Prediction of the Response to Proton Pump Inhibitor Treatment Using Wireless Ambulatory pH Monitoring in Patients with Globus Sense / 대한소화기학회지

BACKGROUND/AIMS: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat and a commonly encountered clinical condition. We aim to evaluate the prevalence of gastroesophageal reflux disease (GERD) and to determine the parameters for predicting the response to treatment with proton pump inhibitor (PPI) using wireless pH monitoring in patients with globus sense. METHODS: We retrospectively reviewed the medical records of 37 patients with atypical GERD symptoms. A total of 27 patients with dominant globus sense were enrolled. Endoscopic examination and 48-hour wireless esophageal pH monitoring were performed, and the patients underwent a therapeutic trial of full dose PPIs daily over a period of 4 weeks. RESULTS: Both typical and atypical GERD symptoms co-existed in 14 patients (51.9%, 14/27). According to ROME III criteria, 19 patients (70.4%, 19/27) were diagnosed as GERD. Twelve patients (44.4%, 12/27) were PPI responders. A significant difference in the frequency of symptom index (+) or symptom associated probability (+) was observed between the PPI responder group and the non-responder group (p<0.01). CONCLUSIONS: In patients with globus sense, 70.4% were diagnosed with GERD. Symptom index/symptom associated probability in wireless ambulatory pH monitoring was a good objective parameter for PPI responder.

Current Status and Clinical Impact of Pediatric Endoscopy in Korea / 대한소화기학회지

BACKGROUND/AIMS: In pediatrics, endoscopic examination has become a common procedure for evaluation of gastrointestinal presentations. However, there are limited data on pediatric endoscopy in Korea. The aim of this study was to analyze the current status and clinical impacts of endoscopic examination in children and adolescents. METHODS: We retrospectively reviewed the medical records of outpatients who visited the tertiary hospital. Patients under 18 years of age who underwent endoscopy were included. Endoscopic findings were classified as specific and normal based on gross findings. Specific endoscopic findings were reflux esophagitis, peptic ulcers, and Mallory-Weiss tear. Other findings included acute gastritis classified according to the updated Sydney system. RESULTS: In 722 of 330,350 patients (0.2%), endoscopic examination (554 esophagogastroduodenoscopies [EGDs], 121 colonoscopies, 47 sigmoidoscopies) was performed between January 2008 and January 2013. In EGD, abdominal pain was the most frequent presentation (64.1%). The most common diagnosis was gastritis (53.2%), followed by reflux esophagitis. The frequency of peptic ulcer disease was 12.8%. Frequent symptoms leading to colonoscopic examination were abdominal pain, diarrhea, and hematochezia. In colonoscopy, a negative result was more likely in children younger than 7 years old. After the procedure, the diagnostic yield of EGD and colonoscopy was 88.1% and 45.8%, respectively, and the rate of change in management was 67.1%. CONCLUSIONS: In pediatrics, endoscopic examination was useful for the choice of therapeutic strategy and it would be a standard method for evaluation of gastrointestinal presentation.

Family Practise Residents' Diagnostic and Therapeutic Behaviors to Acute Diarrheal Patients

BACKGROUND: The purpose of this research was to compare one hospital family practise residents' diagnostic and therapeutic behavior with a Dupont et al described Guidelines on acute infectious diarrhea in adults and HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 15th edition's algorithm for the management of acute diarrheal patients. METHODS: From March 1, 2003 to April 30, 2003, we reviewed 82 acute diarrheal patients (3.19% of the total patients) who had visited one hospital's emergency room which was located in Jeonju district. Doctor's diagnostic and therapeutic approaches were reviewed on the basis of history and physical exam. Then we compared with the standard algorithm referred above. RESULTS: Inpatients were 36.6% (30 patients) among the total of 82 and 63.4% (52 patients) returned home after symptomatic treatment. Among the 52 return home patients, doctors did not entirely conduct stool exam. Among the 30 hospitalized patients, doctors conducted stool exam in 25% among 4 of 16 high fever patients, in 25% among 2 of 8 moderately dehydrated who had diarrhea more than 10 times per day, and in 60% among 6 of 10 patients whose symptom duration was more than 48 hours. Doctors did not use antibiotics in 76.9% (40 patients) of 52 return home patients. Quinolone and Augmentin tablets were administered to each 6 patients of 12 return home patients. Among the 30 inpatients, Augmentin injection were given to 80% (24 patients) and second-generation cephalosporin with aminoglycoside combination injection to 13.3% (4 patients) and quinolone injection to 6.7% (2 patients). CONCLUSION: Compared with standard algorithm, doctors neglected testing stool examination that may be the most important way to diagnose the specific etiology of acute diarrhea. If we actively utilize the stool exam, it may help in providing the correct diagnosis and suitable treatment.

