Clinical characteristics of patients with acute hepatitis A in Gwangju-Chonnam province for recent 10 years / 대한내과학회지

BACKGROUND: The incidence of acute hepatitis A was reported to have increased recently. The purpose of this study was to investigate the epidemiological and clinical characteristics of cases of sporadic acute hepatitis A in Gwangju-Chonnnam area over the last 10 years. METHODS: The medical records of 73 cases with acute hepatitis A, which were diagnosed at the Chonnam National University Hospital from January 1996 to December 2005, were reviewed retrospectively for the epidemiological and clinical manifestations. RESULTS: Of the seventy three patients, there were forty males (54.8%). The mean age of the patients was 25 years and the peak incidence being in the 3rd decade (45.2%). The annual number of hepatitis A patients has increased. There were 16 patients (21.9%) from 1996 to 2000, and 57 patients (78.1%) from 2001 to 2005. There was no significant difference in the seasonal incidence (p=0.09). There were 7 cases (9.6%) in children less than 15 years of age and 66 adult cases (90.4%). Although the source of infection could not be identified in 40 patients (54.8%), it was found to be food in 31 patients (42.5%) and intimate contact in 2 patients (2.7%). Sixty five (89%) patients were hospitalized, and the average admission day was 14.5 days. All patients recovered without complications except for two patients who showed cholestatic hepatitis. CONCLUSIONS: The annual number of sporadic acute hepatitis A patients in Gwangju-Chonnam province has increased and most of patients were in their 3rd decade. Social concern for sporadic acute hepatitis A is needed in Gwangju-Chonnam area.

The Usefulness of Clip Application in Preventing Migration of Self-expandable Metal Stent in Patients with Malignant Gastrointestinal Obstruction / 대한소화기학회지

BACKGROUND/AIMS: Management of malignant gastrointestinal obstruction presents a significant challenge. Recently, self-expandable metal stent (SEMS) has emerged as an effective, safe, and less invasive alternative for the treatment of malignant intestinal obstruction. Accordingly, we reviewed our experience in SEMS insertion with hemoclip placement. METHODS: Between June 2004 and December 2005, a total of 40 SEMS were tried to place in 38 patients with malignant intestinal obstruction. Two stents were placed again due to recurrent obstruction and delayed stent migration after initial stent placement. We analyzed the technical and clinical success rates and complications. RESULTS: Total stent placement was successful in 38/40 (95%). In 2 cases, stent placement was failed due to complete obstruction. Twenty-eight stents for palliation of malignant intestinal stenosis, 9 stents for one-staged operation for malignant colonic obstruction, and 1 stent for management of tracheoesophageal fistula were placed. Stent migration occurred in 6/38 (15.8%). Early stent migration rate was significantly lower in the clipping group (0/19, 0%) than in the non-clipping group (5/19, 26.3%, p=0.04). Recurrent obstruction occurred in 2/38 (6.1%) due to tumor ingrowth and in 1/38 (2.6%) due to hard food materials. CONCLUSIONS: Application of the clips reduce early stent migration in patients with malignant gastrointestinal obstruction.

Agenesis of the Dorsal Pancreas: A Case Report and Review of the Literature

Partial or complete agenesis of the dorsal pancreas is a rare congenital anomaly that results from the embryological failure of the dorsal pancreatic bud to form the body and tail of the pancreas. To date, four cases have been reported in Korea. We report an additional case; a 25-year-old woman presented with diabetes mellitus and abdominal pain. Abdominal computed tomography (CT) revealed a normal-appearing pancreatic head, but the body and tail were not visualized. Endoscopic cholangiopancreatogram (ERCP) revealed a short pancreatic duct in the uncinate process and the head and the duct of Santorini draining into the minor papilla. Abdominal magnetic resonance imaging (MRI) findings were similar to the CT and ERCP results. The patient was diagnosed with partial agenesis of the dorsal pancreas by CT, ERCP and MRI.

