Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.

Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.

A Case of Recurrent Abdominal Pain with Fever and Urticarial Eruption / 대한소화기학회지

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of fever and serosal, synovial, or cutaneous inflammation, caused by a dysfunction of pyrin as a result of mutation within the MEFV gene. It occurs mainly among Mediterranean and Middle Eastern populations, including Jews, Arabs, and Turks. However, FMF cases have been reported outside the Mediterranean and Middle Eastern countries in recent years. Although FMF has been relatively rare in Korea until now, proper recognition of FMF might lead to more frequent diagnoses of FMF. We experienced an interesting case, a 31-year-old Korean man who presented with recurrent abdominal pain with fever and urticarial eruption for 10 years. DNA analysis showed complex mutations (p.Leu110Pro, p.Glu148Gln) in the MEFV gene. To date, three cases have been reported, and this case of FMF with skin conditions is the first case in Korea.

Subclinical Renal Insufficiency Range of Estimated Glomerular Filtration Rate and Microalbuminuria Are Independently Associated with Increased Arterial Stiffness in Never Treated Hypertensives

BACKGROUND AND OBJECTIVES: Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (> or =60 mL/min/1.73 m2) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin. SUBJECTS AND METHODS: Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, 50.1+/-10.4 years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR > or =90 mL/min/1.73 m2 (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/1.73 m2 (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU. RESULTS: Group 1 had the lowest hfPWV (964.6+/-145.4; group 2, 1013.5+/-168.9; group 3, 1058.2+/-238.0; group 4, 1065.8+/-162.9 cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048). CONCLUSION: Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.

Prevalence and Risk Factors of Esophageal Candidiasis in Healthy Individuals: A Single Center Experience in Korea

PURPOSE: Esophageal candidiasis (EC) is the most frequent opportunistic fungal infection in immunocompromised host. However, we have found EC in healthy individuals through esophagogastroduodenoscopy (EGD). The aim of this study was to determine the prevalence and risk factors for EC in healthy individuals. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 281 patients who had been incidentally diagnosed with EC. We also conducted age and sex matched case control study to identify the risk factor for EC. RESULTS: The prevalence of EC was 0.32% (281/88125). The most common coexisting EGD finding was reflux esophagitis (49/281, 17.4%). An antifungal agent was prescribed in about half of EC, 139 cases (49.5%). Follow-up EGD was undertaken in 83 cases (29.5%) and 20 cases of candidiasis was persistently found. Case control study revealed EC were more often found in user of antibiotics (p=0.015), corticosteroids (p=0.002) and herb medication (p=0.006) as well as heavy drinking (p<0.001). CONCLUSION: The prevalence of EC was 0.32% (281/88125) in Korea. Use of antibiotics, corticosteroids and herb as well as heavy drinking were significant risk factors for EC in healthy individuals.

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

When replacing percutaneous endoscopic gastrostomy (PEG) tubes, an internal bolster may be retrieved either percutaneously or endoscopically. The aim of this study was to compare the complications of percutaneous and endoscopic method during PEG tube replacement. The medical records of 330 patients who received PEG tube replacement were retrospectively analyzed. According to the removal method of internal bolster, we categorized as endoscopic group and percutaneous group. Demographic data, procedure-related complications and risk factors were investigated. There were 176 cases (53.3%) in endoscopic group and 154 cases (46.7%) in percutaneous group. The overall immediate complication rate during PEG tube replacement was 4.8%. Bleeding from the stoma (1.3%) occurred in percutaneous group, whereas esophageal mucosal laceration (7.4%) and microperforation (0.6%) occurred in endoscopic group. The immediate complication rate was significantly lower in the percutaneous method (OR, 6.57; 95% CI, 1.47-29.38, P=0.014). In multivariate analysis, old age was a significant risk factor of esophageal laceration and microperforation during PEG tube replacement (OR, 3.83; 95% CI, 1.04-14.07, P=0.043). The percutaneous method may be more safe and feasible for replacing PEG tubes than the endoscopic method in old patients.

A Case of Hepatic Portal Venous Gas as a Complication of Endoscopic Balloon Dilatation

The development of hepatic portal venous gas (HPVG) is rare but it might be associated with serious disease and poor clinical outcome. Recently, several iatrogenic causes of HPVG have been reported. HPVG as a complication of endoscopic balloon dilatation is a previously unreported event. We experienced a case of HPVG after endoscopic balloon dilatation in a 31 yr-old man with pyloric stricture due to corrosive acids ingestion. The patient was treated conservatively with fluid resuscitation, antibiotics and Levin tube with natural drainage. Five days later, the follow-up CT scan showed spontaneous resolution of HPVG. This case reminded us the clinical importance and management strategy of HPVG. We report here a case of iatrogenic HPVG with a review of relevant literature.

A Case of Lateral Femoral Cutaneous Neuropathy after Renal Transplantation / 대한신장학회지

A few cases of Lateral femoral cutaneous neuropathy that developed after renal transplantation have been reported in western literature but there is no reported case in Korea. It may develop from one to nine days after surgery; the clinical course is favorable but the incidence is not low. According to the reported cases of western literature, the major causes of lateral femoral cutaneous neuropathy after renal transplantation included steal phenomenon, clamping the internal iliac artery during surgery, direct surgical damage to the vessels supplying the femoral nerve, and direct compression of the femoral nerve. We experienced one case of lateral femoral cutaneous nerve neuropathy after renal transplantation that developed at postoperative day (POD) 7. It was partially improved symptomatically after POD 60, so we reported this case with a brief review of literatures.