Subretinal Hemorrhages in High Myopia

Ocular changes such as crescents, posterior staphyloma, retinochoroidal degeneration, lacquer cracks and subretinal or choroidal hemorrhage are common In myopia. We examined 13 patients(13 eyes) who had refractive errors of -6.0 Diopter or more and subretinal hemorrhages at initial visit. According to fluorescein angiographic finding, subretinal hemorrhages in high myopia were divided into two groups: 6 eyes without choroidal neovascularization(CNV) and 7 eyes with choroidal neovascularization. Subretinal hemorrhage without choroidal neovascularization was frequent in patients aged 15-32 years(mean, 23.7 years) and choroidal neovascularization was common in patients aged 34-60 years(mean 47.6 years). In the eyes without choroidal neovascularization, the subretinal hemorrhage disappeared spontaneously after a few months and the visual acuity of these patients was variable at the initial visit(range, 5/200-20/30), and was unchanged or improved during the follow-up period. In the eyes with choroidal neovascularization, the visual acuity was less than 0.1 at the initial visit, except 2 cases, and was unchanged or worsened during the follow-up peroid. It will be helpful to divide the high myopia with subretinal hemorrhage into with or without choroidal neovasculrization according to the flourescein angiography to assess the prognosis.

Efficacy of High Dose Corticosteroid Therapy in Experimental Traumatic Optic Neuropathy

We investigated the efficacy of high dose corticosteroid therapy in the treatment of traumatic optic-neuropathy. We experimentally damaged the optic nerves of six white rabbits with a Hartman mosquito. Three of the rabbits were intravenously injected with 0.25mg/kg dexamethasone every six hours for a 48 hour period. The others were used as controls. In both groups, the optic nerves were removed after one month and stained with Hematoxyline-eosin, then examined microscopically. No histological differences were found in either the control or the experimental group.

Treatment of Congenital Nasolacrimal Duct Obstruction Using Silicone Intubation Set

Congenital nasolacrimal duct obstruction, the most common cause of congenital epiphora, occurs in up to 6% of newborns. Bofore the advent of silicone intubation through canaliculus into nasolacrimal duct, management of congenital lacrimal obstruction that had failed with conservative management or probing necessitated bypass surgery such as dacryocystorhinostomy. Less-invastive lacrimal intubation improved the success rate and provided as a less-invasive surgical therapeutic alternative. We achieved 90.6% of success rate in 30 patients(34% eyes) with congenital nasolacrimal duct obstruction managed with silicone tube intubation. The most common complication was extrusion of silicone tube. The Crawford silicone tube intubation in congenital nasolacrimal duct obtruction is safe and a less-invasive surgical alternative, presenting high success rate.

Adherence Syndrome After Weakening Procedure of Inferior Oblique Muscle

Adherence syndrome may be due to fibrofatty proliferation creating adherence between infeiror orbital tissue, sclera, or inferior rectus muscle capule and inflammatory reaction initiated by the rupture of the Tenon's capsule and invasion of the extraconal fat. We report 4 cases of adnerence syndrome after weakening procedure of inferior oblique muscle in the cases of overacting inferior oblique muscle.

Surgieal Result of Intermittent Exotropia: Comparison of Sensory Anomaly

In this study, among intermittent exotropia cases, 38 cases indicating sensory anomaly of diplopia and 27 cases indicating sensory anomaly of suppression, and tried to compare the results of operation. Cases of diplopia ranged from 3 years of age to 21 years of age averaging 4.5 years of age, and the follow up period after operation ranged from 2 months to 18 months averaging 6.5 months. The success rate of operation in cases of diplopia was 92%(35/38), and that in cases of suppression was 74%(20/27). Consequently, among intermittent exotropia patiens indicating sensory anomaly the case of diplopia can be said to be higher in the success rate of operation than that of suppression.