Thirteen cases of intrahepatic biliary cystadenoma and cystadenocarcinoma: a single center experience]

BACKGROUND/AIMS: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCACa) are rare cystic neoplasms that usually arise from the liver. We reviewed the clinicopathologic and radiologic findings of 13 cases of intrahepatic biliary cystic neoplasms. METHODS: Seven patients with BCA and 6 patients with BCACa which were pathologically proven within past 10 years were included in this retrospective study. RESULTS: BCA (7 of 7) was more common in female compared to BCACa (4 of 6). Mean age at diagnosis was 53.4 years (BCA) and 58.5 years (BCACa). Abdominal pain (54%) was the most common presenting symptom. Eleven patients (61.5%) exhibited normal liver function profiles and 5 patients (38%) showed elevated levels of serum CA19-9 levels (mean 894.2 U/mL, range: 78.7-2,080). Mean size of tumor was 11.7 cm (range: 5-15). Most frequent radiologic finding was a single cystic mass with septation. BCACa tended to have intracystic solid portion. The cut surface revealed a unilocular or multilocular cystic mass with mucinous contents. Complete surgical excision was done in 12 patients. After the complete resection, recurrence was observed in 1 case of BCACa. CONCLUSIONS: The possibility of biliary cystic neoplasm should be suspected when an intrahepatic cystic lesion with multiseptation or solid portion is noted on imaging study. In addition, complete excision for definite diagnosis and treatment need to be performed.     

Radiotherapy for 65 patients with advanced unresectable hepatocellular carcinoma

AIM： To evaluate the efficacy of radiotherapy （RT） in patients with advanced unresectable hepatocellular carcinoma （HCC）. METHODS： A total of 65 patients were treated with RT in the Korea University Medical Center. The median age of the patients was 60 years, and 86.2% were men. 18.5% and 81.5% of the patients were diagnosed as TNM stage Ⅲ and Ⅳ-A, respectively. Treatment response was assessed 4 mo after initiation of RT. Tumor regression rate 1 mo after initiation of RT （TRR1m） was also assessed. Duration of survival was calculated from the initiation of RT. RESULTS： The objective treatment response was 56.9%. The 12 mo survival rate was 34.7%. Predictive factors for survival were Child-Pugh grade, α-fetoprotein level and treatment response. An objective response was achieved more frequently in patients with TRR1m ≥ 20% than in those with TRR1m 〈 20% （P 〈 0.001）. CONCLUSION： RT is effective in treating advanced HCC with a tumor response rate of 56.9%.     

Detection of the thyroxine-binding globulin (TBG) gene in six unrelated families with complete TBG deficiency

T4-binding globulin (TBG) is a glycoprotein of hepatic origin which transports thyroid hormone in serum. Inherited TBG defects in man are X-chromosome linked and are expressed in hemizygotes as complete deficiency, partial deficiency, or excess. Since TBG is not necessary for thyroid hormone action, affected subjects are healthy. Using DNA probes for human TBG, we searched for restriction fragment length polymorphisms in six affected males belonging to 6 unrelated families with inherited complete TBG deficiency and an equal number of normal males. TBG could not be detected in the serum of any of the TBG-deficient males by a specific and sensitive RIA capable of detecting as little as 5 micrograms TBG/L or 0.031% of the average normal serum TBG concentration. DNA isolated from white blood cells was digested with 11 restriction endonucleases, and the digests were submitted to DNA blot analysis using two cloned TBG-DNA probes which together covered the entire protein coding and the 5'-flanking sequences of the TBG gene. A total of 26 different bands were detected on DNA blots, identifying 18 restriction sites located within the 4.2-kilobase TBG gene, which includes intronic, exonic, and 5'-flanking sequences. This analysis, which sampled 2.3% of the total TBG genome, failed to reveal differences in fragment size among the 6 TBG-deficient and 6 normal males examined. One restriction endonuclease (NcoI) identified normal sequences at the putative promoter region of the gene, and four other endonucleases (TaqI, SstII, MspI, and HpaII) recognized the cytosine-guanine dinucleotide phosphate sequences representing potential mutation hot spots. Although C was methylated at these sites, no C to T (thymidine) transitions were found. These data suggest that large deletions, insertions, or rearrangements of the TBG gene, or mutations at sites of methylated cytosine-guanine dinucleotide phosphate dimers are not common mechanisms for inherited complete TBG deficiency in man.     

Association among serum ferritin, alanine aminotransferase levels, and metabolic syndrome in Korean postmenopausal women

We examined the relationships among serum ferritin, alanine aminotransferase (ALT) levels, and cardiovascular risk factors of metabolic syndrome in Korean postmenopausal women. We conducted a cross-sectional study of 959 postmenopausal women without an apparent cause of liver disease. Metabolic syndrome was defined as the presence of at least 3 of the following: elevated blood pressure, low high-density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Serum ferritin and ALT levels were found to be correlated (r=0.374, P<.001) and to be associated with the components of metabolic syndrome. Subjects with metabolic syndrome showed significantly higher serum ferritin (74.7+/- 2.0 vs 59.6+/- 2.0 ng/mL, P<.001) and ALT levels (21.3+/-1.6 vs 18.7+/-1.5 IU/L, P<.001). Moreover, the greater the number of metabolic syndrome components present, the higher were the serum ferritin and ALT levels (P<.001). Multiple regression analysis showed that serum ALT levels are significantly associated with serum ferritin levels, waist circumference, fasting blood glucose, age, and white blood cell count (adjusted R(2)=0.147). Elevated iron stores were positively associated with serum ALT levels and metabolic syndrome in Korean postmenopausal women.     

