Sex-Related Outcomes of Successful Drug-Coated Balloon Treatment in De Novo Coronary Artery Disease

Purpose@#Although drug-coated balloon (DCB) treatment is known to be effective for de novo lesions, the influence of sex on angiographic and clinical outcomes remains unknown. This study aimed to investigate the angiographic and clinical impact of DCB treatment in patients with de novo coronary lesions according to sex. @*Materials and Methods@#A total of 227 patients successfully treated with DCB were retrospectively enrolled and divided into two groups according to sex. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF), which included cardiac death, target vessel myocardial infarction, target lesion revascularization, and target vessel thrombosis. @*Results@#The study enrolled 60 women (26.4%) and 167 men (73.6%). Compared to men, women had a smaller vessel size, larger DCB to reference vessel ratio, and more dissections after DCB treatment (55.0% vs. 37.1%, p=0.016). Women also had a significantly higher LLL compared to men (0.12±0.26 mm vs. 0.02±0.22 mm, p=0.012) at the 6-month follow-up angiography. During a median follow-up of 3.4 years (range 12.7–28.9 months), TVF was similar (women 6.7% vs. men 7.8%, p=0.944). In multivariable analysis, women were independently associated with a higher LLL. @*Conclusion@#LLL was higher in women, but there was no difference in TVF between women and men. Based on multivariable analysis, the women sex was an independent predictor of higher LLL (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea

Background@#Early identification of patients with coronavirus disease 2019 (COVID-19) who are at high risk of mortality is of vital importance for appropriate clinical decision making and delivering optimal treatment. We aimed to develop and validate a clinical risk score for predicting mortality at the time of admission of patients hospitalized with COVID-19. @*Methods@#Collaborating with the Korea Centers for Disease Control and Prevention (KCDC), we established a prospective consecutive cohort of 5,628 patients with confirmed COVID-19 infection who were admitted to 120 hospitals in Korea between January 20, 2020, and April 30, 2020. The cohort was randomly divided using a 7:3 ratio into a development (n = 3,940) and validation (n = 1,688) set. Clinical information and complete blood count (CBC) detected at admission were investigated using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-Mortality Score).The discriminative power of the risk model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curves. @*Results@#The incidence of mortality was 4.3% in both the development and validation set.A COVID-Mortality Score consisting of age, sex, body mass index, combined comorbidity, clinical symptoms, and CBC was developed. AUCs of the scoring system were 0.96 (95% confidence interval [CI], 0.85–0.91) and 0.97 (95% CI, 0.84–0.93) in the development and validation set, respectively. If the model was optimized for > 90% sensitivity, accuracies were 81.0% and 80.2% with sensitivities of 91.7% and 86.1% in the development and validation set, respectively. The optimized scoring system has been applied to the public online risk calculator (https://www.diseaseriskscore.com). @*Conclusion@#This clinically developed and validated COVID-Mortality Score, using clinical data available at the time of admission, will aid clinicians in predicting in-hospital mortality.

Sex-Related Outcomes of Successful Drug-Coated Balloon Treatment in De Novo Coronary Artery Disease

Purpose@#Although drug-coated balloon (DCB) treatment is known to be effective for de novo lesions, the influence of sex on angiographic and clinical outcomes remains unknown. This study aimed to investigate the angiographic and clinical impact of DCB treatment in patients with de novo coronary lesions according to sex. @*Materials and Methods@#A total of 227 patients successfully treated with DCB were retrospectively enrolled and divided into two groups according to sex. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF), which included cardiac death, target vessel myocardial infarction, target lesion revascularization, and target vessel thrombosis. @*Results@#The study enrolled 60 women (26.4%) and 167 men (73.6%). Compared to men, women had a smaller vessel size, larger DCB to reference vessel ratio, and more dissections after DCB treatment (55.0% vs. 37.1%, p=0.016). Women also had a significantly higher LLL compared to men (0.12±0.26 mm vs. 0.02±0.22 mm, p=0.012) at the 6-month follow-up angiography. During a median follow-up of 3.4 years (range 12.7–28.9 months), TVF was similar (women 6.7% vs. men 7.8%, p=0.944). In multivariable analysis, women were independently associated with a higher LLL. @*Conclusion@#LLL was higher in women, but there was no difference in TVF between women and men. Based on multivariable analysis, the women sex was an independent predictor of higher LLL (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea

Background@#Early identification of patients with coronavirus disease 2019 (COVID-19) who are at high risk of mortality is of vital importance for appropriate clinical decision making and delivering optimal treatment. We aimed to develop and validate a clinical risk score for predicting mortality at the time of admission of patients hospitalized with COVID-19. @*Methods@#Collaborating with the Korea Centers for Disease Control and Prevention (KCDC), we established a prospective consecutive cohort of 5,628 patients with confirmed COVID-19 infection who were admitted to 120 hospitals in Korea between January 20, 2020, and April 30, 2020. The cohort was randomly divided using a 7:3 ratio into a development (n = 3,940) and validation (n = 1,688) set. Clinical information and complete blood count (CBC) detected at admission were investigated using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-Mortality Score).The discriminative power of the risk model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curves. @*Results@#The incidence of mortality was 4.3% in both the development and validation set.A COVID-Mortality Score consisting of age, sex, body mass index, combined comorbidity, clinical symptoms, and CBC was developed. AUCs of the scoring system were 0.96 (95% confidence interval [CI], 0.85–0.91) and 0.97 (95% CI, 0.84–0.93) in the development and validation set, respectively. If the model was optimized for > 90% sensitivity, accuracies were 81.0% and 80.2% with sensitivities of 91.7% and 86.1% in the development and validation set, respectively. The optimized scoring system has been applied to the public online risk calculator (https://www.diseaseriskscore.com). @*Conclusion@#This clinically developed and validated COVID-Mortality Score, using clinical data available at the time of admission, will aid clinicians in predicting in-hospital mortality.

Impact of Dissection after Drug-Coated Balloon Treatment of De Novo Coronary Lesions:Angiographic and Clinical Outcomes

Purpose@#Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions. @*Materials and Methods@#A total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) following DCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vessel thrombosis). @*Results@#The cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differences in LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, p= 0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, p=0.799) at a median follow-up of 3.4 years. In a multivariate analysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completely healed, and there was no newly developed dissection at 6-month angiography. @*Conclusion@#The presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associated with an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

The Usefulness of a Novel Screening Kit for Colorectal Cancer Using the Immunochromatographic Fecal Tumor M2 Pyruvate Kinase Test

BACKGROUND/AIMS: M2 pyruvate kinase (M2-PK) is an enzyme that is produced in undifferentiated and proliferating tissues. This study aims to evaluate the usefulness of the immunochromatographic M2 pyruvate kinase (iM2-PK) for the screening of colorectal cancer (CRC) and premalignant lesions. METHODS: Healthy volunteers and patients with colorectal neoplasia were enrolled in six academic hospitals in the capital province of Korea. The iM2-PK value was compared with the immunochromatographic fecal occult blood test (iFOBT) and fecal tumor M2-PK enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 323 subjects were enrolled. The sensitivity of iM2-PK for CRC was 92.8%, which was superior to iFOBT (47.5%, p<0.0001). For adenomatous lesions, the sensitivity of iM2-PK was 69.4%, which was also superior to iFOBT (12.1%, p<0.001). Compared with M2-PK ELISA, iM2-PK exhibited significantly enhanced sensitivity for CRC (97.5% vs 80.0%, p=0.0289). The sensitivity of iM2-PK was higher in advanced stages of CRC compared with cancers confined to the mucosa and submucosa (p<0.05). However, lymph node metastasis had no influence on the sensitivity of iM2-PK. CONCLUSIONS: The iM2-PK exhibited increased sensitivity for identifying CRC and adenomatous lesions compared with iFOBT. Given its rapid results and convenience, CRC screening using iM2-PK is promising.