Antibiotic Prophylaxis Using Third Generation Cephalosporins Can Reduce the Risk of Early Rebleeding in the First Acute Gastroesophageal Variceal Hemorrhage: A Prospective Randomized Study

Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the ondemand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

Influence of CYP2C19 Polymorphism and Helicobacter pylori Status on the Antisecretory Effect of Omeprazole in Gastroesophageal Reflux Disease / 대한소화기학회지

BACKGROUND/AIMS: The acid suppressive effect of omeprazole (OMP) is influenced by the metabolic capacity of gastric acid suppression, which is dependent on CYP2C19 polymorphism. The aim of this study was to determine the influence of CYP2C19 polymorphism and Helicobacter pylori (H. pylori) infection on the intragastric acid suppression of OMP. METHODS: Thirty one patients with gastroesophageal reflux disease were treated with a daily oral dose of 20 mg OMP for 28 days. Patients were genotyped for CYP2C19 polymorphism by polymerase chain reaction-restriction fragment length polymorphism and classified into three groups: homogenous extensive metabolizers (Ho-EMs), heterogenous extensive metabolizers (Ht-EMs) and poor metabolizer (PMs). H. pylori infection status were assessed before OMP treatment. Intragastric pH was monitored over twenty four-hours before (day 0) and after (day 29) the treatment with OMP. RESULTS: Twenty four-hour intragastric mean pH in the PMs group was significantly higher than those in Ho-EMs and Ht-EMs (5.3+/-1.3 vs. 2.8+/-0.6, 3.6+/-1.4) (p<0.005). Twenty four-hour intragastric mean pH after the administration of OMP in the H. pylori positive group was significantly higher than the H. pylori negative group (4.7+/-1.4 vs. 3.2+/-1.4) (p<0.001). There was no significant difference in acid suppressive activity of OMP between H. pylori positive and negative group according to CYP2C19 polymorphism. CONCLUSIONS: The acid suppressive effect of OMP on intragastric pH is dependent on CYP2C19 polymorphism and the H. pylori-infected status in patients with gastroesophageal reflux disease. H. pylori infection may play a role in enhancing the acid suppressive potential of OMP.

The effect of YB-1 antisense oligonucleotides on tumor cell growth / 대한내과학회지

BACKGROUND: Human YB-1 is a transcription factor that binds to the inverted CCAAT box in the promoter region of a variety of genes such as PCNA, DNA polymerase and MDR. In this study we evaluated the effect of YB-1 antisense oligonucleotides on tumor cell growth. METHODS: Chang liver, HepG2 and CT-26 cells were cultured as immortalized cell lines. The MTT (3-[4,5-dimethylthiazol-2-yl] 2,5-diphenyltetrazolium bromide) assay, Northern blot and flow cytometric analyses were used to determine cell growth, gene expression and cell cycle changes. In an animal model, CT-26 cells were injected into Balb/c mice to induce tumor; YB-1 antisense oligonucleotides were injected into the tail vein or tumor tissue of the mice; change of tumor size was then measured. RESULTS: Phosphorothioated YB-1 antisense oligonucleotides suppressed the proliferation of the immortalized liver cells (Chang liver cells) and a variety of cancer cells (HepG2 and CT-26 cells); however, it did not inhibit normal cell growth. The DOTAP/antisense oligonucleotide mixture showed stronger effects on cell proliferation than did the antisense oligonucleotide alone. The YB-1 antisense oligonucleotide decreased specific expression of the YB-1 mRNA in the immortalized cancer cell lines. Flow cytometric analysis revealed that the inhibition of cell proliferation might have been due to a decrease in the S phase of the cell cycle. We found that in an animal tumor model, the administration of the YB-1 antisense oligonucleotide, in the vein or tumor tissues, decreased the tumor size significantly. CONCLUSIONS: These results suggest that the YB-1 antisense oligonucleotide may inhibit growth of a variety of cancer cells.

Three Cases of Gastric Anisakiasis Mimicking Submucosal Tumor / 대한소화기내시경학회지

Gastric anisakiasis is a parasitic infestation that occurs after eating raw marine fish that contain Anisakis larvae. The diagnosis is usually confirmed by endoscopy, which often reveals the presence of the larvae itself, mucosal edema, erosion, ulceration, and hemorrhage. However, gastric anisakiasis mimicking submucosal tumor is extremely rare. To date, six cases have been reported in Korea. We report three additional cases of gastrtic anisakiasis mimicking submucosal tumor. An asymptomatic 56-year-old man and a 40-year-old woman underwent endoscopis examination during a physical checkup, and a 63-year-old woman visited our hospital complaining of epigastric discomfort.The endoscopic findings indicated submucosal tumors in all cases. Endoscopic ultrasonography revealed inhomogeneous, hypoechoic lesions in submucosal layer (1 case) and muscle layer (2 cases). A laparoscopic and endoscopic resection was carried out for definite diagnosis and treatment. The pathologic findings of the resected specimens were eosinophilic granuloma caused by Anisakis.

