Esophageal Tuberculosis Mimicking Malignancy / 대한소화기내시경학회지

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.

Bowel Cleansing Method of Sodium Phosphate: Onset and Duration of Bowel Activity / 대한소화기내시경학회지

BACKGROUND/AIMS: Divided-dose oral sodium phosphate laxative is recommended for bowel cleansing before colonoscopy. Patients need information about the onset and duration of activity of the preparation. This study was designed to develop practical prescribing information for the patients to reduce anxiety and insomnia concerning bowel movement. METHODS: one hundred ninety patients were requested to take 45 mL sodium phosphate in the previous evening and the morning of the procedure, and to complete a questionnaire. The overall quality of bowel cleansing were assessed by endoscopists. RESULTS: Bowel activity began 2.25 (90 percentile: 3.58) hours after the first dose and continued for 6.55 (90 percentile: 8.5) hours. For the second dose the time of onset was 0.85 (90 percentile: 1.67) hours, and bowel activity continued for 3.6 (90 percentile: 5.17) hours. CONCLUSIONS: The onset of bowel activity from the first dose of sodium phosphate starts within 4 hours and it is completed within 8.5 hours for most. We can recommend the patients to take the first dose of NaP solution at 4 p.m. of the previous day of the exam and second dose more than 5 hours earlier before the colonoscopy in the care that the onset of the bowel activity after the first dose take longer thna 4 hours.

Effect of Age and Liver Cirrhosis on the Gluthathione Concentration and Glutathione Peroxidase Activity in the Plasma, Erythrocytes and Gastric Mucosa of Human

BACKGROUND: The role of aging in damage to DNA have been of increasing in recent years. DNA damage correlated with biochemical and physiologic changes that are characteristic of cellular impairment in aging and disease. Reduction of oxygen in tissue produces a number of oxygen free radicals which may induce cellular damage and even cell death. Glutathione, its function in reductive processes that are essential for the synthesis (and the degradation) of proteins, formation of deoxyribonucleotide precursors of DNA, regulation of enzymes, and protection of the cell against reactive oxygen compounds and free radicals. The aim of this study was, 1) to measure the glutathione concentration and glutathione proxidase activity of erythroyte, plasma, human gastric mucosa in elderly and liver cirrhosis patient 2) to investigate a role of glutathione mediated cellular defense mechanism against oxidative stress between in liver cirrhosis patient and in elderly. METHODS: We measured glutathione concentration and glutathione peroxidase activity in the plasma, erythrocytes, gastric mucosa of human in 4 group (Group A: 10 patients of liver cirrhosis and portal hypertensive gastropathy in age 40~55 years, Group B: same number and disease of patients in age over 65 years, group C: healthy person of age over 65 years, Group D: control). Glutathione concentration of erythocyte, plasma and human gastric mucosa was measured by spectrophotometer using Bioxytech GSH-400. Glutathione peroxidase activity of plasma was measured by Paglia & Valentine method using Bioxytech pl. Gpx and of erythocyte and human gastric mucosa was measured by using Bioxytech Gpx.340. Statistical significance of the different group was determined by ANOVA. A p<0.05 was considered significant. RESULT: Glutathione concentration of erythrocytes and gastric mucosa was decreased in Group A, B, C compared to group D. plasma concentration of glutathione was decreased in group A, B compared to group C, D. Activity of glutathione peroxidase was not different in any group (ANOVA, p<0.005). CONCLUSION: Even though glutathione concentration of erythrocyte and human gastric mucosa was decreased in elderly and in liver cirrhosis patient, our study shows decreased glutathione related defense mechanism against oxidative stress is different in view of plasma concentration of glutathione.

Can Helicobacter pylori Infection Cause Upper Gastrointestinal and Colonic Lesions Simultaneously? / 대한소화기내시경학회지

BACKGROUND/AIMS: Some studies showed the higher prevalence of H. pylori infection in the patients with colon adenoma and carcinoma than control subjects. The association between H. pylori infection and colonic diseases is controversial. We evaluated H. pylori infection rate and the related upper gastrointestinal lesions in the patients with colon polyp and cancer. METHODS: Ninety-four subjects, 67 with colonic lesions and 27 without colonic lesions were enrolled. Colon polyp and cancer were confirmed by colonoscopic biopsy or polypectomy. The enrolled subjects were received gastroduodenoscopic examination. H. pylori infection was evaluated serologically and/or with rapid urease test. The fasting serum gastrin level was measured. RESULTS: H. pylori infection rates in the patients with and without colonic lesions were 67.2% and 44.4%, respectively (p<0.05). Upper gastrointestinal lesions were observed in 27 of 67 patients (40.3%) with colonic lesions and in 11 of 27 patients (40.7%) without colonic lesions (p=1.0). Mean levels of serum gastrin with and without colonic lesions were 91.7+/-31.1 pg/mL and 88.1+/-37.7 pg/mL, respectively (p=0.15). CONCLUSIONS: Our study supports the relationship between H. pylori infection, colorectal neoplasia. Although there was no significant difference, the possibility of the simultaneous presence of upper gastrointestinal lesions in the patients with colorectal polyp and cancer was suggested. But the relationship between serum gastrin and the development of colorectal polyp and cancer was not documented.

