The Prevalence of Helicobacter pylori Infection in Korean Patients with Inflammatory Bowel Disease, a Multicenter Study / 대한소화기학회지

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.

The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. METHODS: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. RESULTS: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. CONCLUSIONS: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

Short-Term Clinical Results of Amniotic Membrane Application to Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the short-term surgical results of Merocel(R) nasal packing wrapped with human amniotic membrane on the internal ostium during endonasal dacryocystorhinostomy (DCR). METHODS: Sixty patients who underwent endonasal DCR to treat nasolacrimal duct obstruction from October 2005 to April 2006 were enrolled in this prospective study. The patients were divided into two groups: 30 patients treated with Merocel(R) packing wrapped with amniotic membrane were assigned to group 1, and the remaining 30 patients were assigned to group 2. During the follow-up period, the authors evaluated surgical wound healing, the incidence of granuloma, and the patency of the internal ostium. RESULTS: Success rates at 6 months after surgery were higher in group 1 than in group 2, but these rates showed no statistically significant difference between the two groups (group 1: 93.3%, group 2: 86.7%, p=0.67). The time for mean wound healing in group 1 was significantly shorter than that in group 2 (group 1: 4.8+/-1.5 weeks, group 2: 7.3+/-1.5 weeks, p< 0.001). The incidence of granuloma in group 1 was lower than that in group 2 at 2 months after surgery (group 1: 13% (4/30), group 2:33% (14/30), p=0.04). However, there was no difference of granuloma formation between the two groups at 6 months postoperatively (group 1: 33% (11/30), group 2: 46% (14/30)). CONCLUSIONS: The authors believe that the use of Merocel(R) packing wrapped with amniotic membrane after endonasal DCR might decrease postoperative inflammation, accelerate wound healing, and decrease granuloma formation in the early postoperative period.

Forniceal Reconstruction through Subciliary Approach in a Patient with Shallow Inferior Fornix

PURPOSE: To evaluate the usefulness of a new technique for the subciliary approach to the surgical management of anophthalmic, shallow inferior fornices. METHODS: Six patients with difficulty retaining an ocular prosthesis, due to anophthalmic, shallow inferior fornices with sufficient conjunctiva, underwent this operation from October 2003 to April 2005. Surgery consisted of the fixation of the conjunctival fornix to the periosteum immediately posterior to the inferior orbital rim through the subciliary approach. This study was prospective. RESULTS: The mean age of the patients was 40.1+/-14.7 years (range, 21~62 years). Three of six patients were male, and three were female. The mean duration of surgical anophthalmos was 16.8+/-13.2 years (range, 0.6~40 years), and the mean follow-up period was 9.3+/-8.4 months (range, 3~25 months). All 6 patients who could not wear prostheses because of shallow fornices could wear ocular prostheses successfully after the operation. An ocular prosthesis could be fitted at a mean duration of 1.83+/-0.75 weeks (range, 1~3 weeks), postoperatively. Only one patient had mild entropion, but there were no conjunctival contractures or loss of fornices postoperatively. CONCLUSIONS: The authors believe that this new technique through the subciliary approach is simple and easy to perform and enables the patient to wear an ocular prosthesis earlier than does forniceal reconstruction through the transconjunctival approach. This technique is very useful in patients with anophthalmic, shallow inferior fornices who have sufficient conjunctiva but loose attachments of the fornix to the underlying tissue, causing shallow fornices.

Relationship of body iron stores with the development of nonalcoholic fatty liver disease / 대한내과학회지

