The wild edible mushroom, Lentinus lepideus has recently been cultivated for commercial use in Korea. While the mushroom has been widely used for nutritional and medicinal purposes, the possible anti-hyperlipidemic action is unclear. The effects of dietary L. lepideus on plasma and feces biochemical and on the liver histological status were investigated in hypercholesterolemic rats. Six-wk-old female Sprague-Dawley albino rats were divided into three groups of 10 rats each. Biochemical and histological examinations were performed. A diet containing 5% L. lepideus fruiting bodies reduced plasma total cholesterol, triglyceride, low-density lipoprotein, total lipid, phospholipids, and the ratio of low-density to high-density lipoprotein. Body weight was reduced. The diet did not adversely affect plasma biochemical and enzyme profiles. L. lepideus reduced significantly plasma beta- and pre-beta-lipoprotein, while alpha-lipoprotein content was increased. A histological study of hepatic cells by conventional hematoxylin-eosin and oil red O staining revealed normal findings for mushroom-fed hypercholesterolemic rats. The present study suggests that a diet supplemented with L. lepideus can provide health benefits by acting on the atherogenic lipid profile in hypercholesterolemic rats.
Agaricales ; Animals ; Azo Compounds ; Body Weight ; Cholesterol ; Diet ; Electrophoresis, Agar Gel ; Feces ; Female ; Fruit ; Hepatocytes ; Humans ; Insurance Benefits ; Korea ; Lentinula ; Lipoproteins ; Liver ; Phospholipids ; Plasma ; Rats

BACKGROUND: With advances in immunosuppression, graft and patient survival rates have increased significantly, but acute cellular rejection remains an important problem following liver transplantation (LT), and late acute rejection (LAR) occurs in a small percentage of recipients. Some risk factors for LAR have been identified, yet the cause of LAR has not been completely investigated. The efficacy of mycophenolate mofetil (MMF) administered in combination with calcineurin inhibitor (CNI) for reduction of LAR has been demonstrated. METHODS: Between January 2006 and August 2007, adult LT recipients (n=309) were enrolled in this study. Biopsy-proven acute rejection that occurred >6 months after LT was defined as LAR. The immunosuppression regimens, CNI or CNI plus MMF, were used continuously for at least 6 months after LT. The mean follow-up period was 34.8 months (range, 25~46 months). RESULTS: LAR occurred in 17 cases (5.5%). The incidence of LAR in the CNI (n=138) or CNI plus MMF groups (n=171) was 8.6% (n=12) and 2.9% (n=5), respectively (P=0.015). Multivariate Cox regression confirmed that CNI plus MMF versus CNI therapy is associated with a decreased risk of LAR (relative risk, 0.33; P=0.04). CONCLUSIONS: The incidence of LAR in the CNI plus MMF group was significantly lower than the CNI group. Thus, continuous use of CNI plus MMF may represent a better immunosuppression regimen to decrease the rate of LAR in LT recipients.
Adult ; Calcineurin ; Follow-Up Studies ; Humans ; Immunosuppression ; Incidence ; Liver ; Liver Transplantation ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Survival Rate ; Transplants

BACKGROUND: Severe graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). This study intended to assess the effectiveness of plasmapheresis (PP) as a liver supportive measure in LDLT recipients showing severe graft dysfunction. METHODS: During 1 year of 2007, 276 adult LDLTs were performed in our institution. Of them 27 underwent PP therapy as a liver support. RESULTS: Seventeen underwent PP during the first month following LDLT and another 10 underwent PP after that period. The underlying causes of such liver support were acute and chronic rejections, ischemic damage, viral hepatitis recurrence and unknown causes. A total of 329 sessions of PP were performed for these 27 patients, indicating 12.2+/-9.9 times per patient for 28.1+/-32.2 days. Concurrent hemodiafiltration was done in 66.7%. Serum total bilirubin level was significantly reduced following PP therapy: 23.2+/-6.5 mg/dL before PP and 14.4+/-5.6 mg/dL at 1 week after completion of PP (P<0.001). Other biochemical parameters did not significantly affected by PP. Overall 1-year patient survival rate was 63.0%. Six-month graft survival rate after completion of PP was 82.6% in 17 patients undergoing PP during the first posttransplant month and 30% in 10 patients undergoing PP after 1 month (P= 0.013). CONCLUSIONS: The results of this study implicate that PP has a beneficial effect on the recovery of liver graft function, especially during the early posttransplant period. We suggest to perform active application of PP therapy for liver recipients showing severe graft dysfunction of total bilirubin greater than 15~20 mg/dL.
Adult ; Bilirubin ; Graft Survival ; Hemodiafiltration ; Hepatitis ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Plasmapheresis ; Recurrence ; Rejection (Psychology) ; Survival Rate ; Transplants

