Enhancement of preimplantation mouse embryo development with optimized in vitro culture dish via stabilization of medium osmolarity / 대한생식의학회지

Objective@#We evaluated the efficacy of the newly developed optimized in vitro culture (OIVC) dish for cultivating preimplantation mouse embryos. This dish minimizes the need for mineral oil and incorporates microwells, providing a stable culture environment and enabling independent monitoring of individual embryos. @*Methods@#Mouse pronuclear (PN) zygotes and two-cell-stage embryos were collected at 18 and 46 hours after human chorionic gonadotropin injection, respectively. These were cultured for 120 hours using potassium simplex optimized medium (KSOM) to reach the blastocyst stage. The embryos were randomly allocated into three groups, each cultured in one of three dishes: a 60-mm culture dish, a microdrop dish, and an OIVC dish that we developed. @*Results@#The OIVC dish effectively maintained the osmolarity of the KSOM culture medium over a 5-day period using only 2 mL of mineral oil. This contrasts with the significant osmolarity increase observed in the 60-mm culture dish. Additionally, the OIVC dish exhibited higher blastulation rates from two-cell embryos (100%) relative to the other dish types. Moreover, blastocysts derived from both PN zygotes and two-cell embryos in the OIVC dish group demonstrated significantly elevated mean cell numbers. @*Conclusion@#Use of the OIVC dish markedly increased the number of cells in blastocysts derived from the in vitro culture of preimplantation mouse embryos. The capacity of this dish to maintain medium osmolarity with minimal mineral oil usage represents a breakthrough that may advance embryo culture techniques for various mammals, including human in vitro fertilization and embryo transfer programs.

Effects of dynamic oxygen concentrations on the development of mouse pre- and peri-implantation embryos using a double-channel gas supply incubator system / 대한생식의학회지

OBJECTIVE: We aimed to evaluate the effects of different oxygen conditions (20% [high O₂], 5% [low O₂] and 5% decreased to 2% [dynamic O₂]) on mouse pre- and peri-implantation development using a novel double-channel gas supply (DCGS) incubator (CNC Biotech Inc.) to alter the oxygen concentration during in vitro culture.METHODS: The high-O₂ and low-O₂ groups were cultured from the one-cell to the blastocyst stage under 20% and 5% oxygen concentrations, respectively. In the dynamic-O₂ group, mouse embryos were cultured from the one-cell to the morula stage under 5% O₂ for 3 days, followed by culture under 2% O₂ to the blastocyst stage. To evaluate peri-implantation development, the blastocysts from the three groups were individually transferred to a fibronectin-coated dish and cultured to the outgrowth stage in droplets.RESULTS: The blastocyst formation rate was significantly higher in the low-O₂ and dynamic-O₂ groups than in the high-O₂ group. The total cell number was significantly higher in the dynamic-O₂ group than in the low-O₂ and high-O₂ groups. Additionally, the apoptotic index was significantly lower in the low-O₂ and dynamic-O₂ groups than in the high-O₂ group. The trophoblast outgrowth rate and spread area were significantly higher in the low-O₂ and dynamic-O₂ groups than in the high-O₂ group.CONCLUSION: Our results showed that a dynamic oxygen concentration (decreasing from 5% to 2%) had beneficial effects on mouse pre- and peri-implantation development. Optimized, dynamic changing of oxygen concentrations using the novel DCGS incubator could improve the developmental competence of in vitro cultured embryos in a human in vitro fertilization and embryo transfer program.

Irritable Bowel Syndrome Is More Common in Women Regardless of the Menstrual Phase: A Rome II-based Survey

Functional gastrointestinal disorders are more common in women in relation to the fluctuations of female sex hormones. We tried to know the gender-related differences in the prevalence of irritable bowel syndrome and gastrointestinal symptoms according to the menstrual phase. A total of 253 women before menopause and 252 men below age 50 were examined by a gastroenterologist after completing the questionnaire. Blood tests, endoscopic procedures, and imaging studies were done, if needed. Women were subclassified into three groups according to their menst- ruation period; menstrual phase, proliferative phase, and secretory phase. Finally, 179 men and 193 women were analyzed. Irritable bowel syndrome was more frequently noticed in women than in men (p=0.01). The diarrhea-dominant type was more common in men, while constipation-dominant or alternating types were more common in women (p<0.001). Of 193 women, there was no significant difference in their gastrointestinal symptoms according to their menstrual phase. Regardless of the menstrual phase, gastrointestinal symptoms are more frequent in women. Physicians should consider different symptomatic manifestations between men and women should be considered when evaluating functional gastrointestinal disorders.

