A Case of a Successful Band Ligation of a Colonic Perforation during Diagnostic Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.

Effect of Helicobacter pylori eradication on proliferation and apoptosis of gastric epithelial cells / 대한내과학회지

Helicobacter pylori (H. pylori) is the principle cause of type B gastritis and peptic ulcer disease and has been classified as group I carcinogen for gastric cancer. H. pylori may affect the normal balance between gastric cell proliferation and epithelial cell death, thus interfering with the maintenance of gastric mucosal integrity. The aim of this study was to investigate the effect of H. pylori on cell proliferation and apoptosis according to the effect of eradication of H. pylori. METHODS: The subjects were 45 patients who had undergone diagnostic gastroduodenoscopy; 11 with gastritis, seven with gastric ulcer and 27 duodenal ulcer. H. pylori infection was assessed by H&E and immunohistochemical stain with anti-H. pylori polyclonal antibody and rapid urease test. Acute and chronic inflammation, apoptosis and intestinal metaplasia were scored according to the updated Sydney system. Gastric epithelial cell proliferation was assessed by immunohostochemical method using Ki-67 monoclonal antibody. In situ apoptosis was detected with in situ terminal deoxyribonucleotide transferase (TdT)-mediated dUTP nick end labeling. RESULTS: Acute and chronic inflammation, intestinal metaplasia, Ki-67 labeling index, and apoptosis were significantly higher in H. pylori infected persons (n=45) than in uninfected persons (n=5)(p<0.05). Acute and chronic inflammation, intestinal metaplasia, Ki-67 labeling index and apoptosis in H. pylori eradicated group (n=25) significantly decreased after eradication therapy (p<0.05), but no significant differences of them was observed in H. pylori non-eradicated goup (n=20) after eradication therapy. Ki-67 labeling index was significantly correlated with acute inflammation, chronic inflammation and apoptosis (p<0.05). Apoptosis was significantly correlated with acute and chronic inflammation (p<0.05). CONCLUSION: In eradicated group, epithelial apoptosis and proliferation closely associated with gastric carcinogenesis are stabilized after treatment, which suggests H. pylori eradication therapymay preven the early step of gastric carcinogenesis.

The Relationships between Drinking Habits and Biopsychosocial Factors in Korean College Students / 신경정신의학

OBJECTS AND METHODS: In order to evaluate the relationships between drinking habits and biological and psychosocial characteristics, the authors administrated the questionnaires about drinking patterns and acute physiological and psychological responses after drinking, several psychological scales and ethanol patch test to 94 male medical students in Chosun University. RESULTS: 1) Low consumer group had significantly more severe physiological repondents after drinking in family members than high consumer group(p<.005). 2) Low consumer had significantly more severe acute physiological responses(p<.005) and high consumer group revealed more positive psychological responses after drinking(p<.005). But there was no difference in the degree of negative psychological responses between tow groups. 3) High consumer group had significantly more extroversion tedency(p<.01) and recieved more financial support from family than low consumer group(p<.01). 4) In the results of ethanol patch test. low consumer group showed more positive skin reaction in three test occasions than high consumer grou(p<.005). 5) Also the high consumer group revealed higher scores in factor 1,2,4(alpha=0.005), and 3(alpha=0.01) in comparison of factors of Korean Alcohol Use Inventory. 6) In comparison of drinking habits, low consumer group revealed higher incidence of nearly non-drinkers and sublimatory drinkers. But there were more casulal social drinkers, selcontrolled social drinkers, impusive-binge drinkers, and habitual-excessive drinkers in high consumer group(p<.005). And in drinking patterns, the items of dependence and duration of drinking, daily drinking disposition, preferential beverage, average and maximum drinking amount of each liquor, and magnitude of sips taken were higher in high consumer group. Only one item of interval between sips was longer in low consumer group(p<.005). 7) In comparison of sociodemographic variables, there were more students who were smokers(p<.01), from larger cities and small family(p<.05), and whose parents were well educated(p<.05) but had worse marital realtionship(p<.05) in high consumer group. CONCLUSEION: For better explanation of the etiology and characteristics of alcoholism, we investigated the differences in various aspects between low alcohol consumers and high alcohol consumers in college students. The most evident differences lied in the degree of acute physiological reaction and positive rates of ethanol patch test that strongly suggested the relations with the activty of ALDH. Some differences in psychosocial aspects between two groups were noticed but could not appropriately be explained at this time.

