Obesity is an important health problem in the world and related to many critical diseases, such as diabetes, cardiovascular disease, and metabolic syndrome. Obesity leads to fat infiltration of multiple organs and infiltrated adipose tissue produces many cytokines resulting in the dysfunction of organs such as the gallbladder. In the biliary diseases, obesity and overweight have been known as a major risk factor for gallstones. According to current studies, obesity, insulin resistance, hyperinsulinemia, and metabolic syndrome are related to various gallbladder diseases including gallbladder stones, cholecystitis, gallbladder polyps, and gallbladder cancers. We reviewed further literature on the obesity and gallbladder diseases, in aspects of epidemiology, mechanism, pathology and prevention.
Body Mass Index ; Cholecystitis/etiology ; Exercise ; Gallbladder Diseases/drug therapy/epidemiology/*etiology/prevention & control ; Gallbladder Neoplasms/epidemiology/etiology ; Gallstones/epidemiology/etiology ; Humans ; Hyperinsulinism ; Hypolipidemic Agents/therapeutic use ; Insulin Resistance ; Obesity/*complications ; Ursodeoxycholic Acid/therapeutic use ; Weight Loss

Systemic lupus erythematosus (SLE) which is thought to be autoimmune in nature affects multiple organs and produces a diversity of signs and symptoms. However, cardiovascular manifestations of SLE are manifested more frequently by autopsy. Recently, with the prolonged survival and improvement of diagnostic methods in SLE including echocardiography, the morbidity and mortality associated with cardiovascular manifestations of SLE became more apparent and increased. Simultaneous involvement of the pulmonary artery and the myopericardium in SLE is known to be rare. Pulmonary hypertension is known to be associated with poor prognosis. We report a 27 year-old female patient of SLE with pulmonary hypertension, pericarditis and left ventricular systolic dysfunction.
Adult ; Autopsy ; Echocardiography ; Female ; Humans ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Mortality ; Pericarditis* ; Prognosis ; Pulmonary Artery

Carcinoid tumors are well-differentiated epithelial neoplasms that usually can be diagnosed without difficulty based on their distinctive histologic patterns. These tumors are composed of variable numbers of calls that contain endocrine secretory granules in their cytoplasm, which can be identified by histochemistry, immunohistochemistry, and electron microscopy, Carcinoid tumors of the duodenum are relatively rare, the reported incidence being 2.0-8.9% of all gastrointestinal carcinoid tumors dianosed in Western countries. The rate of occurrence among all duodenal tumors is 3-5.5%. We experienced a case of carcinoid tumor of the duodenum in a 53 year-old male patient. He was admitted to our hospital because of epigastric pain. On the gastrofiberscopic examination, 0.7 cm sized Yamada type II polyp with central ulceration was noticed on the duodenal bulb. The biopsy specimen revealed carcinoid tumor. He was treated with polypectomy.
Biopsy ; Carcinoid Tumor* ; Cytoplasm ; Duodenum ; Humans ; Immunohistochemistry ; Incidence ; Male ; Microscopy, Electron ; Middle Aged ; Neoplasms, Glandular and Epithelial ; Polyps ; Secretory Vesicles ; Ulcer

BACKGROUND/AIMS: Chronic cholecystitis and contraction of gallbladder (GB) have been regarded as precancerous lesions. The aim of study is to clarify whether chronic cholecystitis and GB contraction have clinical significance. METHODS: This study included 409 patients underwent cholecystectomy for chronic cholecystitis between January 2006 and June 2011 at a single center. Data regarding radiologic findings and blood tests were collected retrospectively. RESULTS: About 384 patients (94%) had GB stones. Among 409 patients, 104 (25.4%) patients had contracted GB and 305 (74.6%) patients did not. Biliary pain was more common in the contracted GB group (42.3% vs. 31.1%). The contracted GB group had a higher proportion of diffuse wall thickening type and a higher conversion rate to open cholecystectomy. Only seven patients (1.7%) were finally diagnosed with GB cancers. All patients were over 60 years of age and complained of biliary pain; however, only one patient had contraction of GB. CONCLUSIONS: Biliary pain, diffuse wall thickening, and conversion to open cholecystectomy were more frequent in the contracted GB group. Although incidental GB cancers were rarely diagnosed, all were older and had biliary pain. These will be used as significant evidences when making a treatment plan in chronic cholecystitis and contracted GB.
Cholecystectomy ; Cholecystitis* ; Gallbladder Neoplasms ; Gallbladder* ; Hematologic Tests ; Humans ; Retrospective Studies

