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OBJECTIVE To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico-ureteric reflux (VUR). PATIENTS AND METHODS Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents’ request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >105 colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with 99mTc-dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow-up studies at 4–6 months after surgery. RESULTS There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114–207) months after antireflux surgery. Also there was no significant morphological change on follow-up renal scans and no difference between the groups. CONCLUSION These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.

Purpose To present clinical and histological features of prepubertal testicular tumors through the analysis of the long-term experiences of a single surgeon. Materials and Methods The charts of 48 children treated for testicular tumors from 1986 to 2010 were retrospectively reviewed. All patients underwent radical orchiectomy. The patients' ages, clinical presentations, histopathological findings, kinetics of tumor markers, and outcomes were recorded. Results The patients' median age at the initial diagnosis was 19.5 months (range, 3 to 84 months). All patients presented with either a palpable mass (76%) or scrotal size discrepancy (24%). Compared with a palpable mass, scrotal size discrepancy led to delay in diagnosis by 5 months. Regarding histology, yolk sac tumors and teratomas accounted for 53% and 36% of the tumors, respectively. The mean preoperative alpha-fetoprotein (AFP) level was significantly higher in patients with yolk sac tumors than in those with teratomas (4,600 ng/mL vs. 6.3 ng/mL), and only one patient with a teratoma had a preoperative AFP value higher than 20 ng/mL. Following radical orchiectomy, 72%, 8%, and 16% of patients with a yolk sac tumor showed normalization, persistent elevation, and relapse after transient lowering of AFP, respectively. Preoperative AFP was greater in patients with non-normalization than in those with normalization. Five of six patients with non-normalization showed evidence of either vascular invasion or endolymphatic tumor emboli. Conclusions We found a higher number of yolk sac tumors than teratomas in patients with prepubertal testicular tumors. AFP was the most useful marker in the diagnosis and follow-up of childhood yolk sac tumors. Relapsed yolk sac tumors often showed pathological evidence of aggressiveness.

In this study, waste tire rubber (WTR) was successfully converted into magnetorheological (MR) elastomer via high-pressure and high-temperature reclamation. The physical and rheological properties of WTR based MR elastomers were assessed for performance. The revulcanization process was at the absence of magnetic fields. Thus, the magnetizable particles were allowed to distribute randomly. To confirm the particle dispersion in the MR elastomer matrix, an observation by scanning electron microscopy was used. The magnetization saturation and other magnetic properties were obtained through vibrating sample magnetometer. Rheological properties including MR effect were examined under oscillatory loadings in the absence and presence of magnetic fields using rotational rheometer. The WTR based MR elastomer exhibited tunable intrinsic properties under presentation of magnetic fields. The storage and loss modulus, along with the loss factor, changed with increases in frequency and during magnetization. Interestingly, a Payne effect phenomenon was seen in all samples during dynamic swept strain testing. The Payne effect was significantly increased with incremental increases in the magnetic field. This phenomenon was interpreted as the process of formation–destruction–reformation undergone by the internal network chains in the MR elastomers.

Background/Aims: Sequential therapy (ST) for Helicobacter pylori infection in countries other than Korea has shown higher eradication rates than triple therapy (TT). The aim of this study was to evaluate the efficacy of ST in Korea by performing a meta-analysis. Methods: We performed a comprehensive literature search on the efficacy of ST as a first-line therapy. The odds ratios (ORs) of eradicating H. pylori infection after ST compared with TT were pooled. Pooled estimates of the eradication rates of ST and TT were also calculated. Results: A total of six studies provided data on 1,759 adult patients. The ORs for the intention to treat (ITT) and the perprotocol (PP) eradication rate were 1.761 (95% confidence interval [CI], 1.403 to 2.209) and 1.966 (95% CI, 1.489 to 2.595). Pooled estimates of the ITT and PP eradication rate were 79.4% (95% CI, 76.3% to 82.2%) and 86.4% (95% CI, 83.5% to 88.8%), respectively, for the ST group, and 68.2% (95% CI, 62.1% to 73.8%) and 78.9% (95% CI, 68.9% to 81.7%), respectively, for the TT group. Conclusions: Although ST presented a higher eradication rate than TT in Korea, the pooled eradication rates were lower than expected. Further studies are needed to validate ST as a first-line treatment for H. pylori in Korea. (Gut Liver 2013;7:546-551)

Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of diagnostic colonoscopies could pose relevant health problems. Optimizing treatment may reduce the probability of severe complications. This study aimed to determine perforation frequency and the management of perforations that occurred during diagnostic colonoscopy. A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoidoscopy/colonoscopy from 2000 to 2011 in three institutions of The Catholic University of Korea. The patients’ demographic data, endoscopic procedure information, perforation location, therapy, and outcomes along with different therapeutic strategies were recorded. In the 12-year period, a total of 115,285 diagnostic sigmoidoscopic/colonoscopic procedures were performed. A total of 27 perforations occurred. Sixteen patients underwent endoscopic clipping, of which three patients failed and were referred for surgery. Fourteen patients in total underwent surgery for perforation. Endoscopic clip closure was successful in 81 % of the patients. No perforation-related major morbidity or mortality occurred. Endoscopic repair using clips can be effective for the treatment of colon perforations that occur during diagnostic colonoscopy.

