Ultrafiltration failure has been known as a major cause of dropout from long-term peritoneal dialysis and is often related to peritoneal hyperpermeability. This can be explained in part by progressive peritoneal fibrosis. The present experiment has been undertaken to evaluate the effects of peritoneal rest on peritoneal transport and morphology in rat model of peritoneal dialysis. Twenty-four male rats(Sprague-Dawley, 250-300g) were used and divided into three groups : group 1 (control, n=6) without dialysis, group 2(n=9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n=9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Peritoneal dialysis was performed twice a day with 25mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing lipopolysaccharide(5 microgram/mL) in the dialysis fluid on days 8, 10 and 12 of peritoneal dialysis. Peritoneal equilibration tests were performed before dialysis and repeated on the 4th and 8th week of dialysis. Morphometric analysis of the peritoneal membrane and immunohistochemistry for collagen type I and type III were done in tissue specimens obtained at the time of sacrifice. The D/Do ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 were significantly lower than baseline value, indicating increase in the peritoneal penneability to glucose after 3 weeks of dialysis. D/Do in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drained dialysate volumes in groups 2 and 3 at week 4 were significantly lower than at baseline; however, The drained dialysate volume in group 3 at week 8 was significantly greater than at week 4. The thickness of the parietal peritoneal membraoe in group 2 and 3 were significantly greater than in group 1. Severity of the thickness of the parietal peritoneal membrane in group 3 was not much than that of group 2(group 1, 11.4+/-7.6; group 2, 37.5+/-18.4; group 3, 21.4+/-12.1 micromiter). Histologically, the thickened peritoneum in group 2 showed a monolayer of mesothelial cells and under-lying multilayer of curled collagen bundles. Mononuciear cells and fibroblasts were embedded in these collagen layers and capillary proliferation was present. Immunohistochemistry for collagen type I and Z demonstrated that the distribution of collagen type llI was richer than that of collagen l in group 2 at fibrotic area of submesothelial region. These findings were decreased in group 3. Ultrastructural examination of the peritoneum showed thicker fibrotic zone and the activated fibroblasts in group 2 compared to group 1 and 3. Meso-thelial cells were plump and the number of mesothelial microvilli was decreased in group 2. Nucleus was enlarged and irregular. Intracytoplasmic orga-nelles were also richer than those of group I or 3. In conclusion, peritoneal rest improves ultrafiltration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal fibrosis. These data suggest that dialysis-induced changes in peritoneal transport and morphology are reversible under the condition of peritoneal rest in this experimental model.
Animals ; Capillaries ; Collagen ; Collagen Type I ; Dialysis ; Fibroblasts ; Glucose ; Humans ; Immunohistochemistry ; Male ; Membranes ; Microvilli ; Models, Animal ; Models, Theoretical ; Patient Dropouts ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneal Fibrosis* ; Peritoneum ; Peritonitis ; Rabeprazole ; Rats* ; Ultrafiltration

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-ccupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection.
Abscess ; Aged ; Angiography ; Carcinoma, Hepatocellular* ; Cholangitis* ; Coinfection ; Diagnosis ; Diagnosis, Differential ; Hepatitis C, Chronic ; Humans ; Korea ; Liver Abscess* ; Liver* ; Magnetic Resonance Imaging ; Ultrasonography

Ketoconazole, an imidazole derivative, is a broad spectrum antifungal agent which has been used widely in the treatment of systemic or local fungal infections. Mild asymptomatic elevation of plasma transaminase activities occurs in approximately 6% to 17.5% of patients who have used ketoconazole. However, the incidence of symptomatic hepatic injury is low and overt hepatitis develops in about 5% of the patients. Nausea and vomiting are the most frequent side reactions. Histopathological features of the reported ketoconazole induced hepatotoxicity are massive or submassive hepatocellular necrosis involving the acinar zone 3, destroyed lobular architecture with bridging necrosis and inflammatory cell infiltration on portal tracts. However, hepatic septal fibrosis with liver cirrhosis has not been reported yet. We experienced a case of hepatic septal fibrosis that developed after 9 months of ketoconazole administration.
Fibrosis* ; Hepatitis ; Humans ; Incidence ; Ketoconazole* ; Liver Cirrhosis ; Nausea ; Necrosis ; Plasma ; Vomiting

BACKGROUND/AIMS: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. METHODS: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. RESULTS: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (< or =15 mm) was highly distinguished from that of larger lesions (>15 mm). No serious complication was encountered. CONCLUSIONS: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.
Adenoma* ; Biopsy ; Endoscopy ; Humans ; Mucous Membrane ; Stomach Neoplasms* ; Suction

BACKGROUND/AIMS: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. METHODS: From August 1997 to July 2000, 74 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. RESULTS: There was no statistically significant difference between the patients treated with cap and the patients treated without cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). CONCLUSIONS: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential.
Cardia ; Christianity ; Duodenum ; Endoscopes ; Hemorrhage ; Hemostasis ; Humans ; Peptic Ulcer ; Stomach

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.
Alcoholism ; Catheter-Related Infections ; Causality ; Drug Users ; Ductus Arteriosus, Patent* ; Echocardiography, Transesophageal ; Endocarditis* ; Female ; Fever ; Fever of Unknown Origin ; Heart Diseases ; Humans ; Physical Examination ; Pulmonary Valve* ; Sepsis ; Substance Abuse, Intravenous ; Tomography, X-Ray Computed ; Young Adult

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.
Alcoholism ; Catheter-Related Infections ; Causality ; Drug Users ; Ductus Arteriosus, Patent* ; Echocardiography, Transesophageal ; Endocarditis* ; Female ; Fever ; Fever of Unknown Origin ; Heart Diseases ; Humans ; Physical Examination ; Pulmonary Valve* ; Sepsis ; Substance Abuse, Intravenous ; Tomography, X-Ray Computed ; Young Adult