Gastric Endoscopic Submucosal Dissection Is Safe for Day Patients

BACKGROUND/AIMS: Although the advantages of endoscopic submucosal dissection (ESD) are well established, there are important limitations that relate to its higher cost and higher rate of complications compared with endoscopic mucosal resection. This study assessed the therapeutic safety and efficacy of ESD in the treatment of small gastric dysplasia and early gastric cancer (EGC) located within the antrum in an outpatient setting, and it compared the results with those from patients admitted to hospital for ESD treatment. METHODS: This study was a retrospective analysis of a prospectively maintained database. We reviewed consecutive patients with EGC or gastric dysplasia who underwent ESD between October 2007 and May 2008. The lesions were smaller than 2 cm and were located in the antrum. We analyzed 105 lesions in 105 patients. The patients were assigned to two groups according to each patient's preference. RESULTS: The overall rates of complete resection were 98.1% in the inpatients group and 94.3% in the outpatients group. Immediate bleeding occurred in four inpatients, which included one patient in the outpatient group. Delayed bleeding occurred in one inpatient within 24 hours of the procedure. Macroperforations did not occur in either group. A microperforation was found in one outpatient. CONCLUSIONS: The safety and efficacy of ESD used to treat small gastric tumors in the antrum in an outpatient setting appeared to be similar to the safety and efficacy of ESD used to treat patients who were admitted to the hospital.

Eosinophilic Colitis Presenting with Bloody Diarrhea: Case Report / 대한소화기내시경학회지

Eosinophilic colitis is a chronic inflammatory bowel condition of unknown etiology and a rare subtype of eosinophilic gastrointestinal diseases. It is characterized by gastrointestinal symptoms and increased eosinophil numbers in the intestinal mucosa and absence of other potential causes of gastrointestinal eosinophilia. The clinical presentation is varied and depends on the involved layer of the large intestine. There are no confirmatory laboratory tests, and the morphologic evaluation of biopsies or surgical specimens is required to confirm the diagnosis. A 65-year-old man presented with an 8 day duration of bloody diarrhea and lower abdominal pain. The patient was diagnosed with eosinophilic colitis by histopathological evaluation of biopsies and was further categorized as a nonatopic variant associated with non-IgE-mediated reaction. The patient was successfully treated with systemic corticosteroid for 2 weeks. On follow-up after 9 months, the patient remained well without relapse or new lesions.

The trend in the eradication rates of first- and second-line therapy for Helicobacter pylori infection in Daegu and Kyungpook provinces: a single center experience for the most recent 9 years / 대한내과학회지

BACKGROUND/AIMS: The reported prevalence of antibiotic resistance in Helicobacter pylori infection has been increasing. However, recent trends in the eradication rates of H. pylori using first-line triple regimens are rarely reported. Therefore, we determined the trend in the H. pylori eradication rates in a single center for the most recent 9 years in Daegu and Kyungpook provinces, Korea. METHODS: From January 1999 through December 2007, the eradication rates in 615 H. pylori-positive patients who received one-week triple regimens were evaluated retrospectively according to year and ulcer location. RESULTS: The overall H. pylori eradication rate was 81.6%. The eradication rate from the years 1999 to 2007 was 76.3, 78.3, 82.8, 88.5, 77.8, 91.7, 84.8, 75.4, and 83.7%, respectively, based on the per-protocol analysis. No definite evidence of a decreasing tendency of the eradication rate was seen over the 9 years (p=0.760). Furthermore, there was no significant difference in the eradication rate according to ulcer location. CONCLUSIONS: There is no decreasing trend in the H. pylori eradication rate over the past 9 years in Daegu and Kyungpook provinces. However, the eradication rates are not satisfactory, and further investigation is needed to develop more effective regimens.

The Feasibility and Safety of Endoscopic Submucosal Dissection for Gastric Neoplasm in Elderly Korean Patients / 대한소화기내시경학회지

BACKGROUND/AIMS: Elderly patients often have high operative risk due to their comorbid diseases, and the feasibility of performing endoscopic submucosal dissection (ESD) for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of performing ESD in elderly patients. METHODS: From 2005 to 2007, 269 patients with gastric neoplasm were treated by ESD in our hospital. These patients were divided into the elderly patients who were 65 years of age or older and the younger patients. The number of enrolled elderly patients was 123. The en bloc complete resection rate and the complications were assessed and compared with those of the younger patients. RESULTS: The average age of the old age group of patients was 71.1. Of these patients, 53.7% had comorbid diseases and 51.2% revealed adenocarcinoma. The en bloc plus complete resection rate was 85.4%. Perforation during ESD occurred in 4.1% of the patients, and this was immediately closed with endoclips and then it was managed by conservative medical treatment. Bleeding occurred in 17.9% and there were no patients with severe bleeding. The en bloc plus complete resection rate and the complication rate for the elderly patients were not significantly different from those of the younger patients. CONCLUSIONS: The present study shows that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.

Idiopathic hypereosinophilic syndrome associated with skin lesions and multiple brain infarctions / 대한내과학회지

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic disorder that's characterized by peripheral eosinophilia and eosinophilic infiltration of multiple organs, including the heart, lungs, skin, liver, gastrointestinal tract and nervous system. IHES is associated with a broad range of clinical findings, depending on the involved organ and the severity of the infiltration. The diverse modes of clinical presentation occasionally lead to a false clinical diagnosis. There are no specific tests for diagnosing IHES, and the therapies remain controversial. In this report, we describe a 34-year-old man with IHES that was associated with multiple brain infarctions in both cerebral and cerebellar hemispheres. Five months earlier, the patient presented with erythematous scaly hyperkeratotic skin lesions on both legs. He was treated with anticoagulation therapy, aspirin and topical corticosteroid for about 1 month. All his symptoms and signs dramatically improved, except for the persistent peripheral eosinophilia. On follow-up after 8 months, the patient remained well without relapse or new lesions.

Protection of Cardiomyocytes from Acute Ischemic Injury by Protein Kinase Cepsilon Expression

BACKGROUND AND OBJECTIVES: Ischemic injury is the most common and important cause of myocardial damage. Over past decades, a number of studies have identified a protective mechanism known as ischemic preconditioning, which can block or delay cell death from ischemic injury. Protein kinase C (PKC), especially theepsilonisoform has been proposed as a key factor in the signaling pathway of ischemic preconditioning. However, whether PKCepsilon expression in cardiomyocytes can offer such protection from acute ischemia has not been explored. MATERIALS AND METHODS: To demonstrate a direct effect of PKCepsilon expression, a lentiviral vector system was established. Using the lentiviral vector, PKCepsilon was introduced to neonatal rat ventricular myocytes (NRVM) cultured under ischemic conditions, and also to adult rat myocardium subject to left coronary artery ligation. RESULTS: Compared to control, PKCepsilon expression in cultured NRVM under ischemia resulted in preserved cell density and morphology, and a reduction in cell death (77.6+/-12.8% vs 58.1+/-7.2%, p<0.05). In adult rats, the infarcted area after coronary artery ligation was markedly reduced in myocardium injected with PKCepsilon vector compared to control (11.4+/-5.3% vs 20.5+/-11.3%, p<0.01). CONCLUSION: These results provide direct evidence that PKCepsilon is a central player in protection against cell death from acute ischemia.

A Case of Hyperthyroidism with Complete Atrioventricular Block and Cardiac Arrest / 대한내분비학회지

The cardiovascular manifestations of hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular block, bundle branch block, angina pectoris, heart failure, and cardiomyopathy. Though complete atrioventricular block is rare, it is important to recognize it in clinical practice because of the possibility of cardiac arrest. We experienced a 47-year-old female patient who had hyperthyroidism with complete atrioventricular block and developed cardiac arrest despite the initiation of an antithyroid drug. We could resuscitate successfully and inserted a temporary pacemaker, but eventually a permanent pacemaker was needed to prevent the recurrence of cardiac arrest. We report a rare case of complete atrioventricular block and cardiac arrest associated with hyperthyroidism with the review of references.