A Survey of Actual Clinical Application Patterns in Korean Diagnostic Guidelines for Inflammatory Bowel Disease / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to analyze the actual application patterns of how Korean diagnostic guidelines for inflammatory bowel disease (IBD) were applied in clinical practice. METHODS: Questionnaires regarding guidelines for ulcerative colitis (UC), Crohn's disease (CD), intestinal Behcet's disease (BD) and intestinal tuberculosis (TB), were distributed during the 2011 Korean Association for the Study of Intestinal Disease annual conference, and e-mail survey was additionally conducted. Forty eight questionnaires were collected. RESULTS: Most of responders (79.2%) were working at secondary (> or =500 beds) or tertiary referral centers. For the necessity of guidelines, 93.8% of responders gave positive answers in UC; 95.8% in CD; 81.3% in BD; 91.7% in TB. Of the clinicians, 95.8%, 91.7%, 64.6%, 77.1% had read UC, CD, BD and TB guideline, and 87.0%, 93.2%, 90.3%, and 92.0% replied that diagnostic guidelines for UC, CD, BD and TB were helpful in practice, respectively. Practice patterns were changed in 39.1%, 33.2%, 41.9%, and 54.1% of responders by UC, CD, BD and TB guidelines, respectively. For the needs of update, 58.7% of responders answered 'yes' in UC, 54.5% in CD, 51.6% in BD and 48.7% in TB. There were differences between recommendations and practice patterns, including colonoscopy surveillance in UC, radiological examinations for small bowel in CD and for intestinal obstruction in UC, or biopsy method in UC, CD and TB, and diagnostic criteria in BD. CONCLUSIONS: Although most of responders perceived the Korean diagnostic guidelines for IBD, there were differences between recommendations of guidelines and actual practice patterns. Therefore, the publicity and revision of diagnostic guidelines are important to reconcile theory and practice.

Differentiation of Central and Peripheral Causes according to Clinical Features of Dizzy Patients in an Emergency Setting

PURPOSE: Central dizziness infrequently develops to a cerebellar or brainstem infarction. However, in the acute phase, central lesions masquerade as peripheral causes. This study was performed to provide the diagnostic guidelines for differentiation between peripheral and central causes. METHODS: From January 2002 to December 2002, we investigated 307 dizzy patients with normal brain computerized tomography. The patients were analyzed according to age, history, associated symptoms, duration of attacks, neurologic examination, and tests of balance such as gait, tandem gait, and nystagmus. RESULTS: The history of cerebral vascular accidents and neurologic symptoms, such as numbness, diplopia, dysarthria, dysphagia, or weakness, suggested central causes. Episodes of dizziness lasting seconds suggested benign positional vertigo. Dizziness associated with vertebrobasilar insufficiency typically last minutes whereas peripheral inner ear causes of recurrent dizziness typically last hours. Patients with peripheral or central causes have impaired balance, but this is more severe with central causes than with peripheral causes. Spontaneous nystagmus of a central origin changed direction with gaze to the side of the fast phase. CONCLUSION: The history, the associated symptoms, and the tests of balance provided the key information for distinguishing between peripheral and central causes, and the guideline applied in this study will be helpful to diagnose the cause of the dizziness.