Effects of Olfactory Training in Patients With Postinfectious Olfactory Dysfunction

Objectives@#. Postinfectious olfactory dysfunction (PIOD) is the most common etiology of olfactory dysfunction, and olfactory training (OT) is an accepted treatment modality for PIOD. Some studies have investigated OT in Korean patients, but they involved odorants unfamiliar to Koreans or had no control group. The aim of this study was to verify the efficacy of OT in PIOD patients, using odorants familiar to Koreans and including a control group. @*Methods@#. We enrolled a total of 104 Korean patients with PIOD over the 3-year study period. All participants were assessed using endoscopy and an olfactory function test at the baseline assessment and 3 months after OT. The olfactory function test was performed using the Korean version of Sniffin’ stick (KVSS) II. Nasal and psychological function was evaluated using a visual analog scale and the Mini-Mental State Examination. OT was performed over a period of 3 months, using five odorants (rose, lemon, cinnamon, orange, and peach). @*Results@#. OT improved olfactory function in approximately 40% of subjects over a period of 12 weeks compared to non-OT subjects. A comparison of changes between the initial and follow-up assessments demonstrated that the OT group had significantly better olfactory results for the total KVSS II, threshold, and identification scores than the non-OT group. The degree of olfactory improvement after OT was affected by the initial score. @*Conclusion@#. The effects of OT in patients with PIOD were demonstrated in this study. A meaningful contribution of this study is that Korean patients were tested using odors familiar to them in comparison with a control group.

Delayed Tension Pneumocephalus Following Intraoperative Cerebrospinal Fluid Leakage Repair / 대한이비인후과학회지

Tension pneumocephalus is a rare complication of endoscopic sinus surgery (ESS) that may lead to rapid neurologic deterioration. Symptoms typically develop within the first postoperative week after enough air has entered the intracranial cavity to create pressure on the dura. Furthermore, there may be a rapid onset of symptoms after a positive pressure event. However, there may be a more insidious onset of symptoms in the absence of a positive pressure event. We report a rare case of delayed tension pneumocephalus following an intraoperative cerebrospinal fluid leak repair. We discuss here the mechanisms of this complication and the diagnosis and treatment strategies of tension pneumocephalus after an ESS.

Two Cases of Recalcitrant Chronic Rhinosinusitis Treated with Endoscopic Maxillary Mega-Antrostomy in Primary Ciliary Dyskinesia / 대한이비인후과학회지

Primary ciliary dyskinesia (PCD) results in several characteristic clinical symptoms, including chronic pansinusitis, recurrent infections of the respiratory tract, and infertility. Concerning the rhinologic aspect, medical therapy mainly involving a combination of long-term antimicrobial agents and intranasal steroid sprays can control sinusitis in the majority of cases. But, there are no definite treatment guidelines for recalcitrant chronic sinusitis with PCD. Recently, we examined a 28-year-old male with serous otitis effusion, chronic sinusitis, and bronchiectasis, and a 4-year-old female with chronic sinusitis and serous otitis effusion. We confirmed PCD by electron microscopy and endoscopic maxillary mega-antrostomy was performed in both cases for the treatment of chronic sinusitis that was refractory to conservative management.

Cost-Effectiveness Analysis of Immunotherapy in Patient with Allergic Rhinitis / 대한이비인후과학회지

Background and Objectives@#All treatments must be effective and affordable. Although it is clear that immunotherapy is effective in patients with allergic rhinitis, no cost-effectiveness analysis has been conducted in Korea.Subjects and Method We compared 10 years of total treatment costs (medical expense+ transportation cost+time cost) with medications and symptoms scores assuming that adult patients with allergic rhinitis are treated only with symptomatic medication (medication model) or immunotherapy (subcutaneous or sublingual) plus symptomatic medication [subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) models, respectively]. For cost-effectiveness analysis, related papers and domestic medical statistics were used. @*Results@#The total treatment costs for the first 3 years were ₩3330199, ₩6605557, and ₩7130467 for the Medication model, SCIT model and SLIT model, respectively. The total treatment costs for the 10-year period were ₩7996087, ₩8588624, and ₩9113534 for the medication model, SCIT model, and SCIT model, respectively. The cumulative symptoms plus medications scores decreased 0.44 times in both immunotherapy models compared to the medication model. @*Conclusion@#The initial cost of immunotherapy is more expensive than symptomatic medication, but the total cost for 10 years is similar. In addition, immunotherapy can reduce symptoms by more than half. Therefore, it is a cost-effective treatment for allergic rhinitis.