Three Cases of Gastric Anisakiasis Mimicking Submucosal Tumor / 대한소화기내시경학회지

Gastric anisakiasis is a parasitic infestation that occurs after eating raw marine fish that contain Anisakis larvae. The diagnosis is usually confirmed by endoscopy, which often reveals the presence of the larvae itself, mucosal edema, erosion, ulceration, and hemorrhage. However, gastric anisakiasis mimicking submucosal tumor is extremely rare. To date, six cases have been reported in Korea. We report three additional cases of gastrtic anisakiasis mimicking submucosal tumor. An asymptomatic 56-year-old man and a 40-year-old woman underwent endoscopis examination during a physical checkup, and a 63-year-old woman visited our hospital complaining of epigastric discomfort.The endoscopic findings indicated submucosal tumors in all cases. Endoscopic ultrasonography revealed inhomogeneous, hypoechoic lesions in submucosal layer (1 case) and muscle layer (2 cases). A laparoscopic and endoscopic resection was carried out for definite diagnosis and treatment. The pathologic findings of the resected specimens were eosinophilic granuloma caused by Anisakis.

Expression of Cyclooxygenase-2, p53 and Ki-67 in Gastric Cancer

It has been reported that p53 mutation may contribute to upregulate cyclooxygenase (COX)-2 expression that is observed in malignant tissues. These molecules are involved in carcinogenesis by affecting tumor cell proliferation. The aim of this study was to examine the relationship between COX-2 or p53 expression and clinico-pathological characteristics including tumor cell proliferation in gastric cancer. COX-2 and p53 expressions were investigated with immunostaining, in tissue specimens obtained from 119 patients who underwent surgery for gastric cancer. The Ki-67 labeling index (LI) was counted by Ki-67 immunostaining. COX-2 and p53 expressions correlated significantly with depth of tumor invasion. However, there was no association between COX-2 or p53 expression and survival. p53 expression did not correlate with COX-2 expression. There was no significant difference in various clinicopathological variables between Ki-67 LI subgroups. The mean Ki-67 LI value of COX-2 positive tumors was significantly higher than that of negative tumors. The mean Ki-67 LI value of p53 positive tumors was not significantly higher than that of negative tumors. The mean Ki-67 LI value of both COX-2 and p53 positive tumors was significantly higher than that of both negative tumors. These results imply that COX-2 expression is associated with tumor cell proliferation of gastric cancer.

Comparison of Terlipressin and Octreotide with Variceal Ligation for Controlling Acute Esophageal Variceal Bleeding: a Randomized Prospective Study / 대한간학회지

BACKGROUND/AIMS: Terlipressin and octreotide had been used to control acute variceal bleeding and to prevent early rebleeding after endoscopic hemostasis. We compared the efficacy and safety of terlipressin and octreotide combined with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding and we evaluated their clinical significance as related to rebleeding. METHODS: The eighty eight cirrhotic patients were randomized to the terlipressin group (n=43; 2 mg i.v. initially and 1 mg i.v. at every 4 hours for 3 days) or the octreotide group (n=45; continuous infusion of 25 microgram/h for 5 days) combined with EVL for the treatment of acute esophageal variceal bleeding. RESULTS: The initial hemostasis rates were 98% (42/43 cases) in the terlipressin group and 96% (43/45 cases) in the octreotide group. The 5-day and 42-day rebleeding rates were 12% (5/43 cases) and 28% (12/43 cases), respectively, in the terlipressin group and 9% (4/45 cases) and 24% (11/45 cases), respectively, in the octreotide group. No significant difference was demonstrated between the terlipressin and octreotide groups. The mortality at 42 days was similar in both group, but a high mortality rate (48%) was shown to be related to 42-day rebleeding. The risk factors related to 42-day rebleeding were Child-Pugh class C (aOR=30.2, 95% CI=7.7-117.9), ascites above grade II (aOR=6.6, 95% CI=2.2-19.2) and advanced hepatocellular carcinoma (aOR=4.6, 95% CI=1.1-18.9). CONCLUSIONS: Comparing terlipressin and octreotide combined with EVL showed them to be equally safe and effective therapeutic agents in patients with acute esophageal variceal bleeding. The high risk factors related to early rebleeding were poor liver function and advanced hepatocellular carcinoma.