BACKGROUND/AIMS There is an ongoing debate on the relationship between gastric fundic gland polyps and increased incidence of colorectal neoplasia in Caucasians. However, there was no report on the relationship between gastric fundic gland polyp and colorectal neoplasia in Korea. The aim of this study was to identify the characteristics of gastric fundic gland polyps and whether a relationship exists between fundic gland polyps and colorectal neoplasia in Korean population. METHODS Persons who underwent an esophagogastroduodenoscopy and colonoscopy from 1992 to 2007 at the Health Promotion Center of Incheon St. Mary's Hospital, The Catholic University of Korea were reviewed retrospectively. The relationship between gastric fundic gland polyps and colorectal neoplasia were analyzed. RESULTS Among 22,451 subjects, fundic gland polyps were found in 328 subjects (1.5%). Fundic gland polyps were more common in women than in men (odds ratio of 6.25; 95% CI of 4.68-8.34). The odds ratios for colorectal neoplasia in all subjects with gastric fundic gland polyps were 0.56 (95% CI of 0.33-0.95) and men who were 50 years of age or older had an odds ratio of 2.81 (95% CI of 1.03-7.66) as compared to the control group. However, age and sex-adjusted odds ratios for all gastric fundic gland polyps were 0.73 (95% CI of 0.42-1.26), for men 1.78 (95% CI of 0.80-3.98), and for women 0.37 (95% CI of 0.16-0.87). CONCLUSIONS Surveillance colonoscopy in patients with fundic gland polyps can be performed in the same manner as general population in Korea.

Small bowel tumors are relatively rare, and their confirmative diagnosis before surgery is not easy. This study was performed to investigate the clinical characteristics of patients with small bowel tumors who received double-balloon enteroscopy (DBE). Secondary end points were to evaluate the usefulness and safety of DBE for the diagnosis of patients with suspected SB tumors derived from other previous procedures. We retrospectively analyzed consecutive DBE examinations to explore the small intestine in eight university hospitals over a 5-year period. A total of 877 DBE examinations (per oral 487, per anal 390) were performed in 645 patients (405 males, mean age 48.2 years). Small bowel tumors were diagnosed in 112 patients (17.4%), of which 38 patients had benign polyps, 29 had gastrointestinal stromal tumors/leiomyomata, 18 had lymphomas, 14 had adenocarcinomas, five had metastatic or invasive cancers, five had lipomas, and three patients had cystic tumors. The main reasons for DBE among patients with small bowel tumors were obscure gastrointestinal bleeding (OGIB, 40.2%) followed by abnormal imaging study (25.2%). The concordance rate of diagnoses based on DBE with diagnoses based on small bowel follow-through, CT, and capsule endoscopy among patients with small bowel tumors was 68.9% (42/61), 75.3% (70/93), and 78.3% (18/23), respectively. Therapeutic plans were changed due to the DBE results in 64.2% of patients with small bowel tumors. Approximately one-sixth of patients who received DBE had small bowel tumors, and the most common reason for DBE among patients with small bowel tumors was OGIB. DBE is a useful method for the confirmative diagnosis of small bowel tumors and has a good clinical impact on therapeutic plans and short-term clinical results.

INTRODUCTION AND OBJECTIVES: Endoscopic treatment (Deflux® or Macroplastique®) of vesicouretral reflux (VUR) is a accepted treatment for pediatric population. Because of the lower success rate than ureteral reimplanation, postoperative voiding cystourethrogram (VCUG) is usually performed. Therefore we evaluated the presence of the nodule on noninvasive ultrasound could predict the resolution of VUR beside the VCUG. METHODS: The patients who underwent the endoscopic bulking agent (Deflux® or Macroplastique®) injection for VUR from February 2005 to March 2010 were evaluated retrospectively. The patients with neurogenic bladder, Ureteric abnormality (duplication, diverticulum, ureterocele, etc), or insufficient medical records were excluded. We evaluated whether the nodule was present on sonography at postoperative 1 month. The Definition of nodule is the hump shape mass lesion distinguished from bladder at ureteral orifice (figure 1). We compare the success rate of the group which had injection nodule with that of the group which had no injection nodule. The success of injection treatment defined VUR disappeared or downgrade to Grade I on postoperative VCUG. RESULTS: Total 98 patients (138 ureters) were included in our criteria. The mean age at operation is 5.4 years (range 1–17). Male was 60.4% (58 cases) and female was 39.6% (38 cases). Unilateral VUR was 60.8 % (right vs left, 28.4% (28 cases) vs left 32.3% (32 cases)), and bilateral VUR was 39.2% (39 cases). General success rate was 78.3%. The success rates of to VUR Grade I–V were 91.7% (11/12), 95.4% (21/22), 79.0% (45/57), 65.0% (26/40), and 85.8% (6/7), respectively. Injection nodule related success rates were different in two groups. Group with injection nodules had higher success rate than the group with no injection nodules (61/67, 91.0% vs 47/71, 66.2%, p 0.001). There were no differences of age, laterality, gender, and VUR Grade between two groups. CONCLUSIONS: The presence of the postoperative nodule can predict resolution of vesicoureteral reflux.

Gastrointestinal leakage is one of the most serious post surgical complications and is a major source of mortality and morbidity. The insertion of a covered self-expandable metal stent could be a treatment option in selected cases. However, it is unclear how long the stent should be retained to achieve complete sealing, and membrane-covered stents have the problem of a high migration rate. We observed four cases of postsurgical leakage following the primary closure of a duodenal perforation, esophagojejunostomy, and esophagogastrostomy, each of which was successfully managed by the temporary placement of covered stents. In all cases, the optimal time of stent removal could be estimated by the markedly decreased amount of drainage, the lack of leakage observed on radiocontrast images, and the endoscopic findings. In this case series, all of the stents could be removed within 7 weeks. For those cases with a high risk of migration, stents with temporary fixations to earlobes and/or partially uncovered proximal flanges were used. These results suggest that the application of a covered stent could be a treatment option for various gastrointestinal leaks after surgery, particularly when the defect cannot be sealed by conservative care and the leakage has good external drainage.

Urodynamic evaluation in pediatric neurogenic bladder is prerequisite for accurate prediction of prognosis and selection of appropriate treatment modality. We classified normal, hyperreflexic and areflexic bladders by cystometry. Hyperreflexic bladder was subdivided into two groups with or without detrusor sphincter dyssynergia and areflexic bladder into low pressure and high pressure. Among 36 patients with myelodysplasia on whom we performed a videourodynamic study vesicoureteral reflux was found in three of 7 patients with hyperreflexia with detrusor sphincter dyssynergia, two of 6 patients with hyperreflexia without detrusor sphincter dyssynergia and five of 10 patients with areflexia with high pressure. Low pressure areflexic bladder didn't show vesicoureteral reflux. When we evaluated 39 pediatric neurogenic bladder patients with a mean 25.5 follow-up months period, upper tract deterioration was improved and normal findings persisted in all the compliant patients to treatment. In the noncompliant group initial abnormal upper tract findings persisted or aggravated, especially in hyperreflexic bladder with dyssynergia and high pressure areflexic bladder. One of the three hyperreflexic bladders with dyssynergia and two of six high pressure areflexic bladders received augmented cystoplasty. These data show that urodynamic evaluation in pediatric neurogenic bladder provides excellent criteria for selecting high risk groups in pediatric neurogenic bladder.

Background Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. Capecitabine, a pro-drug of 5-FU that induces thymidine phosphorylase can achieve higher levels of intracellular 5-FU when administered concurrently with radiation. We evaluated the feasibility as well as the clinical outcome of concurrent administration of capecitabine with tomotherapy in patients with advanced pancreatic cancer. Methods Nineteen patients with advanced pancreatic cancer including primarily unresectable disease and recurrence after curative surgery were included in the study. Two planning target volumes (PTV) were entered: PTV1 is gross tumor volume; and PTV2, the volume of the draining lymph nodes. The total doses to target 1 and target 2 were 55 and 50 Gy, respectively. Capecitabine at 1600 mg/m2/day was administered on each day of irradiation. Results Twenty six measurable lesions were evaluated. Overall in-field response rate was 42.3%; partial responses were achieved in 53.3% of the pancreatic masses, 28.6% of distant metastatic lesions and 25.0% of regional lymph nodes. The median duration of follow-up after tomotherapy was 6.5 months. None of the lesions showed in-field progression. Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients). Conclusions Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer. We achieved excellent conformal distribution of radiation doses and minimal treatment-related toxicities with promising target volume responses.

This entry covers the development of libraries and archives in Korea, and with a focus on their current status and activities and their vision for the future. The authors present an overview of Korean institutional change, and describe recent government policies concerning libraries and archives. They also discuss various types of libraries as well as professional associations and educational programs for librarians and archivists

We compared the preventive effects of cyclosporine A combined with prednisolone and melatonin (Sigma-Aldrich) on damage to the contralateral testis after ipsilateral testicular torsion-detorsion between pubertal and adult rats.We divided pubertal and adult Sprague-Dawley rats into groups 1-sham operation, 2-detorsion, 3-detorsion plus cyclosporine A with prednisolone and 4-detorsion plus melatonin. After 4 hours of ipsilateral testicular torsion we treated the rats with detorsion only or with detorsion plus drug depending on the group.Seminiferous tubule diameter and germ cell layer thickness were greater in pubertal group 3 and adult group 4 than at each age in group 2 (each p0.05). The number of spermatids per tubule was greater in pubertal groups 3 and 4, and in adult group 4 than at each age in group 2 (each p0.05). Of pubertal rats those in groups 3 and 4 had fewer TUNEL positive cells than group 2 (p = 0.061 and 0.057, respectively). Of adult rats the number of TUNEL positive cells was greater in group 3 and significantly lower in group 4 vs that in group 2 (p0.05).The preventive effects of cyclosporine A combined with prednisolone on contralateral testicular damage were noted only in pubertal rats while the preventive effects of melatonin were noted in pubertal and adult rats. Results suggest that damage to the contralateral testis induced by an immunological mechanism may be more significant during puberty than during adulthood.

