Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1cm is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over cm huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8cm Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8cm sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.
Adenoma* ; Endoscopy ; Hemorrhage* ; Intussusception ; Korea ; Melena

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

OBJECTIVE: Despite the general information of vaginal birth after cesarean section (VBAC), little is known about the duration of active labor in women attempting VBAC. The aim of this study was to compare the time length of active labor in women attempting VBAC compared with nulliparas or multiparas, and then, provide further insight for better management of labor. METHODS: From January 1999 to December 2003, a total of 444 patients with VBAC were entered into the study. Women with two or more history of caesarean section or previous vaginal delivery were all excluded from the study. Time length of active labor in these patients was compared with 335 nulliparas and 218 multiparas consecutively visiting our unit for delivery in 2003. RESULTS: For patients with VBAC, the duration of active and second phase were 184.8+/-115.7, and 25.1+/-15.2 minutes, which was significantly shorter than nulliparas (p<0.05), but longer than multiparas (p<0.05). To eliminate confounding factors affecting the duration, 374 women without use of vacuum, oxytocin, or epidural anesthesia were selected for analysis. Consistently, the time length of active and second phase in women with VBAC was significantly shorter than in nulliparas, but longer than in multiparas (p<0.001) except for active phase compared with nulliparas (p=0.295). CONCLUSION: With regard to the time length of active labor, women attempting VBAC were in the intermediate group when compared with nulliparas or multiparas. Understanding of this unique time interval in women attempting VBAC may help in allowing an appropriate management for labor process.
Anesthesia, Epidural ; Cesarean Section ; Female ; Humans ; Oxytocin ; Pregnancy ; Vacuum ; Vaginal Birth after Cesarean*

BACKGROUND: The Freund's complete adjuvant (FCA)-induced inflammation may produce allodynia against a touch stimulus. The antiallodynic effects of brimonidine, a new selective alpha2 receptor agonist, and of rilmenidine, a new more selective imidazoline receptor agonist, have not been evaluated in rats with FCA induced inflammation. Therefore, we investigated the sympathetic component of mechanical allodynia after the development of allodynia secondary to FCA-induced inflammation in rats. METHODS: A lumbar intrathecal catheter was implantated in male Sprague Dawley rats. Inflammation was induced by the intradermal injection of 0.15 ml FCA under enflurane anesthesia. Using Von Frey filaments, the antiallodynic effects of intrathecal (I.T.) brimonidine (1, 3 microgram), rilmenidine (30, 100 microgram) and saline were examined. In antagonistic study intrathecal yohimbine 30 microgram and rauwolscine 30 microgram were administered to investigate the reversal of the antiallodynic effect by each agonist. We also examined the effects of intradermal norepinephrine followed by I.T. brimonidin, rilmenidine or saline on the withdrawal threshold of rats secondary to allodynia induced by FCA. RESULTS: I.T. brimonidine or rilmenidine produced dose-dependent antiallodynic effect and which were moderately antagonized by I.T. yohimbine or rauwolscine. Intradermal norepinephrine produced a reduction in the withdrawal threshold in rats. CONCLUSIONS: Our results suggest that a sympathetic component is likely to be involved in the mechanism of allodynia secondary to FCA-induced inflammation.
Adrenergic Agonists* ; Anesthesia ; Animals ; Catheters ; Enflurane ; Humans ; Hyperalgesia* ; Inflammation* ; Injections, Intradermal ; Male ; Norepinephrine* ; Rats* ; Rats, Sprague-Dawley ; Yohimbine