BACKGROUND: Although numerous reports have shown the influence of the iron overload state on the development of nonalcoholic fatty liver disease (NAFLD), there have been few reports on the prevalence of NAFLD according to the body iron stores. The aim of the present study was to determine the relationship of body iron stores with the development of NAFLD in apparently healthy women. METHODS: The present cross-sectional study was performed with data obtained from 5,249 women (mean age: 40.6+/-8.9 years), that received an annual health check-up. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, level of C-reactive protein and serum iron tests were measured in each subject. RESULTS: The prevalence of NAFLD was significantly different according to body iron status (normal iron store/iron store depletion/iron deficient erythropoiesis/iron deficiency anemia: 10.6%/4.1%/6.5%/11.2%, p<0.001). Multivariate analysis revealed that age (odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.1161.507) per 10 years), being overweight (OR=1.952; 95% CI: 1.3952.732), diabetes mellitus (OR=1.694; 95% CI: 1.198-2.397), hypertriglyceridemia (OR=2.434; 95% CI: 1.737-3.409), abdominal obesity (OR=3.559; 95% CI: 2.538-4.992), insulin resistance (OR=2.665; 95% CI: 1.979-3.587), anemia (OR=2.015; 95% CI: 1.150-3.532) and stored iron depletion (OR=0.580; 95% CI: 0.405-0.830) were profoundly associated with the development of NAFLD. CONCLUSION: The present study reveals a possible correlation between the development of NAFLD and body iron stores, and stored iron depletion and anemia seem to be key factors for this correlation.

The Results of Revisional Surgery for the Failed Endonasal DCR

PURPOSE: This large case study evaluated the success rate of revisional surgery and the causes of failed endonasal dacryocystorhinostomy (DCR) with long-term follow-ups. METHODS: One hundred nine patients (114 eyes) who underwent revisional surgery for a failed endonasal DCR at the Department of Ophthalmology, Guro Hospital, Korea University between January 1995 and January 2005 were included in this retrospective study. We evaluated the causes of failed endonasal DCR and their success rates of revisional surgeries. RESULTS: The causes of surgical failure were membranous obstruction (83 eyes), granuloma (22 eyes), synechia (11 eyes), common canalicular obstruction (11 eyes), functional block (7 eyes), and canalicular obstruction (1 eye). The revisional surgeries were silicone tube intubation after granuloma removal, synechiolysis and membranectomy using Nd:YAG laser and trephination of canalicular obstruction, and endonasal conjunctivodacryocystorhinostomy (CDCR) for the parts of functional block and the canalicular obstruction. The overall success rates of the revisional surgeries were 83.3% (95/114 eyes). The mean follow-ups period was 18.97 months (range, 9~113 months). CONCLUSIONS: This is the first large case study in Korea on revisional surgery with long-term follow-ups, as far as we know. The overall success rates of endonasal DCR after receiving simple revisional surgery were comparable to those of the standard external DCR.

The Results of Revisional Surgery for the Failed Endonasal DCR

PURPOSE: This large case study evaluated the success rate of revisional surgery and the causes of failed endonasal dacryocystorhinostomy (DCR) with long-term follow-ups. METHODS: One hundred nine patients (114 eyes) who underwent revisional surgery for a failed endonasal DCR at the Department of Ophthalmology, Guro Hospital, Korea University between January 1995 and January 2005 were included in this retrospective study. We evaluated the causes of failed endonasal DCR and their success rates of revisional surgeries. RESULTS: The causes of surgical failure were membranous obstruction (83 eyes), granuloma (22 eyes), synechia (11 eyes), common canalicular obstruction (11 eyes), functional block (7 eyes), and canalicular obstruction (1 eye). The revisional surgeries were silicone tube intubation after granuloma removal, synechiolysis and membranectomy using Nd:YAG laser and trephination of canalicular obstruction, and endonasal conjunctivodacryocystorhinostomy (CDCR) for the parts of functional block and the canalicular obstruction. The overall success rates of the revisional surgeries were 83.3% (95/114 eyes). The mean follow-ups period was 18.97 months (range, 9~113 months). CONCLUSIONS: This is the first large case study in Korea on revisional surgery with long-term follow-ups, as far as we know. The overall success rates of endonasal DCR after receiving simple revisional surgery were comparable to those of the standard external DCR.

