Effect of Transjugular Intrahepatic Portosystemic Shunt for Variceal bleeding in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis / 대한간학회지

BACKGROUND/AIMS: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used in patients with variceal bleeding. However, this procedure is contraindicated in hepatocellular carcinoma patients with portal vein thrombosis. This study was done to evaluate the effect of TIPS in those patients with variceal bleeding. METHODS: Between 1997 and 2004, six hepatocellular carcinoma (HCC) patients with portal vein thrombosis were enrolled in this study due to their variceal bleeding. All the patients underwent TIPS placement to treat the variceal bleeding that had not responded to endoscopic treatment. Effective shunt creation was assessed by the decrease of the portal pressure gradient (less than 12 mmHg) or if good patency and flow were seen on a doppler examination. RESULTS: Shunts were successfully created in all the patients and the bleeding was immediately controlled in the active bleeding cases. The bleeding was caused by esophageal varices in one patient and, by gastric varices in five patients. The HCC types were diffuse or massive in five patients, and a single nodule was present in one patient. All the patients had portal vein thrombosis. Rebleeding was noted in two patients at 10 days and 3 months, respectively, due to the shunt occlusion. Hepatic encephalopathy was noted in two patients. The causes of death were hepatorenal syndrome after 2 weeks in one patient, bleeding due to portal hypertensive gastropathy after 3 weeks in another, and cancer progression after 4 months in third patient. CONCLUSIONS: For HCC patients with portal vein thrombosis, TIPS can be an effective treatment modality if uncontrolled variceal bleeding presents when using endoscopic hemostasis or pharmacologic therapy. However, further studies are needed.

Prevalence Alteration of Reflux Esophagitis in Recent Years / 대한소화기내시경학회지

BACKGROUND/AIMS: Reflux esophagitis is pertained to gastroesophageal reflux disease. On recent studies, western GERD patients shows reflux esophagitis over than 50% on gastroscopy. We expect lower incidence of reflux esophagitis in Korea, but few epidemiological data are available for korean patients. We intended to investigate the alteration of incidence of reflux esophagitis by gastroscopy result for patients who visited general health screening center and department of gastroenterology with chief complaint of gastrointestinal symptoms. METHODS: The 13,439 people of general health screening center visitors, 28,037 patients who visited department of gastroenterology due to gastrointestinal symptoms from March, 1996 to August, 1999 were underwent gastroscopy. And 24,952 patients who showed gastrointestinal symptoms and general health screening center visitors from March, 1993 to Feburary, 1996 were also underwent gastroscopy. The grading of esophagitis was based on the Savary-Miller classification and prevalence alteration of reflux esophagitis was investigated by retrospective manner. RESULTS: 1) Overall prevalence of general health screening people group and patients with gastrointestinal symptoms from March, 1993 to Feburary, 1996 was 2.08%. 2) Overall prevalence of general health sceening group from March, 1996 to August, 1999 was 2.37%. During the same period, Overall prevalence of patients with gastrointestinal symptoms was 3.69%. Overall prevalence was 2.96% and it was higher than that of 3 years ago (2.02%). CONCLUSIONS: On recent gastrofiberscopy studies, prevalence of reflux esophagitis is increasing. So further investigation is needed on the prevalence of reflux esophagitis over the whole country by prospective manner.

The Retrospective Research of the 119 Emergency Medical Services(EMS)System using the new Standardized Record of the 119 EMS system

Regulation for new standardized rescue record from of the 119 EMS system was established by law from February 1, 1998. We have recently evaluated the effectiveness of the record from. Records of 192 patients who visited the Emergency department of Sangggye Paik Hospital. Inje University by the 119 EMS system from February 1 to February 28, 1998 were analyzed statistically according to the contents of record form. In conclusion, the new standardized rescue record form of the 119 EMS system was effective in giving information of patients' history and analysing of the 119 EMS system. But, Detailed modification of the record form about disease entities is needed for proper initial evaluation of emergency patient.