Does Polyethylene Glycol (PEG) Plus Ascorbic Acid Induce More Mucosal Injuries than Split-Dose 4-L PEG during Bowel Preparation?

BACKGROUND/AIMS: The aims of this study were to compare the bowel-cleansing efficacy, patient affinity for the preparation solution, and mucosal injury between a split dose of poly-ethylene glycol (SD-PEG) and low-volume PEG plus ascorbic acid (LV-PEG+Asc) in outpatient scheduled colonoscopies. METHODS: Of the 319 patients, 160 were enrolled for SD-PEG, and 159 for LV-PEG+Asc. The bowel-cleansing efficacy was rated according to the Ottawa bowel preparation scale. Patient affinity for the preparation solution was assessed using a questionnaire. All mucosal injuries observed during colonoscopy were biopsied and histopathologically reviewed. RESULTS: There was no significant difference in bowel cleansing between the groups. The LV-PEG+Asc group reported better patient acceptance and preference. There were no significant differences in the incidence or characteristics of the mucosal injuries between the two groups. CONCLUSIONS: Compared with SD-PEG, LV-PEG+Asc exhibited equivalent bowel-cleansing efficacy and resulted in improved patient acceptance and preference. There was no significant difference in mucosal injury between SD-PEG and LV-PEG+Asc. Thus, the LV-PEG+Asc preparation could be used more effectively and easily for routine colonoscopies without risking significant mucosal injury.

Ulcerative Colitis Complicating Pseudomembranous Colitis of the Right Colon

Clostridium difficile (C. difficile) is a cytotoxin-producing anaerobic gram-positive rod that is responsible for pseudomembranous colitis (PMC). The incidence of C. difficile is increasing in ulcerative colitis (UC) and inflammatory bowel disease patients and is associated with a more severe course, a longer hospital stay, higher financial costs, a greater likelihood of colectomy, and high mortality. PMC may occur anywhere along the intestinal tract, but it is often found in the distal colon. PMC involving the proximal colon with rectosigmoid sparing is rarely reported in patients with UC. We describe the case of a 35-year-old woman in remission from UC who presented with frequent diarrhea and abdominal pain. She was treated with ciprofloxacin for infectious enterocolitis at a local hospital; however, her symptoms did not improve. A colonoscopy revealed yellow-white plaques with edematous, erythematous from the proximal ascending colon to the cecum, and feces positive for C. difficile toxin. She was treated with metronidazole (500 mg, three times a day) for two weeks, and improved rapidly. Physicians should carefully examine the entire colon via colonoscopy, and perform stool exams for C. difficile in patients with UC who have been treated with antibiotics and in those who develop prolonged diarrhea despite medical treatment.

A Case of Corrosive Esophagogastritis after Copper Sulfate Ingestion / 대한소화기내시경학회지

Copper sulfate ingestion is a rare cause of corrosive gastrointestinal injury in the Republic of Korea. In developing countries, copper sulfate is chiefly used for agricultural purposes as a pesticide and in the leather industry. It is also used in school science classes in the form of bright blue crystals. Copper sulfate is a powerful oxidizing agent that is corrosive to mucous membranes. Concentrated solutions are acidic, with a pH of 4. We report a case of corrosive gastritis and esophagitis due to accidental copper sulfate ingestion in a 12-year-old boy.

Esosinophilic Gastroenteritis with Clostridium difficile-associated Colitis: A Case Report / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration in the bowel wall and presents various symptoms depending on the affected site and bowel layer. Pseudomembranous colitis is an antibiotic-associated infection caused by abnormal overgrowth of the toxin-producing Clostridium difficile in the large bowel. A 16-year-old boy was admitted with abdominal pain for 6 days. On admission, we performed an endoscopy and diagnosed gastroduodenitis. Then, we prescribed gastritis medication but he still presented with diffuse abdominal pain and fever above 38.0degrees C after admission. We considered infectious enterocolitis, so we prescribed an antibiotic. The next day, he presented with bloody diarrhea. A diagnosis of pseudomembranous colitis was confirmed by a colonoscopic examination with a biopsy. We also obtained a diagnosis of eosinophilic gastroenteritis through a histological diagnosis. This is the first case of the simultaneous occurrence of eosinophilic gastroenteritis and pseudomembranous colitis in the Korean medical literature. We report this case with a brief review of the literature.

