Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning.

BACKGROUND: Many patients present to the emergency department (ED) complaining of intentional poisoning. Of those, some have major depressive disorder (MDD) in their medical history. The aim of this study was to investigate the prevalence of MDD patients who were treated for poisoning in the ED. MATERIALS AND METHODS: A retrospective review was performed on 268 patients who were treated with poisoning between July 2007 and November 2011. Of these patients, we only included those who were over 18 years of age. Information regarding age, gender, cause, time of ingestion, type of drug, history of attempting suicide, and outcome, among other characteristics, was collected and compared to patients who did not have MDD. RESULTS: A total of 244 patients were included in this study. Of those, 52 patients (21.3%) had a history of MDD. Compared to non-MDD patients, a majority (34.6% vs. 19.8%) of those in the MDD group had a history of suicide attempts (P = 0.027), and 34 (65.4% in the MDD group vs. 34.4% in the non-MDD group) took more than two types of drugs (P < 0.001). There were no differences in age, sex, time of ingestion or disease severity between MDD and non-MDD patients. CONCLUSION: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.

Therapeutic hypothermia in adult cardiac arrest because of drowning.

BACKGROUND: Therapeutic hypothermia in adult victims who suffer cardiac arrest following drowning has been applied in only a small number of cases. In the last 4 years, we have employed therapeutic hypothermia to decrease hypoxia-induced brain injury in these patients. The purpose of the present study was to report the results of the treatment of these patients. METHODS: This study investigated the utilisation of therapeutic hypothermia on consecutive patients with cardiac arrest because of drowning between 2005 and 2008. The study was conducted retrospectively, collecting data by reviewing medical records. Hypothermia, with a target temperature of 32-34°C, was induced for 24 h. Neurological outcomes were classified using the cerebral performance categories (CPCs). The primary outcome was neurological function at discharge. RESULTS: Twenty patients were treated with therapeutic hypothermia. Four patients (20%) exhibited a favourable neurological outcome (CPC 1-2). Two patients (10%) remained in a vegetative state at discharge (CPC 4), and 14 patients (70%) died (CPC 5). The most common complications during therapeutic hypothermia were pancreatitis and rhabdomyolysis. A longer duration of advanced cardiac life support (P = 0.035), an absence of motor response to pain after 3 days (P = 0.003), an abnormal brain imaging (P = 0.005) and a lack of cortical response to somatosensory evoked potential (P = 0.008) were related to an unfavourable outcome (CPC 3-5). CONCLUSION: The present study did not demonstrate an advantage of therapeutic hypothermia in adult cardiac arrest after drowning compared with previous studies treated with conventional therapy. Further prospective studies are needed to evaluate the effects of therapeutic hypothermia.

The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest.

OBJECTIVES: To evaluate whether the ratio (in Hounsfield units; HU) of grey matter (GM) to white matter (WM) on computed tomography (CT) scans taken within 24 h of resuscitation can be used as a predictor of outcome. METHODS: 28 patients who resuscitated from cardiac arrest and had head CT performed within 24 h of resuscitation were retrospectively investigated. 27 subjects with normal head CT findings served as controls. Comatose patients were divided into two groups: those with a Glasgow outcome scale (GOS) score of 3-5 (good outcome subgroup) and those with a GOS score of 1-2 (poor outcome subgroup). HU were measured in GM and WM at the level of the basal ganglia on non-contrast CT scans. RESULTS: The density ratio of GM to WM was significantly lower in comatose patients than in controls (mean 1.21 vs 1.32, p<0.001). The GM:WM ratio was significantly lower in the poor subgroup than in the good subgroup (mean 1.19 vs 1.28, p<0.001). Receiver operating characteristic curve analysis determined a cutoff value of a GM:WM ratio of less than 1.22 for vegetative state or death. This value predicted vegetative state or death with a sensitivity of 63%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 56%. CONCLUSION: The GM/WM ratio correlates with the outcome of hypoxic ischaemic encephalopathy and may be useful as an objective early predictor of vegetative state or death in comatose patients after cardiac arrest.

