High and Frequent Dose of Dexlansoprazole and Amoxicillin Dual Therapy for Helicobacter pylori Infections: A Single Arm Prospective Study / 대한소화기학회지

BACKGROUND/AIMS: Recently, the eradication rate of Helicobacter pylori (H. pylori) infection has decreased to less than 80% worldwide with the use of clarithromycin-based triple therapy owing to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole. This prospective study aimed to determine eradication rate of H. pylori following high and frequent doses of extended-release dexlansoprazole and amoxicillin, as a dual therapy in a region with high clarithromycin resistance rate. METHODS: A total of 50 treatment-naïve patients with active H. pylori infections, who were confirmed through via rapid urease test or histology and serology between November 2015 and February 2016 at our hospital, were included for analysis. All enrolled patients were treated with 750 mg amoxicillin and 30 mg dexlansoprazole, four times a day for a total duration of 14 days. Treatment success was determined using urea breath test four weeks after treatment completion. RESULTS: Seven out of the 50 patients (29 men and 21 women; mean age, 57 years) dropped out during the study. The total eradication rate was 52% (26/50), and that for those with a compliance rate of over 90% was 68.4% (26/38). H. pylori infections were not successfully eradicated in patients with a compliance rate of less than 90%. Nine patients (18%) reported side effects, such as mild diarrhea and abdominal fullness. No significant factors, such as smoking and alcohol consumption, affected the infection the eradication rate. CONCLUSIONS: High and frequent doses of proton pump inhibitor–amoxicillin dual therapy were not effective in eradicating H. pylori infection in a province with high clarithromycin resistance rate.

Central Obesity as a Risk Factor for Non-Erosive Reflux Disease

PURPOSE: Although central obesity is a risk factor for erosive esophagitis, information regarding the association between central obesity and non-erosive reflux disease (NERD) is still scarce. The purpose of this study was to investigate the risk factors for NERD by comparing NERD patients and healthy controls. MATERIALS AND METHODS: Comprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December 2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnaire was used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects according to propensity scores. RESULTS: There were 119 NERD patients and 259 controls. In multivariate analysis, central obesity, female gender, and younger age were significantly associated with NERD [odds ratio (OR)=2.55, 1.93, and 1.80; p=0.001, 0.005, and 0.011, respectively]. After adjusting for 12 clinical variables using propensity score matching, 114 NERD patients were matched to 114 controls. All variables were well balanced between the two groups (average D before matching: 0.248, after matching: 0.066). Patients with NERD were more likely to have central obesity than healthy controls (28.1% vs. 7.9%). After adjusting for propensity scores and all covariates in multivariable logistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001). CONCLUSION: Central obesity appears to be an independent risk factor for NERD. This result supports the presence of an association between GERD and central obesity, even in the absence of esophageal erosion (NERD).

Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review / 대한소화기학회지

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.

Molecular Characterization of Community-Associated Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Children with Skin Infections in Busan, Korea

The prevalence and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-susceptible S. aureus (CA-MSSA) from children with skin infection were investigated by staphylocoagulase (SC) typing, multilocus sequence typing (MLST), SCCmec typing and virulent toxins, including Panton-Valentine leucocidin (PVL), and exfoliative toxins (ET). Among 69 cases of CA-S. aureus for a 3 month period from March to June, 2014 at hospital in Busan, 28 (40.6%) were MRSA and 41 (59.4%) were MSSA. Of the 28 CA-MRSA isolates, two major clones were identified as SC type Vb-ST72-SCCmec type IV (53.6%) and SC type l-ST89-SCCmec type II variant (42.8%), and the remaining one (3.6%) was SC type lll-ST8-SCCmec type IV. In CA-MSSA, the prevalent clone was SC type Vb-ST72 (29.3%), followed by SC type Vb-ST188 (21.9%), SC type Va-ST121 (19.5%) and SC type lV-ST30 (9.6%). None was positive for PVL gene, and all of the SC type l-ST89-SCCmec type II variant clones were ETB gene positive. The data suggest that there are significant clonal relatedness with specific SC types, and genetic diversities in both community strains isolated from children with skin infections.

Improvement in Left Ventricular Systolic Dyssynchrony in Hypertensive Patients After Treatment of Hypertension

