pressure change following right lobectomy after PVE. Conclusively, preoperative PVE may provide safety after major hepatectomy for the patients with cirrhotic livers or small-sized tumors.
Carcinoma, Hepatocellular ; Case-Control Studies ; Hemorrhage ; Hepatectomy* ; Humans ; Indocyanine Green ; Liver Cirrhosis ; Liver Failure ; Liver* ; Mortality ; Portal Pressure ; Portal Vein*

PURPOSE: Surgery remains the treatment of choice for a hepatocellular carcinoma (HCC) confined within the liver. When there is no underlying liver disease, resection is the preferred option. In cases of HCC with cirrhosis, impaired hepatic reserve often precludes safe resection. Recently, acceptable transplantation outcomes have been shown in selected HCC patients. The aim of this study was to review the results of liver transplantation for HCC at the Asan Medical Center. METHODS: 73 HCC patients were treated by liver transplantation between August 1992 and April 2001. There were 7 in-hospital mortalities. The mean age of the patients was 51 years. The period of the median follow-up was 22 months. By reviewing the patients' medical records, we investigated tumor size, and number, TNM stage, survival rates, and recurrences. Statistical analysis was performed using Statistica 5.1 and SPSS 9.0. RESULTS: Among 67 patients, 8 (12%) developed a tumor recurrence or distant metastasis following the liver transplantation. The 3 year and 5 year survival rate were 88 and 57%, respectively. There were 12 incidentalomas. The 1 year and 3 year disease free survival rates of 54 cases, with the exception of the incidentalomas, were 80 and 50%, respectively. There were no statistically significant differences in the survival rates between the groups, with and without preoperative TACE (P=0.70). Also, there were no statistically significant differences in the survival rates between cadaveric donor liver transplantations (CDLT) and living donor liver transplantations (LDLT). CONCLUSION: We assume that transplantation for HCC, in carefully selected patients, may be the solution to HCC in cirrhotic livers. If the donor safety with a LDLT can be ensured, its application to patients with cirrhosis and early HCC may be a solution to the donor shortage, which could improve the survival of this group of patients.
Cadaver ; Carcinoma, Hepatocellular* ; Chungcheongnam-do ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Hospital Mortality ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Survival Rate ; Tissue Donors

Angiotensin II(A II) -a main effector molecule of renin-angiotensin system(RAS) has been known to increase blood pressure and glomerular capillary pressure, and filtration fraction which may be involved in the progressive renal injury process. The action of A II takes place mainly through AT1 receptor. RAS can be blocked by angiotensin converting enzyme inhibitor(ACEI) and recently developed A II AT1 receptor antagonist(AT1 RA). ACEI also activate kinin system, simultaneously. However, AT1 RA does not affect kinin system. The renoprotective mechanism of ACEI may be related with activation of kinin system. In order to evaluate the renoprotective mechanism of long-term ACEI(enalapril, 100mg/L in drinking water for 12 weeks) or AT1 RA treatment(losartan 300mg/L in drinking water for 12 weeks), and its effect on the cytokines and growth factor expressions of renal cortical tissue by compatitive RT-PCR, 46 5/6 nephrectomized(5/6 NPX) rats and 8 sham operated rats were included in this study. Five sixth NPX rats showed marked hypertensin, significant proteinuria and glomerulosclerosis(mean 30.5%) in 12 weeks after surgery. However, enelapril or losartan treated rats revealed significantly lower 24 hour urinary protein excretion(UProtV), systolic blood pressure(SBP), and glomerulosclerosis than those of control 5/6 NPX rats. Plasma renin activity and angiotensin II levels of 5/6 NPX untreated control rats were not significantly increased compared to sham operated rats in 12 week after surgery. Renal cortical renin gene expression of untreated 5/6 NPX rats was significantly suppressed compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly increased renin gene expression compared to untreated 5/6 NPX rats. Renal cortical gene expressions of TGF-beta, TNF-alpha, MCP-1, IL-6, osteopontin, and endothelin-1 were significantly increased in 5/6 NPX untreated control rats compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly less level of renal TGF-beta gene expression compared to 5/6 NPX control rats. The magnitude of SBP and UProtV were significantly positively correlated with the degree of glomeruloslerosis(p<0.001, p<0.001). With the above result, we speculate that because ACEI or AT1 RA showed similar renoprotective effect in 5/6 NPX rats, at least in part, local activation of RAS plays an important role in the progressive renal injury process of this model.
Angiotensin Amide ; Angiotensin II ; Angiotensins ; Animals ; Blood Pressure ; Capillaries ; Cytokines ; Drinking Water ; Enalapril ; Endothelin-1 ; Filtration ; Gene Expression ; Interleukin-6 ; Losartan ; Osteopontin ; Peptidyl-Dipeptidase A ; Plasma ; Proteinuria ; Rats ; Renin ; Renin-Angiotensin System* ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

Angiotensin II(A II) -a main effector molecule of renin-angiotensin system(RAS) has been known to increase blood pressure and glomerular capillary pressure, and filtration fraction which may be involved in the progressive renal injury process. The action of A II takes place mainly through AT1 receptor. RAS can be blocked by angiotensin converting enzyme inhibitor(ACEI) and recently developed A II AT1 receptor antagonist(AT1 RA). ACEI also activate kinin system, simultaneously. However, AT1 RA does not affect kinin system. The renoprotective mechanism of ACEI may be related with activation of kinin system. In order to evaluate the renoprotective mechanism of long-term ACEI(enalapril, 100mg/L in drinking water for 12 weeks) or AT1 RA treatment(losartan 300mg/L in drinking water for 12 weeks), and its effect on the cytokines and growth factor expressions of renal cortical tissue by compatitive RT-PCR, 46 5/6 nephrectomized(5/6 NPX) rats and 8 sham operated rats were included in this study. Five sixth NPX rats showed marked hypertensin, significant proteinuria and glomerulosclerosis(mean 30.5%) in 12 weeks after surgery. However, enelapril or losartan treated rats revealed significantly lower 24 hour urinary protein excretion(UProtV), systolic blood pressure(SBP), and glomerulosclerosis than those of control 5/6 NPX rats. Plasma renin activity and angiotensin II levels of 5/6 NPX untreated control rats were not significantly increased compared to sham operated rats in 12 week after surgery. Renal cortical renin gene expression of untreated 5/6 NPX rats was significantly suppressed compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly increased renin gene expression compared to untreated 5/6 NPX rats. Renal cortical gene expressions of TGF-beta, TNF-alpha, MCP-1, IL-6, osteopontin, and endothelin-1 were significantly increased in 5/6 NPX untreated control rats compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly less level of renal TGF-beta gene expression compared to 5/6 NPX control rats. The magnitude of SBP and UProtV were significantly positively correlated with the degree of glomeruloslerosis(p<0.001, p<0.001). With the above result, we speculate that because ACEI or AT1 RA showed similar renoprotective effect in 5/6 NPX rats, at least in part, local activation of RAS plays an important role in the progressive renal injury process of this model.
Angiotensin Amide ; Angiotensin II ; Angiotensins ; Animals ; Blood Pressure ; Capillaries ; Cytokines ; Drinking Water ; Enalapril ; Endothelin-1 ; Filtration ; Gene Expression ; Interleukin-6 ; Losartan ; Osteopontin ; Peptidyl-Dipeptidase A ; Plasma ; Proteinuria ; Rats ; Renin ; Renin-Angiotensin System* ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha