No abstract available.
Esophageal Atresia* ; Tracheoesophageal Fistula*

To make an accurate diagnosis of esophageal rupture during balloon dilatation without the help of esophagograph, an infusion pump, a pressure transducer and a radiopaque esophageal balloon were connected through a three-way connector. The pressure transducer was connected consecutively to an amplifier, a differentiator and a speaker to detect a pressure drop in the esophageal balloon. Under fluoroscopic monitoring, a radiopaque balloon catheter was inserted in the mid-thoracic esophagus of 30 rabbits and inflated with air until the esophagus was ruptured. A pressure drop in the balloon at the time of esophageal rupture was not only recorded graphically, but also was identified through a speaker. To examine esophageal rupture grossly, the rabbits were sacrificed after esophagography. We could detect the time of esophageal rupture during balloon dilatation in all rabbits accurately by observing the pressure drop on the pressure recorder and by hearing the sound made on a speaker. In 8 patients with esophageal stricture, a deflated radiopaque balloon catheter was inserted to the position inside the narrowing point and inflated by injecting air until the 'hourglass' deformity created by the stricture disappeared from the balloon contour which the pressure change in the balloon was monitored with a pressure recorder. The balloon pressures at the time of disappearance of the "hourglass" deformity from the balloon contour ranged from 200 mmHg to 2000 mmHg in 8 patients with esophageal strictures. Esophageal ruptured did not occur in these patients. In conclusion, our results indicate that this new method is not only safe but promising for patients in the future with esophageal strictures. First, it would reduce the chance of mediastinitis in patients of esophageal rupture. Second, esophageal balloon dilatation can be performed more effectively and safely. Third, it is cost-effective. Forth, radiation esposure to the patient can be reduced.
Catheters ; Congenital Abnormalities ; Constriction, Pathologic ; Diagnosis* ; Dilatation ; Esophageal Stenosis ; Esophagus ; Hearing ; Humans ; Infusion Pumps ; Mediastinitis ; Methods ; Rabbits ; Rupture* ; Transducers, Pressure

To make an accurate diagnosis of esophageal rupture during balloon dilatation without the help of esophagograph, an infusion pump, a pressure transducer and a radiopaque esophageal balloon were connected through a three-way connector. The pressure transducer was connected consecutively to an amplifier, a differentiator and a speaker to detect a pressure drop in the esophageal balloon. Under fluoroscopic monitoring, a radiopaque balloon catheter was inserted in the mid-thoracic esophagus of 30 rabbits and inflated with air until the esophagus was ruptured. A pressure drop in the balloon at the time of esophageal rupture was not only recorded graphically, but also was identified through a speaker. To examine esophageal rupture grossly, the rabbits were sacrificed after esophagography. We could detect the time of esophageal rupture during balloon dilatation in all rabbits accurately by observing the pressure drop on the pressure recorder and by hearing the sound made on a speaker. In 8 patients with esophageal stricture, a deflated radiopaque balloon catheter was inserted to the position inside the narrowing point and inflated by injecting air until the 'hourglass' deformity created by the stricture disappeared from the balloon contour which the pressure change in the balloon was monitored with a pressure recorder. The balloon pressures at the time of disappearance of the "hourglass" deformity from the balloon contour ranged from 200 mmHg to 2000 mmHg in 8 patients with esophageal strictures. Esophageal ruptured did not occur in these patients. In conclusion, our results indicate that this new method is not only safe but promising for patients in the future with esophageal strictures. First, it would reduce the chance of mediastinitis in patients of esophageal rupture. Second, esophageal balloon dilatation can be performed more effectively and safely. Third, it is cost-effective. Forth, radiation esposure to the patient can be reduced.
Catheters ; Congenital Abnormalities ; Constriction, Pathologic ; Diagnosis* ; Dilatation ; Esophageal Stenosis ; Esophagus ; Hearing ; Humans ; Infusion Pumps ; Mediastinitis ; Methods ; Rabbits ; Rupture* ; Transducers, Pressure

The aim of this study was to examine and compare the eating habits and dietary intake patterns of people with or without allergy by the survey during August-September, 2008. The 131 subjects aged 10'-50' (AG = allergy group, n = 62; NG = non-allergy group, n = 69) participated in this study. The questionnaire included general characteristics, dietary habits, and food frequency. Income level tended to be higher in AG than in NG, and AG had more pets and flower pots than NG (p<0.01). In AG, most affected area of allergy was the skin and the subjects in AG experienced the mixed symptoms and more than 2 types of allergy. Family history of allergy was highly related with allergy of the subjects (AG: 66.1%, NG: 33.9%). Both groups did not exercise regularly, but frequency of alcohol drinking in AG was significantly higher than in NG (p<0.01). AG skipped meals and had snacking more often than NG (p<0.05). Most favorite snacks in AG were instant foods, fast foods, cookies, and ice cream (p<0.05). Therefore, AG tended to consume more allergy-related foods than NG. Highly-consumed allergy-related foods were egg, pork, walnut, onion, tuna, shellfish, and kiwi (p<0.05). Therefore, nutrition education and guidance is needed to establish good eating habits, food intakes, and life style in people having allergy.
Aged ; Alcohol Drinking ; Eating ; Fast Foods ; Flowers ; Food Habits ; Humans ; Hypersensitivity ; Ice Cream ; Juglans ; Life Style ; Meals ; Onions ; Ovum ; Surveys and Questionnaires ; Shellfish ; Skin ; Snacks ; Tuna

