PURPOSE: Zinc ion is critical for the functional and structural integrity of eukaryotic cells and participate in the regulation of apoptosis. In general, zinc inhibits a nuclear endonuclease, thereby causing inhibition of apoptosis. Recent studies have pointed to a role for a family of caspase proteases that act upstream of endonuclease. The widely used chemotherapeutic agents exert effects by inducing of apoptosis in sensitive tumor cells. In this study, we investigated the effects of zinc ion and other divalent cation on the idarubicin (IDA)-induced apoptosis of HL-60 cells. In addition, to determine whether Zn inhibits an event upstream of endonuclease activation, we analysed the activity of caspase-3, 9 and proteolytic cleavage of procaspase-3 and PARP [poly (ADP-ribose) polymerase]. METHODS: HL-60 cells were cultured in RPMI 1640 and treated with various doses and time periods of IDA with or without pretreatment of ZnCl2, CaCl2 and MgCl2. Cell viability was measured by trypan blue staining. For detection of apoptotic death, cells were stained with Hoechst dye and observed under fluorescence microscopy. The activities of caspase-3 and caspase-9 were measured by the proteolytic cleavages of Ac- DEVD-AMC and Ac-LEHD-AFC as flurogenic substrates, respectively. The proteolytic cleavages of procaspase-3 and PARP were analyzed by Western blotting using anti- caspase-3 and anti-PARP antibody, respectively. RESULTS: IDA induced the apoptotic death of HL-60 cells in a dose and time dependent manner, which was characterized by increasing chromatin condensation and DNA fragmentation. Pretreatment of HL-60 cells with ZnCl2 caused potent inhibition of IDA-induced apoptosis. Consistent with apoptotic death of HL-60 cells, IDA induced the catalytic activation of caspase-3 and caspase-9. After pretreatment of ZnCl2, the activation of caspase- 3 and the proteolysis of PARP induced by IDA were potently inhibited. But, after pretreatment of CaCl2 and MgCl2, there were no significant changes of IDA-induced apoptosis and proteases activity. CONCLUSION: Zinc ion suppressed the IDA-induced apoptosis via the inhibitions of caspase-9 and caspase-3. But calcium and magnesium ions didn't affect the IDA-induced apoptosis.
Apoptosis* ; Blotting, Western ; Calcium ; Caspase 3 ; Caspase 9 ; Cell Survival ; Chromatin ; DNA Fragmentation ; Eukaryotic Cells ; HL-60 Cells ; Humans ; Idarubicin ; Ions ; Magnesium ; Magnesium Chloride ; Microscopy, Fluorescence ; Peptide Hydrolases ; Proteolysis ; Trypan Blue ; Zinc

Acute pancreatitis is an inflammatory disease that is caused by various etiologies including gallstone, alcohol or hypertriglyceridemia. Although most cases of acute pancreatitis show self-limiting course, severe cases are still associated with significant morbidity and mortality. The pathogenic mechanisms of acute pancreatitis are not fully understood. However, it is a central dogma that premature intracellular activation of trypsinogen is the earliest pathologic event. Even though it remains unknown how intracellular trypsinogen activation can be caused by such diverse etiologies, this initial insult in pancreatic acinar cells lead to local inflammatory complications and a systemic response or death. Pathophysiologic mechanisms related to the progression of acute pancreatitis include microcirculatory injury, chemoattraction of inflammatory cells, release of pro-inflammatory cytokines, and bacterial translocation to pancreas and systemic circulation. Recently, several interesting transgenic mice model experiments shed a light in trypsin independent mechanism of local and systemic inflammation for progression of acute pancreatitis.
Acinar Cells ; Animals ; Bacterial Translocation ; Cytokines ; Gallstones ; Hypertriglyceridemia ; Inflammation ; Light ; Mice ; Mice, Transgenic ; Pancreas ; Pancreatitis ; Trypsin ; Trypsinogen

