Characteristics of Korean Patients with Constipation Who Visited a Tertiary Referral Center / 대한내과학회지

BACKGROUND/AIMS: Korean patients with constipation have differences, both among themselves and as compared to other populations, with regard to race, diet, and cultural factors and are expected to have different characteristics to those of western patients, but few studies have been conducted in this regard. We evaluated the epidemiological and physiological characteristics of patients with constipation who visited a tertiary referral center. METHODS: A total of 338 patients with constipation were included. They completed a questionnaire and took physiological tests such as defecography, colon transit time, and anorectal manometry. We classified the types of constipation according to the physiological tests and analyzed the results. RESULTS: The mean age of the study patients was 53.8 +/- 16.3 years and 42.3% of the patients were > or = 60 years old. Patients who had tried folk remedies reached 64.3%. Among the self-reported patients with constipation, 89.1% satisfied the Rome III criteria for constipation. However, 84% of the patients who did not satisfy the criteria showed abnormal results on the physiological tests. Patients with normal transit constipation, slow transit constipation, and dyssynergic defecation were 21%, 27%, and 29% of the all patients, respectively. Rectal hyposensitivity was found in 16.9% of patients and 25% of them revealed anatomic abnormalities on defecography. CONCLUSIONS: Korean patients with constipation have a tendency to delay an accurate diagnosis and treatment and to use folk remedies. As physiological tests for patients with constipation who visited a tertiary hospital showed a relatively high rate of abnormal results, such as dyssynergic defecation and anatomic problems, active physiological evaluations should be considered for such patients.

Analysis of the Risk Factors That Affect Esophageal Transit Delay When Performing Wireless Capsule Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Capsule endoscopy has become an excellent diagnostic tool for various small bowel diseases. However, some cases of delayed passage of the capsule in the esophagus without obstruction have been reported. The aims of this study were to analyze the risk factors associated with esophageal transit delay. METHODS: From Nov. 2002 to July. 2008, 141 patients underwent capsule endoscopy. Among them, 3 patients were excluded. The 138 patients were divided into two groups (the delayed esophageal transit time (DETT) group, and the normal esophageal transit time (NETT) group), and we compared their characteristics, including age, gender, the reason for examination, the total transit time and the rate of an incomplete examination. RESULTS: DETT occurred in 7 patients (5.1%). The mean age (61.14+/-0.70 vs. 44.01+/-7.37, respectively, p=0.02) was higher in the DETT groups. No statistically increased risk was found for gender and the indications for the procedure. The DETT group showed a higher rate of incomplete examination than did the NETT group (7/7 vs. 41/131, respectively, p=0.001). CONCLUSIONS: Even though delayed esophageal transit on capsule endoscopy is not a serious complication, it could lead to an incomplete examination. Therefore, checking the chest X-rays after swallowing the capsule can be helpful to notice delayed esophageal transit earlier in the procedure.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A Case of Disseminated Mycobacterium intracellulare Infection in an Immunocompromised Host / 결핵및호흡기질환

We report a case of disseminated Mycobacterium intracellulare infection in a 31-year-old man who had been diagnosed as having dermatomyositis and systemic lupus erythematosus 3-years prior. The patient developed a left pleural effusion M. intracellulare was repeatedly isolated from the pleural fluid. After antimycobacterial treatment, the patient's pleural effusion resolved, but a left knee joint effusion developed newly and M. intracellulare was cultured from the joint fluid. At present, the patient has been taking antimycobacterial medication for 15 months but his left knee joint fluid remains positive for M. intracellulare. To our knowledge, this is the second reported case of disseminated NTM infection in a non-HIV infected patient in Korea.