No abstract available.
Abdominal Pain* ; Child* ; Gastritis* ; Helicobacter pylori* ; Helicobacter* ; Humans

We report four cases of toxic hepatitis that occurred after taking a decoction made by boiling down the root of Dictamnus dasycarpus. The four patients had a median age of 60 years, common symptoms of jaundice and general weakness, and stated that they had not consumed alcohol for at least 5 years. The markers of hepatitis A, B, and C were all negative in the patients. Abdominal ultrasonography revealed common bile ducts with normal diameters. Two of the cases were a mother and daughter, and the other two were sporadic. All of them had consumed a decoction made by boiling down the root of Dictamnus dasycarpus five or six times daily until several days before admission. Dictamnus dasycarpus induced liver injury presenting with a benign course lasting less than 1 month after cessation of the causative agent. We suggest that this natural product can cause acute hepatitis in rural areas.
Acute Disease ; Aged ; Dictamnus/*adverse effects ; Female ; Hepatitis, Toxic/*diagnosis/etiology/ultrasonography ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Plant Roots/*adverse effects

Macrolides antibiotics synthesized by Streptomyces strains are prescribed widely and seldom produce hypersensitivity reactions, even when administered topically. Consequently, they are considered very safe drugs. We report the case of a 32.year.old woman who developed anaphylactic shock after ingesting erythromycin, which she had taken twice before. The previous exposure to erythromycin, clinical findings, and a positive skin intradermal test with erythromycin (10 mg/mL) support the postulate that anaphylaxis was induced by erythromycin.
Anaphylaxis ; Anti-Bacterial Agents ; Erythromycin ; Female ; Humans ; Hypersensitivity ; Intradermal Tests ; Macrolides ; Skin ; Skin Tests ; Streptomyces

BACKGROUND/AIMS: Newly developed and potent antiviral agents suffer from the problem of drug resistance. Multidrug resistance is a major impediment in the treatment of patients with chronic hepatitis B (CHB). In line with American Association for the Study of Liver Diseases guidelines, adefovir dipivoxil (ADV) add-on therapy is recommended in the case of lamivudine resistance, while tenofovir disoproxil fumarate (TDF) is recommended for ADV or entecavir (ETV) resistance. TDF is currently not available in Korea. ADV+ETV combination therapy may be a viable alternative to TDF in patients with either ADV or ETV resistance. However, the efficacy of ADV+ETV combination therapy in patients with CHB and multidrug resistance is unclear. This study investigated the efficacy of ADV+ETV combination therapy in patients with multidrug resistance. METHODS: Twenty-five patients were enrolled and were administered ADV+ETV combination therapy for at least 6 months. Blood was drawn at baseline and at 3, 6, 9, and 12 months after commencing treatment, and the following blood parameters were analyzed: alanine transaminase, hepatitis B e-antigen (HBeAg), anti-hepatitis B e-antigen, and hepatitis B virus (HBV) DNA levels. The initial virological response (IVR) was defined as an HBV DNA level of <4 log10 copies/mL after 6 months of combination therapy. RESULTS: The IVR rate was 76%. The proportion of patients with a high viral load (> or =5.0 log) dropped from 76% at baseline to only 5% after 6 months of treatment. The biochemical response rate during the first 6 months was 71%. HBeAg was lost in 2 patients (10%). CONCLUSIONS: ADV+ETV combination therapy induced a good IVR in CHB patients who were refractory to more than 2 antiviral agents. This regimen may be a good alternative to TDF in Korea, where that drug is not available.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Drug Resistance, Multiple, Viral ; Drug Therapy, Combination ; Female ; Genotype ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B Antibodies/blood ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Nucleosides/therapeutic use ; Phosphonic Acids/*therapeutic use

BACKGROUND AND OBJECTIVES: Myocardial ruptures, including: ventricular free wall rupture (VFWR) and ventricular septal rupture (VSR), after acute myocardial infarction (AMI), are fatal complications. Recently, ubiquitous use of echocardiographs, and other imaging techniques, allows us to diagnose these complications in the antemortem period. Thus, this study retrospectively evaluated the clinical characteristics of patients with myocardial ruptures following AMI. SUBJECTS AND METHODS: 620 patients that had had AMIs, between January 1999 and June 2001, were analysed for the purpose of this study. Myocardial ruptures were diagnosed from their clinical symptoms, echocardiographs, and pericardiocenteses or cardiac catheterizations. The clinical characteristics of the patients with myocardial ruptures (n=15) were compared to those patients with myocardial infarction, without rupture (n=397), from their Q waves. RESULTS: The patients with myocardial ruptures were older than those without (67+/-9.7 years vs 60+/-11.7 years, p<0.05), and ruptures were more frequent in women (66.7% vs 25.2%, p<0.001). The frequency of systemic hypertension, DM, and the distribution of infarction sites were similar in both groups. Also, clinical characteristics between patients with VFWR, and those with VSR, were similar. Of the patients with VFWR (n=8), 7 suddenly died, and 1 was alive directly following surgery. Of the patients with VSR (n=7), 4 died. CONCLUSION: Myocardial rupture is a fatal complication of AMI, which is more frequent in women, and the patients with ruptures, in our study, were older than those without.
Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Rupture ; Humans ; Hypertension ; Infarction ; Myocardial Infarction* ; Pericardiocentesis ; Retrospective Studies ; Rupture* ; Ventricular Septal Rupture

