A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 or = 65 yr) were independent risk factors for severe cases (all P or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.

The Usefulness of Endoscopic Retrograde Biliary Drainage Using Plastic Stents for Patients with Common Bile Duct Stone / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic sphincterotomy is considered the primary option for treatment of common bile duct (CBD) stones. In some cases, however, complete stone removal is difficult or even impossible. Endoscopic retrograde biliary drainage (ERBD) has been suggested to be an alternative treatment in such cases or in patients with high surgical risks. In this study, we evaluated the effectiveness of ERBD using a plastic stent for treatment of CBD stones. METHODS: From Mar. 1996 to Aug. 1999, ERBD was performed in 12 patients with CBD stones. Indications for ERBD were old age in 4, a large perivater diverticulum in 4, refusal of surgery in 2, bleeding risk and biliary stricture in 1 each. Nine had one of the significant associated medical conditions. RESULTS: Six of the 12 patients were symptom-free at the time of evaluation (mean 32.9 months). Of the remaining 6 patients, 3 had operation, 1 had a successful endoscopic stone removal, 1 had a stent exchange, and 1 was lost to follow-up at 26 months. Thus, overall success rate of ERBD for treatment of CBD stones was 75% (9/12). Median symptom-free duration was 41 months (range 18~59 months). CONCLUSIONS: In view of its relatively high success rate and long-term effect, ERBD is an alternative modality for treatment of CBD stones, especially in patients with high surgical risks.

A Case of Early Gastric Remnant Cancer Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.

Four Cases of Gastric Mucosal Tear after Blunt Abdominal Trauma / 대한소화기내시경학회지

The incidence of abdominal trauma has increased in recent decades as the frequency of traffic accidents increased. Early symptoms and signs of blunt abdominal trauma may be absent and associated injuries frequently detract physicians from early diagnosis of abdominal trauma. Delayed diagnosis has been shown to be associated with higher morbidity and mortality. Gastrointestinal tract is the third most commonly injured organ from blunt abdominal trauma. Gastric ruptures after blunt abdominal trauma were reported occasionally, but reports of upper gastrointestinal bleeding by gastric mucosal tear were very rare. Four cases of upper gastrointestinal bleeding due to gastric mucosal tear after blunt abdominal trauma are herein reported with a review of related literatures.

Propofol as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. METHODS: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. RESULTS: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p<0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p<0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p<0.01). CONCLUSIONS: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

Clinical Features of Hepatitis A in Korean Adults / 대한내과학회지

OBJECTIVE: This study was aimed to characterize the clinical features and course of acute hepatitis A in Korean adults. METHODS: One-hundred and thirteen cases of acute hepatitis A, diagnosed between Jan. 1995 to July 1998 at 6 medical centers in Korea, were reviewed retrospectively. The clinical course of 94 cases with follow-up duration longer than 3 months were analyzed. RESULTS: The median age was 26 (16-65) years and 97.3% of the patients were under 40 years. The presumed sources of infection were identifed in 62 cases (54.9%). Among those, the leading source was ingestion of raw food. All patients showed normalization of bilirubin level within 8 weeks. The ALT levels normalized within 8 weeks in all patients except three patients (3.2%). Three patients with prolonged elevation of ALT showed second rise of ALT, suggesting a possibility of relapsing hepatitis. Prolonged fever (>38 degree C) more than 10 days was observed in 3 patients (3.2%). One case showed prolonged elevation of alkaline phosphatase (> x3 upper normal limit). No case of fulminant hepatic failure or death was observed. CONCLUSION: The majority of cases with acute hepatitis A in Korean adults showed self-limited course with full recovery.

A Case of Retrograde Jejunogastric Intussusception Diagnosed by Endoscopy / 대한소화기내시경학회지

Retrograde jejunogastric intussusception defined as a segmental invagination of jejunal loop into stomach through stoma is a rare complication following partial gastric resection. Endoscopy and UGI series is very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, an endoscopic reduction can alternatively be attempted. If endoscopic reduction was failed, operation should be immediately per-formed in the acute type because of its high mortality. When anatomical reduction is done on due time, the prognosis is fairly good. We report a case of retrograde jejunogastric intussusception with a brief review of the literature. There was a 56 year old male patient who visited the hospital with chief complaints of severe epigastric pain and vomiting. He had subtotal gastrectomy for gastric carcinoma 6 years ago. On emergency endoscopy the type IIa jejunogastric intussusception was found. As the patient was suspected to be incar-cerated, surgical reduction was performed without delay. He was discharged on the 8th admission day.

Clinical aspects of Primary Epiploic Appendagitis / 대한내과학회지

BACKGROUND: Primary epiploic appendagitis is rarely diagnosed preoperatively and usually results from torsion with subsequent infarction epiploic appendage. Until recent years no diagnostic procedures or clinical symptoms were pathognomic for this disease and the most common preoperative diagnosis were acute diverticulitis and appendicitis. Rapid advance of imaging technique, especially ultrasound, makes it possible to get image of diseased epiploic appandage. Also primary epiploic appendagitis occurs more frequently than it has been suggested in the literature. Therefore authors analyzed and reviewed clinical features and radiological findings of 15 cases with primary epiploic appendagitis to give attention to the acute epiploic appendagitis as one of the ways for diagnosing the acute abdominal pain that has unclear diagnosis, thinking that the rapid diagnosis will helpful to escaping the unnecessary operations. METHODS: This study included twelve men and three women(aged 20-60years). Surgery was done in two patients, one misdiagnosed for acute appendicitis and another for acute diverticulitis with abscess. Follow up examinations were performed with US and CT(n=3), with US, CT and MRI(n=2) and with clinical course (n=13). RESULTS: All patients had localized abdominal pain and tenderness, mostly in the left lower quadrants (n=12). Duration of pain was 3.3 days (1-15days). Two patients had mild fever and two patients had nausea. Leukocytosis was found in four patients. In all cases US revealed a solid hyperechoic(n=13) or isoechoic(n=2) non-compressible ovoid mass with hypoechoic rim. The masses were located under the site of maximum tenderness. CT and MRI finding were compatible with US. CONCLUSION: Primary epiploic appendagitis can be diagnosed pre-operatively using recent imaging technique, and US finding is fairly characteristic. This disorder is not so rare entity as previously known and must be included in the differential diagnosis of acute unexplained abdominal pain in adults.

A Case of Gastric Actinomycosia after Gastrectomy for Early Gastric Cancer / 대한소화기내시경학회지

Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)