A Case of Acute Fatty Liver of Pregnancy Combined with Acute A Viral Hepatitis

( Hyung Bin Yuk ),( Tae Hee Lee ),( Suk Hyun Jang ),( Min Ji Park ),( Sun Hee Oh ),( Ki Hyun Rhyu ),( Hoon Sup Koo ),( Kyung Ho Song ),( Sun Moon Kim ),( Kyu Chan Huh ),( Young Woo Choi ),( Young Woo 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Acute fatty liver of pregnancy, characterized by microvesicular fatty infiltration of hepatocytes, is a disorder which is unique to human pregnancy. It was described in 1940 and was initially thought to be universally fatal. However, early diagnosis and prompt delivery have dramatically improved the prognosis, and maternal mortality should now be the exception rather than the rule. Acute fatty liver occurs typically in the third trimester. The disease is always present before delivery, although it is not always diagnosed prior to delivery. A 34-year-old female at 36-week gestation, presented with generalized myalgia, cold sweating, headache, easy fatigue, dark yellowish urine. She didn’t have any specific past history. Physical examination revealed icteric skin color and dark yellowish urine. Her temperature was 37.9℃, pulse rate was 98/min, respiratory rate 20/min, and blood pressure 90/60mmHg. Ultrasonography reveal IUP around 36 weeks, low parenchymal echoes with GB wall edema and sludges from suspicious acute hepatitis and fatty changes of liver. Initial laboratory finding revealed no anemia, no thrombocytopenia and PT 25.9sec prolongation, INR 2.33, aPTT 36.9sec, fibrinogen 2.38g/L, antithrombin III 53%, D-dimer 26.38ug/ml, FDP 95.2ug/ml, AST > 10,000 IU/L, ALT 2,100 IU/L, protein 5.62g/dl, albumin 3.12g/dl, total bilirubin 3.06mg/dl, direct bilirubin 1.86mg/dl, r-GT 73IU/L. Influenza test was negative. Blood culture was no growth. Serology tests like CMV, EBV, HBsAg, HCV, HEV and HIV were all negative except anti-HAV IgM positive. A presumptive diagnosis of AFLP and acute A viral hepatitis was made. It was decided to perform an emergency lower segment caesarean section was performed 23 hours after admission. After delivery, laboratory finding was dramatically improved except bilirubin, that is, AST 4,520 IU/L, ALT 1,180 IU/L, protein 6.16g/dl, albumin 3.53g/dl, and total bilirubin 3.88mg/dl, Anti-HAV IgM was still positive. Twenty days later, laboratory finding revealed AST 69 IU/L, ALT 12 IU/L, total bilirubin 14.74mg/dl. Although bilirubinemia was continued, the increment stopped. So we planned discharge. She was discharged on hospital day 21. Seven days later, on outpatient department total bilirubin fell to 8.84mg/dl. This report is concerned with a case of 34-year-old female at 36-week gestation with AFLP and acute A viral hepatitis. We believe that this is the first case report of AFLP with acute A viral hepatitis in the world.

<i>Zanthoxylum ailanthoides</i> Suppresses Oleic Acid-Induced Lipid Accumulation through an Activation of LKB1/AMPK Pathway in HepG2 Cells

Kwon, Eun-Bin,Kang, Myung-Ji,Kim, Soo-Yeon,Lee, Yong-Moon,Lee, Mi-Kyeong,Yuk, Heung Joo,Ryu, Hyung Won,Lee, Su Ui,Oh, Sei-Ryang,Moon, Dong-Oh,Lee, Hyun-Sun,Kim, Mun-Ock Hindawi 2018 Evidence-based Complementary and Alternative Medic Vol.2018 No.-