BACKGROUND/AIMS: Chronic cholecystitis and contraction of gallbladder (GB) have been regarded as precancerous lesions. The aim of study is to clarify whether chronic cholecystitis and GB contraction have clinical significance. METHODS: This study included 409 patients underwent cholecystectomy for chronic cholecystitis between January 2006 and June 2011 at a single center. Data regarding radiologic findings and blood tests were collected retrospectively. RESULTS: About 384 patients (94%) had GB stones. Among 409 patients, 104 (25.4%) patients had contracted GB and 305 (74.6%) patients did not. Biliary pain was more common in the contracted GB group (42.3% vs. 31.1%). The contracted GB group had a higher proportion of diffuse wall thickening type and a higher conversion rate to open cholecystectomy. Only seven patients (1.7%) were finally diagnosed with GB cancers. All patients were over 60 years of age and complained of biliary pain; however, only one patient had contraction of GB. CONCLUSIONS: Biliary pain, diffuse wall thickening, and conversion to open cholecystectomy were more frequent in the contracted GB group. Although incidental GB cancers were rarely diagnosed, all were older and had biliary pain. These will be used as significant evidences when making a treatment plan in chronic cholecystitis and contracted GB.
Cholecystectomy ; Cholecystitis* ; Gallbladder Neoplasms ; Gallbladder* ; Hematologic Tests ; Humans ; Retrospective Studies

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation for its successful conduction. We investigated the efficacy and safety of the combined use of intravenous midazolam and propofol for sedation during ERCP. METHODS: A retrospective review of patient records from a single tertiary care hospital was performed. Ninety-four patients undergoing ERCP received one of the two medication regimens, which was administered by a nurse under the supervision of a gastroenterologist. Patients in the midazolam (M) group (n=44) received only intravenous midazolam, which was titrated to achieve deep sedation. Patients in the midazolam pulse propofol (MP) group (n=50) initially received an intravenous combination of midazolam and propofol, and then propofol was titrated to achieve deep sedation. RESULTS: The time to the initial sedation was shorter in the MP group than in the M group (1.13 minutes vs. 1.84 minutes, respectively; p<0.001). The recovery time was faster in the MP group than in the M group (p=0.031). There were no significant differences between the two groups with respect to frequency of adverse events, pain experienced by the patient, patient discomfort, degree of amnesia, and gag reflex. Patient cooperation, rated by the endoscopist as excellent, was greater in the MP group than in the M group (p=0.046). CONCLUSIONS: The combined use of intravenous midazolam and propofol for sedation during ERCP is more effective than midazolam alone. There is no difference in the safety of the procedure.
Amnesia ; Cholangiopancreatography, Endoscopic Retrograde* ; Conscious Sedation ; Deep Sedation ; Humans ; Midazolam* ; Organization and Administration ; Patient Compliance ; Propofol* ; Reflex ; Retrospective Studies ; Tertiary Healthcare

OBJECTIVES: In this study, we evaluated the efficacy of nebulized bovine pulmonary surfactant on experimentally induced otitis media with effusion (OME) in guinea pigs. METHODS: Twenty guinea pigs were divided into three groups. Four untreated animals served as normal controls. Experimental OME was established in both ears of the remaining 16 animals by a transbullar injection of 10 microL of Pseudomonas aeruginosa lipopolysaccharide in saline. Thereafter, the guinea pigs received nebulized phosphate buffered saline (n=8) or nebulized bovine pulmonary surfactant (n=8). Nebulization was given daily for 7 days. On day 8, all the animals' passive opening pressure (POP) of the Eustachian tube was measured and histopathological observations of the bulla were made by light microscopy. RESULTS: Nebulized bovine pulmonary surfactant significantly reduced the POP compared to that of saline nebulization. The bovine pulmonary surfactant improved the tubal patency and produced less histopathologcally-evident edematous bullar mucosa. CONCLUSION: Nebulization of bovine pulmonary surfactant plays an important role in treating otitis media with effusion in guinea pigs. Our results suggest that the chosen nebulized bovine pulmonary surfactant can be of good clinical benefit for treating OME in the future.
Animals ; Blister ; Ear ; Eustachian Tube ; Guinea ; Guinea Pigs ; Light ; Microscopy ; Mucous Membrane ; Otitis ; Otitis Media ; Otitis Media with Effusion ; Pseudomonas aeruginosa ; Pulmonary Surfactants

Acute pancreatitis is occasionally caused by endoscopic treatments or radiologic interventions of the pancreatobiliary tract. However, no reports indicate that acute pancreatitis resulted from the insertion of a percutaneous transhepatic cholangiography (PTCS) catheter in the common bile duct (CBD). A 65-year-old woman visited our hospital with acute cholangitis due to about 3 cm-sized CBD stones. We planned to perform PTCS because of the large stones and altered anatomy (Billroth II). The patient was discharged after tract dilatation and insertion of a PTCS catheter in the distal CBD without manipulations of Ampulla of Vater (AOV). However, she visited the emergency room due to acute pancreatitis at three days after discharge. Computed tomography revealed upstream dilation of the main pancreatic duct following the compressed area of a large stone and catheter. Thus, we report a case that presented with acute pancreatitis induced by insertion of a PTCS catheter without manipulations of AOV.
Aged ; Ampulla of Vater ; Catheters* ; Cholangiography ; Cholangitis ; Common Bile Duct* ; Dilatation ; Emergency Service, Hospital ; Female ; Humans ; Pancreatic Ducts* ; Pancreatitis*

Kallmann's syndrome is a rare condition, and this is defined as hypogonadotropic hypogonadism and anosmia or hyposmia. The syndrome may be associated with cleft lip, cleft palate, color blindness, skeletal abnormalities, renal agenesis, sensory neural hearing loss, obesity, etc. About 10 cases of Kallmann's syndrome have been reported in Korea, but there are no reports on cases of Kallmann's syndrome with atrophy of the frontal lobe, severe mental retardation and unilateral renal agenesis. We experienced a case of 17-year-old boy with abnormalities of the olfactory system, as was noted on magnetic resonance imaging (MRI). He had an atrophy of the frontal lobe, mental retardation, a micropenis and unilateral renal agenesis. Hormonal assay documented low levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and thyroid-stimulating hormone (TSH). So, we report here on an unusual case of Kallmann's syndrome along with briefly reviewing the relevant medical literature.
Adolescent ; Atrophy ; Cleft Lip ; Cleft Palate ; Color Vision Defects ; Congenital Abnormalities ; Follicle Stimulating Hormone ; Frontal Lobe ; Genital Diseases, Male ; Hearing Loss ; Humans ; Hypogonadism ; Intellectual Disability ; Kallmann Syndrome ; Kidney ; Kidney Diseases ; Korea ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Obesity ; Olfaction Disorders ; Penis ; Testosterone ; Thyrotropin

Orientia tsutsugamushi, a causative agent of scrub typhus, is an obligate intracellular parasite. The mechanisms by which O. tsutsugamushi invade host cells are unknown. Given the importance of surface-exposed proteins in the pathogenesis of microbial pathogens, outer membrane proteins (OMP) of O. tsutsugamushi were extracted with detergents and their cellular binding was studied. Outer membrane fraction of O. tsutsugamushi was enriched by a sodium-lauryl sarcosinate (Sarkosyl) treatment of total membranes. Outer membrane proteins were extracted by the treatment with sodium dodecyl sulfate (SDS) and Sarkosyl. The resulting soluble fractions were examined for their cellular binding by the immunofluorescence microscopy. A fifty six kilodalton protein was found to bind to fixed ECV304 cells only when the outer membrane preparation was not treated by DTT or heat. These results suggest that the conformation the 56-kDa OMP is important for the attachment to the host cell surfaces.
Detergents ; Hot Temperature ; Membrane Proteins* ; Membranes* ; Microscopy, Fluorescence ; Orientia tsutsugamushi* ; Parasites ; Scrub Typhus ; Sodium Dodecyl Sulfate