Dental care utilization by diabetics according to the Korea Health Panel Survey / 대한구강보건학회지

OBJECTIVES: The objective of this study was to examine the difference in dental care utilization between diabetics (diabetes group) and nondiabetics (normal group). METHODS: We examined the data of 5108 subjects enrolled in the Korea Health Panel Survey, every year for three years between 2010 and 2012. Of these, 458 subjects were included in the diabetes group and 458 in the normal group using the propensity score matching method to control confounding variables. To compare dental care utilization by the diabetes and normal groups, we examined the odds ratio (OR) and 95% confidence interval (CI) using a generalized estimating equation. RESULTS: We found that the odds of dental care utilization by the diabetes group compared with the normal group was significantly high (OR=1.82, 95% CI: 1.60-2.09). The result was consistent according to sensitivity analysis (OR=1.96, 95% CI: 1.63-2.35). CONCLUSIONS: Dental care utilization by the diabetes group was 82% higher than that by the normal group. Therefore, patients with diabetes need to be more concerned about oral health care.

Impact of Self-Efficacy on Medication Adherence among People Living with Human Immunodeficiency Virus / 대한내과학회지

BACKGROUND/AIMS: It is very important that people living with HIV (PLWH) maintain 95% medication adherence to increase health-related quality of life and prevent transmitting HIV. In this study, we analyzed factors influencing medication adherence among PLWH and used the basic data for practical interventions to increase medication adherence. METHODS: A total of 190 PLWH, who were taking highly active antiretroviral therapy (HAART) from nine hospitals in South Korea, were included. The data were collected by self-administered questionnaire between April 1 and June 31, 2014. RESULTS: About 92% of the subjects were male and 72.9% of the subjects belonged to the high compliance group. Medication-taking self-efficacy was significantly related to compliance. Efficacy expectancy, which is a subscale of medication-taking self-efficacy, indicated that a score of 1 point higher on a 10-point scale increased compliance by 2.63 times. CONCLUSIONS: Medication adherence is associated with increased medication-taking self-efficacy. Therefore, it is necessary to promote self-efficacy to improve compliance considering the infection period and adverse reactions to HAART among PLWH.

Secondary Appendiceal Tumors: A Review of 139 Cases

BACKGROUND/AIMS: This study evaluated the clinicopathologic characteristics of patients with secondary appendiceal tumors (SATs). METHODS: We performed a single-center, retrospective study of patients with pathologically confirmed SATs. RESULTS: Among 180 cases of appendiceal malignancies diagnosed between 2000 and 2007, 139 cases (77.2%, 46 male) were SATs. The median age at SAT diagnosis was 55 years. The most common primary origin was the ovary. The mode of appendiceal involvement was metastasis in 122 and invasion in 17 patients. Extra-appendiceal involvement was present in 134 patients. The only manifestation that could be attributed to the SAT itself was appendicitis (n=8). Serosal involvement was predominant. The median survival after diagnosis of SAT was 22.6 months. In the Cox regression analysis, chemotherapy included in the treatment was the only factor associated with prolonged survival (hazards ratio, 0.12; 95% confidence interval, 0.06-0.23; p<0.001). Complete resection of the SAT had no influence on survival. CONCLUSIONS: SATs accounted for 77.2% of all pathologically diagnosed appendiceal malignancies. The most common origin was the ovary. SATs were usually associated with widespread disease, and the median survival after SAT diagnosis was 22.6 months. Complete resection of the SAT had no influence on survival.

Primary Pancreatic Lymphoma in Korea-A Single Center Experience

The aim of this study was to report a single center experience of primary pancreatic lymphoma (PPL) in Korea. We analyzed the clinicopathological data from four PPL patients (three male, median age 36 yr) diagnosed from 1997 to 2007 at Seoul National University Hospital. The diagnoses were: diffuse large B cell lymphoma (n=2), Ki-1 (+) anaplastic large cell lymphoma (n=1), and Burkitt lymphoma (n=1). Presenting symptoms and signs were: abdominal pain (n=4), pancreatitis (n=2), weight loss (n=2) and abdominal mass (n=1). No patient underwent surgery. The Ann Arbor stages of the patients were: IEA (n=1), IIEA (n=1), and IVEB (n=2). Two patients underwent treatment. The stage IEA patient underwent chemotherapy and radiation therapy that resulted in a complete remission. The stage IVEB patient who underwent chemotherapy relapsed. This patient underwent subsequent peripheral blood stem cell transplantation and is alive at 30 months. Two patients (stages IVEB and IIEA) without treatment died at 0.8 and 7.0 months, respectively. For PPL patients, chemotherapy-based treatment, and addition of radiation therapy, if possible, may offer good prognosis.