<P><I>Zanthoxylum ailanthoides</I> (ZA) has been used as folk medicines in East Asian and recently reported to have several bioactivity; however, the studies of ZA on the regulation of triacylglycerol (TG) biosynthesis have not been elucidated yet. In this study, we examined whether the methanol extract of ZA (ZA-M) could reduce oleic acid- (OA-) induced intracellular lipid accumulation and confirmed its mode of action in HepG2 cells. ZA-M was shown to promote the phosphorylation of AMPK and its upstream LKB1, followed by reduction of lipogenic gene expressions. As a result, treatment of ZA-M blocked de novo TG biosynthesis and subsequently mitigated intracellular neutral lipid accumulation in HepG2 cells. ZA-M also inhibited OA-induced production of reactive oxygen species (ROS) and TNF-<I>α</I>, suggesting that ZA-M possess the anti-inflammatory feature in fatty acid over accumulated condition. Taken together, these results suggest that ZA-M attenuates OA-induced lipid accumulation and inflammation through the activation of LKB1/AMPK signaling pathway in HepG2 cells.</P>

<i>Tripterygium regelii</i> decreases the biosynthesis of triacylglycerol and cholesterol in HepG2 cells

Kang, Myung-Ji,Kwon, Eun-Bin,Yuk, Heung Joo,Ryu, Hyung Won,Kim, Soo-Yeon,Lee, Mi-Kyeong,Moon, Dong-Oh,Lee, Su Ui,Oh, Sei-Ryang,Lee, Hyun-Sun,Kim, Mun-Ock Informa UK (TaylorFrancis) 2017 Bioscience, Biotechnology, and Biochemistry Vol.81 No.12

<P>In the course of screening to find a plant material decreasing the activity of triacylglycerol and cholesterol, we identified Tripterygium regelii (TR). The methanol extract of TR leaves (TR-LM) was shown to reduce the intracellular lipid contents consisting of triacylglycerol (TG) and cholesterol in HepG2 cells. TR-LM also downregulated the mRNA and protein expression of the lipogenic genes such as SREBP-1 and its target enzymes. Consequently, TR-LM reduced the TG biosynthesis in HepG2 cells. In addition, TR-LM decreased SREBP2 and its target enzyme HMG-CoA reductase, which is involved in cholesterol synthesis. In this study, we evaluated that TR-LM attenuated cellular lipid contents through the suppression of de novo TG and cholesterol biosynthesis in HepG2 cells. All these taken together, TR-LM could be beneficial in regulating lipid metabolism and useful preventing the hyper-lipidemia and its complications, in that liver is a crucial tissue for the secretion of serum lipids.</P>

S-68 A Primary Hepatic Leiomyoma in a Gastric Cancer Patient

( Sung Ju Kang ),( Suk Hyun Jang ),( Hyung Bin Yuk ),( Jang Sihn Sohn ),( Ki Hyun Ryu ),( Sun Moon Kim ) 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1

An asymptomatic, 57-year-old man without any significant medical history was referred to our hospital because of early gastric cancer and a hepatic mass. Esophagogastroduodenoscopy revealed a superficial elevated lesion with central depression approximately 20 mm in size in the posterior wall of the antrum of the stomach. Pathologic examination confirmed well-differentiated adenocarcinoma. The laboratory tests and tumor markers, including AFP, CA19-9, and CEA, were within the normal range. Computed tomography (CT) revealed the hepatic mass was approximately 33 mm in size in segment Ⅱ/Ⅲ of the liver. However, the imaging cannot reliably differentiate between sclerosing hemangioma and metastasis. He underwent a US-guided needle biopsy, but we couldn't obtain a biopsy specimen, as the firmness of the liver mass made it impossible to put the needle through into the core. Subsequently underwent a diagnostic laparoscopic wedge resection. The mass was histologically typical for a leiomyoma. Primary hepatic leiomyoma (PHL) is a very rare benign tumor, with only 36 cases reported in the world literature. Surgical resection is both diagnostic and curative. This is the first report describing PHL in the domestic literature and the first report describing PHL diagnosed with coexisting gastric cancer in the world literature. In conclusion, when the patient presents a hepatic mass with another malignancy, reliable tissue diagnosis is necessary to exclude this rare entity, especially if the imaging cannot reliably differentiate between hemangioma and metastasis.

