Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes / 고신대학교의과대학학술지

Objectives@#It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer. @*Methods@#A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC). @*Results@#The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery. @*Conclusions@#Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Endoscopic Septotomy as a Treatment for Chronic Leak after Laparoscopic Sleeve Gastrectomy

Acute leakage after sleeve gastrectomy progresses into chronic leakage by 10-28.1%, which causes the surgeon to be disturbed. The main treatment for chronic leakage is surgery, but the authors report successful care with endoscopic septotomy. Forty-one year old female patient with a BMI of 42.8 (161.6 cm/111.8 kg) underwent a laparoscopic sleeve gastrectomy. The leakage of the proximal part of the staple resection line was verified in the abdominal CT on the fourth day after the procedure due to pain in the left shoulder that could not be clarified. After appropriate treatment including stent, the patient ended the acute leakage treatment 150 days after surgery. However, the patient was visited for 10 months after removed percutaneous catheter drainage due to fever and pain in the left shoulder. Afterwards, chronic leakage was confirmed from the CT and endoscopy at POD 15 months. We performed endoscopic treatment in the operating room under general anesthesia. At the gastroesophageal junction, we could find chronic leak orifice and bridging fold between stomach lumen and abscess pocket. Endoscopic septotomy was performed with the endoscopic knife and electrosurgical surgical unit, until the stomach lumen and abscess pockets were fully in communication. After the patient was discharged without any complications and is currently under close observation. Endoscopic septotomy as a treatment for chronic leak is feasible and safe. Herein, we report this case with video clip.

Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes / 고신대학교의과대학학술지

Objectives@#It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer. @*Methods@#A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC). @*Results@#The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery. @*Conclusions@#Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Endoscopic Septotomy as a Treatment for Chronic Leak after Laparoscopic Sleeve Gastrectomy

Acute leakage after sleeve gastrectomy progresses into chronic leakage by 10-28.1%, which causes the surgeon to be disturbed. The main treatment for chronic leakage is surgery, but the authors report successful care with endoscopic septotomy. Forty-one year old female patient with a BMI of 42.8 (161.6 cm/111.8 kg) underwent a laparoscopic sleeve gastrectomy. The leakage of the proximal part of the staple resection line was verified in the abdominal CT on the fourth day after the procedure due to pain in the left shoulder that could not be clarified. After appropriate treatment including stent, the patient ended the acute leakage treatment 150 days after surgery. However, the patient was visited for 10 months after removed percutaneous catheter drainage due to fever and pain in the left shoulder. Afterwards, chronic leakage was confirmed from the CT and endoscopy at POD 15 months. We performed endoscopic treatment in the operating room under general anesthesia. At the gastroesophageal junction, we could find chronic leak orifice and bridging fold between stomach lumen and abscess pocket. Endoscopic septotomy was performed with the endoscopic knife and electrosurgical surgical unit, until the stomach lumen and abscess pockets were fully in communication. After the patient was discharged without any complications and is currently under close observation. Endoscopic septotomy as a treatment for chronic leak is feasible and safe. Herein, we report this case with video clip.

The Results of Surgical Treatment for Nonunion of Phalanges in the Hand

PURPOSE: To evaluate the results of internal fixation and autogenous bone graft for the phalangeal nonunion in the hand. MATERIALS AND METHODS: From Feb. 2000 until May 2006, thirteen cases that had been treated for non-union of phalanges in the hand were investigated retrospectively. Seven cases were treated with mini-plate fixation and autogenous cancellous graft and six cases with Kirschner wire fixation and autogenous cancellous graft. We analyzed bony union period radiographically and clinical results according to Belsky's score. RESULTS: Thirteen cases obtained bony union. Seven cases of mini-plate fixation and bone graft, and six cases of K-wire fixation and bone graft achieved the bony union postoperatively on average 7.9 weeks and 6.3 weeks, respectively. Clinical results were "good" in four cases and "poor" in nine cases according to the Belsky's score. Only one of ten cases with associated injuries, such as tendon, nerve, arterial injuries and other finger fractures in the injured hand, had the good clinical result, but all three cases without associated injuries had the good one. CONCLUSION: Internal fixation and autogenous bone graft can be a successful treatment of phalangeal nonunion. However, more careful choice of surgical treatment methods and preoperative explanation of poor post-operative results or complications should be made for phalangeal nonunion with associated injuries in the finger because of poor outcome in those cases.

