Prevalence and risk factor of erosive esophagitis observed in Korean National Cancer Screening Program.

Prevalence of erosive esophagitis (EE) has been increasing in Korea. The purpose of this study was to estimate prevalence of EE among low socioeconomic population in Korea and to investigate risk factors for EE. We reviewed the medical records of 7,278 subjects who were examined by upper endoscopy in the Korean National Cancer Screening Program at Chung-Ang University Yong-san Hospital from March 2003 to March 2008. The study population included subjects ≥ 40 yr of age who were Medicaid recipients and beneficiaries in the National Health Insurance Corporation. Multivariate analysis was used to determine risk factors for EE. Prevalence of EE was 6.7% (486/7,278). According to the LA classification system, LA-A in 344 subjects, LA-B in 135 subjects, and LA-C and D in 7 subjects. In multivariate analysis, age ≥ 60 yr, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and endoscopic hiatal hernia were significant risk factors for EE. The prevalence of EE in low socioeconomic Korean population is similar to that in personal annual medical check-ups. Risk factors for EE among them include old age, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and hiatal hernia.

Bilateral coronary artery fistulas communicating with main pulmonary artery and left ventricle: case report.

Coronary artery fistula is an uncommon congenital malformation that generally drains into the main pulmonary artery or the right side of the heart. This is a case report on bilateral coronary artery fistulas communicating with the main pulmonary artery and the left ventricle. A 65-year-old woman was investigated for recurrent chest pain. Coronary angiography revealed this anomalous coronary artery connection without evidence of atherosclerotic coronary artery disease. The rarity of coronary artery fistulas involving both the main pulmonary artery and the left ventricle is emphasized.

Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography.

BACKGROUND: Radial artery spasm is one of the most common complications during coronary angiography via the transradial approach, causing patient discomfort or sometimes interrupting the procedure. This study was designed to compare the spasmolytic effect between nicorandil and a cocktail during transradial coronary angiography. METHODS: A randomized study to compare 4 mg of nicorandil and a cocktail (mixture of normal saline, 200 microg of verapamil) was performed in 150 patients. We examined vasospasms of the radial artery that were expressed as stenosis of the radial artery vessel diameter after the procedure. RESULT: The reductions of systolic and diastolic blood pressures showed no significant differences between the two groups (15.4+/-11.5/7.7+/-7.8 mmHg for nicorandil and 16.3+/-13.4/6.2 mmHg for cocktail). Both agents induced a significant radial artery vasodilation after transradial administration at proximal and mid segments (P < 0.001 for all). Nicorandil showed a significant increase of the mean change of the radial artery diameter compared to the cocktail at mid-segment (0.32+/-0.23 mm for nicorandil and 0.24+/-0.15 mm for a cocktail, P < 0.05). There was no statistically significant difference between the two groups in radial artery spasm (50.7% vs. 52.0% in nicorandil and a cocktail, respectively) after catheterization. CONCLUSION: Nicorandil with vasodilator effects by a dual mechanism was effective as the cocktail in preventing radial artery spasm during transradial coronary angiography.

A case of pulmonary cryptococcosis by capsule-deficient Cryptococcus neoformans.

Pulmonary infection by capsule-deficient Cryptococcus neoformans (CDCN) is a very rare form of pneumonia and it is seldom seen in the immunocompetent host. The authors experienced a case of pulmonary cryptococcosis by CDCN in 25-year-old woman who was without any significant underlying disease. The diagnosis was made from the percutaneous lung biopsy and special tissue staining, including Fontana-Masson silver (FMS) staining. Fungal culture confirmed the diagnosis afterward. Her clinical and radiologic features improved under treatment with fluconazol. It's known that CDCN is not so readily confirmed because fungal culture does not always result in growth of the organism and the empirical fungal stain is not helpful for the differentiation between CDCN and the other infections that are caused by the nonencapsulated yeast-like organisms. In this report, we emphasize the diagnostic value of performing FMS staining for differentiating a CDCN infection from the other confusing nonencapsulated yeast-like organisms.

[A case of spontaneous perforation of the common bile duct associated with cholangitis].

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.