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Sung Gyu Lee,
Gi Won Song,
Shin Hwang,
Tae Yong Ha,
Deok Bog Moon,
Dong Hwan Jung, Ki Hun Kim,
Chul Soo Ahn,
Myung Hwan Kim,
Sung Koo Lee,
Kyu Bo Sung,
Gi Young Ko
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ABSTRACT: Both curative resection and minimized in-hospital mortality offer the only chance of long-term survival in patients with hilar cholangiocarcinoma. The reported resectability rates for hilar cholangiocarcinoma have increased by virtue of combined major hepatectomy, but this procedure is technically demanding and still associated with a significant morbidity and mortality that must be carefully balanced against the chances of long-term survival.
Between January 2001 and December 2008, 350 patients with hilar cholangiocarcinoma underwent exploration for the purpose of potentially curative resection, of whom 302 (86.3%) were resected in the Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine. Combined hepatectomy was carried out in 268 (88.7%) of 302 resected patients. Major hemihepatectomy and parenchyma-preserving hepatectomy were performed in 257 and 11 patients, respectively. Portal vein resection was associated in 40 (14.9%) of 268 hepatectomized patients. To control preoperative cholangitis and reduce risk of postoperative hepatic failure, biliary decompression through endoscopic and/or percutaneous transhepatic drainage and portal vein embolization were preoperatively applied in 329 (94.0%) of 350 explored patients and in 91 (54.2%) of 168 extended hepatectomized patients (154 right hemihepatectomy, 9 right trisectionectomy, 5 left trisectionectomy), respectively. Liver transplantation was not performed as primary treatment for hilar cholangiocarcinoma.
There were 5 cases (1.7%) of in-hospital death after resection and 1 postoperative liver failure that was successfully treated with liver transplantation. Major complications were encountered in 23 patients (7.0%), and the overall morbidity rate was 43%. In 302 resections, 214 (70.9%) were curative resections (R0) and 88 (29.1%) were palliative resections (R1). The overall 1-, 3- and 5-year survival rates after resection, including in-hospital deaths, were 84.6, 50.7 and 47.3% in the R0 group and 69.9, 33.3 and 7.5% in the R1 group, respectively. The 5-year survival rate of extended hemihepatectomy of 36.4% was better than that of parenchyma-preserving hepatectomy at 10.5%. Two significant predictive factors adversely affecting survival after resection were lymph node metastasis and incurability of surgery (P < 0.001). Two patients with vascular involvement who underwent concomitant hepatic artery and portal vein reconstruction are alive after more than 3 years.
Preoperative biliary decompression and portal vein embolization enabled us to reduce in-hospital deaths associated with extended hepatectomy for hilar cholangiocarcinoma. Major hemihepatectomy offers an increased survival because of the higher possibility of curative resection than bile duct resection alone and parenchyma-preserving hepatectomy, but it still carries a certain mortality. Less extensive procedures can be conducted safely and are beneficial for aged patients in poor condition with a less advanced tumor stage if tumor-free resectional margins are obtained.
Journal of hepato-biliary-pancreatic sciences. 10/2009; 17(4):476-89.
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ABSTRACT: Numerous electronic devices have been introduced into operating rooms. Although little is known about the relationship between exposure to electromagnetic fields and health hazards, several studies have demonstrated causal relationships between electromagnetic fields exposure and various symptoms, cancers, and other diseases.
This study was approved by the Institutional Review Board. The intensity of extremely low-frequency electromagnetic fields was measured during surgery with the extremely low-frequency electromagnetic field strength measurement system at the standing position of anesthesiologists in 18 operating rooms and analyzed with EMDEX analysis and graphical program (EMCALC 95; ENERTECH, Campbell, CA).
The average measurement duration per operating room per day was 7.41 +/- 0.70 h (mean +/- SD). The average sample number of measurements was 888.11 +/- 82.75 per operating room. The average magnetic field was 5.83 +/- 5.23 milliGuass (mG) (range, 0.10-33.80 mG), with 70% of these levels 2 mG or greater.
