Risk Factors for Asymptomatic Colon Diverticulosis / 대한소화기학회지

BACKGROUND/AIMS: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis. METHODS: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver. RESULTS: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000–1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026–4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236–21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis. CONCLUSIONS: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.

Risk Factors for Asymptomatic Colon Diverticulosis / 대한소화기학회지

BACKGROUND/AIMS: The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis.METHODS: This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver.RESULTS: This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000–1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026–4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236–21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis.CONCLUSIONS: The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.

Optimal Number of Endoscopic Biopsies in Diagnosis of Advanced Gastric and Colorectal Cancer

Endoscopic biopsy is necessary to confirm a histopathologic diagnosis. Currently, 6 to 8 biopsies are recommended for diagnosis of a suspected malignant lesion. However, multiple biopsies may result in several problems, such as an increased risk of bleeding, procedure prolongation, and increased workload to pathologists. The aim of this study was to clarify the optimal number of endoscopic biopsy specimens required in diagnosis of advanced gastrointestinal cancer. Patients who were diagnosed with advanced gastrointestinal cancer during endoscopy were included. Five specimens were obtained sequentially from viable tissue of the cancer margin. Experienced pathologists evaluated each specimen and provided diagnoses. A total of 91 patients were enrolled. Fifty-nine subjects had advanced gastric cancer, and 32 had advanced colon cancer. Positive diagnosis rates of the first, second, and third advanced gastric cancer specimens were 81.3%, 94.9%, and 98.3%, respectively, while positive diagnosis rates of advanced colon cancer specimens were 78.1%, 87.5%, and 93.8%. Further biopsies did not increase positive diagnosis cumulative rates. This study demonstrated that three specimens were sufficient to make correct pathologic diagnoses in advanced gastrointestinal cancer. Therefore, we recommend 3 or 4 biopsies from viable tissue in advanced gastrointestinal cancer to make a pathologic diagnosis during endoscopy.

The Prevalence of Barrett's Esophagus and the Comparison of Barrett's Esophagus with Cardiac Intestinal Metaplasia in the Health Screening at a Secondary Care Hospital / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.

Effects of Postoperative Oral Care Using Cold Therapy on Nausea, Vomiting and Oral Discomfort in Patients with Laparoscopic Myomectomy / 기본간호학회지

PURPOSE: The purpose of the study was to evaluate the effects of postoperative oral care using cold therapy on nausea, vomiting and oral discomfort after laparoscopic myomectomy. METHOD: The study was conducted with an experimental group (n=29) and a control group (n=35) sampled from patients admitted to a women's hospital in a metropolitan city in Korea. Data were collected between October 10, 2011 and January 31, 2012 and analyzed using Chi-square, Fisher's exact test, t-test, and repeated measure ANCOVA with SPSS/WIN 19.0. RESULTS: After the intervention, postoperative nausea (p<.001) and oral discomfort for patients in the experimental group were significantly lower than in the control group. There were significant differences in the presence of vomiting between both groups at 12 hours (p<.001) and 24 hours (p=.003) after leaving the recovery room. CONCLUSION: Oral care using cold therapy was found to be an effective nursing intervention for reducing postoperative nausea, vomiting and oral discomfort up to 24 hours after recovery in patients with laparoscopic myomectomy.

Research of Acute Poisoning on a Local Emergency Medical Facility in an Urban-Rural Area / 農村醫學 地域保健

OBJECTIVES: The aim of this study was to investigate the characteristics of acute poisoning cases admitted to a local emergency department in an urban-rural area. METHODS: This retrospective study included all patients with acute poisoning who admitted the emergency department between June 2004 and May 2005. We analyzed the medical records for etiological and demographical characteristics of the acutely poisoned patients. RESULTS: There were 155(1.0%) poisoning cases among 15,457 admitted to the emergency department. Of the admitted cases, 51.0% were female and 49.0% male. The poisoning made a peak in the age range of 30-39 and over 60. The seasonal distribution in poisoning patients suggested a peak in spring(38.1%) and summer(24.5%). The majority of exposures(95.5%) occurred in patient's home, 81.8% were deliberate. The most common agents of acute poisoning in deliberate causes were drugs(p<0.01). All of deliberate cases were suicidal attempts. The most common poisoning cases were pesticides in male, but in female were medications(p<0.01). Overall mortality rate of total cases were 12.9%. The overall mortality rate was higher in male(p<0.05), increasing age(p<0.05) and intentional ingestion(p<0.05), pesticides poisoning(p<0.05). CONCLUSIONS: The study forms a foundation for future work on poisoning epidemiology which hopefully will facilitate the allocation of preventive services in order to reduce the incidence as well as morbidity and mortality of toxic exposures.

Relationship of body iron stores with the development of nonalcoholic fatty liver disease / 대한내과학회지

BACKGROUND: Although numerous reports have shown the influence of the iron overload state on the development of nonalcoholic fatty liver disease (NAFLD), there have been few reports on the prevalence of NAFLD according to the body iron stores. The aim of the present study was to determine the relationship of body iron stores with the development of NAFLD in apparently healthy women. METHODS: The present cross-sectional study was performed with data obtained from 5,249 women (mean age: 40.6+/-8.9 years), that received an annual health check-up. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, level of C-reactive protein and serum iron tests were measured in each subject. RESULTS: The prevalence of NAFLD was significantly different according to body iron status (normal iron store/iron store depletion/iron deficient erythropoiesis/iron deficiency anemia: 10.6%/4.1%/6.5%/11.2%, p<0.001). Multivariate analysis revealed that age (odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.1161.507) per 10 years), being overweight (OR=1.952; 95% CI: 1.3952.732), diabetes mellitus (OR=1.694; 95% CI: 1.198-2.397), hypertriglyceridemia (OR=2.434; 95% CI: 1.737-3.409), abdominal obesity (OR=3.559; 95% CI: 2.538-4.992), insulin resistance (OR=2.665; 95% CI: 1.979-3.587), anemia (OR=2.015; 95% CI: 1.150-3.532) and stored iron depletion (OR=0.580; 95% CI: 0.405-0.830) were profoundly associated with the development of NAFLD. CONCLUSION: The present study reveals a possible correlation between the development of NAFLD and body iron stores, and stored iron depletion and anemia seem to be key factors for this correlation.

Lemierre Syndrome: A Case of Postanginal Sepsis

Lemierre syndrome is a rare disease that's characterized by internal jugular vein thrombosis and septic emboli. These symptoms typically develop after acute oropharyngeal infection by Fusobacterium necrophorum1). Although this syndrome is less frequently seen in modern times due to the availability of antibiotics, physicians must be aware of the syndrome in order to initiate prompt antibiotics therapy, including coverage of the anerobic organisms. We discuss here the case of an 18-year-old female with Lemierre syndrome and we review the relevant literature on this syndrome.

Abdominal Wall Endometrosis after Cesarean Section / 대한소화기학회지

No abstract available.

Decrease in serum concentration of nitric oxide (NO) metabolites after lamivudine therapy in patients with chronic hepatitis B / 대한내과학회지

BACKGROUND: It is known that the hepatic nitric oxide (NO) production is induced by various pathologic inflammatory response such as viral hepatitis and mediated by various cytokines from hepatic immune or non-immune cells. We have investigated nitric oxide metabolites (NOx) concentration to know the effect of lamivudine treatment on NOx in chronic hepatitis B patients, and the association between NO metabolic concentration and other clinical factors. METHODS: The study subjects comprised 70 candidates for antiviral treatment for chronic viral hepatitis B. We observed the concentration of NOx in patients group before and after antiviral treatment with lamivudine 100 mg for 24 weeks and compared them with controls. We also examined clinical factors which can affect the concentration of NOx. RESULTS: The mean concentration of NOx in chronic viral hepatitis B patients was significantly higher than that of control group. (patient group: 78.2+/-12.7 micrometer and healthy control group: 31.8+/-11.3 micrometer, p=0.014). The mean concentration of NOx significantly decreased after lamivudine treatment (after treatment: 44.2+/-17.9 micrometer and before treatment: 78.2+/-12.7 micrometer, p=0.027). HBV DNA titer and ALT level were significantly correlated with the concentration of NOx (HBV DNA titer: r=0.697, p=0.038 and ALT level: r=0.402, p=0.012). CONCLUSIONS: The fact that serum NO concentration increased proportionally to the amount of ALT and HBV DNA and decreased after the treatment with lamivudine suggests that serum concentration of NO have correlation with course of HBV infection.

