N/AWe evaluate the regenerating capacity of rat liver according to the severity and duration of the obstructive jaundice. Also we evaluate the regenerating capacity of hepatectomized rat liver according to the duration of the obstructive jaundice. The 10 week-old Sprague-Dawley rats were used. Common bile duct ligation and sequential partial hepatectomies were done. The regenerating capacity was measured by tritiated thymidine incorporation into rat liver DNA. The rate of incorporation of thymidine into DNA in the jaundiced livers increased significantly compared with that in the sham-operated liver on day 3.In jaundiced rats, the regenerating capacity after partial epatectomy decreased markedly without a return toward normal on day 3 and kept low thereafter. The duration of obstructive jaundice may be a key factor in the regeneration of rat liver after partial hepatectomy.
Animals ; Bile Ducts* ; Bile* ; Common Bile Duct ; DNA ; Hepatectomy ; Jaundice, Obstructive ; Ligation* ; Liver Regeneration* ; Liver* ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Thymidine

BACKGROUND: Acute liver failure either after liver resection or as part of underlying liver disease is still associated with high mortality. Various treatments have been tried to improve liver function during acute liver failure, including metabolic and nutritional support, hemodialysis, hemoperfusion, plasmapheresis, and hepatocyte and liver transplantation. Hepatocyte transplantation in various forms has attracted attention recently. We investigated whether allogeneic isolated hepatocytes transplanted in the spleen would prolong survival, facilitate liver regeneration, and improve biochemical parameters in rats with acute liver failure induced by a 90% hepatectomy. METHODS: Allogeneic male Sprague-Dawley rats were used. Group I rats (n=26) received an intrasplenic injection of 2 107 hepatocytes in 0.3 ml of Dulbecco's modified Eagle's medium (DMEM), and 1 days later acute liver failure was induced. Group II acute-liver-failure rats (n=24) received an intrasplenic injection of DMEM. The survival time was determined for 22 rats in Group I and for 20 rats in Group II. The remaining 8 (4/each group) acute liver failure rats were used to assess the liver function and regeneration. RESULTS: The survival was longer and the number of long-term survivors was greater for Group I rats than for the Group II controls. At 24 hour after the hepatectomy, Group I rats had lower ammonia, lower total bilirubin, lower activities of liver enzymes, and higher glucose levels than did Group II rats. In Group I, there was significant increase in the ratio of the weight of the remnant liver lobes to the body weight. CONCLUSION: Compared with the Control group intrasplenic hepatocyte transplantation in acute liver failure rats acts as a bridge to support experimental rats in going from acute or fulminant liver failureto liver regeneration or compensation, prolongs survival in rats with acute liver failure induced by a 90% hepatectomy, and improves the biochemical parameters, except for the albumin levels and prothrombin time. Transplantation of hepatocytes may be beneficial in supporting a liver which has been acutely devastated by a 90% hepatectomy.
Ammonia ; Animals ; Bilirubin ; Body Weight ; Compensation and Redress ; Glucose ; Hemoperfusion ; Hepatectomy* ; Hepatocytes* ; Humans ; Liver ; Liver Diseases ; Liver Failure, Acute* ; Liver Regeneration ; Liver Transplantation ; Male ; Mortality ; Nutritional Support ; Plasmapheresis ; Prothrombin Time ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Renal Dialysis ; Spleen ; Survivors

Congenital lipoid adrenal hyperplasia (CLAH) is the most severe form of congenital adrenal hyperplasia which is caused by mutations in the steroidogenic acute regulatory protein (StAR). The mutations in StAR gene resulted in failure of the transport cholesterol into mitochondria for steroidogenesis in the adrenal gland. Twin sisters (A, B) with normal 46, XX were born at 36+2 gestational week, premature to nonrelated parents. They had symptoms as hyperpigmentation, slightly elevated potassium level and low level of sodium. Laboratory finding revealed normal 17-hydroxyprogesterone level, elevated adrenocorticotropin hormone (A, 4,379.2 pg/mL; B, 11,616.1 pg/mL), and high plasma renin activity (A, 49.02 ng/mL/hr; B, 52.7 ng mL/hr). However, the level of plasma cortisol before treatment was low (1.5 microg/dL) in patient B but normal (8.71 microg/dL) in patient A. Among them, only patient A was presented with adrenal insufficiency symptoms which was suggestive of CLAH and prompted us to order a gene analysis in both twin. The results of gene analysis of StAR in twin revealed same heterozygous conditions for c.544C>T (Arg182Cys) in exon 5 and c.722C>T (Gln258*) in exon 7. We report the first case on the mutation of p.R182C in exon 5 of the StAR gene in Korea.
17-alpha-Hydroxyprogesterone ; 46, XY Disorders of Sex Development ; Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Cholesterol ; Exons ; Genes, vif ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperplasia ; Korea ; Mitochondria ; Parents ; Phosphoproteins ; Plasma ; Potassium ; Renin ; Siblings ; Sodium ; Twins

Adenoviridae ; Animals ; Epithelial Cells ; Epithelium ; Genetic Therapy ; Mice ; Mouth Mucosa ; Organ Culture Techniques ; Palate ; Stainless Steel ; Tongue ; Viruses

