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Biomedical subjects

K G Park

Publications and source records attributed to K G Park.

At least 19 recordsLinked to original sources

Transcription factor decoy for AP-1 reduces mesangial cell proliferation and extracellular matrix production in vitro and in vivo.

Diabetic nephropathy is characterized by an expansion of glomerular mesangium, caused by mesangial cell proliferation and excessive accumulation of extracellular matrix (ECM) proteins, which eventually leads to glomerulosclerosis and renal failure. Activator protein-1 (AP-1), a transcription factor, is implicated in the transcriptional regulation of a wide range of genes participating in cell proliferation and ECM production. This investigation was undertaken to test the hypothesis that AP-1 plays an important role in ECM gene expression, and to develop a molecular therapeutic strategy based on decoy oligodeoxynucleotides (ODN). In this report, we show that transfection with AP-1 decoy ODN strongly inhibits high glucose- and angiotensin II-induced cell proliferation and expression of ECM genes in cultured mesangial cells in vitro. Administration of AP-1 decoy ODN into streptozotocin-induced diabetic rat kidney in vivo using the hemagglutinating virus of Japan (HVJ)-liposome method virtually abolished TGF-beta1 and plasminogen activator inhibitor-1 expression. Our results collectively indicate that AP-1 activation is crucial for mesangial cell proliferation and ECM production in response to high glucose and angiotensin II. Moreover, use of stable AP-1 decoy ODN combined with the highly effective HVJ-liposome method provides a novel potential molecular therapeutic strategy for the prevention of diabetic nephropathy.

Angiotensin II↗

Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery.

BACKGROUND: Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the quality of surgical care provided. Comparison of rates between and within institutions depends on the use of standard definitions and methods of measurement of anastomotic leak. The aim of this study was to review the definition and measurement of anastomotic leak after oesophagogastric, hepatopancreaticobiliary and lower gastrointestinal surgery. METHODS: A systematic review was undertaken of the published literature. Searches were carried out on five bibliographical databases (Medline, Embase, The Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and HealthSTAR) for English language articles published between 1993 and 1999. Articles were critically appraised by two independent reviewers and data on definition and measurement of anastomotic leak were extracted. RESULTS: Ninety-seven studies were reviewed and a total of 56 separate definitions of anastomotic leak were identified at three sites: upper gastrointestinal (13 definitions), hepatopancreaticobiliary (14) and lower gastrointestinal (29). The majority of studies used a combination of clinical features and radiological investigations to define and detect anastomotic leak. CONCLUSION: There is no universally accepted definition of anastomotic leak at any site. The definitions and values used to measure anastomotic failure vary extensively and preclude accurate comparison of rates between studies and institutions.

Anastomosis, Surgical↗

Prognostic value of laparoscopic ultrasound in patients with gastro-esophageal cancer.

Forty-four patients with gastro-esophageal tumors regarded as resectable by conventional staging underwent laparoscopic ultrasonography (LUS). Following LUS, seven were found to be irresectable and were managed by palliative therapies. Thirty-seven patients proceeded to surgical exploration and 36 were resected (R0 80%, R1 11%, and R2 9%). All patients were reviewed until death or for a minimum of 24 months. Patients undergoing resection had a 62% 1-year survival (median 17 months; confidence intervals, CI 6-28). LUS defined nodal status indicated a trend toward prolonged survival in the node-negative group, median 22 months (CI 5-39), compared with 13 months (CI 6-20) in the node-positive group. Disease-free survival was greater in LUS node-negative patients at 29 months (CI 23-35) compared with node-positive patients at 13 months (CI 5-21) P=0.0083. LUS staging allows prediction of the likelihood of recurrence of gastro-esophageal malignancies. This may prove useful for the appropriate allocation of patients to primary and adjuvant therapies.

Adult↗

Laparoscopic port site recurrence in the absence of intra-abdominal disease.

A case is reported of a patient who presented with recurrent tumour at the site of a laparoscopy port where there had been no evidence of intra-abdominal tumour. Possible mechanisms of recurrence are postulated including a haematogenous spread of the primary tumour and the implantation at the port site.

Aged↗

D2 gastrectomy for an antral stomach tumour.

The place of a D2 gastrectomy for dealing with an antral stomach cancer inpatients in the West is a matter of continuing debate. This article describes a standardised operative procedure with the aim of achieving a satisfactory clearance of the gastric cancer in the antrum and a systematic removal of the regional draining lymphatics.