Severe Exogenous Lipoid Pneumonia Following Ingestion of Large Dose Squalene: Successful Treatment with Steroid / 결핵및호흡기질환

Exogenous lipoid pneumonia (ELP) is an uncommon condition resulting from aspiration or inhalation of vegetable, animal or mineral oil. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe ELP requiring steroid or whole lung lavage for treatment is rare. We report a case of 51-year old man with esophageal cancer who developed severe ELP following ingestion of large dose shark oil (Squalene) and successfully treated with prednisolone.

Analysis of Overcrowding in a Local Emergency Department using National Emergency Department Overcrowding Scale (NEDOCS)

PURPOSE: Emergency Department (ED) overcrowding is a national problem and the quantitative measure of ED overcrowding is required. National Emergency Department Overcrowding Scale (NEDOCS) was designed for objective evaluation and quantification of ED overcrowding based on the standard of emergency providers' opinion. NEDOCS is a simple screening tool that can be used to determine the degree of ED overcrowding easily. The purpose of this study was to analyze the overcrowding in a local emergency department using NEDOCS. METHODS: This was a prospective study that medical record obtained from ED census and Order Communicating System (OCS). Three study periods were 1st study-period (from 14 March 2005 to 3 April 2005), 2nd study-period (from 27 October 2005 to 16 November 2005) and 3rd study-period (from 1 March 2006 to 21 March 2006). Sixparameters, the admission time (Admit time), the patient index (Patindex), the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), were used to estimate overcrowding. The comparison between weekday and weekend overcrowding was assessed by using t-test. Also, the same statistical method was used to analyze differences between the 1st study-period and the 3rd study-period. The relationship between NEDOCS and six-parameters was tested by using Pearson's correlation analysis and multiple linear regression analysis. RESULTS: The total number of patients was 4,280. Of these, 2,403 (56.1%) were male and 1,877 female (43.9%). This study showed that ED overcrowding in weekend increased significantly. However, there was no significant change of ED overcrowding during 1 year (between the 1st study-period and the 3rd study-period). NEDOCS has a positive correlation with the Patindex (r=0.856, p=0.000), the BR (r=0.734, p=0.000), the PR (r=0.610, p=0.000), and the DV (r=0.559, p=0.000). Multiple linear regression analysis showed that Patindex was the only independent factor of NEDOCS (beta=0.854, p=0.000, adjusted R2=0.724). CONCLUSION: In conclusion, the NEDOCS was well correlated with overcrowding parameters and the only independent factor of NEDOCS was Patindex.

A case of small bowel Burkitt's lymphoma in AIDS patient / 대한내과학회지

HIV-infected individuals have a high risk of developing non-Hodgkin lymphoma (NHL). NHL is the second most common malignant disorder associated with HIV infection, the first being Koposi's sarcoma. In the late 1990s, however, NHL became more common than Kaposi's sarcoma in some areas. Historically, AIDS-definding lymphomas have included systemic B-cell NHL (ie, immunoblastic and Burkitt's lymphoma) and primary brain lymphoma. We report a case of small bowel NHL in AIDS patient. A 58-year-old man presented with chronic fatigue and progressive abdominal pain. Gastroduodenal endoscopy shows multiple polypoid lesion on duodenum and diagnosed as Burkitt's lymphoma by histologic finding, immunohistochemical study associated with HIV positive. This is the first report of small bowel NHL from AIDS patients in Korea.