Eradication of Helicobacter pylori in Patients with S-2 Stage Duodenal Ulcer Scar an Interim Report / 대한소화기내시경학회지

BACKGROUND/AIMS: It is recommended that duodenal ulcer patients who are infected with H. pylori should be treated with eradication therapy, whether the ulcer is active or in remission. However, there has been no report on the effect of eradication treatment in patients with incidentally found S-2 stage duodenal ulcer scar. METHODS: We prospectively enrolled 80 H. pylori-positive patients with S-2 stage duodenal ulcer scar who have no past history of ulcer treatment. Treatment group received triple therapy consisted of omeprazole, amoxicillin, and clarithromycin for 2 weeks, whereas control group received no treatment. The follow-up endoscopy was performed every 1 year and when the patients have symptoms of ulcer disease. Fifty-three patients were followed up for more than 1 year. RESULTS: The eradication rate of the treatment group was 92.9%. During the follow-up period of 14.7 months, 20% (5/25) of patients in the control group (2 gastric ulcers and 3 duodenal ulcers) and 3.6% (1/28) of patients in the treatment group (1 duodenal ulcer) developed active or healing stage peptic ulcers (p=0.089). CONCLUSIONS: Our results suggest that H. pylori eradication may he effective in preventing peptic ulcers in patients with S-2 stage duodenal ulcer scar.

Role of TGF-beta1 and TGF-beta Type II Receptor in Gastric Cancer

BACKGROUND: TGF - beta is known as a cell growth inhibitory factor to suppress almost all cells, including the epithelial cell. Unlike normal cells, cancer cells are not affected by TGF- beta growth inhibitory action and the lack of TGF- beta receptor expression or mutation is being reported as its mechanism, which is rarely studied in Korea. Therefore, we investigated this study to clarify the role of TGF - beta I and TGF - beta II receptors in gastric cancer. METHODS: 23 cases that underwent operations for gastric cancer provided RNA collected from their carcinoma tissues and adjacent normal tissues. We investigated the level of TGF - beta 1 and T beta R-II mRNA expression with semi- quantitatively reverse transcription PCR and analyzed the correlation with prognostic factors, such as tumor size, depth of invasion, tumor differentiation and lymph-node metastasis. RESULTS: (1) TGF- beta I and T beta R-II mRNA were expressed in all carcinoma tissues and adjacent normal tissues of the 23 cases without statistical difference in the level of the expression. (2) The level of TGF - beta 1 mRNA expression was higher in patients with gastric cancer invaded only at the mucosa and submucosa than in patients with gastric cancer invaded over muscular propria, and also higher in the patients without lymph-node metastasis or perineural invasion than in the patients with lymph-node metastasis or perineural invasion. There was no significant correlation between the level of T beta R-II mRNA expression and several parameters, such as age, gender, tumor size, location, differentiation, Lauren's classification and vascular invasion. (3) There was a significant correlation between the level of TGF - beta 1 and T beta R-II mRNA expression in carcinoma tissues. CONCLUSION: It indicated that TGF - beta 1 mRNA expression in gastric cancer might concern the early stage of gastric carcinogenesis and, unlike the earlier reports, it was higher in patients with early gastric cancer, negative lymph-nodes or negative perineural invasion. Further studies are required to clarify the role of TGF - beta 1 in gastric carcinogenesis with more patients.

Prospective Randomized Trial of Intravenous Ciprofloxacin for Prevention of Bacterial Infection in Cirrhotic Patients with Esophageal Variceal Bleeding / 대한간학회지

BACKGROUND/AIMS: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. METHODS: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. RESULTS: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. CONCLUSIONS: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.

The Effect of Helicobacter pylori Eradication in Patients with Reflux Esophagitis by Symptom Analysis and Endoscopic Assessment / 대한소화기내시경학회지

BACKGROUND/AIMS: The relationship between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) is controversial. A high incidence of reflux esophagitis after H. pylori eradication has been reported in patients with peptic ulcer. However, few study has been reported on the effects of H. pylori eradication in patients with GERD without peptic ulcer. We assessed the reflux symptoms and endoscopic findings among comparable patients having undergone successful versus failed H. pylori eradication. METHODS: Patients with H. pylori-positive endoscopic esophagitis were treated with omeprazole, amoxicillin and metronidazole for 2 weeks and subsequently underwent 8-weeks of omeprazole treatment. All patients underwent a urea breath test 2~4 weeks later. Patients underwent symptom assessment and endoscopy before the therapy and 1 year thereafter. RESULTS: Out of 48 patients randomized, 10 dropped out during the follow-up period, leaving 38 patients with analyzable results. H. pylori eradication was successful in 32 patients (84.2%). By the end of the follow-up period, patients with symptoms (p=0.107) or endoscopic esophagitis (p=0.366) seemed not to be more aggravated in the successful than in the failed eradication group. CONCLUSIONS: H. pylori eradication doesn't aggravate the symptoms or endoscopic esophagitis in patients with H. pylori-positive reflux esophagitis.

