• Title/Summary/Keyword: Liver, cirrhosis

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A Case of Successful Endoscopic and Conservative Treatment for Intentional Ingestion of Sharp Foreign Bodies in the Alimentary Tract (고의로 섭취한 커터칼날의 내시경 및 보존적 치료 증례 보고)

  • Park, Jong-Min;Kim, Seong Yup;Chung, Il Yong;Kim, Woo-Shik;Shin, Yong-Chul;Kim, Yeong Cheol;Park, Sei Hyeog
    • Journal of Trauma and Injury
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    • v.26 no.4
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    • pp.304-307
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    • 2013
  • Food bolus impaction is the most common cause of esophageal foreign body obstruction in adults. Other causes include intentional ingestion in psychiatric patients or prison inmates. We experienced successful treatment of a patient with intentional ingestion of multiple sharp foreign bodies(25 cutter and razor fragments). A 47-year-old male patient who was suffering from chronic alcoholism was admitted, via the emergency room, with dysphagia and neck pain. He was suffering from alcoholic liver cirrhosis and psychiatric problems, such as chronic alcoholism, anxiety disorder and insomnia. The patient had intended to leave the hospital after having swallowed the sharp objects. Plain radiographs and computed tomography (CT) scan showed multiple, scattered metal fragments in the esophagus, stomach, and small bowel. We performed emergent endoscopy and successfully removed one impacted blade in the upper esophagus using by a snare with an overtube. The rest of the fragments had already passed through the pylorus, so we could not find them with endoscopy. We checked the patient with simple abdominal radiographs and careful physical examinations every day. All remaining fragments were uneventfully excreted through stool during the patient's 6 day hospital stay. Finally, we were able to confirm the presence of the objects in the stool, and radiographs were negative. The patient was discharged without complications after 14 days hospital stay and then was followed by the Department of Psychiatry.

Radionuclide Peritoneal Scintigraphy in Patients with Ascites and Pleural Effusion (방사성핵종 복막촬영술을 이용한 복수에 동반된 수흉의 감별 진단)

  • Lee, Jae-Tae;Lee, Kyu-Bo;Whang, Kee-Suk;Kim, Gwang-Weon;Chung, Byung-Cheon;Cho, Dong-Kyu;Chung, Joon-Mo
    • The Korean Journal of Nuclear Medicine
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    • v.24 no.2
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    • pp.279-285
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    • 1990
  • Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosis of the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based soly on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of $^{99m}Tc-labeled$ colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphragmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionaly. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.

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Construction and Characterization of an Anti-Hepatitis B Virus preS1 Humanized Antibody that Binds to the Essential Receptor Binding Site

  • Wi, Jimin;Jeong, Mun Sik;Hong, Hyo Jeong
    • Journal of Microbiology and Biotechnology
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    • v.27 no.7
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    • pp.1336-1344
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    • 2017
  • Hepatitis B virus (HBV) is a major cause of liver cirrhosis and hepatocellular carcinoma. With recent identification of HBV receptor, inhibition of virus entry has become a promising concept in the development of new antiviral drugs. To date, 10 HBV genotypes (A-J) have been defined. We previously generated two murine anti-preS1 monoclonal antibodies (mAbs), KR359 and KR127, that recognize amino acids (aa) 19-26 and 37-45, respectively, in the receptor binding site (aa 13-58, genotype C). Each mAb exhibited virus neutralizing activity in vitro, and a humanized version of KR127 effectively neutralized HBV infection in chimpanzees. In the present study, we constructed a humanized version (HzKR359-1) of KR359 whose antigen binding activity is 4.4-fold higher than that of KR359, as assessed by competitive ELISA, and produced recombinant preS1 antigens (aa 1-60) of different genotypes to investigate the binding capacities of HzKR359-1 and a humanized version (HzKR127-3.2) of KR127 to the 10 HBV genotypes. The results indicate that HzKR359-1 can bind to five genotypes (A, B, C, H, and J), and HzKR127-3.2 can also bind to five genotypes (A, C, D, G, and I). The combination of these two antibodies can bind to eight genotypes (A-D, G-J), and to genotype C additively. Considering that genotypes A-D are common, whereas genotypes E and F are occasionally represented in small patient population, the combination of these two antibodies might block the entry of most virus genotypes and thus broadly neutralize HBV infection.

