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

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

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

The use of intestinal segments in the reconstruction and plasty of urinary bladder for malignant or nonmalignant conditions is widely accepted. Metabolic derangements including hyperchloremic metabolic acidosis and malabsorption of lipid may occur after surgery. Main pathophysiology of hyperchloremic metabolic acidosis is the exchange of urinary chloride with luminal bicarbonate and duration of urine in contact with the intestinal mucosa can affect the severity of metabolic acidosis. We experienced two cases of severe hyperchloremic metabolic acidosis which developed in patients with chronic kidney disease, urinary tract infection and orthotopic neobladder or augmentation enterocystoplasty for the treatment of bladder cancer and neurogenic bladder, respectively.
Acidosis ; Humans ; Intestinal Mucosa ; Phenobarbital ; Renal Insufficiency, Chronic ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Diversion ; Urinary Tract Infections

OBJECTIVES: This study was conducted to estimate the comorbidity rate of ADHD in a group of patients with alcohol dependency and to find out the characteristics of alcoholic patients with ADHD using the diverse clinical and genetic variables. METHODS: Eighty five patients with alcohol dependency were recruited from 4 mental hospitals in Kyoung-Nam and Kyoung-Ki province. For the evaluation of ADHD symptoms in both childhood and adulthood, the highly structured Diagnostic Interview Schedule for Children-IV (DISC-IV)-ADHD module was used. The various standardized scales and questionnaires were also applied to evaluate the comorbid conditions and psychopathological status. All the subjects' blood was collected and genetic study for the polymorphism of DRD2, TH, 5-HTTLPR, COMT, ALDH2 was performed. RESULTS: 1) The comorbid rate of definite ADHD in alcoholic patients was 38% (28/85). 2) The frequency of unmarried status was significantly higher in ADHD group compared non-ADHD group. 3) The onset of pathologic drinking and auditory hallucination was significantly earlier in ADHD group than non-ADHD alcholic group. 4) In ADHD alcoholic group, antisocial behavior was more frequently reported, and the score of co-dependency scale, depression/anxiety, aggression and obsessive compulsive drinking scales were significantly higher compared to non-ADHD alcoholic group. 5) No signficant difference was found in the frequency of polymorphic alleles in COMT, DRD2, 5-HTTLPR, ALDH2, TH between ADHD and non-ADHD alcoholic group. CONCLUSION: In alcoholic patients, the rate of adult type ADHD was higher than expected rate in general population. The alcoholic patients with ADHD suffered from more sever degree of alcohol dependency and earlier alcohol related problems. ADHD-alcoholic group showed higher diverse comorbid psychopathology and lower marital status compared to non-ADHD-alcoholic group. No difference, however, was found in genetic data between two groups.
Adult ; Aggression ; Alcoholics ; Alleles ; Appointments and Schedules ; Comorbidity ; Drinking ; Hallucinations ; Hospitals, Psychiatric ; Humans ; Marital Status ; Polymorphism, Genetic ; Psychopathology ; Surveys and Questionnaires ; Single Person ; Statistics as Topic* ; Weights and Measures

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