Relationship between excretion of 51Cr-EDTA and mucositis in patients with 5-FU based chemotherapy / 대한내과학회지

BACKGROUND: Administration of anticancer drugs may damage gastrointestinal epithelium, thereby increasing the permeability of the gastrointestinal mucosa. It is known that intestinal permeability test using 51Cr-EDTA is a useful test to assess the damage of intestine. The aim of this study was to evaluate intestinal permeability in patients who were treated with 5-fluorouracil (5-FU) based chemotherapy and to evaluate the relationship between the excretion of 51Cr-EDTA and the grading of mucositis. METHODS: Twenty eight patients who were treated with 5-FU based chemotherapy were chosen as study cases while 18 healthy volunteers as controls. Intestinal permeability was assessed by measurement of the urinary excretion of 51Cr-EDTA after oral challenge, and the National Cancer Institute common toxicity criteria were used for assessing oral mucositis. RESULTS: All except 3 patients in the chemotherapy group experienced grade 1~3 stomatitis. The median value of intestinal permeability test was significantly higher in the chemotherapy group than in control group (7.61%, range 2.10-22.92 vs 2.17%, range 1.16-2.76, respectively, p<0.001). The grading of oral mucositis did correlate with the urinary excretion of 51Cr-EDTA (p<0.001, r=0.867). CONCLUSIONS: The measurement of 51Cr-EDTA excretion after oral challenge may be a useful test for evaluating the intestinal permeability by chemotherapy induced intestinal mucosal damage. Testing of intestinal permeability using 51Cr-EDTA may be applicable to evaluate the effect of therapeutic trials in patients with chemotherapy induced mucositis.

Gastric Rupture after Failed Intubation for Cesarean Section / 대한마취과학회지

A 27-year-old parturient in her gestational age of 38(+4) weeks was admitted to the obstetric emergency room due to fetal distress and suspected pneumoperitoneum after a failed intubation during anesthetic induction for cesarean delivery, which occurred at an obstetric clinic. On admission, she was drowsy, her abdomen was excessively distended, and the fetal heart tone was inaudible. An emergency cesarean section was performed after a standard laryngeal mask airway (size 4) was inserted for general anesthesia. At the moment the peritoneum was opened, a great amount of free air escaped. A floppy baby was delivered with an Apgar score 1 at 1 min and 4 at 5 min. Before transfer to the neonatal intensive care unit, the baby was resuscitated and intubated. Immediately after the cesarean section was completed, an emergency exploratory laparotomy was carried out. During the laparotomy, a linear tear, 8.2 cm long, along the lesser curvature of stomach was identified and repaired. The patient and her baby recovered uneventfully and were dischargedon the 7(th) postoperative day.

Combination of Small Doses of Subarachnoid Bupivacaine/Fentanyl and Epidural Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: An intrathecal injection of a small-dose local anesthetic and an opioid using combined spinal-epidural anesthesia (CSEA) technique is a new trend in regional anesthesia for cesarean section. Prophylactic epidural injection may be useful to complete the new regimen. METHODS: Spinal anesthesia via the CSEA technique was performed with 6 mg 0.5% hyperbaric bupivacaine plus 20ng fentanyl in 75 parturients undergoing cesarean section. group S (study, n = 38) received an epidural injection of 10 ml of 0.25% bupivacaine 5 min after intrathecal injection, and was compared with group C (control, n = 37) in sensory levels and Bromage scores, incidences of side effects such as hypotentsion, pain and discomfort, nausea and vomiting, dizziness, pruritus and shivering. Recovery times from sensory and motor block and the duration of postoperative analgesia were assessed between the groups. RESULTS: Sensory block levels were higher (but remained

A Case of XX Male Syndrome with Anophthamia

XX male has a male phenotype with testes or gonads of testicular type and a female chromosomal constitution of 46, XX with no evidence of either ovarian tissue or female genital organs. Generally, they have normal male genitalia and all are infertile. We experienced a neonate with anophthalmia, hypospadia, small penis, and normal testes, whose chromosomal analysis demonstrated 46, XX. Polymerase chain reaction revealed the existence of a sex-determining region of Y (SRY). These findings suggest that the translation of an SRY on the X chromosome led to the development of a male phenotype. We report the case with a review of the related literature.

