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: 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

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 AND PURPOSE: Although acetyl-L-carnitine (ALC) treatment may have beneficial effects on Alzheimer's disease (AD), its underlying neural correlates remain unclear. The purpose of this study was to investigate cerebral perfusion changes after ALC treatment in AD patients using technetium-99m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT). METHODS: A total of 18 patients with early AD were prospectively recruited and treated with ALC at 1.5 g/day for 1.4±0.3 years. At baseline and follow-up, brain SPECT, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), and Neuropsychiatric Inventory (NPI) were used to assess participants. After ALC administration, changes in brain perfusion, severity of dementia, cognitive performance, and neuropsychiatric disturbances were examined. RESULTS: After ALC administration, changes in scores of MMSE, CDR, GDS, and NPI were not statistically significant (p>0.05). Voxel-wise whole-brain image analysis revealed that perfusion was significantly (p<0.001) increased in the right precuneus whereas perfusion was reduced in the left inferior temporal gyrus (p<0.001), the right middle frontal gyrus (p<0.001), and the right insular cortex (p=0.001) at follow-up. CONCLUSIONS: Although previous studies have suggested that AD patients generally demonstrate progressive deterioration in brain perfusion and clinical symptoms, this study reveals that the perfusion of the precuneus is increased in AD patients after ALC administration and their cognitive and neuropsychiatric symptoms are not aggravated. Further studies are warranted to determine the potential association between perfusion increase in the precuneus and clinical symptoms after ALC treatment in AD patients.
Acetylcarnitine* ; Alzheimer Disease* ; Brain ; Cerebral Cortex ; Cognition ; Dementia ; Follow-Up Studies ; Humans ; Parietal Lobe ; Perfusion* ; Prospective Studies ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

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

Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.
Diagnosis ; Gallbladder Neoplasms* ; Gallbladder* ; Hemoperitoneum* ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Rupture ; Rupture, Spontaneous*