Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

Acute Cytomegalovirus Proctocolitis Presenting with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cytomegalovirus (CMV) colitis usually affects immunosuppressed patients. However, CMV colitis may also affect patients with a debilitation caused by a severe illness or affect patients that have a specific physiological status (old age, pregnancy). Clinically, patients with CMV colitis most commonly present with abdominal pain, diarrhea, and gastrointestinal bleeding. The diagnosis of CMV colitis usually requires a biopsy of mucosal tissue. The characteristic finding on biopsy reveals CMV inclusion bodies. CMV colitis can be successfully treated with ganciclovir. We report two cases of CMV proctocolitis in elderly patients with chronic diseases that presented with massive lower gastrointestinal bleeding due to multiple rectal ulcerations. A pathological examination showed CMV inclusion bodies. CMV colitis should be considered in the differential diagnosis of patients with massive rectal ulcer bleeding when other causes fail to explain the course of the disease.

Protective effects of mastic in non-steroidal anti-inflammatory drug induced gut damage and bacterial translocation in a rat model / 대한내과학회지

BACKGROUND: NSAIDs induce gut damage and bacterial translocation throughout the entire gastrointestinal tract. The aim of the present study was to examine whether mastic, a natural resinous exudate obtained from the Pistacia lentiscus treetrees, can reduce diclofenac induce gut damage and bacterial translocation in rats. METHODS: 32 SD rats were divided into four groups; a control group, diclofenac group, diclofenac with 0.3 cc/kg mastic group and diclofenac with 1.0 cc/kg mastic group. Mastic oils were administered 3 hours before diclofenac administration (100 mg/kg orally x2 days). Intestinal permeability, enteric aerobic bacterial counts in the distal ileum and cecum, intestinal adhesion, lipid peroxidation of distal ileum, and bacterial translocation to mesenteric lymph nodes, liver, spleen, kidney and heart were measured, respectively RESULTS: Diclofenac caused marked increase in intestinal permeability, enteric bacterial numbers in distal ileum and cecum, intestinal adhesion, lipid peroxidation of the distal ileum, and bacterial translocation to mesenteric lymph nodes, liver, spleen, kidney and heart of which event were reduced with Mostic coadminist. Howere mastic oil showed significant profect effects in 1.0 cc/kg dose. CONCLUSIONS: Mastic was proven to have beneficial effects on preventing NSAID induced gut injury and bacterial translocation in a rat model.

Comparison of bacterial infection rate between patients with alcoholic liver cirrhosis and viral liver cirrhosis / 대한내과학회지

BACKGROUND: Some studies have reported that bacterial infection is more common in alcoholic compared to non-alcoholic liver cirrhosis such as viral liver cirrhosis. However, other studies reported no significant differences in the bacterial infection rate between alcoholic and non-alcoholic liver cirrhosis. This study was performed to compare the frequency of bacterial infection between alcoholic and viral liver cirrhosis. METHODS: We analyzed 190 cirrhotic patients (alcoholic 83, viral 107) with 539 hospitalized cases (alcoholic 242, viral 297) who were followed for more than 12 months. RESULTS: During the follow up period, 82 patients (43.2%) presented with bacterial infectionsthat developed in 34 (41.0%) patients with alcoholic liver cirrhosis and 48 (44.9%) patients with viral liver cirrhosis. There was no significant difference in the frequency of bacterial infection including community acquired and nosocomial infection between alcoholic and viral cirrhotic patients regarding the Child-Pugh class, various laboratory parameters and site of infection. Gram-negative and enteric bacterial strains were the most frequently isolated pathogens in both groups. CONCLUSIONS: There was no significant difference in the frequency of infection between patients with alcoholic and viral liver cirrhosis. Further efforts are needed to reduce bacterial infection by gram negative and enteric bacteria in patients with both alcoholic and viral cirrhosis.

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.

Chronic mild stress decreases survival, but not proliferation, of new-born cells in adult rat hippocampus

New-born cells continue to proliferate and survive to become mature granule cells in adult rat hippocampus. Although this process, known as neurogenesis, is inhibited by acute stress, it is not clear whether chronic stress affects neurogenesis. To determine whether chronic mild stress (CMS) influences neurogenesis in the adult rat hippocampus, male Sprague-Dawley rats were exposed to CMS and administered bromodeoxyuridine (BrdU) before or after CMS to observe the survival/differentiation or proliferation of new-born cells, respectively. In addition, we measured brain-derived neurotrophic factor (BDNF) mRNA in the granule cell layer (GCL) of the hippocampus, because BDNF is known to play an important role in the survival of new-born cells. CMS significantly decreased the survival of newborn cells in the GCL, but did not influence the proliferation or differentiation of new-born cells. CMS did not affect the proliferation and survival of new-born cells in the hilus. In addition, CMS did not change BDNF mRNA levels in the GCL. These results demonstrate that CMS reduces the survival of new-born cells but not of their proliferation, suggesting that repeated mild stress could influence a part of neurogenesis, but not the whole part of neurogenesis. These results raise the possibility that the survival of new-born cells may be suppressed in the presence of normal BDNF mRNA levels in GCL.

