Trait of Pain Killer Self-Administration among the Doctors Serving at General Hospitals Located in the Capital Area of the Republic of Korea

BACKGROUND: The aim of this study was to identify the painkillers preferred for self-administration by doctors working at general hospitals in the capital of the Republic of Korea.METHODS: We collected data, using a questionnaire, from 224 doctors working at secondary or tertiary hospitals in the capital of the Republic of Korea from July 1, 2017 to August 31, 2017. The questionnaire included questions on the preferred type of painkiller for each type of pain and the frequency of painkiller intake. Further, we evaluated the participants on the Likert scale to analyze the consideration and cognition of self-administration of painkillers.RESULTS: The doctors in this study tended to state the trade name of the painkillers rather than the generic name. They preferred acetaminophen for headache and nonsteroidal anti-inflammatory drugs for gastrointestinal (GI) pain, dysmenorrhea, toothache, and musculoskeletal pain. In the choice of painkiller for self-administration, they set utmost importance on the effectiveness of the medicine, followed by the potential side effects, physician's prescription, and the pharmacy's recommendation, in that order. The side effects attribute GI complications, hepatotoxicity, drug tolerance, and delayed diagnosis to painkiller use. There were some remarkable differences between surgeons and non-surgeons, men and women, and specialists and trainees in the conception of painkillers and pain control.CONCLUSION: This is the first study worldwide on the trait of the self-administration of painkillers by doctors, which can serve as a useful reference in clinical settings.

A Case of Endoscopically Treated Laryngopharyngitis Resulting from Clinostomum complanatum Infection / 대한소화기학회지

A 46-year-old woman visited our hospital presenting throat pain and globus sensation. The symptoms occurred seven days after eating raw perch and mullet. An endoscopy under sedation showed a fluke―with an approximate length of 4.8 mm and width of 1.5 mm―on the left aryepiglottic fold, with active motility on the mucosa. It was extracted from the larynx using biopsy forceps and was identified as Clinostomum complanatum. To the best of our knowledge, this is the second reported case of human infection with Clinostomum complanatum diagnosed and treated by an endoscopy in Korea. Endoscopy is a useful tool in the diagnosis and treatment of patients at risk for parasitic infections complaining of throat pain.

The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

The Adequate Dose of Propofol for Inducing Sedation during Performance of Upper Gastrointestinal Endoscopy in Koreans / 대한소화기내시경학회지

BACKGROUND/AIMS: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation's potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans. METHODS: From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events. RESULTS: Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups. CONCLUSIONS: 1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans.

A Case of Duodenal Fistula Caused by Intra-abdominal Tuberculous Lymphadenopathy during Anti-tuberculous Medication / 대한소화기내시경학회지

Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication.

Three Cases Of Gas-Forming Liver Abscesses Successfully Treated By Early Pigtail Catheter Drainage / 대한내과학회지

Many advances, including the development of antibiotics, the advent of diagnostic techniques and the use of nonsurgical drainage have decreased the mortality rate of pyogenic liver abscess. But, early prompt diagnosis and proper treatment is mandatory in gas-forming pyogenic liver abscess because it may run a fulminating course to death. Gas-forming pyogenic liver abscess mostly occurred to old diabetics. Symptoms of duration are shorter and the prognosis is poorer in the gas-forming than in the non-gas-forming liver abscess. We report three cases of gas-forming pyogenic liver abscess which occurred in old diabetic patients. They were successfully managed by parenteral antibiotics and early percutaneous drainage under sonographic guidance. Early and adequate drainage of pus by pigtail catheter may play a crucial role on the treatment of gas-forming liver abscess.

A Successful Endoscopic Therapy for Uncontrolled Duodenal Varix after Transjugular Intrahepatic Portosystemic Shunt / 대한소화기내시경학회지

Duodenal varix is a rare site of bleeding in patient with portal hypertension and frequently causes massive bleeding. Treatment modalities are endoscopic sclerotherapy, endoscopic ligation, transjugular intrahepatic portosystemic shunt (TIPS), and shunt operation. A patient with duodenal varix was hemodynamically unstable and an emergent salvage transjugular intrahepatic portosystemic shunt was performed. In spite of TIPS procedure, varix bleeding was not controlled and endoscopic band ligation and endoscopic sclerotherapy were performed with successful hemostasis and eradication of duodenal varix.

