No abstract available.
Prospective Studies*

The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.
Adenocarcinoma ; Adenoma* ; Colon ; Follow-Up Studies*

BACKGROUND/AIMS: Infection with Helicobacter pylori activates a proinflammatory gene program in human gastric epithelial cells and is associated with significant epithelial cell damage. We evaluated whether H. pylori infection could increase apoptosis of gastric epithelial cells via caspase-3 activation METHODS: After human gastric epithelial cells were infected with H. pylori, apoptosis was assessed by Hoechst staining, flow cytometric analysis, and cell death detection enzyme linked immunosorben assay. Caspase-3 activation was determined by the detection of the chromophore p-nitroanilide (pNA) after cleavage from the substrate DEVD-pNA. RESULTS: Activation of caspase-3 was first apparent 12 hours and the phenotypic expression of apoptosis was first apparent 18 hours after H. pylori infection The addition of DEVD-fmk inhibited apoptosis of H. pylori-infected epithelial cells. The addition o TNF alpha significantly increased caspase-3 activation and apoptosis of Hs746T gastric epithelial cells infected with H. pylori. The extent of apoptosis was similar in cases of cagA+cytotoxin+, cagA+ cytotoxin- or cagA-cytotoxin- H. pylori-infected gastric epithelial cell cultures. CONCLUSIONS: These results suggest that H. pylori can induce gastric epithelial cell apoptosis by activation of caspase-3 Furthermore, this apoptotic process can be induced directly by H. pylori and regulated by immunemediators such as TNF alpha.
Apoptosis* ; Caspase 3* ; Cell Death ; Epithelial Cells* ; Helicobacter pylori* ; Helicobacter* ; Humans*

BACKGROUND/AIMS: Intestinal epithelial cells can play a role in signaling the influx of inflammatory cells. We investigated the regulated expression of CXC and CC chemokines by intestinal epithelial cells in response to Clostridium difficile (C. difficile) infection. METHODS: Quantitative RT-PCR and ELISA were used to assess the expression of CXC and CC chemokines in human intestinal epithelial cells after stimulation with C. digcile toxin A. To determine the polarity of chemokine secretion, chemokine production was measured from culture supernatants of Caco-2 cells which were cultured in transwell chambers. RESULTS: The expression of the CXC chemokine, GRO-alpha and IL-8, increased in the first hr after stimulation. In contrast, the expression of epithelial neutrophil activating protein (ENA)-78 mRNA was delayed for 18 hr. The CC chemokine monocyte chemotactic protein (MCP)-1 mRNA, was expressed in 3 hr after stimulation. Upregulated mRNA expression of chemokines was paralleled by the increase of protein levels. After stimulating Caco-2 cells with toxin A, CXC and CC chemokines were released predominantly into the basolateral compartment. Moreover, the addition of IFN-y and tumor necrosis factor (TNF)-a to toxin A-stimulated Caco-2 cells showed an increased basolateral release of CC chemokine, MCP-1. CONCLUSIONS: These results suggest that the expression of CXC and CC chemokine in the epithelial cells stimulated with C. difficile toxin A may be an important factor in the mucosal inflammatory response.
Caco-2 Cells ; Chemokines ; Chemokines, CC ; Clostridium difficile* ; Clostridium* ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Humans ; Interleukin-8 ; Monocytes ; Neutrophils ; RNA, Messenger ; Tumor Necrosis Factor-alpha

BACKGROUND AND AIMS: Some water soluble proteins released from Helicobacter pylori (H. pylori) may serve as chemoattractants for neutrophils. Once extravasated, neutrophils may be themselves a source of interleukin-8 (IL-8), further amplifying inflammatory response. We evaluated the expression of IL-8 and the activation of human neutrophils by H. pylori products. METHODS: After human neutrophils were stimulated with H. pylori culture supernatant, the expression of IL-8 mRNA and potein were assessed by quantitative RT- PCR and ELISA for up to 9 hours, respectively. Neutrophil adhesion capacity was determined by the expression of LFA-1B using flow cytometry and the secretion of myeloperoxidase was measured by ELISA. After acetohydroxamic acid (AHA) and/or N-t-butoxycar-bonyl-methionyl- leucyl-phenylalanine (BOC-MLP) was added, IL-8 ELISA was performed until 9 h after the stimulation. The IL-8 level was determined by ELISA after the administration of urease or fMLP in various concentrations. RESULTS: The level of IL-8 mRNA in stimulated neutrophils was increased by 16- to 67-folds, compared with the level in unstimulated neutrophils (peaked at 2 hours). The amount of IL-8 protein was markedly increased at 4 hours. H. pylori culture supernatant enhanced the expression of LFA-1B and the secretion of myeloperoxidase. AHA and/or BOC-MLP decreased IL-8 production. After stimulation by urease or fMLP, the level of IL-8 production of neutrophils paralleled the administered dose. CONCLUSIONS: H. pylori-induced neutrophil recruitment may be mediated via IL-8 from neutrophils activated by urease and fMLP. This may explain gastric mucosal inflammatory response to the non-invasive organism.
Humans

No abstract available.

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.
Biopsy ; Brain Stem ; Central Nervous System ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Frontal Lobe ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Tuberculoma ; Tuberculosis ; Tuberculosis, Pulmonary

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.
Biopsy ; Brain Stem ; Central Nervous System ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Frontal Lobe ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Tuberculoma ; Tuberculosis ; Tuberculosis, Pulmonary

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.
Biopsy ; Brain Stem ; Central Nervous System ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Frontal Lobe ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Tuberculoma ; Tuberculosis ; Tuberculosis, Pulmonary

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.
Biopsy ; Brain Stem ; Central Nervous System ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Frontal Lobe ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Tuberculoma ; Tuberculosis ; Tuberculosis, Pulmonary