Methylation Pattern of DNA Repair Genes and Microsatellite Instability in Hepatocelluar Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Epigenetic silencing of DNA repair genes, O6-methylguanine-DNA methyltransferase (MGMT), hMLH1 and hMSH3, by promoter hypermethylation have been observed in various cancers. However, the relationship between hypermethylation of DNA mismatch repair genes and microsatellite instability (MSI) has not been studied in hepatocellular carcinoma (HCC) associated with cirrhosis. METHODS: We investigated the methylation pattern of CpG islands of 3 genes using methylation-specific PCR (MSP) and MSI in 40 patients with paired hepatocellular carcinoma and associated cirrhosis. RESULTS: hMSH3 and MGMT were the most methylated genes in both cirrhosis (70% and 68%, respectively) and HCC (75% and 73%, respectively). The methylation of hMLH1 was rarely found in both cirrhosis (8%) and HCC (5%). Gene promoters methylated in cirrhosis were also methylated in HCC with the exception of 9 cases found to be methylated either in cirrhosis or HCC. Of 40 cases of HCC associated with cirrhosis, three had MSI-positive phenotype in which two were MSI-low and one was MSI-high. One MSI-positive phenotype was present both in cirrhosis and in HCC, while two were only in HCC. There was no significant correlation between aberrant DNA methylation of mismatch repair genes and MSI status in HCC associated with cirrhosis. Immunohistochemical expressions of hMLH1, MGMT, and hMSH3 proteins were present in 16 (40%), 6 (15%), and 11 (28%) of 40 cases of HCC respectively. There was no significant correlaton between the aberrant DNA methylation of mismatch repair genes and clinical characteristics such as histological differentiation, postoperative recurrence and mortality. CONCLUSIONS: The methylation of MGMT and hMSH3 among DNA repair genes are frequent, but those of hMLH1 and MSI is very rare in both cirrhosis and HCC. There is no significant correlation between the methylation of DNA repair genes and clinical characteristics of HCC.

New risk factors for thromboembolic complications in atrial fibrillation / 대한내과학회지

BACKGROUND: Atrial fibrillation (AF) is the most common cause of embolic cerebral infarction. This study was performed to determine new risk factors and the mechanism underlying thromboembolism (TE) in patients with AF. METHODS: 192 patients (M:F=137:55, 61+/-11 years) with AF were randomly selected and divided into a TE (n=95) and non-TE group (n=97). Another 71 patients with AF (M:F=38:33, 55+/-14) were studied for endothelial function by measuring the level of von Willebrand factor (vWF; factor 8 related antigen), inflammation by WBC, ESR, and high sensitive CRP and coagulation system by fibrinogen, fibrinogen degradation product and fibrin d-dimer; the results were compared with 25 patients with normal sinus rhythm. RESULTS: The TE group was older than non-TE group. Hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, smoking and fine AF (AF wave amplitude <1 mm) were more frequent in the TE group. Mitral valvular disease, an ejection fraction <40% and dilated cardiomyopathy were more frequent in the TE group and the left atrial (LA) dimension was greater in the TE group. The use of anticoagulants, an angiotensin-II receptor blocker and statins were less frequently observed in the TE group. The vWF-factor 8 related antigen was higher in patients with advanced age, LV dysfunction, HTN, DM, mitral stenosis and positively correlated with age, LA dimension, LV end-diastolic and end-systolic dimension, ejection fraction, NYHA class and AF duration. The fibrinogen level was positively correlated with age, NYHA class, LA dimension and d-dimer with NYHA class. Markers for inflammation or coagulation were not significantly different in the atrial fibrillation and the sinus rhythm group. CONCLUSIONS: No use of an angiotensin-II receptor blocker or statin and fine AF may be new risk factors for TE in patients with AF. The TE risk factors are thought to increase TE by impairing endothelial function.

Neostigmine for the Treatment of Acute Hepatic Encephalopathy with Acute Intestinal Pseudo-obstruction in a Cirrhotic Patient

We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple airfluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gutderived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.