A Case of Idiopathic Hypereosinophilic Syndrome Accompanied with Intestinal Obstruction / 대한소화기내시경학회지

The idiopathic hypereosinophlic syndrome (HES) is a disease defined by three diagnostic criteria, first, sustained blood eosinophilia is greater than 1,500/mm3 present for longer than 6 months, second, other apparent etiologies for eosinophilia must be absent, including parasitic infection and allergic disease, third, patients must have signs and symptoms of organ involvement. It is associated with cytotoxic granule proteins released by mature eosinophils. HES mainly affects cardiovascular, neurologic, pulmonary system, liver and spleen while low incidence of gastrointestinal involvement is found, and the development of severe complications such as intestinal obstruction after peritonitis or intestinal perforation is extremely rare. We have experienced a case of HES involving hepatic and digestive system, 39 year old man patient who was operated due to intestinal obstruction that was followed by HES, so we report this case with a review of the literature.

Reevaluation of Standard RIA to Detect dsDNA Antibodies Using Crithidia luciliae amp; IT-1 Cell Lines / 대한류마티스학회지

The presence of anti-dsDNA is included in diagnostic criteria for systemic lupus erythematosus (SLE) according to the American College of Rheumatology (ACR). It has been the most useful factor in the diagnosis, prognosis, and therapeutic monitoring of patients with SLE. A number of methods are available but radioimmunoassay (RIA) has been regarded as standard method. A shift from RIAs to nonisotopic assay has been observed with other tests. Still, RIA assays are standard methods for anti-nDNA antibodies. A comparative study of the Crithidia luciliae immunofluorescence (CLIF) assay and an RIA was made. METHOD: Sera from 144 patients were tested by an indirect immunofluorescent antibody technique employing Crithidia luciliae and IT-1 cell lines as a substrate and radioimmunoassay was based on the Farr technique. RESULTS: 1. Thirty-nine of 122 sera with positive antinuclear antibody (ANA) tests had the possibility of positive anti-nDNA antibodies. 2. The RIA was positive in 54 sera, and 37 of these showed a discrepancy between the RIA and the ANA pattern (false positive rate 25.7%). 3. The CLIF was positive in 15 sera, and 5 of these showed a discrepancy between CLIF and the ANA pattern (false positive rate 3.5%). 4. Only CLIF was positive in 2 sera of which one showed a discrepancy between CLIF and the ANA pattern. 5. Only RIA was positive in 41 sera, and 33 of these showed a discrepancy between RIA amp; the ANA pattern. CONCLUSION: The immunofluorescence assay using Crithidia luciliae is a valid method to detect anti-dsDNA antibodies and has a much lower false positive rate compared with RIA. The simple and inexpensive CLIF test could either replace the RIA in clinical laboratories or be used in conjunction with the ANA pattern as a confirmatory test for antibodies to nDNA.

Two Cases of Diarrheal Disease Caused by Plesiomonas shigelloides / 대한임상병리학회지

Plesiomonas shigelloides is known to cause diarrhea in human. It is a facultatively anaerobic gram-negative rod belonging to the family Vibrionaceae. We isolated P. shigelloides from two patients with diarrhea, a 62-year-old woman with steroid therapy and a 4-year-old boy with no predisposing factor. The organisms were isolated on enteric agars as a nonlactose fermenter and were identified by oxidase, indole, and other biochemical characteristics. The isolates were susceptible to commonly used antimicrobial agents with the exception of ampicillin. P. shigelloides infection is rarely reported in our country, but appears to be a significant cause of diarrhea that responds to antimicrobial therapy. Therefore we suggest the need for correctly identifying P. shigelloides.