Disinfection Efficacy of a New Endoscope Reprocessing System Using Electrolyzed Acid Water: An In-Use Evaluation / 감염

BACKGROUND: Electrolyzed acid water (EAW) is a new liquid chemical germicide containing a mixture of oxidizing species and prepared by mixing a small amount of salt with tap water in an electrolyzer. We attempted an in-use evaluation of the high-level disinfection capability of Cleantop WM-1 , a new endoscope reprocessing system using EAW. METHODS: Forty-seven flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using Cleantop WM-1 . Parts of the endoscopes without contact to EAW were disinfected with 75% ethyl alcohol. Immediately after the disinfection procedure, samples were taken from the biopsy channel (S-1), tip of the insertion tube (S- 2), the umbilical cord (S-3), and the angulation knob (S-4). RESULTS: In EAW-disinfected parts of the endoscopes, the culture-positive rates were 4.3% (2/47) in S-1 samples and 12.8% (6/47) in S-2 samples. In ethyl alcohol-disinfected area, the culture-positive rates were 2.1% (1/47) in S-3 samples and 25.5% (12/47) in S-4 samples. The colony counts of culture-positive samples ranged from 1 to 144. Pseudomonas aeruginasa was recovered from the angulation knob of an endoscope, but other contaminating organisms were mostly: normal flora or opportunistic pathogens. CONCLUSOIN: Although parts of the endoscopes disinfected with 75% ethyl alcohol were contaminated with more organisms than EAW-disinfected areas, Cleantop WM-1 showed a relatively good disinfection efficacy in reprocessing patient-used endoscopes.

Analysis of Clinical, Biochemical and Pathologic Factors According to the Response to Initial Steroid Therapy in Active Crohn's Disease / 대한소화기내시경학회지

BACKGROUND/AIMS: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory factor of the response to initial steroid therapy in active Crohn's disease patients. METHODS: The medical records of 32 patients with active Crohn's disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. RESULTS: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68.8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. CONCLUSIONS: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group.

Clinical characteristics of primary biliary cirrhosis based on the analysis of 16 patients / 대한내과학회지

BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown etiology. The disease is relatively common in western countries, but so far, only about 20 cases have been reported in Korea. Thus, the purpose of our prospective study was to evaluate the clinical characteristics of PBC in Korea. METHODS: Between October 1994 and February 1999, 16 patients diagnosed as PBC at our department were enrolled in this study. We analyzed these patients for the distribution of age and sex, initial symptoms and signs, associated disorders, laboratory, endoscopic, and radiologic and histologic findings. RESULTS: Of the 16 patients, the ratio of male to female was 1:7 and the average age was 57.5 years. Pruritus (37.5%) was the most frequent presenting symptom followed by xerostomia and xerophthalmia (12.5%), jaundice (6.3%), chronic fatigue (6.3%), melena (6.3%). Associated disorders were Sj gren's syndrome (25%), arthropathy (12.5%), Raynaud's phenomenon (6.3%) and diabetes (6.3%). Abnormalities of liver function were found frequently. Antimitochondrial antibody (100%), antinuclear antibody (31.25%) and rheumatoid factor (31.25%) were found. Long-term administration of UDCA improved both clinical and biochemical signs in most patients, however, 2 patients experienced exacerbation during UDCA therapy. CONCLUSIONS: We experienced 16 cases of PBC within a short period. It is expected that we can find these patients more frequently if we suspect this disease in patients with pruritus and unexplained obstructive pattern of liver function abnormality.

The Role of Autonomic Dysfunction in Patients with Functional Dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. METHODS: Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. RESULTS: (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. CONCLUSION: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.

The Effects of Cisapride on Volume of Colonoscopy Lavage Solution / 대한소화기내시경학회지

BACKGROUND/AIMS: Polyethylene glycol (PEG) electrolyte lavage solution is now commonly used for peroral colonic preparation. However, the need to ingest a large volume reduces patient acceptance and may limit compliance, thereby resulting in improper preparation. This study was designed to assess whether adding of magnesium oxide or cisapride to PEG solution decreased the volume of PEG solution required without compromising the quality of the preparation. METHODS: One hundred thirty seven patients undergoing outpatient colonoscopy were randomly chosen to receive one of three preparations (Group A: 4 L PEG; Group B: 2 L PEG plus cisapride 20 mg; Group C: 2 L PEG plus magnesium oxide 2 g). Endoscopist was blinded as to the method of preparation and scored the degree of colonic preparation (1 to 4). RESULTS: Mean scores of preparation in group A, B, and C were 2.85, 2.69, and 2.20, respectively (p=0.001). There were significant differences of the degree of preparation between group A and group C, between group B and group C, but not between group A and group B. CONCLUSIONS: Two liters of PEG plus cisapride induced equally effective colonic preparation compared to four liter PEG solution. This results show that the addition of cisapride to PEG solution can reduce volume of PEG solution during colonoscopy preparation.