Purpose: To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) and postoperative clinical outcome in patients with upper urinary tract carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) and adjuvant chemotherapy (ACH). Materials and Methods: We respectively analyzed the clinical and pathological data of 102 patients who underwent RNU and ACH for UTUC. Patients were divided into 2 groups, according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS) and overall survival (OS). Results: Mean survival time was 50.5±41.2 months. Mean age was 61.4±9.7years. Forty-one of the patients (46.5%) were in the high AST/ALT group. According to receiver operating characteristic analysis, the optimal AST/ALT ratio was 1.2. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in OS (p=0.007) and CSS (p=0.011). Using Cox regression models of clinical and pathological parameters to predict OS, high AST/ALT ratio (hazard ratio [HR], 5.428; 95% confidence interval [CI]; 1.803–16.334; p=0.002), pathological T3 (pT3) or higher (HR, 1.464; 95% CI; 1.156-1.857; p=0.002), and to predict CSS, high AST/ALT ratio (HR, 4.417; 95% CI; 1.545–12.632; p=0.005), and pT3 or higher (HR, 1.475; 95% CI; 1.172–1.904; p=0.002) were determined as independent prognostic factors. Conclusions Pretreatment AST/ALT ratio is a significant independent predictor of CSS and OS in advanced UTUC patients receiving systemic ACH after RNU.

BACKGROUND: Liver fibrosis and cirrhosis are the ultimate histologic consequences of chronic liver damage. Efforts have been made to study the mechanisms of cirrhosis and to discover effective therapeutic strategies. However, to date, no animal model reproduces the disease in man. The purpose of this work is to establish a model of DMN-induced liver cirrhosis for treatment of liver cirrhosis, to understand the basic characteristics of DMN-induced liver cirrhosis, and to confirm the expression of HGF, its receptor c-Met, and TGF-beta1 in Sprague-Dawley rats. METHODS: Five-week-old male Sprague-Dawley rats (n=56) were used for this study. Liver cirrhosis was induced in the rats by using DMN (1 ml/kg body weight, i.p.) given 3 consecutive days a week for 6 weeks. Changes in the portal vein pressure were measured by a venous catheter during the duration of the DMN-treatment. The levels of serum albumin, bilirubin, and ammonia were determined in a clinical laboratory by routive methods. Pieces of the median lobe were cut and fixed in 10% buffered neutral formalin, embedded in paraffin, and stained by hematoxylin-eosin (H&E) & masson-trichrome (M&T). Changes in the extracellular matrix were measured by image analysis and hydroxyproline content. Immunohistochemical staining of alpa-smooth muscle actin was performed to confirm the activation ofhepatic stellate cells. Northern blot analyses were performed to confirm the expression of HGF and TGF-beta1 and western blotting was performed c-Met, HGF receptor. RESULTS: Pressures in the portal vein were significantly increased during the DMN-treatment time (p<0.05). Biochemical parameters were significantly correlated with the progression of liver cirrhosis. H&E staining of 4-week DMN-treated rats demonstrated fibrous tissue bridging between the periportal and the pericentral areas with gradual widening of fibrous bands. Both the extracellular matrix measured by image analysis of the M&T staining and the hydroxyproline content rose continuously throughout the 6 weeks of DMN treatment. alpa-smooth muscle actin was observed in the stellate cells of DMN-treated rats. The northern blot analyses showed that the expression of HGF mRNA decreased with the progression of DMN-induced liver cirrhosis but that of TGF-beta1 mRNA did not. The western blot analyses showed that the expression of the c-Met receptor protein increased continuously, but the expression of HGF mRNA a decreased. CONCLUSION:The model of cirrhosis induced by chronic, discontinuous treatment with a low dose of DMN in rats was simple and predictable and displayed many of the features of human cirrhosis. The decrease in the expression of HGF mRNA may be responsible for the reduced hepatocyte regeneration in liver cirrhosis. The expression of the c-Met protein was related with the decreased expression of HGF. The exact significance of TGF-beta1 was not determined in this study.
Actins ; Ammonia ; Animals ; Bilirubin ; Blotting, Northern ; Blotting, Western ; Body Weight ; Catheters ; Dimethylnitrosamine ; Extracellular Matrix ; Fibrosis ; Formaldehyde ; Hepatocyte Growth Factor* ; Hepatocytes* ; Humans ; Hydroxyproline ; Liver Cirrhosis* ; Liver* ; Male ; Models, Animal ; Paraffin ; Portal Vein ; Proto-Oncogene Proteins c-met ; Rats ; Rats, Sprague-Dawley* ; Regeneration ; RNA, Messenger ; Serum Albumin ; Transforming Growth Factor beta1 ; Transforming Growth Factors*

PURPOSE: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. METHODS: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. RESULTS: The mean reduction ratio of the volume of edema comparison normal volume was 41.1+/-35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. CONCLUSION: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.
Arm ; Breast Neoplasms ; Cytidine Diphosphate ; Drainage ; Edema ; Hemorrhage ; Humans ; Leg ; Lower Extremity ; Lymphedema ; Needles ; Uterine Cervical Neoplasms

