Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial

Background/Aims@#Low-volume preparations for colonoscopy are gaining attention for their higher acceptability. However, the efficacy and safety of oral sulfate solution (OSS) preparations in patients with ulcerative colitis (UC) has not been well known. Therefore, we aimed to compare OSS and 2-L polyethylene glycol with ascorbic acid (PEG+Asc) for bowel preparation in inactive UC. @*Methods@#A multicenter, randomized, single-blind study was conducted at six tertiary referral hospitals in Korea. Outpatients with UC who had stable disease activity were randomly allocated to the OSS group or the 2-L PEG+Asc group for bowel preparation before colonoscopy. The study outcomes included treatment efficacy, safety, tolerability, and acceptability. Bowel cleansing was assessed using the Boston Bowel Preparation Scale and rated as successful cleansing if the score was ≥6. Patient acceptance and tolerability were assessed using a 4-point ordinal scale. Additionally, disease activity and laboratory data before and after colonoscopy were evaluated to check for safety. @*Results@#The OSS and 2-L PEG+Asc groups included 92 and 93 participants, respectively. No significant between-group difference was noted in successful cleansing (OSS [96.7%] vs 2-L PEG+Asc [97.8%], p=0.64). Moreover, the safety, acceptance, and tolerability were not significantly different (all p>0.05). Furthermore, no significant changes were found in serum electrolytes or disease activity in either group. @*Conclusions@#OSS is effective for colonoscopy cleansing, has acceptable tolerability, and does not affect disease activity; thus, it can be used safely for bowel preparation in patients with inactive UC.

A 2-Week Steroid Trial for Differentiating Isolated IgG4-Related Sclerosing Cholangitis from Cholangiocarcinoma / 대한췌담도학회지

Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is rare disease which is steroid-responsive and often associated with IgG4 related systemic disease such as autoimmune pancreatitis. It is characterized by increased serum IgG4 and IgG4-positive lymphoplasmacytic infiltration in bile ducts. It is often difficult to distinguish IgG4-SC to hilar cholangiocarcinoma if it manifests as an isolated bile duct. We report a case of 79-year-old woman with IgG4-SC which was difficult to distinguish hilar cholangiocarcinoma due to similar clinical and radiologic findings, showing good therapeutic effect after a 2-week steroid trial.

The Effects of Life Style Modification on Constipation of the Older Adults at a Geriatric Hospital / 재활간호학회지

PURPOSE: This study aimed to evaluate the effects of lifestyle modifications on the constipation relief, the time required to see the effects, and the effective lifestyles for constipation in older adults admitted to a geriatric hospital. METHODS: Nonequivalent control group pre-post test design was used. The subjects consisted of 25 elderly in the control group and 23 in the experimental group. Constipation was measured with symptoms of constipation, number of bowel movement and use of laxatives. Life style modification consisted of drinking water before breakfast, having a breakfast, scheduled toileting after breakfast and walking everyday for 3 weeks. RESULTS: Symptoms of constipation (t=2.23, p=.030) and number of bowel movement per week (t=-2.55, p=.014) were significantly different between two groups after 3 weeks. Drinking water, scheduled toileting and walking might contribute to the results. CONCLUSION: Lifestyle modification was effective on constipation in older adults admitted to a geriatric hospital. However, the effects were produced after 3 weeks. Nevertheless, it is recommended that nurses continuously encourage older adults for drinking water, regular trying for bowel movement and walking to relieve constipation, since the lifestyle modification does not need any special education and skill.

A Case of Pancreatic Cancer with Markedly Elevated Serum Immunoglobulin G4 / 대한췌담도학회지

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer is often difficult due to similar clinical manifestations and radiological findings. Serum immunoglobulin G4 (IgG4) is a marker to differentiate AIP from pancreatic cancer. Although serum IgG4 can be elevated in 10% of patients with pancreatic cancer, most of serum IgG4 elevation in pancreatic cancer is limited within two times of upper normal limit. Herein, we report a case of pancreatic cancer with markedly elevated serum IgG4 over six times of upper normal limit that needed steroid trial to differentiate from AIP.

Corrosive Esophagitis Caused by Ingestion of Picosulfate

Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water.

Diffuse Ganglioneuromatosis of the Colon Presenting as a Large Subepithelial Tumor in Adults: Report of Two Cases / 대한소화기학회지

Colonic diffuse ganglioneuromatosis is a benign neoplastic condition characterized by disseminated, intramural, or transmural proliferation of neural elements involving the enteric plexuses, sometimes associated with von Recklinghausen's disease and other multiple tumor syndromes. Colonic diffuse ganglioneuromatosis is usually large, ranging from 1 to 17 cm, and thus can distort the surrounding tissue architecture as well as infiltrate the adjacent bowel wall. However, colonic diffuse ganglioneuromatosis is an exceptional finding in adults and only individual cases are reported in the literature. Herein, we report two unusual cases of adult patients with colonic diffuse transmural ganglioneuromatosis presenting as a large subepithelial tumor.

