The Changes in the Outbreak of Rotavirus Gastroenteritis in Children after Introduction of Rotavirus Vaccines: A Retrospective Study at a Tertiary Hospital / 소아감염

PURPOSE: This study aimed to examine the changes in the outbreak of acute gastroenteritis, rotavirus gastroenteritis after the introduction of the rotavirus vaccine in Korea. METHODS: The current study investigated the number of inpatients in the pediatric ward of Inje University Sanggye Paik Hospital during the periods of 2005-2006 and 2011-2012. A retrospective analysis was conducted on the medical records of 2,840 patients <5 years of age who were hospitalized at Inje University Sanggye Paik Hospital in these time periods. RESULTS: When we compared 2 separate sets of data from before (2005-2006) and after (2011-2012) vaccine introduction, there were statistically significant decreases in the number of patients who were hospitalized for acute gastroenteritis across all of the groups of patients <5 years of age except those <2 months of age. The number of patients with rotavirus gastroenteritis in all age groups declined except for children <2 months of age and those 2-5 months of age. CONCLUSION: These results show that after the introduction of a rotavirus vaccine in Korea, the incidence of rotavirus gastroenteritis decreased in 6-59-month-old patients hospitalized for acute gastroenteritis.

A Case of Type 1 Stickler Syndrome Caused by a Novel Mutation in COL2A1 / 대한내과학회지

Stickler syndrome is a genetic disorder characterized by ophthalmologic, craniofacial, audiologic, and joint problems. In this report, we describe a 10-year-old boy presenting with a flat face, high myopia, retinal detachment, arthropathy, short stature, and mental retardation. Sequencing of the COL2A1 gene revealed a novel mutation, c.3055C > T (p.Pro1019Ser), consistent with a diagnosis of Type 1 Stickler Syndrome.

The Prognosis of Liver Cirrhosis in Recent Years in Korea

The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required.

Clinical Significance of Total Colonoscopy in Patients with Active Pulmonary Tuberculosis without Gastrointestinal Symptoms / 대한소화기내시경학회지

BACKGROUND/AIMS: Pulmonary tuberculosis may coexist with intestinal tuberculosis even in the absence of gastrointestinal symptoms. The aim of this prospective study was to define the colonoscopic findings of early lesions of intestinal tuberculosis, incidence of asymptomatic intestinal tuberculosis in patients with active pulmonary tuberculosis and to evaluate the clinical response after standard anti- tuberculosis chemotherapy. METHODS: We examined 59 Korean patients with active pulmonary tuberculosis, who had no gastrointestinal symptoms. Patients underwent diagnostic total colonoscopy up to terminal ileum for evaluation of intestinal tuberculosis. Follow-up total colonoscopy was also done in 1~3 months after start of treatment. RESULTS: Intestinal tuberculous lesions were found in 54% of patients. The common locations of lesion were terminal ileum (84%) and cecum (69%). The combination of circumferential ulceration, hyperemic mucosa and erosions of the colon was the most common finding (37.5%), the combination of hyperemia and ulceration occurred in 34.4% of patients and hyperemia with/without erosion in 12.5%. The direction of ulceration was transevere in relation to long axis of the colon but occasionally longitudinal. Although most ulcers were multiple in number and various in size but some paitents had isolated single ulcer with erosion. All of the lesions regressed within 1~3 months of treatment. CONCLUSIONS: During screening total colonoscopy, if there are nonspecific hyperemia, erosion or shallow ulcer on colon or terminal ileum, it is necessary to check up chest X-ray for rule out tuberculous lesion, especially in countries with a high prevalence of tuberculosis.

Electron Microscopic Evaluation of Adhesion of Helicobacter pylori to the Gastric Epithelial Cells in Chronic Gastritis

BACKGROUND: The adhesion of H. pylori to the gastric epithelial cells may be an essential step for the pathophysiology of various H. pylori-induced gastrointestinal diseases. The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis and H. pylori infection. The specimens were processed for electron microscopy and observed with a transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the adhesions of H. pylori to the gastric epithelial cells were categorized into three types; filamentous connection, adhesion pedestals and membrane fusion. Coccoid and undetermined forms adhered mainly by the filamentous connection, whereas the bacillary forms adhered primarily by the adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to evaluate the influence of different types of adhesion to the pathophysiology of H. pylori.

