• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.10 no.1
• /
• pp.20-27
• /
• 2007

Purpose: This study was performed to review the recent experiences of pediatric gastrointestinal (GI) endoscopy done in one university hospital. Methods: A retrospective review of medical records was conducted of 1,040 pediatric cases who underwent GI endoscopy at the Pusan National University Hospital between January 2001 to June 2005. Results: A total of 1,040 endoscopies (upper 840 and lower 200) were performed. The male/female ratio was 1.25:1. Neonates and infants accounted for 6.0% and 16.5% respectively. Half of the children were below 5 years (mean age $8.5{\pm}2.1$ years). Upper and lower GI diagnostic endoscopies were performed in 634 and 163 children respectively. Abdominal pain (38.8%), vomiting (19.4%), foreign body (17.7%), and hematemesis (10.3%) were the main reasons for esophagogastroduodenoscopy. Hematochezia (56.0%), abdominal pain (27.5%) and diarrhea (3.0%) were the main reasons for colonoscopy. Upper GI therapeutic procedures included retrieval of foreign bodies, balloon dilatations of esophageal stricture, PEG, and variceal ligation in 148, 27, 15, and 3 children, respectively. Therapeutic lower GI endoscopies were performed in 37 children (polypectomy in 92%, argon lazer cauterization for angiodysplasia in 4%). Conclusion: GI endoscopy played an important role in the diagnosis and treatment of GI diseases in children. Procedures in younger aged children, cases evaluated by colonoscopy and therapeutic endoscopies are increasing in pediatric practice.

• Journal of Hospice and Palliative Care
• /
• v.20 no.3
• /
• pp.167-172
• /
• 2017

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC.

• The Journal of the Korea Contents Association
• /
• v.12 no.4
• /
• pp.358-366
• /
• 2012

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules leading to loss of liver function. Liver Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes. Some cases are idiopathic disease from unknown cause. Abdomen of liver Computed tomography(CT) is one of the primary imaging procedures for evaluating liver disease such as liver cirrhosis, Alcoholic liver disease(ALD), cancer, and interval changes because it is economical and easy to use. The purpose of this study is to detect technique for computer-aided diagnosis(CAD) to identify liver cirrhosis in abdomen CT. We experimented on the principal components analysis(PCA) algorithm in the other method and suggested texture information analysis(TIA). Forty clinical cases involving a total of 634 CT sectional images were used in this study. Liver cirrhosis was detected by PCA method(detection rate of 35%), and by TIA methods(detection rate of 100%-AGI, TM, MU, EN). Our present results show that our method can be regarded as a technique for CAD systems to detect liver cirrhosis in CT liver images.

• The Korean Journal of Nuclear Medicine
• /
• v.4 no.1
• /
• pp.37-42
• /
• 1970

In an endeavor to help understand some typical scan findings and portal hemodynamics in liver cirrhosis, several commonly occurring scan changes and esophageal varices as demonstrated by esophagram were correlated one another from quantitative and qualitative stand points. Clinical materials consisted of 34 patients with proven diagnosis of liver cirrhosis and esophageal varices. Liver scan was performed with colloidal 198-Au and the changes in the size and internal architecture of the liver, splenic uptake and splenomegaly were graded and scored by repeated double-blind readings. The variceal changes on esophagrams were also graded according to the classification of Shanks and Kerley following modification. Of 34 patients, 91% showed definite reduction in liver volume (shrinkage) constituting the most frequent scan change. The splenic uptake and splenomegaly were noted in 73.5 and 79.4%, respectively. The present study revealed no positive correlation between the graded scan findings including shrinkage of the liver, splenic uptake or splenomegaly and severity of variceal changes of the esophagus. Exceptionally, however, apparently paradoxical correlation was noted between the severity of mottlings and varices. Thus, in the majority (73.5%) of patients mottlings were either absent or mild. This interesting observation is in favor of the view held by Christie et al. who consider the mottlings to be not faithful expression of actual scarring of the cirrhotic liver. This also would indicate that variceal changes are to be the results of intrahepatic arteriovenous shunting of blood with hypervolemic load to the portal system rather than simple hypertension secondary to fibrosis and shrinkage.

• Journal of Yeungnam Medical Science
• /
• v.28 no.1
• /
• pp.99-104
• /
• 2011

Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.