The Eradication Rate of Helicobacter pylori on the Remnant Stomach after Curative Resection for Gastric Cancer and the Influence of Eradication / 대한소화기내시경학회지

BACKGROUND/AIMS: There are few reports on the rate of H. pylori eradication and the influence of this eradication in the remnant stomach after a curative resection for a gastric carcinoma. METHODS: The medical records of patients who had undergone curative gastrectomy for carcinoma between May, 2003 and June, 2006 were reviewed to evaluate the serial H. pylori status. The eradication regimen was a proton pump inhibitor (PPI) based triple therapy (PPI, amoxicillin, clarithromycin). After eradication, the histological changes were reviewed based on the updated Sidney system. In addition, a CLO test and urea breath test were used for the evaluation. RESULTS: Eighty five patients were found to be positive for a H. pylori infection after the curative gastrectomy. Fifty two patients received eradication therapy and the other 33 patients did not. The eradication rate in patients who received therapy was 82.7% and spontaneous resolution rate in the patients who did not receive therapy was 78.8% (p=0.654). After eradication, the remnant stomach showed a significant decrease in the inflammation and activity scores. CONCLUSIONS: The eradication rate of H. pylori by PPI based triple therapy in the remnant stomach is similar to that in a non-surgical stomach. The decrease in the inflammation and activity score suggests that the eradication may prevent H. pylori related carcinogenesis. However, the high spontaneous negative conversion rate (78.8%) in the remnant stomach after gastrectomy will require further study.

Clinical and pathologic characteristics of gastric cancer in elderly Korean patients in Korea / 대한내과학회지

BACKGROUND: Gastric cancer in elderly patients is one of the most important health issues in Korea, when considering its incidence and mortality rate. We have obtained the preliminary data concerning the diagnosis and treatment of gastric cancer in elderly people by analyzing the clinical and pathologic features. METHODS: We retrospectively analyzed 268 patients who were diagnosed with gastric cancer and who also underwent surgical procedures in Bundang Seoul National University Hospital from May 2003 to May 2005. The patients were divided into two groups: those aged or =65 (n=106). We compared the clinical and pathological characteristics between the older and younger groups. RESULTS: The elderly group had more patients with well differentiated carcinoma (11.8% vs. 33.0%, respectively, p=0.001) and the intestinal type (34.0% vs. 59.4%, respectively, p<0.001). The frequency of microsatellite instability-high (MSI-H) was higher in the elderly group (5.6% vs. 17%, respectively, p=0.010). There was no significant difference in the postoperative recovery time (p=0.374) and the operation-related complication rate between the two groups. CONCLUSIONS: Gastric cancer in elderly patients demonstrated more pathologic types that have a known favorable outcome when compared to the younger patient group. We should more frequently consider surgery for the elderly patient with operable gastric cancer because of they have similar postoperative recovery compared to the younger patients.

Comparison of the Eradication Rates of One-week Low-dose Triple Therapy with Standard-dose Triple Therapy for Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: We can expect to reduce costs and decrease adverse events by using low-dose triple therapy for H. pylori eradication. However, the efficacy of low-dose triple therapy for Koreans is questionable. In this study, we compared the efficacy of low-dose triple therapy with standard-dose triple therapy. METHODS: We enrolled 480 patients who were diagnosed as suffering with H. pylori infection via endoscopy with biopsy or CLO testing. Thirty patients were excluded due to malignancy or having undergone previous antibiotics medication. Two hundred and eighty patients received standard-dose triple therapy (pantoprazole 40 mg b.d, amoxicillin 1,000 mg b.d., and clarithromycin 500 mg b.d.), and 170 patients received low-dose triple therapy (pantoprazole 40 mg b.d., amoxicillin 750 mg b.d., and clarithromycin 250 mg b.d.). Eradication was evaluated 4~6 weeks after administering the medication. RESULTS: The H. pylori eradication rate was 77.9% in the standard-dose group, and 74.7% in the low-dose group. There was no significant difference in the H. pylori eradication rate between the two groups (p=0.444). The adverse events were significantly more frequent in the standard-dose group. One patient each in both groups discontinued medication because of an adverse event. CONCLUSIONS: The efficacy of low-dose therapy is similar to standard-dose therapy, and the adverse events are less frequent with low-dose therapy. This suggests that low-dose therapy would be preferred when considering the cost- benefit and low rate of adverse drug events.

A Case of Cystic Duct Carcinoma with Hepatic Duct Invasion / 대한소화기내시경학회지

A primary carcinoma of the cystic duct is extremely rare, accounting for 2.6% of all biliary carcinomas. However, the prognosis is better than other biliary carcinomas. The median survival is 20.4 months. In Korea, three cases have been reported and there is no case where a pre-operative MRI has been performed. We report a case of a primary carcinoma of the cystic duct with hepatic duct invasion, which presented as a painless right upper quadrant mass, that was diagnosed by MRCP in a pre-operative situation.

Intra-abdominal Angiosarcomatosis Induced by Irradiation

Therapeutic irradiation can induce angiosarcoma. Radiation-induced angiosarcoma constitutes 20% of all angiosarcomas. Although its common site of origin is the skin and subcutaneous tissue, it rarely arises in small or large bowels with a presentation as multifocal abdominal angiosarcomatosis. We report a case of intra-abdominal angiosarcomatosis involving the jejunum, ileum, transverse colon, mesentery and right ovary in a 63-year-old female. It developed 10 years after therapeutic irradiation for squamous cell carcinoma of uterine cervix. She developed panperitonitis due to intestinal perforation. She died from sepsis 3 days after segmental resection of the small bowel and right oophorectomy. We reviewed the previously reported cases and describe the clinicopathologic features of this tumor.