An Immunohistochemical study of the origin and differentiation of gastric stromal tumor / 대한내과학회지

BACKGROUND: Gastrointestinal stromal tumors (GISTs) have the subject of debate and controversy regarding their histogenesis, criteria on malignancy, prognostic features, site-specificity and their nomenclature. These tumors have various phenotypical features and are generally divided into (1) tumors showing differentiation toward smooth muscle cells (2) tumors showing apparent differentiation toward neural elements (3) tumors showing dual differentiation toward smooth muscle and neural elements (4) tumors lacking differentiation toward either cell type (uncommitted type). This study was performed to identify the possible origin and differentiation of gastric stromal tumor. METHODS: This study was performed on 38 patients who had gastric stromal tumors on endoscopy or endoscopic ultrasonography and confirmed by endoscopic or surgical resection between January 1994 and June 1999 at Department of Internal Medicine, Korea University College of Medicine. Formalin-fixed, paraffin-embedded tissues were studied by immunohistochemical method for detecting the presence of CD 34, CD 117, Vimentin, SMA, Desmin, S-100, PGP 9.5 and NSE. RESULTS: The patients' age ranged from 26 to 81 years old, with an average age of 53.8 years. The male to female ratio was 1:1.2. Endoscopic resections were performed on 22 patients and surgical operations on 16 patients. The average tumor size was 25.3 mm in diameter. On immunohistochemical staining method, the uncommitted type was found in 18 patients (47.4%), of which 17 patients (94.4%) were CD117 (+), CD34 (+), Vimentin (+), 12 patients (31.6%) had muscular differentiation, 7 patients (18.4%) showed neural differentiation and 1 patient (2.6%) showed differentiation toward both neural and muscular immunohistochemical pattern. CONCLUSION : Gastric stromal tumors showed phenotypical diversity in immunohistochemical staining suggesting different histogenesis. Most uncommitted type had a phenotype of intersititial cells of Cajal (ICC) and this evidence supports the hypothesis that uncommitted type has the origin of ICC.

A case of dedifferentiated liposarcoma in retroperitoneum / 대한내과학회지

Dedifferentiated liposarcoma occurs in less than 10% of all liposarcomas and is found most often in the retroperitoneum and extremities. Although cases of the primary dedifferentiated liposarcoma have been sporadically reported internationally, only one case with 8x4.5x4 cm size originated from spermatic cord and one case with 10x7x5 cm size in right gluteal region have been reported in Korea, but not in retroperitoneum. We report one case of the primary giant dedifferentiated liposarcoma occurred in retroperitoneum with 32x22x20 cm size and 4,250 g weight. A 56-year old man was admitted due to the weight loss and diffuse abdominal pain. The abdominal computed tomography showed that a round huge mass was pressing the surrounding structures and showed delayed enhancement. Surgical excision was carried out. Histologically the tumor was composed of well differentiated liposarcomatous area and malignant fibrous histiocytoma-like dedifferentiated area. The patient refused further treatment and now he is undergoing the follow-up.

The usefulness of PCR-based restriction fragment length polymorphism (RFLP) analysis for differentiating Helicobacter pylori strains after the triple therapy / 대한내과학회지

BACKGROUND: The aim of this prospective study was to evaluate the usefulness of PCR-based restriction fragment length polymorphism (RFLP) analysis for differentiating H. pylori strains after the triple therapy in patients with duodenal ulcer. METHODS: Following a 1-2 week regimen of omeprazole 40 mg, amoxicillin 2.0 g, and clarithromycin 1.0 g, twice daily, twenty patients with duodenal ulcer were enrolled. Ten patients (group 1) were not successfully treated, and another 10 patients (group 2) exhibited recurrence of infection. Follow-up diagnosis was performed by Giemsa stain and CLO test. RFLP profiles of antral and midbody biopsy specimens were compared before and after therapy. PCR products using the ureC gene were digested with restriction enzymes Hha I, Mbo I, and Hind III, and the fragments generated were analyzed by agarose gel electrophoresis. RESULTS: Hha I, Mbo I, and Hind III digestion produced 13, 7, and 2 distinguishable digestion patterns, respectively. There was no difference in RFLP profiles before and after the therapy in 17 duodenal ulcer patients, while different RFLP profiles following therapy were discovered in 3 patients. Following treatment, one (group 2) patient differed in Mbo I, and two (one each from both groups) patients differed in Hha I and Mbo I RFLP patterns. CONCLUSION: This study supports the hypothesis that PCR-based RFLP analysis can be useful for differentiating reinfection and recrudescence of H. pylori strains following triple therapy.