A Case of HELLP Combined with AFLP

( Suk Hyun Jang ),( Tae Hee Lee ),( Hyung Bin Yuk ),( Min Ji Park ),( Sun Hee Oh ),( Hyun Rhyu ),( Kyung Ho Song ),( Hoon Sup Koo ),( Sun Moon Kim ),( Kyu Chan Huh ),( Young Woo Choi ),( Young Woo Kan 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

HELLP is an acronym that refers to a syndrome characterized by hemolysis with a microangiopathic blood smear, elevated liver enzyme, and a low platelet count. It probably represents a severe form of preeclampsia, but the relationship between the two disorders remains controversial. HELLP may be difficult to distinguish clinically from AFLP since both occur at the same time in gestation and share several clinical features. A 37-year-old female at 25-week gestation, twin pregnancy, presented with labor pain, abdominal pain, spotting vaginal bleeding. She didn’t have any specific medical history. Physical examination revealed alert mental status, acute ill looking appearance. Her blood pressure 124/67mm Hg. Initial laboratory finding revealed mild anemia, no thrombocytopenia, PT 11.0 sec, INR 1.00, aPTT 25.6 sec, AST 34 IU/L, ALT 37 IU/L, protein 6.36g/dl, albumin 3.28g/dl, total bilirubin 0.28mg/dl and no proteinuria. Serology tests like HBsAg, HCV, HIV and HAV were all negative. We tried to suppress premature labor using tocolytics. After fourteen days, liver function test abruptly increased from 71 to 1,680 and from 53 to 840, respectively AST and ALT during 2 days. In the same period, platelet fell from 183,000/uL to 23,000/uL. LDH was 2,192 IU/L. PT was still normal. Ultrasonography revealed IUP around 27 weeks, hepatomegaly with increased periportal echogenicity and secondary GB wall mild swelling, that is, hepatitis finding and increased parenchyme echogenicity of liver, that is, underlying severe fatty liver. Although we did not check hemolysis in PB smear, presumptive diagnosis of HELLP was made. It was decided to perform an emergency lower segment caesarean section performed after about 5 hours. One day later, laboratory finding was aggravated, that is, AST 4,900 IU/L, ALT 1,790 IU/L, protein 4.24g/dl, albumin 2.48g/dl, PT 17.3 sec, INR 1.57, aPTT 33.6 sec, fibrinogen 1.71 g/L, antithrombin 60%, platelet 29,000/uL. Bilirubin increased from 1.19mg/dl to 3.34mg/dl next five days. It revealed AFLP feature. We did supportive care. After six days later, overall finding was improved. There was no hemolysis in PB smear. This report is concerned with a case of 37-year-old female at 25-week gestation with HELLP and AFLP. We guess that this case is the mixed

Positive Vascular Remodeling in Culprit Coronary Lesion is Associated With Plaque Composition: An Intravascular Ultrasound-Virtual Histology Study

이정섭,서영훈,Dong Ju Yang,Ki Hong Kim,Hyun Woong Park,Hyung Bin Yuk,Moo-Sik Lee,Wan-Ho Kim,Taek-Geun Kwon,배장호 대한심장학회 2012 Korean Circulation Journal Vol.42 No.11