Enlarged perihepatic lymph nodes reflects histologic and biochemical inflammatory activity of the liver in chronic hepatitis B / 대한내과학회지

BACKGROUND: It is common to find enlarged lymph nodes within hepatoduoedenal ligament during ultrasonography in patients with chronic hepatitis B. But, its clinical significance has not been clearly understood. METHODS: Lymph node volume within the hepatoduodenal ligament in 50 patients with chronic hepatitis B and 15 healthy controls was evaluated using ultrasonography. In patients with chronic hepatitis B, possible correlation of lymph node volume with biochemical tests, hepatitis activity index, and hepatitis B viremia was investigated. RESULTS: One or more lymph nodes were detected in 48 (96%) out of 50 patients with chronic hepatitis B (volume=3.4+/-2.4 mL, mean+/-S.D.) and 2 (13%) out of 15 controls (volume=0.4 mL, 0.6 mL). In chronic hepatitis B, lymph node volume showed a significant correlation with serum AST (r=0.66), ALT (r=0.63), gammaGT (r=0.53), total score of histologic activity index (r=0.59), and necroinflammatory score (r=0.59, p<0.05 for all); but not with fibrosis score and serum hepatitis B viremia. CONCLUSION: Enlarged perihepatic lymph nodes reflects histologic and biochemical inflammatory activity of the liver in chronic hepatitis B.

Clinical investigations of Crohn's disease in Korea / 대한내과학회지

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disease that has difficulty in treatment due to various complications and frequent recurrence. There have been many studies on the clinical aspects of CD in western countries, however there have been few studies in Korea. We try to perform this study to elucidate the clinical features of CD in Korea. METHODS: We retrospectively reviewed the medical records of 62 patients diagnosed as CD in Samsung Medical Center from October 1994 to July 1999 and investigated their clinical features. RESULTS: Male to female ratio was 1.7:1 and the mean age at diagnosis was 29.6 years. The most common symptom was abdominal pain (58%), followed by diarrhea. Perianal lesions were observed in 27 cases (44%) of 62 patients. Fistula was the most common (60%) among the perianal lesions, followed by abscess, fissure, and stricture. Extraintestinal manifestations were observed in 23 cases (37%) of 62 patients. Arthritis was the most common (44%), followed by oral, skin, and ocular lesions. All patients were classified into three groups on the basis of disease extent by the radiologic and endoscopic findings; combined type (66%), colitis alone (23%), and small bowel disease alone (11%). Empirical anti-tuberculous medications were administered to 28 cases (45%) of 62 patients before CD was diagnosed. The presenting features were classified into inflammatory (71%), fistulizing (14.5%), and fibrostenotic (14.5%) type. Operation was performed in 31 cases (50%) of 62 patients during clinical course. The causes of operation were fistulizing complication (48%), fibrostenotic obstruction (32%), and indefinite diagnosis (20%). CONCLUSION: We noticed little difference in the clinical features of CD in Korea compared to those of western countries. And, intestinal tuberculosis should be considered in differential diagnosis of CD in endemic areas of tuberculosis like Korea.

Mechanism of an increase in concentration of intracellular calcium by carbachol in human gastric smooth muscle cell / 대한내과학회지

BACKGROUND: The contraction of smooth muscle depends on an increase in the concentration of intracellular calcium ion and the source of this increase to various stimuli is different according to organs or species. Nevertheless, there have been only a few studies on human stomach smooth muscle. This study was designed to identify the source of the calcium utilized in the muscle contraction induced by carbachol, which is an important factor among various stimuli. METHODS: After the administration of carbachol with various conditions in cultured human stomach smooth muscle cells, fura-2-acetoxymethyl ester was used to measure the increase in the intracellular calcium concentration. RESULTS: (1) The carbachol-induced increase in the intracellular calcium concentration was not attenuated after removal of extracellular calcium. (2) Carbachol induced a small increase in the intracellular calcium concentration even after the depletion of intracellular calcium store. (3) Repeated histamine administration blocked the carbachol-induced increase in the intracellular calcium concentration in calcium-free extracellular solution. CONCLUSION: The main source of calcium utilized in human stomach smooth muscle contraction by carbachol is intracellular calcium store, particularly inositol triphosphate(IP3)-sensitive calcium stores. However, extracellular calcium also contributes to the carbachol-induced increase in the intracellular calcium concentration.