• The Korean Journal of Nuclear Medicine
• /
• v.33 no.4
• /
• pp.388-397
• /
• 1999

Purpose: Propranolol is known to decrease portal pressure by reducing blood flow of portal vein. Perrectal portal scintigraphy with Tc-99m pertechnetate has been introduced to evaluate the portal circulation and early diagnosis of liver cirrhosis. We evaluated the effects of propranolol on portal circulation by using per-rectal portal scintigraphy. Materials and Methods: We analyzed the portal hemodynamics by per-rectal portal scintigraphy in 51 patients with liver cirrhosis, 10 chronic hepatitis and 10 normal subjects. 38 patients with cirrhosis underwent per-rectal portal scintigraphy before and after propranolol medication. Perrectal portal scintigraphy was performed after per-rectal administration of 370 MBq of Tc-99m pertechnetate. The shunt index was calculated as the ratio, expressed as a percentage of heart radioactivity to the sum of heart and liver radioactivity during the first 30 seconds. Results: The shunt index in 40 patients with cirrhosis ($59.8{\pm}27.2%$) was significantly higher than that of normal control ($5.0{\pm}1.2%$. p<0.01) and chronic hepatitis ($11.4{\pm}3.5%$, p<0.01). Shunt index was significantly different according to Child's classification and the degree of esophageal varix (p<0.01). After propranolol medication, shunt index was significantly decreased from $59.9{\pm}27.3%$ to $51.3{\pm}15.3%$ (p<0.01) in 38 patients with liver cirrhosis. There was no significant difference of the amount of shunt index reduction after propranolol according to Childs' classification and the degree of esophgageal varix. Conclusion : The effect of propranolol on portal circulation was demonstrated as decreasing shunt index on per-rectal portal scintigraphy in patients with liver cirrhosis. Per-rectal portal scintigraphy may be useful to evaluate the portal circulation and to predict the effect of propranolol in patients with liver cirrhosis.

• The Korean Journal of Food And Nutrition
• /
• v.26 no.1
• /
• pp.66-77
• /
• 2013

In this study, we investigated the preventive effects of the mulberry leaf tea fermented by Monascus pilosus on high fat-induced obesity, hyperlipidemia, and fatty liver in mice. Non-fermented mulberry leaf tea powder (UM) and fermented mulberry leaf tea powder (FM) were supplemented with high-fat diet at 2% (wt/wt) dosage for 8 weeks. Both UM and FM lowered body weight gain, feed efficiency ratio, epididymal fat, serum triglyceride, total cholesterol and LDL-cholesterol increased markedly with high fat diet (HC) in mice. FM showed more significant effects when it was compared with UM. In addition, Hepatic lipid peroxides and xanthin oxidase activities of the UM and FM were significantly lower than those of HC, despite the lack of a big difference in the amount of hepatic GSH. Activities of ROS scavenging enzymes and serum alanine aminotransferase activity were also examined as a parameter of hepatic damage. The UM and FM groups showed a recovery to NC group from significant changes induced by HC. Finally, histopathological analyses of liver samples revealed a decrease of lipid accumulation in hepatocytes in the UM and FM groups. These results suggest that UM and especially FM can reduce the development of obesity, hyperlipidemia and fatty liver.

• The Korean Journal of Nuclear Medicine
• /
• v.4 no.2
• /
• pp.11-27
• /
• 1970

Cardiac output, plasma volume and renal plasma flow were determined to evaluate hemodynamic changes in 29 patients with cirrhosis of the liver. The results obtained were as follows. 1. The mean plasma volume was 3793+895ml and it was significantly higher than the normal controls. The mean blood volume ($5266{\pm}1222ml$) and blood volume per kg body weight ($95.7{\pm}23.41ml$) were also increased significantly. The mean plasma volume per kg body weight ($69.1{\pm}19.1ml$) showed increased tendency and the mean difference between blood volume and plasma volume per kg body weight ($26.4{\pm}7.05ml$) was in lower limit of normal range. 2. The mean cardiac output was $7708{\pm}2652ml/min$ and it was significantly increased. The mean cardiac index ($4924{\pm}1998ml/min/M^2$), stroke volume ($96.2{\pm}34.2ml/beat$), stroke index ($62.3{\pm}27.34ml/M^2$) and fractional cardiac index ($1.54{\pm}0.577$) were also increased significantly. The mean total -peripheral resistance was $1664{\pm}753.8\;dynes\;sec\;cm^{-5}M^2$ and it was significantly lower than the normal controls. 3. The mean renal plasma flow was $537{\pm}146.8ml/min/1.73M^2$ and it was normal to decreased tendency. The mean endogenous creatinine clearance ($66.7{\pm}23.0ml/min/1.73M^2$) was significantly decreased. Filtration fraction was variable, but it was slightly lower than normal in most cases. The mean renal fraction of cardiac output ($11.4{\pm}6.27%$) was relatively decreased. 4. Although renal plasma flow was normal or decreased in general, it was definitely diminished in patients with creatinine clearance less than $60ml/min/1.73M^2$, resistant ascites, and signs of azotemia (elevated BUN and serum creatinine). 5. Diminished glomrular filtration rate with low filtration fraction and decreased renal fraction of cardiac output observed strongly supported increased renal afferent arteriolar resistance. 6. Renal circulatory impairment preceded azotemia or oroliguria in cirrhosis. 7. Clinical findigns and liver function were not correlated with hemodynamic changes, except for esophageal varices associated with high cardiac output obsedved. 8. No definite correlation of renal hemodynamics with plasma volume or cardiac output was found.