A patient, with severe chest pain and isolated ST segment elevation, was evaluated in order to differentiate ischemic heart disease, such as acute myocardial infarction. A fishhook was incidentally found during coronary angiography, chest CT and esophagoscopy. With this information, the patient was re-interviewed, and it was learned that the patient had swallowed the fishhook from cooked fish after fishing trip. The patient was diagnosed as traumatic acute pericarditis with acute mediastinitis, associated with esophageal and pericardial perforation. The patient was successfully treated by surgical treatment drainage and adequate antibiotic use. We report a case of traumatic acute pericarditis, which mimicked an acute myocardial infarction, with a review of the literature.
Chest Pain ; Coronary Angiography ; Deglutition* ; Drainage ; Esophagoscopy ; Humans ; Mediastinitis ; Myocardial Infarction* ; Myocardial Ischemia ; Pericarditis* ; Tomography, X-Ray Computed

This study outlines the current status of the autopsy practice and the medical records for autopsies at the Department of Pathology, Seoul National University Hospital. Total number of autopsy cases from 1954 to 1995 was 3,131. Adults aged over 17 were 371 cases and children were 2,515 cases. The demographic data in 245 cases was not available. The number of adult autopsies and its proportion among total number of autopsies during 10-year periods decreased from 144 cases (40%) during the 10-year-period from 1956 to 52 cases (3%) during the 10-year-period from 1986. The number of children cases during the same period groups increased slightly from 210 cases (58%) to 393 cases (25%). But the number of fetal cases increased rapidly from 7 cases (2%) to 1,146 cases (72%). Among fetal autopsies the proportion of fetuses died earlier than 24 weeks of gestation increased and this figure exceeds that of fetuses that died later than 24 weeks of gestation from 1992. Forty percent of the cases were submitted from the clinical departments of the Seoul National University Hospital but the remainders were referred from 73 hospitals. Final autopsy diagnoses were analysed according to the Korean Standard Classification of Disease (KCD)-3 coding system and by searching key words for all cases. Common diagnoses as coded among cases from 1990 were P9, P0, P2, Q2 and Q0. Common diseases by key words for adult cases were liver disease, tuberculosis and pneumonia. Common diseases for children cases were pneumonia, hyaline membrane disease, meningitis and tuberculosis. Through this study we could show the importance of autopsy services for fetuses. We could also establish a regular registration system for autopsies at general hospitals.
Adult ; Autopsy* ; Child ; Classification ; Clinical Coding ; Diagnosis ; Epidemiology ; Fetus ; Hospitals, General ; Humans ; Hyaline Membrane Disease ; Infant, Newborn ; Liver Diseases ; Medical Records ; Meningitis ; Pathology ; Pneumonia ; Pregnancy ; Seoul* ; Tuberculosis

BACKGROUND AND OBJECTIVES: Cancer invasion of the laryngeal cartilage is mainly found in the ossified portion of cartilage and contraindication for conservation surgery of laryngopharyngeal cancer. Thus, it is an important factor to consider in planning the management of laryngopharyngeal cancer. Computed tomographic (CT) scan is an useful tool for the evaluation of laryngopharyngeal cancer, but it is difficult to distinguish cancer invasion from non-ossified cartilage regions by the CT scan. Knowledge of the precise ossification pattern will be useful to determine the cancer invasion of laryngeal cartilage. The purposes of this study include ossi6cation pattern according to age, symmetry of ossification and incidence of bone marrow formation. MATERIALS AND METHODS: Fifty-three cases of normal laryngeal CT scans which were reviewed by two radiologists. They were all males, ranging in the ages from 40 to 69 (mean age 53). Ossification degree (%) was measured from the inferior cornu in the thyroid cartilage and the superior border of the posterior lamina in the cricoid cartilage. Age relation and symmetry of ossification and incidence of bone marrow formation were evaluated. RESULTS: There were no correlation between age and degree of laryngeal cartilage ossification (p> 0.05). But there was symmetry and definite pattern of ossification. Symmetry of ossification was 84.9% in the thyroid cartilage. Incidence of bone marrow formation was 60.6% in the thyroid cartilage and 82.8% in the cricoid cartilage. CONCLUSION: This study reveals that there is no ossification-age relationship, but the symmetry and the definite pattern of ossification in the laryngeal cartilage are useful clues in determining the cancer invasion on CT scan.
Bone Marrow ; Cartilage ; Cricoid Cartilage ; Humans ; Incidence ; Laryngeal Cartilages* ; Male ; Thyroid Cartilage ; Tomography, X-Ray Computed*

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms