Clinical Comparison of Drug-Eluting Stents and Bare Metal Stents in Large Coronary Arteries / 대한내과학회지

BACKGROUND/AIMS: Drug-eluting stents (DES) are superior to bare metal stents (BMS) in reducing restenosis rates across a wide range of patients and lesion subsets.This study compared the clinical outcomes of DES versus BMS in patients with large coronary arteries (> or = 3.5 mm). METHODS: The study compared 134 patients (59.9 +/- 10.6 years, 90 men, 44 women) who underwent single vessel angioplasty with DESimplantation in large vessels with 115 patients (60.3 +/- 8.9 years, 82 men, 33 women) who received BMS. The clinical outcomes at 12 months were compared between groups. The study end points were major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and the need for target vessel and target lesion revascularization. RESULTS: The baseline clinical coronary angiography and procedural characteristics were similar in both groups. The duration of dual antiplatelet therapy was longer in the DES group than in the BMS group (240 +/- 2.7 vs. 348 +/- 1.7 days, p = 0.042). During the 12-month clinical follow-up, MACE were observed in 13 patients (11.3%) with BMS and 12 patients (9.0%) with DES (p = 0.486). CONCLUSIONS: For coronary stents implanted in large coronary arteries, DES seems to be more favorable, although no significant differences were observed in the clinical outcomes between DES and BMS during a 1-year clinical follow-up.

A case of autoimmune hepatitis accompanied by systemic lupus erythematosus / 대한내과학회지

Autoimmune hepatitis accompanied by systemic erythematosus lupus is rare. Usually, lupus-related advanced liver involvement is indistinguishable from autoimmune hepatitis accompanied by lupus, as they share common clinical, biochemical, serological, and histological manifestations. However, each disease has its own diagnostic criteria, and they have been defined as two different categories. Therefore, distinguishing between the two diseases is important to determine the correct diagnosis and treatment. A 41-year-old woman was hospitalized with jaundice and a malar rash. The patient met the diagnostic criteria of both systemic erythematosus lupus and autoimmune hepatitis. After corticosteroid treatment, the patient's condition improved. Therefore, we report our experience of a rare case of autoimmune hepatitis accompanied by systemic erythematosus lupus with a review of the literature.

Two cases of endobronchial actinomycosis that were cured by bronchoscopic removal and short-term antibiotic therapy / 대한내과학회지

Actinomycosis is an uncommon, chronic granulomatous, suppurative disease related to Actinomyces israelii, which is a natural inhabitant of the oropharyngeal cavity and the major human pathogen of actinomycosis. In the past, dramatic presentation of thoracic actinomycosis, in conjunction with prominent chest pain and cutaneous fistulas that discharge sulfur granules, has frequently been reported. However, more recent data indicate that chest wall or rib involvement is now much less common than was previously encountered. This could result in more favorable responses to short-term intravenous antibiotic therapy. Foreign-body-associated actinomycosis is a very rare type of thoracic actinomycosis. We report two cases of endobronchial actinomycosis associated with a foreign body. In both cases, the foreign body was successfully removed by bronchoscopy. Each patient was treated with antibiotics for about 70 days. The duration of antibiotic therapy was relatively short, as compared to conventional therapy. Nevertheless, there was no recurrence or complications over 1 year.

Culture and Polymerase Chain Reaction of Helicobacter pylori from Rectal and Terminal Ileal Fluid after Polyethylene Glycol (Colyte(R)) Ingestion in Healthy Adults with Positive Urea Breath Test / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) transmission route is not yet clearly understood. Isolating H. pylori from stool, saliva, and vomitus is very difficult. However, H. pylori could be cultured from feces in the setting of rapid gastrointestinal tract transit. The aim of this study was to isolate H. pylori by culture and PCR in the rectum and terminal ileum during colonoscopy. METHODS: Twenty subjects with positive UBT (urea breath test) were included. We performed polymerase chain reaction (PCR) test and culture of H. pylori with the rectal fluid and terminal ileal fluid during colonoscopy. RESULTS: H. pylori was cultured with rectal fluid from 9 (45.0%) of 20 subjects and with ileal fluid from 11 (55.0%) of 20 subjects. H. pylori was a little more frequently cultured from the terminal ileal fluid than the rectal fluid without statistical significance (p>0.05). PCR test detected flaA (16/20, 80.0% and 17/20, 85.0%), 16S rRNA gene (16/20, 80.0% and 17/20, 85.0%), cagA (10/20, 50.0% and 12/20, 60.0%), and ureC (9/20, 45% and 11/20, 54.5%) from the rectal fluid and the terminal ileal fluid, respectively. The specificity and sensitivity of ureC were 100%. CONCLUSIONS: H. pylori could be cultured from the rectal fluid and terminal ileal fluid in the setting of rapid gastrointestinal tract transit. These results suggest of fecal-oral transmission of H. pylori.

