Validation of a Novel Endoscopic Feature that Predicts Helicobacter pylori-negative Status: Does the Scratch Sign Reflect H. pylori Non-infection?

Background/Aims@#Identification of Helicobacter pylori infection status is necessary as H. pylori is associated with gastric malignancy. Recently, a red linear scrape-like appearance on the gastric mucosa, called the “scratch sign,” was reported to be associated with H. pylori-negative gastric mucosal status. Herein, we aimed to validate the association between the scratch sign and H. pylori infection status. @*Methods@#The data of patients who underwent screening endoscopy at Bundang Jesaeng General Hospital between March 2023 and April 2023 were reviewed. Patients were classified as having an H. pylori current infection or non-infection status based on the results of rapid urease tests. Patients who had undergone H. pylori eradication therapy were excluded. Endoscopic features of the gastric mucosa were assessed using the Kyoto classification of gastritis. @*Results@#The scratch sign appeared more frequently in patients with non-infection than in those with current infection status (32.7% vs. 10.6%, respectively; P<0.001). Multivariate analysis showed that only the presence of sticky mucus was significantly associated with the presence of the scratch sign. Patient without the scratch sign had a higher prevalence of open-type atrophy, intestinal metaplasia, enlarged folds, and diffuse redness, which reflected a higher Kyoto score. @*Conclusions@#Presence of the gastric mucosal scratch sign, a novel endoscopic marker, is indicative of H. pylori-negative status and appears to be inversely correlated with the presence of sticky mucus. In addition to the Kyoto classification of gastritis, detection of the scratch sign may facilitate identification of the H. pylori infection status.

Acquired Immunodeficiency Syndrome Presenting with Abdominal Tuberculosis / 이화의대지

The incidence of tuberculosis (TB) had gradually been declining all over the world, but in recent years, TB has been increasing due to the spread of the human immunodeficiency virus (HIV). When immune-suppression status deteriorates further, extrapulmonary TB generally appears more often. Abdominal TB is one type of extra-pulmonary TB, which may involve the gastrointestinal tract, peritoneum, lymph nodes or solid viscera. We encountered a case who had initially been diagnosed as having abdominal TB, had progressed to acute respiratory distress syndrome and was eventually confirmed as having developed acquired immune deficiency syndrome. In cases of coinfection of TB and HIV, it is reported that immunological responses become poor and complications with higher morbidity frequently occur. Therefore, the Korean guidelines for TB should be revised to ensure whether HIV infection exists in TB patients.

The Prevalence of Sarcopenia in Korean Hospitalized Elderly

BACKGROUND: Sarcopenia is a syndrome characterized by the progressive loss of skeletal muscle mass and muscle strength. Although data exist on the prevalence of sarcopenia among the community-dwelling elderly, there is no systematic research on hospitalized elderly patients in Korea, in accordance with the newly developed criteria. METHODS: A cross-sectional study was conducted at the Daejin Medical Center, Bundang Jesaeng Hospital, Korea, from May 2013 to March 2015. In this study, we evaluated the levels of hemoglobin, total cholesterol, serum albumin, serum prealbumin, and serum zinc. Handgrip strength was measured with a hand grip dynamometer (FT-7110). Furthermore, the skeletal muscle mass was measured by bioelectrical impedance analysis (BIA). Sarcopenia was defined by skeletal muscle mass as measured with BIA, according to the Asian Working Group for Sarcopenia. RESULTS: Of the hospitalized elderly subjects, 40 (46.5%) had a definite diagnosis of sarcopenia and 46 (53.5%) had no sarcopenia. The prevalence of sarcopenia of the subjects was higher in males than females (males, 46.9% vs. females, 46.3%). The correlation analysis showed that the score of skeletal muscle index (SMI) was negatively correlated with age; whereas, it was positively correlated with the BMI, body weight, and serum prealbumin level. CONCLUSION: The results of the study showed that sarcopenia was associated with several factors, including age, BMI, serum prealbumin level, among the study subjects. Sarcopenia can be used as a sensitive predictive marker for prognosis of the hospitalized elderly.

