A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department

PURPOSE: This study was done to compare the rates of hemolysis and repeated sampling in blood samples obtained by a syringe needle versus a vacuum tube needle. METHODS: A randomized, prospective study was used to evaluate the differences between the two blood sampling methods. The study group consisted of patients seen in the emergency department (ED) for blood sampling to determine electrolyte level. ED patients were randomly assigned to either the syringe group or the vacuum tube group. All blood samples were collected by experienced ED nurses and hemolysis was determined by experienced laboratory technologists. Data were analyzed using Fisher's exact test and binary logistic regression. RESULTS: One hundred forty-five valid samples were collected (74 in the syringe group versus 71 in the vacuum tube group). 5 of 74 (6.8%) blood samples in the syringe group and 8 of 71 (11.3%) in the vacuum tube group hemolyzed. Repeated blood sampling occurred for 2 of 74 (2.7%) and 3 of 71 (4.2%) in each group respectively. There were no significant differences in rates of hemolysis and repeated sampling between two groups (B=1.97, p=.204; B=2.36, p=.345). CONCLUSION: Venipuncture with syringe needles can be recommended for ED nurses to obtain blood samples.

Evaluation of the Nanopia P-FDP Reagent Kit for Use in the STA-R EVOLUTION Automated Blood Coagulation Analyzer / 임상검사와정도관리

BACKGROUND: In this study on fibrinogen/fibrin degradation products (FDPs), we evaluated the performance of a quantitative immunoturbidimetric assay (ITA) using the new Nanopia P-FDP reagent kit (Sekisui Medical Co., Japan) in comparison with a semiquantitative latex agglutination assay (LA) currently performed using the FDP PLASMA kit (Diagnostica Stago SAS, France). METHODS: The quantitative Nanopia P-FDP method using the STA-R EVOLUTION automated coagulation analyzer (Diagnostica Stago SAS) was evaluated with respect to precision, linearity, carryover, and reference interval. The correlations were measured for each of the 145 samples by using the Nanopia P-FDP method and the semiquantitative FDP PLASMA method. RESULTS: The coefficients of variation with regard to precision in low and high control concentrations were 2.97% and 5.77%, respectively. The correlation coefficient of linearity (r) was 0.990 in the measurement range of 2.4-122.8 microg/mL. The level of carryover was 0.83%, while the reference interval range was 0.22-4.32 microg/mL. The results of FDP assay showed an acceptable accord in 115 samples (79%) among the 145 samples by both LA method and ITA method. Seventeen samples (12%) showed relatively lower FDP values in the LA method than those in the ITA method. Thirteen cases (9%) showed relatively higher FDP values in the LA method than those in the ITA method. CONCLUSIONS: The quantitative Nanopia P-FDP method showed good precision, linearity, carryover, reference interval, and an acceptable concordance rate with the semiquantitative FDP PLASMA method. Thus, the Nanopia P-FDP reagent using the STA-R EVOLUTION automated coagulation analyzer can replace the FDP PLASMA reagent for the quantitative analysis of FDPs.

A Case of Obstructive Jaundice after Insertion of Metallic Stent for Duodenal Obstruction by Recurrent Duodenal Ulcer / 대한소화기내시경학회지

Insertion of self-expandable metallic stent has been performed as a palliative therapeutic modality for cases with gastrointestinal obstruction caused by inoperable malignancies such as pancreatic cancer, stomach cancer, and cholangiocarcinoma. Although the clinical efficacy is not established yet, it can also be performed for benign gastroduodenal obstruction. Especially, when balloon dilatation is failed and patients are at high risk for surgery or general anesthesia, and when patients refuse operation, insertion of metallic stent can be considered. Complications of this therapeutic modality include intestinal perforation, hemorrhage, migration or malposition of metallic stent, and occlusion of stent by ingrowth and overgrowth of tumor or impaction of food. We report a rare case of obstructive jaundice developed after the insertion of gastroduodenal stent for duodenal obstruction caused by recurrent duodenal ulcer.

