The modifying potential of capsaicin (CAP) on lesion development was examined in a rat multiorgan carcinogenesis model. Groups 1 and 2 were treated sequentially with diethylnitrosamine (DEN) (100 mg/kg, ip, single dose at commencement), N-methylnitrosourea (MNU) (20 mg/kg, ip, 4 doses at days 2, 5, 8, and 11), and N,N-dibutylnitrosamine (DBN) (0.05% in drinking water during weeks 3 and 4). Group 3 received vehicles without carcinogens during the initiation period. Group 4 served as the untreated control. After this initiating procedure, Groups 2 and 3 were administered a diet containing 0.01% CAP. All surviving animals were killed 20 weeks after the beginning of the experiment and the target organs examined histopathologically. The induction of GST-P+ hepatic foci in rats treated with carcinogens was significantly inhibited by treatment with CAP. CAP treatment significantly decreased the incidence of adenoma of the lung but increased the incidence of papillary or nodular (PN) hyperplasia of the urinary bladder. The tumor incidence of other organs, such as the kidney and thyroid, was not significantly different from the corresponding controls. These results demonstrated that concurrent treatment with CAP not only can inhibit carcinogenesis but can also enhance it depending on the organ. Thus, this wide-spectrum initiation model could be used to confirm organ-specific modification potential and, in addition, demonstrate different modifying effects of CAP on liver, lung, and bladder carcinogenesis.
Animals ; Capsaicin/pharmacology/*toxicity ; Cocarcinogenesis ; Diethylnitrosamine ; Liver Neoplasms, Experimental/chemically induced/prevention & control ; Lung Neoplasms/chemically induced/prevention & control ; Male ; Methylnitrosourea ; Neoplasms, Experimental/*chemically induced/prevention & control ; Nitrosamines ; Rats ; Rats, Inbred F344 ; Urinary Bladder Neoplasms/chemically induced

BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Immunoglobulins ; Iodine* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyrotropin

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaingl, multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatations, biliary calculi. Dopper frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomotraphy(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated duets are another helpful diagnostic criteria and these findings are easily depicted on routine sonograms with color mapping.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Caroli Disease* ; Dilatation ; Fibrosis ; Gallstones ; Humans ; Pathology ; Polycystic Kidney Diseases ; Siblings ; Ultrasonography

PURPOSE: Abernethy malformation is a rare condition, which was first described in 1793 as a congenital extrahepatic porto-systemic shunt (CEPS) directing splanchnic blood flow into the inferior vena cava. Eighty cases have been published so far that reported CEPS, while in Korea, very few cases have been reported. Through this study, we present 6 cases of patients diagnosed with CEPS at Samsung Medical Center and compare these with other such cases published in France and China. METHODS: We reviewed clinical, laboratory, and imaging data of 6 children with CEPS in our pediatric clinic between 2004 and 2017. RESULTS: A total of 6 children with CEPS was included in this study, namely, one with type 1a, two with type 1b, and three with type 2 CEPS. The most common presenting symptom was gastrointestinal bleeding (50.0%). Therapeutic interventions included shunting vessel ligation (16.7%) in type 2 CEPS and liver transplantation (16.7%) in type 2 CEPS patient with suddenly developed hepatic encephalopathy. CONCLUSION: There is no consensus guideline for the optimal management of patients with CEPS. Large-sample studies regarding CEPS are needed to evaluate the characteristics of patients with CEPS and determine the treatment guideline for CEPS.
Child* ; China ; Consensus ; France ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Korea ; Ligation ; Liver Transplantation ; Vena Cava, Inferior

Pyoderma gangrenosum is one of the dermatological extra-intestinal manifestations of ulcerative colitis (UC). We report a case of a 26-year-old male patient suffering from relapsed UC with a newly developed pyoderma gangrenosum. His skin and intestinal symptoms were intractable to treatment with steroids, immunosuppressants, or a single biological agent such as infliximab, golimumab, or vedolizumab. For the first time in Korea, we report a successful treatment experience of pyoderma gangrenosum in UC using dual biological agents, vedolizumab and infliximab. We strategically targeted each of the intestinal and skin symptoms, with a specific biological agent based on the drug’s mechanism of action.

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis(anti- GBM antibody mediated RPGN) is defined by the clinical picture of renal failure developing over days or weeks and the histological appearance of crescents and linear immune deposits mediated by the circulating autoantibodies. We report a case of anti-GBM antibody mediated RPGN with review of literature. A 59-year-old female patient was admitted to the Chungang Gil Hospital because of fever and acute deterioration of renal function. On admission, hemoglobin was 7.39g/dL, hematocrit was 20.9%, and BUN/Cr were 39.7 and 5.23mg/dL respectively. Urinalysis showed albumin (1+) with many RBCs. Renal biopsy revealed the presence of segmental or circumferential cellular crescents associated with smooth linear staining of glomerular basement membrane with antibody to IgG. High titer of circulating antibody to glomerular basement membrane antigen was demonstrated by the ELISA. High doses of corticosteroid with plasmapheresis were administered, but her renal function was progressively deteriorated.
Autoantibodies ; Basement Membrane* ; Biopsy ; Enzyme-Linked Immunosorbent Assay ; Female ; Fever ; Glomerular Basement Membrane ; Glomerulonephritis* ; Hematocrit ; Humans ; Immunoglobulin G ; Middle Aged ; Plasmapheresis ; Renal Insufficiency ; Urinalysis