Cataracts among Adults Aged 30 to 49 Years: A 10-Year Study from 1995 to 2004 in Korea

PURPOSE: To investigate the long-term characteristics of cataracts among adults aged 30 to 49 years in Korean over a span of 10 years. METHODS: Subjects between the ages of 30 to 49 years who underwent cataract surgery at St. Mary's Hospital from 1995 to 2004 (n = 976) were included. Patients with a history of ocular trauma, uveitis, other ocular or systemic diseases, and congenital cataracts were excluded. Additional information including type of lens opacity, urban/rural region, and pre- and postoperative visual acuities were analyzed. Lens opacity grading was conducted using Lens Opacity Classification System III. The Cochran-Armitage proportion trend test was used to analyze vision changes with the passage of time. RESULTS: Among the patients who had undergone cataract surgeries, 8.8% (976 / 11,111) met the inclusion criteria. The mean age was 41.7 +/- 5.45 years. Gender breakdown of the patient population included 79.0% male and 21.0% female. In terms of home environment, 60.9% were from an urban region and 39.1% from a rural region. Opacity type included anterior polar (AP), posterior subcapsular (PSC), AP and PSC, cortical, and nuclear in 35.7%, 35.1%, 7.0%, 6.0%, and 5.4% of patients, respectively. At a 2-month postoperative follow-up appointment, 92.7% of patients showed a best-corrected visual acuity of more than 20 / 40. CONCLUSIONS: Predominance of AP and PSC opacities as well as male patients was observed in this study population.

Is There a Difference between Endoscopic Finding and Helicobacter pylori Infection in Patients with Chronic Gastritis?

BACKGROUND/AIMS: This study verifies whether endoscopic findings differ according to the infection of Helicobacter pylori in patients with chronic gastritis. MATERIALS AND METHODS: The study surveyed upper gastrointestinal symptoms of 382 patients with chronic gastritis and conducted esophagogastroduodenoscopy. The endoscopic findings were classified according to the Sydney classification, as edema, erythema, friability, exudates, flat erosion, raised erosion, rugal hyperplasia, atrophy, visibility of vascular pattern, intramural bleeding spot, nodularity, respectively in antrum, body, fundus. RESULTS: 1) The average age of 382 patients was 52.3 years and there were 176 males and 206 females. 2) Among 382 patients, 167 (43.7%) had epigastric pain syndrome and 215 (56.3%) had postprandial distress syndrome. 3) Among 167 patients with epigastric pain syndrome, 85 (51.1%) patients were infected with H. pylori, while 82 (48.9%) patients were uninfected. Among 215 patients with postprandial distress syndrome, patients infected with H. pylori were 102 (47.6%), while those uninfected with H. pylori were 113 (52.4%). This shows no difference between patients with and without H. pylori infection (P>0.05). 4) Compared to patients uninfected with H. pylori, those infected with H. pylori had more erythema (70.2% vs. 66.4%, P>0.05) in antrum, (48.5% vs. 45.2%, P>0.05) in body, and (36.4% vs. 32.7%, P>0.05) in fundus, which shows no difference (P>0.05). CONCLUSIONS: Patients infected with H. pylori tend to show more erythema, while those uninfected with H. pylori showed more atrophy. However, such difference between two groups was statistically insignificant, leading to a conclusion that endoscopic findings do not differ according to H. pylori infection.

Melanosis ilei induced by prolonged charcoal ingestion / 대한외과학회지

Gastrointestinal melanosis is observed most frequently in the colon it also can develop in the ileum, duodenum and esophagus very rarely. Melanosis ilei was thought that causative materials such as aluminum, magnesium, silicate, titanium and other compounds entered the body through the ingestion of agents. We experienced a case of melanosis in the terminal ileum that a 65-year-old female patient ingested 10 g edible charcoal everyday for 3 years to address symptoms of chronic abdominal pain. In Korea, edible charcoal has been considered to be an effective folk remedy for patients with diarrhea or chronic abdominal pain. In our case, a follow up colonoscopy was performed 3.5 years after the termination of the ingestion of edible charcoal, at which point pigmentation was faded color intensity. In conclusion, it is thought that melanosis ilei is a rare disease by ingestion of causative materials and is discontinuous, local and reversible disease.