Significance of Non-erosive Minimal Esophageal Lesions in Gastro-esophageal Reflux Disorder

BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.2% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.

Acute Acalculous Cholecystitis Associated with Cholecystoduodenal Fistula and Duodenal Bleeding: A Case Report

Although acute acalculous cholecystitis (AAC) accounts for less than 10% of acute cholecystitis in the adult population, gangrene and perforation are much more frequent compared to the usual cases of acute cholecystitis (calculus cholecystitis). However, spontaneous biliary-enteric fistula is well recognized in AAC, 90% of which are cholecystoduodenal fistula (CDF) though it is an uncommon disorder. The majority of the CDF are caused by cholelithiasis. As patients are usually associated with complicated clinical illness, the diagnosis is often difficult to make and required surgery is often delayed. We have studied a rare complication of acute acalculous cholecystitis which was presented as intermittent upper gastrointestinal bleeding. Ulceration of the superficial branch of the cystic artery has been observed due to acalculous cholecystitis associated with a cholecystoduodenal fistula. We have performed a transfixing ligation of the bleeding vessel, cholecystectomy and simple closure of the CDF. We have finally made a diagnosis of early gallbladder cancer through a frozen section. There was no serious complication after the operation and the patient has achieved an uneventful recovery.

A Case of a Lymphoepithelial Cyst of the Pancreas / 대한소화기내시경학회지

Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.

Risk factors for ascitic fluid infection in cirrhotic patients with variceal bleeding / 대한내과학회지

BACKGROUND: Ascitic fluid infection is frequently associated with gastrointestinal bleeding and heralds poar prognosis in patients with liver cirrhosis. The aims of this study were to assess the incidence of ascitic fluid infection and to determine the risk factors associated with ascitic fluid infection in cirrhotic patients with variceal bleeding. METHODS: Total 148 bleeding cirrhotic patients receiving endoscopic variceal ligation were evaluated. Characteristics of patients and bleeding were compared between the infected group (with ascitic fluid infection) and non-infected group (without ascitic fluid infection). RESULTS: Ascitic fluid infection was detected in 22 (14.9%) of 148 patients. Child-Pugh class B or C (90.9% vs 61.9%, p<0.001), diabetes melitus (36.4% vs 12.7%, p=0.01), systolic blood pressure lower than 90 mmHg (40.9% vs 17.5%, p=0.02), active bleeding (68.1% vs 31.9%, p=0.02), transfusion of 4 pints or more (54.5% vs 20.6%, p=0.002) were more frequently found in infected group compared to non-infected group (n=126). Multivariate analysis showed that Child-Pugh class (p=0.03, R=0.21) and transfusion amount (p=0.02, R=0.34) were independent risk factors of ascitic fluid infection. CONCLUSION: In bleeding cirrhotics with Child-Pugh class B or C or transfusion of 4 pints or more, risk for ascitic fluid infection was high and antibiotic prophylaxis should be considered.

Prevalence and risk factors of gallbladder polyps in health screening subjects / 대한내과학회지

BACKGROUND: Gallbladder (GB) polyps are now increasingly detected by ultrasonography. We investigated the prevalence and risk factors of GB polyps in health screening population. METHODS: An ultrasonographic study of GB polyps were conducted in 35,012 subjects who received a paid health screening examination at Samsung Medical Center. Controls, twice the subjects with GB polyp, were randomly selected from the cases with normal GB. The demographic characteristics and biochemical parameters were recorded. RESULTS: The overall prevalence of GB polyps was 2.94% (1,330/15,573). Among them, 3.63% were men, 2.09% were women. In both males and females, the prevalence was highest in their 40s. The diameter of GB polyps ranged from 2 mm to 20 mm (mean 4.5 mm). Most polyps (98.3%) were less than 10 mm in diameter. Of 1,030 subjects, 64% had a single polyp and 36% had multiple polyps. Multiple logistic regression, with reference group of body mass index (BMI, <22.5 kg/m2), showed odds ratio of 1.074 and 1.864 for BMI groups of 22.5-24.9 and 25 or more respectively. In contrast, other demographic characteristics and biochemical parameters, such as age, smoking, alcohol use, glucose, liver function tests, lipid profiles and HBsAg carriage were lack of any relation to GB polyps. CONCLUSIONS: GB polyps are not likely to be rare in Korean adults despite their low prevalence compared to other reports. The body mass index may be a risk factor for GB polyps.