Clinical Features of Menetrier's Disease in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: Menetrier's disease is a poorly defined condition that is of unknown origin, characterized by giant folds in the stomach. The histologic features are foveolar hyperplasia and cystic dilatation of the gland. We presented the characteristic findings of Menetirer's disease in Korea with a review of literatures to understand the Menetirer's disease more precisely. METHODS: The sixteen cases of Menetrier's disease was reported in Korea. We analyzed their age, sex, symptoms, signs, laboratory findings and treatments, retrospectively. RESULTS: The average age was 46 years. There were 11 men and 4 women. The most common symptom was epigastric pain (94%). The most common sign were epigastric tenderness (69%) and pretibial pitting edema (63%). Patients were often associated with the hypoalbuminemia (73%). All patients showed hypertrophic folds on either gastrofiberscopy or upper gastrointestinal series. All patients showed foveolar hyperplasia histologically. Three patients were operated to control a massive upper gastrointesinal bleeding. Two patients were operated to control the intractable edema. Two patients were operated to exclude gastric malignancy. CONCLUSIONS: Menetrier's disease showed broad clinical features such as epigastric pain, hypoalbuminemia, massive hematemesis and mimicking gastric malignancy. The giant gastric folds and foveolar hyperplasia were the most commom and important findings in the Menetrier's disease.

Effectiveness of a Rectal Tube for Relief of Pain after Colonoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: Abdominal distension from the insufflation of air can create more troublesome discomfort after colonoscopy (CFS) than after upper endoscopy. Many patients report difficulty in expelling insufflated air after CFS. One previous study demonstrated that insertion of rectal tube at the conclusion of CFS significantly improves patient satisfaction with the procedure. The aim of this study was to compare the effectiveness of rectal tube placement for abdominal decompression after CFS in an effort to limit patient discomfort by carefully applying air suction during CFS. METHODS: We conducted a prospective trial in 103 consecutive patients undergoing elective CFS. Patients were randomized to receive rectal tube placement at the end of the procedure or simple air suction during the procedure. Patients were evaluated by clinical symptoms and signs 10 minutes after completion of CFS. RESULTS: All 103 patients had a complete examination of the colon to the cecum. No specific complications occurred during and a day after examination. The two groups were well matched with respect to age, sex, height, weight, chief complaints. There were no significant differences between the two groups for bowel preparation, duration of examination, abdominal pain during procedure, abdominal disten-sion 10 minutes after CFS, and abdominal pain 10 minutes after CFS (p >0.05). CONCLUSIONS: Meticulous air suction during CFS reduces abdominal discomfort and distension after CFS and is as effectively as the placement of a rectal tube at the con-clusion of CFS.

Enhanced expression of inducible nitric oxide synthase may be responsible for altered vascular reactivity in streptozotocin-induced diabetic rats

Growing evidence indicates that enhanced generation or actions of nitric oxide (NO) are implicated in the pathogenesis of hypertension in spontaneously hypertensive rats and diabetic nephropathy in streptozotocin (STZ)-induced diabetic rats. We investigated whether inducible nitric oxide synthase (iNOS) expression in STZ-induced diabetic rats is responsible for the alterations of vascular reactivity. Diabetic state was confirmed 28 days after injection of STZ (i.p) in rats by measuring blood glucose. In order to evaluate whether short term (4 weeks) diabetic state is related with altered vascular reactivity caused by iNOS expression, isometric tension experiments were performed. In addition, plasma nitrite/nitrate (NOx) levels and expression of iNOS in the lung and aorta of control and STZ-treated rats were compared by using Griess reagent and Western analysis, respectively. Results indicated that STZ-treated rats increased the maximal contractile response of the aorta to phenylephrine (PE), and high K+, while the sensitivity remained unaltered. Endothelium-dependent relaxation, but not SNP-mediated relaxation, was reduced in STZ-treated rats. Plasma nitrite/nitrates are significantly increased in STZ-treated rats compared to controls. The malondialdehyde (MDA) contents of liver, serum, and aorta of diabetic rats were also significantly increased. Furthermore, nitrotyrosine, a specific foot print of peroxynitrite, was significantly increased in endothelial cells and smooth muscle layers in STZ-induced diabetic aorta. Taken together, the present findings indicate that enhanced release of NO by iNOS along with increased lipid peroxidation in diabetic conditions may be responsible, at least in part, for the augmented contractility, possibly through the modification of endothelial integrity or ecNOS activity of endothelium in STZ-diabetic rat aorta.

A case of pheochromocytoma with electrocardiographic changes mimicking angina pectoris, and hypotensive crises / 대한내과학회지

No abstract available.