Decrease in serum concentration of nitric oxide (NO) metabolites after lamivudine therapy in patients with chronic hepatitis B / 대한내과학회지

BACKGROUND: It is known that the hepatic nitric oxide (NO) production is induced by various pathologic inflammatory response such as viral hepatitis and mediated by various cytokines from hepatic immune or non-immune cells. We have investigated nitric oxide metabolites (NOx) concentration to know the effect of lamivudine treatment on NOx in chronic hepatitis B patients, and the association between NO metabolic concentration and other clinical factors. METHODS: The study subjects comprised 70 candidates for antiviral treatment for chronic viral hepatitis B. We observed the concentration of NOx in patients group before and after antiviral treatment with lamivudine 100 mg for 24 weeks and compared them with controls. We also examined clinical factors which can affect the concentration of NOx. RESULTS: The mean concentration of NOx in chronic viral hepatitis B patients was significantly higher than that of control group. (patient group: 78.2+/-12.7 micrometer and healthy control group: 31.8+/-11.3 micrometer, p=0.014). The mean concentration of NOx significantly decreased after lamivudine treatment (after treatment: 44.2+/-17.9 micrometer and before treatment: 78.2+/-12.7 micrometer, p=0.027). HBV DNA titer and ALT level were significantly correlated with the concentration of NOx (HBV DNA titer: r=0.697, p=0.038 and ALT level: r=0.402, p=0.012). CONCLUSIONS: The fact that serum NO concentration increased proportionally to the amount of ALT and HBV DNA and decreased after the treatment with lamivudine suggests that serum concentration of NO have correlation with course of HBV infection.

Relationship between Heart Rate Reduction and Insulin Resistance in Normoglycemic Individuals

BACKGROUND AND OBJECTIVES: It is well known that, regardless of whether a person has cardiovascular diseases, the reduction of heart rate after exercise reflects the impairment of the autonomic nervous system. It is also a predictive factor of death rate and it correlates to insulin resistance. Therefore, we assessed these correlations in normoglycemic subjects. SUBJECTS AND METHODS: Exercise stress testing was performed according to the Bruce protocol. Anthropometric indices of adiposity, metabolic variables, blood pressure (BP) and several cardiovascular risk factors were measured. The HOMA index was used as the insulin resistance, and the impairment of the autonomic nervous system was assessed by measuring the reduction of heart rate for 2 minutes after the cessation of exercise. RESULTS: The reduction of heart rate during 2 minutes after the cessation of exercise statistically correlated with the HOMA index, gender, age, body mass index, the waist circumference, heart rate during rest, the maximum heart rate, serum total cholesterol concentration, serum high density lipoprotein cholesterol concentration and serum low density lipoprotein cholesterol concentration, (p<0.05). However, on multiple regression analysis, the HOMA index, gender, heart rate during rest, and the maximum heart rate significantly correlated to the reduction of heart rate during 2 minutes after the cessation of exercise. CONCLUSION: In individuals with normal serum glucose levels, even after adjustment was made for other factors, the reduction of heart rate after the cessation of exercise correlated to insulin resistance. Hence, in individuals with normal serum glucose levels, efforts to improve insulin resistance have to be made, and prospective study on this subject is required.

Assessment of Factors Influencing Plasma BNP Level in Patients with Chronic Atrial Fibrillation and Preserved Left Ventricular Systolic Function

BACKGROUND AND OBJECTIVES: Several studies have reported that Brain Natriuretic Peptide (BNP) were increased in patients with chronic atrial fibrillation (AF). The objective of this study was to assess the factors influencing plasma BNP levels in patients with chronic AF and preserved left ventricular (LV) systolic function. SUBJECTS AND METHODS: Transthoracic echocardiography was performed in 55 patients (25 men, 30 women; mean age 66.6+/-11.5 years) with chronic AF. At the same time, plasma BNP was measured with a Triage(r) kit (Biosite, San Diego, California). RESULTS: Women, long duration of AF and hypertension were more prevalent in the highest quartile group of BNP levels than in the lowest quartile group of BNP levels. Significant correlations were observed between plasma BNP levels and the following: mitral E velocity (r=0.339), mitral annular E'-velocity (r=-0.396), ratio of mitral E-velocity and mitral annular E' velocity (r=0.473), left atrium (LA) size (r=0.648), LA volume index (r=0.744), right atrium (RA) volume index (r=0.554), maximal velocity (Vmax) of mitral regurgitation (MR) (r=0.444), tricuspid regurgitation (TR) Vmax (r=0.544), MR grade (r=0.431), TR grade (r=0.427) and LV mass index (r=0.570). In stepwise multiple linear regression analysis, LA volume index (beta=0.299, p=0.014), LV mass index (beta=0.404, p<0.001) and duration of AF (beta=0.488, p<0.001) independently predicted plasma BNP levels in this study subjects. The patients with increased LA volume index exhibited longer duration of AF, larger RA volume index and LV mass index, higher MR Vmax, TR Vmax, MR and TR grade and plasma BNP level. CONCLUSION: LA volume index, LV mass index and duration of AF were independent predictors of plama BNP level in patients with chronic AF and preserved LV systolic function.