Endoscopic Finding According to Symptoms in Patients with Functional Dyspepsia

BACKGROUND/AIMS: This study verifies whether endoscopic findings differ according to the symptoms of patients with functional dyspepsia. MATERIALS AND METHODS: This study surveyed upper gastrointestinal symptoms in 325 patients with functional dyspepsia and conducted esophagogastroduodenoscopy. The endoscopic findings were classified according to the Sydney classification, as edema, erythema, friability, exudates, flat erosion, raised erosion, rugal hyperplasia, atrophy, visibility of vascular pattern, intramural bleeding spot, nodularity, respectively in antrum, body and fundus. RESULTS: 1) The average age of 325 patients was 47.8 years. There were 134 males and 191 females among the 325 patients. 2) Among 325 patients, 134 (41.2%) had epigastric pain syndrome, 169 (52.0%) had postprandial distress syndrome, and 22 (6.7%) had unspecific dyspepsia. 3) Compared to postprandial distress syndrome patients, those with epigastric pain syndrome had more erythema (85.1% vs. 60.2%, P<0.01) and raised erosion (26.0% vs. 18.9%, P=0.01) in antrum, and more erythema (59.0% vs. 36.7%, P=0.02) in body. 4) Compared to epigastric pain syndrome patients, those with postprandial distress syndrome had more atrophy (23.7% vs. 10.4%, P=0.04) in fundus. CONCLUSIONS: Erythma and raised erosion were more frequently observed in antrum of epigastric pain syndrome patients, and atrophy was frequently observed in fundus of postprandial distress syndrome patients, through endoscopy.

Nasopharyngeal Metastasis from Colon Cancer / 대한내과학회지

Metastatic adenocarcinoma from the gastrointestinal tract to the nasopharynx is rare. The histological morphology of this lesion is indistinguishable from the colonic variant of primary head and neck adenocarcinoma or intestinal-type adenocarcinoma (ITAC) of the nasal cavity. This is a report of metastatic adenocarcinoma of colorectal origin to the nasopharynx in a 58-year-old man who was previously treated for adenocarcinoma of the sigmoid colon. A histopathological study of the specimen from the nasopharynx demonstrated a tumor that was identical to the patient's previous primary tumor from the colon. There was no tumor mass in the nasal cavity or paranasal sinuses. The nasopharyngeal tissue expressed cytokeratin 20 and CDX-2, but not cytokeratin 7. The patient received palliative radiation after the diagnosis. Distinguishing metastatic adenocarcinoma from the gastrointestinal tract from ITAC can be difficult. The clinical manifestation is important in differentiating these conditions. It is important to recognize these as metastatic lesions because treatment is primarily palliative.

The Preoperative Prognostic Factors for Outcome After LASEK Using the MEL60

PURPOSE: To investigate the preoperative clinical factors affecting the refractive outcome after laser-assisted subepithelial keratomileusis (LASEK). METHODS: This retrospective study was conducted on 58 patients (116 eyes) who underwent bilateral LASEK using the MEL60. The outcome efficacy and predictability of LASEK was examined by analyzing data including age, gender, preoperative uncorrected visual acuity, preoperative refraction (spherical equivalent and cylindrical diopter), central corneal thickness, tear breakup time, and Schirmer test through multiple logistic regression analysis. RESULTS: The preoperative factor associated with postoperative uncorrected visual acuity was the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased efficacy. Predictability was also associated with the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased predictability. The other preoperative factors including sex, age, preoperative uncorrected visual acuity, amount of preoperative cylinder diopter, intraocular pressure, tear breakup time, Schirmer test and central corneal thickness did not show any association with efficacy or predictability. CONCLUSIONS: The preoperative spherical equivalent was determined as the most important prognosis factor in LASEK, as it is in PRK or LASIK.

Remission of Ulcerative Colitis after Appendectomy: A Case Report / 대한소화기학회지

The inverse correlation of appendectomy and ulcerative colitis is well known, but the effect of appendectomy on the clinical course of ulcerative colitis remains unclear. Although the majority of opinions were negative for the therapeutic advantage of appendectomy in patients with ulcerative colitis, advocates for positive effect of appendectomy have been proposed in a few case reports and a prospective study from Western countries. We herein report a case of ulcerative colitis who experienced clinical remission after appendectomy for acute appendicitis. The patient was 35 year old male and had been managed with immunosuppressant before appendectomy. The very acute change in clinical course and a long period of remission after appendectomy highly suggest the therapeutic effect of appendectomy for ulcerative colitis.

Activation of Innate Immune System During Viral Infection: Role of Pattern-recognition Receptors (PRRs) in Viral Infection

Innate immunity and adaptive immunity are two major immune responses against pathogens. Innate immunity is responsible for the immediate immune response to pathogens. Pattern-recognition receptors (PRRs) play an important role in innate immune response. PRRs recognize regular patterns of molecule structure known as pathogen-associated molecular patterns (PAMPs). Among the PRRs, Toll-like receptors (TLRs), RIG-I-like receptors (RLRs), and DNA-dependent activator of interferon regulatory factors (DAI) display key roles in response to viral infections. This article reviews how viral infections activate PRR-PAMP signal pathways and how viruses evade immune responses elicited by PRR signal pathways.

Expression of Plus- and Minus-strand Viral RNA in Coxsackievirus B3-Infected A/J Mice

In order to investigate the implication of viral replication in acute, subacute, and chronic infections of coxsackievirus B3 (CVB3), we examined the histopathological changes and plus- and minus-strand viral RNA dynamics in heart, pancreas, brain, and liver of CVB3-infected A/J mice. Mice were inoculated intraperitoneally with CVB3 and sacrificed on 1, 2, 3, 4, 7, 10, 14, 21, 30, 60, and 90 days post infection (p.i.). Plus- and minus-strand viral RNAs in the organs were quantitated and the organs were additionally evaluated histopathologically for inflammation. No inflammatory infiltrates were observed in the liver, brain, and heart. In contrast, massive lymphocyte infiltration and fat replacement were shown in the pancreas with loss of acinar cells. Both plus- and minus-strand viral RNA levels were detected by 21 days p.i. in heart, 90 days p.i. in pancreas, 4 days p.i. in liver, and 10 days p.i. in brain. The plus-strand RNA was found at least fifty fold higher than the minus-strand RNA by 4 days p.i. in heart and pancreas and by 3 days p.i. in liver. The plus- to minus-strand RNA ratio in brain was found less than 1:20. Our data indicate that viral replication was actively occurred in heart, pancreas, and liver during acute CVB3 infection, whereas viral replication was limited in brain. Furthermore, chronic persistent viral RNA was observed in pancreas. In conclusion, CVB3 at low dose of virus induces severe pancreatitis but marginal or no inflammatory changes in the heart, liver, and brain.

The Effect of Photodynamic Therapy with Verteporfin Retreatment on Corneal Neovascularization in Rabbits

PURPOSE: This study evaluated the effect and safety of photodynamic therapy (PDT) with verteporfin retreatment on patients with corneal neovascularization. METHODS: Corneal neovascularization was induced with a silk suture of the corneal stroma in 24 white rabbits (48 eyes). Four rabbits were examined histologically before performing PDT. Ten rabbits were chosen randomly, one eye from each rabbit was treated with PDT at 50 J/cm2, and the other eye was used as a control. Both eyes of the remaining 10 rabbits were treated with PDT at 150 J/cm2. One week later, one eye was further retreated with PDT at the same intensity. The area of corneal neovascularization was measured and evaluated histologically using light and electron microscopies. RESULTS: The least neovascularized area was observed in the retreated group (P=0.04). The histologic examination revealed fewer new corneal vessels in the retreated group, but the corneal epithelium, stroma, and endothelium showed a normal appearance. Results from electron microscopic examination demonstrated thrombi as well as destruction and nuclear fragmentation of the vascular endothelial cells. However, there were no other changes in the cornea except for vascular endothelial cells, even in the retreated group. CONCLUSIONS: In conclusion, these results suggest that PDT with verteporfin retreatment appears to be safe and significantly more effective in patients with regression of corneal neovascularization.

Role of HGF/c-Met in Serum-Starved ARPE-19 Cells

PURPOSE: Hepatocyte growth factor (HGF) and its receptor (HGFR/c-Met) regulate motility, mitogenesis, and morphogenesis in a cell type-dependent fashion. We report the role of HGF and c-Met on stress-induced ARPE-19 human retinal pigment epithelial (RPE) cells in this study. METHODS: The cells were cultured either with or without serum. Southern and Western blot analyses were done to determine the expression patterns of HGF/c-Met in serum-starved ARPE-19 cells. The cell proliferation pattern in serum-starved condition was analyzed using MTS assay. Inhibition level of cell proliferation was analyzed using a neutralizing monoclonal antibody against c-Met (2 microgram/ml). RESULTS: Abnormal cell proliferation and scattering of ARPE-19 cells was observed under serum starvation. HGF/c-Met were expressed in serum-starved ARPE-19 cells. ARPE-19 cell proliferation was also enhanced with recombinant HGF treatment. Neutralization against c-Met inhibited the proliferation of serum-deprived ARPE-19 by 64.5% (n=9, S.D. 5.5%). Serum starvation appears to induce epithelial-mesenchymal transition of ARPE-19 cells, resulting in scatter, and the expression of alpha-smooth muscle actin (alpha-SMA), a marker for fibrosis. CONCLUSIONS: In conclusion, c-Met induced under non-physiologic conditions has significant effects on the activation of RPE cells.

