PURPOSE: Bile acids (especially deoxycholate) was known to be toxic and mutagenic on colon epithelium. They proposed at least four mechanisms for the bile acid toxicity. It is the one of these mechanisms that bile acid inhibits the xenobiotic metabolizing enzyme activity (esp glutathione S-transferase, GST). So we measured the cytosolic GST level of colon carcinoma cell lines after deoxycholate exposure whether or not the deoxycholate lowered the cytosolic GST activity. METHODS: Three colon cancer cell lines (LoVo, SW480, HT29) were used for this study. We calculated the cellular toxicity by MTS method. And cytosolic GST activity was measured according to the method as Habig described. For total GST activity, 2.5 mM 1-chloro-2,4-dinitrobenzene was used for substrate, and measured as absorbance in 340 nm. RESULTS: Basal cytosolic GST level for LoVo, SW480, HT29 cell line was 514.59+/-27.01, 291.63+/-38.44 and 344.58+/-47.92 nmol/min/mg cytosol protein. GST level did not changed significantly after 5 days culture without DCA. But GST level was decreased significantly to 128.63+/-21.35, 134.33+/-41.76 and 163.10+/-22.73 nmol/min/mg cytosol protein each cell line after 5 days deoxycholate exposure (p<0.005). CONCLUSION: Cytosolic GST level was lowered significantly after deoxycholate exposure for 5 days. One of the mechanisms of bile acid toxicity for colon cancer cell is proposed to inhibit cytosolic GST activity.
Bile ; Bile Acids and Salts ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Cytosol* ; Deoxycholic Acid* ; Dinitrochlorobenzene ; Epithelium ; Glutathione Transferase* ; Glutathione* ; HT29 Cells ; Humans

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.
Coma ; Delirium* ; Hospitals, General* ; Humans ; Intensive Care Units* ; Length of Stay ; Mortality ; Observational Study*

BACKGROUND/AIMS: As a preliminary study to test the possibility of oral transmission of hepatitis C virus (HCV), many investigations in order to detect the extrahepatic localization of HCV have been performed. In this study, we examined the presence of HCV viral proteins in gastric mucosa. METHODS: Immunohistochemical staining to NS3 protein were done to detect the HCV virus in gastric mucosa. The results were compared with NS5a protein staining to confirm the NS3 protein staining. RESULTS: Total of 164 patient were included. 58 patients with anti-HCV (+) were designated to case group and 70 with anti-HCV (-) to control group. 36 were excluded in this study due to concomittent illness. Anti-HCV (+) group showed 50.0% (29/58) of positivity to NS3 protein staining and anti-HCV (-) group showed 12.6% (9/70) of positivity (p<0.001). Immunohistochemical staining to NS5a protein were done to validate the result of NS3 (+) staining in the anti-HCV (+) group (n=58). NS5a (+) staining were observed in 58.6% (34/58). The results of NS5a staining were consistent with that of NS3 in 70.7%. The reliability coefficients by Chronbach's Alpha for NS3 and NS5a stain test was 0.59. CONCLUSIONS: HCV can exist in gastric mucosal cell as an extrahepatic presence. In the future, this study may provide some fundamental data for the research of possible oral transmission route of HCV.
Aged ; English Abstract ; Female ; Gastric Mucosa/*virology ; Hepacivirus/*isolation & purification ; Hepatitis C Antigens/*analysis ; Humans ; Male ; Middle Aged