Long-term clinical outcomes of platelet glycoprotein IIb/IIIa inhibitor combined with low molecular weight heparin in patients with acute coronary syndrome.

BACKGROUND: Platelet activation and aggregation with resultant arterial thrombus formation play a pivotal role in the pathophysiology of acute coronary syndrome (ACS). In the present study the efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin or low-molecular-weight heparin (dalteparin), was evaluated for the management of ACS. METHODS AND RESULTS: One hundred and sixty patients (60.9+/-11.1 years, 104 male) with unstable angina or non-ST elevation myocardial infarction and who had ST-T changes and elevated troponin were randomly assigned to 4 groups: group I (n=40: heparin alone), group II (n=40: dalteparin alone), group III (n=40: tirofiban + heparin) and group IV (n=40: tirofiban + dalteparin). The occurrence of major adverse cardiac events (MACE) was compared prospectively during a 6-month clinical follow-up. Percutaneous coronary intervention or coronary artery bypass graft was performed in 32 cases in group I, 29 in group II, 28 in group III and 31 in group IV (p=0.72). Minor bleeding complication developed in 2 patients (5.0%) in group I, 2 (5.0%) in group II, 4 (10.0%) in group III and 3 (7.5%) in group IV (p=0.78). During the follow-up MACE occurred in 10 patients (31.3%) in group I, 9 (31.0%) in group II, 4 (14.3%) in group III and 4 (12.9%) in group IV (p=0.02: Group I and II vs Group III and IV). CONCLUSIONS: Tirofiban combined with dalteparin was associated with relatively more bleeding complications in the short term, but was effective in reducing the incidence of MACE during long-term clinical follow-up in patients with ACS.     

Percutaneous coronary intervention with drug-eluting stent implantation vs. minimally invasive direct coronary artery bypass (MIDCAB) in patients with left anterior descending coronary artery stenosis.

The aim of this study was to assess the effects of percutaneous coronary intervention with drug-eluting stents (DESs) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery in the management of patients with proximal left anterior descending (LAD) coronary artery stenosis. Until recent years, despite the advantages of percutaneous transluminal coronary angioplasty (PTCA) with bare metal stent implantation, such as shorter hospital stays and recovery time, MIDCAB showed better results with regard to the need for repeated intervention in the target vessel than PTCA with proximal LAD lesions. Symptomatic patients (n = 189) were randomly assigned to DES group (n = 119) and MIDCAB group (n = 70). Patients with an isolated high-grade lesion (stenosis of > or = 70% of the luminal diameter) in the proximal LAD coronary artery (from the ostium to the first diagonal branch) were included in this study. During the 6-month follow-up period, 1.7% (n = 2) in the DES group needed repeated revascularization procedures for target lesion revascularization compared with 5.9% (n = 4) in the MIDCAB group (P = 0.196). The rates of death and myocardial infarction were similar in both groups [DES 0.0% (n = 0) vs. MIDCAB 2.9% (n = 2), P = 0.135; DES 1.7% (n = 2) vs. MIDCAB 2.9% (n = 2), P = 0.627; respectively] during 6 months of follow-up. In-hospital length of stay was significantly shorter in the DES group compared with the MIDCAB group (5.8 +/- 2.1 days vs. 8.9 +/- 2.6 days; P = 0.001). DES implantation and MIDCAB surgery showed similar rates of myocardial infarction, the need for repeated revascularization, and death during 6 months of follow-up. However, DES implantation resulted in lower average number of hospital stays and similar postoperative complications.     

Characterization of the first Korean isolate of a Chlamydia pneumoniae strain

Chlamydia pneumoniae is a common pathogen that causes upper and lower respiratory tract infections and is difficult to isolate from clinical specimens. Recently, we succeeded in isolating the first C. pneumoniae strain in Korea. This study characterizes the morphology, infectivity, and drug sensitivity of the Korean strain, designated LKK-1. Electron microscopy was performed for thin sections, and the infectivity over time was tested by counting the inclusion-forming units every 12 h. The minimum inhibitory concentrations of doxycycline, erythromycin, clarithromycin, ciprofloxacin, and levofloxacin were determined following the standard Japanese method. The elementary bodies of LKK-1 were round, like those in Japanese strain KKpn-1, whereas those of TW-183 have wavy cell membranes and are pear-shaped. The infectivity curve and drug sensitivities of LKK-1 were nearly the same as those of KKpn-1. In conclusion, LKK-1, the first strain from Korea, is similar to the Japanese strain KKpn-1 in terms of morphology, growth, and drug sensitivities, and shows a distinct difference in morphology compared with TW-183. Further studies are needed to elucidate the morphological differences between round strains and classical pear-shaped strains of C. pneumoniae.     

