Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

Background/Aims@#The risk for colonoscopic postpolypec-tomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, espe-cially those with liver cirrhosis. @*Methods@#We retrospectively reviewed the medical records of patients with CLD who un-derwent colonoscopic polypectomy at Seoul National Univer-sity Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB. @*Results@#A total of 1,267 consecutive patients with CLD were included in the study. Im-mediate PPB occurred significantly more often in the ChildPugh (CP) B or C cirrhosis group (17.5%) than in the CP-A (6.3%) and chronic hepatitis (4.6%) groups (p10 mm in size (p=0.010). @*Conclusions@#Patients with CP-B or C cirrhosis had an increased risk for bleeding fol-lowing colonoscopic polypectomy.

A Case of Adenocarcinoma in situ of the Distal Common Bile Duct Diagnosed by Percutaneous Transhepatic Cholangioscopy

Extrahepatic cholangiocarcinoma is often clinically challenging to diagnose. Even multidisciplinary approaches which include computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiography are unsatisfactory in some cases, especially with biliary stricture. Percutaneous transhepatic cholangioscopy (PTCS) with its direct visualization for biopsy appears to be a promising technique for detecting cholangiocarcinoma at an early stage. We report a case of adenocarcinoma in situ of the distal common bile duct (CBD) that was confirmed by PTCS. This case suggests the useful role of PTCS in the differential diagnosis of a distal CBD obstruction, particularly when other diagnostic modalities do not provide definitive information.

Recent Trends in the Eradication Rates of Second-Line Quadruple 14 Therapy for Helicobacter Pylori and the Clinical Factors that Potentially Affect the Treatment Outcome / 대한소화기내시경학회지

BACKGROUND/AIMS: The present study aimed to evaluate the efficacy of second-line quadruple therapy for treating patients with Helicobacter Pylori, and these patients were treated at our hospitals for September, 2003 through April, 2008 in Seongnam, Korea. METHODS: One hundred and thirty-three patients who failed to respond to the initial PPI-based triple therapy received quadruple therapy, whcih consisted of PPI, bismuth, tetracycline and metronidazole. The patients were divided into two groups. One group was treated for 7 days and the other group was treated for 14 days. Four to six weeks after completing the schedule, a 13C-urea breath test was performed to detect the presence of H. pylori. RESULTS: The overall intention-to-treat and per-protocol (PP) eradication rates were 75.2% and 81.1%, respectively. The PP eradication rates for the years 2003~2004, 2005, 2006 and 2007~2008 were 76.5%, 82.5%, 91.3% and 75%, respectively. There was no significant difference of the eradication rates according to gender, age and the duration of treatment. Yet the eradication rate of the chronic gastritis group (66.7%) was significantly lower than that of the peptic ulcer group (84.7%) (p=0.030). CONCLUSIONS: There was no definite downward trend for the eradication rates of second-line quadruple therapy during the 6 year study period. However, the eradication rate in the recent 2 years guaranteed only a 75% cure rate and the quadruple therapy was less effective for the patients with chronic gastritis. Therefore, a novel, more potent novel second-line regimen may be needed for the eradication of H. pylori.

Clinical Features of Re-infection of Helicobacter pylori after Successful Eradication / 대한소화기내시경학회지

BACKGROUND/AIMS:Studies on re-infection of Helicobacter pylori are limited. This study was designed to determine if there are clinical features of H. pylori re- infection related to gastroduodenal diseases or histological findings. METHODS: From a population of patients that were treated for H. pylori eradication from May 2003 to September 2007, 129 subjects were enrolled. Regimens were PPI-based triple or quadruple agents and follow-up methods were UBT, CLO or histology. RESULTS: A total of 29 subjects experienced a recurrence (within one year, 17 subjects; between one and two years, eight subjects; more than two years, four subjects). Recurrence periods were 2 to 32 months, and the mean period was 12.62+/-8.40 months. Among 29 subjects, eight subjects had chronic atrophic gastritis, 14 subjects had a peptic ulcer, five subjects had stomach cancer and two subjects had a MALT lymphoma; there were no statistical differences of the odds ratio between matched diseases. By use of the Updated Sydney System, neither H. pylori colonization density nor neutrophil infiltration nor monocyte infiltration grade in histology was associated with recurrence or re-infection. CONCLUSIONS: Neither histological findings nor gastroduodenal diseases was associated with H. pylori re-infection. The re-infection rate in this study was approximately 6.2%. This rate was slightly higher than rates reported in other recent studies in Korea.

Attention Deficits of Euthymic Bipolar Patients in the Sustained Attention to Response Task / 신경정신의학

OBJECTIVES: Euthymic patients with bipolar disorder have been reported to show deficits in sustained attention. This study aimed to compare the attention capacities of euthymic bipolar patients with those of control subjects using the sustained attention to response task (SART) and to examine the differences in the performance of SART related to the type of the stimulus. METHODS: The four SART tasks were performed to measure attention capacities in 42 euthymic patients with bipolar disorder and 28 control subjects. Happy, neutral, fearful faces and digit '3' were used as target stimuli in happy, neutral, fear and digit task conditions, respectively. The severity of mood symptoms was assessed with 17-item Hamilton Rating Scale for Depressive symptoms and Young Mania Rating Scale for manic symptoms. The efficiency estimate which reflects both the response accuracy and speed was used as the main outcome variable. RESULTS: Bipolar patients showed significantly lower correct response rate than control group in all task conditions. Efficiency estimates of the bipolar patient group were significantly lower than those of the control group in the SART using facial stimuli, but not in the digit task condition. There was no significant difference in task performances related to the emotional categories of facial stimuli. CONCLUSION: Bipolar patients showed deficits in sustained attention even in the euthymic state. The attention deficits shown in the euthymic bipolar patients may be prominent in a more complex task condition with stimuli such as facial stimuli.

Temperament and Character in Euthymic Bipolar I Patients with or without Psychotic Features / 신경정신의학

OBJECTIVES: The aim of this study was to exam whether personality, i.e. temperament and character, has an association with a previous presence of psychotic features in euthymic bipolar I disorder. METHODS: We recruited 25 psychotic patients with bipolar I disorder, 23 non-psychotic bipolar I patients and 48 normal controls. All subjects were asked to perform Temperament and Character Inventory (TCI). Euthymic state was defined in bipolar patients by scores of below 10 on the Hamilton Depression Rating Scale (HDRS) and on the Young Manic Rating Scale (YMRS). RESULTS: Psychotic bipolar patients, compared to normal controls, showed higher harm avoidance (HA) and self-transcendence (ST). In addition, HA in psychotic bipolar patients was higher than that in non-psychotic bipolar patients. However, no significant differences on TCI were demonstrated between non-psychotic patients and normal controls. CONCLUSION: There are significant discrepancies in personality between psychotic and non-psychotic bipolar patients on HA and ST. These findings are consistent with the hypothesis of a continuum between bipolar disorder with psychotic features and psychotic disorders.