Most patients with bile duct carcinoma are diagnosed at an advanced stage, commonly after the appearance of jaundice. The prognosis is generally poor when the diagnosis is made at this stage. Early diagnosis of cholangiocarcinoma at a nonicteric stage may more likely allow curative resection. Initial workup of suspected biliary tract obstruction begins with noninvasive radiologic examinations including US and CT, but these and with even ERCP have a limitation in the diagnosis of early bile duct carcinoma. A case of intrahepatic early bile duct carcinoma without jaundice in a 53-year-old man, is herein reported. The lesion could be early diagnosed, especially with the use of MR cholagiography and percutaneous transhepatic cholangioscopic examination, and eventually could be completely resected.
Bile Ducts* ; Bile* ; Biliary Tract ; Cholangiocarcinoma ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Early Diagnosis ; Humans ; Jaundice ; Middle Aged ; Prognosis

BACKGROUND/OBJECTIVES: Evidence indicates that berry anthocyanins are anti-atherogenic, antioxidant, and anti-inflammatory. However, berries differ vastly in their anthocyanin composition and thus potentially in their biological and metabolic effects. The present study compared hypolipidemic, antioxidant, and anti-inflammatory properties of blueberry (BB), blackberry (BK), and blackcurrant (BC) in a diet-induced obesity (DIO) mouse model. MATERIALS/METHODS: Male C57BL/6J mice were fed a high fat (HF; 35% fat, w/w) control diet or a HF diet supplemented with freeze-dried 5% BB, 6.3% BK or 5.7% BC for 12 weeks (10 mice/group) to achieve the same total anthocyanin content in each diet. Plasma lipids, antioxidant status and pro-inflammatory cytokines were measured. The expression of genes involved in antioxidant defense, inflammation, and lipid metabolism was determined in the liver, epididymal adipose tissue, proximal intestine, and skeletal muscle. Histological analysis was performed to identify crown-like structure (CLS) in epididymal fat pads to determine macrophage infiltration. RESULTS: No differences were noted between the control and any berry-fed groups in plasma levels of liver enzymes, insulin, glucose, ferric reducing antioxidant power, superoxide dismutase, and tumor necrosis factor α. However, BK significantly lowered plasma triglyceride compared with the HF control and other berries, whereas BC significantly reduced F4/80 mRNA and the number of CLS in the epididymal fat pad, indicative of less macrophage infiltration. CONCLUSIONS: The present study provides evidence that BB, BK and BC with varying anthocyanin composition differentially affect plasma lipids and adipose macrophage infiltration in DIO mice, but with no differences in their antioxidant capacity and anti-inflammatory potential.
Adipose Tissue ; Animals ; Anthocyanins ; Blueberry Plant* ; Cytokines ; Diet ; Fruit ; Glucose ; Humans ; Inflammation ; Insulin ; Intestines ; Lipid Metabolism ; Liver ; Macrophages ; Male ; Mice* ; Muscle, Skeletal ; Obesity* ; Plasma* ; RNA, Messenger ; Rubus* ; Superoxide Dismutase ; Triglycerides ; Tumor Necrosis Factor-alpha

BACKGROUND: We have recently shown that lipopolysaccharide (LPS), a major biologically active component of Gram-negative bacteria, mediate the activation of human keratinocytes by CD14 and Toll-like receptor (TLR 4). However, the mechanism of activation of keratinocytes by Gram-positive bacterial toxins remains unclear. OBJECTIVE: We investigated the mechanism of activation of human keratinocytes by lipoteichoic acid (LTA), a main stimulatory component of Gram-positive bacteria. METHODS: The effects of LTA on CD14, TLR2 and TLR4 mRNA expression were measured by quantitative RT-PCR in cultured human keratinocytes. To determine whether the effects of LTA on CD14, TLR2 and TLR4 expressions of the human keratinocytes were biologically functional, NF-kappaB nuclear translocation and IL-1alpha secretion were measured by immunofluorescence staining and ELISA, respectively. Furthermore, to determine whether these effects by LTA were specific for CD14, TLR2 and TLR4, some cells were pretreated with anti-CD14, anti-TLR2, or anti-TLR2 monoclonal antibodies prior to the addition of LTA. RESULTS: TLR4 mRNA expression on keratinocytes was augmented by exposure to LTA. LTA binding to keratinocytes resulted in NF-kappaB nuclear translocation and secretion of interleukin-1alpha. These responses by LTA were effectively abrogated by preincubating cells with anti-TLR4 monoclonal antibody, but not with anti-CD14 or anti- TLR2 monoclonal antibodies. CONCLUSION: These results indicate that, similar to LPS, LTA induces activation of human keratinocytes mainly through TLR4, however, in contrast to LPS signaling, LTA-induced keratinocyte activation is CD14-independent.
Antibodies, Monoclonal ; Bacterial Toxins ; Enzyme-Linked Immunosorbent Assay ; Fluorescent Antibody Technique ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans* ; Interleukin-1alpha ; Keratinocytes* ; NF-kappa B ; RNA, Messenger ; Toll-Like Receptor 4* ; Toll-Like Receptors*