Dieulafoy's Lesion Coexisting with Early Gastric Cancer / 대한소화기내시경학회지

Dieulafoy's lesion is an uncommon cause of gastrointestinal (GI) bleeding, but can be associated with massive, life-threatening GI bleeding. This lesion is an isolated protruding vessel of the submucosal artery associated with a small mucosal defect and normal surrounding mucosa. Although this lesion can occur throughout the GI tract (esophagus, stomach, duodenum, colon, rectum, etc), it has been rarely reported elsewhere than the stomach. Especially, there have been no reports of Dieulafoy lesion coexistent with early gastric cancer in Korea. We report the successful application of endoscopic hemoclipping for the treatment of a very rare Dieulafoy lesion coexistent with early gastric cancer.

A Case of Neonatal Cholelithiasis Induced by Prolonged Lack of Enteral Feeding and Total Parenteral Nutrition

Cholelithiasis in infancy is a rare disorder. A number of conditions that occur in the neonatal period predispose to the development of cholelithiasis. Cholelithiasis is more marked in the premature than adult, because of the immaturity of the enterohepatic circulation of bile acids which renders the newborn more susceptible to the cholestatic effect of total parenteral nutrition (TPN). Parenteral nutrition associated cholelithiasis is the major indication for cholecystectomy in the pediatric age group because of severe complication, but a number of recent studies report spontaneous resolution of the stones. We report a case of a female infant with cholelithiasis diagnosed by ultrasonogram at 88 days of age which is probably induced by prolonged lack of enteral feeding and TPN.

Management with High Frequency Ventilation of Acute Idiopathic Pulmonary Hemorrhage in Infants / 대한마취과학회지

Acute idiopathic pulmonary hemorrhage in infants (AIPHI) is characterized by a sudden onset of pulmonary hemorrhage in previous healthy infants. Evidence of pulmonary hemorrhage may present as hemoptysis or a finding of blood in the nose or airway with no evidence of upper respiratory or gastrointestinal bleeding. Patients presenting with acute, severe respiratory distress or failure, and those requiring mechanical ventilation and often demonstrate bilateral infiltrates by chest radiography. We report a case of AIPHI which developed during the induction of anesthesia. A 3-month-old male infant received right herniorraphy under general endotracheal anesthesia. After intubation, blood tinged fluid was aspirated using an endotracheal tube during operation. Chest radiography showed bilateral ground glass opacity. We transferred the patient to the ICU and applied conventional mechanical ventilation. However hypoxemia and respiratory acidosis were persisted. We then switched to a high frequency ventilator (HFV), the hypoxemia and respiratory acidosis were corrected. The patient was transferred to the general ward on the 7th postoperative day.

Correlation of Coagulation Disorder and Bronchopulmonary Dysplasia in Preterm Infants / 대한주산의학회잡지

OBJECTIVE: Neonatal respiratory distress syndrome (RDS) occurs in preterm infants, due to structural immaturity of the lungs and immaturity of the pulmonary surfactant metabolism and activation of inflammation and clotting contribute to the development of bronchopulmonary dysplasia (BPD). The purpose of this study is to evaluate the influencing factors in the development of BPD among RDS infants with coagulation disorder. METHODS: A retrospective chart review for 49 premature infants who were admitted to Pochun CHA University neonatal intensive care unit between May 2001 and July 2003. Infants with a gestational age <32 weeks or birth weight <1,500 g who had RDS and coagulation disorder were included in this study. Infants were divided into two groups, 22 infants in the BPD group and 27 infants in the Control group. And we evaluated the perinatal, clinical and bleeding manifestations and laboratory finding of 1st, 3rd, 6th days after coagulation disorder occurred. RESULT: The incidence of pregnancy induced hypertension was higher in the control group. Birth weight and gestational age were lower in the BPD group. Duration of ventilatory support and total parenteral nutrition were longer and the incidence of sepsis was higher in the BPD group. No significant difference was observed in laboratory finding when coagulation disorder occurred. CONCLUSION: Laboratory finding of premature when coagulation disorder occurred, was not associated with the prevalence of BPD, The compound effects of other risk factors may be important in the development of BPD.

