Clarithromycin-based standard triple therapy can still be effective for Helicobacter pylori eradication in some parts of the Korea.

We evaluated the antibiotic resistance rates and eradication rates of clarithromycin based triple therapy from 2005 to 2010 retrospectively. In addition, we investigated the mechanism of clarithromycin resistance in Helicobacter pylori strains isolated from Korean patients. Two hundred and twelve strains of H. pylori were isolated from 204 patients. H. pylori ATCC 43504 was used as the standard strain. The eradication rates of H. pylori from 2005 to 2010 were 89.3%, 82.6%, 86.3%, 87.7%, 81.8%, and 84.2%, respectively. Total eradication rate was 84.9%. DNA sequences of the 23S RNA gene in clarithromycin-resistant strains were determined. The resistance rates of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, moxifloxacin, and levofloxacin were 9.0%, 8.5%, 36.3%, 0%, 14.2%, 14.2%, and 14.2%, respectively. The multidrug resistance rate of H. pylori was 16.5%. Sequence analysis of clarithromycin-resistant strains showed an A2144G mutation in 8 of 14 strains (57.1%), a T2183C mutation in 5 of 14 strains (35.7%), and double mutations of both A2144G and T2183C in 1 of 14 strains (7.1%). In the present study, triple therapy may still be an effective eradication therapy for H. pylori infections in Korea. The A2144G and T2183C mutations are mainly present in clarithromycin-resistant isolates.

Extended hemangioma from pharynx to esophagus that could be misdiagnosed as an esophageal varix on endoscopy.

Giant hemangioma in the neck and head is an uncommon vascular neoplasm and has an unpredictable clinical behavior. We report a hemangioma that extended from the pharynx to the esophagus that could have been misdiagnosed as an esophageal varix. A 42-year-old man with dilated varices-like vessels on his esophagus that were incidentally detected by endoscopy was referred to our hospital for further evaluation. On re-examined endoscopy, multiple vascular dilatations were noted in the pharynx, expanding into the esophagogastric junction. These dilatations looked like esophageal varices that are found in patients with liver cirrhosis. There was no significant abnormality, including liver cirrhosis, on the abdomino-pelvic computed tomography scan. On the endoscopic esophageal biopsy, dilatedsubmucosal blood vessels were diagnosed as hemangioma. In consultation with an otorhinolaryngologist for evaluation of the risk of hemangioma, it was determined that the hemangioma was not dangerous to the patient as long as it did not cause hoarseness, dyspnea or dysphagia. We planned regular 6-month follow ups. We report a case of extended hemangioma that could possibly have been misdiagnosed as an esophageal varix on endoscopy. Even if head and neck hemangioma is uncommon, careful consideration during endoscopy is required to avoid the misdiagnosis of varices or hemangioma.

Influence of exposure to extremely low frequency magnetic field on neuroendocrine cells and hormones in stomach of rats.

Extremely low frequency magnetic fields (ELF-MF) have the ability to produce a variety of behavioral and physiological changes in animals. The stomach, as the most sensitive part of the neuroendocrine organ of the gastrointestinal tract, is crucial for the initiation of a full stress response against all harmful stress. Thus, the purpose of this study was to examine whether ELF-MF stimuli induce changes in the activity of neuroendocrine cells, considering their involvement in endocrine or paracrine effect on surrounding cells. The exposure to ELF-MF (durations of 24 h and 1 or 2 weeks, 60 Hz frequency, 0.1 mT intensity) altered the distribution and occurrence of gastrin, ghrelin and somatostatin-positive endocrine cells in the stomach of rats. The change, however, in the secretion of those hormones into blood from endocrine cells did not appear significantly with ELF-MF exposure. Comparing with sham control, ELF-MF exposure for 1 and 2 week induced an increase in BaSO(4) suspension propelling ratio of gastrointestinal tract, indicating that ELF-MF affects gastrointestinal motility. Our study revealed that ELF-MF exposure might influence the activity of endocrine cells, an important element of the intrinsic regulatory system in the digestive tract. The pathophysiological character of these changes and the mechanism responsible for neuroendocrine cell are still unclear and require further studies.

Myocardial infarction with huge mural thrombus due to spontaneous coronary artery dissection detected by 64-multidetector computed tomography.

A 28-year-old man without medical history of cardiovascular disease came to the clinic to have the cause of his ECG abnormalities and chest discomfort evaluated. Echocardiogram showed regional wall motion abnormality of the anteroseptum and inferoseptum from the upper mid-left ventricle to apex with aneurysm and anterior wall from the mid-left ventricle to apex. It also showed huge and broad mural thrombus (5.2x1.4 cm in size) harboring in the left ventricle. Coronary angiography revealed a middle part of left anterior descending coronary artery (LAD) dissection with good distal flow. ECG gated 64-multidetector computed tomography (MDCT) demonstrated the proximal and middle part of LAD dissection. There has been no observation of myocardial infarction with huge mural thrombi complicating a spontaneous coronary artery dissection in which MDCT allowed an accurate and non-invasive diagnosis.

Unstable angina complicated by vasospasm and intracoronary thrombus and no evidence of plaque rupture.

A 57-year-old man came to the emergency room because of abrupt chest pain for 30min. ST elevations in inferior lead were normalized following sublingual nitroglycerin. He performed an exercise test on Bruce protocol and exercised up to 12min (13 METs) without chest pain and ST-T changes on the next day. We performed coronary angiography to rule out coronary vasospasm; however, we did not perform provocation test due to thombus in the culprit lesion. After medical treatment for 6days, follow-up coronary angiogram revealed no thrombus in the previous site and intravascular ultrasound did not demonstrate plaque rupture. We concluded that prolonged spasm might cause prolonged coronary flow limitation and induce acute thrombus formation without plaque rupture. This finding may be an important pathogenesis of acute coronary syndrome in patients with variant angina.