The roles of inducible nitric oxide synthase expression in pancreatic cancer / 대한내과학회지

BACKGROUND: The finding of frequent inducible nitric oxide synthase (iNOS) expression in human cancer indicates that nitric oxide has a pathological role in tumor progression. Increased expression of iNOS in human pancreatic cancer cells was also recently reported, but the clinicopathological and biological significance of the iNOS expression remains unclear. The aim of our study was to look for possible roles and clinical significance of iNOS expression in pancreatic cancer. METHODS: 72 pancreatic adenocarcinoma tissue specimens were obtained from surgical resection. We investigated the immunohistochemical expression of iNOS in respect to variable clinicopathological characteristics, proliferation activity (assayed by Ki-67 expression), apoptosis (by TUNEL stain), and microvessel density (by CD34 expression; angiogenesis). RESULTS: Immunohistochemical positivity for iNOS in pancreatic epithelial cells was observed in 48/72 (66.7%). Apoptotic index (AI) of positive iNOS expressions were significantly higher than for negative expression (p <0.001) and increasing intensity of COX-2 expression showed a trend with increasing AI (p<0.001). No significant association was found between iNOS expression and proliferation index or microvessel density in pancreatic cancer. The expression of iNOS protein did not correlated with age, bilirubin, CA 19-9, location, size, AJCC stage, differentiation, distant metastasis or patient survival. CONCLUSION: The expression of iNOS enzyme in pancreatic cancer contributes to apoptosis of tumor cells. However, we could not find any correlation between iNOS expression and cell proliferation, angiognesis or clinical characteristics. Further in vivo investigations are necessary to determine the putative role of the iNOS expression for tumor progression in human pancreatic cancer.

Accuracy of GenediaTM H. pylori ELISA for the Diagnosis of Helicobacter pylori Infection in Korean Population / 대한내과학회지

BACKGROUND: GenediaTM H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of GenediaTM H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. METHODS: GenediaTM H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with GenediaTM H. pylori ELISA. H. pylori infection was determined by rapid urease test, histology, culture or 13C-urea breath test in adults. In children, the subject was considered to be H. pylori positive if 13C-urea breath test was positive. RESULTS: In adults, the sensitivity and specificity of GenediaTM H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of GenediaTM H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of GenediaTM H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%; plt;0.005 and 92.5% vs 71.4%; p<0.005, respectively). CONCLUSION: GenediaTM H. pylori ELISA is a relatively accurate method for the serodiagnosis of H. pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of GenediaTM H. pylori ELISA for epidemiological studies of H. pylori infection in Korea.

A case of primary solitary tuberculoma of the liver treated with antituberculosis chemotherapy and surgical excision / 대한내과학회지

The solitary form of primary hepatic tuberculosis is a rare disease. We report an unusual case of primary solitary hepatic tuberculosis treated with surgical resection and second-line antituberculosis chemotherapy due to the recurrence after first-line antituberculosis chemotherapy alone. A 36-year-old man was presented with right upper abdominal discomfort, chills and weight loss for 2 months. Computerized tomography demonstrated the solitary space occupying lesion on the left lobe of liver suggesting a malignant disease. The open biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis. The patient was treated with antituberculosis chemotherapy for nine months and eighteen months respectively with the interval of eighteen months. But the hepatic lesion had become larger and symptoms were aggravated after the discontinuation of therapy. He underwent surgical excision of the lesioin. With second-line antituberculosis chemotherapy, the symptoms improved in postoperative days. Twenty four months later, no evidence of recurrence was noted in symptoms, laboratory findings and imaging studies.