BACKGROUND AND OBJECTIVES: Left ventricular (LV) dyssynchrony has been commonly detected among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The purpose of our study was to assess the changes in LV systolic dyssynchrony (SDSLV) among hypertensive patients after antihypertensive treatment, and to determine the relationship between SDSLV and other conventional echocardiographic parameters. SUBJECTS AND METHODS: Forty one hypertensive patients with normal LV ejection fraction were enrolled. By performing a conventional echocardiographic study, the SDSLV was measured as the time difference between the shortest and longest time of the peak myocardial systolic velocities among 12 segments of the basal and mid-levels of the 3 apical views, and radial dyssynchrony of the basal (RDSbase) and mid-levels (RDSmid) measured as the time difference between the earliest and latest peak values on the radial strain curves of each level of the parasternal short-axis views. RESULTS: Compared to baseline after six months of antihypertensive treatment, the SDSLV improved significantly (48.7+/-37.9 ms vs. 29.5+/-34.1 ms, p=0.020). Also the RDSbase and RDSmid improved significantly in respect to the baseline values (129.9+/-136.3 ms vs. 38.8+/-45.4 ms, p=0.002 and 75.2+/-63.8 ms vs. 28.2+/-37.7 ms, respectively, p<0.001). CONCLUSION: The severity of SDSLV improved with antihypertensive treatment, and was associated with the regression of LV mass. Furthermore, it might precede improvement in the mitral inflow pattern, as assessed by conventional echocardiography, so that early detection of the benefit of antihypertensive treatment may be possible.

Isolated Double-Chambered Right Ventricle in a Young Adult

Double-chambered right ventricle (DCRV) is a rare congenital heart disorder in which the right ventricle is divided by an anomalous muscle bundle into a high pressure inlet portion and a low pressure outlet portion. We report a case of isolated DCRV without symptoms in adulthood, diagnosed through echocardiography, cardiac catheterization and cardiac magnetic resonance imaging.

A Case of Uremic Pericarditis and Cardiac Tamponade That Developed after Ethylene Glycol Poisoning: A Case Report / 대한구급학회지

Ethylene glycol is commonly incorporated into automotive antifreeze agents and a variety of other commercial products. Ethylene glycol poisoning can cause life-threatening metabolic acidosis, cardiopulmonary failure, and renal failure that may be fatal. We present an unusual case of a patient who ingested a large amount of ethylene glycol for the purpose of suicide and developed multiorgan damage, including acute renal failure followed by uremic pericarditis and cardiac tamponade. This unusual complication was effectively managed with echocardiography-guided percutaneous pericardiocentesis and continuous catheter drainage for 3 days. After intensive hemodialysis and supportive care, the patient made a good recovery with near normal cardiac and renal function. Physicians should be aware of the possibility of acute pericarditis and cardiac tamponade in cases of acute renal failure caused by ethylene glycol poisoning.

Left Ventricular Dyssynchrony in Patients Showing Diastolic Dysfunction without Overt Symptoms of Heart Failure

BACKGROUND/AIMS: Few studies have assessed left ventricular (LV) dyssynchrony in cases of diastolic dysfunction that do not include overt symptoms of heart failure. We hypothesized that systolic or diastolic dyssynchrony involves unique features with respect to the degree of diastolic impairment in isolated diastolic dysfunction. METHODS: We examined 105 subjects with no history of overt symptoms of heart failure and a left ventricular ejection fraction > 50% for mechanical dyssynchrony using tissue Doppler imaging. RESULTS: In terms of longitudinal dyssynchrony, four cases showed (6.3%) LV intraventricular systolic dyssynchrony (SDS(LV)), whereas none had LV intraventricular diastolic dyssynchrony (DDS(LV)) or co-existing systolic dyssynchrony. Radial dyssynchrony (RD) was found in six cases (9.4%). After adjusting for age, SDS(LV) and DDS(LV) were found to be significantly related to increases in the E/E' ratio (r = 0.405 and p < 0.001 vs. r = 0.216 and p = 0.045, respectively). RD at the base and apex was also significantly related to increases in E/E' (r = 0.298 and p = 0.002 vs. r = 0.196 and p = 0.045, respectively). CONCLUSIONS: Systolic and diastolic dyssynchrony in subjects with isolated diastolic dysfunction but without overt symptoms of heart failure was not as common as in patients with diastolic heart failure; however, the systolic and diastolic intraventricular time delay increased with increases in the E/E' ratio, an indicator of diastolic dysfunction.

Characteristics of Myocardial Deformation and Rotation in Subjects With Diastolic Dysfunction Without Diastolic Heart Failure

BACKGROUND AND OBJECTIVES: There have been very few pathophysiologic studies on isolated diastolic dysfunction. We hypothesized that the characteristics of isolated diastolic dysfunction would be located, on the clinical continuum, between those of a normal heart and diastolic heart failure. SUBJECTS AND METHODS: We enrolled 102 subjects who had no history of overt symptoms of heart failure and who had a left ventricular ejection fraction of more than 50%. They were examined for myocardial deformation and rotation using the two-dimensional speckle tracking image (2D-STI) technique. RESULTS: The circumferential strains and radial strain at the apical level (RS(apex)) were related to the ratio of the transmitral early peak velocity over the early diastolic mitral annulus velocity (E/E'). After adjustment for age, the RS(apex) showed a positive relationship with the E/E' ratio; whereas, the circumferential strains did not. Instead, the circumferential strains demonstrated a significant correlation with age. Basal rotation and left ventricular (LV) torsion were also related to age, but had no relationship with the E/E' ratio. However, as the E/E' ratio value increased, systolic mitral annular velocity decreased. CONCLUSION: Except for the RS(apex), LV myocardial deformation and rotation did not vary with the degree of E/E' ratio elevation when there was no associated diastolic heart failure. Additionally, in clinical situations such as isolated diastolic dysfunction, the advancement of age has a relatively greater influence on characteristics of LV myocardial deformation and rotation rather than on the E/E' ratio.

Expression of CC Chemokines in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The number of eosinophil in nasal polyps has been reported to be strongly elevated when compared to non-affected nasal tissue, indicating an important role for eosinophils in the pathogenesis of nasal polyposis. The mechanisms determining selective eosinophilic tissue infiltration into diseased nasal mucosa as yet are specualtive. Panleukotactic factors also known to be present on nasal polyps cannot explain the type-selective tissue infiltration in eosinophilic or neutrophilic-featured diseases. Chemokines are known to have leukocyte subtype-selective chemotactic properties in vitro and thus are candidates explaining leukocytic characteristic tissue infiltration. The aim of this study was to investigate whether specific chemokines are associated with different forms of nasal polyps. This study was designed to demonstrate the expressions of various CC chemokines. MATERIALS AND METHODS: Nasal polyp from patients with systemic allergy (AP group, n=7) and negative allergic skin tests (NP group, n=10) were sampled. Expressions of RANTES, eotaxin, MCP-1, MIP-1alpha,beta were studies by RT-PCR and immunohistochemical studies. RESULTS: Expression and mean density of RANTES, MCP-1, MIP-1beta were significantly stronger in NP group than in AP group (p<0.05). However, those of eotaxin and MIP-1alpha were significantly stronger in AP group than in NP group (p<0.01). CONCLUSION: This results suggest that only selective chemokines could be involved to develop the pathologic conditions in different type of nasal polyp.

Functional Changes of Interleukin-4 and Interferon-gamma of Peripheral Blood and Nasal Mucosa after Immunotherapy in Patients with Perennial Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Immunologic changes of immunotherapy can include reduced allergenstimulated mononuclear cells prolifer-ation and lymphokine production and the generation of allergic-specfic suppressor T cells. The changes and the relationships of the mononuclear cells between the peripheral blood and the nasal mucosa are still unclear during immunotherapy. The purpose of this study was to evaluate the functional changes of the mononuclear cells in peripheral blood and the nasal mucosa following immunotherapy. MATERIALS AND METHODS: We collected the mononuclear cells from the peripheral blood and the nasal mucosa in 25 patients who had received immunotherapy and 10 patients without any treatment. All of the patients were sensitive to house dust mites. And 5 healthy subjects were used as a control. The mononuclear cells were incubated with antigen or phytohemaglutinin (PHA) for 48 hours. And productions of Interleukin-4 and Interferon-gamma were measured in supernatants by ELISA. On the peripheral mononuclear cells stimulated by antigens, the production of Inter-leukin-4 was dominant in the non-treated allergic group and there were no differences of the productions in the group of immunotherapy and healthy control group. Similar findings of Interleukin-4 production were seen on mononuclear cells from the nasal mucosa. And there were no differences of Interferon-gamma production in the nontreated and control group. However the immunotherapy group showed more Interferon-gamma production than those 2 groups in mononuclear cells from both sites. CONCLUSION: These findings suggests that immunotherapy can change the function of mononuclear cells from the peripheral blood as well as the nasal mucosa.

Usefulness of 2D PC MRA of the Circle of Willis in the Evaluation of Acute Cere b ral Infarction

PURPOSE: To evaluate the usefulness of axial 2-D PC MRA of the circle of Willis in the evaluation of acute cerebral infarction. MATERIALS AND METHODS: We evaluated 42 patients with acute cerebral infarction who had undergone T2 weighted and diffusion weighted MR imaging (T2WI, DWI) and 2-D PC MRA of the circle of Willis within 72 hours of the onset of symptoms. In conjunction with high-signal lesions on DWI, the findings of 2-D PC MRA were classified as normal, stenotic, or indicative of arterial occlusion; negative 2-D PC MRA was not considered useful. In addition, the signal intensity of T2WI and DWI was compared. RESULTS: (The findings of 2-D PC MRA showed that 15 cases (35.7%) were normal, 13(31%) were stenotic, and that in 14 (33.3 %), occlusion was present). Thus, 2-D PC MRA detected vascular abnormality in 27 cases (64.3 %). On T2WI, six cases (14.3 %) showed no signal change and 36 (85.7 %) showed high signal change. In six cases without signal change, MR images were obtained within 12 hours of ictus; in one of these patients MRA findings were normal, one had stenosis, and in four, occlusion was noted. CONCLUSION: 2-D PC MRA is a useful modality for the detection of vascular abnormality in patients with acute cerebral infarct.