Characterization and regulation of glutathione S-transferase gene from Schizosaccharomyces pombe.

A glutathione S-transferase (GST) gene has been cloned from Schizosaccharomyces pombe for the first time. The nucleotide sequence determined was found to contain 2030 base pairs including an open reading frame of 229 amino acids that would encode a protein of a molecular mass of 27017 Da. The cloned GST gene was expressed and was found to function in S. pombe, Saccharomyces cerevisiae, and Escherichia coli. The plasmid pGT207 encoding the S. pombe GST gene appeared to be able to accelerate the growth of a wild type S. pombe culture. In a culture of S. pombe containing plasmid pGT207, the growth was inhibited less by mercuric chloride than in a culture with vector alone. The 1088 bp region upstream from the GST gene as well as the region encoding the N-terminal 14 amino acids was transferred into the promoterless beta-galactosidase gene of plasmid YEp357R to yield the fusion plasmid pYSH2000. beta-Galactosidase synthesis was induced by cadmium chloride, mercuric chloride, hydrogen peroxide, and menadione. It was also induced by high temperature. These results suggest that the cloned S. pombe GST gene is involved in the oxidative stress response.

Association between Helicobacter pylori infection and the risk of gastric cancer in the Korean population: prospective case-controlled study.

BACKGROUND: Gastric cancer is still the most common malignant tumor in Koreans. Although many reports have supported the association of Helicobacter pylori infection and the development of gastric cancer, few studies have been adjusted by variable factors such as age. sex, education, and economic status. Furthermore, most results from areas with a high incidence of gastric cancer, such as China and Korea, have failed to document any relationship between H. pylori infection and gastric cancer. We conducted a prospective case-controlled study, with controls matched for and adjusted by age, sex, education, and economic status, to evaluate the causal relationship between H. pylori infection and gastric cancer in Korean people. METHODS: From March 1997 to October 1998, 136 consecutive patients with gastric cancer, diagnosed by endoscopic histology, and 136 age- and sex-matched control subjects, confirmed to be free of gastric cancer by endoscopy during the same period, were enrolled in the study. The presence of H. pylori infection was determined by enzyme immunoassay (EIA) serology test. RESULTS: Seventy-two of the 136 gastric cancer patients (53%) were positive for H. pylori infection and 54 of the 136 control subjects (40%) were positive for H. pylori infection. The odds ratio (OR), adjusted by variable risk factors, such as age, sex, education, and economic status, for gastric cancer in H. pylori-infected patients was 1.82 (95% confidence internal [CI], 1.10-3.00; P = 0.019). The age- and sex-matched OR by conditional logistic regression was 1.6 (95% CI., 1.01-2.53; P = 0.043). CONCLUSIONS: H. pylori infection may be one of the important risk factors for the development of gastric cancer in Korea, an area of high prevalence of H. pylori infection and a high incidence of gastric cancer.

Pharmacological effects of metronidazole+tetracycline+bismuth subcitrate versus omeprazole+amoxycillin+bismuth subcitrate in Helicobacter pylori-related gastritis and peptic ulcer disease.