Quantity and Quality Assessment of Randomized Controlled Trials Published in Five Korean Medical Journals, from 1980 to 2000

BACKGROUND: As evidence-based medicine is getting popular recently, the importance of randomized controlled trial as a research methodology is also getting highlighted. This study was conducted in order to identify the status quo of randomized controlled trial research in major domestic journals and to provide baseline data for constructing Korean clinical trial database such CCTR (Cochrane Clinical Trial Registry). METHODS: Five journals issued by domestic publication industry were selected, out of which 127,560 original articles, equal to 253 volumes, were investigated. The author extracted the articles, which performed prospective clinical trial, targeting human beings. The selected papers were analyzed with experts to single out randomized controlled trial among them. Furthermore, the quality of the re-selected ones were assessed according to Jadad Quaility Assessment Scale. RESULTS: After analysis, it turned out that the number of papers adopting prospective clinical trial were 406 volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s. However, the percentage of prospective clinical trial monographs, introduced during 1980s and 1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115, accounting for 0.9% of total articles. The number of RCT increased to approximately two fold from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers, which won the marks of 4 and 5. CONCLUSION: It was found that domestic randomized controlled trial research was weak both in number and quality. Therefore, it is necessary to activate clinical medicine study with good quality to upgrade the amount and quality of monographs.

Effect of Ca2+-channel Blockers on Norepinephrine Release in the Rat Hippocampal Slice and Synaptosome

The aim of this study was to investigate the role of Ca2+-channel blockers in norepinephrine (NE) release from rat hippocampus. Slices and synaptosomes were incubated with [3H]-NE and the releases of the labelled products were evoked by 25 mM KCl stimulation. Nifedipine, diltiazem, nicardipine, flunarizine and pimozide did not affect the evoked and basal release of NE in the slice. But, diltiazem, nicardipine and flunarizine decreased the evoked NE release with a dose-related manner without any change of the basal release from synaptosomes. Also, a large dose of pimozide produced modest decrement of NE release. omega-conotoxin (CTx) GVIA decreased the evoked NE release in a dose-dependent manner without changing the basal release. And omega-CTxMVIIC decreased the evoked NE release in the synaoptosomes without any effect in the slice, but the effect of decrement was far less than that of omega-CTxGVIA. In interaction experiments with omega-CTxGVIA, omega-CTxMVIIC slightly potentiated the effect of omega-CTxGVIA on NE release in the slice and synaptosomal preparations. These results suggest that the NE release in the rat hippocampus is mediated mainly by N-type Ca2+-channels, and that other types such as L-, T- and/or P/Q-type Ca2+-channels could also be participate in this process.

Upper Basilar Artery Aneurysm Surgery via Transclinoidal Approach

OBJECTIVE: The authors present the results of management outcomes for upper basilar artery aneurysms via transclinoidal approach. METHODS: Clinical and angiographic evaluations were performed in twenty two consecutive patients with upper basilar artery aneurysms(three of them had superior cerebellar artery aneurysms) treated by surgery via transclinoidal approach between January, 1990 and April, 2000. RESULTS: Of the 22 patients, fifteen patients had multiple aneurysms including basilar bifurcation aneurysms and basilar-superior cerebellar aneurysms. Seventy seven percent were in good preoperative neurological status(H-H grade I-III), 23% were in poor grade(H-H grade IV). The management outcome was:Glasgow outcome scale(GOS) I 54.5%, GOS II 18%, GOS III 13.6%, GOS IV 4.5% and GOS V(death) 9%. The major causes of morbidity were direct brain damage, perforator occlusion, vasospasm and meningitis. CONCLUSION: The management outcome of upper basilar artery aneurysms treated via clinoidectomy was good(72.5%). Transclinoidal approach is an acceptable alternative for upper basilar artery aneurysms.

Effect of Tetrahydro-9-Aminoacridine on Acetylcholine Release in the Rat Hippocampus / 대한정신약물학회지

It is well known that the cholinergic innervation of hippocampal formation plays an important role in the process of memory and learning, and the deficit of this system might be a cause of the senile dementia including Alzheimer's disease. Several studies have suggested that increased central cholinergic activity could improve the cognitive deficits of the senile dementia. Therefore, many attempts have been made to reverse theses cognitive impairment by enhancing the central cholinergic activity through the use of cholinomimetics such as ACh precusor, cholinesterase(ChE) inhibitors and direct cholinoceptor agonists. Since Summers et al. reported that tacrine is worthy of novice as a possible palliative treatment for Alzheimer's disease, it has been shown to improve the memory and cognitive functions in some patients. Although tacrine is a potent centrally cholinesterase inhibitor, it seems unlikely that this property alone could underlie its clinical effect. Because the eserine, a specific cholinesterase inhibitor, showed little improvement in such patients, it is possible that tacrine may act in a different way to produce its clinical efforts. There are reports that tacrine blocked the some types of cation channels and the muscarinic receptors, and stimulated the nicotinic receptors in the central nervous system. After all, though a large body of experimental data have been accumulated, the mechanism controlling ACh release be tacrine still remains to be elucidated. In attempt to address the abode issue, this study was designed to delineate the action mechanism of tacrine on the electrically-evoked ACh release in the rat hippocampus.

