PURPOSE: Various vasopressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. After grafted liver was reperfused, postreperfusion syndrome could be treated with various vasopressors. However, epinephrine can decrease the splanchnic perfusion and oxygen saturation and then hepatic blood flow would be jeopardized. Decreased hepatic blood flow might result in centrilobular necrosis which contributes to disruption of liver functions. We tried to know the effect of epinephrine on tissue perfusion of the liver. METHODS: In this study, measurement of hepatic microcirculation (HMC) and hemodynamic changes was performed in eight dogs to investigate the effect of vasopressors on hepatic microcirculation. Animals were divided into four groups in which low-dose epinephrine (0.05mug/Kg/min) and high-dose epinephrine (0.5mug/Kg/min) were randomly infused into the systemic vein and portal vein (1/6 of systemic dose) for ten minutes. Hepatic microcirculation was measured by Thermal Diffusion Probe. RESULTS: At low-dose systemic infusion of epinephrine, mean arterial bloodpressure (MABP), cardiac output (CO), and hepatic microcirculation (HMC) were significantly increased but systemic vascular resistance (SVR) was decreased. On high-dose epinephrine, MABP, CO (P=0.01), and SVR were significantly increased without changes of HMC. Intraportal infusion of low- and high-dose epinephrine increased hepatic vein pressure and SVR, respectively. CONCLUSION: These results would provide clues that systemic low-dose epinephrine infusion is enough to raise HMC and high-dose infusion of epinephrine to raise SVR could be used without jeopardizing HMC.
Animals ; Cardiac Output ; Dogs ; Epinephrine ; Hemodynamics ; Hepatic Veins ; Liver ; Liver Transplantation ; Microcirculation* ; Necrosis ; Oxygen ; Perfusion ; Portal Vein ; Thermal Diffusion* ; Transplants ; Vascular Resistance ; Vasoconstrictor Agents ; Veins

A 43 years old woman had suffered from a lower back pain for 2 months. She experienced pain aggravation after spinal manipulative therapy that was practiced by non-licentiate. Physical examination showed tenderness on L1 and L2 spinous processes. Radionuclide bone scan with 99mTc-MDP showed increased radioactivity of L1, L2 vertebral bodies. The MRI finding showed low signal intensity of L1 and L2 vertebral bodies in T1-weighted image and high signal intensity in T2-weighted image. Needle biopsy finding showed fibrosis and inflammatory cell invasion of bone marrow. We concluded that she had tuberculous spondylitis and non-detection or negligent treatment of a preexisting disease contributed to aggravation of her symptoms. We report one case of tuberculous spondylitis aggravated by spinal manipulative therapy with review of literatures.
Adult ; Biopsy, Needle ; Bone Marrow ; Female ; Fibrosis ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Musculoskeletal Manipulations* ; Physical Examination ; Preexisting Condition Coverage ; Radioactivity ; Spondylitis* ; Technetium Tc 99m Medronate

Resection of hepatic tumors located near the confluence of hepatic vein or invading retrohepatic vena cava has become technically feasible and relatively safe with the introduction of veno-venous bypass. Hepatic vascular exclusion(HVE) with the aid of veno-venous bypass using centrifugal pump enables safe resection and reconstruction of vena cava without hemodynamic instability, compared to conventional HVE. The authors report a case of a successful en bloc resection of right lobe and caudate process of liver, right adrenal, right kidney, and retrohepatic vena cava, in order to extirpate huge retroperitoneal tumor, with the aid of veno-venous bypass using centrifugal pump. Pathologic diagnosis revealed B cell type non Hodgkin's lymphoma arising from adrenal gland. After resection, caval defect was reconstructed with Dacron graft. Patency of reconstructed cava could be observed at five months postoperatively.
Adrenal Glands ; Diagnosis ; Hemodynamics ; Hepatic Veins ; Kidney* ; Liver* ; Lymphoma, Non-Hodgkin ; Polyethylene Terephthalates ; Transplants