Proteomics Analysis for Helicobacter pylori-infected Gastric Mucosa / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori infection is linked to the development of gastric cancer. H. pylori-associated gastric inflammation is considered to be the first important step in the histogenesis of such neoplasia. However, studies that compare proteome of gastric mucosa infected with or without H. pylori are lacking. METHODS: We employed proteomics analysis on the endoscopic biopsy specimens of gastric mucosa obtained from two groups (30 cases): healthy subjects without H. pylori infection (15 cases), and gastritis patients with H. pylori infection (15 cases). The pooled proteins obtained from gastric mucosa infected with or without H. pylori were separated by two-dimensional gel electrophoresis and analyzed by a computer-aided program. The altered protein expressions were then identified by mass spectrometry and validated by Western blotting and immunohistochemistry. RESULTS: On mass spectrometry using MALDI TOF(TM) Analyzer, the up-regulation of Keratin 1, ezrin, adenosine triphosphate (ATP) synthase subunit alpha mitochondrial isoform c, Keratin type I cytoskeletal 19, and Keratin type I cytoskeletal 9 were identified; in contrast, 71 kd heat shock cognate protein, ATP synthase subunit alpha mitochondrial precursor, and annexin IV were down-regulated. Among them, membrane cytoskeleton linker ezrin was validated using Western blot and immunohistochemistry. CONCLUSIONS: Expression of ezrin was significantly different between the gastric mucosa with and without H. pylori infection. Therefore, ezrin could be considered a promising potential molecular marker for detecting H. pylori infection in gastric mucosa.

A Case of Intraductal Papillary Mucinous Neoplasm of the Pancreas with Pancreatoduodenal Fistula Diagnosed by Pancreatoscopy Using a Standard Upper Endoscope / 대한췌담도학회지

Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is characterized by the production of mucin and marked dilatation of pancreatic duct. There are only several cases reports about fistula formation with adjacent organs in IPMN. A 61-year-old man was admitted due to jaundice and weight loss. CT scans showed that multiloculated cystic mass had replaced the body and tail of the pancreas. Interestingly, a fistula was found between cystic mass and duodenal bulb. With a diagnosis of malignant IPMN and pancreatoduodenal fistula, endoscopic forcep-biopsy was performed at the orifice of the fistula and pancreatic duct, through the fistula, under a fluoroscopic guidance. Pathologic examination showed only inflammatory cells. Direct peroral pancreatoscopy was performed through the pancreatoduodenal fistula using a standard upper endoscope with saline irrigation. Endoscopic forcep-biopsy was performed on the papillary tumor. Pathologic examination revealed intestinal type IPMN and radical total pancreatectomy was performed. Pathologic examination of the surgical specimen showed tubular adenocarcinoma arising from 15 cm sized intestinal type IPMN.

Atrophic Gastritis: Pathophysiology and Etiology

In Korea, a lot of Helicobacter pylori infection, atrophic gastritis (AG) is very important due to AG is a well-established precursor of intestinal gastric cancer. H. pylori is a major risk factor for AG. In addition, environmental and host factors are also considered as risk factors, however, autoimmune induced AG is rare. In Korea, prevalence of AG is approximately 30% and gastric cancer occurs in AG at about 1% per year. Therefore, endoscopic screening less than every two year is recommended. In accordance with these aspects, decreasing the occurrence or progression of AG by treating H. pylori infection should be considered.

A Case of Synchronous Triple Primary Cancers Occurring in the Stomach, Colon and Liver

Multiple primary cancers are defined as more than two primary cancers occuring in one patient, synchronously or metachronously. Detection of multiple primary cancers have been increased gradually, because of the improvement of diagnostic and therapeutic tools. Nevertheless, synchronous triple primary cancers have been regarded as rare disease. Here, we report a case of synchronous triple primary cancers occurring in the stomach, colon and liver. The patient was a 68-year-old man who complained intermittent dyspepsia. All of these cancers were diagnosed by upper and lower GI endoscopy, and abdominal CT scans in early stages. The patient was managed successfully with endoscopic submucosal dissection and radiofrequency ablation.

Focal nodular hyperplasia: with a focus on contrast enhanced ultrasound / 대한간학회지

No abstract available.

Mycobacterium Kansasii Disease Presenting As a Lung Mass and Bronchial Anthracofibrosis / 결핵및호흡기질환

The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predominance of an upper lobe infiltration and cavitary lesions), even though some suggest that cavities are more commonly thin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.

Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.

A Case of Infective Endocarditis due to Staphylococcus lugdunensis / 감염과화학요법

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Actinobacillus actinomycetemcomitans Bacteremia Associated with Permanent Pacemaker Lead Infection / 감염과화학요법

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan

A Case of Infective Endocarditis due to Staphylococcus lugdunensis / 감염과화학요법

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Actinobacillus actinomycetemcomitans Bacteremia Associated with Permanent Pacemaker Lead Infection / 감염과화학요법

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan

A Case of Lipoid Pneumonia with Hypercalcemia Caused by Squalelne Intake by Force

Lipoid pneumonia is a chronic, interstitial, proliferative inflammation resulting from aspiration of lipoid material and occurs principally in debilated infants. We experienced a case of lipoid pneumonia with hypercalcemia in a 15 month-old boy who showed irritability, poor weight gain, cough, dyspnea, fatigue, diarrhea and pale face after ingestion of Squalene (shark liver oil : 20-30 cap/day) by force for 2 months. Calcium preparation was also given for 5 months.Lipoid pneumonia was suspected from history and simple chest X-ray. Chest CT showed mixed interstitial reticular density in portions of affective lung fields and the density of the lesion is slightly lower than that of muscle. Although diagnosis was confirmed by tracheal aspiration cytology, chest CT findings could be used as a non-invassive diagnostic tool in lipoid pneumonia.