PURPOSE: The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. MATERIALS AND METHODS: Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. RESULTS: A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. CONCLUSIONS: History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time.
Colonoscopy* ; Gastrectomy* ; Humans ; Intubation ; Lymph Node Excision ; Postoperative Period ; Risk Factors

PURPOSE: Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. METHODS: We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. RESULTS: The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. CONCLUSION: Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.
Appendectomy ; Appendicitis ; Female ; Humans ; Incidence ; Korea ; Postoperative Complications ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Wound Infection

The serine/threonine kinase Akt has been shown to play a role of multiple cellular signaling pathways and act as a transducer of many functions initiated by growth factor receptors that activate phosphatidylinositol 3-kinase (PI3K). It has been reported that phosphorylated Akt activates eNOS resulting in the production of NO and that NO stimulates soluble guanylate cyclase (sGC), which results in accumulation of cGMP and subsequent activation of the protein kinase G (PKG). It has been also reported that PKG activates PI3K/Akt signaling. Therefore, it is possible that PI3K, Akt, eNOS, sGC, and PKG form a loop to exert enhanced and sustained activation of Akt. However, the existence of this loop in eNOS-expressing cells, such as endothelial cells or astrocytes, has not been reported. Thus, we examined a possibility that Akt phosphorylation might be enhanced via eNOS/sGC/PKG/PI3K pathway in astrocytes in vivo and in vitro. Phosphorylation of Akt was detected in astrocytes after KA treatment and was maintained up to 72 h in mouse hippocampus. 2 weeks after KA treatment, astrocytic Akt phosphorylation was normalized to control. The inhibition of eNOS, sGC, and PKG significantly decreased Akt and eNOS phosphorylation induced by KA in astrocytes. In contrast, the decreased phosphorylation of Akt and eNOS by eNOS inhibition was significantly reversed with PKG activation. The above findings in mouse hippocampus were also observed in primary astrocytes. These data suggest that Akt/eNOS/sGC/PKG/PI3K pathway may constitute a loop, resulting in enhanced and sustained Akt activation in astrocytes.
Animals ; Astrocytes ; Cyclic GMP-Dependent Protein Kinases ; Endothelial Cells ; Guanylate Cyclase ; Hippocampus ; Kainic Acid ; Mice ; Nitric Oxide ; Phosphatidylinositol 3-Kinase ; Phosphorylation ; Phosphotransferases ; Receptors, Growth Factor ; Transducers

Melatonin has been reported to protect neurons from a variety of neurotoxicity. However, the underlying mechanism by which melatonin exerts its neuroprotective property has not yet been clearly understood. We previously demonstrated that melatonin protected kainic acid-induced neuronal cell death in mouse hippocampus, accompanied by sustained activation of Akt, a critical mediator of neuronal survival. To further elucidate the neuroprotective action of melatonin, we examined in the present study the causal mechanism how Akt signaling pathway is regulated by melatonin in a rat primary astrocyte culture model. Melatonin resulted in increased astrocytic Akt phosphorylation, which was significantly decreased with wortmannin, a specific inhibitor of PI3K, suggesting that activation of Akt by melatonin is mediated through the PI3K-Akt signaling pathway. Furthermore, increased Akt activation was also significantly decreased with luzindole, a non-selective melatonin receptor antagonist. As downstream signaling pathway of Akt activation, increased levels of CREB phoshorylation and GDNF expression were observed, which were also attenuated with wortmannin and luzindole. These results strongly suggest that melatonin exerts its neuroprotective property in astrocytes through the activation of plasma membrane receptors and then PI3K-Akt signaling pathway.
Androstadienes ; Animals ; Astrocytes ; Cell Death ; Cell Membrane ; Glial Cell Line-Derived Neurotrophic Factor ; Hippocampus ; Melatonin ; Mice ; Neurons ; Phosphorylation ; Rats ; Receptors, Melatonin ; Tryptamines