The authors' results indicate that anesthesiologists in operating rooms are exposed to extremely low-frequency electromagnetic field levels that exceed magnetic field intensity of 2 mG recommended by the Swedish Board for Technical Accreditation for production by computer monitors and detected 30 cm from them. It currently is not clear if this exposure has health effects on anesthesiologists and other operating room personnel.
Anesthesiology 07/2009; 111(2):275-8. · 5.36 Impact Factor
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ABSTRACT: Compounds isolated from Magnolia officinalis such as magnolol, honokiol and obovatol exhibit several pharmacological effects on CNS including depressant, anxiolytic and anticonvulsant effects, as well as neuroprotective effects against chemical and heat damages. Recently, honokiol was found to have a neurotrophic effect in fetal rat cortical neurons. In the present study, we show that 4-O-methylhonokiol, a novel compound from Magnolia officinalis, promotes neurite outgrowth in a concentration- dependent manner in rat embryonic neuronal cells. In parallel with the neurite outgrowth activity, the expression of neurite outgrowth marker proteins is also increased by treatment with 4-O-methylhonokiol. We also found that 4-O-methylhonokiol promotes the release of NGF and BDNF into cell culture medium. In addition, lower concentration of 4-O-methylhonokiol (1 and 2 lM) further enhanced neurite outgrowth and expression of neurite outgrowth marker proteins in the presence of NGF (50 ng/ml) or BDNF (10 ng/ml). Subsequently, we found that 4-O-methylhonokiol activates ERK in a concentration- dependent manner. However, the neurite outgrowth activity and the NGF and BDNF release induced by 4-O-methylhonokiol are suppressed by an ERK-specific inhibitor. These results suggest that 4-O-methylhonokiol has the ability to induce neurite outgrowth via the increase of neurotrophic factor levels through ERK activation.
Neurochemical Research 07/2009; 34(12):2251-60. · 2.24 Impact Factor
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ABSTRACT: We compared the clinical, laboratory and diagnostic features of Kawasaki disease (KD) in children <6 mo and >5 y of age to those in the more typical age range at diagnosis (6 mo-5 y of age).
Retrospective analysis.
Severeance Children Hospital attached to a Medical School, Korea.
All children with a discharge diagnosis of KD at Severance Childrens Hospital (2006-2007) were retrospectively reviewed and grouped according to age at presentation in 3 groups: <6 mo, 6 mo-5 y and >5 years. Clinical, hematological, and biochemical features and involvement of coronary artery and proportion of Classic vs. Incomplete KD were compared between the 3 groups.
A total of 185 children were identified. Complete KD was found in 63 (34%) children and Incomplete KD in 122 (66%). There was 22(12%) children below 6 months of age, 131 (71%) between 6 months to 5 years) and 32 (17%) above 5 years of age. Clinical, hematological and biochemical features were comparable between the three age groups. Overall, coronary artery lesions occurred in 9% children without any preference for age. The proportion of Classical vs. Incomplete KD was also similar in the three age categories.
The clinical and laboratory phenotype of KD does not vary significantly with age.
Indian pediatrics 07/2009; 46(7):585-90. · 1.05 Impact Factor
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ABSTRACT: Magnolol, honokiol, and obovatol are well-known bioactive constituents of the bark of Magnolia officinalis and have been used as traditional Chinese medicines for the treatment of neurosis, anxiety, and stroke. We recently isolated novel active compound (named 4-O-methylhonokiol) from the ethanol extract of Magnolia officinalis. The present study aimed to test two different doses of ethanol extracts of Magnolia officinalis (5 and 10 mg/kg/mouse, p.o., 1 week) and 4-O-methylhonokiol (0.75 and 1.5 mg/kg/mouse, p.o., 1 week) administered for 7 days on memory impairment induced by scopolamine (1 mg/kg body weight i.p.) in mice. Memory and learning were evaluated using the Morris water maze and the step-down avoidance test. Both the ethanol extract of Magnolia officinalis and 4-O-methylhonokiol prevented memory impairment induced by scopolamine in a dose-dependent manner. The ethanol extract of Magnolia officinalis and 4-O-methylhonokiol also dose-dependently attenuated the scopolamine-induced increase of acetylcholinesterase (AChE) activity in the cortex and hippocampus of mice, and inhibited AChE activity in vitro with IC(50) (12 nM). This study, therefore, suggests that the ethanol extract of Magnolia officinalis and its major ingredient, 4-O-methylhonokiol, may be useful for the prevention of the development or progression of AD.