PURPOSE: Two 4-week triple-therapy treatment regimens, metronidazole+tetracycline+bismuth subcitrate and omeprazole+amoxycillin+bismuth subcitrate, were compared in a randomly allocated double-blind trial for their efficacy in eradicating Helicobacter pylori from the gastric mucosa of patients with gastritis and/or peptic ulcer disease. PATIENTS AND METHODS: The presence of gastritis and/or peptic ulcers was confirmed by endoscopy in all patients included in the study. To evaluate drug effects, we used the urease test on gastric mucosa, and haematoxylin-eosin and specific Giemsa stains on biopsy tissues obtained by endoscopic procedures; we also evaluated the improvement in clinical symptoms before and after the 4-week treatments. RESULTS: Among 164 patients with gastritis and/or peptic ulcers, H. pylori infection was confirmed in 93.9% (154 patients) by the urease test and in 87.8% (144 patients) by haematoxylin-eosin stain. Following 4 weeks of treatment with both combination regimens, negative conversion rates by the urease test and haematoxylin-eosin staining and rates of recovery from clinical symptoms were similar in both regimens (metronidazole+tetracycline+bismuth subcitrate: 82.3, 72.9 and 73.9%; omeprazole+amoxycillin+bismuth subcitrate: 89.6, 83.4 and 76.1%, respectively). Also, the extent of inflammatory activity and the H. pylori score by the Giemsa method indicated high rates of recovery, with improvements to grade 0 (lowest grade) from higher grades with both combination regimens (60.4 and 66.7% of patients taking metronidazole+tetracycline+bismuth subcitrate and 64.6 and 83.3 of those taking omeprazole+amoxycillin+bismuth subcitrate). However, the prevalence of side effects during the 4 weeks of treatment was doubled in the former group compared to the latter (25.5 versus 12.5% of patients). CONCLUSIONS: Significant improvements in biochemical and histopathological findings and in the clinical symptoms of gastritis and/or peptic ulcer disease in patients with a high rate of H. pylori infection were observed equally with both regimens. However, there were notably fewer side effects in patients treated with omeprazole+amoxycillin+bismuth subcitrate. We therefore recommended this regimen in preference to metronidazole+tetracycline+bismuth subcitrate for the treatment of H. pylori-related gastritis and peptic ulcer disease.

The changes in electrolytes and acid-base balance after artificially induced acute diarrhea by laxatives.

Following the acute diarrhea in patients (n = 24) overnight with commonly used laxatives for bowel preparation, the changes in electrolytes and acid-base balance in blood and urine were investigated. Though no alterations of serum sodium or potassium concentrations were noted, mild but significant reduction of mean values (+/- SEM) of plasma pH and HCO3 after diarrhea when compared to those before it developed (pH, from 7.42 +/- 0.01 to 7.39 +/- 0.01, p < 0.01; HCO3, from 25.8 +/- 0.6 to 23.7 +/- 0.6 mEq/L, p < 0.05). However, significant reduction of concentration in spot urine sodium from 150 +/- 12.3 to 93 +/- 14 mEq/g of crea. (p < 0.01) and increase in spot urine potassium from 33 +/- 3.2 to 51 +/- 6.0 mEq/g of crea. (p < 0.05) following diarrhea were seen with significant reduction of urine pH from 6.67 +/- 0.21 to 5.5 +/- 0.13 (p < 0.001). Also, with this effective urinary acidification following diarrhea, a significant reduction of urinary anion gap as well as significant increment of spot urine ammonium was accompanied (anion gap, from 80.4 +/- 11.1 to 44 +/- 8.5 mEq/g of crea. p < 0.001; ammonium, from 87 +/- 18.5 to 229 +/- 37 mg/g of crea. p < 0.001) in addition to the significant inverse correlation between these changes in spot urine from basal levels in 24 study subjects (y = -1.13 x +61, r = 0.7, p < 0.001). In conclusion, we observed that the acute diarrhea with laxatives used for bowel preparation caused a mild degree of metabolic acidosis with no changes in blood electrolytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Histological and immunohistochemical studies on primary gastrointestinal lymphomas.