BACKGROUND: Even though the five year survival rate and prognosis of childhood solid tumors have been improved through the introduction of dose-escalation using tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT), changes in cardiac function have not yet been studied. We therefore evaluated cardiac function after tandem HDCT/auto-SCT.METHODS: This study retrospectively analyzed 56 pediatric patients who were diagnosed with solid tumors and who underwent tandem HDCT/auto-SCT at Samsung Medical Center. We investigated the cardiac function of these patients using echocardiography to evaluate the parameters of the left ventricular ejection fraction, e/e', and left ventricular Tei index.RESULTS: The mean left ventricular ejection fraction, e/e', and left ventricular Tei index at one year after the second HDCT/auto-SCT were 65.7%, 0.32, and 8.6, respectively. When compared those with before the first tandem HDCT/auto-SCT, there were no significant negative changes. We evaluated the changes in cardiac function in different subgroups, based on doxorubicin, radiotherapy involving heart, and the age of the patient at diagnosis. There were no significant changes of cardiac function after the treatment in any of the subgroups. Clinical heart failure did not develop in any of the patients.CONCLUSION: This study showed no significant negative changes in cardiac function at one year after tandem HDCT/auto-SCT. However, long-term follow-up studies of cardiac function in survivors and further studies of cardiac function are needed.
Child ; Diagnosis ; Doxorubicin ; Drug Therapy ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Failure ; Humans ; Prognosis ; Radiotherapy ; Retrospective Studies ; Stem Cell Transplantation ; Stroke Volume ; Survival Rate ; Survivors

Etretinate(Ro 10-9359), an aromatic analogue of vitamin A acid, has been known to be effective in the treatment of psoriasis, Darier's disease, pityriasis rubra pilaris, ichthyosis, and palmoplantar keratoderma when administered orally. In this experiment, we compared the therapeutic and side effects between a group with high dose therapy(initially 75mg of etretinate a day) and an another group with low dose therapy(initially 40mg of etretinate a day). We also observed whether the pretreatment followed by combined treatment with vitamin E could potentiate the therapeutic effect as well as reduce the side effects of oral etretinate. This experiment comprised 102 moderate to severe psoriatic patients. The following results were obtained from this experiment. 1. Fifty-six among 92 patients(61%) who were treated with etretinate for more than 4 weeks showed good to excellent therapeutic effect. 2 The high dose therapy was more effective, but showed more side effects than low dose therapy. 3 Vitamin E did not potentiate the effect of etretinate. In low dose therapy, the pretreatment followed by combined treatment with vitamin E showed a tendency to reduce the side effects of etretinate.
Acitretin* ; Darier Disease ; Etretinate* ; Humans ; Ichthyosis ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Psoriasis* ; Tretinoin ; Vitamin E* ; Vitamins*

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.
Anoxia ; Compliance ; Dyspnea ; Heart ; Humans ; Insurance ; Insurance Coverage ; Korea ; Lung ; Lung Neoplasms ; Male ; Medical Records ; National Health Programs ; Oxygen ; Partial Pressure ; Prescriptions ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Stress, Psychological ; Telephone