BACKGROUND/AIMS: Among borderline resectable pancreatic cancer (BRPC), group B BRPC patients have findings that are suggestive but not diagnostic of metastasis. In this study, we attempted to validate whether group B could truly be categorized as a borderline resectable group. METHODS: We placed the BRPC patients into group A or group B. The survival outcomes were compared between the groups. RESULTS: A total of 53 patients with pancreatic adenocarcinoma was classified as either group A or B borderline resectable. In group A, 23 (60.5%) of 38 patients underwent pancreatectomy after concurrent chemoradiotherapy or chemotherapy, but in group B, only five (33.3%) of 15 patients underwent pancreatectomy, mainly because of the progression of suspected distant metastasis. There was a significant difference in overall survival (OS) between group A and B patients (median OS, 21.2 months vs 10.2 months, respectively; p=0.007). Of the patients who underwent pancreatectomy, group B had a higher recurrence rate compared to group A (recurrence rate: 11 of 23 patients [47.8%] vs five of five patients [100%], respectively; p=0.033). CONCLUSIONS: This report is the first to validate the definition of BPRC. Group B had much worse outcomes, and whether group B BRPC can be categorized as BRPC together with group A is questionable.
Adenocarcinoma/classification/mortality/pathology/surgery ; Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Pancreatectomy ; Pancreatic Neoplasms/*classification/mortality/pathology/*surgery ; Retrospective Studies ; Treatment Outcome

PURPOSE: Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. MATERIALS AND METHODS: A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. RESULTS: The mean duration of follow-up after CBD stone extraction was 25.4+/-22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). CONCLUSION: A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Adult ; Aged ; Bile Duct Diseases/*diagnosis/epidemiology/surgery ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy/*methods ; Common Bile Duct/*pathology/radiography ; Elective Surgical Procedures ; Female ; Gallstones/epidemiology/*surgery ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Republic of Korea/epidemiology ; Risk Factors ; *Sphincterotomy, Endoscopic

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy. METHODS: We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed. RESULTS: The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59+/-2.35 mm vs. 4.82+/-2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007). CONCLUSIONS: Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.
Colonic Polyps ; Colonoscopy* ; Humans ; Mass Screening* ; Polyps* ; Retrospective Studies

Mucin-hypersecreting bile duct tumors, which closely resemble intraductal papillary mucinous neoplasms of the pancreas, are rare, and both the clinical features and management thereof are poorly understood. As the biliary tract and the pancreas share a common origin, the two diseases may exhibit homologous histopathological features. Certain intraductal papillary tumors of the bile duct are associated with production of large amounts of mucin that disturb bile flow and cause severe biliary dilatation, obstructive jaundice, and cholangitis. Herein, we report on a patient with an extensive intraductal papillary mucinous neoplasm of the bile duct, involving both the right and left intrahepatic ducts. The ducts were subjected to photodynamic therapy, followed by left hepatectomy. The surgical specimen revealed an adenocarcinoma with a negative resection margin. Photodynamic therapy of the intrahepatic ducts was well-tolerated in the present case, and may serve as a useful therapeutic option for selected patients with intraductal papillary mucinous neoplasms of the bile duct.
Adenocarcinoma ; Bile ; Bile Duct Neoplasms ; Bile Ducts* ; Biliary Tract ; Cholangitis ; Dilatation ; Hepatectomy* ; Humans ; Jaundice, Obstructive ; Mucins* ; Pancreas ; Photochemotherapy*

Infectious arthritis is an important medical emergency with high morbidity. The most frequent causative organism of infectious arthritis is Staphylococcus aureus, and Candida is an uncommon pathogen. Candida arthritis has been reported to occur in seriously ill or immunocompromised patients and neonates. We report the first case of C. parapsilosis arthritis in a patient with ulcerative colitis. A 52-year-old woman was diagnosed with ulcerative colitis 1 year previously and took balsalazide. Pain and swelling in the right knee joint developed 6 months after diagnosis. She was diagnosed with enteropathic arthritis associated with ulcerative colitis and took methotrexate, sulfasalazine, and prednisolone for 3 months, but the symptoms did not improve. We finally diagnosed her with infectious C. parapsilosis arthritis by culturing the synovial fluid. The patient received amphotericin B for 6 weeks and underwent arthroscopic synovectomy. She finally experienced improvement of inflammation in the right knee joint.
Amphotericin B ; Arthritis ; Arthritis, Infectious ; Candida ; Colitis, Ulcerative ; Emergencies ; Female ; Humans ; Immunocompromised Host ; Infant, Newborn ; Inflammation ; Knee Joint ; Mesalamine ; Methotrexate ; Middle Aged ; Phenylhydrazines ; Prednisolone ; Staphylococcus aureus ; Sulfasalazine ; Synovial Fluid ; Ulcer