It is generally accepted that seroconversion of hepatitis B virus (HBV) surface antigen (HBsAg) to an antibody to HBsAg (anti-HBs) indicates clearance of HBV. Here we report a case of severe hepatitis that manifested during chemotherapy in a female patient with chronic lymphocytic leukemia (CLL) who had been initially seronegative for HBsAg and seropositive for anti-HBs. The patient received chlorambucil and prednisolone for the treatment of CLL. After 6 months the serum levels of aminotransferases were increased, and HBsAg and HBV DNA were present in serum. Lamivudine was administered immediately after confirming the HBV reactivation, which considerably improved jaundice and aminotransferase levels after 3 weeks. The patient was able to resume the chemotherapy whilst continuing lamivudine treatment. This case report highlights the need for physicians to be aware of the potential risk of HBV reactivation even in an HBsAg-negative person but with detectable anti-HBc and/or anti-HBs, underscoring the need for future studies that explore the role of antiviral prophylaxis in this setting.

Background/Aims Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique. Methods One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion. Results The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109). Conclusions The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.

Polypectomy is the current modality of choice to prevent benign colorectal adenoma from progressing to an invasive cancer. However, in cases of small colorectal adenoma, it remains unclear as to whether polypectomy is actually an effective treatment modality. We evaluated the clinical significance of polypectomy in cases of small colorectal adenomas, measuring less than 10 mm.All colonoscopies were performed at 11 Korean tertiary medical centers, between July 2003 and March 2004. A total of 5996 colorectal adenomas were detected and divided into 5 groups according to their size (Group 1; 1-5 mm, Group 2; 6-7 mm, Group 3; 8-9 mm, Group 4; 10-19 mm, Group 5; more than 20 mm). The term 'advanced adenoma' refers here to tubular adenomas with diameters of at least 10 mm, or to tubulovillous, villous, or high-grade dysplasia, irrespective of size. 'Cancer' here is defined as the invasion of malignant cells beyond the muscularis mucosa.As the sizes of the adenomas increased, the prevalence of advanced adenoma was also observed to increase. In Groups 2 and 3, the prevalence of tubulovillous or villous adenoma were higher than was expected (5.2% and 6.6%, p0.001). Interestingly enough, in Group 2, the prevalence of cancer was at least as high as in Group 4 (0.7% vs. 0.5%, p0.001).In cases of small colorectal adenomas, measuring between 6 and 9 mm, the prevalence of cancer was at least as high as that seen in the cases of colorectal adenomas measuring between 10 and 19 mm. Therefore, small colorectal adenomas measuring between 6 and 9 mm should not be ignored, in order to decrease the prevalence of colorectal cancer.

Background Double balloon endoscopy (DBE) is a new diagnostic and therapeutic tool for the management of patients with small-bowel disease. Objective To evaluate the feasibility, clinical usefulness, and safety of DBE in Korean patients with suspected or known small-bowel disease. Design Retrospective, multicenter study from April 2004 to March 2006. Setting University hospitals. Patients Two hundred twenty-five consecutive patients. Interventions Subjects underwent 311 procedures with DBE via the oral and/or anal routes. Main Outcome Measurements The indications, diagnostic yield, therapeutic use, and complications. Results Overall diagnostic yield was 75% (169/225). Diagnostic yields for obscure GI bleeding (OGIB) (n = 137), chronic abdominal pain (n = 32), radiologic/capule endoscopic abnormality (n = 25), polyposis (n = 9), and chronic diarrhea (n = 9) were 73.7% (101/137), 75.0% (24/32), 64% (16/25), 100% (9/9), and 0% (0/9), respectively. In patients with OGIB, ulcerating lesions (n = 54) were more common than vascular lesions (n = 20) or tumors (n = 27). Some lesions detected in DBE were treated effectively with electrocoagulation or argon plasma coagulation, polypectomy, and dilation. Entrapped capsules were removed easily with polypectomy snare in 3 patients with small-bowel stricture. Some patients with strictures had transient abdominal discomfort during and/or after the procedure. With the exception of 1 mucosal tear, there were no technical problems or serious complications. Limitations Descriptive, retrospective study. Conclusions DBE is safe and useful for diagnosis and treatment of a variety of small-bowel diseases. The most common indication of DBE was OGIB. Ulcerating small-bowel lesions are more common than vascular lesions in Korea.