Background and Objectives: The relationship between the positive remodeling (PR) of a coronary artery and plaque composition has been studied only in a relatively small number of study population or non-culprit lesion. We evaluated the association between coronary plaque composition and coronary artery remodeling in a relatively large number of culprit lesions. Subjects and Methods: The study population consisted of 325 consecutive patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. The remodeling index (RI) was calculated as the lesion external elastic membrane (EEM) area divided by the average reference EEM area. Results: The lesions with PR (RI>1.05, n=97, mean RI=1.19±0.12) had a higher fibrous volume/lesion length (3.85±2.12 mm3/mm vs. 3.04±1.79 mm3/mm, p=0.003) and necrotic core volume/lesion length (1.26±0.89 mm3/mm vs. 0.90±0.66 mm3/mm, p=0.001) than those with negative remodeling (NR) (RI<0.95, n=132, mean RI=0.82±0.09). At the minimal luminal area site, the lesions with PR had a higher fibrous area (5.81±3.17 mm2 vs. 3.61±2.30 mm2, p<0.001), dense calcified area (0.73±0.69 mm2 vs. 0.46±0.43 mm2, p=0.001), and necrotic core area (1.93±1.33 mm2 vs. 1.06±0.91 mm2, p<0.001) than those with NR. RI showed significant positive correlation with fibrous volume/lesion length (r=0.173, p=0.002), necrotic core volume/lesion length (r=0.188, p=0.001), fibrous area (r=0.347, p<0.001), fibrofatty area (r=0.111, p=0.036), dense calcified area (r=0.239, p<0.001), and necrotic core area (r=0.334, p<0.001). Multivariate analysis showed that the independent factor for PR was the necrotic core volume/lesion length (beta=0.130, 95% confidence interval; 0.002-0.056, p=0.037) over the entire lesion. Conclusion: This study suggests that PR in a culprit lesion is associated with the necrotic core volume in the entire lesion, which is a characteristic of vulnerable plaque.

Impact of Plaque Composition on Long-Term Clinical Outcomes in Patients with Coronary Artery Occlusive Disease

김기홍,Wan Ho Kim,Hyun Woong Park,In Girl Song,Dong Ju Yang,서영훈,Hyung Bin Yuk,Yo Han Park,Taek-Geun Kwon,Charanjit S Rihal,Amir Lerman,이무식,Jang-Ho Bae 대한심장학회 2013 Korean Circulation Journal Vol.43 No.6

Background and Objectives: It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. Subjects and Methods: The study subjects consisted of 339 consecutive patients (mean 61.7±12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. Results: Patients with high fibrofatty volume (FFV, >8.90 mm 3 , n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p<0.001) and post-stent slow flow (10.7% vs. 2.4%, p=0.002) than those with low FFV (FFV ≤8.90 mm 3 , n=170). Other plaque composition factors such as fibrous area/volume, dense calcified area/volume, and necrotic core area/volume did not show any impact on MACCE. Cardiogenic shock {hazard ratio (HR)=8.44; 95% confidence interval (CI)=3.00-23.79; p<0.001 } and FFV (HR=1.85; 95% CI=1.12-3.07; p=0.016) were the independent predictors of MACCE by Cox regression analysis. Thin-cap fibroatheroma, necrotic core area, and necrotic core volume were not associated with MACCE. Conclusion: FFV of a culprit lesion was associated with unfavorable long-term clinical outcomes in patients with CAOD.

본태혈소판증가증 환자에서 골수흡인 및 생검 후 발생한 후복막출혈

정익주 ( Ik Ju Jung ),임승택 ( Seung Taek Lim ),최연석 ( Yeon Seok Choi ),장태수 ( Tae Soo Jang ),오선희 ( Sun Hee Oh ),육형빈 ( Hyung Bin Yuk ),조도연 ( Do Yeun Cho ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5

Bone marrow examination is useful in the diagnosis and staging of hematologic disease. This procedure is generally considered safe; however, there are several adverse events associated with bone marrow biopsy. The most frequent and serious adverse event is hemorrhage. Risk factors include coagulopathy, myeloproliferative disorders, and anticoagulant or antiplatelet medications. Most hemorrhage is local hematoma; however, infrequently retroperitoneal hemorrhage occurs. In the case of massive hemorrhage, operation or angiographic embolization may be required. We report on a case of retroperitoneal hemorrhage after bone marrow aspiration and biopsy in an essential thrombocythemia patient. (Korean J Med 2015;88:598-601)