Flank Pain is a leading indicator of renal and upper urinary tract disease or trauma, and rarely results from pelvic congestion syndrome. Although pelvic congestion syndrome occurs commonly in multi-parous women, pelvic congestion syndrome should also be considered as the cause of flank pain in an adolescent girl. We report the first case of pelvic congestion syndrome presenting with chronic left flank pain in an adolescent girl.
Adolescent* ; Estrogens, Conjugated (USP)* ; Female* ; Flank Pain* ; Humans ; Urologic Diseases

The purpose of this research was to understand the current status of hospital information system(HIS) in Korea. Our main interests were when hospitals adopted each component of HIS and how they developed and managed the system. Structured questionnaires were applied to the department of each hospital in charge of managing information system. All hospitals, 276 in 1997, were included, and among them 93.5% responded. The HIS has been rapidly developed to include medical record management system, order communication system, laboratory information system, and picture archiving and communication system. The software for HIS was developed extramurally in more than half of all hospitals, and usually hardware was secured by buying than leasing them. Recently more hospitals has separated departments for His as independent units in hospital.
Clinical Laboratory Information Systems ; Hospital Information Systems* ; Information Systems ; Korea ; Medical Records ; Surveys and Questionnaires

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and personal dicision of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.
6-Mercaptopurine/analogs & derivatives/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Antibodies, Monoclonal/therapeutic use ; Antimetabolites, Antineoplastic/therapeutic use ; Budesonide/therapeutic use ; Crohn Disease/*drug therapy/pathology ; Databases, Factual ; Female ; Fistula/therapy ; Humans ; Intestinal Perforation/surgery/therapy ; Male ; Mesalamine/therapeutic use ; Methotrexate/therapeutic use ; Prednisolone/therapeutic use ; Pregnancy ; Recurrence ; Risk Factors ; Severity of Illness Index ; Sulfasalazine/therapeutic use

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and personal dicision of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.
Anal Canal ; Constriction, Pathologic ; Crohn Disease ; Female ; Fistula ; Gastrointestinal Tract ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Korea ; Lactation ; Mouth ; Pregnancy ; Prevalence ; Recurrence

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and personal dicision of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.
Anal Canal ; Constriction, Pathologic ; Crohn Disease ; Female ; Fistula ; Gastrointestinal Tract ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Korea ; Lactation ; Mouth ; Pregnancy ; Prevalence ; Recurrence

Video capsule endoscopy (VCE) is an ingestible video camera that transmits high-quality images of the small intestinal mucosa. This makes the small intestine more readily accessible to physicians investigating the presence of small bowel disorders, such as Crohn's disease (CD). Although VCE is frequently performed in Korea, there are no evidence-based guidelines on the appropriate use of VCE in the diagnosis of CD. To provide accurate information and suggest correct testing approaches for small bowel diseases, the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy, developed guidelines on VCE. Teams were set up to develop guidelines on VCE. Four areas were selected: diagnosis of obscure gastrointestinal bleeding, small bowel preparation for VCE, diagnosis of CD, and diagnosis of small bowel tumors. Three key questions were selected regarding the role of VCE in CD. In preparing these guidelines, a systematic literature search, evaluation, selection, and meta-analysis were performed. After writing a draft of the guidelines, the opinions of various experts were solicited before producing the final document. These guidelines are expected to play a role in the diagnosis of CD. They will need to be updated as new data and evidence become available.
Capsule Endoscopy* ; Crohn Disease* ; Diagnosis ; Endoscopy, Gastrointestinal ; Hemorrhage ; Intestinal Mucosa ; Intestine, Small ; Korea ; Writing

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from mouth to anus and is associated with serious complications such as bowel stricture, perforation, abscess, and fistula formation. The incidence and prevalence rates of CD in Korea are still low compared with those of Western countries, but are rapidly increasing during the past decades. The diagnosis of CD is a challenging issue in some clinical situations and it is often difficult to differentiate CD from intestinal tuberculosis or Beh?et's enterocolitis which are more prevalent in Korea than in Western countries. Therefore, IBD Study Group of KASID has set out to establish the diagnostic guideline of CD in Korea. There is no single gold standard for the diagnosis of CD and diagnosis is made by clinical evaluation including detailed history, physical examination, and combination of endoscopic findings, histology, radiologic findings and laboratory investigations. The typical symptoms of CD are abdominal pain, diarrhea, and weight loss especially in late adolescence or early adulthood. Initial laboratory investigations include CBC, C-reactive protein, and serum chemistry. Ileocolonoscopy and biopsies are recommended as the first line procedures to establish the diagnosis. Typical endoscopic findings of CD are non-continuous distribution of longitudinal ulcers, cobblestone mucosal appearance, and aphthous ulcerations arranged in a longitudinal fashion. The evaluation of small bowel with small bowel follow-through is recommended for suspected CD to establish diagnosis and to determine the extent and location of disease. Focal and patchy chronic inflammation, focal crypt irregularity, and non-caseating granulomas are usual microscopic features of CD. This is the first Korean diagnostic guideline for CD and needs revision with further data on CD in Koreans.
Biopsy ; Blood Chemical Analysis ; Colonoscopy ; Crohn Disease/classification/*diagnosis/epidemiology ; Diagnostic Imaging ; Hematologic Tests ; Humans ; Remission, Spontaneous ; Severity of Illness Index

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; C-Reactive Protein ; Enalapril ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Peptidyl-Dipeptidase A ; Plasma ; Prospective Studies ; Renin-Angiotensin System ; Stroke Volume ; Tetrazoles ; Valine ; Valsartan

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; C-Reactive Protein ; Enalapril ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Peptidyl-Dipeptidase A ; Plasma ; Prospective Studies ; Renin-Angiotensin System ; Stroke Volume ; Tetrazoles ; Valine ; Valsartan

Background/Aims: Little is known about the clinical course of hepatitis B virus (HBV)-infected patients undergoing anti-tumor necrosis factor α (TNF-α) therapy for inflammatory bowel disease (IBD). We aimed to investigate the clinical course of HBV infection and IBD and to analyze liver dysfunction risks in patients undergoing anti-TNF-α therapy. Methods: This retrospective multinational study involved multiple centers in Korea, China, Tai-wan, and Japan. We enrolled IBD patients with chronic or resolved HBV infection, who received anti-TNF-α therapy. The patients’ medical records were reviewed, and data were collected using a web-based case report form. Results: Overall, 191 patients (77 ulcerative colitis and 114 Crohn’s disease) were included, 28.3% of whom received prophylactic antivirals. During a median follow-up duration of 32.4 months, 7.3% of patients experienced liver dysfunction due to HBV reactivation. Among patients with chronic HBV infection, the proportion experiencing liver dysfunction was significantly higher in the non-prophylaxis group (26% vs 8%, p=0.02). Liver dysfunction occurred in one patient with resolved HBV infection. Antiviral prophylaxis was independently associated with an 84% reduction in liver dysfunction risk in patients with chronic HBV infection (odds ratio, 0.16; 95% confidence interval, 0.04 to 0.66; p=0.01). The clinical course of IBD was not associated with liver dysfunction or the administration of antiviral prophylaxis. Conclusions Liver dysfunction due to HBV reactivation can occur in HBV-infected IBD patients treated with anti-TNF-α agents. Careful monitoring is needed in these patients, and antivirals should be administered, especially to those with chronic HBV infection.