A Randomized, Prospective, Comparative, Multicenter Study of Rabeprazole and Ranitidine in the Treatment of Reflux Esophagitis / 대한소화기학회지

BACKGROUND/AIMS: This study was done to evaluate the efficacy of rabeprazole (proton-pump-inhibitor) and ranitidine (H2-receptor antagonist) in the symptom relief and treatment of erosive esophagitis diagnosed by endoscopy. METHODS: A total of 110 patients with typical gastroesophageal reflux disease (GERD) symptoms were enrolled in this multicenter study. They were randomized into rabeprazole group (53 patients) and ranitidine group (57 patients) respectively. The patients in rabeprazole group were given 10 mg of rabeprazole and ranitidine group received 300 mg of ranitidine before breakfast and dinner for 8 weeks. After the end of treatment, we evaluated the endoscopic healing rate of reflux esophagitis and symptomatic improvement. RESULTS: After 8 weeks of treatment, rabeprazole group showed significantly higher complete endoscopic cure rate than ranitidine group (86.8% [46/53] vs. 57.9% [33/57], p=0.001) and higher symptomatic improvement of heartburn (91.2% [31/34] vs. 76.2% [32/42], p=0.085), especially in the first 7 days (76.7% vs. 45.3%, p=0.008). Also, rabeprazole group showed significantly higher improvement of regurgitation symptom than ranitidine group (100% [35/35] vs. 83% [39/47], p=0.009). Both group showed no differences in the improvement of chest pain and globus sensation. All the adverse events (rabeprazole group 4 events vs. ranitidine group 3 events) were mild and there was no abnormality in laboratory test. CONCLUSIONS: In patients with GERD, rabeprazole 10 mg b.i.d. is superior to ranitidine 300 mg b.i.d. in healing of reflux esophagitis and resolving typical GERD symptoms. Rabeprazole is an effective and well-tolerated drug for GERD treatment.

Atypical clinical manifestations of amebic colitis

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.

Nosologic Study of Nevus Spilus (Speckled lentiginous lnevus) / 대한피부과학회지

The nevus spilus, also called speckled lentiginous nevus, presents itself as a patch of melanization dotted by smaller macules of darker color, frequently occuring on the trunk, and in some respect, resembeing the cafe au lait of von Recklinghausens disease and Albrights syndrome. We present clinical and histopathologic observation made on 14 patients, 13 male and 1 female, who agreed to go through a biopsy, during 5 years period from 1975 to 1980. The age at the visit ranged from 11 years to 61, with a mean of 22. 4. The location of lesions were shouIder (in 5 cases), neck (in 2), back (in 2), trunk (in 4),arm (in 1), and buttock (in 1). The epidermal changes consist of hypererkatosis (in 7), acanthosis (in 6), elongation of rete ridge and papillomatosis (in 9), basilar hypermelanosis (in 14), and nevus cell nests(in 3) The dermal changes consists of mild perivascular lymphoid and histiocytic cellular infiltrations (in 11), chromatophores (in 8) and dilated blood vessels (in 6). It is suggested that nevus spilus should be considered as a giant lentigo, a neoplasia of epictermal melanocytes, where junctional nevus is to develop.

Transcutaneous Dlectrical Nerve Stimulation (TNS or TENS) for Relief of Pain in Herpes Zoster / 대한피부과학회지

The gate control theory was proposed by Melzack & Wall in 1965. This theory implies that selective stimulation of cutaneous afferent fibers of large diameter inhibits pain. Transcutaneous electrical stimulation(TNS) is a practical employment of this concept. TNS was used on 14 herpes zoster patients to relieve associated pain. Good effeet was obtained in 13 patients. They experienced relief of their pain for 1-4 hours after 20 minutes of application. TNS has many advantages over analgesic drugs in the control of pain in herpes zoster.

Histology of Secondary Syphilid / 대한피부과학회지

Fundamental pathologic cianges of secondary syphilid are said to be swelling and proliferation of endothelials and a predominantly parivascular infiltrates composed chiefly of lymphoid cells and plasma cells. But recentIy this theory has heen challenged. We present bistologic observation made on 10 patients who agreed to go through a biopsy, during 2 years period. from 1975 to l977. Male to female ratio was 9: 1 The age of patient ranged from 20 to 33, with a mean of 26. 8. The duration of lesion before the visit to the department ranged frorn 6 weeks to 20 weeks, with a mean of 11.9. The lesions in 2 were classified as macule, 3 as papule (1 as moist papule), and 5 as papulo-squamous lesions. The VDRL titer was higher in papular type. Dark fieId examination was performed on all patient and 6 showed positive result. The edidermal changes consist of hyperkeratosis (in 6 cases), parakeratosis (in 5), acanthosis (in 6), elongation of rete ridges (in 8) and exocytosis (in 3). The dermis showed mild to severe perivascular infiltration consist chiefly of lymphoid cells and histiocytic cells (in 10), plama cells (in 7), eosinophils (in 4), neutrophils (in 2), chromatophores (in 4), extra vasation of RBC (in 5), and dilated bload vessels endothelial swellings (in 8). Of particular interest was the finding that plasma cell infiltration is more pronounced at the lower portion of dermal infiltrate and in 3 cases plasma cell infiltration was totally absent. Vascular changes were seen in 8 cases.

A Case of Lichen Nitidus / 대한피부과학회지

Lichen nitidus is a comparatively rare, asymptomatic, chronic disease displaying small, sharpIy defined, fresh colored papules usually localized on the penis, arms and the abdomen. Waisman found immunoglobulin at the dermo-epidermaI junction in lichen planus, but not in lichen nitidus. This settled the argument whether lichen nitidus is a variant of lichen planus. A 11 year old healthy girI was brought to the clinic because of many flesh colored discrete papules on the cubital fossae and the anterior chest. The papules are skin colored. pinhead sized, round, and flat-topped The lesions appeared first at the age of 8 on the antecubital folds and in the following years, increased in number and extended slowly to the upper arms and the anteior chest.