Clinical Features and Functional Outcome of the Patients with Idiopathic Chronic Constipation Who Underwent Surgical Treatment / 대한소화관운동학회지

BACKGROUND: In patients with intractable constipation who are poorly responsive to medical treatments, surgical treatments may be considered. However, how preoperative physiologic evaluations contribute to some information in making surgical decision is not established. The aim of this study was to evaluate the outcome of surgical treatment in patients with severe constipation who underwent preoperative functional study. METHODS: Preoperative functional evaluation included colon transit time test, defecography, scintigraphic gastric emptying time test, anorectal manometry and balloon expulsion test. Nine patients with a mean age of 48 years old were taken total colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. All patients were available for follow-up, with median time of 35 (range; 10-55) months. RESULTS: Seven patients (78%) were satisfied with outcome, improved the quality of life, and felt the operation was valuable despite of residual symptoms. Two patients did not experience symptom improvements. Six of seven colonic inertia or combined spastic pelvic floor syndrome patients had a satisfactory outcome. In contrast, one of two patients with generalized intestinal dysmotility did not show any improvement after surgery. CONCLUSIONS: Preoperative physiologic testing reliably identified patients with severe constipation who might have benefits from surgery. If cases are carefully diagnosed and selected, the surgical treatment may be highly effective in alleviating symptoms.

Clinical Patterns and Prognostic Factors of Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonic ischemia is recognized as the most common vascular disorder of the intestines in the elderly. The severity of the disease may vary considerably with the prevalent benign transient forms, being amenable to conservative treatments and the severe gangrenous forms, requiring surgery. Correct diagnosis is usually made after the ischemic episode is over and colonic ischemia is frequently misdiagnosed. The aim of this study is to identify the clinical patterns and prognostic factors of ischemic colitis. METHODS: We found 60 patients with nonoccusive ischemia of the large intestine. We analyzed age, sex, symptoms, signs, associated disease, location, endoscopy, hematologic, histologic, radiologic finding and treatment, retrospectively. RESULTS: The mean age was 60.2+/-16.3 years. The most common symtoms were abdominal pain or bloody diarrhea. The most common sign was diffuse abdominal tenderness. The most common hematologic findings were anemia and leukocytosis. Associated medical illnesses were diabetes, rhematoid arthritis and cerebrovascular accident, et al. Both computed tomography (CT) and endoscopy were useful diagnostic tools. The most common involved site was sigmoid colon. 46 patients were treated conservatively and 14 patients were managed surgically. CONCLUSIONS: Male gender, those with rebound tenderness, severe anemia, right or total colon involvement as well as rheumatoid arthritis had a poor prognosis. Both CT and endoscopy were useful in predicting prognosis.

Clinical Patterns and Prognostic Factors of Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonic ischemia is recognized as the most common vascular disorder of the intestines in the elderly. The severity of the disease may vary considerably with the prevalent benign transient forms, being amenable to conservative treatments and the severe gangrenous forms, requiring surgery. Correct diagnosis is usually made after the ischemic episode is over and colonic ischemia is frequently misdiagnosed. The aim of this study is to identify the clinical patterns and prognostic factors of ischemic colitis. METHODS: We found 60 patients with nonoccusive ischemia of the large intestine. We analyzed age, sex, symptoms, signs, associated disease, location, endoscopy, hematologic, histologic, radiologic finding and treatment, retrospectively. RESULTS: The mean age was 60.2+/-16.3 years. The most common symtoms were abdominal pain or bloody diarrhea. The most common sign was diffuse abdominal tenderness. The most common hematologic findings were anemia and leukocytosis. Associated medical illnesses were diabetes, rhematoid arthritis and cerebrovascular accident, et al. Both computed tomography (CT) and endoscopy were useful diagnostic tools. The most common involved site was sigmoid colon. 46 patients were treated conservatively and 14 patients were managed surgically. CONCLUSIONS: Male gender, those with rebound tenderness, severe anemia, right or total colon involvement as well as rheumatoid arthritis had a poor prognosis. Both CT and endoscopy were useful in predicting prognosis.

Clinical usefulness of KolomarkTM, a Korean radio-opaque marker for measuring colon transit time / 대한내과학회지

BACKGROUND: Among various methods for measuring colon transit time, radio-opaque marker study is simple, reproducible and economical method. The commonly used marker, Sitzmarks (Konsyl Pharmaceuticals Inc. Texas) had limitation in its use due to expensiveness and difficulty in importation. We thought that the new domestic marker comparable to Sitzmarks is necessary and made a Kolomark (Korean colon marker)TM. The comparison of radio-opaqueness and the measurement of colon transit times by two markers were done. METHODS: In two 1000 ml beakers, 350 ml of rice-gruel, several chicken-bones and ten rings of Sitzmarks and KolomarkTM were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by Image and the value of pixels were obtained. These were repeated five times. Colon transit times were measured in 60 healthy persons stratified by age, 30 by Sitzmarks and 30 by KolomarkTM. RESULTS: The mean value of pixel of KolomarkTM was much lower than that of Sitzmarks. The difference between background or beaker and KolomarkTM was much greater than that of Sitzmarks . There was no significant difference between colon transit time studied by Sitzmarks and KolomarkTM. CONCLUSION: KolomarkTM, a more radio-opaque and cheaper marker than Sitzmarks will be applied usefully for measuring colon transit time.