A clinical study and short-term outcame of low-grade gastric MALT lymphoma / 대한내과학회지

Low-grade gastric MALT lymphoma arises from long-standing Helicobacter pylori(Hp) infection. High remission rates for these lymphoma have been observed after H. pylori eradication. There was debates on the optimal treatment of low-grade gastric MALT lymphoma. The purpose of this study is to investigate clinical and endoscopic characteristics of primary low-grade gastric MALT lymphoma and to assess short-term clinical outcome of various modalities of treatment. METHODS: 30 patients(14 male, 16 female, mean age 44.9 years, range 26-76, mean follow-up 22.9 months) with primary low-grade gastric MALT lymphoma, diagnosed at the Samsung Medical Center from March 1995 to September 1998, were evaluated in a retrospective study. We evaluated patient's presenting symptoms, endoscopic finding, Hp status, staging by Musshoff system, and recurrence rate according to treatment mordalities. RESULTS: The most common symptom is epigastric discomfort or pain(36.7%). Endoscopic appearances of gastric MALT lymphoma shows the wide variation from mucosal thickening to overt malignancy. The most common site of gastric MALT lymphoma is the gastric antrum and lower body(9 and 6 patients). Histologically, 70% were found to be Hp infected. Of 21 Hp(+) patients, 11 patients were clinical stage IE and received Hp eradication by PPI-based triple regimens. 81.8%(9/11) showed complete remission. Among 11 patients, 6 patients studied by PCR. After Hp eradication, 5 in 6 patients showed persistent IgH rearangement by PCR. The mean follow-up time is 22.8 months(range 3 to 36 months), One patient, who showed complete histologic regression during second endoscopy, relapsed MALT lymphoma after 6 months. The other one patient showed no change of lymphoma and underwent surgery. 12 patients underwent surgical treatment and showed no evidence of relapse. The mean follow-up time is 35.9 months. 2 patients received chemotherapy with CHOP regimen and showed complete remission. The mean follow-up time is 6.7 months. 2 patients received radiotherapy and showed no evidence of relapse. The mean follow-up time is 15 months. CONCLUSION: Our study shows that complete remission rate after Hp eradication is as high as some studies recently reported. This suggest that Hp eradication may be considered as first-line therapy of low-grade gastric MALT lymphoma of stage IE.

Cardiovascular Regulation of GABAB Receptor in the Spinal Cord of the Rats / 대한내과학회지

OBJECTIVES: The purpose of present study is to investigate the influence of a spinal gamma-aminobutyric acid B (GABAB) receptor on a central regulation of blood pressure(BP) and heart rate(HR), and to define its mechanism in the spinal cord. METHODS: In urethane-anesthetized, d-tubocurarine- paralyzed and artificially ventilated male Sprague-Dawley rats, intrathecal administration of drugs were carried out using injecton cannula(33-gauge stainless steel) through the guide cannula(PE 10) which was inserted intrathecally at lower thoracic level through the puncture of a atlantooccipital membrane. RESULTS: Intrathecal injection of an GABAB receptor agonist baclofen(30, 60, 100 nmol) decreased both blood pressure and heart rate dose-dependently. Pretreatment with 8-bromo-cAMP(50 nmol), a cAMP analog or glipizide(50 nmol), a ATP-sensitive K+ channel blocker attenuated the depressor and bradycardic effects of baclofen (100 nmol) but not with 8-bromo-cGMP(50 nmol) a cGMP analog. CONCLUSIONS: The GABAB receptor in the spinal cord plays an inhibitory role in central cardiovascular regulation and that this depressor and bradycardic actions are mediated by the decrease of cAMP via the inhibition of adenylate cyclase and the opening of K+ channel.