Duodenum↗

Familial gastric cancer: overview and guidelines for management.

Families with autosomal dominant inherited predisposition to gastric cancer have been described. More recently, germline E-cadherin/CDH1 mutations have been identified in hereditary diffuse gastric cancer kindred. The need to have protocols to manage and counsel these families in the clinic led a group of geneticists, gastroenterologists, surgeons, oncologists, pathologists, and molecular biologists to convene a workshop to produce consensus statements and guidelines for familial gastric cancer. Review of the available cancer pathology from people belonging to families with documented germline E-cadherin/CDH1 mutations confirmed that the gastric cancers were all of the diffuse type. Criteria to define the different types of familial gastric cancer syndromes were agreed. Foremost among these criteria was that review of histopathology should be part of the evaluation of any family with aggregation of gastric cancer cases. Guidelines for genetic testing and counselling in hereditary diffuse gastric cancer were produced. Finally, a proposed strategy for clinical management in families with high penetrance autosomal dominant predisposition to gastric cancer was defined.

Cadherins↗

Detection of response to chemotherapy using positron emission tomography in patients with oesophageal and gastric cancer.

BACKGROUND: The aim of the study was to determine whether 2-[18F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) could detect response to chemotherapy in patients with oesophageal and gastric cancer. METHODS: Fourteen patients underwent imaging before and after chemotherapy using FDG-PET. Computed tomography (CT), dysphagia scores and weight changes were used for comparison of evidence of response. Tumour to liver ratios (TLRs) and influx constants for FDG (K) were used for quantification purposes. RESULTS: Thirteen of 14 lesions were successfully imaged before therapy. Changes were seen in all follow-up scans, ranging from a complete response to a 15 per cent increase in tumour FDG uptake. Response was demonstrated by CT in four patients; all four had large reductions in FDG uptake after chemotherapy. Two patients with an increase in FDG uptake reported no improvement in dysphagia and continued to lose weight during therapy. CONCLUSION: Changes in tumour FDG uptake were seen in all tumours after chemotherapy. FDG-PET may have a role to play in the assessment of patients with upper gastrointestinal malignancy receiving chemotherapy.

Adenocarcinoma↗

Training for minor surgery in general practice: is it adequate?

To assess training and operative practice in minor surgery a postal questionnaire was sent to all general practitioners practising in the Scottish Highlands and Western Isles in 1992. Information was requested regarding the type and adequacy of surgical training, operations performed, the desire for surgical skills training and possible methods of assessment. Seventy per cent (144/205) of general practitioners (GPs) replied to the questionnaire. Teaching in minor surgery had been received by 74% of GPs (107/144), yet 43% (62) considered their training inadequate. Although confident to suture simple wounds or excise skin lesions from the trunk, significantly fewer were confident to excise such lesions from the face (P < 0.001, 1 df, Chi square test). From 86% of GPs (124/144) who wished to attend a training course on minor surgery, 62% (77) would prefer to be taught on patients and 36% (45) on a realistic skin simulator. Assessment of technical competence by a hospital consultant was considered desirable by 56% (80/144) either on patients 40% (57), or using a skin simulator 38% (54). While most GPs receive some training in minor surgery, there is a perceived need for improved training. The use of a skin simulator may allow both the teaching and assessment of surgical competence for GPs who undertake minor surgery.

Adult↗

Accuracy of laparoscopic ultrasonography in the staging of upper gastrointestinal malignancy.

Laparoscopic ultrasonographic staging was compared prospectively with conventional computed tomography (CT) and ultrasonographic staging of 24 lower-third oesophageal tumors and 20 gastric malignancies. Following laparoscopic ultrasonography, seven patients regarded as being resectable after conventional imaging were excluded from surgical exploration because of ascites with peritoneal deposits (four patients), liver metastases (one), advanced local disease (one) and poor tolerance of general anaesthesia (one). Preoperative T and N stages were compared with the pathological staging following resection in 34 patients. Laparoscopic ultrasonography was significantly more accurate than conventional CT and ultrasonography in assessment of the primary tumour (91 versus 64 per cent, P < 0.01) and nodal status (91 versus 62 per cent, P < 0.05). The addition of laparoscopic ultrasonography to conventional procedures for staging upper gastrointestinal malignancy improved the overall accuracy of staging. Although this may have future implications for the selection of patients for multimodality treatment, management decisions are currently based on laparoscopic findings, which in this study resulted in a resection rate of 97 per cent.