To study the characteristics and histogenesis of the malignant lymphomas derived from the gastrointestinal mucosa, histologic and immunohistochemical analyses were performed on a series of 28 malignant lymphomas of the gastrointestinal tract. By cytomorphologic classification, there were two small lymphocytic lymphomas, one small cleaved cell lymphoma, two mixed small cleaved and large cell lymphomas, 17 large cell lymphomas, one small noncleaved cell lymphoma, three immunoblastic lymphomas, and two lymphoblastic lymphomas. This distribution of histologic types was compatible with that of nodal lymphoma. The lymphomas with poor prognostic histology (23 cases) outnumbered those with favorable prognosis (five cases). Three of 28 cases (one in the stomach and two in the small intestine) had cytologic features consistent with centrocytoid cell lymphoma of the mucosa associated lymphoid tissue and were large cell lymphomas. Immunophenotypically, 23 cases expressed B-cell markers (82.1%) and three cases reacted with T-cell markers. Two cases did not react with either T-cell or B-cell markers. True histiocytic lymphomas were not identified. Gastric lymphomas (nine cases) and colorectal lymphomas (three cases) were of B-lymphocyte origin whereas T-cell lymphomas were noted in the small intestine (two cases) and ileocecal region (one case). Three cases of centrocytoid lymphoma were of B-lymphocyte origin. Histologically B-cell lineage lymphomas were evenly distributed on various histologic subtypes but all T-lineage lymphomas belonged to the large cell type. The two cases with undetermined phenotype were lymphoblastic lymphomas histologically. This study showed that the primary GIT lymphomas, mostly of B-cell lineage, were not cytomorphologically distinctive from the nodal lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Mediastinal pancreatic pseudocyst with recurrent pleural effusion. Demonstration by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan.

Mediastinal pseudocysts of internal pancreatic fistulas are rare as a cause of bilateral pleural effusions even in relapsing pancreatitis. We describe a 38-year-old man with recurrent bilateral pleural effusion as a complication of a pancreatic pseudocyst. Extension of a pancreatic pseudocyst into the posterior mediastinum was clearly identified by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan of the abdomen and chest, and the complication was successfully treated by surgical management. We stress the importance of definite assessment of the communication of pancreatic pseudocyst with mediastinum in patients with pancreatitis who develop recurrent pleural effusions.

Gallbladder motility in diabetes mellitus using real time ultrasonography.

OBJECTIVES: Diabetes mellitus is one of the risk factors in cholesterol gallstones. Individuals with diabetes mellitus are reported to have a 2-fold to 3-fold increase in the incidence of cholesterol gallstones. Though the pathophysiologic mechanisms of this phenomenon are unclear, hypotheses such as reduced gallbladder motility were presented to explain the higher incidence of gallstones in diabetes. METHODS: We compared the gallbladder volume and ejection fraction of 24 diabetics with those of 19 age-matched and weight-matched controls using real-time ultrasonography. Blood sampling for biochemical study of all the subjects were performed. RESULTS: No significant differences in any physiochemical parameters between the diabetic group and control group could be found. Fasting gallbladder volume increased significantly in the diabetic group (21.90 +/- 9.53 cm3) compared with the control group (16.99 +/- 5.97 cm3). Gallbladder volume measured after a fatty meal were greater in the diabetic group (10.76 +/- 7.19 cm3) than in the control group (4.22 +/- 3.31 cm3) (p < 0.04). When the diabetic group was divided according to the presence or absence of autonomic neuropathy, a significant reduction of ejection fraction was found in diabetics with autonomic neuropathy (42.75 +/- 19.37%) in comparison with diabetics without autonomic neuropathy (61.75 +/- 17.63%) (p < 0.02). CONCLUSIONS: Gallbladder volume in diabetics was significantly greater compared with that of the control. Moreover, in diabetics with autonomic neuropathy, gallbladder motility was markedly reduced in comparison to diabetics without autonomic neuropathy. Thus, we suggest that impairment of gallbladder motility complicated with autonomic neuropathy causes stasis and results in cholesterol gallstone crystal formation and gallstone growth.

A case of Behçet's syndrome with supeior vena cava syndrome.

Behçet's syndrome is a multi-systemic and chronic disorder that affects many organs. It has been suggested that the diagnosis was based on the presence of the 'major' and 'minor' clinical criteria. When thromobophlebitis, arthritis, central nervous system or gastrointestinal lesions are also present. Behçet's syndrome will be thought to be present in the appropriate geographic area. We report a case of superior vena cava syndrome caused by Behçet's disease in a 40-year-old man with recurrent oral aphthous ulcers and skin rashes on the anterior chest wall. There were multiple thrombosis of the superior vena cava, innominate and subclavian veins. This patient also had a solitary cecal ulcer with an ileocecal fistula and downhill varix. The chest CT, veno-cavography, pulmonary angiography and colon study were taken and follow-up was performed.

Biliary proteins in patients with and without gallstones.

BACKGROUND: Nucleation from supersaturated bile of calcium salts of cholesterol and bilirubinate is essential in the formation of gallstone. Nucleation requires gallbladder mucin and its main component, glycoprotein, may contribute to gallstone formation by providing a nidus or matrix for precipitation of lipid components. However, biliary protein patterns of patients with gallstones have not been completely explored. METHODS: We have tried to extract, isolate and characterize the proteins in patients with gallstones and without gallstones. 21 bile samples were obtained from patients with different types of gallstones and with no stones at cholecystectomy. Biliary protein concentrations were measured by Lowry and Bensadoun methods, and individual glycoproteins from each of the patients were compared by silver staining and densimetric quantification of Sodium Dodesyl Sulfate Polyacrylamide Gel Electrophoresis. RESULTS: 1) Among 16 gallstones, 5 were cholesterol stones, 5 were calcium bilirubinate stones, and 6 were black pigment stones. 2) The mean protein concentration was highest in bile with cholesterol stones (47.6 mg/ml), 24.2 mg% in bile without gallstones, and 15.9 mg/ml in brown pigment stones. 3) Cholesterol gallstones were found to have 14.2 KD glycoproteins, whereas pigment stones were found to have 66 KD glycoproteins. CONCLUSIONS: Gallbladder proteins from both cholesterol and pigment stones play an important role in the nucleation and growth of calcium salt crystals.

Evaluation of omeprazole as a treatment for gastric and prepyloric ulcer in Korean patients.

The healing efficacy of omeprazole was assessed in 57 Korean patients with endoscopically-proven gastric (GU) and/or prepyloric (PPU) ulcers of at least 5 mm diameter. Fifty-three patients presented with GU, two with PPU and two with both types of ulcer. The maximum ulcer diameter was 5-10 mm in 27 patients and greater than 10 mm in 30 patients. All patients received 20 mg of omeprazole each morning for 4-8 weeks depending on ulcer healing. Ulcer healing rates were comparable using both 'intention to treat' (IT) and 'per protocol' (PP) analyses. Following the IT approach 82% (47 of 57) of patients were healed at 4 weeks and 98% (56 of 57) at 8 weeks. Following the PP approach, the corresponding healing rates were 83% (44 of 53) and 98% (55 of 56), respectively. Smoking was found to have a significant effect on ulcer healing at 4 weeks (P = 0.03), with 96% (26 of 27) of non/occasional smokers healed versus only 69% (18 of 26) of daily/heavy smokers. Ulcer size did not have a significant effect on healing, however. Ulcer symptoms, reported by all patients at entry, disappeared rapidly after commencement of omeprazole therapy. Only four patients reported mild symptoms at 4 weeks and no symptoms were reported at 8 weeks. No clinically significant changes in haematology or clinical chemistry (other than a rise in leucocytes in one patient) and no serious adverse events were observed. In conclusion, omeprazole 20 mg each morning was found to be safe and highly effective for treatment of gastric and prepyloric ulcer in Korean patients, producing a 98% healing rate. Symptom relief was rapid and the drug was well tolerated.

Right atrial mass associated with hepatoma--2 case reports.

Hepatoma has a tendency to spread into the venous system, but intracavitary cardiac extension or metastasis of hepatocellular carcinoma is an uncommon form of cardiac malignancy. When the carcinoma grows from the hepatic vein into the right atrium, the right atrial tumor thrombis may hinder the blood flow. Therefore, these patients have the risk of sudden death. In the past, antemortem diagnosis of right atrial tumor thrombi in patients with primary hepatocellular carcinoma was difficult. But, echocardiography allowed easy detection of the intracardiac tumor thrombi. We describe two cases of hepatocellular carcinoma with right atrial tumor thrombi. In these cases, the right atrial tumor thrombi was detected by two-dimensional echocardiography. Recently, successful surgical removal of the right atrial tumor thrombi are reported in several cases. We advocate performing echocardiographic examination in patients with hepatoma who have cardiac symptoms and signs.