Total Hip Arthroplasty using a Ceramic on Ceramic Bearing Surfaces / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip arthroplasty using a ceramic on ceramic bearing surfaces. MATERIALS AND METHODS: From April 1999 to April 2005, 53 hips had total hip arthroplasty with a ceramic on ceramic bearing surfaces in our hospital. Causes of total hip arthroplasty were avascular necrosis of femoral head in 47 hips, osteoarthritis in 3 hips and ankylosing spondylitis in 3hips. We used three kinds of acetabular cup and two kinds of femoral stem in this study. Follow-up period was an average of 55months (24-92). Clinical results were evaluated with Harris hip score and squeak sound. Radiological results included liner wear rate, breakage of ceramic, component loosening and osteolysis. RESULTS: Mean Harris hip scores improved from 58 to 88.3. No breakage of ceramic liner or head occurred. No acetabular or femoral osteolysis was seen. Audible squeak sound or sensation was detected in 10 hips (18%). Revision was done in three cases (5.7%), the cause of one of them was acetabular cup loosening. CONCLUSION: Total hip arthroplasty with a ceramic on ceramic bearing surfaces showed satisfactory clinical and radiological results in an average of 4.6 years follow-up. However, we have to study causes and adverse effect of squeaking on the total hip arthroplasty.

Multidrug-resistant Tuberculosis Spondylitis: A Case Report / 대한척추외과학회지

Multidrug-resistant tuberculosis, resistant to at least isoniazid and rifampicin, continues to present a serious challenge to human health. However, there are no reports addressing multidrug-resistant tuberculous spondylitis in Korea. We report a case of multidrug-resistant tuberculous spondylitis at L2-L3 in a 30-year-old woman.

Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Although there were many studies to prevent recurrent variceal bleeding, studies about primary prophylaxis of variceal bleeding have been relatively few. We retrospectively evaluated the efficacy of endoscopic variceal ligation (EVL) and propranolol therapy for primary prevention. METHODS: 64 patients who underwent EVL or received propranolol for primary prophylaxis were enrolled and these patients were in the state of Child A or B with large varices and/or red markings on varices. We compared the cumulative bleeding-free rate and the survival rate between EVL group (n=40) and propranolol group (n=24) for primary prophylaxis. RESULTS: The Child classification, the size of varices, and the presence of red color sign were not different statistically between both groups. The mean duration of follow-up in each group was 44 18 and 22 12 months, respectively (p=0.023). The cumulative bleeding- free rate was high in EVL group than in propranolol group (p=0.03). The cumulative survival rate was not different statistically between both groups. CONCLUSIONS: In patients with high-risk varices, EVL therapy prolonged bleeding-free interval compared with propranolol therapy for the primary prophylaxis of variceal bleeding.

A Study of Polymorphism in UDP-glucuronosyltransferase 1 (UGT-1A1) Promoter Gene in Korean Patients with Gilbert's Syndrome / 대한간학회지

BACKGROUNDS/AIMS: Hepatic glucuronidating activity, essential for efficient biliary excretion of bilirubin, is reduced to about 30 percent of normal in patients with Gilbert's syndrome. Patients with Gilbert's syndrome have an additional TA insertion in the A(TA)TAA of UDP-glucuronosyltransferase 1 (UGT-1A1) promoter gene. This results in reduced frequency and accuracy of transcription initiation and enzyme activity. The frequency and location of the mutation vary according to races. This study was done to determine the UGT-1A1 promoter gene mutation in Korean cases of Gilbert's syndrome. METHODS: Promoter regions of the gene for bilirubin UGT-1A1 in twelve patients with Gilbert's syndrome and twenty healthy subjects (controls) were sequenced. RESULTS: 1) Among twelve Gilbert's syndrome five patients were homozygous for A(TA)6/6TAA, two were homozygous for A(TA)7/7TAA, and the other five were heterozygous for A(TA)6/7TAA. The prevalence of A(TA)TAA mutation was 58.3 percent. 2) Among twenty healthy subjects seventeen were homozygous for A(TA)6/6TAA, one was homozygous for A(TA)7/7TAA, and two were heterozygous for A(TA)6/7TAA. The prevalence of A(TA)TAA mutation was 15 percent. 3) The prevalence of A(TA)TAA mutation in Gilbert's syndrome patients was significantly higher than in the controls (p=0.018). CONCLUSION: Although the prevalence of A(TA)TAA mutation in Korean patients with Gilbert's syndrome is significantly higher than in the controls, the mutations of the promoter region of UGT-1A1 gene appear not to be the main or sole cause in Gilbert's syndrome in Korea since the prevalence of A(TA)TAA mutation is not so high. Further studies to determine the relationship between other UGT-1A1 gene mutation and Gilbert's syndrome in Korea are needed.

