BACKGROUND/AIMS: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT. METHODS: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks. RESULTS: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (kappa=1.00) and substantial agreement between MDCT and MRI (kappa=0.67). CONCLUSIONS: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.
Aged ; Aged, 80 and over ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/pathology/therapy/*ultrasonography ; Chemoembolization, Therapeutic ; Contrast Media/*chemistry ; Female ; Gadolinium DTPA/chemistry ; Humans ; Liver Neoplasms/pathology/therapy/*ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pilot Projects ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.
Abscess/etiology/radiography/*surgery ; Aged ; Aged, 80 and over ; Calcinosis/complications/surgery ; Drainage/methods ; Holmium ; Humans ; Lasers, Solid-State/*therapeutic use ; Male ; Middle Aged ; Prostatic Diseases/etiology/radiography/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Transurethral Resection of Prostate/*methods ; Treatment Outcome ; Urinary Bladder Neck Obstruction/complications/surgery

Androgen receptor (AR) signaling is important for prostate cancer (PCa) cell proliferation. Here, we showed that proliferation of hormone-sensitive prostate cancer cells such as LNCaP was significantly enhanced by testosterone stimulation whereas hormone-insensitive prostate cancer cells such as PC3 and VCaP did not respond to testosterone stimulation. Blocking of AR using bicalutamide abolished testosterone-induced proliferation of LNCaP cells. In addition, knockdown of AR blocked testosterone-induced proliferation of LNCaP cells. Basal expression of low-density lipoprotein receptor-related protein 6 (LRP6) was elevated in VCaP cells whereas stimulation of testosterone did not affect the expression of LRP6. However, expression of LRP6 in LNCaP cells was increased by testosterone stimulation. In addition, knockdown of LRP6 abrogated testosterone-induced proliferation of LNCaP cells. Given these results, we suggest that androgen-dependent expression of LRP6 plays a crucial role in hormone-sensitive prostate cancer cell proliferation.
Cell Proliferation* ; Low Density Lipoprotein Receptor-Related Protein-6* ; Prostatic Neoplasms* ; Receptors, Androgen ; Testosterone

Tetrahydrobiopterin (BH4) is an essential cofactor in NO synthesis by endothelial nitric oxide synthase (eNOS) enzymes. It has been previously suggested that reduced intrahepatic BH4 results in a decrease in intrahepatic NO and contributes to increased hepatic vascular resistance and portal pressure in animal models of cirrhosis. The main aim of the present study was to evaluate the relationship between BH4 and portal hypertension (PHT). One hundred ninety-three consecutive patients with chronic liver disease were included in the study. Liver biopsy, measurement of BH4 and hepatic venous pressure gradient (HVPG) were performed. Hepatic fibrosis was classified using the Laennec fibrosis scoring system. BH4 levels were determined in homogenized liver tissues of patients using a high performance liquid chromatography (HPLC) system. Statistical analysis was performed to evaluate the relationship between BH4 and HVPG, grade of hepatic fibrosis, clinical stage of cirrhosis, Child-Pugh class. A positive relationship between HVPG and hepatic fibrosis grade, clinical stage of cirrhosis and Child-Pugh class was observed. However, the BH4 level showed no significant correlation with HVPG or clinical features of cirrhosis. BH4 concentration in liver tissue has little relation to the severity of portal hypertension in patients with chronic liver disease.
Adult ; Aged ; Biopterin/*analogs & derivatives/analysis ; *Chromatography, High Pressure Liquid ; Chronic Disease ; Elasticity Imaging Techniques ; Female ; Hepatic Veins/physiology ; Humans ; Hypertension, Portal/complications/*diagnosis/metabolism ; Liver/pathology ; Liver Cirrhosis/ultrasonography ; Liver Diseases/complications/*diagnosis/metabolism ; Male ; Middle Aged ; Nitric Oxide/metabolism ; Portal Pressure ; Regression Analysis ; Severity of Illness Index

BACKGROUND: Mitotic arrest deficiency protein 2 (MAD2) is a key component of spindle assembly checkpoint function, which mediates cell apoptosis through microtubule kinetics. Aberrant expression of MAD2 is believed to be associated with the development of chromosome instability. MAD2 also has a signihicant role in cellular drug resistance to taxane chemotherapeutic agents. METHODS: Expression of MAD2 and p53 was investigated using immunohistochemistry in 85 cases of ovarian carcinomas. Clinicopathological data including progression-free survival were analyzed. RESULTS: A significant (p=.035) association was observed between the grade of serous carcinoma and the expression level of MAD2. While low-grade serous carcinoma showed a low-level expression of MAD2, high-grade serous carcinoma showed a high-level expression of MAD2. We also determined that low-level expression of MAD2 was associated with reduced progression-free survival (PFS) (p=.016) in high-grade serous carcinoma. CONCLUSIONS: MAD2 expression in ovarian carcinoma is related to the grade of serous carcinoma and PFS of high-grade serous carcinoma. Expression level of MAD2 detected by immunohistochemistry may serve as an indicator in predicting the response of microtubule-interfering chemotherapeutic agents.
Apoptosis ; Bridged Compounds ; Calcium-Binding Proteins ; Cell Cycle Checkpoints ; Cell Cycle Proteins ; Chromosomal Instability ; Disease-Free Survival ; Drug Resistance ; Immunohistochemistry ; Kinetics ; M Phase Cell Cycle Checkpoints ; Microtubules ; Ovarian Neoplasms ; Repressor Proteins ; Taxoids