Measurement of antioxidant capacity using the biological antioxidant potential test and its role as a predictive marker of metabolic syndrome

BACKGROUND/AIMS: Oxidative stress increases the risk of cardiovascular complications of metabolic syndrome (MetS). This study was conducted to examine the difference in antioxidant capacity according to the presence of MetS, and to characterize the association between antioxidant capacity and MetS-related factors. METHODS: We used the biological antioxidant potential (BAP) test to estimate antioxidant capacity. The BAP test has recently been used as an indicator of antioxidant capacity. We measured BAP levels in 45 patients with MetS (mean age, 44.6 +/- 1.1 years) and 47 age- and sex-matched controls (mean age, 42.7 +/- 1.1 years). To evaluate the association between antioxidant capacity and MetS, adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-alpha, and homeostatic model assessment for insulin resistance (HOMA-IR), linear regression and logistic analyses were performed. RESULTS: The mean BAP of the MetS group (1,937.3 +/- 36.5 micromol/L) was significantly lower than that of the non-MetS group (2,101.7 +/- 29.5 micromol/L). Also, the mean BAP was low in persons having low high density lipoprotein and high triglyceride. Reduced antioxidant capacity was significantly associated with adiponectin, HOMA-IR and hs-CRP after adjusting for age and sex. The odds ratios for MetS with BAP, log adiponectin, log HOMA-IR, and log hs-CRP were 0.63 (95% confidence interval [CI], 0.49 to 0.82), 0.22 (0.10 to 0.51), 14.24 (4.35 to 46.58), and 1.93 (1.36 to 2.75), respectively. CONCLUSIONS: Persons with MetS showed reduced antioxidant capacity. We identified relationships between antioxidant capacity measured by BAP test and MetS, as well as MetS-related factors, such as insulin resistance, hs-CRP, and adiponectin.

Effect of Intravenous High-Dose Selenium Supplementation in Patients with Systemic Inflammatory Response Syndrome: A Pilot Study / 대한내과학회지

BACKGROUND/AIMS: Systemic inflammatory response syndrome (SIRS) can induce occurrence of oxidative stress. Several reports have evaluated selenium supplementation in SIRS patients with encouraging results. Therefore, we evaluated the effect of intravenous high-dose selenium supplementation in patients with SIRS. METHODS: Patients were randomly assigned to one of two groups: the selenium group (800 microg/day of selenoic acid by intravenous bolus injection for 7 days) or the placebo group. Physical and biochemical measurements were used to assay acute phase reactants, severity of illness index and serum selenium concentration. RESULTS: A total of 23 patients classified as mild-to-moderate severity of illness index were enrolled between March 2010 and October 2011. Serum selenium concentration increased in the selenium group after intervention, but there was no significant change in the placebo group. In the selenium group, the white blood cell (WBC) count, serum level of c-reactive protein (CRP), Acute Physiology and Chronic Health Evaluation II (APACHEII) score and Sequential Organ Failure Assessment (SOFA) score improved significantly by days 7 and 14 compared with day 0. In the placebo group, only the serum CRP level at day 14 and APACHE II score at days 7 and 14 improved significantly compared to day 0. CONCLUSIONS: Intravenous supplementation with high-dose selenium improved acute phase reactants and the severity of illness index in patients with SIRS. However, larger prospective clinical trials are required to determine the efficacy of selenium supplementation in SIRS patients.

The Effect of Low-intensity Pulsed Ultrasound on Osteogenesis in Mini-pig Mandibles

Management of Proteus Syndrome with Craniofacial Hemihyperostosis: Case Report

THE COMPARATIVE EVALUATION USING HATCH REAMER TECHNIQUE AND OSTEOTOME TECHNIQUE IN SINUS FLOOR ELEVATION

0.05). 2. At the total success rate, osteotome group was 92.4% and Hatch reamer group was 94.9%. There was no statistically significant difference between the two groups (P > 0.05). 3. On the discomfort during the operation by using numerical rating scale, osteotome group was 2.87 +/- 0.83 and Hatch reamer group was 1.12 +/- 0.64. There was statistically significant difference between the two groups (P < 0.05). The Hatch reamer group' clinical results was similar to osteotome group and we thought that Hatch reamer technique can overcome the faults of osteotome technique.

