We aimed to examine the effects of angiotensin II AT1 receptor blocker on the expression of major renal sodium transporters and aquaporin-2 (AQP2) in rats with chronic renal failure (CRF). During 2 wks after 5/6 nephrectomy or sham operation, both CRF rats (n=10) and sham-operated control rats (n=7) received a fixed amount of low sodium diet and had free access to water. CRF rats (n=10) were divided into two groups which were either candesartan-treated (CRF-C, n=4) or vehicletreated (CRF-V, n=6). Both CRF-C and CRF-V demonstrated azotemia, decreased GFR, polyuria, and decreased urine osmolality compared with sham-operated rats. When compared with CRF-V, CRF-C was associated with significantly higher BUN levels and lower remnant kidney weight. Semiquantitative immunoblotting demonstrated decreased AQP2 expression in both CRF-C (54% of control levels) and CRF-V (57%), whereas BSC-1 expression was increased in both CRF groups. Particularly, CRF-C was associated with higher BSC-1 expression (611%) compared with CRF-V (289%). In contrast, the expression of NHE3 (25%) and TSC (27%) was decreased in CRF-C, whereas no changes were observed in CRF-V. In conclusion, 1) candesartan treatment in an early phase of CRF is associated with decreased renal hypertrophy and increased BUN level; 2) decreased AQP2 level in CRF is likely to play a role in the decreased urine concentration, and the downregulation is not altered in response to candesartan treatment; 3) candesartan treatment decreases NHE3 and TSC expression; and 4) an increase of BSC-1 is prominent in candesartan-treated CRF rats, which could be associated with the increased delivery of sodium and water to the thick ascending limb.
Angiotensin II Type 1 Receptor Blockers ; Animals ; Aquaporins/genetics ; Benzimidazoles/*pharmacology ; Blood Urea Nitrogen ; Kidney Failure, Chronic/drug therapy/*metabolism ; Male ; Organ Size/drug effects ; Rats ; Rats, Sprague-Dawley ; Receptors, Drug/*genetics ; Research Support, Non-U.S. Gov't ; Sodium-Hydrogen Antiporter/*genetics ; Sodium-Potassium-Chloride Symporters/*genetics ; Symporters/*genetics ; Tetrazoles/*pharmacology

Waldenstrom's macroglobulinemia is a disorder of malignant proliferation of plasmacytoid lymphocytes and monoclonal immunoglobulin M. However, the patients occasionally present with malabsorption and diarrhea due to deposition of extracellular periodic acid-Schiff positive homogenous eosinophilic, amorphorous, and proteinaceous materials in the villi and/or lamina propria of the duodenum. We report a 62-year-old man who, despite involvement of the duodenal mucosa, presented only with fatigue, dypnea on exertion, and anemia. Characteristic duodenoscopic and pathologic findings of this patient are described.
Anemia ; Diarrhea ; Duodenum ; Eosinophils ; Fatigue ; Humans ; Immunoglobulin M ; Lymphocytes ; Middle Aged ; Mucous Membrane ; Waldenstrom Macroglobulinemia*

BACKGROUND/AIMS: It can be difficult to differentiate an extraluminal compression from a true submucosal tumor (SMT) in the stomach. The best method for differentiating an extraluminal compression from a true SMT is endoscopic ultrasonography (EUS). Extragastric compression is frequently observed, but its clinical significance has rarely been reported on. We evaluated the clinical findings of extraluminal compression according to the site of the stomach. METHODS: Ninety-one patients were diagnosed by EUS as having extragastric compressions from January 2006 to July 2008. Abdominal sonography or computed tomography was performed in some cases. RESULTS: The causes of normal structures (64 cases) were the vessels, spleen, intestine, gallbladder, liver, mesentery, pancreas and kidney. The causes of pathologic lesions (27 cases) were hepatic cyst, distended gallbladder with sludge, splenic cyst, hepatic hemangioma, polycystic hepatic and renal disease, pancreatic cyst, renal cyst, calcified lymph node and hepatocelluar carcinoma. The great curvature of the fundus was the most frequent site of extraluminal compressions. The lesions in the anterior wall of the body showed a higher frequency of pathologic lesions than did those lesions in other sites. CONCLUSIONS: EUS is useful for finding the causes of extragastric compression. Careful evaluation is needed because many lesions in the anterior wall of the body of the stomach were due to pathologic causes.
Endosonography ; Gallbladder ; Hemangioma ; Humans ; Intestines ; Kidney ; Liver ; Lymph Nodes ; Mesentery ; Pancreas ; Pancreatic Diseases ; Sewage ; Spleen ; Stomach

Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD.
Biliary Tract ; Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Gastrointestinal Tract ; Humans ; Liver ; Neoplasm Metastasis

Strongyloides stercoralis, which has two different generations: the free living and parasitic generation, is primarily adapted to warm climates, but strongyloidiasis has been reported sporadically in temperate and cold regions. Strongyloidiasis may be asymptomatic in almost 50 percent of the cases, rarely, infestation presents with severe clinical pictures. The reason for this exacerbation of illness is probably a rapid increase in the number of infecting larvas through the development or acceleration of a cycle of autoinfection. A breakdown of the host-parasite equilibrium due to decreased host resistance may occur in malnutrition, debilitating diseases or therapy with immunosuppressive drugs. Corticosteroid treatment may have an important role in the sudden occurrence of severe stongyloidiasis. We experienced a case of strongyloidiasis with severe malnutrition, accompanied with bronchial asthma and diabetes mellitus. This patient has been treated with corticosteroid for several years. So, we report this rare case with the literature review.
Acceleration ; Asthma ; Climate ; Diabetes Mellitus ; Family Characteristics ; Humans ; Larva ; Malnutrition* ; Strongyloides stercoralis ; Strongyloidiasis*

BACKGROUND: We performed the study on the changes of beta2-microglobulin(beta2M) clearance and urea reduction ratio after reuse of dialyzers with three different membranes. METHODS: 9 patients who had received regular hemodialysis more than five years were enrolled. Three kinds of dialyzer membrane were used; i.e. : Two of them were high-flux and the other was low-flux. Dialyzer reprocessing was performed by an automated machine using glutaraldehyde and bleach. Each dialyzer was reused 10 times. Solute clearance was determined for each dialyzer after the 1st, 5th, 8th and 10th reuse. RESULTS: Urea clearance was well maintained after reuse with both high-flux and low-flux membrane but beta2M clearance was significantly greater with high-flux dialyzers than low-flux dialyzer. Effects of each dialyzer reuse on beta2M clearance showed no significant decrease until the 10th reuse and no significant difference in beta2M clearance between the two high-flux dialyzers(polyamide vs PEPA membrane, p= 0.197). CONCLUSION: Reuse of dialyzers was cost-effective. After reuse of dialyzer, clearance of solute was maintained in both small and large solutes until the 10 th reuse. Further study is needed regarding the maintenance of solute clearance with increased number of reuses.
Blood Urea Nitrogen* ; Cellulose ; Glutaral ; Humans ; Membranes* ; Nylons ; Renal Dialysis ; Urea

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.
Abdominal Pain ; Adult ; Anemia ; Appendicitis ; Colon* ; Colonoscopy ; Developed Countries ; Diagnosis ; Diarrhea ; Dysentery ; Eggs ; Humans ; Mucous Membrane ; Ovum ; Parasites ; Rectal Prolapse ; Sanitation ; Trichuriasis ; Trichuris* ; Weight Loss

Edema ; Humans ; Lifting ; Maxillary Sinus ; Sinus Floor Augmentation ; Sinusitis ; Stress, Psychological ; Transplants

BACKGROUND/AIMS: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. METHODS: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. RESULTS: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. CONCLUSIONS: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction.
Gastric Outlet Obstruction ; Humans ; Mucous Membrane ; Stents