EEG Abnormalities in Henoch-Schonlein Purpura

Schonlein-Henoch purpura is a generalized small vessel vasculitis characterized by nonthrombocytopenic purpura, arthritis, abdominal pain and nephritis. In 1914 Osler described an allergic purpura associated with hemiplegia. After then Lewis et al. reported the cases of Schonlein-Henoch purpura associated with convulsion, coma, confusion, intracranial hemorrhage, and chorea, CNS complication has been reported in 1-8% of children and subsided spontaneously in most cases. Headache is a remarkable sympton and appears nonspecific nature. In 1991 Ostergaard and Storm reported that headache occured during the first week following skin rash and frequently showed abnormal EEG findings. We investigated prospectively the presence of a possible cerebral and renal involvement in the case of Schonlein-Henoch purpura. EEG abnormality demonstrated in 52.6% of all cases, and headache or irritability in 47.4% of all cases. A significant association was found between abnormal EEG finding and presence of headache, but was not found between EEG findings and presence of renal involvement and hypertension. Patients with abnormal EEG had no Past or famity history of febrile convulsion or ididopathic epilepsy.

A Clinical Observation of Neonatal Hyperbilirubinemia Due to ABO incompatibility

A clinical and statistical study was performed on 213 neonates of hyperbilirubinemia who were admitted to department of pediatrics of Korea University Hospital from Jan. 1989 to Jun. 1991. and we studied the difference between ABO compatible group and incompatible group, such as, day of apperance of hyperbilirubinemia, tendency of bilirubin concentration change, reticulocyte, hemoglobin and duration of hyperbilirubinemia. The following results were obtained. 1) There were no difference of initial body weight and gestational age between compatible (3.0 +/- 0.72kg, 38.2 +/- 3.2 weeks) and incompatible groups (3.2 +/- 0.54kg, 39.1 +/- 2.8 weeks). 2) Onset of hyperbilirubinemia within 2 days in the incompatible group (40.5%) was earlier than the compatible group (23.5%) significantly (p<0.05). 3) Mean bilirubin level in the incompatible group was higher than the compatible group significantly (p<0.05). 4) Peak bilirubin level in the incompatible group(18.7+/-4.1mg/dl) was higher than the compatible group (14.8+/-3.4mg/dl) significantly (p<0.05). 5) There were no difference of hemoglobin level, reticulocyte count, coombs positive finding and the ratio of exchange transfusion between two groups.

Study on Iron Deficient State in The Female Adolescent Athletes

Iron deficient state occurs commonly in the athlets, and the cause may be inadequate iron intake, loss of iron from sweat, blood loss of gastrointestinal tract, and hematuria. The age of the athletes ranged from 11 to 17 years old. I messured red blood cell count, hemoglobin, hematocrit, and related hematologic factors in the 32 adolescent female athletes and 21 female controls. a hematologic comparison was perfomed between the athletes and controls. The results obtained were as follows: 1) A value of hemoglobin were 11.6+/-1.4g/dl in the athletes and 12:4+/-0.8g/dl in controls (p<0.05). 2) Hematocrits were 34.1+/-3.4% in the athletes and 37.4+/-2.3% in controls (p<0.05). 3)A value of red bolld cell distribution width values were 13.9+/-2.1% in the athletes and 12.2+/-1.1% in controls (p<0.05). 4) Serum iron was 87.7+/-30.3ug/dl in the athletes and 121.8+/-39.0ug/dl in controls (p<0.001). 5) Total iron binding capacity was 445:6+/-31.8ug/dl in the athletes and 384:6+/-54.2ug/dl in controls (p<0.001). 6) Mean transferrin saturation values were 19.7+/-6.9% in the athletes and 32.5+/-10.8% in control (p<0.001). 7) Ferritin was 14.5+/-10.0ng/ml in the athletes and 33.9+/-13.9ng/ml in controls (p<0.001). 8) The duration of exercise was 4.8+/-2.5 years in the stage III iron deficiency, whil 3.0+/-2.0 years in normal group in iron deficient state (p<0.05).

