Association Between Serum Bilirubin and Atrial Fibrillation: A Mendelian Randomization Study

Background and Objectives@#The association between bilirubin and atrial fibrillation (AF) has been evaluated previously in observational studies but with contradictory results. This study evaluated the causal association between serum bilirubin level and AF using Mendelian randomization (MR) analysis. @*Methods@#This cross-sectional study includes 8,977 participants from the Dong-gu Study.In the observational analysis, multivariate logistic regression was performed to evaluate the association between bilirubin and prevalent AF. To evaluate the causal association between bilirubin and AF, MR analysis was conducted by using the UGT1A1 rs11891311 and rs4148323 polymorphisms as instrumental variables. @*Results@#Elevated serum bilirubin levels were associated with an increased risk for AF in observational analysis (total bilirubin: odds ratio [OR], 1.31; 95% confidence interval [95% CI], 1.15–1.48 per 1 standard deviation [SD]; direct bilirubin: OR, 1.31; 95% CI, 1.18–1.46 per 1 SD), whereas the genetically predicted serum bilirubin levels in MR analysis did not show this association (total bilirubin: OR, 1.02; 95% CI, 0.67–1.53 per 1 SD; direct bilirubin: OR, 1.03; 95% CI, 0.61–1.73 per 1 SD). @*Conclusions@#Genetically predicted bilirubin levels were not associated with prevalent AF.Thus, the observational association between serum bilirubin levels and AF may be noncausal and affected by reverse causality or unmeasured confounding.

A case of exophytic pedunculated gastrointestinal stromal tumor with cystic changes / 대한내과학회지

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and cystic changes are commonly observed. However, there have been few reports of cases of exophytic pedunculated GIST with cystic changes. Here, we report a 45-year-old man who presented with a palpable mass in the left upper quadrant of the abdomen. The mucosal folds were endoscopically abnormal, but there was no mucosal lesion. Computed tomography demonstrated a large, low-density cystic lesion surrounding an enhanced nodule in the greater curvature of the gastric body, and there was no tumor infiltration to other organs. The patient underwent hemigastrectomy and the lesion was shown to be an exophytic pedunculated cystic tumor. Histopathological examination showed epithelioid cells with marked hemorrhaging. Immunohistochemical examination indicated that most of the tumor cell cytoplasm was positive for the c-kit protein (CD117) and CD34. The tumor was diagnosed as an exophytic pedunculated GIST of the stomach with cystic changes.

A Case of Intermediate Grade Bronchial Mucoepidermoid Carcinoma and Review in Korean Cases / 결핵및호흡기질환

Bronchial mucoepidermoid carcinoma is uncommon, representing 0.2% of all lung tumors. The disease usually presents with symptoms of airway obstruction and recurrent pneumonia. It is commonly classified into two grades in Korea, low and high. We report a case of a bronchial mucoepidermoid carcinoma in a 40-year-old woman who complained of symptoms of an upper respiratory infection. The histological grade after a bronchoscopic biopsy was intermediate. A left upper lobectomy was performed as treatment. The TNM stage of this case was IA (T1N0M0). In addition, 25 cases of bronchial mucoepidermoid carcinoma from 1984 in Korea are also reviewed from the viewpoint of the relationship between the histological grade, TNM stage and clinical course of the tumor.

A Case of the Duodenal Bulb Abscess / 대한소화기내시경학회지

Duodenal abscess is a rarely reported disease throughout the entire world. Duodenal abscesses are developed mostly from the complication of duodenal ulcer perforation, and only small percentage of duodenal abscesses are the result of cholecysto-duodenal fistula which was made by gall bladder perforation. We report a 84-year-old male patient who presented to the emergency department with severe anorexia and generalized weakness for 2 weeks. The upper gastrointestinal endoscopy done and revealed a protruding mass at the lesser curvature of the duodenal bulb. As soon as the mass was punched with a biopsy forceps, a large amount of abscess began to pour out into the intestinal lumen. Abdominal CT scan demonstrated the presence of an air-fluid level the in gall bladder and also abscess in the porta hepatitis which was located between the gall bladder and the duodenum. Because the patient refused any surgical intervention, we treated him conservatively with intravenous antibiotics. Patient's symptom of anorexia was slowly resolved, and patient was discharged 10 days later.

A Case of Enteritis Cystica Profunda in the Duodenal Bulb / 대한소화기내시경학회지

Enteritis cystica profunda (ECP) is characterized by mucin-filled cystic spaces that are partially lined by non-neoplastic columnar epithelium, and these are found in the wall of the small bowel. This is a very rare disease compared to cystica profunda involving the stomach or colon. The cause of ECP is still unclear. Most ECP is related to or it may accompany other intestinal diseases. We encountered one case of ECP of the duodenal bulb that presented as polyp, and this was not related to adenocarcinoma or any other intestinal diseases like Crohn's disease or ulcerative colitis. Endoscopic polypectomy was done and the ECP was later confirmed through histological evaluation.

Effects of High Frequency Ventilation after Surfactant Replacement Therapy Compared with Conventional Ventilation in the Neonatal Respiratory Distress Syndrome

PURPOSE: We performed a retrospective study to compare effects of Surfacten(R) with HFV administration and meticulous conventional ventilatory support for neonatal RDS by analyzing clinical effects, complication and mortality between two groups. METHODS: Of 107 cases admitted to the nursery in Taegu Fatima hospital from February 1990 to June 1996, 52 neonates (admitted from January 1993 till June 1996) with RDS on high frequency ventilation after Surfacten(R) replacement were included as study group while 57 neonates(admitted from January 1990 till December 1996) with RDS on only conventional ventilation as control group. Serial change of FiO2, MAP, PaO2 and PaCO2 within 48hours after Surfacten(R) replacement, chest X-ray, clinical course, complication and mortality rate were propectively analyzed between two groups. RESULT: 1) After 24 hours Surfacten(R) replacement FiO2 had gradually decreased to 40% in the treated group, while in the control group, decreased to 50% within 48 hours. 2) MAP was maintained at 5.2cmH2O in the treated group, while in the control group, at 6.9cmH2O. 3) Serial change of PaO2 during weaning period after Surfacten(R) replacement between two groups were not significantly different(in the treated group : 74.5mmHg, in the conrol group : 76.1mmHg). 4) Serial change of PaCO2 during weaning period after Surfacten(R) replacement in the treated group were maintained significantly below the level of PaCO2 in the control group(in the treated group : 42.3mmHg, in the control group : 46.6mmHg). 5) In the treated group, complications were a series of PDA, IVH and pneumothorax, while in the control group, of PDA, Sepsis and IVH, and there were no differences between two groups with respect to mortality. CONCLUSION: It was concluded that the combined treatment with Surfacten(R) replacement and high frequency ventilation for neonatal RDS improved short term clinical effects than in the control group, but there were no significant difference in terms of complications and mortality rate between two groups