A Case of Primary Adenosquamous Carcinoma of the Liver Presented with Liver Abscess

Primary adenosquamous carcinoma of the liver is a very rare type of cholangiocarcinoma and is defined as a cancer containing both squamous and adenomatous components in the same lesion. Recently, we experienced a primary adenosquamous carcinoma of the liver presented as liver abscess. A 63-year-old man was presented with a 4-day history of fever and chill. The radiologic study showed a 4 cm-sized, central hypoattenuated mass with peripheral rim enhancement in the left lobe of the liver. Ultrasonography-guided aspiration and biopsy suggested an adenocarcinoma with abscess in the liver. At laparotomy, the tumor occupied the left lobe of the liver and invaded the right diaphragm. An extended left lobectomy and a partial excision of the involved diaphragm were done. Grossly, the tumor was 6x5x5 cm in size and had an eccentric necrosis. Microscopically, the tumor was composed of adenocarcinoma and squamous cell carcinoma with a transitional area.

Electron microscopic study of adhesion between Helicobacter pylori and gastric epithelial cell / 대한내과학회지

BACKGROUND: The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis. These specimens were processed and observed by transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the different types of adhesion of the organism with the epithelial cells were categorized as filamentous connection, adhesion pedestals, membrane fusion. Coccoid and intermediate forms were associated with filamentous connection whereas bacillary forms were associated with adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to investigate biophysiologic influence to epithelial cells by ultrastructural relationship.(Korean J Med 60:16-21, 2001)

A Case of Esophageal Involvement of Cicatrical Pemphigoid / 대한소화기내시경학회지

Cicatrical pemphigoid is regarded as a chronic, autoimmune subepithelial blistering disease of mucous membranes in which lesions often heal with scar formation. Cicatrical pemphigoid typically involves the oral and/or ocular mucosa but may affect the nasal, pharyngeal, laryngeal, esophageal, anogenital regions as well. Immunopathologic studies have shown that patients with cicatrical pemphigoid typically have autoantibodies directed against basement membrane antigens and that they demonstrate continuous deposits of immunoglobulins (IgG, A), complement components and fibrin along the basement membrane. A 69-year-old female was admitted with chief complaints of hoarseness, dyspnea, multiple painful oral ulcer and vesiculobullous skin lesion on upper trunk. During admission, dysphagia and epigastric discomfort was developed. Endoscopic examination revealed multiple erosion and ulcerative lesion with scar formation. Immunopathologic studies showed that linear deposit of IgG, A, C3 along the basement membrane zone. We report a case of cicatrical pemphigoid with esophageal involvement with brief review of literature.

A Case of Two Synchronous Colon Cancers Accompanied by Streptococcus bovis Endocarditis / 대한소화기내시경학회지

Streptococcus bovis (S. bovis) organisms, part of the gastrointestinal normal flora are gram-positive group D streptococci that may be misidentified as enterococci or viridans streptocci. The most important clinical infections caused by S. bovis are bacteremias and endocarditis. S. bovis causes 27% of the episodes of streptococcal native valve endocarditis. Besides, it has been known that there is a association between S. bovis bacteremia and underlying malignancy of the colon. After this association was demonstrated by Klein in 1977, many cases have been reported. But, it is not clear if S. bovis plays an etiologic role in carcinoma of colon or merely a marker for the disease and cases from Korea have rarely been reported. Therefore, we report one case that two synchronous colon cancers, the one on ascending colon and the other on sigmoid colon is accompanied by S. bovis endocarditis.