To evaluate the role of the genetic polymorphisms of CYP2E1, GSTM1 and GSTT1, and their interaction with smoking in lung cancer development in Korean males, a hospital-based case-control study was conducted. Histologically confirmed male lung cancer patients (n=171) and male patients with no present or previous history of systemic illness who visited the urology department (n=196) were recruited from Seoul National University Hospital, Korea (1998-1999). CYP2E1 genotypes were determined by PCR-RFLP using RsaI digestion and GSTM1 and T1 genotypes were determined by multiplex PCR. Risks were estimated as odds ratios (ORs) and 95% confidence intervals (CIs) using a logistic regression model adjusting for age and pack-year. Smoking was a significant risk factor for lung cancer (P

Because of their potential for malignancy, flat colorectal neoplasias are a current topic of debate. This study was designed to investigate the clinicopathologic features of flat neoplasia and to compare them with those of polypoid neoplasia, as well as to identify the determinants of malignant transformation of both flat and polypoid colorectal neoplasia. A prospective, cross-sectional study of 3,360 patients diagnosed with adenomas via total colonoscopy and polypectomy was performed at 11 tertiary medical centers between July 2003 and July 2004. In this study, potential risk factors for malignant transformation were analyzed. If multiple adenomas were identified, then only the adenoma with the most advanced degree of histology was recorded for the patient. Of a total of 3,360 neoplasias identified, we found that the incidence of flat and polypoid neoplasias were 207 (6.2 percent) and 3,153 (93.8 percent), respectively. Patients with flat neoplasias tended to be older (59.6 vs. 57.1, P

To evaluate prospectively the hemodynamic state of the left renal vein with Doppler ultrasonography (US) and venography in pediatric patients with varicocele to assess the "nutcracker phenomenon."The institutional review board considered this study ethically sound, and parental informed consent was obtained for all subjects. Doppler US of the left renal vein was performed in 27 consecutive boys with varicocele (age range, 7-15 years; mean, 11.9 years) and in 20 boys without varicocele as control subjects (age range, 7-17 years; mean, 11.4 years). Doppler US was used to evaluate left renal vein diameters and peak velocities in the proximal left renal vein near the renal hilum and in the left renal vein between the aorta and superior mesenteric artery (aortomesenteric portion). The diameter ratios and peak velocity ratios between two sites were obtained. For statistical comparison of results, the t test was used. Left renal venography and renocaval pressure measurement were performed in 13 patients with varicocele. The Fisher exact test was used to evaluate the associations between the nutcracker phenomenon (renocaval pressure gradient/=3 mm Hg) and the development of collateral veins.The diameters of the proximal left renal vein and the peak velocities in the aortomesenteric portion of the left renal vein were significantly different between the varicocele group and the control group (P.001). The diameter ratios (5.7 +/- 1.8 [standard deviation]) and peak velocity ratios (5.2 +/- 2.6) in patients with varicocele were significantly higher than those in control subjects (3.5 +/- 1.0 and 3.1 +/- 0.8, respectively) (P.005). According to findings at left renal venography (n = 13), 10 patients (77%) met the criteria for the nutcracker phenomenon. The nutcracker phenomenon was significantly associated with the development of collateral veins (P = .035).Doppler US and venography of the left renal vein can show hemodynamic changes of the left renal vein and depict the presence of the nutcracker phenomenon in pediatric varicocele.

Objectives The aims of this prospective study were to document the incidence of colon immediate postpolypectomy bleeding (IPPB) according to grade, and to identify potential risk factors of IPPB in patients who have received complete colonoscopy and polypectomy because of a colorectal polyp. Methods This was a prospective, cross-sectional study of 5,152 patients treated at 11 tertiary medical centers between July 2003 and July 2004. Patient-related, polyp-related, and procedure-related variables were evaluated as potential risk factors for IPPB. IPPB was defined as a bleeding occurring during the procedure and was graded as G1-G4. Risk factors associated with IPPB were analyzed by univariate and multivariate logistic regression analysis. Results A total of 9,336 colonic polyps were removed in 5,152 patients, and 262 (2.8%) colorectal polyps in 215 patients presented with IPPB. Polyp-based multivariate analysis revealed that old age (>or=65 yr), comorbid cardiovascular or chronic renal disease, anticoagulant use, polyp size greater than 1 cm, gross morphology of polyps such as pedunculated polyp or laterally spreading tumor, poorer bowel preparation, cutting mode of the electrosurgical current, and the inadvertent cutting of a polyp before current application were significant risk factors for IPPB. Conclusion Nine factors have been found to be associated with IPPB and polypectomy should be undertaken with caution under these conditions.

Multidrug resistance 1 (MDR1) gene encodes P-glycoprotein in intestinal epithelium, which serves as a transmembrane efflux pump of various toxins. mdr1 knockout mice develop spontaneous colitis under specific pathogen free conditions. However, it is unclear that C3435T polymorphism of MDR1 is related to ulcerative colitis. Other studies suggest MDR1 may have an important role in colorectal carcinogenesis. Thus, we evaluated whether MDR1 C3435T polymorphism is present in Korean and it is associated with inflammatory bowel disease or colorectal cancer.The genotype distributions of the C3435T polymorphism were investigated by PCR-RFLP method in 94 patients with ulcerative colitis, 24 patients with Crohn's disease, 64 patients with colorectal cancer and each of gender-matched controls with equal numbers.There was no significant difference in frequencies of 3435T allele and 3435TT genotype between patients with ulcerative colitis and controls (p=0.443, p=0.194). No significant difference was present in frequencies of 3435T allele and 3435TT genotype between patients with Crohn's disease and controls (p=0.378, p=1.000). There was neither significant difference in frequencies nor 3435T allele or 3435TT genotype between patients with colorectal cancer and controls (p=0.250, p=0.211). C3435T genotype was not associated with the age of onset or other clinical characteristics in patients with ulcerative colitis, Crohn's disease or colorectal cancer.MDR1 C3435T polymorphism is also present in Korean and the dominant allele is C. However, there is no evidence that C3435T polymorphism of MDRI is associated to inflammatory bowel disease or colorectal cancer in Korean.