Gastroesophageal Reflux in Peptic Ulcer Patients / 영남의대학술지

BACKGROUND: It is well known fact to the patients of duodenal ulcer that their condition is frequently accompanied with reflux esophagitis. Therefore this condition is called an "acid-related disorder" because it is commonly associated with increased acidity. But there has been disputes on the effect of Helicobacter pylori eradication in these two conditions and whether H. pylori infection may have a protective role in reflux esophagitis. Only few reports have dealt with the prevalence of reflux esophagitis and gastroesophageal reflux in patients with peptic ulcer. The aim of this study is to estimate the prevalence of gastroesophageal reflux and to analyze the pattern ofthe pathologic reflux in peptic ulcer patients. MATERIALS AND METHODS: The study population consisted of 57 patients with endoscopically confirmed duodenal and/or gastric ulcer who all underwent 24hr ambulatory esophageal pH monitoring. RESULTS: The prevalnace of gastroesophageal reflux in peptic ulcer patients was 54.2% and 54.5% in gastric ulcer, and 62.5% in duodenal ulcer, 50% in combined ulcer, respectively. The prevalence of gastroesophageal reflux in the control group was 22.7%. CONCLUSION: We discovered significantly higher prevalence of gastroesophageal reflux in patients with peptic ulcer disease than in those without it. In conclusion, the presence or absence of gastroesophageal reflux must be considered in the setting of peptic ulcer disease management.

Prognostic Values of Exercise Testing after Acute Myocardial Infarction

BACKGROUND: Uncomplicated myocardial infarction is often the harbinger of future cardiac events such as unstable angina pectoris,recurrent myocardial infarction or death. The feasibility and safety of exercise testing performed soon after myocardial infarction have been established but the prognostic value of exercise test after myocardial infarction remain inconclusive. The object of this study is to determine whether exercise test results can be utilized to predict of future cardiac events after uncomplicated myocardial infarction. METHODS: The study group comprised 149 patients with an uncomplicated myocradial infarction. A low level exercise test was performed before discharge from the hospital 8 to 10 days after myocardial infarction. The exercise thst results was considered positive if there was new > or =1mm horizontal or downsloping ST segment depression at 0.08 sec after the J point compared with baseline. The patients were followed for the development of new cardiac events. RESULTS: 1) The exercise test after acute myocardial infarction was performed in 149 patients without complication. The mean duration of exercise test was 14 min(range 1-20 min) and the mean work-load(Metabolic equivalents) was 3.7+/-1.1 METs. 2) 37 patients had ST-segment depression, 13 had ST-segment elevation and 27 had an inadequate blood pressure response to exercise. During the exercise, there were angina in 5 patients, dyspnea in 17 and no symptom in 127 patients. 3) During the follow-up period(1 to 75 month, mean 27.4 month), 29 patients experienced post-myocardial infarction angina, 1 had recurrent myocardial infarction, 4 had revascularization therapy(PTCA 2, CABG 2),5 had ischemic cardiomyopathy and 5 died a cardiac death. 4) The patients with cardiac events such as cardiac death, myocardial infarction and post MI angina had a significantly shorter exercise duration(13.1+/-4.0 and 14.6+/-2.7min, p<0.05), lower exercise tolerance(3.5+/-1.0 and 3.9+/-1.0 METs, p<0.05) and lower peak heart rate(117 +/- and 126+/-5, p<0.05). 5) The ST-segment depression, lower exercise tolerance(<3.0 METs) and history of hypertension were associated significantly with cardiac events(p<0.05) but ST-segment elevation, inadequate blood pressure response to exercise, the use of thrombolytic agents and non-Q wave infarction did not predict future cardiac events. Conclusions: The exercise test after acute myocardial infarction is safe and of limited value for predicting patients at risk of cardiac events in the follow-up period. The ST-segment depression and lower exercise tolerance(<3.0 METs) can predict cardiac events and the prognosis of the patients of this group can be improved with aggressive management and careful follow-up.

The Clinical, Angiographic, and Prognostic Significance of Patients with Exercise Induced ST-segment Elevation

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.