Electron microscopic study of adhesion between Helicobacter pylori and gastric epithelial cell / 대한내과학회지

BACKGROUND: The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis. These specimens were processed and observed by transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the different types of adhesion of the organism with the epithelial cells were categorized as filamentous connection, adhesion pedestals, membrane fusion. Coccoid and intermediate forms were associated with filamentous connection whereas bacillary forms were associated with adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to investigate biophysiologic influence to epithelial cells by ultrastructural relationship.(Korean J Med 60:16-21, 2001)

The Hepatitis B Carrier Rate in Siblings of Patients with HBV-associated Chronic Liver Disease / 대한간학회지

Backgrounds/Aims: This study aimed to estimate the seroepidemiology of hepatitis B virus (HBV) infection with emphasis on the transmission of HBV infection between mothers and their children. METHODS: For 452 patients with HBV associated chronic liver disease, and 1,098 of their offspring, who visited Korea University Kuro Hospital from February, 2000 to February, 2001, HBsAg was tested by radioimmunoassay. RESULTS: Among siblings whose mothers were HBsAg-positive, the overall prevalence rate of HBV infection was 44.9% (140/312) and decreased with decreasing age (54.7% in > or =20 years old age group, 33.3% in 10-19 years old age group, 7.6% in <10 years old age group). The estimated proportion of perinatal infection out of modes of HBV transmissions in the general population was 38% in <10 years and 63.4% in 10-19 years. CONCLUSION: The present hepatitis B vaccination strategies -especially against perinatal infection- of Korea have performed to their utmost. More effective methods for the prevention of HBV transmission are now needed.

A Case of Synchronous Quadruple Early Gastric Cancer Which was Detected Preoperatively / 대한소화기내시경학회지

Early diagnosis of gastric cancer is very important since gastric cancer is one of the leading causes of cancer-mortality in Korea. The incidence of early gastric cancer has increased recently with much advances in diagnostic modalities and increasing concerns about individual health status. The incidence of multiple gastric cancer is also increasing. The number of lesions in cases with multiple gastric cancer is usually 2 or 3, and lesions over 4 sites are rare. The problem in the diagnosis of multiple gastric cancer is the low preoperative detection rate in spite of the recent advances of diagnostic techniques, especially in cases with small flat or elevated lesions. We report a case of a synchronous quadruple early gastric cancer which was preoperatively diagnosed with endoscopy. Of the four lesions, one was depressed (IIc) and the other three were superficial elevated (IIa). All four lesions were well differentiated adenocarcinomas confined to the mucosa.

A Case of Dieulafoy's Lesion of the Terminal Ileum Treated by Colonoscopic Electrocoagulation / 대한소화기내시경학회지

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage and is understood to represent a tiny submucosal defect with fibrinoid necrosis at its base, overlying a large, tortuous, thick-walled artery in the muscularis mucosa. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. Moreover, Dieulafoy's lesion of the terminal ileum is very rare. We herein report a case of a patient who presented with massive hematochezia from Dieulafoy's lesion of the terminal ileum which was successfully controlled with endoscopic treatment by utilizing electrocoagulation.

The Effects of Ranitidine (300mg) and Omeprazole (10, 20mg) on Gastroesophageal Reflux and Intragastric pH in Healthy Subjects / 대한소화관운동학회지

BACKGROUND/AIMS: This study was done to compare the effects of Omeprazole (OMD) 10 or 20 mg with Ranitidine(RAN) 300 mg on intragastric acidity and gastroesophageal reflux in healthy subjects. METHODS: Ten healthy male volunteers were studied after administrations of 5 days dosing with either RAN 300 mg, OMD 10 mg or 20 mg, once each morning. On the 5(th) day, intragastric pH and lower esophageal pH were measured by a dual channel antimony pH catheter for 10 hours. RESULTS: Gastroesophageal reflux was reduced after administrations of RAN 300 mg, OMD 10 mg or 20 mg (p 0.05). The gastric holding time of pH > 4 was significantly prolonged over fasting and postprandial periods after RAN 300 mg, OMD 10 mg or 20 mg administrations (p 0.05). OMD administrations (10 mg or 20 mg) exhibited a more potent effect on gastric acid suppression during the postprandial period than RAN 300 mg (p < 0.05). CONCLUSIONS: OMD 10 mg was as potent as RAN 300 mg on inhibition of gastric acid, but less potent than OMD 20 mg. There was no difference among the three drugs in regard to gastroesophageal reflux in healthy subjects.