To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults.From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis.Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult.Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.

The number of patients with ulcerative colitis has steadily increased since the mid-1980s. As the risk of colon cancer increases with duration and extents, colitic cancers are expected to increase in number in Korea. We surveyed the current status of colitic cancers and provided the perspectives in Korea.Korean Association for the Study of Intestinal Diseases (KASID) collected and descriptively analyzed a total of eleven cases of colitic cancers occurred between 1993 and 2003.The mean age at the diagnosis of colitic cancer was 49.3 years, and the mean duration of ulcerative colitis was 12.5 years. Of the diagnosed cases, 91% was associated with pancolitis, 28% had right colon cancers and 18.2% had multiple tumors. Colitic cancers diagnosed at Dukes' stage D were 36.3%. Stages at diagnosis were lower in patients with good compliance. Up to 2003, cumulative incidence ratio of colitic cancer to ulcerative colitis was estimated to be 0.5%, which was much less than the overall prevalence of 3.7% in the Western countries. This incidence was also less than the expected cumulative incidence ratio of 0.9%, which was estimated by adopting the average results of meta-analysis in the Western world.As the incidence of ulcerative colitis has not reached a plateau, and as the diagnosis of colitic caners are delayed in Korea, the cumulative incidence of colitic cancers might have appeared to be low. Geographic and racial factors, and the effect of preventive measures might have contributed to the lower incidence which remains to be proven. Since colitic cancers are expected to increase steeply in the near future in Korea, the importance of surveillance and prevention cannot be over-emphasized.

The pathogenesis of liver fibrosis has evolved dramatically in recent years. Hepatic stellate cells (HSCs) have been recognized as the main fibrogenic cells in the injured liver, and key fibrogenic cytokines have been identified. We propose the use of DNA microarrays to study changes in gene expression in activated HSCs and in fibrotic livers in order to identify key genes involved in liver fibrosis. For this purpose, RNA can be extracted from both cultured cells and liver tissue. The target RNA is hybridized to probes, which are gene-specific sequences immobilized on chips. The hybridization signal is assessed using a confocal laser scanner. Comparison of hybridization signals and patterns allows the identification of mRNAs that are differentially expressed. Statistical analysis enables classification and clustering of genes according to their up- or downregulation. By using this powerful technique, we have identified genes that are differentially regulated in both HSCs and the fibrotic human liver.

Background/Purpose We evaluated the impact of a surgeon's experience, divided our first 20 consecutive series that involved a single surgeon at the numerical midpoint of his experience, and compared outcomes regarding this midpoint. Methods From August 1996 to August 2001, laparoscopic nephrectomy or nephroureterectomy was performed in 20 consecutive children, 12 girls and 8 boys aged between 1 and 15 years (median, 5.9 years). Disease was in the right side in 11 patients and in the left side in 9. The children were divided into 2 groups of 10. We retrospectively obtained data on all patients and compared pertinent perioperative information including operation time, blood loss, length of hospital stay, and postoperative complications. Results The procedure was feasible in all cases and did not require conversion to open surgery or perioperative transfusion in any case. The operation time reduced from a median of 181 minutes over the first 10 patients to 125 minutes over the second 10, and this difference was significant ( P = .02). Estimated blood loss and days to the first postoperative oral feeding for the second 10 patients were less than for those of the first 10 but there was no significant difference. The median hospital stay of the first 10 patients was 5.4 days (range, 2-10 days), significantly longer than the 2.5 days of the second 10 (range, 2-7 days) ( P = .009). Conclusions Laparoscopic nephrectomy operation times in children reduced when the surgical experience level exceeded approximately 10 cases.

OBJECTIVES To investigate the roles of glutathione and glutathione-S-transferase (GST) in cisplatin-resistance mechanisms in human bladder cancer, by using glutathione-depleting or GST-blocking agents. MATERIALS AND METHODS Cisplatin-resistant human bladder cancer cell lines were established by continuous exposure of T24 cells to increasing concentrations of cisplatin. Buthionine sulphoximine (BSO), ethacrynic acid and indomethacin were used to deplete glutathione or block GST. Intracellular glutathione content, GST activity and cisplatin cytotoxicity were determined after exposing parental and drug-resistant cell lines to these agents. RESULTS Intracellular glutathione content and GST activity were significantly decreased, and cisplatin cytotoxicity significantly enhanced, in both parental and resistant cell lines by glutathione-depleting or GST-blocking agents. However, the resistance of cisplatin-resistant cell lines did not fully recover to that of the parental cells with combined BSO and indomethacin. CONCLUSIONS Both increased glutathione content and GST activity are significant in the cisplatin resistance of human bladder tumour cells. Because BSO, ethacrynic acid and indomethacin caused a partial recovery of resistance in the cisplatin-resistant cell line, further studies are needed to investigate their efficacy for treating patients with metastatic bladder carcinoma resistant to cisplatin.

