Staging Gastritis Based on Endoscopic Atrophic Border Backed by Operative Link for Gastritis Assessment System in 158 Health Checkup Subjects: Single Center Study

BACKGROUND/AIMS: Newer operative link for gastritis assessment (OLGA) system tried to stage gastritis in view of gastric cancer (GC) risk and endoscopic atrophic border (EAB) was well correlated with OLGA. We described the gastritis on the base of EAB during endoscopic sessions and classified them into high or low stage gastritis as suggested by Quach et al. and analyzed them. MATERIALS AND METHODS: A total of 158 subjects who visit our health promotion center were graded on the base of EAB by conventional endoscopy and reallocated according to ages. Linear-by-linear association was performed to identify the differences of gastritis among age-groups. RESULTS: In our study 31% of patients had atrophic gastritis (AG) over AG closed type 3~open type 1 compatible with OLGA stages III/IV (high stage gastritis). High and low stage gastritis showed significantly different distribution at each age group. The proportion of endoscopically diagnosed high stage gastritis increased in proportion to age. Contrast to Quach et al. our study showed prevalence of high stage gastritis under 40s, even in 20s or 30s (P=0.002). CONCLUSIONS: OLGA based EAB is easy and useful in GC risk stratification. In our study unlike the previous study of Quach et al., high stage gastritis was found in younger age groups. We should and could make an effort to prevent GC in even younger age groups with the aid of EAB. Additionally we could get organized and communicable stratified data about GC risk.

Staging Gastritis Based on Endoscopic Atrophic Border Backed by Operative Link for Gastritis Assessment System in 158 Health Checkup Subjects: Single Center Study

BACKGROUND/AIMS: Newer operative link for gastritis assessment (OLGA) system tried to stage gastritis in view of gastric cancer (GC) risk and endoscopic atrophic border (EAB) was well correlated with OLGA. We described the gastritis on the base of EAB during endoscopic sessions and classified them into high or low stage gastritis as suggested by Quach et al. and analyzed them. MATERIALS AND METHODS: A total of 158 subjects who visit our health promotion center were graded on the base of EAB by conventional endoscopy and reallocated according to ages. Linear-by-linear association was performed to identify the differences of gastritis among age-groups. RESULTS: In our study 31% of patients had atrophic gastritis (AG) over AG closed type 3~open type 1 compatible with OLGA stages III/IV (high stage gastritis). High and low stage gastritis showed significantly different distribution at each age group. The proportion of endoscopically diagnosed high stage gastritis increased in proportion to age. Contrast to Quach et al. our study showed prevalence of high stage gastritis under 40s, even in 20s or 30s (P=0.002). CONCLUSIONS: OLGA based EAB is easy and useful in GC risk stratification. In our study unlike the previous study of Quach et al., high stage gastritis was found in younger age groups. We should and could make an effort to prevent GC in even younger age groups with the aid of EAB. Additionally we could get organized and communicable stratified data about GC risk.

The effects of growth hormone administration on the markers of cardiovascular disease in growth hormone deficient adults / 대한내과학회지