BACKGROUND: IL-18 was originally cloned as a IFN-gamma inducing factor in primed T cells. In synergy with IL-12, IL-18 has been shown to induce strikingly high levels of IFN-gamma production by T cells and to enhance Th1 development. Also this cytokine exerts induction of Th2 development through IL-4 induction. METHODS: Resting CD4+ T cells were sorted by negative selection and activated by anti-CD3 plus anti-CD28 Ab. Expression of IL-12 binding sites, IL-18 binding sites, IL-18Ralpha, and GATA-3 mRNA were analysed by FACS and RT-PCR, respectively. RESULTS: Resting CD4+ T cells expressed IL-18Ralpha chain but not IL-18 binding sites, suggesting a lack of IL-18Rbeta expression. IL-18Ralpha was maintained on the Th1 and Th2 committed cells. IL-18 binding sites were induced on the Th1 but not Th2 cells. Exposure of these cells to IL-18 led to up-regulation of GATA-3 mRNA expression only in Th2 committed cells. To elucidate the relationship between IL-18Ralpha expression and GATA-3 induction by IL-18, Th1 and Th2 committed cells were further cultured in medium with or without IL-12 for 2 days. IL-12 binding sites were maintained on the Th1 and Th2 cells regardless of IL-12 treatment, but IL-18Ralpha expression was rapidly down-regulated on the IL- 12-untreated Th2 cells which did not induce GATA-3 mRNA expression followed by IL-18 stimulation. CONCLUSION: IL-12 supports expression of IL-18Ralpha and GATA-3 mRNA expression was induced by IL-18 through IL-18Ralpha without expression of IL-18 binding site in Th2 cells.
Binding Sites ; Clone Cells ; Interleukin-12* ; Interleukin-18 ; Interleukin-4 ; RNA, Messenger ; T-Lymphocytes ; Th2 Cells* ; Up-Regulation

Hepatoid carcinoma is a primary extrahepatic neoplasm exhibiting features of hepatocellular carcinoma (HCC) in terms of morphology, immunohistochemistry, and behavior. In many cases, tumor cytoplasm is positive for alpha- fetoprotein (alpha-FP) with elevated serum alpha-FP level. Because not all hepatoid carcinomas are associated with alpha- FP overproduction, diagnosis should be made essentially by histological features of the tumor. We present a case of hepatoid carcinoma of the pancreas in a 21-year-old male patient. Abdominal computed tomography and magnetic resonance imaging revealed an inhomogeneously enhanced pancreatic head mass. Serum alpha-FP level was markedly elevated. He underwent pylorus-preserving Whipple's operation. The tumor showed hepatoid and neuroendocrine components simultaneously. The histopathological diagnosis was hepatoid carcinoma associated with neuroendocrine tumor of the pancreas. Seven months after the surgery, the patient is healthy without evidence of recurrence. To date, only 7 cases of hepatoid carcinoma of the pancreas have been reported in the literature, and this is the first case report in Korea.
Adult ; Carcinoma, Hepatocellular/pathology ; Humans ; Male ; Pancreatic Neoplasms/*diagnosis/pathology

PURPOSE: Continuous renal replacement therapy(CRRT) has been the first choice for the treatment of acute renal failure in critically ill children not only in western countries but also in Korea. However, there are very few studies that have analyzed the outcome and prognosis of this modality in Korean children. We performed this study to evaluate the factors associated with the outcome and prognosis of patients treated with CRRT. METHODS: We retrospectively reviewed the medical records of 32 children who had received CRRT at Severance hospital from 2003 to 2006. The mean age was 7.5 years(range 4 days- 16 years) and the mean body weight was 25.8 kg (range 3.2-63 kg). RESULTS: Eleven(34.4%) of the 32 patients survived. Bone marrow transplantation and malignancy were the most common causes of death and underlying disease leading to the need for CRRT. Mean patient weight, age, duration of CRRT, number of organ failures, urine output, estimated glomerular filtration rate(eGFR), C-reactive protein, and blood urea level did not differ significantly between survivors and nonsurvivors. (1) Pediatric risk of mortality(PRISM) III score at CRRT initiation(9.8+/-5.3 vs. 26.7+/-7.6, P<0.0001), (2) maximum pressor number (2.1+/-1.2 vs. 3.0+/-1.0, P=0.038), and (3) the degree of fluid overload(5.2+/-6.0 vs. 15.0+/-8.9, P=0.002) were significantly lower in survivors than in nonsurvivors. Multivariate analysis revealed that fluid overload was the only independent factor reducing survival rate. CONCLUSION: CRRT was successfully applied to the treatment of acute renal failure in a wide range of critically ill children. To improve survival, we suggest the early initiation of CRRT to prevent the systemic worsening and progression of fluid overload in critically ill children with acute renal failure.
Acute Kidney Injury ; Body Weight ; Bone Marrow Transplantation ; C-Reactive Protein ; Cause of Death ; Child* ; Critical Illness* ; Filtration ; Humans ; Korea ; Medical Records ; Multivariate Analysis ; Prognosis* ; Renal Replacement Therapy* ; Retrospective Studies ; Survival Rate ; Survivors ; Urea