BACKGROUND: Valvular heart surgery (VHS) utilizing cardiopulmonary bypass (CPB) is inevitably associated with ischemic-reperfusion injury, which is known to depend on oxygen tension during reperfusion. The aim of this study was to evaluate the effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing VHS. METHODS: Fifty-six patients undergoing isolated VHS were randomly exposed to an oxygen fraction of 0.7 (hyperoxic group, n = 28) or 0.5 (normoxic group, n = 28) during reperfusion. All patients received an oxygen fraction of 0.7 during CPB. In the normoxic group, the oxygen fraction was lowered to 0.5 from the last warm cardioplegia administration to 1 minute after aortic unclamping, and was then raised back to 0.7. Hemodynamic data were measured after induction of anesthesia, weaning from CPB, and sternum closure. The frequency of cardiotonic medications used during and after weaning from CPB, and the short-term outcomes during the hospital stay were also assessed. RESULTS: The frequency of vasopressin and milrinone use during weaning from CPB, but not norepinephrine, was significantly less in the normoxic group. The post-operative cardiac enzyme levels and short-term outcomes were not different between the groups. CONCLUSIONS: Normoxic reperfusion from the last cardioplegia administration to 1 minute after aortic unclamping in patients undergoing VHS resulted in significantly less frequent use of vasopressin and inotropics during weaning from CPB than hyperoxic reperfusion, although it did not affect the post-operative myocardial enzyme release or short-term prognosis.
Anesthesia ; Cardiopulmonary Bypass ; Heart ; Heart Arrest, Induced ; Hemodynamics ; Humans ; Length of Stay ; Milrinone ; Norepinephrine ; Oxygen ; Prognosis ; Reperfusion ; Reperfusion Injury ; Sternum ; Thoracic Surgery ; Vasopressins ; Weaning

BACKGROUND: The decision to administer oral anticoagulation therapy depends on accurate assessment of stroke risk in patients with atrial fibrillation (AF). Various stroke risk stratification schemes have been developed to help inform clinical decision making. The CHADS2 and CHA2DS2-VASc scores have been used in estimating the risk of stroke in patients with AF. Recently R2CHA2DS2-VASc score was developed. The objective of the current study is to validate the usefulness of the R2CHA2DS2-VASc score and to compare the accuracy of the CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores in predicting a patient's risk of stroke. METHODS: Based on medical records, we conducted a retrospective study of patients hospitalized with AF from March 2011 to July 2013. A total of 448 AF patients were included in this study. The receiver operating characteristic (ROC) curve analysis in MedCalc was used for comparison with respective diagnostic values. RESULTS: The patient characteristics showed male predominance (60.9%). Among the 448 AF patients, 131 (29.2%) patients had strokes during the study. A R2CHA2DS2-VASc score of more than 5 is the optimal cut-off value for prediction of stroke. A risk score of three, the area under the ROC curve (AUC) of R2CHA2DS2-VASc score (AUC 0.631; 95% confidence interval, 0.585-0.679) was the highest. A significant difference was observed between AUC for R2CHA2DS2-VASc, CHADS2, and CHA2DS2-VASc scores, but no meaningful difference between CHADS2 and CHA2DS2-VASc scores. CONCLUSION: We determined the usefulness of the R2CHA2DS2-VASc score, which showed better association with stroke than the CHADS2 and CHA2DS2-VASc scores.
Area Under Curve ; Atrial Fibrillation* ; Clinical Decision-Making ; Humans ; Male ; Medical Records ; Retrospective Studies ; ROC Curve ; Stroke

PURPOSE: We evaluated the usefulness of quantitative analysis of computed tomography (CT) pulmonary angiography as a predictor of the prognosis of acute pulmonary embolism (PTE). METHODS: We performed a retrospective analysis of 55 patients who visited our emergency department from January 2000 to November 2007 who were confirmed with PTE by CT pulmonary angiography. Two radiologists blinded to patient outcome measured CT parameters including the diameter of vessels and chambers, and the quantified pulmonary artery (PA) clot load score on the basis of embolus size and location. CT parameters and other clinical predictors were analyzed to determine their ability to predict major adverse event (MAE). RESULTS: Of the 55 patients, 16 (29.1%) had a MAE PTE related shock, intubation, death, thrombolysis, right ventricular (RV) dysfunction within 30 days). Geneva score (odds ratio 2.5, 95% CI 1.18-5.29, p=0.02) and PA clot load score (odds ratio 1.64, 95% CI 1.18-2.27, p<0.01) were strong independent predictors of MAE. The cut-off value of Geneva and PA clot load scores were 4.5 and 19.0, respectively, and the area under the ROC curve were 0.697 (0.546~0.848) and 0.908 (0.828-0.988), respectively. CONCLUSION: Geneva and PA clot load score are significant predictors of PTE related shock, intubation, death, thrombolysis, and RV dysfunction within 30 days. CT pulmonary angiography is a useful predictor for the prognosis of PTE as well as a useful diagnostic tool.
Angiography ; Embolism ; Emergencies ; Humans ; Intubation ; Prognosis ; Pulmonary Artery ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve ; Shock