The present studies were performed to investigate the interaction of 17beta-estradiol and human growth hormone(hGH) on the proliferation of human periodontal ligament(hPDL) cell. The independent effects of 17beta-estradiol and hGH on hPDL cell proliferation were investigated and the effects of hGH on hPDL cell proliferation after 17beta-estradiol pre-treatment were also investigated. Lastly, the change of hGH receptor expression in hPDL cell after 17beta-estradiol pre-treatment were investigated The obtained results were as follows; 1. The treatment of 17beta-estradiol or hGH had no significant effects on hPDL cell proliferation. 2. After pre-treatment of 17beta-estradiol, hGH stimulated the proliferation of the hPDL cell, regardless of hHG concentration. 3. Although there was not hGH receptor in the hPDL cell, hGH receptors were expressed in hPDL cell after more than 6 hours pre-treatment cf 17beta-estradiol. 4. The effect of hGH on hPDL, cell proliferation was related to the hGH receptor expression. 17beta-estradiol pre-treatment contributed to the hGH effects on the hPDL cell by stimulating hGHR expression.
Cell Line* ; Cell Proliferation ; Estrogens* ; Growth Hormone* ; Human Growth Hormone ; Humans* ; Periodontal Ligament* ; Receptors, Somatotropin*

We report a case of recurrent subacute necrotizing lymphadenitis with pancytopenia in 21-years-old-woman. She was admitted to our hospital 4-years interval with fever and abdominal pain. Laboratory findings of the last admission showed pancytopenia, such as WBC 700/microliter, hemoglobin 6.0mmol/L (9.7g/dL), hematocrit 28.8%, and platelet 54,000/microliter. Abdominal CT showed hepatosplenomegaly, enlarged conglomerated lymph nodes in splenic hilum, lesser sac, celiac root, and paraaortic areas. Bone marrow biopsy showed hypocellular marrow (20%) with increased number of megakaryocyte, myeloid hyperplasia, and hemophagocytic histiocytes suggesting infectious process. We performed exploratory laparotomy, and pathologic finding revealed subacute necrotizing lymphadenitis-Kikuchi disease-. She was recovered on 26th hospital day with conservative treatment.
Abdominal Pain ; Biopsy ; Blood Platelets ; Bone Marrow ; Fever ; Hematocrit ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis ; Hyperplasia ; Laparotomy ; Lymph Nodes ; Lymphadenitis* ; Megakaryocytes ; Pancytopenia* ; Peritoneal Cavity ; Tomography, X-Ray Computed

Abnormal thyroid function is associated with impaired glucose homeostasis. This study aimed to determine whether free thyroxine (FT4) influences the prevalence of prediabetes in euthyroid subjects using a cross-sectional survey derived from the Korea National Health and Nutrition Examination Survey, conducted between 2013 and 2015. We studied 2,399 male participants of >20 years of age who were euthyroid and non-diabetic. Prediabetic participants had lower FT4 concentrations than those without prediabetes, but their thyrotropin concentrations were similar. We stratified the population into tertiles according to FT4 concentration. After adjusting for multiple confounding factors, glycosylated hemoglobin (HbA1c) levels significantly decreased with increasing FT4 tertile, whereas fasting plasma glucose (FPG) levels were not associated with FT4 tertiles (HbA1c, P<0.01 in T3 vs. T1; FPG, P=0.489 in T3 vs. T1). The prevalence of prediabetes was significantly higher in T1 (odds ratio, 1.426; 95% confidence interval, 1.126 to 1.806; P<0.01) than in T3. In conclusion, subjects with low-normal serum FT4 had high HbA1c and were more likely to have prediabetes. These results suggest that low FT4 concentration is a risk factor for prediabetes in male, even when thyroid function is within the normal range.
Blood Glucose ; Cross-Sectional Studies ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Korea ; Male ; Nutrition Surveys ; Prediabetic State ; Prevalence ; Reference Values ; Risk Factors ; Thyroid Gland ; Thyrotropin ; Thyroxine

Fifteen cases of the primary duodenal malignancies were radically resected from July 1989 to September 1996. These cases were analysed retrospectively with the literature review. The male to female ratio was 8:7. The mean age was 49 years. Histopatholgically, adenocarcinomas were 10 cases, sarcomas were 4 cases and malignant lymphoma was 1 case. The symptoms and signs were abdominal pain and discomfort, weight loss, nausea and vomiting, jaundice, melena and diarrhea in the order of the frequency. We performed Whipple's operations in 11 cases, regional pancretectomy in 1 case, Whipple's operation with Right hemicolectomy in 2 cases and local resection in 3 cases. There was no operative mortality. The perioperative morbidity was 33%. The post operative complications were abscess in abdomen in 3 cases and wound infections in 2 cases. 1 year and 2 years survival rate were 93.3% and 33.3%. Aggressive and radical treatment with curative intention even in the presence of locally advanced disease, could be performed with acceptable mortality and morbidity and expect a better outcome.
Abdomen ; Abdominal Pain ; Abscess ; Adenocarcinoma ; Diarrhea ; Female ; Humans ; Intention ; Jaundice ; Lymphoma ; Male ; Melena ; Mortality ; Nausea ; Retrospective Studies ; Sarcoma ; Survival Rate ; Vomiting ; Weight Loss ; Wound Infection