The Benegits of Segnental Latissimus Dorsi Muscle Free Flap

Since the first report by Tansini in 1896, the latissimus dorsi muscle free flap has been widely used for various types of soft tissue defect due to reliable anatomy with a sufficient diameter of neurovascular pedicle and a sizable muscle. However, for relatively small soft tissue defect, latissimus dorsi free flap offers several distinct disadvantages of donor site including loss of the posterior axillary fold and flattening of the posterolateral chest wall, weakness of upper arm strength in extension, adduction and internal rotation. We treated three patients having various types of soft tissue defect using segmental latissimus dorsi muscular free flap depending on its descending branch of thoracodorsal neurovascular pedicles. There were no serious complications during 18 months of mean follow-up. We concluded that this method has some advantages such as no weakness of strength of the upper arm including walking on crutches, preserving the posterior axillary fold, preventing winging of the scapula and increased chance of using a flow-through technique. Here we present our cases of reconstruction of soft tissue defect using segmental latissimus dorsi free flap with a review of the literature.

The Effect of Laser in Situ Keratomileusis to Correct Refractive Errors

We evaluated the effect of laser in situ keratomileusis(LASIK) to correct refractive errors in myopic patients. We performed LASIK using microkera-tome(SCMD, U.S.A.) an excimer laser (Aesculap Meditec, Germany). Five hundred eighty eyes of three hundred ninty-seven patients underwent LASIK from March 1996 to February 1997. Of 580 eyes, 140 eyes(male 49, female 99 eyes) of 90 patients with minimum follow-up of 6 months were included in this study. They aged from 20 to 63 and among them, simultaneous binocular surgeries were carried out in 38 patients(48%). Topical antibiotics and steroid were instilled for 1 week postoperatively. Preoperative refractive errors ranged from -24.00 to -2.13D (mean -9.17D) and postoperative refractive errors at 6 months ranged from -9.25 to +3.13D (mean -1.70D). The amount of corrected refractive errors ranged from 17.50 to 1.75D(mean 9.17D). Uncorrected visual acuity(UCVA) was hand motion to 0.5 preoperatively and 0.04 to 1.0 at 6 months postoperatively. There was no decreased UCVA postoperatively. Myopia over -1D occured in 79 eyes (56.4%). Among them, 20 eyes (14.3%) underwent enhancements. Seventy-eight percent of cases including enhancements showed UCVA of 0.5 or better at 6 months. LASIK is effective refractive surgery with relatively few complications.

A Case of Ocular Ischemic Syndrome with Neovascular Glaucoma

Ocular ischemic syndrome is a disorder which includes the ocular symptoms and signs secondary to marked carotid artery occlusion, and typically occurs in elderly men. The ocular signs are unilateral injected eye with corneal edema, anterior uveitis, rubeosis iridis, neovascular glaucoma and cataract. On ophthalmologic examinations, unilateral venous dilation, narrowed retinal arteries, equatorial dot-blot hemorrhage and disc or retinal neovasculization are oftenly noted. The characteristic angiographic findings are delayed choroidal and retinal circulations associated with ipsilateral internal carotid artery occlusion. We have experienced a case of ocular ischemic syndrome with neovascular glaucoma, who is 61 year old man with right ocular pain and visual disturbance. Angiographic examinations revealed nearly total occlusion of ipsilateral proximal internal carotid artery.

Treatment of Chronic Prostatitis by Intraprostatic Injection of Fosfomycin: 6 Years' Experience / 대한비뇨기과학회지

The therapeutic efficacy and significance of intraprostatic fosfomycin injection in treating patients with chronic prostatitis were reviewed. During the last 6 years, 350 patients were treated with intraprostatic fosfomycin injection for chronic prostatitis, and among them, 218 patients who could be followed up at least for 3 months were analysed. As for chronic prostatitis, when a patient's WBC count of EPS per high power field remains invariable below 15 for at least 3 months, he is said to be cured. Intraprostatic injection was performed once or twice in all patients and 153 (70.2%) cases were responsive to this treatment. But eleven patients recurred immediately within 3 months after the response. Therefore, final cure rate reached 65.1% (142/218): Adverse effects were rare, if any, they were just trivial symptoms such as mild suprapubic pain or discomfort, transient hematuria and hemospermia. These facts demonstrate that intraprostatic fosfomycin injection has much advantage in patients with chronic prostatitis as treatment modality compared with ordinary method.