Factors Affecting Treatment Response of Disseminated Intravascular Coagulation in Pretem Infants

PURPOSE: Disseminated intravascular coagulation(DIC) occurs most frequently in premature infants. The purpose of this study is to evaluate the influencing factors in treatment of DIC among premature infants. METHODS: A retrospective chart review for 41 premature infants who were admitted to Pochun CHA University neonatal intensive care unit between May 2001 and July 2002 was done. Infants were divided into two groups depending upon their response in improvement of symptoms and laboratory values occurring within or after 72 hours of initiation of therapy. A comparative analysis of various parameter to delineate influencing factors affecting treatment outcome was studied. RESULTS: The factors related to delayed response in treatment of DIC between early response group (19) and late response group (22) included male, low birth weight, severe birth asphyxia, prolongation of prothrombin time, petechiae and oozing of puncture site. CONCLUSION: Awareness of factors associated with delayed response in treatment of DIC may aid in prediction of treatment outcome among premature infants with DIC.

The Relationship between the Bronchopulmonary Dysplasia and Illness Severity (SNAP)

PURPOSE: The objective of this study was to evaluate differences of Scores for Neonatal Acute Physiology (SNAP) in between neonates with bronchopulmonay dysplasia (BPD) and control group, and to utilize SNAP as an early predictive tool for development of BPD. METHOD: A retrospective chart review was done for a total of 30 neonates who were admitted to Pochun CHA University neonatal intensive care unit between April, 1995 and May, 2001. A study group included 15 neonates with BPD and a control group included 15 neonates matched for gestational age and birth weight. SNAP and cumulative SNAP were obtained at 1st, 4th, 6th postnatal day for each group. A comparative analysis of cumulative SNAP scores of various parameters was done in two groups. RESULTS: SNAP of 10.86 and 6.86 were obtained at 4th postnatal day for BPD and control group, respectively (P<0.05). Cumulative SNAP for 1st, 4th, 6th postnatal day were 30.40 and 21.93 in BPD and control group (P=0.059). A comparison of cumulative SNAP of various parameters between two groups showed that respiratory rate and apnea to be significant parameters as well as for blood pressure and arterial oxygen tension in neonates with BPD. CONCLUSION: Score for Neonatal Acute Physiology could be utilized as a tool to predict the development of BPD although larger study is needed to simplify its scoring system to be used easily and better predict the development of BPD.

Usefulness of measuring peak expiratory flow rate for diagnosing the airway hyperresponsiveness in childhood / 천식및알레르기

BACKGROUND: Airway hyperresponsiveness has been estimated by means of forced expiratory volume in 1 second(FEV1) through the methacholine inhalation challenge test(MIC). But it is difficult to do the forced expiratory maneuver for measuring FEV1 in children. It is relatively easy to measure peak expiratory flow rate(PEFR) by portable peak expiratory flow meter(PEFM). OBJECTIVE: The purpose of this study is to evaluate whether FEV1 by means of MIC could be appropriately replaced by the measurement of PEFR. METHOD: A total of 30 subjects aged from 7 to 15 years with recurrent cough were enrolled in this study. MIC was performed with stepwise cumulative dose and both FEV1 and PEFR were measured at each step. The study was discontiued at the point of 20% reduction of FEV1 from the baseline value. FEV1 and PEFR were measured after salbutamol was inhaled by nebulizer. RESULT: There were significant correlations with reduction rates(r1=0.59, P<0.05) and recovery rates(r2=0.60, P<0.05) between FEV1 and PEFR, respectively. The sensitivity, specificity, positive predictive and negative predictive value of PEFR(PC20-FEV1 and PC20-PEFR<8 mg/ml) were 63.6, 94.7, 87.8 and 81.8%, respectively(P<0.05). CONCLUSION: Although PEFR measurement by means of MIC revealed low sensitivity, high specificity and positive predictive value could be obtained. These results indicate that PEFR measurement by means of MIC may be useful for diagnosing the airway hyperresponsiveness in children, although it cannot be replaced completely.