BACKGROUND/AIMS: In patients with advanced biliary malignancies, a chance of curability is obtained by only performing extended liver resection with concomitant pancreatoduodenectomy. This hepatopancreatoduodenectomy(HPD) is known to carry high risk of hepatic failure. We evaluated the effect of pancreatoduodenectomy on liver regeneration and the risk of hepatic failure in patients having undergone HPD to prevent complications associated with liver function. METHODS: Sixteen cases of HPD with extended liver resection were reviewed in the aspects of liver regeneration and hepatic failure. Twenty cases of extended right hepatectomy were selected as a control group(ERL group) for comparison of liver regeneration. Liver volumes were measured by computed tomogram volumetry. RESULTS: Resection rates of the liver and the pancreas in the HPD group were more than 51% and about 40%, respectively. Right portal vein embolization was performed in 66% of cases and all cases with obstructive jaundice underwent percutaneous biliary drainage. Rate of liver regeneration at postoperative 1 month in HPD group was 162%, and that of the ERL group was 169%, resulting in no statistical difference. There was no occurrence of hepatic failure in the HPD group. CONCLUSIONS: Forty percent resection of pancreatic parenchyme following concomitant pancreatoduodenectomy may not compromise liver regeneration after extended liver resection. Complete external drainage of obstructive jaundice and preoperative portal vein embolization are recommended as preoperative procedures for patients undergoing extended liver resection with pancreatoduodenectomy.
Drainage ; Hepatectomy ; Humans ; Jaundice, Obstructive ; Liver Failure ; Liver Regeneration* ; Liver* ; Pancreas ; Pancreaticoduodenectomy* ; Portal Vein ; Preoperative Care

Ectopia cordis is a rare congenital anomaly in which the heart is situated outside the chest cavity and has been known for many years, being reported first in 1671 by Neil Stenson. Ectopia cordis appears closely related with defective embryonic development, arising as the result of defective formation and differentiation of the ventral mesoderm at 14 to 18 days of embryonic life. Ectopia cordis is usually classified into many types according to the site at which the heart protrudes: thoracic type, abdominal type, thoraco-abdominal type, cervical type. We have experinced one case of ectopia cordis which was diagnosed by ultrasonography at 16th gestational weeks in 30 year old multiparity. We report this case with brief review of literatures.
Adult ; Ectopia Cordis* ; Embryonic Development ; Female ; Heart ; Humans ; Mesoderm ; Parity ; Pregnancy ; Thorax ; Ultrasonography ; Ultrasonography, Prenatal*

PURPOSE: To evaluate between DHS and ITST nail (2nd generation) on the treatment of unstable femur intertrochanteric fracture in patients over 70 years old. MATERIALS AND METHODS: 61 cases of unstable intertrochanteric fracture (grouped 37 patients with DHS and 24 patients with ITST) who were taken the operation from Mar. 2003 to Sep. 2007 were analysed regarding to union time, sliding length of lag screws, operation time, blood loss, postoperative complications and functional recovery score by Skovron. RESULTS: The mean union time was 14.7 weeks in study group (ITST). The mean union time was 16.2 weeks in control group (DHS). The lag screw slidings were 7.2 mm in study group and 8.7 mm in control group. The operation times were 57.9 min in study group and 76.9 min in control group. The amount of blood loss were 67.7 ml in study group and 227.4 ml in control group. The complications were 4 cases in study group and 4 cases in control group. The Skovron recovery scores were 76.5% in study group and 73.7% in control group. CONCLUSION: From a practical point of short operation time, less amount of bleeding and less complication, author think that the ITST nail is useful implant for treatment of unstable femur intertrochanteric fracture in patient of old age.
Femur ; Hemorrhage ; Hip ; Humans ; Nails ; Postoperative Hemorrhage