A Case of Iatrogenic Tension Pneumoperitoneum following Colonoscopy in a Patient with Cytomegalovirus Colitis / 대한소화기학회지

Perforation of the colon occurs in 0.2 to 2% of all colonoscopic examinations. The most common sites of perforation are rectosigmoid junction and cecal area. Colonic perforation, leading to tension pneumoperitoneum in most cases, may be caused by direct trauma or pressurized air. It should be suspected in patients with hypotension, tachycardia and tachypnea during or after the colonoscopy. An 83-year-old woman was admitted due to pulmonary embolism and left cerebellar infarction. Colonoscopy was performed due to bloody diarrhea. She was diagnosed as cytomegalovirus (CMV) colitis. One week after the colonoscopy, colon perforation was incidentally found on ascending colon, and tension pneumoperitoneum occurred immediately after the procedure. The perforated site was primarily closed and the patient discharged 20 days later. Herein, we report a case of tension pneumoperitoneum following colonoscopy in a patient with CMV colitis.

A Case of Clonorchiasis Presenting with Acute Pancreatitis and Cholangitis / 대한소화기내시경학회지

Clonorchiasis is a parasitic disease that is often found in Japan, Korea, China, Hong Kong as well as in countries in Southeast Asia. The disease is caused by the ingestion of infected raw freshwater fish. The clinical manifestations depend on the number of flukes in a patient, the period of infestation, and the complications. In patients with a heavy infestation, extrahepatic bile duct, the gallbladder and even the pancreas are involved. We experienced a 62-year-old man who had a history of ingestion of raw freshwater fish and presented with acute pancreatitis and cholangitis. The pancreaticobiliary-associated clonorchiasis was successfully treated with endoscopic sphincterotomy, and praziquantel.

A Case of Peritoneal Mesothelioma without a History of Asbestos Exposure / 대한소화기학회지

Peritoneal mesothelioma is an unusual disease which diffusely involves the peritoneal surface. The incidence is approximately one per 1,000,000, and one fifth to one third of all mesothelioma are peritoneal in origin. Asbestos exposure is linked to the development of peritoneal mesothelioma as a significant etiology, but further investigation shoud be conducted. Abdominal sonography, abdominal CT and cytologic examination of ascitic fluid are used to confirm the diagnosis, but rarely provides proper diagnosis. Laparoscopy with biopsy is the most common diagnostic method for definite diagnosis of mesothelioma. Cytoreductive surgery and intraperitoneal chemotherapy have been suggested for better survival since the median survival after the initial diagnosis is near to 50 months. This report describes a case of 73-years-old male patient presented with abdominal pain and distension. This patient had not been exposed to asbestos. Abdominal sonography and CT showed massive ascites, multiple omental masses and peritoneal thickening. It was difficult to distinguish peritoneal mesothelioma from carcinomatosis. Laparoscopy and peritoneal biopsy was conducted and immunostaining examination confirmed the diagnosis of peritoneal mesothelioma.

Long-term follow-up of alpha-interferon treatment in patients with HBeAg-positive chronic hepatitis B / 대한내과학회지

BACKGROUND: Data on the long-term effects of interferon alpha (IFN) treatment on disease progression and mortality in patients with chronic hepatitis B (CHB) are limited. To evaluate factors that influence clinical outcome and survival, we performed a follow-up study on hepatitis B e antigen (HBeAg) positive CHB patients treated with IFN. METHODS: A total of 98 patients with biopsy-proven HBeAg-positive CHB were treated with IFN- between 1988 and 2000 and followed. Data were collected by review of medical record, direct contact, or using database from Korea Central Cancer Registry. Sustained response (SR) to treatment was defined as HBeAg loss within 12 months after the end of IFN therapy and maintenance of HBeAg negativity for at least 3 years. We tried to find the factors associated with SR, hepatocellular carcinoma (HCC) incidence and survival. We also compared the cumulative rate of HCC and survival between SR group and non-sustained response (NSR)/nonresponder group. RESULTS: The mean IFN dose was 375+/-205 mega units. Mean follow-up was 92.0 months (SD 45 months). Twenty-six patients (27%) had sustained response to IFN treatment, although transient response was seen in 39% (38 out of 98 patients). Nine patients died of liver-related causes (hepatic failure, variceal bleeding) during follow-up. There were no significant differences of clinical outcomes such as survival and HCC incidence between responders and nonresponders (p=0.18, p=0.10, respectively). However, HCC developed in 6 patients, all of whom were nonresponders with an age older than 39 years. CONCLUSION: Age of 39 years and above at the time of IFN treatment might increase the risk of developing HCC. Therefore, interferon should be applied at the younger age to prevent HCC in patients with HBeAg-positive CHB.