A case of gastric adenocarcinoma presented as internal jugular vein thrombosis / 대한내과학회지

The migratory thrombophlebitis and thromboembolic disorders of the venous and arterial systems in the setting of malignancy are termed Trousseau's syndrome. The overall incidence of clinical thromboembolic events in patients with cancer has been reported to vary between 1~11%. Pancreatic carcinoma has been associated with the greatest risk of thromboembolic events. Other tumor type also prone to an increased risk of thromboembolic events, including lung, prostate, stomach, acute leukemia and colon cancer. Hypercoagulability associated cancer may result from activation of coagulation, injury to the endothelium, or alteration of blood flow. Unlike other coagulopathies, Trousseau's syndrome may manifest with thromboses in unusal areas, including the upper extremities, face and visceral organs. Neck vein thrombosis associated with distant cancers have been rarely reported. Jugular vein thrombosis associated with gastrc cancer is very rare. We report one case of gastic adenocarcinoma presented as internal jugular vein thrombosis.

Two Cases of Tsutsugamushi Meningitis

Meningitis associated with tsutsugamushi is not a rare disease and simple, effective treatments are available. However, the diagnosis of meningitis is important since it is potentially associated with significant mortality rates. Case 1 : A 47-year-old woman had a headache and high fever with chills for 3 days. She fell into a stupor, and her blood pressure dropped to 80/60 mmHg on the fifth day of admission to the hospital. The patient was treated with 200 mg of doxycycline given intravenously. Case 2 : A 48-year-old woman was admitted with a 7-day history of fever with chills, severe headache, vomiting, and a generalized non-pruritic erythematous maculopapular rash. The patient was treated with 200 mg of doxycycline given orally. CSF examinations revealed predominantly lymphocytic pleocytosis in all cases. The indirect immunofluorescent antibody titer for Orientia tsutsugamushi were 1:20,480 in case 1 and 1:5, 120 in case 2. We report two cases of meningitis associated with tsutsugamuschi disease.

Quantitation of Hepatitis C Virus RNA by Competitive RT-PCR and DNA-ELISA Method / 대한간학회지

BACKGROUND/AIMS: Quantitation of Hepatitis C Virus (HCV) RNA in serum is important for monitoring the response to interferon-alpha therapy in patients with chronic hepatitis C. Several commercial assays are recently available, but they are expensive and cannot be used as a gold standard. METHODS: An in-house competitive reverse transcription-polymerase chain reaction (cRT-PCR) was developed and validated. The procedure involves the construction of a mutant and wild type HCV RNA internal standard (IS), cRT-PCR, and colorimetric detection with DNA-ELISA. A standard curve was obtained and used for final HCV RNA quantitation. RESULTS: The standard curve was linear over the range of 1x104 to 5x107 copies/mL of the HCV RNA standard (r=0.976). This in-house cRT-PCR was comparable with the branched DNA (bDNA) assay (Quantiplex HCV 2.0, Chiron, USA) with positive correlation between the two tests (r=0.735). CONCLUSION: The quantitation of HCV RNA by in-house cRT-PCR and DNA ELISA was more sensitive and had wider range of detection compared to bDNA assay. This assay is useful for follow-up of HCV RNA concentration after interferon-alpha therapy.

Role of tissue inhibitors of metalloproteinases (TIMPs) in colorectal carcinoma

Increased production of matrix metalloproteinases (MMPs) has been associated with increases in invasive and metastatic potential in many types of human carcinoma. Tissue inhibitors of metalloproteinase (TIMP)-1 inhibits most interstitial collagenases and MMP-9. TIMP-2 binds specifically and noncovalently to the pro-form of MMP-2 and inhibits its enzyme activity. In this study, we examined TIMP-1 and TIMP-2 expressions in relation to clinicopathological variables in colorectal carcinoma with in situ hybridization and immunohistochemistry. TIMP-1 and TIMP-2 expressions were localized overwhelmingly to pericancer stromal cells, while malignant and normal mucosal cells were weak or negative. Strong stromal TIMP-1 immunoreactivity correlated with Dukes' stage (p=0.022), status of lymph node metastasis (p=0.044) and poor survival (p= 0.005). The degree of immunohistochemical staining of TIMP-2 did not correlate with all clinicopathological variables. The correlation between enhanced TIMP-1 expression and advanced stage and poor survival suggest a growth promoting activity of TIMP-1 in colorectal carcinoma.

Coronary Artery Dissection Secondary to Blunt Chest Trauma: A Case Report / 대한흉부외과학회지

A 27-year-old male presented with an anterior myocardial infarction following blunt chest trauma sustained in motorcycle accident. On examination, there was no visible wound on the chest wall. Echocardiogram showed dyskinesia over anterior left ventricular wall. Subsequent coronary angiogram demonstrated dissection at the proximal portion of the left anterior descending coronary artery and left ventriculogram showed apical anerysm and thrombus. He was treated by coronary artery bypass graft.