PURPOSE: Pancreatic neuroendocrine tumors (PNET) are a rare subgroup of tumors. For PNETs, the predictive factors for survival and prognosis are not well known. The purpose of our study was to evaluate the predictive factors for survival and disease progression in PNETs. MATERIALS AND METHODS: We retrospectively analyzed 37 patients who were diagnosed with PNET at Severance Hospital between November 2005 and March 2010. Prognostic factors for survival and disease progression were evaluated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50.0+/-15.0 years. Eight cases (21.6%) were described as functioning tumors and 29 cases (78.4%) as non-functioning tumors. In univariate analysis of clinical factors, patients with liver metastasis (p=0.002), without resection of primary tumors (p=0.002), or American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) stage III/IV (p=0.002) were more likely to demonstrate shorter overall survival (OS). Patients with bile duct or pancreatic duct invasion (p=0.031), sized-lesions larger than 20 mm (p=0.036), liver metastasis (p=0.020), distant metastasis (p=0.005), lymph node metastasis (p=0.009) or without resection of primary tumors (p=0.020) were more likely to demonstrate shorter progression-free survival (PFS). In multivariate analysis of clinical factors, bile duct or pancreatic duct invasion [p=0.010, hazard ratio (HR)=95.046] and tumor location (non-head of pancreas) (p=0.036, HR=7.381) were confirmed as independent factors for predicting shorter PFS. CONCLUSION: Patients with liver metastasis or without resection of primary tumors were more likely to demonstrate shorter OS. Patients with bile duct or pancreatic duct invasion or tumors located at body or tail of pancreas were more likely to demonstrate shorter PFS.
Bile Ducts ; Disease Progression ; Disease-Free Survival ; Humans ; Joints ; Liver ; Lymph Nodes ; Methods ; Multivariate Analysis ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors* ; Pancreas ; Pancreatic Ducts ; Prognosis ; Retrospective Studies ; Tail

Achromobacter xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). CAPD peritonitis caused by Achromobacter xylosoxidans carries high mortality and recurrence rates because of its virulence and resistance to most antimicrobial agents. We experienced a case of CAPD peritonitis caused by Achromobacter xylosoxidans in a patient with hypertension, diabetes mellitus, and end stage renal disease. The patient was treated with intravenous imipenem/cilastatin, and the CAPD catheter was removed. However, the patient died by aspiration pneumonia on the 34th day of hospitalization.
Achromobacter ; Achromobacter denitrificans ; Anti-Infective Agents ; Catheters ; Diabetes Mellitus ; Hospitalization ; Humans ; Hypertension ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pneumonia, Aspiration ; Recurrence

Inflammatory bowel disease (IBD) is an idiopathic chronic inflammation of the intestines. IBD treatment may require anti-inflammatory agents such as sulfasalazine or 5-aminosalicylate (5-ASA) and immunomodulators to control the symptoms. However, these agents have a variety of common adverse effects such as nausea, vomiting, skin rash, leukopenia, thrombocytopenia, and infections. Moreover, rare side effects such as nephrotic syndrome, pneumonitis, and pericarditis can occur. A 21-year-old male was admitted to the hospital due to acute chest pain, fever, and sweating. The patient had a history of Crohn's disease and had been taking mesalazine for 3 weeks. Chest x-ray, echocardiography, and clinical manifestations revealed that the patient had acute pericarditis. However, we did not recognize the relationship between these findings and 5-ASA at that time. Two years later, the patient took 5-ASA again, and similar symptoms occurred, which led us to confirm that he suffered from pericarditis induced by this drug. We report a case of acute recurrent pericarditis that developed after taking 5-ASA for IBD treatment with a review of the literature.
Anti-Inflammatory Agents ; Chest Pain ; Colitis, Ulcerative ; Crohn Disease ; Echocardiography ; Exanthema ; Fever ; Humans ; Immunologic Factors ; Inflammation ; Inflammatory Bowel Diseases ; Intestines ; Leukopenia ; Male ; Mesalamine ; Nausea ; Nephrotic Syndrome ; Pericarditis ; Pneumonia ; Sulfasalazine ; Sweat ; Sweating ; Thorax ; Thrombocytopenia ; Vomiting ; Young Adult