The Significance of Interleukin-1beta Polymorphism as a Risk Factor of Helicobacter pylori-associated Gastric Adenocarcinoma and Its Limit / 대한소화기학회지

No abstract available.

A Case of Pedunculated Leiomyoma Found during Colonoscopic Examination for Anal Bleeding / 대한소화기학회지

Gastrointestinal leiomyomas are commonly found in the stomach, and but 3% of them arises from the colon. Colonic leiomyomas are often found incidentally during colonoscopic examination. Most of patients with colonic leiomyoma are asymptomatic, but patients with large size leiomyoma occasionally have abdominal mass, hemorrhage, intestinal obstruction or perforation. Pedunculated leiomyomatous polyp is rare. Leiomyomatous polyps are occasionally misjudged as adenomatous polyps by endoscopist. We report a case of pedunculated leiomyomatous colonic polyp in 65 year-old female patient. She has complained of intermittent hematochezia and lower abdominal discomfort for 5 months. During colonoscopy, an 1 cm sized long pedunculated polyp at the splenic flexure was detected. It was removed by colonoscopic snare polypectomy. Leiomyomatous polyp was confirmed by microscopic and immunohistochemical findings.

Cost-Effectiveness Analysis of Colon Cancer Screening by Colonosopic Examination in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: The mortality of colon cancer is reduced by a proper screening test. Recently, colonoscopic screening was reported more cost-effective than stool occult blood test or sigmoidoscopy in America. In this study, we performed cost-effectiveness analysis of colonoscopy as a colon cancer screening test in Korea by using Markov model. METHODS: A hypothetical population of 50 years of age divided into 2 groups. Markov model was applied to those with colonoscopic screening and consecutive polypectomy or without screening. The effect of screening test to the general health was expressed as quality-adjusted life years (QALYs). The variables during the screening test and treatment were regarded carefully by sensitivity analysis. RESULTS: The mean cost estimates for colonoscopic exam was 75,164 won and colon cancer treatment was 10,867,177 won. From the analysis using Markov model, the mean cost required for the screening group was 166,717 won and 76,938 won for non-screening group. The QALY in screening group was 18.49. The incremental cost-effectiveness was 1,097,992 won/QALY. CONCULSIONS: Regular colonoscopic exam requires higher medical cost than non-screening group, with its property of reducing mortality from colorectal cancer, however, colonoscopy is a cost-effective means of colorectal cancer screening.

A Case of Gastritis Cystica Profunda Associated with High Grade Tubular Adenoma / 대한소화기학회지

Gastritis cystica profunda is usually characterized by hyperplastic and cystic dilatation of pseudopyloric gland with submucosal invasion. These lesions possess malignant histologic features as metaplastic and even dysplastic alteration can be observed, however they usually exhibit benign behavior. Macroscopically, gastritis cystica profunda may present as a submucosal tumor or as a polyp. In rare case, however, it can be found as a giant mucosal fold. The proposed pathogenesis of lesion relates to ischemia, chronic inflammation, and the presence of foreign body. Herein, we report a case of gastritis cystica profunda associated with high grade tubular adenoma in a patient without antecedent surgery.

Clinical Features of Duodenopathy Associated with Liver Cirrhosis / 대한소화기내시경학회지

BACKGROUND/AIMS: Congestive duodenopathy could be associated with liver cirrhosis with portal hypertension. The aims of this study were to assess the incidence of duodenopathy and to evaluate the relationship between duodenopathy and the presence of esophageal varices and portal hypertensive gastropathy in cirrhotic patients. MEHTODS: A total of 56 patients with liver cirrhosis and 481 controls were taken upper endoscopic examination. RESULTS: Prevalence of duodenopathy was significantly higher in the liver cirrhosis group (26.8%) compared to the control group (6.9%), although positive rate of Helicobacter pylori was significantly lower in the liver cirrhosis group. Duodenal erosions in cirrhotic patients were predominately located in 2nd portion of duodenum compared to contol group and tended to be circular or linear along the Kerck's ring. Vascular congestion was evident in 5 of the 10 cases. Presence of duodenal lesions had no relationship with the size and extent of esophageal varices and congestive gastropathy. CONCLUSIONS: Although histology of duodenopathy tends to show vascular congestion in patients with liver cirrhosis, few clinical markers of portal hypertension support them. Therefore, further studies including endoscopic ultrasonogram are needed to demonstrate the pathogenesis of the duodenal lesions in patients with liver cirrhosis.