Ectopic opening of the common bile duct in the duodenal bulb: clinical implications

BACKGROUND: An ectopic opening of the common bile duct in the duodenal bulb is extremely rare, and the clinical significance of this anomaly has not been clarified. This study analyzed the clinical implications and cholangiographic findings of this anomaly. METHODS: A total of 18 patients (15 men, 3 women; median age, 51 years) with an ectopic opening of the common bile duct in the duodenal bulb were studied. Medical records, endoscopic findings, and cholangiographic and other radiographic findings were reviewed. RESULTS: All 18 patients had biliary pain; 7 had fever and chills. Fifteen (83%) had diffuse dilatation of the extrahepatic bile ducts with or without intrahepatic bile duct dilation. Associated bile duct stones were found in 10 (56%) patients. The papilla in the bulb had an orifice stained with bile at endoscopy, which was associated with duodenal ulcer disease found in 13 (72%) patients. The distal end of the common bile duct was tapered and narrowed and had a hook shape in all patients. CONCLUSION: An ectopic opening of the common bile duct in the duodenal bulb may be associated with clinical entities such as recurrent or intractable duodenal ulcer, choledocholithiasis, or acute cholangitis. Although these openings are rare, knowledge of the endoscopic and radiographic findings of an ectopic opening of the common bile duct in the duodenal bulb may help to clarify the cause of chronic recurrent duodenal ulcer disease in some patients and prevent damage to the bile duct during surgery.     

PPAR agonists treatment is effective in a nonalcoholic fatty liver disease animal model by modulating fatty-acid metabolic enzymes

Background and Aims: In a previous study, the authors found that reduced expression of peroxisome proliferator‐activated receptor (PPAR)‐α might play an important role in developing nonalcoholic fatty liver disease (NAFLD). The aim of this study was to analyze the effects of PPAR‐α and ‐γ agonists on NAFLD and verify the mechanisms underlying the PPAR‐α and ‐γ agonist‐induced improvements by evaluating the hepatic gene expression profile involved in fatty‐acid metabolism, using the Otsuka–Long Evans–Tokushima fatty (OLETF) rat. Methods: Rats were assigned to a control group (group I), fatty liver group (group II), PPAR‐α agonist treatment group (group III), or PPAR‐γ agonist treatment group (group IV). Fasting blood glucose, total cholesterol, and triglycerides were measured. Liver tissues from each group were processed for histological and gene expression analysis. mRNAs of enzymes involved in fatty‐acid metabolism and tumor necrosis factor (TNF)‐α were measured. Results: After 28 weeks treatment with PPAR‐α or ‐γ agonist, steatosis of the liver was improved in groups III and IV compared with group II. Fasting blood glucose levels were significantly lower in groups III and IV than in group II. In group III, mRNA expression of fatty‐acid β‐oxidation enzymes, such as fatty‐acid transport protein (FATP), fatty‐acid binding protein, carnitine palmitoyltransferase II, medium‐chain acyl‐CoA dehydrogenase (MCAD), long‐chain acyl‐CoA dehydrogenase, and acyl‐CoA oxidase, was significantly increased. However, the treatment‐induced modulation of fatty‐acid β‐oxidation enzymes was confined to FATP and MCAD in group IV. TNF‐α tended to be reduced in groups III and IV compared with group II. Conclusions: Treatment with PPAR agonists, especially a PPAR‐α agonist, improved the histological and biochemical parameters in the OLETF rat model by inducing fatty‐acid metabolic enzymes.     

Contribution of 18F-fluorodeoxyglucose positron emission tomography to the diagnosis of early pancreatic carcinoma

Background/Purpose

Pancreatic carcinoma has a poor prognosis, and early detection is essential to allow potentially curative resection. Despite the wide array of diagnostic tools available, the detection of small pancreatic tumors remains difficult. The aim of this study was to investigate the contribution of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) to the diagnosis of early pancreatic cancer.

Methods

FDG-PET was performed in 56 patients with pancreatic cancer who underwent curative surgery. The standardized uptake value (SUV) for FDG was calculated in each patient and the relationships between the SUV and various clinicopathological factors were analyzed.

Results

The tumors ranged from 0.8 to 6.5 cm in diameter. When the cutoff value for the SUV was set at 2.5, 51 of the 56 patients (91%) had a positive FDG-PET study. The SUV did not show a significant difference in relation to tumor differentiation or pTS and pT factors. There was also no correlation between the SUV and the maximum tumor diameter (r = 0.22; P = 0.1). Five tumors had an SUV below the cutoff value, and all of these lesions had intermediate or scirrhous stroma rather than medullary stroma.

Conclusions

These results indicate that FDG-PET is useful for the detection of small early pancreatic cancers.