Gastrointestinal Neoplasms↗

Gastric lymphoma in Grampian Region: presentation, treatment and outcome.

Forty cases of gastric lymphoma presenting in Grampian Region (1974-91) were reviewed to examine the effects of changing ideas in the fields of chemotherapy, gastric surgery and diagnostic techniques, as well as the impact of Helicobacter pylori. Presentation was non-specific, and the diagnosis was made pre-operatively in only 12 cases. Survival was related to tumour size, staging (Ann Arbor), and grade, with a crude 5-year survival of 49%. Helicobacter pylori was found in all specimens reviewed. Patients who underwent "potentially curative' surgery followed by adjuvant therapy had the best survival (85% at 5 years). There remains a need for larger studies to define the best treatment for this uncommon condition.

Adult↗

Gallbladder motility in diabetes mellitus using real time ultrasonography.

OBJECTIVES: Diabetes mellitus is one of the risk factors in cholesterol gallstones. Individuals with diabetes mellitus are reported to have a 2-fold to 3-fold increase in the incidence of cholesterol gallstones. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes. METHODS: We compared the gallbladder volume and ejection fraction of 24 diabetics with those of 19 age-matched and weight-matched controls using real-time ultrasonography. Blood sampling for biochemical study of all the subjects were performed. RESULTS: No significant differences in any physiochemical parameters between the diabetic group and control group could be found. Fasting gallbladder volume increased significantly in the diabetic group (21.90 +/- 9.53 cm3) compared with the control group (16.99 +/- 5.97 cm3). Gallbladder volume measured after a fatty meal were greater in the diabetic group (10.76 +/- 7.19 cm3) than in the control group (4.22 +/- 3.31 cm3) (p < 0.04). When the diabetic group was divided according to the presence or absence of autonomic neuropathy, a significant reduction of ejection fraction was found in diabetics with autonomic neuropathy (42.75 +/- 19.37%) in comparison with diabetics without autonomic neuropathy (61.75 +/- 17.63%) (p < 0.02). CONCLUSIONS: Gallbladder volume in diabetics was significantly greater compared with that of the control. Moreover, in diabetics with autonomic neuropathy, gallbladder motility was markedly reduced in comparison to diabetics without autonomic neuropathy. Thus, we suggest that impairment of gallbladder motility complicated with autonomic neuropathy causes stasis and results in cholesterol gallstone crystal formation and gallstone growth.

Autonomic Nervous System Diseases↗

Prediction of recurrent bleeding after endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage.

Endoscopic haemostasis by injection of adrenaline was attempted in 135 consecutive patients with active upper gastrointestinal bleeding. Initial haemostasis was obtained in 127 patients following injection of 5-15 ml 1:10,000 adrenaline; eight patients in whom haemostasis was not achieved underwent immediate laparotomy. There was further haemorrhage in 25 patients, which was successfully treated by further injection of adrenaline in ten. Fifteen patients had major rebleeding requiring emergency surgery. Stepwise logistic regression analysis identified three factors that, taken together, were highly predictive of the need for surgery: pulse rate on admission, the position of the ulcer and whether the patient was obese. A scoring system was derived from the logistic analysis equation that was found to predict correctly the need for emergency surgery in 84 per cent of patients. In patients with a high probability of rebleeding surgery should be considered after initial endoscopic haemostasis and stabilization. In the majority of patients endoscopic treatment alone is sufficient for permanent haemostasis.

Adolescent↗

Loop ileostomy fixation: a simple technique to minimise the risk of stomal volvulus.

Turnbull's "loop" ileostomies is a routinely performed procedure in the management of a variety of colorectal problems. Mechanical and functional complications occur with both permanent and temporary ileostomies, however they are more common with the loop than with the end (Brooke) variety. With the advent of restorative proctocolectomy with pouch formation, and the documented benefit of simultaneous temporary faecal diversion, the incidence of such complications will rise. Bowel obstruction, requiring laparotomy in the interval before stoma closure, is more commonly associated with the loop ileostomy. A loop stoma is routinely brought out directly through the abdominal wall, with little or no fixation or closure of the lateral space. However, anti-mesenteric fixation, as described here, minimises the risk of volvulus by widening the attachment of the adjacent ileum to the parities, creating a broader fulcrum. Since adopting this simple technique, we report no complications in over 30 loop ileostomies, "fixed" by this technique and followed up for a minimum of 4 years. Where applicable, no difficulty was encountered with stoma closure, either by a transverse single layer serosubmucosal technique, or as a minimal resection with end to end anastomosis (sewn or stapled), following bowel mobilisation. This technique should minimise the frequency of obstructive events, and we recommend it's routine use.