Journal of Natural Medicines 05/2009; 63(3):274-82. · 1.39 Impact Factor
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ABSTRACT: The aim of this study was to investigate whether serum levels of anti-Müllerian hormone (AMH) and inhibin B at ovulation triggering day correlate with the number of immature oocytes obtained from stimulated in vitro fertilization (IVF) cycles. Fifty-nine consecutive cycles of ovarian hyperstimulation and IVF were selected from 45 women who had tubal (n=18) or unexplained infertility (n=27) and obtained at least one oocyte. Serum levels of AMH and inhibin B at ovulation triggering day were measured by enzyme-linked immunosorbent assay (ELISA). Univariate analysis and multiple regressions revealed that serum AMH or inhibin B levels were significantly correlated with immature oocyte count and the correlation coefficients were higher compared to the mature oocyte count. Serum AMH and inhibin B levels on triggering day seems to be more closely related with the immature oocyte count and thus could be good predictors to determine the immature oocyte count in IVF cycle.
Journal of Korean Medical Science 09/2008; 23(4):657-61. · 0.99 Impact Factor
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ABSTRACT: Human keratinocytes are generally cultured in media containing bovine pituitary extract (BPE), an animal product that can be a source of infectious contaminants. We investigated whether a safer plant product could replace BPE in the culture medium. Medium containing both BPE and soy protein hydrolysates (Bacto Soytone and Soy Hydrolysate) produced the largest number of viable cells, followed in descending order by medium supplemented only with BPE, only with the hydrolysates, and without supplementation (basal medium only). Soybean protein is thus an excellent source of nutrients for the growth of adherent keratinocytes, although they do not fully substitute for BPE.
Biotechnology Letters 08/2008; 30(11):1931-6. · 1.68 Impact Factor
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ABSTRACT: Hepatic artery pseudoaneurysm is a rare and potentially life-threatening vascular disorder. Careful consideration and early management of this lesion can be life-saving. The authors report a case of a hepatic artery pseudoaneurysm which was successfully controlled by endovascular repair using a covered stent-graft.
Emergency Radiology 05/2008; 16(3):247-9.
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ABSTRACT: To determine the performance of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal eosinophilic infiltration (FEI) from metastasis.
Gadobenate dimeglumine-enhanced MRI conducted in 38 patients (lesions of 43 metastases and 33 FEIs) with extrahepatic abdominal carcinoma were reviewed retrospectively. Images were divided into 2 sets. Set 1 was composed of precontrast MRI with dynamic phase images. Set 2 included hepatobiliary phase images in addition to the images of set 1. Two blinded radiologists independently categorized each set of images into 5 grades to differentiate metastases from FEI. The area under the receiver operating characteristic curve (Az) was calculated for each set of images. The observers evaluated the shape, signal intensity (SI), and enhancement pattern of the lesions in consensus.
The Az values for set 2 images (reader 1: 0.976, and reader 2: 0.743) were greater than those of set 1 (0.961 and 0.709), without statistical significance (P = 0.470 and 0.223). Target appearance was seen in 27 of 43 (63%) metastases on hepatobiliary phase imaging, but none on the FEI. Twenty-five (76%) of the 33 FEIs showed intermingled hypo-SI and iso-SI on hepatobiliary phase images with changing size and shape compared to the T2-weighted images, whereas none of the metastases did.
Gadobenate dimeglumine-enhanced MRI may assist in the differentiation of FEI from metastasis by highlighting the distinctive features between them, even without hepatobiliary phase imaging.
Journal of computer assisted tomography 33(1):119-24. · 1.38 Impact Factor
