DNA Double Strand Breaks in Gastric Epithelium with Helicobacter pylori Infection / 대한소화기학회지

BACKGROUND/AIMS: DNA double strand breaks (DSB) is one of the critical types of DNA damage. If unrepaired, DSB is accumulated in the nucleus of cells, the cells become apoptotic or transform to tumor by way of genomic instability. Some of malignant cancers and its premalignant lesions were proven to have DSB in their nuclei. There was no report that Helicobacter pylori (H. pylori), the gastric carcinogen, induce DNA DSB in gastric epithelium in vivo. The aim of this study was to investigate whether H. pylori induce DSB in the gastric epithelial cells of chronic gastritis. METHODS: Immunohistochemical stains were performed for the DSB markers, phospho-53BP1 and gammaH2AX, in the gastric epithelium derived from 44 peptic ulcer disease patients before and after H. pylori eradication. DNA fragmentation assay was performed in the cell line to investigate the DNA damage by H. pylori infection. RESULTS: The mean expression score of gammaH2AX was significantly higher in the H. pylori infected gastric epithelium as compared to the H. pylori eradicated gastric epithelium (8.8+/-5.5 vs. 6.2+/-5.3 respectively; p=0.008). The expression score of phospho-53BP1 between before and after eradication of H. pylori was not statistically different, but tended to be higher in H. pylori infection. DNA fragmentation was developed significantly more in the cell lines after infection with H. pylori. CONCLUSIONS: DSB of DNA damage was typical feature of H. pylori infection in the gastric epithelium.

The Expression of Human beta-defensin 2 in Helicobacter pylori Infection

BACKGROUND/AIMS: Induction of human beta-defensin-2 (hBD2), an innate antimicrobial peptide in the intestinal mucosa, occurs after bacterial infections. The aim of this study is to evaluate the relationship between the expression of hBD2 and Helicobacter pylori (H. pylori) infection in the gastric epithelia. MATERIALS AND METHODS: Gastric mucosa was sampled from the patients with chronic gastritis and peptic ulcers before and after H. pylori eradication and the expression of hBD2 was assessed with immunohistochemistry. The antimicrobial effect was assayed as the number of colony forming units of H. pylori incubated with the various concentrations of hBD2. RESULTS: Thirty six patients were included in this study and 30 patients (83%) revealed expression of the hBD2 in their gastric epithelia. The hBD2 was not expressed in 22 patients after successful H. pylori eradication, but did expressed in 8 patients after H. pylori eradication failure. The expression of hBD2 was well correlated with the density of H. pylori, acute and chronic inflammation, and the degree of atrophy of gastric mucosa. CONCLUSIONS: The hBD2 is induced in the gastric epithelia in response to the H. pylori infection, and its expression is well correlated with the severity of gastric inflammation.

Double Strand Break of DNA in Gastric Adenoma and Adenocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: DNA double strand break (DSB) is one of the critical types of DNA damage. When unrepaired DSB is accumulated in the nucleus of the cells having mutations in such genes as p53, it will lead to chromosomal instability and further more to mutation of tumor-activating genes resulting in tumorogenesis. Some of malignant cancers and its premalignant lesions were proven to have DSB in their nuclei. The aim of this study was to define the differences in expression of 53BP1 and gamma-H2AX, the markers of DSB, among normal, gastric adenoma, and gastric adenocarcinoma tissues. METHODS: Tissue microarray was made with the tissues taken from 121 patients who underwent gastrectomy for gastric adenocarcinoma, and 51 patients who underwent endoscopic mucosal resection for gastric adenoma. Immunochemical stain was performed for the marker of DSB, 53BP1 and gamma-H2AX in the tissue microarray. The normal tissues were collected from histologically confirmed tissues with no cellular atypia obtained from the patients with gastric adenocarcinoma. RESULTS: In gastric carcinoma cells, 53BP1 and gamma-H2AX were highly expressed as compared to normal epithelial cells and gastric adenoma (p<0.01). There were no differences in the expression of 53BP1 and gamma-H2AX between normal epithelium and gastric adenoma. The expression of 53BP1 in the adenoma with grade II and III atypism was more elevated than in those with grade I atypism. The expression of 53BP1 and gamma-H2AX were not significantly different according to the clinicopathologic parameters in the patients with gastric adenocarcinoma. CONCLUSIONS: The DSB in DNA seems to be associated with the development of gastric adenocarcinoma, but does not affect the premalignant adenoma cells.