Metabolic classification of herb plants by NMR-based metabolomics

  • Kim, Hee-Eun;Choi, Ye Hun;Choi, Kwang-Ho;Park, Ji Su;Kim, Hyeon Su;Jeon, Jun Hyeok;Heu, Min Soo;Shin, Dong-Seon;Lee, Joon-Hwa
    • Journal of the Korean Magnetic Resonance Society
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    • v.16 no.2
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    • pp.91-102
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    • 2012
  • Metabolomics is the systematic identification and quantification of all metabolites in an organism or biological sample. NMR has been used as a major application tool in plant metabolomics such as quality control, chemotaxonomy, and analysis of genetically modified plants. Herbal medicines are the important therapeutics and are used to manage common diseases such as cold, inflammation, pain, heart diseases, liver cirrhosis, diabetes and central nerve system diseases. Herb plants include various kinds of species such as geranium, mint, and thyme and so on and contain different kinds of metabolites. We performed NMR-based metabolomics study on the seven different species of herb plants using $^1H$ NMR experiments and OPLS-DA to understand the correlation between the classification of herb plants and their metabolite contents. This study showed clear metabolic discrimination among various herb plants. This metabolmics study found several diagnostic NMR signals which are able to be used as bio-markers for identification of the specific herb plants among various species. Clear metabolic discrimination of herb plants suggests three chemotaxonomic groups of herb species.

A Case Study of Taeeumin Patient with Edema Treated with Gunyuljejo-tang (태음인 부종 환자의 건율제조탕 치험 1례)

  • Han, Suzy;Yu, Jun-Sang
    • Journal of Sasang Constitutional Medicine
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    • v.33 no.3
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    • pp.138-145
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    • 2021
  • Objectives Edema occurs in various disorders, such as heart failure, nephrotic syndrome, renal failure, liver cirrhosis, and cancer. The excessive accumulation of interstitial fluid in limb tissue will often manifest with ankle and knee swelling and lowers patient's quality of life. But the conventional treatment includes restricting dietary sodium and using diuretics. The purpose of this study is about significant improvement of a patient with edema who had suffered from dependent gait accompanied by mild pain, after treatment by herbal medicine based on SCM(Sasang constitutional medicine). Methods The pattern identification of the patient was diagnosed with a superficial disease of Taeeumin. So after the admission, Gunyuljejo-tang was used, almost two times per day during 2 weeks. Also, we applied acupuncture routinely every day and western medicine as needed. We measured the circumferences of Lt. thigh and followed up the bioelectrical impedance analysis and checked the appearance of lower limb. Results and Conclusions The therapy was effective, and the circumferences, which was 59.69cm at onset time, decreased to 52.07cm almost same to the healthy side of her thigh. There was no more edematous sign on the body, either. This case showed that management of Taeeumin's healthy energy(呼散之氣, the energy of exhalation) could be effective in treating edema.

Hepatitis C Virus Nonstructural Protein 5A Interacts with Immunomodulatory Kinase IKKε to Negatively Regulate Innate Antiviral Immunity

  • Kang, Sang-Min;Park, Ji-Young;Han, Hee-Jeong;Song, Byeong-Min;Tark, Dongseob;Choi, Byeong-Sun;Hwang, Soon B.
    • Molecules and Cells
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    • v.45 no.10
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    • pp.702-717
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    • 2022
  • Hepatitis C virus (HCV) infection can lead to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. HCV employs diverse strategies to evade host antiviral innate immune responses to mediate a persistent infection. In the present study, we show that nonstructural protein 5A (NS5A) interacts with an NF-κB inhibitor immunomodulatory kinase, IKKε, and subsequently downregulates beta interferon (IFN-β) promoter activity. We further demonstrate that NS5A inhibits DDX3-mediated IKKε and interferon regulatory factor 3 (IRF3) phosphorylation. We also note that hyperphosphorylation of NS5A mediates protein interplay between NS5A and IKKε, thereby contributing to NS5A mediated modulation of IFN-β signaling. Lastly, NS5A inhibits IKKε-dependent p65 phosphorylation and NF-κB activation. Based on these findings, we propose NS5A as a novel regulator of IFN signaling events, specifically by inhibiting IKKε downstream signaling cascades through its interaction with IKKε. Taken together, these data suggest an additional mechanistic means by which HCV modulates host antiviral innate immune responses to promote persistent viral infection.

Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report (코일을 이용한 역행성 경정맥 폐색술에 의한 십이지장 정맥류 출혈의 성공적 치료: 증례 보고)

  • Se Jin Park;Young Hwan Kim;Ung Rae Kang;Seung Woo Ji
    • Journal of the Korean Society of Radiology
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    • v.81 no.1
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    • pp.231-236
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    • 2020
  • Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management

  • Ananya Panda;Durgadevi Narayanan;Arjunlokesh Netaji;Vaibhav Kumar Varshney;Lokesh Agarwal;Pawan Kumar Garg
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.27 no.3
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    • pp.307-312
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    • 2023
  • Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.

Early mobilization and delayed arterial ligation (EMDAL) as a surgical technique for splenectomy and shunt surgery in portal hypertension

  • Harilal S L;Biju Pottakkat;Kalayarasan Raja;Senthil Gnanasekaran
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.1
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    • pp.48-52
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    • 2024
  • Backgrounds/Aims: Splenectomy is the most frequently performed procedure as definitive management or as part of shunt surgery or devascularization in portal hypertension. Splenectomy is technically challenging because of the frequent coexistence of multiple collateral varices, splenomegaly, poor liver function, and thrombocytopenia. Early arterial ligation and late mobilization (EALDEM) is the traditional method for splenectomy in portal hypertension. Early spleen mobilization offers good control of the hilum. We aim to compare the effect of the early mobilization and delayed arterial ligation (EMDAL) technique with that of the conventional splenectomy technique in patients with portal hypertension. Methods: During the study period from September 2011 to September 2022, 173 patients underwent surgical intervention for portal hypertension at our institution. Among these patients, 114 underwent the conventional method of splenectomy (early arterial ligation and late splenic mobilization) while 59 underwent splenectomy with the EMDAL technique. Demographics were compared between the two groups. Intraoperative and postoperative outcomes were analyzed using the Mann-Whitney test in each group. A minimum follow-up of 12 months was performed in each group. Results: Demographics and type of surgical procedure were comparable in the two surgical method groups. Median blood loss was higher in the conventional group than in the EMDAL method. The median duration of surgery was comparable in the two surgical procedures. Clavien-Dindo grade III/IV complications were reported more frequently in the conventional group. Conclusions: The splenic hilum can be controlled well and bleeding can be minimised with early mobilization and delayed arterial ligation.

The Prevalence of Chronic Degenerative Disease and Utilization of Medical Facility in Rural Population (농촌지역(農村地域) 주민(住民)의 만성퇴행성질환(慢性退行性疾患) 유병률(有病率) 및 이용의료기관(利用醫療機關))

  • Ann, Kil-Soo;Chun, Byung-Yeol;Yeh, Min-Hae
    • Journal of agricultural medicine and community health
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    • v.21 no.2
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    • pp.209-220
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    • 1996
  • This study was performed to investigate the prevalence of chronic disease and utilization of medical facility in rural area. 5,797 persons were randomly selected from 28,883 rural residents who were over 30 years old and living in Moonkyung city in Kyungsangpook Province during the period October 1 1983 to February 28 1994. The person prevalence rate was 336 per 1,000. The prevalence rate in men(278 per 1,000) was higher than that(388 per 1,000) in women. The spell prevalence rate in men(367) was significantly higher than that(429) in women (p<0.05). The prevalence was increased with the age, 106 in the 30's. 223 in the40's, 336 in the 50's, 407 in the 60's, and 457 in the age group of 70 above. Of all chronic diseases, the prevalence of neuralgia ranked first(128), chronic gastrointestinal disorders(64), degenerative arthritis(54). hypertension (44) and diabetes (14) were followed in descending order. In men, the prevalence of neuralgia ranked first, chronic gastrointestinal disorders, degenerative arthritis, hypertension and bronchial asthma were followed in descending order. In women, the prevalence of neuralgia ranked first, degenerative arthritis, chronic gastrointestinal disorders, hypertension and diabetes were followed in descending order. The prevalences of neuralgia, degenerative arthritis and hypertension were significantly higher in women than those in men, however, those of cardiovascular disease, pulmonary tuberculosis and liver cirrhosis in men were significantly higher than those in women(p<0.05). Most patients with chronic diseases were more likely to utilize hospital and/or local clinics than public health facility or community health providers. Patients with neuralgia, degenerative arthritis and bronchial asthma tended to utilizing local clinics initially, however, they were changed to visit public health facility or community health providers afterwards. Patients with hypertension or pulmonary tuberculosis were more likely to visit public health facility, however, those with diabetes, cancer, heart failure, CVD, liver cirrhosis were more likely to visit hospital.

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