Adolescent↗

Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis?

Endometriotic deposits are not uncommon in the large bowel of women. Because the symptoms produced by endometriosis may lead to investigation by colorectal endoscopic biopsy, the aims of this study were to assess the range of mucosal abnormalities that may occur and to determine whether this could represent a significant potential diagnostic problem. We found mucosal changes in eight of 10 cases of colorectal endometriosis; however, the abnormalities (ulceration, gland architectural disturbance, crypt abscess formation, increased inflammatory cell presence, and smooth muscle fibers between glands in the mucosa) were focal and directly related to endometrial deposits. In one case an abnormal colonic biopsy specimen from a patient with endometriosis supported the erroneous clinical diagnosis of Crohn's disease. Comparing a group of women with endometriosis to a group with adenomyosis of the uterus showed that although more women with endometriosis have endoscopic large bowel biopsies, there was no significant excess of biopsy specimens showing inflammatory changes. Our conclusion is that the endometriosis of the large bowel can masquerade as inflammatory bowel disease or ischemic changes and the possibility should be borne in mind, particularly in cases with atypical clinical features or very focal histological changes.

Adult↗

Tumour and host tissue responses to branched-chain amino acid supplementation of patients with cancer.

1. Rates of protein synthesis have been measured from the incorporation of 57 mg of L-[1-13C]leucine/kg for 90 min into muscle tissue and colorectal tumours removed at surgery from cancer patients. 2. For the 20 h preceding surgery and during the measurement of protein synthesis, the patients received intravenous saline, conventional intravenous nutrition (0.2 g of N and 103 non-protein kJ/kg body weight) or intravenous nutrition enriched with the branched-chain amino acids leucine, isoleucine and valine (0.2 g of N with 30% from branched-chain amino acids and 103 non-protein kJ/kg body weight). 3. Conventional intravenous nutrition resulted in a significant stimulation of the rate of protein synthesis in both muscle tissue (2.64 +/- 0.75%/day versus 1.78 +/- 0.51%/day in saline control, means +/- SD) and tumour tissue (43.9 +/- 10.3%/day versus 22.6 +/- 5.6%/day in saline control). 4. Pre-operative nutrition enriched with branched-chain amino acids was less effective than conventional intravenous nutrition in stimulating protein synthesis in both muscle and tumour. The rates of protein synthesis were 2.12 +/- 0.41%/day in muscle and 33.7 +/- 5.3%/day in the tumours. 5. The expression of proliferating cell nuclear antigen in sections of the tumours showed changes with intravenous feeding of the two different amino acid mixtures that were similar to the changes in protein synthesis, and these two variables were significantly correlated. This is evidence that feeding with conventional mixtures and mixtures enriched with branched-chain amino acids stimulates tumour growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Lymphocyte protein synthesis in vivo: a measure of activation.

1. The 'flooding' dose technique was used to measure rates of lymphocyte protein synthesis after infusion of [1-13C]leucine (20 atoms % enrichment, 4 g/70 kg body weight). Lymphocyte protein synthesis was measured in healthy subjects and in patients with metastatic colorectal cancer before and during infusion of recombinant interleukin-2. Rates of protein synthesis were compared with thymidine uptake in vitro and phenotypic analysis of lymphocytes. 2. The median rate of lymphocyte protein synthesis in four healthy subjects was 9% (range 7.2-11.4%/day) and in seven patients with colorectal cancer was 6.4% (range 4.2-8.2%/day). After recombinant interleukin-2 treatment the median rate of lymphocyte protein synthesis was 27.8% (range 25.2-33.7%/day). 3. The increased rates of lymphocyte protein synthesis in vivo, after recombinant interleukin-2 infusion, corresponded with increased rates of thymidine uptake and changes in the phenotypic expression of lymphocytes, but these were less consistent than the measured rates of protein synthesis. 4. It is concluded that lymphocyte activation is accompanied by a marked increase in lymphocytic protein synthesis which may have important implications for whole body protein metabolism. Furthermore, measurement of lymphocyte protein synthesis may provide a determination of lymphocyte activation in vivo.

Adult↗