• Journal of Preventive Medicine and Public Health
• /
• v.21 no.1 s.23
• /
• pp.172-182
• /
• 1988

To reveal the association between blood selenium level and the gastric diseases, 180 persons received the gastrofiberscopic examination at the outpatients department of the two university hospitals from July to September 1987, after the exclusion of the persons having the esophageal varix, were randomly selected. Their general characteristics such as age, sex and educational level and so on, were inverstigated. Five mi venous blood was collected from each subjects and stored at $0^{\circ}C$ in heparinized vaccum tube. The blood selenium level was measured by the flameless atomic absorption spectrophotometry. In the procedure of data analysis, five subjects having benign tumor and anomaly of the stomach, were also excluded. The mean blood selenium levels of the $155.5{\mu}g/{\ell}$ among gastritis cases, the $154.8{\mu}g/{\ell}$ gastric ulcer and the $133.0{\mu}g/{\ell}$ gastric malignancy were significantly lower(p<0.05) than that of the $173.3{\mu}g/{\ell}$ among normal controls. In men the mean blood selenium levels .among gastritis, gastric ulcer and gastric malignancy cases were significantly lower(p<0.05) than that among normal controls. In females, the mean blood selenium levels among gastritis and gastric maligancy cases were significantly lower(p<0.05) than that among normal controls($169.7{\mu}g/{\ell}$), but that among gastric ulcer cases($177.7{\mu}g/{\ell}$) was not significantly higher. In the logistic analysis, coefficient of the blood selenium level was -0.0436(p<0.05 : odds ratio 0.957) for gastritis, -0.0197(p=0.17 : 0.981) for gastric ulcer, -0.4876(p<0.05 : 0.614) for gastric malignancy and -0.0411(p<0.05 ; 0.960) for gastric diseases including the gastritis, the gastric ulcer and the gastric malignancy. These data support the hypothesis that the gastric diseases are to be associated with the low selenium level but, for the gastric ulcer, the further research is recommended.

• Applied Microscopy
• /
• v.39 no.3
• /
• pp.205-218
• /
• 2009

This experiment was performed to evaluate the morphological responses of the gastric epithelial cells of the mouse, inoculated with Ehrlich carcinoma cells in the inguinal area, following administration of BCG. Healthy adult ICR mice weighing 25 gm each were divided into normal and experimental groups (tumor control group and BCG-treated group). In the experimental groups, each mouse was inoculated with $1{\times}10^7$ Ehrlich carcinoma cells subcutaneously in the inguinal area. From next day after inoculations, 0.2 mL of saline or BCG (0.5 mL/25 g B.W.: $0.03{\times}10^8{\sim}0.32{\times}10^8$ CFU) were injected subcutaneously to the animals every other day, respectively. The day following the 7th injection of saline or BCG, each mouse was injected with a single dose of 0.7 ${\mu}Ci/g$ of methyl-$^3H$-thymidine (25 Ci/mmol, Amersham Lab., England) through tail vein. Seventy minutes after the thymidine injection, animals were sacrificed, and gastric tissues were taken and fixed in 10% neutral formalin. Deparaffinized sections were coated with autoradiographic emulsion EM-1 (Amersham Lab., England) in a dark room. The number of labeled epithelial cells in the gastric mucosae (mean number of labeled epithelial cells per 3.5 mm length of mucosa) were observed and calculated. And for electron microscopic observation, gastric tissues were prefixed with 2.5% glutaraldehyde-1.5% paraformaldehyde solution, followed by post-fixation with 1% osmium tetroxide solution. On the light microscopic study, gastric mucosae had no morphological changes following the injection of BCG. On the electron microscopic study, in the BCG-treated mice, myelin figures and multivesicular bodies within the gastric epithelial cells were observed more frequently than in those of the normal control ones. On the autoradiographic study, number of the labeled cells of normal control, tumor control and BCG-treated mice were 380.2 (${\pm}31.35$), 426.1 (${\pm}28.43$) and 301.8 (${\pm}34.63$), respectively. In the BCG-treated mice, poorly-labeled cells containing only a few silver grains of 3H-thymidine were observed more frequently as compared in those of the normal control and tumor control ones. From the above results, BCG may suppress the DNA synthesis of the gastric epithelial cells, but does not results severe fine structural defect on the gastric epithelial cells. These results suggest that BCG is expected as one of the effective supplemental anticancer drugs.