Natural Course of Atrial Septal Defect Diagnosed Within the First 4 Weeks of Life

PURPOSE: The purpose of our investigation was to explore the natural course, and the factors that influence the natural course, in ostium secundum atrial septal defect(ASD) diagnosed within the first 4 weeks of life. METHODS: We studied patients with ASD diagnosed within the first 4 weeks of life during the period from September 1995 to September 1999 in our hospital. The diagnosis and measuring of the size of ASD was carried out by two-dimensional echocardiogram(2DE, Hewlett-Packard Sonos 2500 ) from subcostal long and short axis views. RESULTS:There were 61 patients - 29 males and 32 females. According to the size of their defects, we divided them into four groups; group A(less than 4 mm : 24 cases), group B(four mm- six mm : 27 cases), group C(six mm-eight mm : six cases), group D(more than eight mm : four cases). In groups A and B, 22 of 24 patients(91.7%) and 23 of 27 patients(85.2%) had each closed spontaneously. In group C, four of six patients had closed spontaneously. In group D, no patient had closed spontaneously and three of four patients had been closed surgically. There were significant differences in the rate of spontaneous closure between less than six mm group and more than six mm group in the size of the defect(P<0.05). There were no significant differences in the rate of spontaneous closure between ASD combined with simple cardiac defect and isolated secundum ASD. CONCLUSION: We conclude that defects smaller than six mm in diameter are very likely to close spontaneously.

Passage Pattern of the Colon during Colonoscopy Based on the 'Axis-Maintaining and Bowel-Shortening Method'

PURPOSE:During colonoscopy, smooth insertion of the colonoscope is an important basic procedure. However, it is not necessarily easy. An understanding of the passage patterns of the colon is helpful for colonoscopy. In this study, the authors aimed to contribute information that could be useful to effect a smooth and effective introduction of the colonoscope. METHODS:The authors performed 7,560 colonoscopies from May 2000 to December 2000. All cases were performed without using sedatives or analgesics. Out of those 7,560 cases, 2,289 cases, which were performed by one colonoscopist, were selected, excluding those with incomplete colonoscopy, those with a history of bowel resection, those with poor bowel preparation, those with advanced disease, such as inflammatory bowel disease, cancer, etc., and those with conditions that could markedly affect colonoscopy. Those 2,289 cases were classified as 4 patterns according to the passage patterns through the colon during colonoscopy:pattern A, passage is possible using right torque and pull-back; pattern B, bowel-shortening is possible at the peak point of the sigmoid colon; pattern C, bowel-shortening is possible at the transverse colon because of a markedly redundant sigmoid colon; and pattern D, pattern is difficult to specify. Those 2,289 cases were also analyzed regarding age. As to age, they were divided into two groups, those under the 6th decade and those of the 6th decade or older. RESULTS:The most common pattern was pattern A, comprising 71.3%; next was pattern B, 19.7%. There was no significant difference in distribution of the passage patterns between the two age groups (P>0.05). CONCLUSIONS:Ninety-one percent (91%) of the cases were patterns A and B. An understanding of the passage patterns will be helpful for smooth insertion of the colonoscope. The 'axis-maintaining and bowel-shortening method' is a useful and effective approach to colonoscopy.

Cervical tuberculous lymphadenitis : Clinicopathological reatures and AFB positivity / 결핵

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.

A case of hypersensitivity pneumonitis with positive precipitin antibody to Trichosporon cutaneum / 천식및알레르기

A 25-year-old woman complaining of dyspnea on exertion, coughing, fever and chills was admitted in January, 1998. Her clinical, radiological, and pathological findings were compatible with hypersensitivity pneumonitis and precipitin antibody to Trichosporon cutaneum was detected in her serum. Although some cases of T. cutaneum-induced hypersensitivity pneumonitis developed during the winter season were reported in Japan, there had been no report of such a case in Korea. This case suggests that T. cutaneum-induced hypersensitivity pneumonitis can develop beyond the summer season in certain environments.