Antioxidant properties have been proposed as a mechanism for the putative anti-inflammatory effects of phenolic compounds. To reveal the relationship between antioxidant activity and anti-inflammatory effects of various antioxidants, we measured 1, 1-diphenyl-2-picryhydrazyl (DPPH)-reducing activity and examined the inhibitory effects on LPS-induced inflammation-related gene expression in the BV2 microglial cell line. Lipopolysaccharide (LPS) (0.2microgram/ml) was used with or without antioxidants to treat cells, and the regulation of iNOS and cytokine gene expression was monitored using an RNase protection assay (RPA). Although, all tested antioxidants had similar DPPH-reducing activity and inhibited nitrite production, but the curcuminoid antioxidants (ferulic acid, caffeic acid, and curcumin) inhibited LPS-induced gene expression (iNOS, TNF-alpha, IL-1beta, IL-6, and IL-1 Ra) in a concentration-dependent manner. Other tested antioxidants did not exhibit the same effects; N-acetylcysteine (NAC) only began to suppress IL-1beta gene expression just below the concentration at which cytotoxicity occurred. Moreover, the antioxidant potency of curcuminoids appeared to have no correlation with anti-inflammatory potency. Only curcumin could inhibit LPS-induced microglial activation at a micromolar level. These data suggest that curcumin may be a safe antioxidant possessing anti-inflammatory activity.
Acetylcysteine ; Antioxidants* ; Cell Line* ; Curcumin ; Gene Expression ; Interleukin-1 ; Interleukin-6 ; Nitric Oxide ; Phenol ; Ribonucleases ; Tumor Necrosis Factor-alpha

Neuronal death is a common characteristic hallmark of a variety of neurodegenerative disorders including Alzheimer's disease and Parkinson's disease. However, there have been no effective drugs to successfully prevent neuronal death in those diseases, whereas oriental medicinal plants have to possess valuable therapeutic potentials to treat neurodegenerative diseases. In the present study, in an attempt to provide neuroprotective agents from natural plants, 80% methanol extracts of a wide range of medicinal plants, which are native to Jeju Island in Korea, were prepared and their protective effects on hydrogen peroxide-induced apoptotic cell death were examined. Among those tested, extracts from Smilax china and Saururus chinesis significantly decreased hydrogen peroxide-induced apoptotic cell death. The extracts attenuated hydrogen peroxide (H2O2)-induced caspase-3 activation in a dose-dependent manner. Further, plant extracts restored H2O2-induced depletion of intracellular glutathione, a major endogenous antioxidant. The data suggest that Jeju native medicinal plants could potentially be used as therapeutic agents for treating or preventing neurodegenerative diseases in which oxidative stress is implicated.
Alzheimer Disease ; Caspase 3 ; Cell Death ; China ; Glutathione ; Humans* ; Hydrogen Peroxide ; Hydrogen* ; Korea ; Methanol* ; Neuroblastoma* ; Neurodegenerative Diseases ; Neurons ; Neuroprotective Agents* ; Oxidative Stress ; Parkinson Disease ; Plant Extracts ; Plants, Medicinal ; Saururaceae ; Smilax

PURPOSE: Although many studies on the clinicopathological characteristics of signet ring cell (SRC) carcinoma of the stomach have been made, there is no consistent report of the characteristics and prognosis of this condition. In this study, the clinicopathological features and prognosis of patients with SRC and non-SRC gastric cancer were compared. METHODS: Between 1990 and 2002, 1,884 patients, who underwent a curative resection for gastric cancer in our hospital, were analyzed retrospectively. Among them, 185 (9.8%) patients with SRC were compared with 1,699 (90.2%) patients with non-SRC. RESULTS: SRC in gastric cancer was found more commonly in younger patients and women. The depth of the invasion in the SRC patients was less invasive and a lymph node metastasis is less frequent. A higher frequency of the depressed gross type and middle third tumor location in SRC are similar characteristics of the undifferentiated type of gastric cancer. However, SRC in EGC have similar characteristics to the differentiated type of gastric cancer such as a higher rate of mucosa-confined tumors and less frequent lymph node metastasis. The five-year survival rate of SRC in AGC was similar to that of other pathologic types, and the pathologic type does not influence the survival rate. CONCLUSION: SRC patient in EGC should be considered as a differentiated type. Therefore, the mucosa confined tumor and less frequent lymph node metastases are expected.
Carcinoma, Signet Ring Cell* ; Female ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Pathology ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate

Kainic acid (KA) is a structural analogue of glutamate that interacts with specific presynaptic and postsynaptic receptors to potentiate the release and excitatory actions of glutamate. Systemic or intracerebroventricular (i.c.v.) administration of KA to experimental animals elicits multifocal seizures with a predominantly limbic localization, and results in neuronal death of cornu ammonia 1 (CA1), reactive gliosis and biochemical changes in the hippocampus and other limbic structures. Several lines of evidence suggest that reactive oxygen species (ROS) play a pivotal role in the pathogenesis of excitotoxic death by KA. Curcumin has been known to possess anti-oxidative and anti-inflammatory activities. In this study, the effects of curcumin on KA induced hippocampal cell death, reactive gliosis and biochemical changes in reactive glia were investigated by immunohistochemical methods. Our data demonstrated that curcumin attenuated KA-induced astroglial and microglial activation although it did not protect KA-induced hippocampal cell death.
Ammonia ; Animals ; Astrocytes ; Cell Death* ; Curcumin* ; Gliosis ; Glutamic Acid ; Hippocampus ; Kainic Acid ; Microglia ; Neuroglia* ; Neurons* ; Reactive Oxygen Species ; Seizures

PURPOSE: The supply of donor organs does not meet the demand of transplantation. To find a possible way of expanding the donor pool, we have evaluated the risk factors of cadaveric donors that influence the graft survival. METHODS: Between Feb. 1995 and Dec. 1999, we performed 200 cases of cadaveric kidney transplantation. The graft survival rates in 1 yr, 2 yr, & 3 yr are 93.0%, 91.1%, & 89.9%, respectively. We defined the marginal donor as a donor who possesses one of the risk factors of donor age > or = 50, or < or =5 year old (n=18), ICU stay > or =10 days (n=46), history of hypertension (n=30), CPR > or =20 min (n=7), prolonged hypotension (SBP < or =80 mmHg, over 6 hr) (n=40), high dose inotropic support (dopamine > or =20microgram/kg/min, or dobutamine > or =15microgram/kg/min) (n=78), serum creatinine level > or =2.5 mg/dl (n=16), or cold ischemic time > or =12 hr (n=34). We compared graft survival rates between the marginal donor group and the non-marginal donor group, and analyzed risk factors affecting graft survival by univariate and multivariate methods. RESULTS: CPR > or =20 min (71.5%, 71.5%, - vs 93.8%, 91.8%, 90.6%, p=0.027), prolonged hypotension (85.0%, 85.0%, 80.3% vs 95.0%, 92.6%, 92.6%, p=0.028) and serum creatinine > or =2.5 mg/dl (75.0%, 75.0%, 75.0% vs 94.6%, 92.4%, 91.0%, p=0.001) affect graft survival in univariate analysis. There is, However, no risk factor that affects graft survival in multivariate analysis. CONCLUSION: We can increase the supply of donor organs for kidney transplantation by the selective use of high-risk cadaver donor. However, a prospective randomized study including recipient factors is needed to define the acceptable conditions better.
Risk Factors

PURPOSE: To evaluate the charateristic CT and MR findings of primary ovarian fibromas. MATERIALS AND METHODS: We retrospectively reviewed 11 cases which had undergone precontrast and postcontrast scanning, and two in which cases T1-weighted (WI) and postcontrast T1WI and T2WI images had been done. All cases were pathologically confirmed after surgical resection. These masses were analysed on the basis of clinical symptom, age, size (longest diameter), laterality, margin, attenuation (unenhanced and enhanced), signal intensity (SI), calcification, and amount of the ascites. RESULTS: The patients' mean age was 46.6 (range, 22-81) years, and the longest diameter was 14.8 (range, 8-28)cm. All tumors were unilateral, and eight were located in the left ovary and five in the right ovary. In all cases, the tumor margin was well-defined; seven were lobulated, four were oval, one was round, and one was nodularly marginated. On CT scan, the masses showed mildl to moderate heterogenous enhancement with irregular lower density portions. The amount of the ascites was marked in three cases (23%) mild in two (15%), and minimal in three cases. Calcifications were seen in 3 of 11 CT cases (27%), and in one, this was extensive. On MR scans, signal intensity (SI) of the masses on T1WI was isoSI, relativetive to the uterine myometrium, and heterogeneously enhanced after infusion of contrast media. On T2WI, SI was slightly lower that of the uterine myometrium with internal high SI portions. CONCLUSION: The characteristic finding of ovarian fibroma is a unilateral, well-defined, oval or lobulated, solid mass with or without ascites and calcification. On CT scan, tumor has mild to moderate heterogeneous enhancement. On MR scan, SI of mass is isoSI on T1WI with heterogeneous enhancement, and low SI on T2WI due to fibrous component.
Animals ; Ascites ; Contrast Media ; Female ; Fibroma* ; Mice ; Myometrium ; Ovary ; Retrospective Studies ; Tomography, X-Ray Computed