The pathogenesis of liver fibrosis has evolved dramatically in recent years. Hepatic stellate cells (HSCs) have been recognized as the main fibrogenic cells in the injured liver, and key fibrogenic cytokines have been identified. We propose the use of DNA microarrays to study changes in gene expression in activated HSCs and in fibrotic livers in order to identify key genes involved in liver fibrosis. For this purpose, RNA can be extracted from both cultured cells and liver tissue. The target RNA is hybridized to probes, which are gene-specific sequences immobilized on chips. The hybridization signal is assessed using a confocal laser scanner. Comparison of hybridization signals and patterns allows the identification of mRNAs that are differentially expressed. Statistical analysis enables classification and clustering of genes according to their up- or downregulation. By using this powerful technique, we have identified genes that are differentially regulated in both HSCs and the fibrotic human liver.

Iron-containing mesoporous material, Fe-MCM-41, with 4 mol% Fe loading was prepared by direct synthesis route and characterization was performed using XRD, SEM/TEM, EDS, N 2 adsorption, and FT-IR and UV-Vis spectroscopies. Fe-MCM-41 exhibited high catalytic activity in phenol hydroxylation using H 2 O 2 as oxidant, giving phenol conversion of ca. 60% at 50 °C [phenol:H 2 O 2 =1:1, water solvent], and the factors affecting the reaction were examined. Multi-walled carbon nanotubes (MWCNTs) were also prepared using Fe-MCM-41 in a CVD reactor using acetylene as a carbon source at 700 °C. These studies revealed that Fe-MCM-41 is a useful catalyst for diverse uses, despite problems in thermal stability of the Fe species incorporated in mesoporous silica structure.

fistula resulting from migration of a biliary stent: a case report. Gastrointest Endosc 1998;48:80-3. 12. Yoshida EM, Steinbrecher UP. Abdominal pain and rectal bleeding as a complication of biliary stent migration in a liver transplant recipient. Gastrointest Endosc 1998;47:418-20. 13. Liebich-Bartholain L, Kleinau U, Elsbernd H, Buchsel R. Biliary pneumonitis after proximal stent migration. Gastrointest Endosc 2001;54:382-4. 14. Tan CC, Hall RI, Pallan JP, Irons RP, Freeman JG. Transhepatic proximal migration of percutaneous-endoscopic biliary stent presenting as an abdominal wall abscess. Gastrointest Endosc 1996;43:152-4. Brief Reports B-I Lee, B-W Kim, H Choi, et al.

Angiotensin II (Ang II) is a pro-oxidant and fibrogenic cytokine. We investigated the role of NADPH oxidase in Ang II-induced effects in hepatic stellate cells (HSCs), a fibrogenic cell type. Human HSCs express mRNAs of key components of nonphagocytic NADPH oxidase. Ang II phosphorylated p47phox, a regulatory subunit of NADPH oxidase, and induced reactive oxygen species formation via NADPH oxidase activity. Ang II phosphorylated AKT and MAPKs and increased AP-1 DNA binding in a redox-sensitive manner. Ang II stimulated DNA synthesis, cell migration, procollagen alpha1(I) mRNA expression, and secretion of TGF-beta1 and inflammatory cytokines. These effects were attenuated by N-acetylcysteine and diphenylene iodonium, an NADPH oxidase inhibitor. Moreover, Ang II induced upregulation of genes potentially involved in hepatic wound-healing response in a redox-sensitive manner, as assessed by microarray analysis. HSCs isolated from p47phox-/- mice displayed a blunted response to Ang II compared with WT cells. We also assessed the role of NADPH oxidase in experimental liver fibrosis. After bile duct ligation, p47phox-/- mice showed attenuated liver injury and fibrosis compared with WT counterparts. Moreover, expression of smooth muscle alpha-actin and expression of TGF-beta1 were reduced in p47phox-/- mice. Thus, NADPH oxidase mediates the actions of Ang II on HSCs and plays a critical role in liver fibrogenesis.

We studied the expression of trefoil peptides in the different types of intestinal metaplasia of the stomach. Endoscopic biopsy was performed in 132 patients with dyspepsia. Intestinal metaplasia subtype was classified according to the pattern of alcian blue/PAS staining and high iron diamine staining. Expression of trefoil peptides was measured by immunohistochemistry. TFF1 and TFF3 were mainly expressed in goblet cells and TFF2 in columnar cells in all the types of intestinal metaplasia. There was a gradual decrease of TFF1 and TFF3, and increase of TFF2, during the progression of intestinal metaplasia from type I to type III via the type II intermediate.