PURPOSE: Population based structural and functional maps of the brain provide effective tools for the analysis and interpretation of complex and individually variable brain data. Brain MRI and PET standard templates and statistical probabilistic maps based on image data of Korean normal volunteers have been developed and probabilistic maps based on cytoarchitectonic data have been introduced. A quantification method using these data was developed for the objective assessment of regional intensity in the brain images. Materials and METHODS: Age, gender and ethnic specific anatomical and functional brain templates based on MR and PET images of Korean normal volunteers were developed. Korean structural probabilistic maps for 89 brain regions and cytoarchitectonic probabilistic maps for 13 Brodmann areas were transformed onto the standard templates. Brain FDG PET and SPGR MR images of normal volunteers were spatially normalized onto the template of each modality and gender. Regional uptake of radiotracers in PET and gray matter concentration in MR images were then quantified by averaging (or summing) regional intensities weighted using the probabilistic maps of brain regions. Regionally specific effects of aging on glucose metabolism in cingulate cortex were also examined. RESULTS: Quantification program could generate quantification results for single spatially normalized images per 20 seconds. Glucose metabolism change in cingulate gyrus was regionally specific: ratios of glucose metabolism in the rostral anterior cingulate vs. posterior cingulate and the caudal anterior cingulate vs. posterior cingulate were significantly decreased as the age increased. 'Rostral anterior'/ 'posterior' was decreased by 3.1% per decade of age (P< 10 (-11), r=0.81) and 'caudal anterior'/ 'posterior' was decreased by 1.7% (P< 10 (-8), r=0.72). CONCLUSION: Ethnic specific standard templates and probabilistic maps and quantification program developed in this study will be useful for the analysis of brain image of Korean people since the difference in shape of the hemispheres and the sulcal pattern of brain relative to age, gender, races, and diseases cannot be fully overcome by the nonlinear spatial normalization techniques.
Aging ; Brain* ; Continental Population Groups ; Glucose ; Gyrus Cinguli ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Metabolism ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Recent progress in neonatal intensive care has led to increased survival of infants weighing less than 1500 gm. Many studies to declining sequelae of intensive care, addition to increasing survival, were made. So, we investigated particulary the relationship between survival and birth weight, gestational age, and factors associated with morbidities. METHOD: The retrospecitve review of medical records was analyzed for 92 VLBW infants(birth weight <1,500gm) who were admitted to the neonatal intensive care unit of Samsung seoul hosptial from 1994 to 1996. We compared the outcomes of 32 VLBW infants between October 1994 and September 1995 (period I), with the outcomes of 60 VLBW infants between October 1995 and September 1996 (period II). RESULTS: 1) The incidence of VLBW infants was 1.01% in period I and 1.55% in period II. The overall survival rate increased to 76.7% in period II, compared with 71.9% in period I. 2) By birth weight, the highest survival rate was 100% at 750gm in peeriod I, and 86.4% at 1000 to 1249gm in period II. The survival rate at birth weight 1000 to 1249 gm increased significantly in period II. According to gestational age, the highest was at 31-32 weeks(85.7%) in period I, and at 29-30 weeks(88.9%) in period II. 3) The male : female ratio was 1:1 in period I versus 1:1.07 in period II. There was no significant difference in sex and mode of delivery. 4) The most common major morbidity occurred in VLBW infants was respiratory distress syndrome (65.6% in period I, 53.3% in period II). 5) There was no difference of neonatal death rate during period I, while 2-3 days after birth was the highest(30.0%) during period II. Major causes of death, during both periods, were infection and respiratory distress syndrome and/or its sequelae. CONCLUSION: This report demonstrates marked increased survival rate than previous other reports and especially during period II. With increasing survival, more attention to neonatal sequelae, including chronic lung disease and neurodevelopmental delay, is required.
Birth Weight ; Cause of Death ; Female ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Critical Care* ; Intensive Care, Neonatal ; Lung Diseases ; Male ; Medical Records ; Mortality ; Parturition ; Seoul ; Survival Rate

A tuberculous pleural effusion may be a sequel to a primary infection or represent the reactivation of pulmonary tuberculosis. It is believed to result from a rupture of a subpleural caseous focus in the lung into the pleural space. It appears that delayed hypersensitivity plays a large role in the pathogenesis of a tuberculous pleural effusion. We encountered a 52 years old man with pleural effusion that developed several days after a CT guided percutaneous needle biopsy of a solitary pulmonary nodule. He was diagnosed with TB pleurisy. It is believed that his pleural effusion probably developed due to exposure of the parenchymal tuberculous focus into the pleural space during the percutaneous needle biopsy. This case might suggest one of the possible pathogeneses of tuberculous pleural effusion.
Biopsy, Needle* ; Humans ; Hypersensitivity, Delayed ; Lung ; Middle Aged ; Needles* ; Pleural Effusion* ; Pleurisy ; Rupture ; Solitary Pulmonary Nodule* ; Tuberculosis, Pulmonary

Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Alkaline Phosphatase ; Bile Ducts ; Bile Ducts, Intrahepatic ; Biopsy ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Jaundice ; Liver ; Recurrence ; Cholangiocarcinoma