Clinical aspects of the cystic tumors of the pancreas confirmed by operation / 대한내과학회지

BACKGROUND: Cystic tumors of the pancreas are uncommon, and frequently mistaken for pancreatic pseudocysts. Recently if the patient is a good surgical candidate and is symptomatic, resection is the treatment of the choice without the cytological and chemical analysis by the fine needle aspiration. But, we have no data in Korean population. The aim of this study was to evaluate the subclassification of the cystic tumors of the pancreas and the differential points between pancreatic pseudocysts and cystic tumors of the pancreas which had to be operated. METHODS: fifty-nine patients with cystic lesions of the pancreas have been operated at the Samsung Seoul Hospital from 1994 to 1999 and evaluated about the subclassification, frequency and the difference between pseudocysts and cystic tumors retrogradely. RESULTS: There were 14 mucinous cystic neoplasms (mucinous cystadenomas : 11 cases, mucinous cyst-adenocarcinomas : 3 cases), 10 serous cystadenomas, 9 solid and papillary epithelial neoplasms, 8 intra-ductal papillary mucinous neoplasms, 5 pseudocysts, 4 retention cysts, 3 endocrine tumors, 1 pancreatic ductal adenocarcinoma with cystic change, 1 solid pseudopapillary tumor, 1 pancreatic ductal adenocarci-noma with pseudocyst, 1 cavernous lymphangioma, 1 lymphoepithelial cyst and 1 simple cyst. 57.6% of the patients were females and the mean age was 50.0 years (16 years-77 years). The characteristics between pseudocysts and cystic tumors of the pancreas (sex differentiation, mean age, previous history of alcohol drinking and pancreatitis, communication with the main duct on the pancreatogram and the sign of the pancreatitis on the radiologic study) had no differences. CONCLUSION: We conclude there were no other methods to differentiate accurately the pseudocyst from the cystic tumor of the pancreas other than the operation.

Disinfection Efficacy of Glutaraldehyde and an Automated Endoscope Reprocessor: an In-Use Evaluation / 대한소화기내시경학회지

BACKGROUND/AIMS: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. METHODS: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-1), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). RESULTS: In 63.3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-1, S-2, S-3, and S-4 samples were 20.0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. CONCLUSIONS: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients.

Role of TGF-1 and TGF-beta Type II receptor in gastric cancer / 대한내과학회지

BACKGROUND: Transforming growth factor-beta (TGF-beta) is a potent inhibitor of epithelial cell growth. However, carcinoma cells, unlike normal cells, can escape from negative regulation by TGF-beta through lack of expression or mutation of TGF-beta receptor gene. In this study, we investigated the role of TGF-beta1 and TGF-beta type II receptors (TbetaR-II) in the progression of gastric cancer. METHODS: We analyzed TGF-beta1 and TbetaR-II mRNA expression semi-quantitatively, measured by comparative RT-PCR using GAPDH, in 23 patients who underwent gastric resection for gastric cancer. We analyzed the relationship between the clinicopathologic findings and the level of the TGF-beta1 and TbetaR-II mRNA expression in carcinoma tissues and in adjacent normal tissues of gastric cancer. RESULTS: (1) TGF-beta1 and TbetaR-II mRNA were expressed in all of the carcinoma tissues and adjacent normal tissues without statistical difference in the level of the expression. (2) The level of TGF-beta1 mRNA expression was higher in patients with early gastric cancer, negative lymph nodes or negative perineural invasion. There was no significant correlation between the level of TGF-beta1 mRNA expression and several parameters such as age, gender, tumor size, differentiation, Lauren's classification, and vascular invasion. (3) There was no significant correlation between the level of TbetaR-II mRNA expression and several prognostic variables described above. (4) There was significant correlation between the level of TGF-beta1 and TbetaR-II mRNA in carcinoma tissues. CONCLUSION: The above data indicates that TGF-beta1 may contribute in the early stages of gastric carcinogenesis. Further studies are required to clarify the role of TGF-beta 1 in gastric carcinogenesis.