Evaluation of Transnasal Esophagogastroduodenoscopy as a Surveillance Endoscopy in a General Medical Checkup

BACKGROUND/AIMS: Transnasal esophagogastroduodenoscopy (T-EGD) has been reported to be well tolerated and is known to reduce patient discomfort that occurs with conventional EGD (C-EGD) performed via an oral route. We aimed to evaluate factors that influence preferences for T-EGD as a surveillance EGD in a general medical checkup. MATERIALS AND METHODS: A total of 658 subjects (median age, 49 years; 45% men) underwent T-EGD procedures by 8 endoscopists using a 5.2-mm diameter endoscope. All examinees and endoscopists were asked to assess the T-EGD examinations using the post-endoscopy questionnaire. The post-endoscopy questionnaire included a 10-point visual analogue scale, which asked the patient to place a cross on the line according to examinee's or endoscopist's experience of the endoscopy procedure. Zero represented the worst experience and 10 the best experience. RESULTS: T-EGD was feasible in 96.6% of the subjects. Younger age ( or =35 years) or male examines preferred T-EGD as the modality for the next examination. The endoscopist's overall discomfort level was higher in the beginner group than in the expert group. CONCLUSIONS: The T-EGD may be better tolerated than C-EGD and offers a more comfortable surveillance endoscopic procedure to older (> or =35 years), male, or sedated C-EGD-experienced examinees in a general medical checkup. More experience with and education about T-EGD may help to improve the tolerance of the beginner group of endoscopists.

The Risk Facotr Associated with Hypertensive Intracerebral Hemorrhage

BACKGROUND: The hypertension is known to be the most important risk factor for the intracerebral hemorrhage. We analyzed other risk factors associated with hypertension that may contribute in the episode of hypertensive intracerebral hemorrhage. METHODS: Medical records of 100 patients with hypertensive intracerebral hemorrhage between January 1995 and December 2000 were reviewed and analyzed for age, sex, serum total cholesterol level, regular management of hypertension, systolic and diastolic blood pressure, arrhythmia and left ventricular hypertrophy in ECG. RESULTS: 1) Mean age was 64.1+/-11.3 years old and there were 35 males and 65 females. 2) Mean systolic and diastolic blood pressure were 176.9+/-35.9 mmHg and 106.3+/-20.7 mmHg. 3) Mean serum total cholesterol level was 182.6+/-46.4 mg/dL. 35.5% of the patients had serum total cholesterol levels less than 160 mg/dl and 33.4% were between 160-199 mg/dL. 4) Only 16% of the patients had any kind of treatment for hypertension. CONCLUSION: The high blood pressure and the treatment for hypertension were most important risk factors for hypertensive intrace- rebral hemorrhage. Also, 68.9% of the patients with hypertensive intracerebral hemorrhage had normal to low serum total cholesterol level. Thus low to normal serum total cholesterol level could be a risk factor of hypertensive intracerebral hemorrhage.

The effects of dietary caloric distribution and exchange on insulin secretion and insulin resistance in rats / 대한내과학회지

BACKGROUND: In Korea, the prevalence of type 2 diabetes has been rapidly increased in parallel with the westernization of eating behavior, which can be potential contributors for insulin resistance. We determined whether Western diet (WD), Korean diet (KD), Western-Korean exchange diet (WDK), Korean-Western exchange diet (KDW) and control diet (CD) altered insulin secretion and insulin resistance in weaning male Sprague Dawley rats. METHODS: Weaning rats were provided by KD (77 En% of starch, 5 En% of corn oil and 13 En% of gluten plus 5 En% of casein), WD (42 En% of starch, 40 En% of butter and 18% of casein) or CD (62 En% of starch, 20 En% of corn oil and 18% of casein) for 21 weeks. At the 13th week, rats in the WDK and KDW groups exchanged the diets from WD to KD and KD to WD, respectively, and they continued on the exchanged diets for 9 weeks. RESULTS: Fasting serum glucose levels were lower in KD and WDK than any other groups. Insulin secretion was higher by 2.2+/-0.4 folds in WD and 1.9+/-0.3 folds in KDW than KD at baseline. In hyperglycemic clamp, insulin secretion to maintain 11.1 mmol/L of serum glucose levels showed the same results as the baseline. Whole body glucose disposal rates were highest in KD among all groups. Glycogen deposits in soleus and quadriceps muscles were highest in KD among all groups, and their triglyceride contents were lowest. GLUT4 contents and fraction velocity of glycogen synthase were highest in KD in soleus muscles. CONCLUSION: Westernized high fat diets increased insulin resistance, and insulin secretion increased to overcome insulin resistance. Increased insulin resistance was due to increased triglyceride and decreased glycogen, GLUT4 and glycogen synthase contents in muscles.

Inappropriate Secretion of Antidiuretic Hormone in a Patient with Squamous Cell Carcinoma of the Lung mimicking Pulmonary Tuberculosis

A 71-year-old man with squamous cell carcinoma of lung mimicking pulmonary tuberculosis associated with the syndrome of inappropriate secretion of ADH(SIADH). Laboratory examination showed serum sodium concentration of 108 mEq/l. serum osmolality 247 mEg/l urine sodium concentration of 141 mEq/l urine osmolality 547 mEq/l. normal levels (<0.56 pg/ml) of serum antidiuretic hormone (ADH). ADH release was regulated normally with changes in serum osmolality. SIADH was diagnosed on the basis of hyponatremia with corresponding serum hypoosmolality and a high urine osmolality due to continuous sodium excretion. In this case, SIADH was probably induced by increased renal sensitivity to ADH and suspected high serum ANP level of unknown origin.