Various causes of dyspepsia: to determine organic and functional cause of dyspepsia / 대한소화관운동학회지

BACKGROUND/AIMS: Dyspepsia is very common in the community. The aim of this study was to assess the frequency of various causes of dyspepsia. METHODS: Two hundreds nine patient with dyspepsia were investigated. Basic laboratory screening, ECG, Upper gastrointestinal endoscopy or upper gastrointestinal barium study, upper abdominal ultrasound were performed in every dyspeptic patients. RESULTS: Functional dyspepsia was the cause of symptoms in 92.3%, peptic ulcer in 2.9% (duodenal ulcer in five patients, gastric ulcer in one patient), reflux esophagitis in 0.5%, esophageal ulcer in 0.5%. Of dyspeptic patients, gallstone was found in 1.4%, gastric submucosal tumor in 1.0%, fatty liver in 1.9% (two of four patients with fatty liver had elevated transaminase), upper gastrointestinal cancer in 0%. Of functional dyspepsia patients, women was 60.3%, men was 39.7%. CONCLUSIONS: The most common cause of dyspepsia was functional dyspepsia. Various causes of organic dyspepsia was peptic ulcer, reflux esophagitis, and esophageal ulcer.

A Case of metastatic lid carcionoma of stomach cancer / 대한내과학회지

Eyelid tumors, including metastatic lid tumors, present clinically as recurrent chalazia, multicentric nodules, ul cerated lesions, diffuse swelling, or chronic blepharocon juntivitis. Lid tumors consist of benign lesions(69%) and malignant lesions(31%). Basal cell carcinoma and squa mous cell carcinoma account for 92% of the malignant lesions. Metastatic lid disease was found to be of rare occurence, accounting for 0.1% of all lid lesions and 0.3% of malignant lid lesions. We report a case of metastatic lid carcinoma of sto mach cancer. A 60-year-old man developed a painless, slow-growing nodular lesion of his right lower eyelid. Excisional biopsy revealed metastatic undifferentiated ade nocarcinoma. We believe this is the first case in Korean literature.

Metronidazole Resistance and the Eradication of Helicobacter pylori / 대한소화기내시경학회지

BACKGROUND/AIMS: The success of Helicobacter pylori eradication is limited by antibiotic resistances, and the primary resistance to metranidazole seems to be high. In this study, the frequency af metronidazole resistance and the eradication rate in metronidazole-resistant H. pylori strain was evaluated. METHODS: Sixty-eight patients were tested for metronidazole resistance using microdilution broth, the E test and disk diffusion method. Twenty-two patients were treated for 14 days with amoxicilline 2000 mg, metronidazole 750 mg, and tripotassium dicitrate bismuth 1200 mg. RESULTS: Metronida-zole resistance was 46% (31/68). The eradication rates for H. pylori was 91.7% in patients with metronidazole-sensistive strains and 70% in patients with metronidazole-resistant strains. CONCLUSIONS: Metronidazole resistance was high (46%) in Korea, however, triple therapy was an efficient method of eradicating H. pylori in both metronidazole sensitive and resistant strains.