BACKGROUND: Subjects with growth hormone-deficiency (GHD) have increased cardiovascular mortality, and growth hormone (GH) replacement may modulate cardiovascular disease risk. Therefore, we evaluated the effects of GH administration on the markers of cardiovascular disease in subjects with GHD. METHODS: 37 subjects (12 men and 25 women) with GHD and 65 normal subjects were enrolled in this study. GH or placebo were given for 3 months at a dose adjusted for normal serum insulin-like growth factor-I (IGF-I) level. Height, weight, waist circumference, hip circumference, lean body mass, fat mass, blood pressure, fasting blood glucose, IGF-I, lipid profile, uric acid, C-reactive protein (CRP), plaminogen activator inhibitor-1 (PAI-1), apolipoprotein AI, and quality of life-assessment of growth hormone deficiency in adults (QoL-AGHDA) were measured at baseline and month 3. RESULTS: Subjects with GHD showed higher levels of triglyceride, CRP, and PAI-1, but lower level of fasting glucose than normal subjects. Fat mass, CRP, and PAI-1 levels decreased in GH recipients (fat mass; 21.9+/-6.6 to 21.3+/-6.7%, p<0.05, CRP; 2.73+/-2.11 to 1.47+/-1.29 mg/L, p<0.001, PAI-1; 48.9+/-33.2 to 31.6+/-28.5 ng/mL, p<0.05). Fasting blood glucose and total cholesterol levels increased in GH recipients (fasting blood glucose; 4.58+/-0.46 to 4.81+/-0.36 mmol/L, p<0.05, total cholesterol; 5.36+/-1.31 to 6.17+/-1.12 mmol/L, p<0.01). Placebo recipients showed decrease in waist-hip ratio (0.93+/-0.05 to 0.92+/-0.04, p<0.05) and increase in fasting blood glucsoe (4.63+/-0.38 to 4.89+/-0.45 mmol/L, p<0.05) and uric acid (319.6+/-89.2 to 335.6+/-89.2 micro mol/L, p<0.05). QoL-AGHDA score improved in both groups (GH recipients; 10.0+/-6.0 to 7.4+/-5.5, p<0.01, placebo recipients; 9.8+/-4.4 to 6.7+/-3.4, p<0.05). CONCLUSION: Our results demonstrated favourable effects of GH on cardiovascular disease through modulating CRP and PAI-1 plasma level in subjects with GHD.

A Case of Mycobacterium avium Pulmonary Disease with Massive Pleural Effusion in an HIV-negative, Nonimmunosuppressed Patient: Using PCR-Restriction Fragment Length Polymorphism Assay

The Mycobacterium avium complex (MAC) comprises slow-growing mycobacteria that is ubiquitous in the environment and capable of infecting diverse species with consequences ranging from asymptomatic infection to clinically significant and even fatal disease. Especially, basal pleural disease is infrequently found in immunocompetent person. We report a very rare case of M. avium pleuritis with massive pleural effusion without any predisposing conditions. A previously healthy 36-year-old man was admitted to our hospital because of generalized malaise, low-grade fever, and right pleuritic chest pain of 5 days' duration. Chest X-ray showed mottled infiltration in the right upper lung zone with minimal right pleural effusion which was exudate with lymphocyte-dominance. The pleural effusion progressively increased without responding to anti-tuberculosis treatment. Afterwards M. avium was identified from the pleural effusion using PCR-Restriction Fragment Length Polymorphism Assay(PCR-RFLP). The treatment regimen was changed to rifampine, ethambutol, clarithromycin and streptomycin afterwhich the patient recovered.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

A Case of Mycobacterium avium Pulmonary Disease with Massive Pleural Effusion in an HIV-negative, Nonimmunosuppressed Patient: Using PCR-Restriction Fragment Length Polymorphism Assay

The Mycobacterium avium complex (MAC) comprises slow-growing mycobacteria that is ubiquitous in the environment and capable of infecting diverse species with consequences ranging from asymptomatic infection to clinically significant and even fatal disease. Especially, basal pleural disease is infrequently found in immunocompetent person. We report a very rare case of M. avium pleuritis with massive pleural effusion without any predisposing conditions. A previously healthy 36-year-old man was admitted to our hospital because of generalized malaise, low-grade fever, and right pleuritic chest pain of 5 days' duration. Chest X-ray showed mottled infiltration in the right upper lung zone with minimal right pleural effusion which was exudate with lymphocyte-dominance. The pleural effusion progressively increased without responding to anti-tuberculosis treatment. Afterwards M. avium was identified from the pleural effusion using PCR-Restriction Fragment Length Polymorphism Assay(PCR-RFLP). The treatment regimen was changed to rifampine, ethambutol, clarithromycin and streptomycin afterwhich the patient recovered.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.