A Case of Acute Multifocal Hemorrhagic Retinal Vasculitis

Acute multifocal hemorrhagic retinal vasculitis is a disorder of abrupt onset, of unilateral or bilateral visual loss associated with mild anterior uveitis multifocal retinal vasculitis, retinal hemorrhage, retinal capiHary nonperfusion,papillitis, vitritis. After the onset of the disease, recurrent episode of intraocular inflammation, vasculitis, and visual loss ate commonly seen associated with the late complications of secondary vitreous hemorrhage, neovascular glaucoma, and epiretinal membrane formation. In 1988, Blumenkranz and associates were the first to report 7 cases of this disease in America. The mode of presentation, associated symptoms, and fundus findings are suggestive of herpes class virus infection, although the etiology remains unknown. We experienced a case of acute multifocal hemorrhagic retinal vasculitis associated with multifocal retinal vasculitis, retinal hemorrhage and neovascu lar complications.

Two Cases of the Fournier's Gangrene / 대한비뇨기과학회지

Genitourinary gangrene is an uncommon, potentially lethal disorder characterized by the abrupt onset of a rapidly progressive necrotizing soft tissue infection caused by the synergistic action of various organisms that spread along fascial planes, causing subfascial soft tissue necrosis and destruction. Many factors, debilitating condition such as carcinoma, diabetes and alcoholism, contribute to the development and perpetuate the course of Fournier's gangrene. In our two cases , predisposing causes were as follow ; chronic liver disease, diabetes mellitus, chronic alcoholism, perianal abscess. The patients were hemodynamically unstable and extensive necrosis was noted. After aggressive debridement of the wound and triple antibiotic therapy, general condition became improved and then we performed split thickness skin grafts and the results of reconstructive surgery were satisfactory.

A case of pelvic lipomatosis / 대한비뇨기과학회지

Pelvic lipomatosis is a condition characterized by a nonmalignant overgrowth of normal fat in the perirectal and perivesical spaces in the pelvis which may be to occur obstructive uropathy. On cystography the full bladder has an abnormal shape as a gourd, banana, pear or inverted tear-drop. Compulerized tomography shows the bladder and rectosigmoid surrounded and displaced by homogeneous tissue with a low attenuation coefficient and the CT features provide diagnostic proof or pelvic lipomatosis. We present a case of pelvic Lipomatosis.

A clinical review on 33 cases of prostatic adenocarcinoma / 대한비뇨기과학회지

A clinical study was retrospectively made on 33 patients with prostatic adenocarcinoma who were admitted to the Department of Urology, Eulji General Hospital, Seoul and DaeJeon between May 1985 and April 1992. The results were as follows: 1. The age distribution range was from 47 to 86 years (mean age 68.2 years). 2. The major presentations were prostatism (69%), acute urinary retention, gross hematuria and pain. On digital rectal examination, 14 patients (42.4%) had hard nodules on the prostate, and 7 patients had multiple nodules. 3. The clinical stages were stage A in 2 cases, stage B in 3, stage C in 8, and stage D in 20. The grades were: grade I in 7 cases, grade II in 14 and grade III in 12. Distant metastasis was round in 28 patients (84.8%). The sites involved were bone in 20 patients, lymph node in 5 patients, lune, liver and kidney in 1 patient each. Skeletal sites most frequently involved were spine (65%), pelvis (55%) and rib (50%). 4. For the treatment of 28 patients, orchiectomy only (9), DES only (7), DES +orchiectomy (3), endocrine therapy(orchiectomy or DES) + irradiation (8) and radical prostatectomy + irradiation (1) were performed. 5. In the response rate of treated 28 patients, partial or stable response 12 cases (42.9%) and progression 16 cases(57.l%). 7 patients expired, the causes of death were multiple metastasis with cachexia (4), sepsis (2) and congestive heart failure (1).

A case of malignant lymphoma of testis, adrenal gland and retroperitoneal lymph nodes / 대한비뇨기과학회지

We experienced a case of malignant lymphoma with the simultaneous involvement of right testis left adrenal gland and retroperitoneal lymph nodes and treated with radical orchiectomy followed by systemic chemotherapy, who died with widespread malignant lymphoma 9 months later.

A case of mucinous adenocarcinoma of the prostate gland / 대한비뇨기과학회지

Recently we experienced a case of mucinous prostatic adenocarcinoma treated with radical prostatectomy. The needle biopsy of indurated both lateral lobes showed prostatic adenocarcinoma. But the radical prostatectomy specimen showing a prostatic adenocarcinoma of which 90% was mucinour component.