A Case of Duodenal Ischemic Enteritis Due to Mesenteric Venous Thrombosis / 대한소화기내시경학회지

Mesenteric vein thrombosis (MVT) is an infrequent but old form of acute mesenteric ischemia, various forms of which have been recognized through imaging techniques. Pre- viously, diagnosis was made only by a laparotomy or autopsy. MVT is an abdominal emergency that is rarely diagnosed early. Review of the literature has shown that most cases have been treated by intestinal resection, and a few by thrombectomy with or with- out resection. Most are primary thromboses, but some are related to thromboembolic dise- ases, sepsis, cirrhosis, coagulopathy, abdominal neoplasms, traurna, or use of oral contra- ceptives. We report a case of superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early through a duodenoscopy and definitively assessed by superior mesenteric angiography and computed tomography. The predisposing factor for this case was a pelvic abscess post placenta previa operation. The first symptoms were hematemesis and abdominal pain. An intestinal mucosal lesion and clinical symptoms were improved by only heparinization and symptomatic treatment without resection.

A Case of Scleredema Preceded by Upper Respiratory Infection / 감염

Scleredema is a rare connective tissue disease of unknown etiology and characterized by non-pitting thickening of subcutaneous tissue of the neck, face, head, upper trunk and arms. We present a 28 year-old man with extensive skin changes following upper respiratory infection, who have not any concurrent disorders such as diabetes mellitus. Histopathological findings of skin showed normal epidermis with a widening of spaces between collagen bundles by infiltration of acid mucopolysaccharide in the dermis.

Cryosuperna. tant for the Therapeutic Plasma Exchange in Hemolytic Uremlc Syndrome: The Characteristics of Home-made Cryosupernatant / 대한수혈학회지

Cryosupernatant which is the residual plasma fraction after removing cryoprecipitate has been used for plasma exchange in thrombotic thrombocytopenic purpura and hemolytic uremic syndrome replacing the fresh frozen plasma. Recently, the unusually large yon Willebrand factor multireefs (ULvWFM) has been observed in patients with refractory or chronic relapsing hemolytic uremic syndrome as well as thrombotic thrombocytopenic purpura which disappeared by infusion or plasma exchange with cryosupernatant, and infusion of fresh frozen plasma, the largest multimers of yon Willebrand factor were replenished that it might be a cause of refractoriness. This study was conducted to investigate the characteristics of home-made cryosupernatant from thawed fresh frozen plasma and its thehrapeutic effect in a hemolytic uremic syndrome patient. The level of fibrinogen, coagulation factor VIII, vWF antigen, and ristocetin cofactor activity was decreased and yon Willebrand factor multimers were barely seen in cryosupernatant than those of in fresh frozen plasma. A hemolytic uremic syndrome patient tried with exchange and infusion of cryosupernatant showed excellent recovery. It is concluded that home-made cryosupernatant shares many of the features of fresh frozen plasma except factor VIII, especially von Willebrand factor multimers, and thus it could be a useful alternative to fresh frozen plasma in case of refractory hemolytic uremic synydrome.

Astigmatic Changes after 6mm Scleral Tunnel Incisions at 1mm and 2.5mm from the Limbus in Sutureless Cataract Surgery

We evaluated an effect of the distance between the incision line and corneal limbus on surgically induced astigmatism in sutureless cataract surgery with scleral tunnel incision. We made a 6mm scleral tunnel incision 1.0mm from the limbus (Group 1, 24 eyes) and 2.5mm from the limbus (Group 2, 30 eyes) and implanted polymethylmethacrylate (PMMA) intraocular lenses with a round optic of 6mm following phacoemulsification. We employed the Jaffe method and Cravy method of vector analysis to evaluate the change of Surgically induced astigmatism. The mean surgically induced astigmatism using Jaffe method was 1.24 D and 0.98 D one day after surgery in Group 1 and 2, respectively. The difference between them was statistically significant(p0.05) after postoperative one week. In the superior incision cases, the difference using Cravy method was not statistically significant for whole followup period. In the temporal incision cases, the surgically induced astigmatism was 0.39 D and 0.02 D one day after surgery in Group 1 and 2, respectively. The difference was statistically significant(p0.05) after postoperative one week. In this study it was found that a distance of incision line from corneal limbus longer than 1 mm was not an important factor in influencing the surgically induced astigmatism one week after sutureless cataract surgery using a watertight scleral tunnel incision.