Objective To investigate the histologic and molecular changes in the ipsilateral and contralateral epididymides in response to unilateral testicular torsion followed by detorsion. Design Controlled experimental study using rats. Setting Seoul National University College of Medicine, Seoul, Korea. Animal(s) Thirty-five, 8-week-old Sprague-Dawley male rats: six experimental groups and a sham-operated control group. Intervention(s) Testes of male rats were subjected to torsion for 10 minutes. At 0, 1, 4, 8, 24 hours and 1 week after detorsion, ipsilateral and contralateral epididymides were harvested. Microscopic examination and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) staining was performed. The percentage of apoptotic ducts in the epididymis was determined by counting 100 duct cross-sections of the head and the tail of the epididymis of each specimen. Main outcome measure(s) Morphologic change, including in situ apoptosis, of the ductal epithelium was evaluated. Result(s) There was no evidence of morphologic or apoptotic changes in the 0- or 1-hour detorsion groups. However, enlargement of the interstitial fibrous tissue was found 8 and 24 hours after detorsion and marked degeneration of ductal epithelium was observed at 1week in both the ipsilateral and contralateral epididymides. Apoptosis was first observed at 4 hours after detorsion, and the percentage of apoptotic ducts was significantly increased at 8 hours, peaked at 24 hours, and slightly decreased at 1 week in both the ipsilateral and contralateral epididymides. Conclusion(s) Both morphologic changes and intracellular molecular alterations occur not only in the ipsilateral but also in the contralateral epididymis following unilateral testicular torsion/detorsion.

Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.

Applying proper coding is important for doctors practicing gastroenterology. The coding systems established by various organizations define tumors differently. As a result of changing concepts of tumor classification, there are coding and reimbursement issues following the confirmation of malignant lesions by nationwide cancer screening in patients with intramucosal carcinoma and neuroendocrine tumors of the colorectum. In addition, there have been discrepancies between the views of endoscopists and pathologists regarding tumor coding. The Korean Society of Gastrointestinal Endoscopy held an expert meeting and established a consensus for the coding of intramucosal carcinoma and neuroendocrine tumor of the colorectum.

Serum levels of hepatitis B virus (HBV) DNA are direct measures of viral replication in hepatocytes. We compared branched-DNA assay (Quantiplex(TM), bDNA) and Hybridization Capture II (HCII), and evaluated the clinical significance of HBV DNA quantitation in the natural course of HBV infection.We analyzed results of bDNA in 324 serum samples from 83 untreated male patients with chronic hepatitis B. Mean follow up period was 11.8 years. HCII was also performed in 157 arbitrarily selected samples.HBV DNA levels measured with two assays were very similar (r(2)=0.893, p0.0001). HBV DNA detection rate of HCII was 6.4% higher than that of bDNA in HBeAg positive samples. HBV DNA detection rate was higher in cases with higher ALT. Among 73 patients with initial diagnosis of chronic hepatitis, 38 patients (52.1%) experienced progression to cirrhosis, and hepatocellular carcinoma (HCC) was developed in 9 (12.3%). HCC was developed in 5 (50.0%) of 10 patients with initial diagnosis of cirrhosis. While HBeAg positive rates during chronic hepatitis, cirrhosis and HCC were 57.8%, 55.0% and 14.3%, respectively (p=0.006), HBV DNA detection rates were 70.6%, 64.0% and 42.9%, respectively (p=0.08). Especially in HCC, the discrepancy between HBeAg positive rate and HBV DNA detection rate may suggest the appearance of variants which cannot produce HBeAg.Both HCII and bDNA were similar HBV DNA quantitation assays for clinical use. HBV DNA level correlated with the severity of liver disease. Screening tests for HCC should be recommended in patients whose HBeAg is negative and have detectable HBV DNA.

Telomere shortening controls the entry of cells into senescence. Functional expression of the telomerase catalytic subunit (human telomerase reverse transcriptase or hTERT) stabilizes telomere length and extends the life span of various normal human cells. Our aim was to assess the role of telomerase activity and telomere maintenance in regulating the proliferation of activated human hepatic stellate cells (HSCs), to establish an immortal human HSC cell line. Human HSCs were isolated from surgical specimens of normal liver and infected with a retrovirus expressing hTERT. Ectopic expression of hTERT reconstituted telomerase activity and maintained telomere length in human HSCs. Control human HSCs, which were either not infected or infected with a retroviral vector containing only the neomycin resistance gene, showed no detectable telomerase activity and had slightly shortened telomeres. These telomerase-negative HSCs entered a nondividing state after about 9 to 15 passages and senesced. In contrast, telomerase-positive HSCs to date have undergone 69 passages. Telomerase-positive HSCs did not undergo oncogenic transformation and exhibit morphologic and functional characteristics of activated HSCs. Microarray and RT-PCR analysis showed that mRNA expression patterns in telomerase-positive HSCs are very similar to those in activated human HSCs. Plating telomerase-positive HSCs on a basement membrane-like matrix reverts them toward a more quiescent phenotype. In conclusion, introduction of hTERT into activated human HSCs immortalizes them and maintains their activated phenotype. This newly developed cell line will be a useful tool to study the cell biology of human HSCs in culture.