A Case of Acute Tubular Necrosis Induced by Paraquat (Gramoxon) Intoxication

Paraquat (1, 1'-dimethy-14, 4' dipyridium chloride: Gramoxon(r)) was first discovered in England in 1955. It has been widely distributed for use in Korea since 1970 as a pesticide and also often the cause of accidental intoxications. The authors would like to report the following case of paraquat intoxicatio in a 13 year old female child admitted via emergency room with complaints of epigastric pain, vomiting and hematuria of four days duration. On admission the data of laboratory evaluation were as follows: BUN/Cr 126/11.6 mg/dl; sGOT/sGPT 641/641 IU/L; total bilirubin/direct bilirubin 3.9/2.4 mg/dl; alkaline phosphatase 396.1 U/L; fecal occult blood test-positive; pH 7.428, pCO2 26.2 mmHg, pO2 131.4 mmHg, base excess -5.0 mmol/L on arterial blood gas analysis (ABGA). Gastroendoscopy revealed esophageal ulcers, and as symptoms of renal failure could not be relieved by hemodialysis, kidney biopsy was performed on the otherwise previously healthy child to establish the cause of renal failure. The result of biopsy revealed tubular necrosis with eosinophilic infiltrations. A more detailed retrograde probe of the child's past medical history evoked that the patient had ingested paraquat in a suicidal attempt. Supportive therapy and hemodialysis were continued thereafter, but the symptoms of renal failure could not be reversed, and the patient eventually died due to acute respiratory distress syndrome.

Clinical assessment of neonatal transient tricuspid insufficiency: Doppler echocardiographic study

Eight neonates with transient tricuspid insufficiency are presented which was confirmed clinical and two dimensional echocardiographic assessment. We found that two dimensional Doppler echocardiography was very useful in the detection of transient tricuspid insufficiency during neonatal age as noninvasive method. Transient tricuspid insufficiency is a clinical disorder in the newborn period caused by myocardial dysfunction, secondary to asphyxia with or without hypoglycemia and associated with right ventricular overloading caused by pulmonary hypertention. The clinical diagnosis was based on a history of perinatal distress, distinctive murmur, ECG changes, biochemical abnormalities and myocardial imaging. 1) The sex ratio of TTI was 1:1. 2) The average gestational age was 34 weeks and mean body weight was 2.06 Kg, respectably. 3) Major symptoms were dyspnea, cyanosis, and tachypnea. 4) Tricuspid regurgitation was detected from the lst day to the 4th day of the life and was improved from the 7th day to the 30th day of the life. 5) The peak velocity through tricuspid valve ranged from the 2.7 m/sec to 4.0 m/sec and the estimated right ventricular pressure ranged from 39 mmHg to 74 mmHg. 6) Associated diseases were neonatal hyperbilirubinemia (100%), prematurity (87.5%), atrial right to left shunt (87.5%), patent ductus arteriosus (75%), hyaline membrane disease (25%), and transient tachypnea of newborn (12.5%).

Two cases of Dyke-Davidoff-Masson syndrome

Dyke-Davidoff-Masson syndrome is a rare disorder which developed hemiatrophy of brain, enlargement of ventricles and prominent pneumatization of petrous pyramid of the temporal bone. It manifests hemiparesis, varying type seizure, and mental retardation. We experienced two cases of Dyke-avidoff-Masson Syndrome, in a 6/12 year-old boy and a 1, 10/12 year-old girl who were admitted to our department of pediatrics, because of convulsion and hemiparesis The brain CT scan showed marked dilatation of lateral ventricle, prominent sylvian fissure and cortical sulci. So we report two cases of Dyke-Davidoff-Masson syndrome with review of literature.