Analysis of Eradication Rate of Helicobacter pylori According to Treatment Duration by Using 13C-Urea Breath Test Comparison of OAC 7, 10 or 14 days regimen / 대한소화기내시경학회지

BACKGROUND/AIMS: Efficacy of triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) for Helicobacter pylori (H. pylori) varies among different geographic regions and patient populations. And, there is no full consensus on how long this treatment should be maintained. We assessed the efficacy of the OAC regimen according to the treatment duration (7, 10 or 14 days) using 13C-urea breath test (13C-UBT). METHODS: Two hundred fifty five H. pylori positive patients with peptic ulcer were randomly assigned to a OAC (omeprazole 20 mg b.d., amoxicillin 1.0 g b.d. and clarithromycin 500 mg b.d.) 7, 10 or 14 days regimen. Eradication of H. pylori was assessed by 13C-UBT 4 weeks after the completion of therapy. RESULTS: 140 male and 115 female (mean age, 51.3) patients were enrolled. The overall eradication rate of H. pylori in each group was significantly higher in OAC 14 days regimen than OAC 7 and 10 days regimen (91.9% in OAC 14 days, 74.4% in OAC 7 days, and 80.2% in OAC 10 days, respectively, p<0.05). CONCLUSIONS: The overall eradication rate of H. pylori was highest in OAC 14 days regimen in our study. We have found significant differences in eradication rates with previous reports, using CLO and histology, in Korea. Thus, further studies focusing on the treatment period may be warranted.

A Case of Multiple Lymphomatous Polyposis Developed after Complete Remission of Diffuse Large B-cell Type Nasopharyngeal Lymphoma / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is a term used to describe malignant lymphoma of the gastrointestinal tract that manifest as polyposis. MLP is believed to represent gastrointestinal involvement by mantle cell lymphoma (MCL), primarily based on its histologic and immunophenotypic similarities with MCL. We have experienced a case of MCL presented as a peculiar feature of multiple lymphomatous polyposis in a 49-year old male patient. He had been diagnosed diffuse large B cell lymphoma of nasopharynx and treated by radiation therapy and CHOP chemotherapy. He newly developed MCL after 10 years in complete remission of diffuse large B cell lymphoma. After newly developed lymphoma was compared with former diagnosed lymphoma, we concluded that they were not same type each other. We reviewed a total of 13 patients including this case, of MLP, which were reported in various Korean literature, and literatures are reviewed.

Feasibility of Low-Molecular-Weight-Heparin (Fraxiparine) for Primary Stenting in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The optimal anti-thrombotic strategy for primary stenting in acute myocardial infarction (AMI) is still controversial. We evaluated prospectively the efficacy and safety of low-molecular-weight-heparin (LMWH) for primary stenting in AMI. MATERIALS AND METHOD: From 1/1997 to 7/1998, 54 AMI pts underwent primary stenting with 96% of procedural success rate (52/54). Of these, five pts were excluded from the study for warfarinization or use of GP II b/ III a inhibitor despite of successful stenting (TIMI 3 flow and less than 30% of residual stenosis). In 47 pts included in the study, 5,000-10,000 U of unfractionated heparin was administered (IV/bolus) bofore primary stenting. After sheath removal, LMWH(Fraxiparine, 7500 U/S.C.BID) maintained for 10.6+/-5.7 days. Aspirin and ticlopidine (500mg/day for > or =4 weeks) were given before stenting. Pts were followed to determine early (0-30 days) and late (31-180 days) major adverse cardiac events (MACE). Subsequent revascularization involving other coronary arteries did not constitute an end point. RESULTS: In 47 Pts (M:F=32:15, age=57.7+/-11.3 yrs, range: 37-88), 50 stents (Nir:38, micro:7, Jo:5, LAD:LCX:RCA-=24:9:14) were implanted. Their immediate post-stenting MLD and diameter-stenosis (%) were 2.9+/-0.4 mm, 4.3+/-8.7%, respectively. No patient showed sub-acute stent thrombosis or major bleeding requiring blood transfusion or surgery. During 0-30 days, the primary combined end point occurred in 2 (4.2%):one repeated angioplasty for in-stent restenosis; one hospital death for pump failure (1 of 2 Killip IV pts at admission). 44 patients were followed for 180 days and additional three TVR (3/44(6.8%), one CABG, one repeated angioplasty and one recurrrent myocardial infarction)occurred between 30-180 days due to recurrent ischemia. CONCLUSION:Anti-thrombotic therapy with LMWH (Fraxiparine) is safe and feasible for primary stenting in AMI. But to illuminate the impact on the clinical outcomes such as major adverse cardiac events and restenosis, we need more large and controlled study.