A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.
Amyloidosis* ; Biopsy ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Diagnosis ; Diarrhea ; Gastrointestinal Tract ; Hematoma* ; Hemorrhage* ; Humans ; Lower Gastrointestinal Tract* ; Plaque, Amyloid ; Sepsis ; Ulcer

The effects of nitric oxide (NO) on inhibitory neurotransmitter receptors and some types of inhibitory receptors in dissociated rod bipolar cell (RBC) were investigated. In the whole cell voltage-clamping mode, the gamma-aminobutyric acid (GABA) activated current showed both sustained and transient components. GABA activated transient current was fully blocked by bicuculine, a GABAA receptor antagonist. The cis-4-aminocrotonic acid (CACA), a GABAC receptor agonist, evoked the sustained current that was not blocked by bicuculline (BIC). Glycine activated the transient current. These results indicate that the RBCs possess GABAA, GABAC, and glycine inhibitory receptors. Sodium nitroprusside (SNP), a NO analogue, reduced the currents activated by GABAA receptor only, however, did not reduce the currents activated by either GABAC or glycine receptors. This study signifies further that only NO depresses the fast inhibitory response activated by GABAA receptor in RBC. We, therefore, postulate that NO might depress the light-on/off transient inhibitory responses in RBCs in the rat retina.
Animals ; Bicuculline ; gamma-Aminobutyric Acid ; Glycine ; Nitric Oxide* ; Nitroprusside ; Rats* ; Receptors, GABA ; Receptors, Glycine ; Receptors, Neurotransmitter ; Retina*

BACKGROUND: In Korea, there has been a few medical studies on the relationship between religion and health. In future, active research is anticipated in this area. However, the validity and methods of performing religious inquiry should be tested beforehand. This study was designed to look into the attitudes of patients about religious inquiries by their physicians and to suggest better methods of religious approach to aid future researches on the effect of religion on health. METHODS: A survey was performed on the religious attitude among 177 patients among which 92 were randomly selected from an outpatient clinic of tertiary teaching hospitals and 85 from two local family practice offices on August, 2002. x2 test was used to verify the difference of results between the subgroups. RESULTS: As a whole, more than half of patients disagreed with religious inquiries by their physicians regardless of medical situation; however, there was a trend that a critical health reasons produced a higher percentage of patients accepting religious inquiry than in ordinary patients. There was no significant difference in answer between the two practice settings but a significant difference among the subgroups with strong religious belief and among those with a particular type of religion existed. CONCLUSION: The results of this study may be used as data on the method of approaching patients with religious inquiries for future studies on the relationship between religion and health, and also should encourage active researches on this subject.
Ambulatory Care Facilities ; Family Practice ; Hospitals, Teaching ; Humans ; Korea ; Religion

BACKGROUND AND AIMS: In the management of patients with extrahepatic bile duct carcinoma, histologic diagnosis is crucial to determine therapeutic modalities, to predict their outcomes, and to avoid an unnecessary operation. Though various methods were developed, none of them yielded satisfactory results. A combination of those methods was reported to yield superior sensitivity and specificity to a single method. To evaluate the diagnostic efficacy, endoscopic transpapillary biopsy (ETPB) and exfoliative bile aspiration cytology (BAC) was performed in 40 patients with extrahepatic bile duct carcinoma. METHODS: After visualization of the biliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), ETPB (n=40) and BAC (n=28) was done in one session with or without endoscopic sphincterotomy (EST) and the results of two methods were analyzed. RESULTS: The final diagnoses were made by surgical pathology and by clinical follow-ups of more than a year. The locations of the 40 bile duct carcinomas were in the upper area in 25, the middle in 14 and the lower in 1. ETPB was performed in all patients and BAC in 28 patients. The overall sensitivity of the ETPB was 65.0% (26/40). According to the morphology and location, the sensitivity of ETPB was 65.6% (11/32) for sclerotic, 60.0% (3/5) for papillary, and 66.7% (2/3) for the protruding type, and 68.0% (17/25) for the upper bile duct lesion, 64.3% (9/14) for the middle, and 0% (0/1) for the lower. The overall sensitivity of the BAC was 71.4% (20/28). According to the morphology and location, the sensitivity of BAC was 80.0% (16/20) for sclerotic, 20% (1/5) for papillary, and 100% (3/3) for the protruding type, and 82.4% (14/17) for the upper bile duct lesion and 54.5% (6/11) for the middle bile duct lesion. When the two tests were combined, the sensitivity rose to 96.4% (27/28). CONCLUSIONS: A combination of ETPB and BAC is useful in making a histologic diagnosis in patients with bile duct carcinoma.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Biliary Tract ; Biopsy* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Follow-Up Studies ; Humans ; Pathology, Surgical ; Sensitivity and Specificity ; Sphincterotomy, Endoscopic

BACKGROUND AND AIMS: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. METHODS: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28~86 years; M:F, 44:47), who underwent EST for choledocholithiasis. RESULTS: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (<30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24~134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. CONCLUSIONS: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence.
Bile Ducts ; Cholecystectomy ; Choledocholithiasis ; Gallbladder ; Hemorrhage ; Humans ; Pancreatitis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Sphincterotomy, Endoscopic