PURPOSE: Splenectomy during living donor liver transplantation (LDLT) in a hepatitis C virus (HCV)-related cirrhotic recipient was performed by a Tokyo group to enhance the patient's tolerability to post-operative anti-viral treatment by improving complete blood count (CBC) profiles. At our institution, interruption of the splenic artery (SPA) by ligation or embolization in lieu of splenectomy, has been performed in LDLT to modulate portal blood flow in small-for-size graft LDLT or to prevent rupture of SPA aneurysms in recipients. We aimed to determine if interruption of the SPA can serve as an alternative management to splenectomy in LDLT recipients based on our data. METHODS: Patients were classified into the splenic artery ligation group (SAL; n=26) and splenic artery embolization group (SAE; n=19), respectively. Among the recipients without SPA interruption, age-, gender-, and severity of cirrhosis-matched 25 recipients were selected as a control group. Post-operative CBC profiles and spleen size were reviewed retrospectively and compared between the groups. RESULTS: After SAL, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 1 month, respectively (p<0.05). After SAE, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 3 months, respectively. There were no significant complications related to interruption of the SPA. CONCLUSION: Interruption of the SPA may have a role in improving neutrophil and platelet counts in LDLT recipients with severe pancytopenia or in whom antiviral treatment for HCV in anticipated.
Aneurysm ; Blood Cell Count ; Blood Platelets ; Hepacivirus ; Humans ; Ligation ; Liver ; Liver Transplantation ; Living Donors ; Neutrophils ; Pancytopenia ; Platelet Count ; Retrospective Studies ; Rupture ; Spleen ; Splenectomy ; Splenic Artery ; Tokyo ; Transplants

PURPOSE: Splenectomy during living donor liver transplantation (LDLT) in a hepatitis C virus (HCV)-related cirrhotic recipient was performed by a Tokyo group to enhance the patient's tolerability to post-operative anti-viral treatment by improving complete blood count (CBC) profiles. At our institution, interruption of the splenic artery (SPA) by ligation or embolization in lieu of splenectomy, has been performed in LDLT to modulate portal blood flow in small-for-size graft LDLT or to prevent rupture of SPA aneurysms in recipients. We aimed to determine if interruption of the SPA can serve as an alternative management to splenectomy in LDLT recipients based on our data. METHODS: Patients were classified into the splenic artery ligation group (SAL; n=26) and splenic artery embolization group (SAE; n=19), respectively. Among the recipients without SPA interruption, age-, gender-, and severity of cirrhosis-matched 25 recipients were selected as a control group. Post-operative CBC profiles and spleen size were reviewed retrospectively and compared between the groups. RESULTS: After SAL, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 1 month, respectively (p<0.05). After SAE, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 3 months, respectively. There were no significant complications related to interruption of the SPA. CONCLUSION: Interruption of the SPA may have a role in improving neutrophil and platelet counts in LDLT recipients with severe pancytopenia or in whom antiviral treatment for HCV in anticipated.
Aneurysm ; Blood Cell Count ; Blood Platelets ; Hepacivirus ; Humans ; Ligation ; Liver ; Liver Transplantation ; Living Donors ; Neutrophils ; Pancytopenia ; Platelet Count ; Retrospective Studies ; Rupture ; Spleen ; Splenectomy ; Splenic Artery ; Tokyo ; Transplants

BACKGROUND: The objective of the present study was to examine the association of educational level and socioeconomic status with glucose metabolism including prediabetes. METHODS: This cross-sectional study subjects were 882 (mean age: 51.0 +/- 13.4 years, M:F = 241:641) without diabetes, aged more than 20 years and residing in Whasu 2 dong in Incheon. We classified them into three levels according to their educational level: primary (illiterate or up to elementary school), secondary (middle school or high school) and tertiary (university), and into three levels according to their socioeconomic status by self reported questionnaire: low, middle and high. Subjects were diagnosed as three groups (normal, prediabetes and diabetes) by American Diabetes Association criteria using 75 g oral glucose tolerance test. The association of educational level and socioeconomic status with glucose metabolism was analyzed. RESULTS: The number of normal group was 300 (34.0%), that of prediabetes was 470 (53.3%) and that of diabetes was 112 (12.7%). In women, the proportion of primary educational group was larger than that of secondary educational group in diabetes (Odds ratio [OR] = 1.88; 95% confidence interval [CI]: 1.01-3.51) and larger than that of tertiary educational group in prediabetes ([OR] = 2.00; [CI]: 1.06-3.78). But socioeconomic status did not have the statistical association with glucose metabolism in women. Also both educational level and socioeconomic status had no statistical association with glucose metabolism in men. CONCLUSIONS: The proportion of low educational level is larger in prediabetes and diabetes compared with normal group in women.
Aged ; Cross-Sectional Studies ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Prediabetic State ; Self Report ; Social Class

