No abstract available.
Dysentery, Bacillary*

It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

No abstract available.
Endoscopes

The prevalence of hospital malnutrition is still high in patients with digestive diseases, especially for those suffering from cancer and bowel diseases which cause malabsorption. It is well known that malnutrition is associated with delayed wound healing, impaired immunity, infection, increased complication, and poor convalenscence. Recently, nutrition screening and assessment by nutrition support team has become essential for nutrition management, and gastroenterologists comprise a dominant member of the nutrition support team. In critically ill patients and older people with chronic disease, nutritional support with enteral feeding and early feeding contributes to recovery and rehabilitation of patients. Securing enteral feeding routes, such as feeding tube insertion and placement of percutaneous endoscopic gastrostomy/jejunostomy, is an essential part of nutrition care that should be accomplished by gastroenterologists without much difficulty. It will also be necessary to recommend nutrition care as one of the clinical routines in gastrointestinal clinical practices. Therefore, education on nutrition care is strongly required as a part of gastroenterologist's training.
Critical Illness ; Digestive System Diseases/*pathology ; Enteral Nutrition ; Humans ; Malnutrition/*prevention & control ; *Nutritional Support

No abstract availble.
Adenoma/diagnosis/epidemiology/*etiology ; Anticipation, Genetic ; Colonic Neoplasms/diagnosis/epidemiology/*etiology ; Humans ; *Insulin Resistance ; Obesity/*complications/epidemiology ; Risk Factors

OBJECTIVES: The causes of benign esophageal stricture were postoperative, corrosive, peptic and after esophageal sclerotheraphy, etc. The patients mainly suffered from dysphagia and insufficient nutrition. Recently, balloon and bougie dilatation were introduced to these patients. This study was performed to evaluate the effectiveness and safety of both procedures in different types of strictures METHODS: 32 patients who presented dysphagia enrolled from March 1996 to August 1997 who visited Pusan National University Hospital. Balloon dilatation was performed on 22 patients and bougie on 10 patients. RESULTS: 1) The causes of stricture were postoperative (18 cases), corrosive (10 cases), hypertensive LES (2 cases), peptic (1 case) and web (1 case). 2) Overall cure rate was 59% in bougie dilatation and 40% in balloon dilatation 3) The cure rate of postopertive stricture was 59% which is significantly higher than that of corrosive stricture (27%), and cure rate of hypertensive LES, peptic stricture and web was 100%. 4) The cure rate of corrosive stricture was significantly higher on bougie dilatation than balloon dilatation. 5) The cure rate of postoperative stricture was similiar between balloon and bougie dilatation 6) The length of stricture was inversly affected on cure rate of both dilatation procedures. 7) Overall complication was 5.6% and similiar between balloon and bougie dilatation. CONCLUSIONS: These results suggested that bougie dilatation was recommended on corrosive stricture and balloon dilatation on postopertive stricture
Busan ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation* ; Esophageal Stenosis* ; Humans

Secondary amyloidosis occurs in patients with chronic inflammatory diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The major therapeutic approach to secondary amyloidosis involves controlling the underlying inflammatory disease. Tumor necrosis factor-alpha (TNF-alpha) inhibitors have revolutionized the treatment of rheumatic diseases; in many cases dramatic clinical improvement of secondary amyloidosis due to AS has been observed in response to treatment with these agents. However, the development of secondary amyloidosis associated with AS refractory to treatment with TNF-alpha inhibitors has been infrequently reported. Here, we described a case of a 37-year-old male patient with longstanding AS who was diagnosed with secondary amyloidosis due to high disease activity despite treatment with etanercept, adalimumab and infliximab.
Adult ; Amyloidosis* ; Arthritis, Rheumatoid ; Humans ; Male ; Rheumatic Diseases ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha* ; Adalimumab ; Infliximab ; Etanercept

BACKGROUND/AIMS: Determining the depth of tumor invasion and the presence of regional lymph node metastasis is important in deciding therapeutic strategies. We aimed to evaluate the diagnostic accuracy of EUS in detecting the depth of tumor invasion and regional lymph node metastasis. MATERIALS AND METHODS: A total of 141 consecutive patients underwent preoperative evaluation using EUS, CT, and PET CT from November 2005 to June 2009 in Pusan National University Hospital. We reviewed the patients' medical records and compared EUS and pathologic findings. RESULTS: A total of 59 patients were included in the final analysis. The overall accuracy of EUS in predicting the correct T stage was 79.7% (95% CI, 66.8~88.6%). EUS accurately predicted T stage in 93.2% (95% CI, 82.7~97.8%) of T1 tumors, 79.7% (95% CI, 66.8~88.6%) of T2 tumors, and 86.4% (95% CI, 74.5~93.6%) of T3 tumors. Overall, EUS accurately predicted N stage in 83.1% of cases. EUS correctly predicted N stage in 91.4% of N0 tumors and 70.8% of N1 tumors. CONCLUSIONS: Overall accuracy of EUS for the T and N staging of esophageal cancer was high. Thus, EUS is a useful diagnostic modality in determining the initial stage of esophageal cancer.
Busan ; Diagnosis ; Endosonography* ; Esophageal Neoplasms* ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

BACKGROUND: In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. METHODS: The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. RESULTS: In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. CONCLUSIONS: This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.
Colitis ; Colitis, Ulcerative* ; Colon ; Cytoplasm ; Glycoconjugates ; Glycosylation ; Goblet Cells ; Humans ; Lectins ; Mucins* ; Mucous Membrane* ; Mucus ; Peroxidase ; Phenobarbital ; Sialomucins ; Ulcer*