Long-term Follow-up Astigmatic Changes in Cataract With or Without Suture

We performed an analysis of corneal astigmatism of 123 eyes with suturing(sutured group) and 56 eyes without suturing(sutureless group) after phacoemulsification and PCL implantation through 7.0 mm straight incision wound 2.0-2.5 mm from superior limbus by use of algebraic and vector methods for two years following surgery. In both groups, the amount and axis of astigmatism were continued to change for 2years(p>0.05). The amount of astigmatisms in sutureless group was less than in sutured group until 2 months postoperatively(p0.05). Astigmatic changes in sutureless group were stable and had lower against-the-rule shift than the sutured group after 6 months postoperatively(p<0.01). Surgically induced astigmatism was stabilized after 1 month postoperatively in sutured group and after 2 weeks psotoperatively in suture less group(p<0.01), and it was lower in suture less group than sutured group during the two years postoperatively.(p<0.01).

Effects of Hydrogen Peroxide on Rabbit Corneal Bioelectric Properties

The rabbit cornea was studied in vitro in modified Ussing chambers to determine the effects of ion transport inhibitors and hydrogen peroxide(H2O2) on ion transport through the cornea by measuring the bioelectric properties. Apical(tear side, T side) addition of furosemide, bumetanide and SITS were ineffective on resting Isc(short circuit current). Apical addition of 1.0mM amiloride(Na+/H+ antiport inhibitor) and NPAA(Cl- channel blocker) markedly reduced the resting Isc, but basolateral(stromal side, S side) addition of amiloride was ineffective. The site of action of these agents was the apical membrane. H2O2, an oxygen free radical, markedly increased the lsc when was added to the T side, but S side addition of the H2O2 was ineffective. To determine the degree of cellular catalase participation in protection against H2O2 induced injury the cornea was pretreated with ATAZ for 30 min prior to H2O2 action. The increase of lsc by H2O2 was markedly potentiated after pretreatment with ATAZ on T side compared to that of S side addition. This result indicates that the corneal endothelial H2O2 may be largely degraded by catalase. When H2O2 was added to the T side, Isc was raised by increased ion transport. All ion transport inhibitors that were used inhibited the H2O2 effect on Isc. Moreover, amiloride and NPAA markedly inhibited induced lsc by H2O2. These results suggest that H2O2 stimulates the corneal epithelial ion transport and that its site of action is apical membrane Na+/H+ antiport system and CI- channel system.

The Evaluation of Incidence of Hyphema as Early Complication following Sutureless Cataract Surgery

Postoperative hyphema following cataract extraction surgery is not usually a serious complication and clears quickly in the most cases. Sutureless cataract surgery was reported to have less incidence of postoperative hyphema than conventional cataract surgery. We analyzed the incidence of postoperative hyphema in each group according to the depth and the length of scleral pocket incision in 500 eyes with the sutureless cataract surgery via superior incision during two years. One day after surgery, 90 cases(18.0%) had hyphema and most of them(74.4%) showed grade 1 severity. The incidence of hyphema was 23.0% in the deep incision group and only 11.9% in the superficial incision group(p<0.01). The percentage of grade 1 hyphema was 66.6% in the deep group and 92.6% in the superficial group, then severity was greatly reduced in the superficial incision group(p<0.01). The incidence of hyphema in the group of 7.0 mm in length was highest among the 6.0, 6.5, 7.0 mm groups(p<0.01), and the shorter the incision length, the milder the serverity of hyphema(p<0.01). The incidence of hyphuma was the lowest(6.2%) in the group of 6.0 mm in length and superficial incision, and it was the highest(28.5%) in the 7.0 mm in length and deep incisional group(p<0.01).