PURPOSE: The technique of laparoscopic gastrectomy has developed for early gastric cancer, but a few reports have studied the objective advantages of laparoscopic techniques in a prospective manner. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LG) with conventional open gastrectomy (OG) by the operative outcomes, the recovery of bowel function, and the complications in a prospective nonrandomized manner. METHODS: We studied 73 patients with gastric cancer who were diagnosed as stage I (IA, IB) preoperatively between July 2003 and September 2004. 38 patients underwent LG and 35 patients underwent OG. All patients underwent radical lymphadenectomy (D2), and were treated by a single surgeon. RESULTS: Patients of the two groups were comparable by age, sex, BMI (Body mass index), preoperative stages and mean number of retrived lymph nodes. The mean operative time was shorter in the OG group (P=0.012), and the mean amount of blood loss was significantly less in the LG group than in the OG group (P=0.002). The patients in the LG group recovered bowel function significantly earlier than those in the OG group (P=0.01), thus, the mean hospital stay was significantly shorter in the LG group (P=0.007). The postoperative pain was significantly lower in the LG group (P<0.001). The postoperative complications were 4 cases in the LG group and 6 cases in the OG group, and there were no conversions and no mortalities. CONCLUSION: LG, when compared with OG, has several advantages, including less blood loss, rapid return of gastrointestinal function, less pain, and shorter hospital stay with compromising the cure rate. In addition, for evaluation of the validity of laparoscopic surgery in gastric cancer, a large scaled randomized prospective multicenter study is required.
Gastrectomy* ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Prospective Studies* ; Stomach Neoplasms*

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires

Hepatocellular carcinoma (HCC) with obstructive jaundice that is caused by bile duct tumor thrombi (BDT) is a rare finding and the appropriate treatment has not yet been detrmined. Some authors have reported that hepatic resection and the removal of the BDT without extrahepatic bile duct resection were sufficient procedures. On the other hand, other authors have reported that it was reasonable to resect the extrahepatic bile duct with the primary lesion. The 55-year-old man was admitted with obstructive jaundice and he was without any other symptoms. Preoperative ERCP (Endoscopic retrograde cholangiopancreatography) and CT (Computed tomography) showed the BDT extending from the main mass in the left lobe to the common hepatic duct. An ENBD (endoscopic naso-biliary drainage catheter) was placed to decrease the serum total bilirubin concentration (17.5 mg/dl on admission). The serum total bilirubin concentration was 4.7 mg/dl one day before the operation. The ICG-R15 was 36% one week before the operation. The serum AFP (alpha-fetoprotein) concentration was 4872 ng/ml. The serum ALP (alkaline phosphatase) and GGT (gamma-glutamyl transferase) concentrations were elevated. The serum albumin concentration and prothrombin time were normal. Left lobectomy, extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy were performed with stenting each bile duct orifice. Histologically, the BDT had partially invaded the confluence of the bile duct. At present, the patient is doing well without any recurrence of tumor. Many reports have insisted the BDT rarely invades the confluence portion of bile duct. Therefore BDT extraction without extrahepatic bile duct resection is a sufficient procedure for HCC with the BDT. However, this strategy was inadequate for our case.
Bile Ducts ; Bile Ducts, Extrahepatic ; Bilirubin ; Carcinoma, Hepatocellular* ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Hand ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Middle Aged ; Prothrombin Time ; Recurrence ; Serum Albumin ; Stents

PURPOSE: To evaluate the treatment outcomes of the three-dimensional conformal radiotherapy (3D-CRT), in conjunction with induction chemotherapy, for the treatment of stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between November 1998 and March 2003, 22 patients with histologically proven, clinical stage III NSCLC, treated with induction chemotherapy, followed by 3D-CRT, were retrospectively analyzed. There were 21 males (96%) and 1 female (4%), with a median age of 68.5 (range, 42~79). The clinical cancer stages were IIIA and IIIB in 41 and 59%, respectively. The histologies were squamous cell carcinoma, adenocarcinoma and others in 73, 18 and 9%, respectively. Twenty patients (91%) received induction chemotherapy before radiation therapy. The majority of the chemotherapy regimen consisted of cisplatin and gemcitabine. Radiation was delivered with conventional anteroposterior/ posteroanterior fields for 36 Gy, and then 3D-CRT was performed. The total radiation dose was 70.2 Gy. The median follow-up period was 17 months (range, 4~59 months). RESULTS: The median overall survival was 19 months. The two and four-year overall survival rates were 37.9 and 30.3%, respectively. The median progression-free survival was 21 months. The two and four-year progression-free survival rates were 42.1 and 21%, respectively. The prognostic factors for overall survival by a univariate analysis were age, histology and T stage (p<0.05). Acute radiation toxicities, as evaluated by the RTOG toxicity criteria, included two cases of grade 3 lung toxicity and one case of grade 2 esophagus toxicity. CONCLUSIONS: The radiation dose could be increased without a significant increment in the acute toxicities when using 3D-CRT. It also seems to be a safe, well- tolerated and effective treatment modality for stage III NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Lung ; Male ; Radiotherapy, Conformal* ; Retrospective Studies ; Survival Rate