A Case of Fabry Disease, Pathologically Revealed as Focal Segmental Glomerulosclerosis / 대한신장학회지

Fabry disease is an X-linked recessive lysosomal storage disease that is caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. This deficiency results in progressive lysosomal accumulation of glycosphingolipid with particular globotriaosylceramide which accumulates in the heart, kidneys, and the nervous system. The classic Fabry diease affects males, who typically experience an early onset of neuropathic pain, angiokeratoma, and anhydrosis or hypohydrosis. The introduction of enzyme replacement therapy necessitates early awareness of Fabry disease and knowledge of disease- related complications. We experienced a man presenting with acroparesthesia, anhydrosis and proteinuria, who had no residual alpha-galactosidase A activity on leukocytes and mutation analysis demonstrated thiamine deletion at position 1077, exon 7 of GLA gene. He was initially diagnosed as focal segmental glomerulosclerosis without electron microscopic examination three years ago. Now he is being treated with recombinant alpha-galactosidase A via intravenous administration for 1 month.

Seven Cases of Monoclonal Gammopathies Involving Kidney / 대한신장학회잡지

Monoclonal gammopathies are associated with a wide range of renal diseases, including cast nephropathy, light chain amyloidosis, monoclonal immunoglobulin deposition diseases, and so on. We describe seven cases of monoclonal gammopathies involving kidney. The mean age was 61.6+/-3.6 years and male to female ratio was 1:1.3. Among 7 patients, diagnoses were cast nephropathy with light chain deposition disease, two light chain deposition diseases, three light chain amyloidosis and light chain deposition disease with light chain amyloidosis. Two cases were monoclonal gammopathy of undetermined significance and three cases were multiple myeloma in five cases underwent bone marrow biopsy. It showed that renal function was severly decreased in light chain deposition disease. It is clear that monoclonal gammopathies show various renal disease and clinical course in our cases. It is necessary to do renal biospy for adequate diagnosis and treatment even to old patients suspecting monoclonal gammopathy.

Clinical characteristics of rapidly progressive glomerulonephritis / 대한내과학회지

BACKGROUND: Rapidly progressive glomerulonephritis (RPGN) is microscopically characterized by formation of crescents in more than 50% of glomeruli observed. The patients usually move on rapidly to renal failure and the prognosis is not favorable. But there was only a few study because of the rarity in incidence. METHODS: We reviewed and analyzed the records of 15 patients diagnosed as crescentic glomerulonephritis (CrGN) by renal biopsy from March 1990 to December 2003. RESULTS: Fifteen out of 1055 biopsy cases were CrGN including 6 (40%) of pauci-immune glomerulonephritis (PIGN) and 9 (60%) of immune complex glomerulonephritis (ICGN). Underlying diseases of PIGN were: unknown 2, Wegener's granulomatosis 2, focal segmental glomerulosclerosis 1, and rectal cancer 1. For ICGN were: IgA nephropathy 3, lupus nephritis class IV 3, Henoch-Schonlein purpura 2, and HBV-associtated membranoproliferative glomerulonephritis type I. The incidence of major manifestation in PIGN vs. ICGN was respectively: hypertension 50% vs. 22.2%, nephrotic syndrome 50% vs. 88.9%, percents of crescents 73.9% vs. 57.3%. The levels of BUN (mg/dL) and serum creatinine (mg/dL) were higher in PIGN as 76.8 +/- 14.3 and 6.6 +/- 1.2 vs. 26.9 +/- 8.9 and 1.6 +/- 0.3 in ICGN. With methylprednisolone pulse, 5 out of 7 patients showed some improvement in their renal function. A case of Wegener's granulomatosis taken oral prednisolone and another case of lupus nephritis given cyclophosphamide pulse also had relatively favorable course. At the end of follow-up, the more crescents they had the higher creatinine level (r=0.711, p<0.01). CONCLUSION: RPGN manifested nephrotic syndrome commonly and many of them progressed to the chronic kidney disease or even developed end stage renal disease. But appropriate immunosuppre- ssive treatment could help to preserve renal function. When considering the proportion of crescentic glomeruli, it was related to the worse prognosis. It is necessary to make an effort to diagnose early and treat vigorously.

Serum IgG and IgG subclass in aspirin-sensitive asthma / 천식및알레르기

BACKGROUND AND OBJECTIVES: Immunoglobulin G (IgG) subclass deficiency has been reported in patients with bronchial asthma and is associated with recurrent respiratory tract infections. Aspirin-sensitive asthma (ASA) which affects 10% of adult asthmatics, asthma runs a chronic course with frequent asthma exacerbations, often related to respiratory infections. We performed this study to identify the prevalence of IgG subclass deficiency and evaluate the association between recurrent asthma exacerbations and IgG subclass deficiency in ASA. SUBJECTS AND METHODS: We measured serum levels of IgG and IgG subclass in 26 aspirin- sensitive asthmatic patients (15 steroid used and 11 steroid not used) and 55 healthy controls using nephelometry. Reference values of each IgG subclass was defined as cumulative percentile between 2.5% to 97.5% of controls. RESULTS: Total IgG, IgG1, IgG2 and IgG3 of aspirin-sensitvie asthmatics, were significantly lower than for those of controls (p0.05, respectively). CONCLUSION: Lowered levels of IgG, IgG1, IgG2 and IgG3 were noted in ASA sensitive asthma patients, which might be associated with use of steroid. Further studies will be needed to evaluate their clinical significance.

