Effectiveness of Walking-exercise on Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: This prospective study was conducted to assess the effect of walking-exercise on the bowel cleansing before colonoscopy and to define subgroup of patients to whom walking-exercise was beneficial. METHODS: Before taking 2.5 L of polyethylene glycol, 393 out-patients were randomized into two groups (G1; walking-exercise, G2; non-exercise) and the amount of walking-exercise was estimated by the step counter. A single colonoscopist performed the procedure with a single-blinded manner and estimated the bowel cleansing. RESULTS: A total of 366 patients were included by per protocol analysis. The number of step count was significantly different between two groups (p<0.000). However, the groups were similar in other data collected. The degree of bowel cleansing between two groups was significantly different (p<0.01). Age, history of abdominal surgery, constipation, obesity and walking- exercise were related to the degree of bowel cleansing. Interestingly, walking-exercise was especially beneficial to patients with age less than 65 years, without history of abdominal surgery, and non-obesity. Multivariate analysis demonstrated that absence of constipation (OR=4.74), walking- exercise (OR=2.04), and younger age (OR=1.97) were independent factors associated with better bowel cleansing. Most of walking patients (97.4%) answered that walking-exercise is more comfortable than taking the solution. CONCLUSIONS: The walking-exercise was of an additional benefit to improve colonoscopic bowel cleansing without significant patients discomfort.

Association of Estrogen Receptor Genotypes with Serum Lipids and Responsiveness of Serum Lipids to Hormonal Replacement Therapy in Korean Postmenopausal Women / 대한내분비학회지

BACKGROUND: Several biologically plausible mechanisms have been proposed for estrogen-mediated caridoprotection, including estrogen-assocaited changes in lipid metabolism and endothelial function of vessel walls. These effects are thought to be mediated via estrogen receptor (ER). Relationships between ER polymorphisms and serum lipid levels were not investigated enoughly. METHODS: Three restriction fragment length polymorphisms (RFLPs) at the ER gene locus, represented as B-variant, PvuII and XbaI, and their relationship to serum lipid levels were examined in 318 postmenopausal women. Their mean age was 54.5+/-6.5 years (mean+SD). An association between ER genotypes and changes in lipid levels after 1 year of estrogen replacement therapy was also investigated in follow-up 251 women. RESULTS: The B-variant was not found in Korean women. The distribution of the PvuII and XbaI polymorphisms was as follows: PP 109 (34%), Pp 166 (52%), pp 43 (14%), and XX 204 (64%), Xx 95 (30%), xx 19 (6%). Significant relationship was found between genotypes and changes in serum total cholesterol levels after lyr estrogen replacement therapy. There was no significant relationship between ER genotypes and changes in HDL cholesterol, LDL cholesterol and triglyceride levels after estrogen therapy. CONCLUSION: These data indicate that these polymorphisms are possible predictor on lipid response to estrogen replacement therapy.

Endoscopic Mucosal Resection for Premalignant Lesions and Early Gastric Cancer / 대한내과학회지

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.

Fine Structure and Albumin Gene Expression in Intrasplenically Transplanted Hepatocytes / 대한내과학회지

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.

Clinical Characteristics of Periampullary Diverticulum / 대한소화기내시경학회지

Background/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis.(continue..)