Ventilation Impairment due to Obstruction of a Bifurcated Connector: A case report / 대한마취과학회지

Ventilation impairment sometimes developes in patients with a double-lumen tube (DLT) during thoracic anesthesia. A 27-year old man who suffered from a left pneumothorax showed ventilation impairment with right lung obstruction after the induction of anesthesia. We checked breathing sounds before and after clamping each lumen. Correct positioning was confirmed by direct visualization using a flexible fiberoptic bronchoscope and by chest X-ray. The DLT was removed and replaced by a single lumen endotracheal tube because of severe ventilation impairment. On careful examination of the DLT, manufacturing defects in a bifurcated connector were noted, and its openings were occluded with a thin plastic membrane. After replacing the DLT, the ventilation impairment was improved. It is important to test DLT prior to use, and to maintain an awareness that airway obstruction can occur due to structural defects.

A Comparison of the Therapeutic Effects of Hyaluronic Acid and Triamcinolone Used in an Intra-articular Injection for Knee Osteoarthritis / 대한마취과학회지

BACKGROUND: Both steroid and hyaluronic acid (HA) are effective therapeutic regimens when used as intra-articular (IA) injections for knee osteoarthritis. This study was performed to re-estimate the hypothesis that the IA injection of HA is more effective than that of steroid. METHODS: A retrospective study was conducted by reviewing the medical records of osteoarthritis of the knee patients treated only by IA injection with HA or triamcinolone (Triam) at our pain clinic over the last 28 months. The HA group (N = 17) received an IA injection of 25 mg of HA followed by a 5 ml injection of 1% lidocaine once a week for 5 weeks. The triam group (N = 34) received an IA injection of a mixed solution of 5-10 mg of triamcinolone and 6-8 ml of 1% lidocaine 3 to 5 times at one or two week intervals. Pain improvement was compared using pain relief scale (PRS) scores at the end of a series of IA injections in each patient. RESULTS: Both groups showed significant pain improvement following a series of IA injection, compared to the pre-treatment pain state; mean PRS post-injections was 5.1 +/- 2.6 in the HA group and 6.1 +/- 2.9 in the Triam group (P < 0.05 for both). However, there were no significant differences between the groups. CONCLUSIONS: Our results suggest that IA injections with either HA or triamcinolone are effective in knee osteoarthritis. No significant difference was found between Triam and HA use in IA injections for knee osteoarthritis.

Analysis of Postoperative Nausea and Vomiting after Pediatric Strabismus Surgery with Sevoflurane-N2O/O2 Anesthesia / 대한마취과학회지

BACKGROUND: Children undergoing strabismus surgery have a high incidence of postoperative nausea and vomiting (PONV). Previous reports have proposed PONV risk factors with conflicting results. We reevaluated the risk factors following pediatric strabismus surgery. METHODS: After obtaining informed consent, we conducted a prospective study of 58 ASA I children (aged 3-15 years) who had undergone elective strabismus surgery performed by the same ophthalmologist to investigate PONV risk factors. Anesthesia was induced with thiopental and rocuronium and maintained by inhalation anesthesia with 2 vol.% sevoflurane in 50% N2O/O2. Premedicants, anticholinergics, analgesics, or subtenon lidocaine injection were not used perioperatively. PONV was recorded by patients' parents during the first 24 hours after surgery. We analyzed the influence on PONV of age, sex, preoperative anxiety, oculocardiac reflex (OCR), and procedure duration. RESULTS: The incidence of PONV was 25.9%. Age was found to be associated with PONV (P or = 8 year of age, 4.2, with 95% Cl 1.2-15.4). Sex, OCR, preoperative anxiety, and procedure duration did not affect PONV. CONCLUSIONS: We found that only age is associated with PONV, and that the incidence of PONV is higher in school children than in preschoolers after pediatric strabismus surgery. These results suggest that much more attention should be paid to preventing PONV during strabismus surgery in school children.