Angiotensin II(A II) -a main effector molecule of renin-angiotensin system(RAS) has been known to increase blood pressure and glomerular capillary pressure, and filtration fraction which may be involved in the progressive renal injury process. The action of A II takes place mainly through AT1 receptor. RAS can be blocked by angiotensin converting enzyme inhibitor(ACEI) and recently developed A II AT1 receptor antagonist(AT1 RA). ACEI also activate kinin system, simultaneously. However, AT1 RA does not affect kinin system. The renoprotective mechanism of ACEI may be related with activation of kinin system. In order to evaluate the renoprotective mechanism of long-term ACEI(enalapril, 100mg/L in drinking water for 12 weeks) or AT1 RA treatment(losartan 300mg/L in drinking water for 12 weeks), and its effect on the cytokines and growth factor expressions of renal cortical tissue by compatitive RT-PCR, 46 5/6 nephrectomized(5/6 NPX) rats and 8 sham operated rats were included in this study. Five sixth NPX rats showed marked hypertensin, significant proteinuria and glomerulosclerosis(mean 30.5%) in 12 weeks after surgery. However, enelapril or losartan treated rats revealed significantly lower 24 hour urinary protein excretion(UProtV), systolic blood pressure(SBP), and glomerulosclerosis than those of control 5/6 NPX rats. Plasma renin activity and angiotensin II levels of 5/6 NPX untreated control rats were not significantly increased compared to sham operated rats in 12 week after surgery. Renal cortical renin gene expression of untreated 5/6 NPX rats was significantly suppressed compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly increased renin gene expression compared to untreated 5/6 NPX rats. Renal cortical gene expressions of TGF-beta, TNF-alpha, MCP-1, IL-6, osteopontin, and endothelin-1 were significantly increased in 5/6 NPX untreated control rats compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly less level of renal TGF-beta gene expression compared to 5/6 NPX control rats. The magnitude of SBP and UProtV were significantly positively correlated with the degree of glomeruloslerosis(p<0.001, p<0.001). With the above result, we speculate that because ACEI or AT1 RA showed similar renoprotective effect in 5/6 NPX rats, at least in part, local activation of RAS plays an important role in the progressive renal injury process of this model.
Angiotensin Amide ; Angiotensin II ; Angiotensins ; Animals ; Blood Pressure ; Capillaries ; Cytokines ; Drinking Water ; Enalapril ; Endothelin-1 ; Filtration ; Gene Expression ; Interleukin-6 ; Losartan ; Osteopontin ; Peptidyl-Dipeptidase A ; Plasma ; Proteinuria ; Rats ; Renin ; Renin-Angiotensin System* ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

Angiotensin II(A II) -a main effector molecule of renin-angiotensin system(RAS) has been known to increase blood pressure and glomerular capillary pressure, and filtration fraction which may be involved in the progressive renal injury process. The action of A II takes place mainly through AT1 receptor. RAS can be blocked by angiotensin converting enzyme inhibitor(ACEI) and recently developed A II AT1 receptor antagonist(AT1 RA). ACEI also activate kinin system, simultaneously. However, AT1 RA does not affect kinin system. The renoprotective mechanism of ACEI may be related with activation of kinin system. In order to evaluate the renoprotective mechanism of long-term ACEI(enalapril, 100mg/L in drinking water for 12 weeks) or AT1 RA treatment(losartan 300mg/L in drinking water for 12 weeks), and its effect on the cytokines and growth factor expressions of renal cortical tissue by compatitive RT-PCR, 46 5/6 nephrectomized(5/6 NPX) rats and 8 sham operated rats were included in this study. Five sixth NPX rats showed marked hypertensin, significant proteinuria and glomerulosclerosis(mean 30.5%) in 12 weeks after surgery. However, enelapril or losartan treated rats revealed significantly lower 24 hour urinary protein excretion(UProtV), systolic blood pressure(SBP), and glomerulosclerosis than those of control 5/6 NPX rats. Plasma renin activity and angiotensin II levels of 5/6 NPX untreated control rats were not significantly increased compared to sham operated rats in 12 week after surgery. Renal cortical renin gene expression of untreated 5/6 NPX rats was significantly suppressed compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly increased renin gene expression compared to untreated 5/6 NPX rats. Renal cortical gene expressions of TGF-beta, TNF-alpha, MCP-1, IL-6, osteopontin, and endothelin-1 were significantly increased in 5/6 NPX untreated control rats compared to sham operated rats. Enalapril or losartan treated 5/6 NPX rats showed significantly less level of renal TGF-beta gene expression compared to 5/6 NPX control rats. The magnitude of SBP and UProtV were significantly positively correlated with the degree of glomeruloslerosis(p<0.001, p<0.001). With the above result, we speculate that because ACEI or AT1 RA showed similar renoprotective effect in 5/6 NPX rats, at least in part, local activation of RAS plays an important role in the progressive renal injury process of this model.
Angiotensin Amide ; Angiotensin II ; Angiotensins ; Animals ; Blood Pressure ; Capillaries ; Cytokines ; Drinking Water ; Enalapril ; Endothelin-1 ; Filtration ; Gene Expression ; Interleukin-6 ; Losartan ; Osteopontin ; Peptidyl-Dipeptidase A ; Plasma ; Proteinuria ; Rats ; Renin ; Renin-Angiotensin System* ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