Associations between Nonalcoholic Fatty Liver Disease and Colorectal Adenoma in Health Screen Examinees / 대한소화기내시경학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) and colorectal cancer share several risk factors. However the relationship between NAFLD and colorectal adenoma is unclear. Therefore, we investigated the possibility of an association between NAFLD and colorectal adenoma. METHODS: We reviewed the records of 3,106 subjects who had undergone colonoscopy and abdominal ultrasonography between April 2007 and August 2009. RESULTS: The sex ratio (male/female) was 4.94:1 and the mean age was 50.6+/-9.7 years in patients with colorectal adenoma; the corresponding numbers were 2.23: 1 and 45.0+/-9.2 years in patients without colorectal adenoma (p<0.001). The prevalence of NAFLD was 26.0% in the adenoma group and 21.4% in the control group (p=0.013). Additionally, there were positive associations between colorectal adenoma and BMI and lipid profile. Among the risk factors selected by univariate analysis, older age (OR 2.592; 95% CI 2.087~3.219), and being male (OR 2.470; 95% CI 1.878~3.247) were independent risk factors for colorectal adenoma. Patients with NAFLD had more colorectal adenomas (p=0.005) and their adenomas were located more in the proximal colon (p=0.009). CONCLUSIONS: NAFLD is not associated with increased risk for colorectal adenoma. However, among patients with NAFLD, colorectal adenomas were likely to be increased in number and they were likely to be located in the proximal colon.

An Evaluation of Web-based Information about Barrett's Esophagus in Korea / 대한소화기학회지

BACKGROUND/AIMS: Internet has become an important source of medical information not only for doctors but also patients. However, information available in the Internet may provide wrong or even harmful knowledge to the public. The aim of this study was to evaluate the quality of Internet-based medical information about Barrett's esophagus in Korea. METHODS: The first 50 Internet links were retrieved from the Google using the key word 'Barrett's esophagus'. The quality of information from a total of 49 websites was evaluated using a checklist. RESULTS: Among total 49 sites related to 'Barrett's esophagus', only 4 sites (8.2%) were made by hospitals or clinics, and 11 sites (22.4%) were for patients. Of the 49 sites, only one web site (2.0%) had all HON CODE principles (authority, complementarity, confidentiality, attribution, justifiability, transparency of authorship, transparency of sponsorship, honesty in advertising and editorial policy). Sixteen Internet links (32.0%) had fair contents for the definition, and 24 links (48.0%) for the diagnosis, and 15 links (30.0%) for the treatment. CONCLUSIONS: Information about Barrett's esophagus was incomplete in the majority of medical web sites. It will bring about confusion in patients who want to get information about Barrett's esophagus from the Internet. There is a need for better evidence-based information about Barrett's esophagus on the web.

The Clinical Characteristics and Outcomes of Barrett's Cancer at a Single Institution in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: The prevalence of Barrett's esophagus might also be changing along with changes in the epidemiology of GERD, and the incidence of Barrett's cancer is expected to increase even more. The aim of this study is to evaluate the clinicopathologic features and outcome of the patients with Barrett's cancer and who were seen at a single institution over a period of 13 years. METHODS: The records of 39 patients with the esophageal adenocarcinoma and who were treated at Samsung Medical Center from January 1995 to August 2008 were reviewed. Among them, 11 patients (28%) with histologically-confirmed Barrett's cancer were included in the study. The clinicopathological features, endoscopic manifestations and treatment outcome were evaluated. RESULTS: The male to female ratio was 10:1. The mean age was 64 years. Most of the patients were diagnosed with Barrett's cancer after 2000, and there were three such patients (27.3%) in 2008. The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. The macroscopic types based on the endoscopic findings were as follows: 4 lesions with a type IIa appearance (36.4%) and 2 with a type IIb appearance (18.2%). The mean tumor size was 1.2 cm at the longest dimension and 0.8 cm at the shortest dimension. Tumor was located in the mucosal layer in six cases (54.5%) and the 5 cases (45.5%) showed submucosal invasion. Lymph node metastasis was found in one case (9.1%). All the cases underwent surgery, except one case for which the tumor was removed by endoscopic submucosal dissection. There was no recurrence during the follow up period. CONCLUSIONS: As the incidence of Barrett's cancer is increasing, a standard surveillance program that includes the endoscopic biopsy method, the grading system for the dysplasia and the treatment modality should be established.