The evaluation and treatment of patients with dyspepsia and Helicobacter pylori infection in Korean primary care physician / 대한내과학회지

BACKGROUND: Although Helicobacter pylori infection is now known to be the most common cause of various gastrointestinal diseases and progress in our knowledge about H. pylori is remarkable, whether this knowledge is transferred to general community of practicing physicians is questionable. We wished to investigate the clinical practice and prescribing patterns for dyspepsia and H. pylori infection in primary care in Korea. METHODS: We obtained information about the patterns of practice from reply to questionnaire by mail to physician. We restricted our study to the primary care physicians registered on the Korean Association of Internal Medicine Practitioners. The questionnaire was made of three compartments, which were diagnostic evaluation of dyspepsia, indication and methods of diagnosis and management in H. pylori infection. RESULTS: In case with initial visit of dyspeptic patient, 64.1% of physicians prescribe prokinetics (85.7%), antacid (61.5%), histamine-2-receptor blockers (59.4%), initially. The indications of H. pylori test were as follows; 91.6% in gastric ulcer including scar, 85.3% in duodenal ulcer, 59% in patient-want cases, 51.9% in gastric cancer, 42.7% in gastritis, and 22.8% in gastro-oesophageal reflux disease. And the indications of H. pylori eradication were as follows; 90.6% in gastric ulcer, 88.7% in duodenal ulcer, 35% in gastric cancer, 30.7% in gastritis, 23.5% in patient-want cases, and 24.8% in gastro-oesophageal reflux disease. In addition, 79.7% of physicians prescribe triple therapy including clarithromycin and amoxicillin for H. pylori eradication. CONCLUSION: From this study, we obtained more information about the clinical practice and prescribing patterns about dyspepsia and H. pylori related diseases. More studies are needed to prepare the guidelines for H. pylori under close cooperation between primary care physicians and tertiary hospitals.

A Case of Linitis Plastica Involving the Entire Colon, Ileum, and Appendix / 대한소화기학회지

Linitis plastica of the colon is an uncommon presentation of primary colorectal cancer. This entity of colorectal cancer is characterized by a diffuse infiltrating tumor with desmoplastic reaction and poor prognosis. Although widespread infiltration is the main feature of linitis plastica, the tumor extending to more than 2 segments of the colon is uncommon. We report a case of primary linitis plastica involving the entire colon, ileum and appendix. The clinical characteristics are discussed with a review of literatures.

A Case of Methicillin Resistant Staphylococcus Aureus Enterocolitis Presenting with Massive Diarrhea / 대한소화기학회지

Methicillin resistant Staphylococcal aureus (MRSA) enterocolitis is characterized by high fever, abdominal distension, and watery diarrhea that leads to severe dehydration, shock, a sharp decrease in the white cell counts and sometimes multiple organ failure. Clinically, it can be an another cause of nosocomial diarrhea. If MRSA enteritis is suspected from the clinical symptoms, prompt treatment and strict prophylactic measures including vancomycin, are most important for its management. We recently observed a case of MRSA enterocolitis as a nosocomial infection in a patient with acute pancreatitis. This patient showed uncontrolled massive diarrhea, fever, and multiple organ failure. We report a case of MRSA enterocolitis with a review of literatures.

A Study on Clinical Characteristics of Mallory-Weiss Syndrome with Complicated Course / 대한소화기내시경학회지

BACKGROUND/AIMS: Mallory-Weiss syndrome is a benign and self-limiting disease, but occasionally cases with complications are encountered. The aim of this study was to identify the risk factors for complicated course and predisposing factors of Mallory-Weiss syndrome, and its associated conditions. METHODS: Fifty-nine patients diagnosed as having Mallory-Weiss syndrome were subjects of this study. Patients' medical records were reviewed retrospectively. A complicated course was defined if there was a need for transfusion of > 6 pints, evidence of shock, rebleeding or angiographic or surgical interventions. RESULTS: Risk factors for a complicated Mallory-Weiss syndrome in univariate analysis were the followings; low hemoglobin, melena, presence of visible vessel or active bleeding on initial endoscopy. In multivariate analysis, the presence of visible vessel and active bleeding on initial endoscopy were the only significant risk factors. Predisposing factors of Mallory-Weiss syndrome were as follows: vomiting after alcohol intake (62.7%), vomiting without alcohol (18.6%), nausea (1%), cough (1%), seizure (1%) and unknown etiology (13.6%). Associated medical conditions were as follows: alcoholic liver disease (45.8%), hiatal hernia (27.1%) and liver cirrhosis (18.6%). CONCLUSIONS: We suggest that the presence of visible vessel and active bleeding on initial endoscopy are a independent risk factors of Mallory-Weiss syndrome with a complicated course. In such patients, aggressive treatment and careful observations are essential.