Tumor necrosis factor-alpha (TNF-alpha) plays important roles in inflammatory responses. Some of tetrahydroisoquinoline (THI) compounds exhibited to inhibit iNOS expression in animal studies and RAW 264.7 cells, but the action of THI on inflammatory reaction was not fully investigated. In the present study, we examined a limited series of THIs (higenamine, YS-51 and THI-52) on the TNF-alpha mRNA expression in mouse peritoneal macrophages by Northern analysis. When thioglycollate-stimulated peritoneal macrophages were incubated with LPS (100 ng/ml), expression of TNF-alpha mRNA was evident and reached its maximum at 2.5 h, which was reduced concentration-dependently by treatment with THIs. When the TNF-alpha activity of macrophage-conditioned media was measured using a TNF-sensitive L929 fibroblast cell line, CCL 1, all THIs increased the cell viability in a concentration dependent manner. The concentrations of THIs used are not cytotoxic by itself when analysed by MTT. Furthermore, nitrite/nitrate level was significantly reduced by the presence of THIs in cells treated with LPS+ interferon-gamma (IFN-gamma). It is concluded, thus, that these results strongly indicated that THIs can suppress the TNF-alpha expression and reduce NO, which may be useful for the inflammatory disorders.
Animals ; Cell Line ; Cell Survival ; Fibroblasts ; Interferon-gamma ; Macrophages, Peritoneal* ; Mice* ; RNA, Messenger* ; Tetrahydroisoquinolines* ; Tumor Necrosis Factor-alpha*

BACKGROUND AND AIMS: Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT). METHODS: We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed. RESULTS: HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient's age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period. CONCLUSIONS: Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT.
Adult ; Aged ; Antiviral Agents/therapeutic use ; Combined Modality Therapy ; Female ; Graft Survival ; Hepacivirus/drug effects/isolation & purification ; Hepatitis C, Chronic/complications/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2a/therapeutic use ; Liver Cirrhosis/mortality/*surgery/*virology ; Liver Neoplasms/mortality ; *Liver Transplantation ; Living Donors ; Male ; Middle Aged ; Polyethylene Glycols/therapeutic use ; Recurrence ; Retrospective Studies ; Ribavirin/therapeutic use ; Severity of Illness Index ; Treatment Outcome

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. This study established an individualized HBV prophylaxis protocol, through optimization of hepatitis B immunoglobulin (HBIG) administration, with application of simulative half-life (SHL). METHODS: This study involved five parts: Part 1 developed the SHL estimation method with 20 patients; Parts 2 and 3 assessed the SHL variability and developed a simulation model to apply SHL in 100 patients; Part 4 validated the simulation model in 114 patients, and Part 5 was a cross-sectional study on the current status of HBIG infusion intervals in 660 patients. RESULTS: In Part 1, infusion of 10,000 IU HBIG induced add-on rise hepatitis B surface antibody (anti-HBs) titer of 5,252.5 ± 873.7 IU/L, which was 4.4% lower than actual measurement. Mean SHL of 20.0 ± 3.7 days was 2.2% longer than actual measurement. In Part 2, the medians of the intra- and inter-individual coefficient of variation in SHL were 13.5% and 18.5%, respectively. Pretransplant HBV DNA load and posttransplant antiviral therapy did not affect SHL. In Part 3, a simulation model was developed to determine the interval of HBIG infusion, by using SHL. In Part 4, all 114 patients were successfully managed with regular HBIG infusion intervals of ≥ 8 weeks, and the interval was prolonged to ≥ 12 weeks in 89.4%, with a target trough anti-HBs titer ≥ 200 IU/L. In Part 5, 47.4% of our patients received HBIG excessively, at a target trough titer of 500 IU/L. CONCLUSION: SHL estimation using only clinically available parameters seems to be reliably accurate when compared with actual measurements. We believe that SHL estimation is helpful to establish a personalized HBV prophylaxis protocol for optimizing HBIG administration.
Cross-Sectional Studies ; DNA ; Half-Life ; Hepatitis B virus ; Hepatitis B ; Hepatitis ; Humans ; Immunoglobulins ; Liver Transplantation ; Methods ; Recurrence

Purpose: When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. Methods: This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. Results: The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. Conclusion The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.

BACKGROUND: Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death.METHODS: We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016.RESULTS: The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively (P = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively (P < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM.CONCLUSION: Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.

Purpose: When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. Methods: This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. Results: The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. Conclusion The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.