A lipoma of the mouth floor : A case report

Lipoma is most common tumor that compromises 4% to 5% of all benign neoplasm, but in oral cavity it is uncommon. In oral cavity, lipoma presents painless, asymptomatic , slow growing, but sometimes it grows to larger size causing deformities, mastication and speech difficulties. While lipoma in commonly affects female patients (68-73%), oral lipoma appears more frequently in male patients. The majority of oral lipoma is seen after the age of forty (uncommon in children). Lipoma of oral cavity and maxillofacial region occurs most commonly in the parotid region, followed by the buccal mucosa, lip, tongue, palate, mouth floor, gingiva in order. A treatment of lesion is surgical excision with recurrence not expected. In this paper we present the case of a patient who has Lipoma in the mouth floor.

Diabetes Mellitus and the Risk of Colorectal Adenoma

BACKGROUND/AIMS: Diabetes mellitus (DM) is associated with an increased incidence of colon cancer. However, the relationship between DM and colorectal adenoma is not definite. In this study, we sought to determine the association between DM and the prevalence of colorectal adenoma. METHODS: We enrolled 606 patients with DM and 606 asymptomatic adults who underwent colonoscopy for routine health evaluations from June 2003 to June 2007. The frequency and characteristics of the colorectal adenomas were analyzed and compared between the two groups. RESULTS: The sex ratio and mean age were 1.67:1 (M:F) and 58.1+/-10.6 years, respectively, in patients with DM, and 1.68:1 and 57.6+/-8.9 years, respectively, in patients without DM, and these values were similar. The frequency of colorectal adenoma was 33.2% for the patients with DM and 32.3% for the patients without DM. The frequency, location, number, size and histopathologic findings of the colorectal adenomas were not different between the two groups. Among the patients with DM, the frequency of colorectal adenoma was 35.7% in the patients treated with oral hypoglycemic agents and 31.4% in the patients treated with insulin. Also, the other characteristics of the colorectal adenomas were not different according to the treatment method. CONCLUSIONS: The frequency and characteristics of colorectal adenomas were not different between the patients with and without DM.

Hepatocellular Carcinoma with Metastasis to the Cavernous Sinus of Skull Base Causing Ptosis / 대한소화기학회지

The cavernous sinus of skull base is a extremely rare metastastatic site for hepatocellular carcinoma (HCC). A 51-year-old man was diagnosed with HCC by liver biopsy and palliative radiotherapy on HCC including main portal vein was performed. One month later, he was admitted due to sudden onset ptosis. Neurologic findings were normal except for abnormal movement of right eye, and it raised the possibility of abnormality in the right occulomotor, trochlear and the abducens nerves. Contrast-enhanced CT scan of brain showed a mass with homogeneous enhancement involving the right cavernous sinus. T2-weighted axial MR images demonstrated a homogeneous mass with intermediate signal intensity, and contrast-enhanced axial T1-weighted MR images demonstrated a mass with homogeneous enhancement in the right cavernous sinus. We describe a case of HCC metastasis to the cavernous sinus with symptoms of ptosis and disturbance of right eyeball movement.

Treatment of unicystic ameloblastoma by intraoral approach after marsupialization: A case report

Ameloblastoma is the most frequently accuring odontogenic tumor in mouth. The biologic behavior of this neoplasm is locally invasive tumor with a high rate of recurrence. But in case of unicystic ameloblastoma, it was known that the neoplasm can be treated by marsupialization and the recurrence rate is lower. In our clinic, we tried to treat one of ameloblastoma cases by marsupialization and finished the treatment by enucleation via intra-oral approach with sagittal ramus osteotomy. This is a report of that case about 29 years old female patient.