The aims of this study were to estimate daily intake of macrominerals from beverages, liquid teas, and liquid coffees and to evaluate their potential health risks for Korean children and adolescents (1-to 19 years old). Assessment of dietary intake was conducted using the actual level of sodium, calcium, phosphorus, potassium, and magnesium in non-alcoholic beverages and (207 beverages, 19 liquid teas, and 24 liquid coffees) the food consumption amount drawn from "The Fourth Korea National Health and Nutrition Examination Survey (2007-2009)". To estimate the dietary intake of non-alcoholic beverages, 6,082 children and adolescents (Scenario I) were compared with 1,704 non-alcoholic beverage consumption subjects among them (Scenario II). Calculation of the estimated daily intake of macrominerals was based on point estimates and probabilistic estimates. The values of probabilistic macromineral intake, which is a Monte-Carlo approach considering probabilistic density functions of variables, were presented using the probabilistic model. The level of safety for macrominerals was evaluated by comparison with population nutrient intake goal (Goal, 2.0 g/day) for sodium, tolerable upper intake level (UL) for calcium (2,500 mg/day) and phosphorus (3,000-3,500 mg/day) set by the Korean Nutrition Society (Dietary Reference Intakes for Koreans, KDRI). For total children and adolescents (Scenario I), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 7.93, 10.92, 6.73, 23.41, and 1.11, and 95th percentile daily intake of those was, respectively, 28.02, 44.86, 27.43, 98.14, and 3.87 mg/day. For consumers-only (Scenario II), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 19.10, 25.77, 15.83, 56.56, and 2.86 mg/day, and 95th percentile daily intake of those was, respectively, 62.67, 101.95, 62.09, 227.92, and 8.67 mg/day. For Scenarios I.II, sodium, calcium, and phosphorus did not have a mean an 95th percentile intake that met or exceeded the 5% of Goal and UL.
Adolescent ; Beverages ; Calcium ; Child ; Humans ; Korea ; Magnesium ; Models, Statistical ; Nutrition Surveys ; Phosphorus ; Potassium ; Sodium ; Tea

BACKGROUND: This study aimed to investigate whether stimulated C-peptide is associated with microvascular complications in type 2 diabetes mellitus (DM). METHODS: A cross-sectional study was conducted in 192 type 2 diabetic patients. Plasma basal C-peptide and stimulated C-peptide were measured before and 6 minutes after intravenous injection of 1 mg glucagon. The relationship between C-peptide and microvascular complications was statistically analyzed. RESULTS: In patients with retinopathy, basal C-peptide was 1.9+/-1.2 ng/mL, and stimulated C-peptide was 2.7+/-1.6 ng/mL; values were significantly lower compared with patients without retinopathy (P=0.031 and P=0.002, respectively). In patients with nephropathy, basal C-peptide was 1.6+/-0.9 ng/mL, and stimulated C-peptide was 2.8+/-1.6 ng/mL; values were significantly lower than those recorded in patients without nephropathy (P=0.020 and P=0.026, respectively). Stimulated C-peptide level was associated with increased prevalence of microvascular complications. Age-, DM duration-, and hemoglobin A1c-adjusted odds ratios for retinopathy in stimulated C-peptide value were 4.18 (95% confidence interval [CI], 1.40 to 12.51) and 3.35 (95% CI, 1.09 to 10.25), respectively. The multiple regression analysis between nephropathy and C-peptide showed that stimulated C-peptide was statistically correlated with nephropathy (P=0.03). CONCLUSION: In patients with type 2 diabetes, the glucagon stimulation test was a relatively simple method of short duration for stimulating C-peptide response. Stimulated C-peptide values were associated with microvascular complications to a greater extent than basal C-peptides.
C-Peptide ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; Glucagon ; Hemoglobins ; Humans ; Injections, Intravenous ; Odds Ratio ; Plasma ; Prevalence

Teratoma is a congenital tumor containing tissues derived from all germ layers. Teratoma in the region of the adrenal gland is a very uncommon retroperitoneal tumor. Only 7 cases of adrenal teratoma have been reported worldwide, but in Korea, no similar cases have been reported until now. This case report describes an adrenal teratoma in a 38-year-old healthy woman who was incidentally diagnosed with a left adrenal mass on abdominal ultrasonography during a medical inspection. Computed tomographic scans revealed a 9-cm heterogeneous circumscribed round mass, containing primarily fat tissue, and a solid calcification component in the left adrenal gland. Adrenal hormonal assessment results and biochemical markers for gonadal neoplasia were negative. Result of serum laboratory tests were normal. The patient underwent laparoscopic adrenalectomy. Histologic analysis confirmed the diagnosis of a mature teratoma; the obtained specimen measured 5 x 7 x 7.5 cm and weighed 267 g. The surface of the mass was smooth, and sebaceous tissue and hair with hard material were observed on the incisional surface. The patient was discharged on postoperative day 4, without complications. In this case report, we describe the incidental finding of a teratoma occurring in the adrenal gland region in a healthy woman; the teratoma was laparoscopically excised.
Adrenal Glands ; Adrenalectomy ; Adult ; Female ; Germ Layers ; Gonads ; Hair ; Humans ; Incidental Findings ; Korea ; Teratoma ; Biomarkers

A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.
Aged ; Anxiety ; Arrhythmias, Cardiac ; Delayed Diagnosis ; Delirium ; Depression ; Early Diagnosis ; Fever ; Humans ; Hydrocortisone ; Hyperthyroidism ; Iodides ; Lethargy ; Meningism ; Parkinson Disease ; Precipitating Factors ; Thyroid Crisis ; Thyroid Gland ; Weight Loss

No abstract available.
Atherosclerosis ; Biomarkers ; C-Peptide ; Humans