Clinical Significances of Serum Soluble Fas and Soluble Fas Ligand in Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: Apoptosis via Fas/FasL system is thought to be involved in the development of hepatocyte death in viral hepatitis B. In chronic hepatitis C, sFas/sFasL system was reported to control liver injury induced by Fas/FasL mediated apoptosis. To determine the role of sFas/sFasL system in chronic hepatitis B, we analyzed serum sFas/sFasL in 58 HBV patients and 29 healthy controls. METHODS: HBV patients were categorized into two groups; normal ALT (40 IU/L). Serum sFas/sFasL levels in HBV patients were measured by ELISA and was compared with those in 29 healthy controls. Serum ALT levels, histological activity, and Fas/FasL expression of liver were compared. RESULTS: Chronic hepatitis B patients with elevated ALT had significantly higher serum sFas levels than those in healthy controls (P<0.01). Serum sFasL levels, however, were significantly lower than those in healthy controls (P<0.01). Patients with moderate to marked degree of inflammation and fibrosis had significantly higher serum sFas levels than those in healthy controls (P<0.05). Serum sFasL levels had no correlation with the hepatic histological activity. Serum sFas/sFasL levels also had no significant correlation with the Fas/FasL expression of liver. CONCLUSIONS: Serum sFas/sFasL levels play a possible role in the pathogenesis of chronic hepatitis B. These results suggest that serum sFas levels might serve as a marker for estimating the degree of hepatic histological activity.

The Diagnostic Value of Polymerase Chain Reaction in Intestinal Tuberculosis / 대한소화기내시경학회지

BACKGROUND/AIMS: It is quite difficult to differentiate intestinal tuberculosis from Crohn's disease because of the similarities of their clinical and pathological features and low detection rate of acid fast bacilli. The diagnostic value of PCR has been studied in pulmonary tuberculosis, tuberculous pleuritis and meningitis, but few reports were made in cases of intestinal tuberculosis. The aim of this study is to evaluate the diagnostic value of PCR in intestinal tuberculosis. METHODS: The subjects, a total of 70 cases are composed of clinically diagnosed intestinal tuberculosis, Crohn's disease and intestinal Behcet's disease. We performed PCR with paraffin-embedded intestinal tissue to detect the DNA of Mycobacterium Tuberculosis and the data was analyzed. RESULTS: The positive rate of PCR for Mycobacterium Tuberculosis was 9.8% (4/41) in intestinal tuberculosis, 0% (0/29) in Crohn's disease, and 0% (0/3) in intestinal Behcet's disease. The granulomas were not found in 50% (2/4) of the PCR positive intestinal tuberculosis cases. CONCLUSIONS: We were not able to find evidences to prove the excellent value of PCR assay in making differential diagnosis of intestinal tuberculosis from other granulomatous diseases. But it might be helpful in detecting cases of intestinal tuberculosis which were not pathologically or microbiologically confirmed.

A Case of Duodenal Intramural Hematoma Associated with Henoch - Schonlein Purpura / 대한소화기내시경학회지

Henoch-Schonlein purpura is a condition of unknown origin probably related to an autoimmune phenomenon involving an IgA immune complex disorder. Henoch-Schonlein purpura is a rare cause of intramural hematoma of the duodenum. We herein report a case of intramural hematoma of the duodenum and duodenal obstruction associated with Henoch-Schonlein purpura in a 14-yearold boy. On admission, the patient presented with hematemesis due to duodenal ulcer bleeding. Three days later, he developed both forearm and calf purpurae, fever and severe bile juice vomiting. An endoscopy revealed a luminal obstructing erythematous mass with bulging nature at the third portion of the duodenum. Abdominal CT scan and hypotonic duodenography showed intramural hematoma in the third portion of the duodenum and luminal obstruction. Hematoma removal was performed for the correction of intestinal obstruction. Increased awareness of the gastrointestinal manifestations of Henoch-Schonlein purpura should aid in the recognition of this disorder.