A case of mycoplasma pneumonia associated with pulmonary and bronchial eosinophilia / 천식및알레르기

Epidemiologic evidences suggest a close linking exist between Mycoplasma infection and asthma exacerbation, and possibly as a factor in the pathogenesis of asthma. However, little is known about the pathogenetic mechanism of respiratory M. pneumonia infection on airway inflammation. We report a case of mycoplasma pneumonia associated with pulmonary and bronchial eosinophilia. A 25-year-old man developed fever, coughing and dyspnea for 5 days prior to the admission. Initial chest x-ray showed bilateral interstitial or nodular infiltration and right pleural effusion. In High-resolution chest CT, demonstrated bilateral interstitial thickening with perivascular blurring. Pulmonary function test showed mild restrictive ventilatory pattern. Differential cell count in induced sputum showed marked eosinophilia(70% of non-squamous cells). Furthermore, bronchoalveolar lavage fluid analysis showed excessive eosinophils(39%). Mycoplasmal antibody was detected in patient's serum in titer of 1 to 160 by indirect hemagglutination method. Methacholine PC20 was 11.4 mg/ml. After treatment with macrolide antibiotics only, patient's subjective symptoms, abnormalities in chest x-ray film and bronchial hyperreactivity were disappeared.

A comparative study on the efficacy between interferon alpha monotherapy and lamivudine-interferon combination therapy in chronic hepatitis B patients / 대한내과학회지

BACKGROUND: At present, lamivudine-interferon combination therapy is being tried on chronic hepatitis B patients who had no significant response to interferon-alpha mono-therapy. The therapeutic effect of lamivudine-interferon combination therapy is showing various outcomes depending on the period of therapy and the status of the patient. Thus we conducted this study to compare the therapeutic effect of lamivudine-interferon combination therapy versus interferon-alpha monotherapy in korean patients with chronic hepatitis B. METHOD: Among the chronic hepatitis B patients, 138 patients who showed positive to HBeAg, and serum HBV DNA levels are over 5 pg/mL and serum ALT levels are over 40 IU/L were allocated to IFN-alpha monotherapy group (70 patients) and lamivudine-interferon combination therapy group (66 patients). We compared two groups on ALT normalization rate, HBeAg seroconversion rate, HBV DNA loss rate and HBeAg loss rate in both group. IFN-alpha was percutaneously injected three times a week. Mean administered dose was 27125 (+/-11841) MU and mean administered duration was 6.4 (+/-1.6) months. Lamivudine was concomitantly and continuously administered with IFN-alpha for over 6 months (mean 13.2 +/- 16.5). The lamivudine therapy was terminated at the point when HBeAg turned positive into negative. RESULTS: Mean follow-up period was 28 months. HBeAg loss rate was 40.9% in lamivudine- interferon combination therapy group and 28.6% in IFN-alpha monotherapy group on the 12th month of the therapy, showing there was no significant difference between the two groups (p=0.13). HBeAg seroconversion rate was 40.9% in lamivudine-interferon combination therapy group and 21.4% in IFN-alpha monotherapy group on the 12th month of the therapy (p=0.014). HBV DNA loss rate was 90.9% in lamivudine-interferon combination therapy group and 88.6% in IFN-alpha monotherapy group within 12months of the therapy, showing there was no significant difference between the two groups (p=0.35). Serum ALT normalization rate was 92.4% in lamivudine-interferon combination therapy group and 85.7% in IFN-alpha monotherapy group within 12months of the therapy, showing there was no significant difference between the two groups (p=0.11). CONCLUSION: The lamivudine-interferon combination therapy compared to the Interferon-alpha monotherapy showed a statistically significant higher HBeAg seroconversion rate.

A case of minimal change nephrotic syndrome associated with systemic lupus erythematosus / 대한내과학회지

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by the overprocuctionofautoantibodiesandthedepositionofimmune complexes in various organs. Unusual case of systemic lupus erythematosus (SLE) associated with minimal change nephrotic syndrome(MCNS) is described. A 30-year-old woman who has been diagnosed as SLE and treated with prednisolone presented symptoms of nephrotic syndrome. Renal biopsy revealed minor glomerular abnormalities without deposition of immune complexes. The initial heavy proteinuria promptly decreased after the prednisolone dosage was increased and disappeared 10 weeks later. She developed proteinuria again 3 years after the initial episode. Repeated renal biopsy revealed membranous nephropathy. T-cell dysfunction, which is present both in SLE and MCNS, might have triggered MCNS during the course of SLE.