Flat depressed early colon cancer--a case report.

A flat depressed early colon cancer (FDEC) is characterized by non-polypoid growth pattern, no association of adenomatous tissues and a tendency of even small lesions toward submucosal invasion and lymph node metastasis. It supports de novo carcinogenesis of colorectal cancer, although most colorectal cancers arise in pre-existing adenoma (adenoma-carcinoma sequence). There have been few reports of small depressed cancers because of the difficulty in colonoscopic detection and the rapid development to ulcerating advanced cancers. We report a case of flat depressed early colon cancer confined to mucosa detected by indigo carmine contrast colonoscopy.

Negative conversion of antimitochondrial antibody in primary biliary cirrhosis: a case of autoimmune cholangitis.

Autoimmune cholangitis is a clinical constellation of chronic cholestasis, histological changes of chronic nonsuppurative cholangitis and the presence of autoantibodies other than antimitochondrial antibody (AMA). It is uncertain whether this entity is definitely different from AMA positive primary biliary cirrhosis (PBC), though it shows some differences. We report a case of autoimmune cholangitis in a 59-year-old woman, who had been previously diagnosed as AMA-positive PBC associated with rheumatoid arthritis, has been converted to an AMA-negative and anticentromere antibody-positive PBC during follow-up. The response to ursodeoxycholic acid treatment is poor except within the first few months, but prednisolone was dropping the biochemical laboratory data.

A double-blind, randomized, parallel group study of omeprazole and ranitidine in Korean patients with gastric ulcer.

The efficacy of the proton pump inhibitor omeprazole, 20 mg every morning, was compared with that of the H2-receptor antagonist ranitidine, 150 mg every morning and at bedtime, in a double-blind randomized parallel group study in 250 patients with gastric or prepyloric ulcers. At both 4 and 8 weeks, significantly more patients had healed ulcers in the omeprazole group than the ranitidine group, whether the results were analysed on a per-protocol or an intention-to-treat basis. At 4 weeks, 74% of patients in the omeprazole group were healed compared with 51% in the ranitidine group (P = 0.001), and at 8 weeks the corresponding values were 99 and 82% (P = 0.001, per-protocol cohort). Omeprazole treatment and small ulcer size significantly increased the probability of healing, but smoking had no significant effect. Patients in the omeprazole group had significantly fewer occurrences of daytime epigastric pain during the first 4 weeks than the ranitidine group (P = 0.0037), as shown by their diary cards. Both treatments were well tolerated.

Gallbladder motility change in late pregnancy and after delivery.

OBJECTIVES: The incidence of gallstone disease has increased recently in Korea and there seems to be an increased prevalence of gallstones when in association with pregnancy. Although the pathogenesis is incompletely defined, and altered motility of the gallbladder may contribute to the increased risk of gallstones during pregnancy. METHODS: We measured gallbladder volume using real-time ultrasonography to find out the mechanism for the changes of gallbladder motility during late pregnancy. Eighteen pregnant women took the gallbladder ultrasonography during their last trimester of pregnancy and after delivery; gallbladder volume and ejection fraction were calculated in each patient. RESULTS: Fasting gallbladder volumes increased significantly in the last trimester of pregnancy (25.28 +/- 14.26ml) compared with postpartum (17.44 +/- 5.82 ml) (p < 0.05). Gallbladder volumes measured after fatty meals showed more increment in pregnant women (10.13 +/- 7.19 ml) than in those after delivery (4.34 +/- 3.36 ml) (p < 0.005). A significantly reduced gallbladder ejection fraction was found in the pregnant group (60.56 +/- 18.80%) compared with those after delivery (77.48 +/- 13.37%) (p < 0.005). CONCLUSION: Gallbladder motility in late pregnancy shows significant impairment compared with that in postpartum. Thus, we suggest that gallbladder hypomotility may occur during late pregnancy, and this impairment of gallbladder motility may play an important role in gallstone formation.