Gastroduodenal Injury in Patients with Low-Dose Enteric Coated Aspirin Treatment / 대한소화기학회지

BACKGROUND/AIMS: Low-dose aspirin therapy is widely used to prevent cardiovascular thrombotic events. However, the safety of low-dose aspirin therapy in the gastrointestinal tract is uncertain. Our aim was to evaluate endoscopic findings in patients taking low-dose aspirin. METHODS: Sixty-two patients who received 100 mg enteric coated aspirin daily more than 30 days were included in this study. Patients' medical records and endoscopic data were reviewed retrospectively. As controls, 70 of age- and gender-matched patients who received an endoscopy without gastrointestinal symptoms were employed. RESULTS: The overall prevalence of gastroduodenal mucosal injury was higher in the aspirin group than in the control group. Erosive gastritis was noted more frequently in the aspirin group than in the control group. However, the prevalence of ulcer was not different between the aspirin group and the control group. CONCLUSIONS: Patients treated with low-dose aspirin therapy are more likely to have endoscopic evidence of mucosal damage. Our study suggests that even a low-dose aspirin therapy can induce a gastroduodenal mucosal injury. In the future, a prospective randomized control study is needed.

Conservative Treatment of Compression and Stable Burst Fractures in the Thoracolumbar Junction: Early Ambulation Vs. Late Ambulation / 대한정형외과학회잡지

PURPOSE: To analyze the efficacy of early ambulation in a selected group of patients with compression and stable burst fractures in the thoracolumbar junction. MATERIALS AND METHODS: We reviewed retrospectively 65 cases of compression and stable burst fractures in the thoracolumbar junction. Group I was composed of 36 cases treated with bed-rest for 2 weeks or less followed by ambulation with bracing, Group II 29 cases treated with bed-rest for 4 weeks or more followed by ambulation with bracing. Radiologic results were compared for the two groups using lateral radiographs, and functional results were analyzed using Denis pain and work scores. RESULTS: Change in wedge angle at last follow up was 6.39+/-3.67degrees in group I and 5.28+/-2.72degrees in group II. Change in anterior body height was 14.46+/-8.25% in group I and 12.25+/-4.58% in group II (p>0.05). Satisfactory pain scores of less than or equal to P3 were noted in 11 cases (69%) of group I and in 12 cases (80%) of group II. Satisfactory work scores of less than or equal to W3 were noted in 12 cases (75%) of group I and in 12 cases (80%) of group II (p>0.05). CONCLUSION: Conservative management of compression and stable burst fractures in the thoracolumbar junction with 2 weeks or less of bed-rest followed by ambulation with bracing can predictably lead to satisfactory functional results.

Interactions of Unconjugated Bilirubin with Bile Acid by Rapid Solvent Partition / 대한간학회지

BACKGROUND/AIMS: Our previous studies of ionization and solubility of unconjugated bilirubin (UCB) yielded inappropriately large differences between the two carboxylic pK'a values of UCB. These data, however, were not ideal due to crystal effects, matastability, impurities of the bilirubin, and imprecision of analyses at low UCB. METHODS: The sodium salt of taurocholate (TC) was purified and dissolved in water to 100 mM. Chloroform (CHCl3) was purified by vacuum distillation. Buffers used were: citrate from pH 4 to 6, phosphate from pH 6 to 8, and borate above pH 8. All had an ionic strength of 0.10. The problems were minimized by rapid solvent partition of UCB from CHCl3 into buffered aqueous NaCl, and a new, accurate assay of low UCB in the aqueous phase which was achieved by concentrating the UCB through back extraction into small volumes of CHCl3. RESULTS: In contrast with the crystal dissolution studies, the two pK'a value were similar. H2B0, not HB-, was the dominant UCB species in the pH range of bile (6.0 to 8.0). The aqueous solubilities of UCB were 90 to 98% less. Less than 0.01% of the bile salt partitioned into the CHCl3 phase and self-association of B= was negligible. UCB solubilities in 50 mM TC were 2 to 10% of those obtained by crystal dissolution, and, up to pH 7.9, were below the maximum UCB concentration in normal human bile. CONCLUSIONS: We suggest that the markedly increased binding of UCB with each ionization step is due to the disruption of the internal hydrogen bonds of the ionized carboxyl groups on interaction with the bile salt. We propose to extend the study of partition to determine the activity and the degradation products of calcium salts of unbound bilirubin fractions.