The Usefulness of Ice Test for Diagnosis of Myasthenia Gravis in Patients with Ptosis

PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.

The Usefulness of Ice Test for Diagnosis of Myasthenia Gravis in Patients with Ptosis

PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.

Seasonal Variation in Insulin Resistance in Koreans

BACKGROUND AND OBJECTIVES: There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular disease. Insulin resistance is important in the development of both non-insulin dependent diabetes mellitus (Type II DM) and cardiovascular disease. Hyperinsulinemia, induced by an insulin resistant state, causes the development of a chronic inflammatory response in vascular structures, which is one of the main causes of cardiovascular disease. There have been several studies on seasonal variation in insulin resistance. Therefore, seasonal variation in insulin resistance were investigated to discover if any relationship existed. SUBJECTS AND METHODS: Korean people examined at a health care center were included. The subjects were divided into four groups, according to the season, and a homeostasis model assessment index (HOMA) calculated, as an indicator of insulin resistance, and compared between the groups. RESULTS: Using the homeostasis model assessment, the highest insulin resistance was observed during winter. Also, the body mass index and waist-hip ratio were highest during winter. CONCLUSION: Compensating for other metabolic factors (age, gender, body mass index, waist-hip ratio and season), insulin resistance was still found to be higher during winter. Seasonal variation in insulin resistance can be associated with the incidence of DM or cardiovascular disease. Therefore, a prospective study will be needed.

Serum C-Reactive Protein Level and its Association with Atrial Fibrillation in Korean Adults

BACKGROUND AND OBJECTIVES: Recent studies have implicated inflammation as playing an important role in the occurrence, persistence and recurrence of atrial fibrillation and that C-reactive protein is a useful marker of the inflammation. The purpose of this study is to evaluate the association between serum CRP levels and the risk of atrial fibrillation. SUBJECTS AND METHODS: This study was performed on 9,487 subjects (5,263 men and 4,224 women; mean age: 58.8+/-6.6 years) who underwent medical check-ups at the Health Promotion Center in Kanbuk Samsung Hospital. 9,438 normal control subjects and 49 atrial fibrillation patients were included in the study. The CRP was measured using a highly sensitive Behring Nephelometer II. RESULTS: When comparing the two groups, there were significant differences in age, gender and the presence of hypertension and cerebrovascular accident, and these are the previously known risk factors for atrial fibrillation. After adjustment was made for the clinical significant variables of atrial fibrillation, multiple regression analysis revealed that the hsCRP levels were not associated with the risk for atrial fibrillation (p=0.52). CONCLUSION: The inflammatory markers (CRP, WBC count) were not predictive of a higher risk for atrial fibrillation in the Korean population.

Associations between White Blood Cell Count and Features of the Metabolic Syndrome

BACKGROUND AND OBJECTIVES: The proinflammatory state is considered to be a risk factor for develop atherosclerosis. Recently, certain components of the metabolic syndrome have been related to inflammatory markers. The purpose of this study was to assess the association of white blood cell (WBC) count with different components of the metabolic syndrome (MS). SUBJECTS AND METHODS: We performed this study to investigate the relationships of white blood cell count, uric acid, and C-reactive protein (CRP) to components of metabolic syndrome (MS), such as abdominal obesity, elevated triglyceride, low high-density lipoprotein cholesterol (HDL), high blood pressure, and impaired fasting glucose in 3134 koreans. RESULTS: WBC count, uric acid, and CRP were associated with several components of MS. WBC count increased, as did the number of MS. CONCLUSION: Our data suggests an association between the metabolic syndrome and WBC count.