In order to evaluate the renal expression of renin, TGF-beta, TNF-alpha, IL-6, MCP-1, endothelin-1, osteopontin, and the role of renin-angiotensin system(RAS) in renal injury mechanism of experimental unilateral ureteral obstruction(UUO), 44 male Sprague-Dawley rats weighing 260-280g underwent sham operation(n= 8), UUO without treatment(n=12), UUO with angiotensin converting enzyme inhibitor(ACEI, enalapril 100 mg/kg body weight in drinking water, n=12) and UUO with angiotensin II AT1 receptor antagonist(AT1 RA, losartan 300mg/Kg body weight in drinking water, n= 12) under thiopental sodium anesthesia(50mg/kg, body weight, I.P.). Half number of each group was sacrificed at 3 and 7 days after surgery. With standard point count method, we evaluated the magnitude of tubulointerstitial mononuclear cell infiltration and relative volume of interstitium by light microscopic examination (PAS stain and immunohistochemistry for ED-1). Competitive RT-PCR was performed for the estimation of renin, TGF-beta, TNF-alpha, IL-6, MCP-1, endothelin-1, osteopontin and beta-actin gene expression levels of the kidneys. Renal gene expressions of renin, TGF-beta, MCP-1, TNF-alpha, IL-6, endothelin-1, and osteopontin of untreated control UUO rats were significantly increased compared to sham operated rats at 3 and 7 days after surgery. The level of TGF-beta, TNF-alpha, IL-6 and endothelin-1 gene expressions of ACEI treated UUO rats was significantly lower than those of untreated control UUO rats. AT1 RA treated UUO rats also showed significantly lower level of TGF-beta and osteopontin gene expression than those of control UUO group. Untreated control UUO rats showed significantly increased mononuclear cell infiltration of tubulointerstitium and relative volume of interstitium of the kidney compared to sham operated rats. ACEI or AT1 RA treated UUO rats showed significantly less relative volume of interstitium and mononuclear cell infiltration than those of untreated UUO rats(p<0.05, p<0.05). With the above result, we speculate that the upregulation of renin, TGF-beta, MCP-1, TNF-alpha, IL-6, osteopontin and endothelin-1 genes is closely related to the progressive renal injury process in this model and at least in part, the early activation of renin angiotensin system of the kidney is involved in this mechanism.
Actins ; Angiotensin II ; Animals ; Body Weight ; Drinking Water ; Enalapril ; Endothelin-1 ; Gene Expression ; Humans ; Immunohistochemistry ; Interleukin-6 ; Kidney ; Losartan ; Male ; Osteopontin ; Peptidyl-Dipeptidase A ; Rats ; Rats, Sprague-Dawley ; Renin ; Renin-Angiotensin System* ; Thiopental ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Up-Regulation ; Ureter* ; Ureteral Obstruction*

