PURPOSE: To investigate the chemotherapeutic effect of quercetin against cancer cells, signaling pathway of apoptosis was explored in human pancreatic cells. METHODS: Various anticancer drugs including adriamycin, cisplatin, 5-fluorouracil (5-FU) and gemcitabine were used. Cell viability was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphe-nyltetra zolium bromide assay. Apoptosis was determined by 4'-6-diamidino-2-phenylindole nuclei staining and flow cytometry in PANC-1 cells treated with 50 microg/mL quercetin for 24 hours. Expression of endoplas mic reticulum (ER) stress mediators including, Grp78/Bip, p-PERK, PERK, ATF4, ATF6 and GADD153/CHOP proteins were measured by Western blot analysis. Mitochondrial membrane potential was measured by fluorescence staining with JC-1, rhodamine 123. Quercetin induced the apoptosis of PANC-1, which was characterized as nucleic acid and genomic DNA fragmentation, chromatin condensation, and sub-G0/G1 fraction of cell cycle increase. But not adriamycin, cisplatin, gemcitabine, and 5-FU. PANC-1 cells were markedly sensitive to quercetin. RESULTS: Treatment with quercetin resulted in the increased accumulation of intracellular Ca2+ ion. Treatment with quercetin also increased the expression of Grp78/Bip and GADD153/CHOP protein and induced mitochondrial dysfunction. Quercetin exerted cytotoxicity against human pancreatic cancer cells via ER stress-mediated apoptotic signaling including reactive oxygen species production and mitochondrial dysfunction. CONCLUSION: These data suggest that quercetin may be an important modulator of chemosensitivity of cancer cells against anticancer chemotherapeutic agents.
Apoptosis* ; Benzimidazoles ; Blotting, Western ; Carbocyanines ; Cell Cycle ; Cell Survival ; Chromatin ; Cisplatin ; Deoxycytidine ; DNA Fragmentation ; Doxorubicin ; Drug Therapy ; Flow Cytometry ; Fluorescence ; Fluorouracil ; Humans ; Membrane Potential, Mitochondrial ; Pancreatic Neoplasms ; Quercetin* ; Reactive Oxygen Species ; Reticulum ; Rhodamine 123

PURPOSE: The aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) with respect to clinical outcomes. METHODS: Patients with less than a 28 body mass index (BMI) and a benign gall bladder disease were enrolled in this study. From January 2011 to February 2012, 30 consecutive patients who underwent SILC were compared with 30 patients who underwent CLC during the same period. In this study, all operations were performed by one surgeon. In each group, patient characteristics and perioperative data were collected. RESULTS: There was no significant difference in the preoperative characteristics. There was no significant difference in the postoperative laboratory result (alanine aminotransferase, aspartate aminotransferase, and alanine aminotransferase), number of conversion and complication cases, and length of hospital stay. The operation time was significantly longer in the SILC group (78.5 +/- 17.8 minutes in SILC group vs. 34.9 +/- 5.75 minutes in CLC group, P < 0.0001). The total nonsteroidal antiinflammatory drug usage during perioperative period showed significantly higher in SILC groups (162 +/- 51 mg in the SILC group vs. 138 +/- 30 mg in the CLC group), but there was no statistically significant difference in opioid usage between two groups. The postoperative pain score was significantly higher in the SILC group at second, third, and tenth postoperative day. Satisfaction of postoperative wound showed superiority in SILC group. CONCLUSION: SILC seems to be an acceptable alternative to CLC with acceptable results. However, it is not enough to propose any real benefits of SILC when compared with CLC in terms of operation time and postoperative pain.
Alanine ; Aspartate Aminotransferases ; Body Mass Index ; Cholecystectomy, Laparoscopic ; Gallbladder Diseases ; Humans ; Length of Stay ; Pain, Postoperative ; Perioperative Period ; Prospective Studies

A 21-year-old woman presented gastrointestinal manifestation showing intermittent abdominal pain, nausea, and vomiting. An upper endoscopic examination showed round, elevated mucosa at the antrum of the stomach anterior wall. After CT scanning, a huge degenerated gastrointestinal stromal tumor was suspected. Subtotal gastrectomy with Billroth II anastomosis was performed. Histologically, pseudocystic degeneration of the heterotopic pancreas was confirmed. The patient showed eventful postoperative course except temporary dilated gastric emptying. The patient is doing well without any abnormal symptom at 8-month follow-up. This report is a rare case of gastric outlet obstruction caused by a pseudocyst originating from a heterotopic pancreas in the gastric antrum.
Abdominal Pain ; Female ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastric Outlet Obstruction ; Gastroenterostomy ; Gastrointestinal Stromal Tumors ; Humans ; Mucous Membrane ; Nausea ; Pancreas ; Pyloric Antrum ; Stomach ; Vomiting ; Young Adult

Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.
Chyle ; Chylous Ascites ; Humans ; Pancreatic Neoplasms ; Pancreatitis ; Parenteral Nutrition, Total ; Peritoneum ; Portal Vein ; Rare Diseases ; Rupture ; Thrombosis

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Emergencies ; Gallbladder ; Humans ; Laparotomy ; Postoperative Complications ; Risk Factors