Expression of PTEN and Its Correlation with Angiogenesis in Gastric Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Phosphatase and tensin homolog deleted on chromosome ten (PTEN) is a recently clarified tumor suppressor gene located in 10q23.3. Alterations of this gene are associated with tumor progression and unfavorable outcome in various human cancers. Recently, PTEN has a possible role in angiogenesis by modulating angiogenic factor including vascular endothelial growth factor (VEGF). The aim of this study was to investigate the roles of PTEN and VEGF status for angiogenesis in human gastric cancer. METHODS: We conducted an immunohistochemical investigation of PTEN and VEGF expression in 90 cases of paraffin section obtained from gastric cancer patients undergone surgical treatment. RESULTS: Negative expression of PTEN and positive expression of VEGF in gastric cancer tissues, were demonstrated in 40.0% and 77.8% of cases, respectively. However, no significant correlation was found between PTEN, VEGF expression and various clinicopathological parameters. PTEN expression did not correlate significantly with VEGF expression (p=0.301). High microvessel density (MVD) was significantly associated with lymph node metastasis and poor survival (p=0.014, 0.011, respectively). The mean MVD value of PTEN negative tumors was 90.4+/-43.0 and significantly higher than that of PTEN positive tumors (p=0.028). The mean MVD value of VEGF positive tumors was 86.4+/-36.7 and significantly higher than that of VEGF negative tumors (p=0.002). The mean MVD value of PTEN negative and VEGF positive tumors was 98.0+/-42.2, and significantly higher than those of the others. CONCLUSIONS: These results suggest that loss of PTEN expression may play a critical role in tumor progression and metastasis by stimulating tumor angiogenesis in human gastric cancer.

Expression of Cyclin Dependent Kinase Inhibitors of KIP Family in Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The cyclin-dependent kinase inhibitors (CDKI) including p21, p27, and p57 of the kinase inhibitor protein (KIP) family are negative regulators of cell cycle progression and potentially act as tumor suppressor. Tumor behavior and growth are influenced by the extent of tumor cell proliferation. The aim of this study was to evaluate the expression of KIP family CDKI in gastric cancer tissue, and to examine the relationship between these expression and various clinicopathological parameters including tumor cell proliferation. METHODS: We conducted an immunohistochemical analysis of p21, p27, and p57 expression in 109 gastric cancer tissues. Tumor cell proliferation was assessed by immunohistochemistry with antibody against Ki-67. RESULTS: Negative expression of p21, p27, and p57 was demonstrated in 45.9%, 65.1%, and 57.8% of cancer tissues, respectively. Negative expression of p21 correlated with larger tumor size, poor differentiation, depth of invasion, lymph node metastasis and advanced TNM stage (p=0.048, 0.041, 0.001, 0.005, and 0.001 respectively). Negative expression of p21 correlated with poor survival (p=0.037). Tumors with negative p21 expression had higher Ki-67 expression than those with positive p21 expression (p=0.024). No significant correlation could be observed between status of p27 and p57 expression and various clinicopathological parameters including survival and tumor cell proliferation. CONCLUSIONS: These results suggest that negative expression of p21 may play an important role in carcinogenesis by stimulating tumor cell proliferation, and may help in predicting the prognosis of gastric cancer.

A Case of Osteoclast-like Giant Cell Tumor of the Pancreas with Ductal Adenocarcinoma: Histopathological, Immunohistochemical, Ultrastructural and Molecular Biological Studies

Osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, of which the histiogenesis remains controversial. A 63-yr-old woman was hospitalized for evaluation of epigastric pain. An abdominal computerized tomography revealed the presence of a large cystic mass, arising from the tail of pancreas. A distal pancreatectomy with splenectomy was performed. Histologically, the tumor was composed of mononuclear stromal cells intermingled with osteclast-like giant cells. In addition, there was a small area of moderately to well differentiated ductal adenocarcinoma. The final pathologic diagnosis was osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma. Here, we describe the histopathological, immunohistochemical, ultrastructural and molecular biological findings of this tumor with review of the literature pertaining to this condition.

A Case of Primary Pure Squamous Cell Carcinoma of the Stomach / 대한소화기내시경학회지

Primary pure squamous cell carcinoma of the stomach is extremely rare. To date, five cases have been reported in Korea. We report an additional case of a 71-year-old male with pure squamous cell carcinoma of the stomach. Upper gastrointestinal endoscopy showed a large ulceroinfiltrating mass with irregular margin in the body of the stomach. Histologic examination of biopsy specimen confirmed moderately differentiated squamous cell carcinoma. Abdominal computed tomography showed metastatic mass in the left hepatic lobe, pancreatic body and tail. Despite the combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil, the patient died from wide spread metastasis.