Morphometric Analysis of Tibial Bone in Three Strains of Mice Using Micro-computed Tomography / 한국실험동물학회지

This study investigated the trabecular and cortical bone microarchitecture of tibia in 14-week-old C3H/HeN, C57BL/6J and ICR mice using micro-computed tomography (micro-CT). Defined volumes of interest were scanned at a resolution of 17 micrometer (isotropic). The X-ray tube was set at photon energy of 50 kV, current of 200 microA, exposure time 1.2 sec, and a 0.5 mm-thick aluminium filter. For quantification of bone mineral density (BMD), the bone samples were scanned by micro-CT together with 2 calibration phantoms. The image slices were reconstructed using 3-dimensional CT analyzer software. C3H/HeN mice showed significantly higher levels of bone volume fraction, trabecular number and BMD, and lower levels of trabecular separation, structure model index and degree of anisotropy compared to C57BL/6J or ICR mice in trabecular bone area. So the C3H/HeN mouse appeared to be a good model animal for the study on the changes of trabecular bone with high trabecular bone mass.

Morphometric Analysis of Tibial Bone in Three Strains of Mice Using Micro-computed Tomography / 한국실험동물학회지

This study investigated the trabecular and cortical bone microarchitecture of tibia in 14-week-old C3H/HeN, C57BL/6J and ICR mice using micro-computed tomography (micro-CT). Defined volumes of interest were scanned at a resolution of 17 micrometer (isotropic). The X-ray tube was set at photon energy of 50 kV, current of 200 microA, exposure time 1.2 sec, and a 0.5 mm-thick aluminium filter. For quantification of bone mineral density (BMD), the bone samples were scanned by micro-CT together with 2 calibration phantoms. The image slices were reconstructed using 3-dimensional CT analyzer software. C3H/HeN mice showed significantly higher levels of bone volume fraction, trabecular number and BMD, and lower levels of trabecular separation, structure model index and degree of anisotropy compared to C57BL/6J or ICR mice in trabecular bone area. So the C3H/HeN mouse appeared to be a good model animal for the study on the changes of trabecular bone with high trabecular bone mass.

Cross-talk between BubR1 expression and the commitment to differentiate in adipose-derived mesenchymal stem cells

BubR1 mitotic checkpoint kinase monitors attachment of microtubules to kinetochores and links regulation of the chromosome-spindle attachment to mitotic checkpoint signaling. Defects in BubR1-mediated signaling severely perturb checkpoint control and are linked to diseases such as cancer. Studies using BubR1 mouse models suggest that BubR1 activities prevent premature aging and infertility. In this study, we show that BubR1 depletion in human adipose-derived mesenchymal stem cells (ASCs) precedes loss of the differentiation potential and induction of replicative senescence. These effects occur independently of p16(INK4A) expression and may involve DNA methylation. Our results reveal a new and unsuspected feature of BubR1 expression in regulation of adult stem cell differentiation.

Factors Influencing the Serum Bilirubin Level in Air Force Pilots / 항공우주의학회지

BACKGROUND: The Republic of Korea Air Force (ROKAF) makes its pilots undergo regular aero-medical checkups. About 15% of the pilots undergoing this check-up show increased serum bilirubin levels without any abnormality in other liver function test items, and even reexamination is required for those with a marked increase. In this study, we investigated the factors associated with increased serum bilirubin. METHODS: Questionnaires and blood tests were used for the ROKAF pilots who visited the Aerospace Medical Center for the aero-medical check-up. Various information from the questionnaire and blood test was statistically analyzed to identify the factors associated with increased bilirubin. RESULTS: In univariate analysis, age, fasting > or =12 hours, exercise in the last 3 days, and last alcohol intake > or = 120 g were statistically associated with increased serum bilirubin. In multivariate analysis, fasting > or =12 hours, exercise in the last 3 days, and last alcohol intake > or = 120 g were independent risk factors significantly associated with increased bilirubin. CONCLUSION: Prolonged fasting, recent exercise and drinking were associated with increased serum bilirubin as previously known. Pilots expecting regular aero-medical check-up should avoid intense exercise and drinking in order to get accurate blood test results.

Efficient Induction of Th1-type Immune Responses to Hepatitis B Virus Antigens by DNA Prime-Adenovirus Boost

BACKGROUND: Chronic infection with hepatitis B virus (HBV) affects about 350 million people worldwide, which have a high risk of development of cirrhosis and hepatocellular carcinoma. Treatment of chronic HBV infection relies on IFN-alpha or lamivudine. However, interferon-alpha is effective in only about 30% of patients. Also, the occurrence of escape mutations limits the usage of lamivudine. Therefore, the development and evaluation of new compounds or approaches are urgent. METHODS: We comparatively evaluated DNA and adenoviral vaccines expressing HBV antigens, either alone or in combined regimens, for their ability to elicit Th1-type immune responses in Balb/c mice which are believed to be suited to resolve HBV infection. The vaccines were tested with or without a genetically engineered IL-12 (mIL-12 N220L) which was shown to enhance sustained Th1-type immune responses in HCV E2 DNA vaccine. RESULTS: Considering the Th1-type cytokine secretion and the IgG2a titers, the strongest Th1-type immune response was elicited by the DNA prime-adenovirus boost regimen in the presence of mIL-12 N220L. In addition, the codelivery of mIL-12 N220L modulated differentially the immune responses by different vaccination regimens. CONCLUSION: Our results suggest that the DNA prime-adenovirus boost regimen in the presence of mIL-12 N220L may be the best candidate for HBV vaccine therapy of the regimens tested in this study and will be worthwhile being evaluated in chronic HBV patients.