A 65-year old man underwent wedge resection for a gastrointestinal stromal tumor (GIST) of the gastric fundus in 1997. In 2003, the abdominal CT and sono-guided biopsy revealed he had a large GIST liver metastasis. He underwent treatment with 400 mg/day of imatinib mesylate. As a result, the liver metastasis markedly decreased in size. However, focal progression of the liver metastasis was observed on the follow up CT, so we increased the imatinib from 400 mg/day to 800 mg/day. We then performed extended left hepatectomy. We report here on a patient who presented with an isolated metastatic GIST to the liver, and the patient was successfully treated with imatinib therapy and hemihepatectomy.
Benzamides ; Biopsy ; Follow-Up Studies ; Gastric Fundus ; Gastrointestinal Stromal Tumors ; Hepatectomy ; Humans ; Indoles ; Liver ; Mesylates ; Neoplasm Metastasis ; Piperazines ; Pyrimidines ; Pyrroles ; Imatinib Mesylate

BACKGROUND/AIMS: Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. METHODS: From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. RESULTS: Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD. CONCLUSIONS: For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Endoscopy, Gastrointestinal ; Female ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/*etiology ; Proton Pump Inhibitors/therapeutic use ; Questionnaires ; Recurrence ; Risk Factors ; Sex Factors ; Smoking ; Stomach Ulcer/etiology

PURPOSE: Various methods have evolved for laparoscopic cholecystectomy: the four-port, three-port or two-port methods. Some authors have recently recommended 2 port laparoscopic cholecystectomy as a useful method. We compared the clinical characteristics of the two-port method and the three-port method, and we estimated the usefulness of each method. METHODS: We performed a prospective analysis of 40 patients who underwent laparoscopic cholecystectomy by a single surgeon from September 2008 to January 2009. The two port and 3 port techniques were alternatively done during the study period by one surgeon who had adequate experience with laparoscopic surgery at Wonkwang university hospital. We compared the two groups according to the parameters of the operation time, the intraoperative complications, the conversion rate, the postoperative complications, the postoperative hospital stay, the pain at the trocar sites and the patients' satisfaction. RESULTS: There were significant differences between the two and three port groups in terms of the mean operation time, the conversion rate and the intraoperative events. The mean operation time (2 port; 38.95+/-10 min., 3 port; 23.25+/-5 min.: p<0.01), conversion rate (2 port; 5 cases, 3 port; 0 case: p=0.016) and there were fewer intraoperative events using the three port technique that that of the two port technique (2 port; 14 events, 3 port; 2 events: p<0.01). There were no significant differences of the trocar site pain, the hospital stay and the patients' satisfaction. CONCLUSION: Considering our results, the tree port technique could be regarded as the optimal surgical technique compared to the 2 port technique for performing laparoscopic cholecystectomy, or at least until new instruments for gall bladder traction and new port were not developed.
Cholecystectomy, Laparoscopic ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments ; Traction ; Urinary Bladder

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. The tumor was characterized by high serum alpha-fetoprotein (AFP) levels. A 73-year-old male patient was admitted to the hospital with abdominal pain. Gastrofiberscopy revealed a gastric tumor occupying the antrum and pylorus. Radical subtotal gastrectomy was done and the result of biopsy was poorly differentiated adenocarcima of stomach and stage 3B. At postoperation 8 month, AFP was elevated and liver mass was detected on CT. Right extended hepatectomy was done under the impression of primary liver tumor. But, the biopsy revealed metastatic hepatoid adenocarcinoma of the stomach. Re-examination of the resected stomach was done and the result was hepatoid adenocarcinoma of the stomach. Two months later, after the hepatic resection, multiple metastases developed. This type of tumor has frequent early liver metastasis and poor prognosis. Therefore, early diagnosis and more careful investigation for liver metastasis are recommended.
Abdominal Pain ; Adenocarcinoma ; Aged ; alpha-Fetoproteins ; Biopsy ; Early Diagnosis ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Pylorus ; Stomach

PURPOSE: Portal branching patterns (ramification) that differ from those previously described are occasionally encountered during liver surgery. We studied the portal vein branching patterns by performing 64 MDCT. METHODS: A total of 100 patients with normal liver underwent MDCT during arterial portography. Next, the 3 dimensional portograms were reconstructed and the portal branching patterns were assessed. RESULTS: In 80 (80%) of the 100 patients we examined, the right anterior portal vein bifurcated into the ventral and dorsal branches. Only 20 percent of the patients showed the classic pattern, that is, bifurcating into the right anterior superior (P8) and right anterior inferior branches (P5). The portal branches in segment 5 showed many variations in their origins and numbers. The portal branches in segment 7 originated from both the right anterior and posterior portal veins, and not just the right posterior portal vein. CONCLUSION: Instead of dividing the right liver into the superior and inferior segments, we proposed that the right liver can be divided into 3 segments, which are designated as the right anterior, middle and posterior segments. In the view of the vascular watershed, the division of the right anterior and posterior sections by using the right hepatic vein might be inaccurate.
Hepatic Veins ; Humans ; Liver ; Portal Vein ; Portography