Efficacy of N-Butyl 2-Cyanoacrylate Injection Therapy for Gastric Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to clinical outcome. METHODS: Sixty-seven patients treated with n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding were retrospectively reviewed. RESULTS: Initial hemostasis was achieved in all 12 patients. Success of therapy was achieved in 88% of the patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site, initial hemoglobin, and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure. Rebleeding occurred in 19% of the patients during the 4 weeks after therapy. The cumulative probability of 4-week remaining free of rebleeding was significantly higher in Child-Pugh A and B than in Child-Pugh C. Mortality at 4 weeks was 15%. The Child-Pugh class and the presence of hepatocellular carcinoma were the independent predictive factors of mortality at 4 weeks. CONCLUSIONS: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices. Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy.

The pH of the Gastric Mucosal Surface and Helicobacter pylori Infection in Non-Ulcer Dyspepsia / 대한소화기내시경학회지

BACKGROUND/AIMS: The Helicobacter pylori(H. pylori) infection induces gastric mucosal injury through the various bacterial cytotoxins, the inflammatory reaction of the host and the increased gastric acid secretion. Urease is a kind of adaptive protein of H. pylori to survive in strong acid environment of the stomach, may increase the pH of the gastric mucosal surface and induces gastrin release by the feedback mechanism. This study was performed to evaluate whether 0.1% phenol red solution without urea is useful as a pH indicator of the gastric mucosa for the diagnosis of H. pylori infection in stomach and whether the pH of the gastric mucosal surface is changed by H. pylori infection. METHODS: The gastric mucosa was stained by 0.1% phenol red solution without urea during endoscopy in 89 patients with non-ulcer dyspepsia. The patterns of staining of the gastric mucosa were divided into unstained, patchy regional and diffuse staining by the area of color change from yellow to red. The pH of the gastric mucosal surface was measured directly on the stained and unstained areas of the gastric mucosa by using pH meter and antimony pH electrode through the biopsy channel. RESULTS: The pH of the stained areas after spray of phenol red solution was significantly higher(6.9) than that(1.9) of the unstained gastric mucosa(P<0.01). The patterns of the staining were different between antrum and body. The patterns of unstaining and patchy staining were more common in the body than in the antrum. But the patterns of regional and diffuse staining were more common in the antrum than in the body(P<0.05). The positive rates of H. pylori in antrum, body and total gastric biopsies were higher in stained than in unstained mucosa significantly(P<0.05). Severity of active inflammatory reactions was higher in stained mucosa than unstained mucosa in the antrum. But there was no difference in severity of active inflammatory reactions between stained mucosa and unstained mucosa in the body. CONCLUSIONS: 0.1% phenol red solution without urea is useful as a pH indicator for the diagnosis of the H. phlori infection in the stomach. H. pylori infection may increase the pH of gastric mucosal surface and induce severe active inflammation of the gastric mucosa in non-ulcer dyspepsia.

Correlation between High-Resolution CT and PulmonaryFunction Tests in Patients with Emphysema / 결핵

BACKGROUND: The diagnosis of emphysema during life is based on a combination of clinical, functional, and radiographic findings, but this combination is relatively insensitive and nonspecific. The development of rapid, high-resolution third and fourth generation CT scanners has enabled us to resolve pulmonary parenchymal abnormalities with great precision. We compared the chest HRCT findings to the pulmonary function test and arterial blood gas analysis in pulmonary emphysema patients to test the ability of HRCT to quantify the degree of pulmonary emphysema. METHODS: From October 1994 to October 1995, the study group consisted of 20 subjects in whom HRCT of the thorax and pulmonary function studies had been obtained at St. Mary's hospital. The analysis was from scans at preselected anatomic levels and incorporated both lungs. On each HRCT slice the lung parenchyma was assessed for two aspects of emphysema: severity and extent. The five levels were graded and scored separately for the left and right lung giving a total of 10 lung fields. A combination of severity and extent gave the degree of emphysema. We compared the HRCT quantitation of emphysema, pulmonary function tests, ABGA, CBC, and patients characteristics(age, sex, height, weight, smoking amounts etc.) in 20 patients. RESULTS: 1) There was a significant inverse correlation between HRCT scores for emphysema and percentage predicted values of DLco(r = -0.68, p < 0.05),DLco/VA(r = -0.49, p < 0.05),FEVl(r = -0.53, p < 0.05),, and FVC(r = -0.47, p < 0.05). 2) There was a significant correlation between the HRCT scores and percentage predicted values of TLC(r = 0.50, p < 0.05),RV(r = 0.64, p < 0.05). 3) There was a significant inverse correlation between the HRCT scores and PaO2(r = -0.48, p < 0.05) and significant correlation with D(A-a)02(r = -0.48, p < 0.05) but no significant correlation between the HRCT scores and PaCO2. 4) There was no significant correlation between the HRCT scores and age, sex, height, weight, smoking amounts in patients, hemoglobin, hematocrit, and wbc counts. CONCLUSION: High-Resolution CT provides a useful method for early detection and quantitating emphysema in life and correlates significantly with pulmonary function tests and arterial blood gas analysis.

