Is the Prevalence of Cryptogenic Hepatocellular Carcinoma Increasing in Korea? / 대한소화기학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) has been characterized by a wide spectrum of liver damages that span from steatosis to cryptogenic liver cirrhosis and even to hepatocellular carcinoma (HCC). The aims of this study were to determine whether the prevalence of HCC arising from cryptogenic cirrhosis has increased during the last ten years and to characterize the clinical features of cryptogenic HCC in Korea. METHODS: A retrospective and hospital-based analysis of the clinical data was done in 1,145 HCC patients; group A (Jan. 1993-Dec. 1995), group B (Jan. 2000-Dec. 2002). The etiologies of HCC with liver cirrhosis in group A and group B were analyzed. The risk factors of NAFLD such as obesity, type 2 diabetes mellitus, hypertriglyceridemia and hypertension between cryptogenic HCC and HCC with well-defined etiologies were compared. RESULTS: The major leading causes of HCC in each group were hepatitis B virus infection, followed by alcohol, hepatitis C virus and cryptogenic. There was a significant increase in the proportion of cryptogenic HCC in group B (A: 2.3%, B: 5.4%, p<0.05). In the case of HCV, it was 5.3% in group A and 9.9% in group B (p<0.05). Although the prevalence of cyptogenic HCC was significantly increased at an interval of seven years apart, there was no significant difference in the proportions of risk factors of NAFLD between cryptogenic HCC group and well-defined etiology group. CONCLUSIONS: The prevalence of cryptogenic HCC was significantly increased in Korea during the last decade. Although statistically insignifcant, there was a trend toward the higher proportion of risk factors with NAFLD in patients with cryptogenic HCC. This suggests that increased proportion of risk factors associated for NAFLD may have contributed to the development of cryptogenic HCC.

24 hour esophageal pH changes in patients with peptic ulcer disease before and after Helicobacter pylori eradication / 대한내과학회지

BACKGROUND: There are many arguments that Helicobacter pylori is a protective factor or a risk factor for GERD. Some authors reported a high incidence of reflux esophagitis in patients who had received Helicobacter pylori eradication therapy. We studied the prevalence of pathologic gastroesophageal reflux in Helicobacter pylori positive peptic ulcer patients and the effects of Helicobacter pylori eradication therapy on development of pathologic gastroesophageal reflux. METHODS: A total of 44 patients with endoscopically documented peptic ulcer disease and Helicobacter pylori infection underwent 24-hour esophageal pH monitoring and received a week of triple therapy. After three months of cessation of triple therapy, patients underwent 24-hour esophageal pH monitoring again. 24-hour esophageal pH monitoring of 44 patients were compared before and after the triple therapy. Helicobacter pylori status was evaluated by Giemsa stain, rapid urease test and urea breath test at each examination. RESULTS: The patients were classified into cured and ongoing Helicobacter pylori infection group. In cured patients group, there was no significant difference in the prevalence of pathologic gastroesophageal reflux before and after Helicobacter pylori eradication (p=0.8). In 44 patients, 30 patients had pathologic gastroesophageal reflux before eradication. In these patients, 27 patients cured Helicobacter pylori infection and 3 patients were ongoing Helicobacter pylori infection. Among 27 patients who cured Helicobacter pylori infection, 5 patients recovered from pathologic gastroesophageal reflux after eradication. In patients without pathologic gastroesophageal reflux before eradication, the prevalence of pathologic gastroesophageal reflux was not associated with Helicobacter pylori eradication (p=1). CONCLUSION: We find that the prevalence of pathologic gastroesophageal reflux in patients with peptic ulcer is high before Helicobacter pylori eradication. We suggest that Helicobacter pylori eradication in patients with peptic ulcer disease is not associated with development of pathologic gastroesophageal reflux.

A Case of Ascites by Pseudomembranous Colitis, Initially Diagnosed Malignant Asites / 대한소화기내시경학회지

Pseudomembranous colitis (PMC) is mostly related with the antibiotics and it presents with diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. In the clinical course of pseudomembranous colitis (PMC), ascites is a rare presentation, and high elevation of carcinoembryonic antigen (CEA) associated with PMC is also a very rare presentation. We experienced a case taken cephalosporin group antibiotics for six weeks and presented with fever, abdominal pain, severe diarrhea, and massive ascites. During evaluation, we found low serum-ascites albumin gradient and high level of CEA in both ascites and plasma. With the impression of hidden malignancy, the special studies were done, but PMC was only found without malignancy. After vancomycin therapy, all symptoms were relieved and CEA level declined.

The Relationship of QT Variables with Ischemic Heart Disease in Diabetic Patients

BACKGROUND: Diabetic patients have an excess risk of dying from cardiovascular disease, QT interval variables on EKG were suggested as a non-invasive diagnostic tool in the assessment of diabetic cardiac autonomic neuropathy. It has been recently reported that QT interval variables could predict cardiac death in diabetic patients. We investigated whether QT interval variables also predicted ischemic heart disease in diabetic patients. METHODS: Among non-insulin dependent diabetic patients who were admitted to Hangang Sacred Heart Hospital since 1993, we selected study subjects who had no ischemic heart disease at the time of EKG and were follewed up for more than 4 years. Sex, age, duration of diabetes, blood pressure, smoking, HbAlc, diabetic, retinopathy, serum creatinine concentration at the time of EKG and QT interval variables(QT, QTc,QT dispersion, QTc dispersion) were analysed by regression analysis with ischemic heart disease as the sole end point. RESULTS: Out of total 118 patients, 21 patients developed ischemic heart disease during follow-up. Patients were followed up for a mean of 68 months. Sex,age, duration of diabetes, serum creatinine concentration and all QT variables were identified as the potentially important variables in univariate analysis. In Cox multivariate analysis with these variables, serum creatinine concentration and all QT variables were significant and independent predictors of ischemic heart disease in diabetic patients. Among QT variables, QTc dispersin outperformed all other predictors(risk ratio 8.132; confidence interval 3.908~16.921) CONCLUSION: These results suggest that QT interval variables, especially QTc dispersion, could be a useful predictor of ischemic heart disease in diabetic patients and could be used as screening test to select diabetic patients for more extensive cardiac investigation.

A Case of Acute Fulminant Myocarditis Progressed into and Recovered from Congestive Heart Failure and Multiorgan Failure

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.