BACKGROUNDS: Living-donor liver transplantation (LDLT) has been established as an efficacious option to resolve the shortage of cadaveric donor organs for pediatric recipients. This surgical innovation has significantly reduced the pretransplantation mortality for children, but the crisis of increasing scarcity of donor organs in our hospital has led us to extend LDLT to adult recipients. However, the extension of LDLT from pediatric recipients to adult recipients has been made only with limited success largely because of the inability of a relatively small-size left-lobe graft to meet the metabolic demands of an adult recipient. It has been postulated that a left-lobe graft smaller than 40% of the recipient's standard liver volume will not result in a successful adult-to-adult LDLT in chronic parenchymal liver disease. METHODS: From February 1997 to October 1997, 10 LDLTs, using 9 extended left-lobe grafts and 1 right-lobe graft, were performed on patients with end-stage parenchymal liver diseases (9 cases of B-hepatitis-induced cirrhosis with or without an associated hepatocellular carcinoma and 1 case of alcoholic cirrhosis) at the Department of Surgery, Asan Medical Center. The ratios of the graft to the standard liver volume of the recipients were in the range of 30% to 55%. RESULTS: All grafts showed immediate function, but delayed normalization of the serum total bilirubin was demonstrated in all recipients receiving left-lobe grafts. There were no mortalities and serious complications in donors. Two recipients died of sepsis 21 days and 40 days after transplantation, and 8 recipients (80%) are alive with good liver function at a median follow-up of 5.1 months (range 2~10 months). CONCLUSIONS: The aim of this article is to report our experience with adult-to-adult LDLT shows that a graft size greater than 30% of the recipient's standard liver volume is able to meet the metabolic demands of adult recipients with chronic parenchymal liver disease and that LDLT might open a new donor pool for adult recipients when the supply of cadaveric organs is severely restricted.
Adult ; Alcoholics ; Bilirubin ; Cadaver ; Carcinoma, Hepatocellular ; Child ; Chungcheongnam-do ; Fibrosis ; Follow-Up Studies ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Mortality ; Sepsis ; Tissue Donors ; Transplants

BACKGROUND: To evaluate the clinical efficacy of Simvastatin, a HMG-CoA reductase inhibitor, We ibsweved the changes of clinical characteristics and lipid profiles after Simvastatin administration in patients with hypercholesterolemia. METHODS AND RESULTS: Simvastatin 10mg was given once daily for 12 weeks in 35 patients (60+/-6.0 years : 14 male, 21 female) with hypercholesterolemia. High density lipoprotein-cholesterol (HDL-C) was increased from 38+-10 to 45+-9mg/dl(p<0.05). Simvastatin significantly decreased total cholesterol(TC) from 235+-15 to 181+-21mg/dl(23.0%), low-density lipoprotein cholesterol (LDL-C) from 164+-19 to 104+-18mg/dl(36.5%), TC/HDL-C from 7.0+-2.0 to 4.4+-1.1, LDL-C/HDL-C from 4.9+-1.7 to 2.5+-0.8(p<0.01 respectively). Apo B was decreased by 31%(119+-19 to 87+-15mg/dl), apo B/A1 ratio was decreased by 41%(1.2+-0.2 to 0.7+-0.2) amd lipoprotein(a) edcreased by 12%(33+-22 to 29+-17), while apo A1 was increased by 25%(104+-18 to 130+-23mg/dl, p<0.01 respectively). No patients complained of chest pain, but two had skin rashes. Creatine kinase and creatinine were not changed in all patients. CONCLUSIONS: Somvastatin is an effective and well tolerated cholesterol lowering agent in patients with hypercholesterolemia.
Apolipoprotein A-I ; Apolipoproteins ; Apolipoproteins B ; Chest Pain ; Cholesterol ; Creatine Kinase ; Creatinine ; Exanthema ; Humans ; Hypercholesterolemia* ; Lipoprotein(a) ; Lipoproteins ; Male ; Oxidoreductases ; Simvastatin*

PURPOSE: To determine the usefulness of MR imaging and MR angiography (MRA) in the evaluation of patients with hemifacial spasm. MATERIAL AND METHODS: One hundred and twenty-five patients with hemifacial spasm were included in this study. Axial T1-, T2-weighted images, proton density image (3mm thickness, 256 x 192) and 3-D TOF MRA were performed. Relation between facial nerve and adjacent arterial structures was carefully evaluated, which was correlated with surgical findings. RESULTS: MRA identified the presen(~e of offending vessels at the root exit zone of facial nerve and its origin in 117 patients(52 PICA, 50 AICA, 6 vertebral artery, 9 dual vessels). There were 4 false negatives and 4 false positives. Vascular groove at the root exit zone was identified in 52 cases, but there was no positive correlation between severity and duration of symptoms. The presence of ipsilateral or contralateral distal loop formation of vertebral artery were noted in 63 patients. In addition, 4 cases of neoplastic and vascular lesions were also demonstrated on MR imaging. CONCLUSION: Combination of MR imaging and MRA is an useful screening modality in the presurgical evaluation of hemifacial spasm, which can demonstrate the offending vessels as well as other pathologic lesions.
Angiography* ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Magnetic Resonance Imaging* ; Mass Screening ; Pica ; Protons ; Vertebral Artery