Effect of Helicobacter pylori Infection on Reflux Gastritis after Gastrectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Reflux gastritis after gastrectomy is believed to be due to reflux of bile into residual stomach. However the substances that cause gastritis have not yet been precisely defined. Helicobacter pylori (H. pylori) infection is considered one of the most important pathogenetic factors in gastritis. The prevalence of H. pylori infection and the role of its infection on reflux gastritis after gastrectomy were investigated. METHODS: Eighty-one patients who had undergone subtotal gastrectomy were enrolled. Rapid urease test and histologic examination for H. pylori infection were performed during gastrofiberscopy. An eradication of H. pylori was attempted in fifteen H. pylori-positive patients who suffered from gastritis symptoms after gastrectomy. Follow-up endoscopy was performed more than 4 weeks after the end of eradication treatment. RESULTS: Forty-nine patients (60.5%) demonstrated H. pylori infection in their residual stomach. The histological gastritis score in patients with H. pylori infection was significantly higher than that without infection. Ten of the 15 patients (66.7%) with H. pylori infection had their infection successfully eradicated. And also their symptoms and histological gastritis score were significantly improved. CONCLUSIONS: H. pylori infection does play an important role on reflux gastritis after subtotal gastrectomy.

The Infection Rate of Helicobacter pylori and Its Relation to Gastrointestinal Symptoms in Patients with Chronic Renal Failure / 대한소화기내시경학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) can survive in the acid milieu of stomach by producing urease, which generates acid neutralizing ammonia by splitting gastric urea and creates a satisfactory environment for H. pylori. Thus the patients with chronic renal failure (CRF) with increased diffusion of blood urea to gastric lumen may be theoretically more susceptible to colonization with H. pylori. To investigate the infection rate of H. pylori in CRF and its relation to gastrointestinal symptoms, we performed prospective controlled study. METHODS: We performed gastroscopy in forty-two patients with CRF. Rapid urease test and histologic examination for H. pylori infection were performed. Histological gastritis was graded by updated Sydney classification. Gastrointestinal symptoms were assessed in all CRF patients and serum blood urea nitrogen and creatinine levels were also measured. RESULTS: Twenty-one (50.0%) demonstrated H. pylori infection in patients with CRF. H. pylori infection and major endoscopic findings were not related to the gastrointestinal symptoms in patients with CRF. In H. pylori-positive CRF patients, density of H. pylori and grade of histological gastritis were not related to the severity of gastrointestinal symptoms. CONCLUSIONS: The infection rate of H. pylori was 50% in patients with CRF. Gastrointestinal symptoms in CRF were related to factors other than H. pylori infection.

Efficacy and Safety of Weekend Therapy for the Eradication of Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: Because treatment duration directly influences both patient compliance and side effects in the eradication of Helicobacter pylori (H. pylori), shortening the duration remains the main goal of therapeutic strategies. The aim of the present study was to evaluate the efficacy and safety of short-term regimen (weekend therapy) for curing the H. pylori infection. METHODS: Twenty-eight patients with H. pylori-positive peptic ulcer received omeprazole 40 mg once daily for 7 days (from Monday to Sunday), bismuth 240 mg q.i.d., amoxicillin 1 g q.i.d., and metronidazole 500 mg q.i.d. for only 2 days (Saturday and Sunday). We compared the eradication rate with that of seventy-eight patients with H. pylori-positive peptic ulcer who had received either OAC (omeprazole, amoxicillin, and clarithromycin) or BMA (bismuth, metronidazole, and amoxicillin) regimens during the same period. H. pylori infection was assessed before treatment by rapid urease test or histologic examination. Four weeks after the end of treatment, the infection was also assessed by rapid urease test, histologic examination or urea breath test in weekend group and by urea breath test in control group. RESULTS: H. pylori eradication rates were 61.1% by per-protocol analysis and 39.3% by intention-to-treatment analysis. There were no treatment associated serious side effects, and only one patient (5.6%) showed mild epigastric discomfort. All patients completed the course of treatment. CONCLUSIONS: Weekend therapy have relatively low eradication rate, however, this therapeutic approach is safe and shows good compliance for the treatment of H. pylori infection.

Systemic Necrotizing Vasculitis Presenting as Multiorgan Failure and Spontaneous Intra-abdominal Hemorrhage / 대한신장학회잡지

Ruptured aneurysms complicate the course of polyarteritis nodosa only infrequently. Most often they occur in renal or mesenteric vessels. We experienced a case of 48-year old woman with systemic necrotizing vasculitis who developed multiorgan failure and spontaneous intra-abdominal hemorrhage. Angiography showed diffuse narrowing and spontaneous hemorrhage of medium and small sized arteries in visceral and pelvic vasculature. So emergency embolization and removal of hematoma was done. About 3000cc of blood was collected in the abdominal cavity. There were fine small aneurysmal dilatations of arteries with multiple collaterals and they oozed spontaneously. Bleeding small vessels were ligated. Pathologic findings of the involved arteries showed severe inflammation and necrosis of vessel wall. She was treated with corticosteroid and cyclophsphamide for one year and achieved improvement in her clinical status.

A Case of Bronchial Mucoepidermoid Carcinoma / 결핵

Mucoepidermoid carcinoma developed in tracheobronchjal tree is one of rare lung tumor. It is histologically divided into low grade malignancy of relatively benign course versus high grade malignancy of fatal course. In low grade malignancy, it can be curative with a surgical resection. We experienced a case of mucoepidermoid carcinoma in a 28-year-old woman who complained sudden dyspnea and presented right total lung collapse on chest roentgenogram. It was diagnesed as a low grade mucoepidermoid carcinoma and removed by the surgical excision.

Unilateral Absence of Lung Perfusion Caused by Non-thromboembolic Compression in Bronchogenic Carcinoma / 대한내과학회지

Perfusion scintigraphy has proved to be an essential part for the diagnosis of pulmonary thromboembolism. The wedge shaped perfusion defect extending to lung base is a highly probable finding of pulmonary embolism. Occasionally, great perfusion defects could be presented as a false positive finding under the circumstance of nonthromboembolic origin, such as neoplastic compression or invasion of pulmonary artery. We report an unusual case of massive perfusion defect resulting from pulmonary arterial compression by bronchogenic carcinoma. A 71-year-old man visited our hospital because of productive cough and was diagnosed as bronchogenic carcinoma. The perfusion scintigraphy showed unilateral total defect of lung, not accompanied by any clinical evidence of thromboembolism. A contrast enhanced computed tomogram showed heterogeneous mass shadow in left hilum, abutting to the descending aorta and compressing left main pulmonary artery. These findings suggested a nonembolic mechanism of perfusion defects which were produced by the neoplastic compression of pulmonary artery.