A Case of Interstitial Pneumonitis developed by Interferon- alpha Treatment for Chronic Hepatitis C / 결핵

Interstitial pneumonitis associated with interferon alpha therapy for chronic hepatitis C was first described in 1994 by Kazuo et al in Japan. The mechanism of interstitial pneumonitis deveoped by interferon alpha was still unknown but immunologic, allergic or direct lung toxicity were suggested. We experienced a case of interstitial pneumonitis developed during interferon alpha therapy for chronic hepatitis C in a 52-year-old male patient. He was treated with 6 million units of interferon alpha intramuscularly 3 times per week for 4 weeks and noted progressive dyspnea and cough. These symptoms were subsided after 6 weeks' discontinuation of interferon alpha therapy. And so, he was retreated with 3 million units of interferon alpha 3 times per week for 8 weeks and felt dyspnea again. He was admitted to our hospital for further evaluation of progressive dyspnea. Arterial blood gas(ABG) values were PaO2 90.7 mmHg and PaCO2 31.9 mmHg, and antinuclear antibody(ANA) was negative. A chest X-ray film revealed diffuse reticulo-nodular shadows in bilateral lung fields, suggesting a diagnosis of interstitial pneumonitis. A marked increase in lymphocyte count and suppressor T cell were observed in bronchoalveolar lavage(BAL) fluid. Lymphocyte stimulation test with interferon alpha was positive. Interstitial pneumonitis was confirmed by transbronchial lung biopsy. After discontinuation of interferon alpha, we gave oral steroid in the condition that clinical symptoms were being improved gradually.

The Changes of Coronary Artery Stenosis by Sequential Coronary Angiographies

BACKGROUND: QT dispersion(QTd) has been shown to be ventricular electrical instability, especially predictor of ventricular arrythmia and indicator of antiarrythmic effect. It was reported that there was a relationship between acute myocardial infarction and increased QTd in that QTd is dependent of the degree of reperfusion as well as the site and size of infarction. In this study, we intended to verify a significant association between myocardial ischemia and QTd by comparing the changes in QTd with or without chest pain in patients with unstable angina who had proven myocardial ischemic changes. METHOD: We studied 20 patients (12 men and 8 women : mean age, 58+/-3.4 years) with unstable angina who had proven myocardial ischemic changes and perfusion defect by 24 hour Holter monitoring, Treadmill test, or coronary angiography. Each case was measured QTd during chest patin and resting state 24 hours after chest pain. All standard 12-lead ECGs were recorded at a speed of 25 mm/sec and examined retrospectively by one observer. QTd corrected for heart rate (QTcd) was calculated by Bazett's formula. The difference of QTd was assessed by comparing by paired t-test. RESULTS: The mean values of QTd were 117.9+/-49.9 msec and 69.7+/-30.2 msec with existence and the absence of chest pain. There was significant increment of QTd when the paients with unstable angina had chest pain(p<0.01). QTcd also significantly increased with the mean value of 119.7+/-57.1 and 74.9+/-36.6 msec (p=0.015). CONCLUSIONS: The results of this study clarified the change of QTd with myocardial ischemia. We expect QTd using a single, noninvasive method to indicate that the chest pain is induced by myocardial ischemic changes. For the furture, it may be possible to study as to the significance of QTd as a predictor of cardiovascular accidents in patients with unstable angina by measuring the serial QTd.