Treatment of unicystic ameloblastoma by intraoral approach after marsupialization: A case report

Ameloblastoma is the most frequently accuring odontogenic tumor in mouth. The biologic behavior of this neoplasm is locally invasive tumor with a high rate of recurrence. But in case of unicystic ameloblastoma, it was known that the neoplasm can be treated by marsupialization and the recurrence rate is lower. In our clinic, we tried to treat one of ameloblastoma cases by marsupialization and finished the treatment by enucleation via intra-oral approach with sagittal ramus osteotomy. This is a report of that case about 29 years old female patient.

Calcifying odontogenic cyst: a case report

The calcifying odontogenic cyst(COC) is considered to occupy a position between a cyst and an odontogenic tumor-having charateristics of both. Gorlin and col. described the COC for first time as an own pathological entity in 1962. Clinically, the COC represents 1% of the odontogenic lesion. It is possible to be found from the first decade to the eight decade but is more frequent during the second decade. It affects in same proportion the maxilla and jaw, being the most in tooth-bearing area of the jaw. This case of COC associated with an unerupted tooth which appeared in the right mandible of 22-year-old woman, was reported. This case report is to present a review of the literature relates to this case of COC and its treatment, discuss clinical, radiographic, histological and therapeutic aspects.

A Case of a Jejunal Dieulafoy's Lesion Mimicking a Submucosal Tumor / 대한소화기내시경학회지

Dieulafoy's lesion is a rare cause of severe gastrointestinal bleeding. In most cases, Dieulafoy's lesion is typically found in the stomach within 6 cm from the gastroesophageal junction, but the presence of lesions has also been described throughout the gastrointestinal tract. A jejunal Dieulafoy's lesion is extremely rare, and only a few cases have been reported in the Korean population. We experienced a case of a jejunal dieulafoy's lesion mimicking a submucosal tumor that presented with massive gastrointestinal bleeding. The lesion was diagnosed by the use of double balloon enteroscopy and was then confirmed by a pathological examination of the surgical specimen.

Two Cases of Colon Anisakiasis: Asymphtomatic Cecal Anisakiasis and Ascending Colon Anisakiasis Detected One Month Later after Infestation / 대한소화기내시경학회지

Anisakiasis of the gastrointestinal tract is usually caused by the ingestion of raw marine fish infested with Anisakis larvae. A majority of cases present as gastric and intestinal anisakiasis. Anisakiasis of colon is rare and asymptomatic colon anisakiasis has a particularly low incidence. A 45-year-old man received colonoscopy that revealed a 1.0 cm sized whitish linear larva penetrating the mucosa of the cecum and it was removed by colonscopy. He had no complaint before the colonoscopy. A 52-year-old man complained of right upper quadrant abdominal pain with weight loss for one month. Colonoscopy revealed a 1.5 cm sized whitish linear larva penetrating the mucosa of the distal part of ascending colon. Abdominal pain and weight loss were improved by colonoscopic removal of larva.

Risk factors for hospital acquired infections in patients with decompensated liver cirrhosis / 대한내과학회지

BACKGROUND: Infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. This study was performed to investigate the risk factors for infections in hospitalized patients with decompensated liver cirrhosis. METHODS: We analyzed 108 decompensated hospitalized cirrhotic patients (34 cases with infection and 117 cases without infection) without clinical evidence of infection at the time of admission and during initial 72 hours after admission. RESULTS: Univariate and multivariate analysis revealed that patients who developed an infection were more likely to have a lower serum albumin levels. Gram-negative bacterial strains were detected most frequently, in 13 of the 18 strains isolated. There was no significant difference in etiology of disease, Child-Pugh classification, cirrhotic complications including upper G-I bleeding, hepatocelluar caricnoma, invasive procedure, diabetus mellitus, admission to ICU, duration of admission, survival rate and various parameters related to liver and renal function between patients with infection and without infection. CONCLUSION: The present study indicates that decompensated cirrhotic patient with low serum albumin levels have a higher risk of developing a hospital acquired infection, especially by gram negative bacteria.