A Case of Duodenal Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor of the gastrointestinal tract. GISTs are most common in the stomach, followed by small intestine, colon and rectum, and esophagus. We report a case of duodenal GIST presenting with gastrointestinal bleeding in a 53-year-old male. Upper gastrointestinal endoscopy revealed a protruded mass with central ulceration on the second portion of the duodenum. Spontaneous spurting blood was encountered from the central ulcer of the mass. Abdominal computed tomography scan and celiac angiography revealed hypervascular tumor, located in the second portion of the duodenum. Laparotomy with wedge resection was performed. Histological and immunohistochemical studies on resected specimen revealed a duodenal GIST of a combined smooth muscle and neural type.

A Clinical Study On Liver Abscess For Recent 15 Years In Gwangju-Chonnam Province / 대한내과학회지

BACKGROUND: The mortality of liver abscess markedly decreased because of the improvement of diagnosis and treatment modalities, however, the incidence is still high and various complications have been developed. Our study was to clarify the clinical features, complications, changing patterns of causative organisms and predicting parameters for development of complications in liver abscess. METHODS: We reviewed 197 cases of pyogenic and amebic liver abscesses treated at Chonnam University Hospital from January 1989 to March 2003. These cases were divided into subgroups by time of occurrence, and the data was reviewed comparatively. Predicting parameters for development of complications in recent 5 years were also analyzed. RESULTS: The male to female ratio was 1.59 : 1 and the peak incidence age of liver abscess was in the 7th decade. There were no significant interval changes in incidence of pyogenic liver abscess (96.4%) and amebic liver abscess (3.6%) from January 1989 to March 2003. The most common infection route in pyogenic liver abscess was biliary tract (45.8%), followed by cryptogenic cause (44.2%), pulmonary disease (2.6%), hematogenous (2.1%) and abdominal trauma (1.5%). The pus culture came out positive in 50.4% of pyogenic liver abscess. Klebsiella pneumoniae was the most commonly isolated organism in pyogenic liver abscess (32.9%). The significant predicting parameters for development of complications were age (>or=60), systemic inflammatory response syndrome (SIRS, >or=2 factors), C-reactive protein (CRP, >or=8 mg/dL), bilirubin (>or=2 mg/dL), albumin (or=200 IU/L, p<0.05). CONCLUSION: There were no significant interval changes in etiologies and predisposing conditions of liver abscess in Gwangju-Chonnam Province from January 1989 to March 2003. Age, SIRS, CRP, bilirubin, albumin and AST were considered as significant predicting parameters for development of complications in liver abscess.

Clinical Effectiveness of Transcatheter Arterial Embolization for Acute Upper and Lower Non-variceal Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Although the initial rate of hemostasis achieved by endoscopic treatment for acute non-variceal gastrointestinal bleeding (NVGIB) is high, recurrent or persistent bleeding occurs in 10% to 25% of the patients. The aim of this study was to assess the efficacy and safety of transcatheter arterial embolization (TAE) in patients with acute upper and lower NVGIB who could not be managed by endoscopic treatment. METHODS: A retrospective analysis of the clinical data was done in 43 patients (M/F: 26/17, mean age: 60 years) whom underwent angiography or TAE for acute upper and lower NVGIB between January 1998 and December 2003. Among 43 patients, 18 had upper NVGIB, 19 had lower NVGIB, and 6 had obscure gastrointestinal bleeding. Demographic characteristics and outcome parameters including the rates of hemostasis, in-hospital death, and complications were analyzed. RESULTS: Thirty-four patients underwent TAE while 9 patients underwent angiography. TAE was used as the first line treatment in 17 patients and as the second line treatment in others. Hemostasis was achieved in 29 of 34 patients (85.3%) by TAE. According to the site of bleeding, hemostasis was achieved in 14 of 17 patients (82.4%) with upper NVGIB and in 15 of 17 patients (88.2%) with lower NVGIB. There was no significant angiography or TAE-related complications such as bowel ischemia or infarction except a hematoma on the angiography site in one patient. CONCLUSIONS: TAE is effective and safe in patients with acute upper or lower NVGIB who cannot be managed by endoscopic treatment.