A Case of Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia / 대한간학회지

Distinction of hepatocellular carcinoma from benign entities such as focal nodular hyperplasia is important because failure of prompt diagnosis could result in a missed opportunity for curative resection. The differential deagnosis, especially among focal nodular hyperplasia and adenoma and even hepatocellualr carcinoma, may have difficult; and when using inly a single imaging method, the diagnosis is often equivocal. Therefore, a combination of imaging modalities is preferred. For focal nodular hyperplasia, the combination of computerized tomography (CT ), magnetic resonance imaging (MRI), and radionuclide scintigraphy showed a high sensitivity and specificity. But, histologic examination is required for the differential diagnos is of hepatic mass. We report a case of hepatocellular carcinoma without clinical evidence of malignancy or serum elevation of tumor marker, that mimicked the CT , MRI, and radionuclide scint igraphic appearance of focal nodular hyperplasia.

A Case of Intestinal Tuberculosis Extensively Involving the Upper and Lower Intestinal Tract, Accompanied by Tuberculous Lymphadenitis / 대한소화기내시경학회지

The prevalence of intestinal tuberculosis has been markedly decreased with the development of anti-tuberculous chemotherapy, preventive medicine, vaccinations, early detection and treatment of pulmonary tuberculosis, and improved eeonomic conditions. Nowadays, intestinal tuberculosis is a disease that should be differentiated from the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, Behcet's disease, and colon cancer and amebic colitis. This disease also has a new clinical significance in that it has an increased infection rate and unfavorable outcomes in patients infected by HIV or in those who undergo organ transplantation or receive immunosuppressive agents. Tuberculosis of the duodenum was a rare disease and was not reported in the last decade. Moreover Intestinal tuberculosis extensively involving the small bowel including the duodenum and colon was very rarely reported in the various relateid literature. Recently we experienced a case of advanced intestinal tuberculosis involving the duodenum, jejunum, ileum, and colon accompanied by tuberculous cervical and abdominal lymphadenopathies, in a 49-year-old woman who manifested profound general weakness, diarrhea, and marked weight loss. She was diagnosed pathologically by upper gastrointestinal endoscopy, colonoscopy, and fine needle aspiration cytology as well as by roentgenologic examination. The patient was given antituberculous medication which resulted in dramatic clinical improvement. In this report, we present this case with review of the related literature.

A Study on the Positivities of Anti - HCV by Second - Generation ELISA in Rural Area of Chonnam Province / 대한내과학회지

BACKGROUND: Hepatitis C virus(HCV) is well known major cause of posttransfusion hepatitis. There were a lot of studies about the prevalence of anti-HCV. But, most of these focused on healthy blood donors or patients with liver diseases in urban areas. So they may not represent the prevalence of anti-HCV in the entire Korean population. This study focused on people of a rural area which consisted of six towns near Reservoir Juam in the Chonnam province in Korea. METHODS: Nine hundred and sixty three persons were selected by multi-stage cluster sampling method from January to February in 19%, Anti-HCV and HBsAg were examined by microparticle enzyme immunoassy(MELA; Abbott Co., USA). Alanine aminotransferase(ALT) was examined by enzyme kinetic method. RESULTS: 1) The positivity of anti-HCV in all subjects was 0.9%. 2) The positivity of anti-HCV in male(1.1%) was not significantly higher than in female(0.9%). 3) The positivity of anti-HCV was 0% below the 5th decade, 0.7% in the 6th decade, 1.4% in the 7th decade, 1.7% in 8th decade, 0% above the 9th decade. There was no significant relationship between the positivity of anti-HCV and age. 4) The positivity of anti-HCV was 0.8% in normal ALT(35U/L) subjects. There was no statistical relationship between the positivity of anti-HCV and ALT level. 5) HBsAg was serologically negative in all of nine anti-HCV positive subjects. CONCLUSION: The positivity of anti-HCV was 0.9% in rural area of Korea and was similar to the prevalence of anti-HCV in urban areas.

Esophagus, Stomach & Intestine; A Case of Malignant Carcinoid Tumor of the Ampulla of Vater / 대한소화기내시경학회지

Carcinoid tumor of the ampulla of Vater comprises about 2.0-8.9% of the gastrointestinal earcinoid tumors and 3-5.5% of the duodenal tumor. The climcal manifestations of the carcinoid tumor of the ampulla of Vater are jaundice, hemorrhage, obstruction of duodenurn, or carcinoid syndrome. But the symptoms of carcinoid tumor are nonspecific and diagnosis is delayed until far advanced state, usually. Recently we experienced one case of carcinoid tienor in a 33-year-old woman who had epigastric pain and intermittent melena, so we report it with a review of the literature