Portal vein thrombosis is a rare complication accompanied with acute pancreatitis or cholangitis/cholecystitis. The main pathogenesis of portal vein thrombosis in pancreatitis or cholangitis/cholecystitis are suggested to be venous compression by pseudocyst and an imbalance between the blood coagulation and fibrinolysis. In this case report, we experienced a 63 year old male who developed portal vein thrombosis later in the course of the treatment of acute gallstone pancreatitis with cholangitis/cholecystitis without any symptom or sign. The diagnosis of portal vein thrombosis was given on follow up CT scan and serum protein S activity was decreased to 27% in laboratory study. Immediate anticoagulation therapy with heparin and thrombolytic therapy with urokinase and balloon dilatation were performed. Despite the aggressive treatment, complete reperfusion could not be obtained. With oral warfarin anticoagulation, the patient showed no disease progression and was discharged. We report a case of portal vein thrombosis as a complication of acute pancreatitis and cholangitis/cholecystitis with a review of literatures.
Acute Disease ; Cholangitis/*complications/diagnosis ; Cholecystitis/complications ; Humans ; Male ; Middle Aged ; Pancreatitis/*complications/diagnosis ; *Portal Vein ; Tomography, X-Ray Computed ; Venous Thrombosis/diagnosis/*etiology

Adenomatous polyp in colorectal area is clinically important as being a precursor of colorectal cancer. Early detection of cancer reduces colorectal cancer mortality. Finding and removing precursor adenomas reduces colorectal cancer incidence especially in high risk groups. FDG-PET/CT is a new imaging technology in which a number of clinical applications has been recognized in oncologic imaging. FDG-PET has been shown to detect a wide variety of tumor foci including lymphoma, melanoma, lung cancer and colorectal cancer. Colorectal adenoma can also be detected by FDG-PET. In this case, we describe a colorectal villous adenoma, which was found by FDG-PET/CT. There was a mass of intensely increased FDG uptake in rectal area. The adenoma was confirmed with sigmoidoscopy and removed by polypectomy.
Adenoma ; Adenoma, Villous* ; Adenomatous Polyps ; Colorectal Neoplasms ; Early Detection of Cancer ; Incidence ; Lung Neoplasms ; Lymphoma ; Melanoma ; Mortality ; Rectum ; Sigmoidoscopy

Although advances in imaging technology have allowed for earlier detection of disease, hepatocellular carcinoma is usually asymptomatic and discovered at an advanced stage with metastasis. The most common sites of metastasis include lung, peritoneum, adrenal gland, and bone, but rarely, the nasal cavity, orbit, gallbladder, and ovary can be metastatic sites. We experienced a case of metastatic hepatocellular carcinoma of the ovary in a living patient. The differential diagnosis includes hepatoid yolk sac tumor of the ovary, primary or metastatic hepatoid carcinoma and primary or metastatic oxyphil cell tumor of the ovary. To the best of our knowledge, there have been eight cases of metastatic hepatocellular carcinoma of the ovary in the English literature and only six cases discovered in living patients. This is the first report of a metastatic hepatocellular carcinoma of the ovary in Korea.
Adult ; Carcinoma, Hepatocellular/*secondary ; Diagnosis, Differential ; English Abstract ; Female ; Humans ; Liver Neoplasms/*pathology ; Ovarian Neoplasms/diagnosis/*secondary

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.