Papillary carcinoma, the commonest thyroid malignancy, has an indolent clinical course and carries a good prognosis. Metastasis usually occurs to regional lymph nodes, including cervical and upper mediastinal nodes. Distant metastasis is uncommon, lung and bone being the commonest sites. Brain metastasis from papillary thyroid cancer is rare, with a frequency of less than 1% in several reported series and an extremely poor prognosis. The first case was a 74-year-old female patient with papillary cancer who took total thyroidectomy followed by 131I therapy 1 month later. Two days after 131I therapy, she developed headache, vomiting and left hemiplegia. Brain MRI and 131I whole body scan showed solitary brain metastasis in right parietal lobe. After a few weeks her condition improved enough to maintain her usual daily activity despite mild motor weakness. The second one, a 64-year-old female patient presented with headache and vomiting. Two years previously, she had taken total thyroidectomy and 131I ablation therapy after diagnosis of thyroid papillary cancer. Eight months before, she had undergone radical neck dissection because of relapse in cervical lymph nodes. Brain MRI revealed multple metastatic lesions including cerebellum. This patient did not report for follow-up after 2 months of discharge.
Aged ; Brain* ; Carcinoma, Papillary ; Cerebellum ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Hemiplegia ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neck Dissection ; Neoplasm Metastasis* ; Parietal Lobe ; Prognosis ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Vomiting ; Whole Body Imaging

The aim of this study was to evaluate the efficacy of clinical strategies to reduce nosocomial sepsis (NS) in extremely low birth weight infants (ELBWI) less than 1,000 g. Data from the period before (P1, 1995-2000) and after (P2, 2001-2002) implementation of the strategies were collected and analyzed. The intervention strategies included restriction of antibiotic therapy, less use of invasive procedures such as umbilical vessel catheterization and endotracheal intubation, establishment of guidelines for hand-washing, infant handling, and central intravascular line management. NS was defined as positive blood cultures in symptomatic patients after the third day of life with the use of antibiotics for more than 5 days. Although the gestational age (GA) and birth weight (BW) were significantly lower in P2 (GA 26.7 +/-2.1 wk; BW 796 +/-130 g) compared to P1 (GA 27.2 +/-1.6 wk; BW 857 +/-121 g), the incidence of NS decreased significantly from 70% (69/99) in P1 to 17% (24/71) in P2 with the implementation of the intervention strategies. The coagulase negative Staphylococcus infection was also significantly reduced from 34% in P1 to 11% in P2. The implementation of the clinical strategies was quite effective in reducing the incidence of NS in ELBWI.
Cross Infection/*prevention & control ; Female ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Male ; Sepsis/*prevention & control

The aim of this cross-over study was to investigate whether albumin infusion before furosemide administration could potentiate the diuretic action of furosemide. Seven patients with nephrotic syndrome were given the following infusions in random order on two separate days: 1) a sham solution followed by 160 mg of furosemide, 2) 100 ml of 20% human albumin followed by 160 mg of furosemide. Urine and serum furosemide concentrations were measured by high-performance liquid chromatography. The increment of urine volume was greater in albumin preinfusion than in furosemide alone. However, the increments of sodium and chloride excretions between furosemide alone and albumin preinfusion were not different. No significant differences in the pharmacokinetic parameters between the two treatments were observed: area under the concentration-time curve (AUC: 12.7+/-2.2 vs 15.1+/-4.4 g/ml hr), total plasma clearance (253+/-41 vs 256+/-54 ml/min), volume of distribution (341+/-34 vs 494+/-153 ml/kg), elimination half life (4.0+/-1.1 vs 4.6+/-0.8 hr), and urine furosemide excretion of the administered amount (16.5+/-7.3 vs 7.5+/-1.6%). In conclusion, these data show that albumin preinfusion potentiated diuresis, but not natriuresis, of furosemide without any change in the pharmacokinetics of the agent in patients with nephrotic syndrome.
Adolescence ; Adult ; Aged ; Albumins/*pharmacology ; Cross-Over Studies ; Diuretics/*pharmacology ; Drug Synergism ; Female ; Furosemide/*pharmacology ; Human ; Male ; Middle Age ; Nephrotic Syndrome/*drug therapy/metabolism ; Serum Albumin/analysis

Background/Aims: Although mucosal healing (MH) is acknowledged as the treatment target in the treat-to-target era, there are limitations on repeated endoscopic examinations, especially in pediatric patients. We aimed to investigate whether fecal calprotectin (FC) could serve as a surrogate marker for the assessment of MH in pediatric patients with Crohn’s disease (CD) who have achieved sustained clinical remission (CR) while treated with anti-tumor necrosis factor (TNF) agents. Methods: This multicenter retrospective cross-sectional study included pediatric CD patients who had sustained a CR for at least 6 months with anti-TNF agents and who simultaneously underwent ileocolonoscopy and FC tests during follow-up. MH was defined as the absence of any ulcer on ileocolonoscopy. Results: A total of 131 patients were included in this study. MH was observed in 87 patients (66.7%). The FC level was significantly lower in patients with MH than in those without MH (median 49.0 mg/kg vs 599.0 mg/kg; p<0.001). According to the multivariate logistic regression analysis, FC was the only factor associated with MH (odds ratio, 0.62; 95% confidence interval [CI], 0.52 to 0.73; p<0.001). According to the receiver operating characteristic curve analysis, the optimal cutoff value for FC for the association with MH was <140 mg/kg (area under the curve 0.890, 95% CI 0.829 to 0.951, sensitivity 78.2%, specificity 88.6%, p<0.001). Conclusions FC was associated with MH in pediatric patients with CD who had achieved a sustained CR for at least 6 months with anti-TNF agents. In these patients, FC can be used to stratify patients and guide decisions regarding ileocolonoscopy in the treat-to-target era.