The Effect of Lamivudine in Chronic Liver Disease associated with Hepatitis B Virus / 대한간학회지

BACKGROUND/AIMS: Lamivudine has demonstrated a potent suppression of viral replication and a substantial histologic improvement in many patients with chronic hepatitis B. This study is intended to evaluate the effects of lamivudine and the breakthrough rate in patients with HBV associated chronic liver diseases including decompensated liver cirrhosis, and to investigate the clinical factors closely related with these events. METHODS: A total of 58 patients(chronic hepatitis 21, cirrhosis 37) showing abnormal serum levels of aminotransferase and detectable serum HBV DNA for at least 6 month received 150 mg of lamivudine once a day for 3-27 months (median 13). The Kaplan-Meier methods and the Cox regression model were used for statistic analysis. RESULTS: The one-year cumulative incidences of the negative conversion of serum HBV DNA, normalization of aminotransferase, and seroconversion of HBeAg were 98.3%, 86.2% and 20.6%, respectively. Eighteen-month and 2-year cumulative breakthrough rates were 24% and 47%, respectively. The Child-Pugh scores were improved (p<0.001) in patients with decompensated liver cirrhoses(n=21). The negative conversion of HBV DNA, breakthrough rates and seroconversion were not significantly associated with the progression of disease, mutation in pre-core region and previous treatment with interferon. The pre-treatment aspartate aminotransferase (AST) level was associated with a higher rate of seroconversion(p<0.03). CONCLUSION: Despite a higher breakthrough rate, 2-year lamivudine treatment has induced the seroconversion of HBeAg in 26% of patients, and improved the clinical manifestations in decompensated cirrhotic patients.

Endoscopic Removal of Embedded Chicken Bone from Sigmoid Colon Using Balloon Dilatation / 대한소화기내시경학회지

Ingested foreign bodies usually pass through the digestive system uneventfully. The diagnosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon. Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon. The chicken bone was successfully removed by using balloon dilatation during colonoscopy.

A Case of Cutaneous Metastasis from Hepatocellular Carcinoma Manifested as Multiple Nodules on Whole Body / 대한간학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Frequent sites of extrahepatic metastasis are the lung, adrenal gland, bone, etc. But, cutaneous metastasis from HCC is rare event. Several cases of subcutaneous seeding after percutaneous transhepatic biopsy or aspiration of liver were reported, however, most of these cases had solitary nodular lesion which was located at the biopsy site. We experienced a case of multiple cutaneous metastasis on whole body from HCC which was not related to percutaneous transhepatic biopsy of liver in a 34-ear-ld male patient. Thus, we report a case of multiple cutaneous metastasis from HCC with brief review of related literature.

Long-erm Follow-p of Patients Treated with Interferon Alfa for Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: Several randomized controlled studies have shown that responders who had treated with interferon alpha for chronic hepatitis B had better rate of sustained loss of HBeAg and HBV DNA than non-esponders. These studies also showed that non-esponders had higher rates of liver related complication and mortality. But there is very little data on how well sustained responders are and whether the responders eventually lose HBsAg in Korea. The aims of this study were to better define the long term remission of chronic hepatitis B induced by interferon alfa therapy and compare the clinical outcome among the interferon responders and non-esponders in Korea. METHODS: Sixty-ight patients with chronic hepatitis B who were treated with interferon alfa between 1987 and 1998 were followed up for serologic status (HBsAg, HBeAg, HBV DNA), biochemical tests and liver related complication or mortality. RESULTS: Among 68 patients with chronic hepatitis B who were treated with interferon alfa, 28 (41%) responded to treatment with loss of HBeAg within 1 year of starting treatment. Up to 129 months (mean 58 months) after therapy, responders had higher rate of cumulative clearance of HBeAg at five years than non-esponders (100% vs 35.1%, p<0.05). Responders had maintained the normal serum ALT than nonresponders at five years (94% vs 55.6%, p<0.05). Loss of HBsAg was not different between responders and non-esponders (5% vs 4%, NS). The rates of liver related complication and mortality did not differ between both groups. Delayed clearance of HBeAg occured in twelve out of forty non-esponders (30%). There were no differences in age, baseline ALT, histologic finding of liver biopsy, HBV DNA at the end of first year after study with IFN therapy between the non-esponders with and without delayed clearance of HBeAg. CONCLUSION: Remission in chronic hepatitis B induced by alfa interferon maintained in long duration. But clinical outcomes such as liver related complication, mortality and the elimination of HBV infection have no differences between responders and non-esponders. Further studies are needed for the role of interferon therapy in long-erm clinical outcome for chronic hepatitis B.