BACKGROUND/AIMS: The success of Helicobacter pylori eradication is limited by antibiotic resistances, and the primary resistance to metranidazole seems to be high. In this study, the frequency af metronidazole resistance and the eradication rate in metronidazole-resistant H. pylori strain was evaluated. METHODS: Sixty-eight patients were tested for metronidazole resistance using microdilution broth, the E test and disk diffusion method. Twenty-two patients were treated for 14 days with amoxicilline 2000 mg, metronidazole 750 mg, and tripotassium dicitrate bismuth 1200 mg. RESULTS: Metronida-zole resistance was 46% (31/68). The eradication rates for H. pylori was 91.7% in patients with metronidazole-sensistive strains and 70% in patients with metronidazole-resistant strains. CONCLUSIONS: Metronidazole resistance was high (46%) in Korea, however, triple therapy was an efficient method of eradicating H. pylori in both metronidazole sensitive and resistant strains.
Amoxicillin ; Bismuth ; Diffusion ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Metronidazole* ; Peptic Ulcer

BACKGROUND/AIMS: Our previous studies of ionization and solubility of unconjugated bilirubin (UCB) yielded inappropriately large differences between the two carboxylic pK'a values of UCB. These data, however, were not ideal due to crystal effects, matastability, impurities of the bilirubin, and imprecision of analyses at low UCB. METHODS: The sodium salt of taurocholate (TC) was purified and dissolved in water to 100 mM. Chloroform (CHCl3) was purified by vacuum distillation. Buffers used were: citrate from pH 4 to 6, phosphate from pH 6 to 8, and borate above pH 8. All had an ionic strength of 0.10. The problems were minimized by rapid solvent partition of UCB from CHCl3 into buffered aqueous NaCl, and a new, accurate assay of low UCB in the aqueous phase which was achieved by concentrating the UCB through back extraction into small volumes of CHCl3. RESULTS: In contrast with the crystal dissolution studies, the two pK'a value were similar. H2B0, not HB-, was the dominant UCB species in the pH range of bile (6.0 to 8.0). The aqueous solubilities of UCB were 90 to 98% less. Less than 0.01% of the bile salt partitioned into the CHCl3 phase and self-association of B= was negligible. UCB solubilities in 50 mM TC were 2 to 10% of those obtained by crystal dissolution, and, up to pH 7.9, were below the maximum UCB concentration in normal human bile. CONCLUSIONS: We suggest that the markedly increased binding of UCB with each ionization step is due to the disruption of the internal hydrogen bonds of the ionized carboxyl groups on interaction with the bile salt. We propose to extend the study of partition to determine the activity and the degradation products of calcium salts of unbound bilirubin fractions.
Bilirubin/*chemistry ; Chloroform ; English Abstract ; Hydrogen-Ion Concentration ; In Vitro ; Solubility ; Solvents ; Taurocholic Acid/*chemistry

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.
Duodenum ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hemorrhage* ; Humans ; Hypertension, Portal* ; Melena ; Portal Vein ; Prognosis ; Splenic Vein ; Splenorenal Shunt, Surgical ; Varicose Veins* ; Young Adult

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.
Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Stents ; Surgical Instruments

BACKGROUND: We evaluated the efficacy and toxicity of docetaxel plus cisplatin combination as first-line chemotherapy for advanced gastric cancer. METHODS: Patients with metastatic or recurrent gastric adenocarcinoma, performance score Adenocarcinoma ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Febrile Neutropenia ; Humans ; Neutropenia ; Stomach Neoplasms*

BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (> or = 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (> or = 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp > or = 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp > or = 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp > or = 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.
Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bone Marrow/*pathology ; Combined Modality Therapy ; Female ; *Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Multiple Myeloma/mortality/pathology/*therapy ; Plasma Cells/*pathology ; Predictive Value of Tests ; Retrospective Studies ; Transplantation, Autologous

The interstitial cells of Cajal (ICCs) are the pacemaker cells in gastrointestinal tract and generate electrical rhythmicity in gastrointestinal muscles. Therefore, ICC may be modulated by endogenous agents such as neurotransmitter, hormones, and prostaglandins (PGs). In the present study, we investigated the effects of prostaglandins, especially PGE2, on pacemaker currents in cultured ICCs from murine small intestine by using whole-cell patch clamp techniques. ICCs generated spontaneous slow waves under voltage-clamp conditions and showed a mean amplitude of -452+/-39 pA and frequency of 18+/-2 cycles/min (n=6). Treatments of the cells with PGE2 (1muM) decreased both the frequency and amplitude of the pacemaker currents and increased the resting currents in the outward direction. PGE2 had only inhibitory effects on pacemaker currents and this inhibitory effect was dose-dependent. For characterization of specific membrane EP receptor subtypes, involved in the effects of PGE2 on pacemaker currents in ICCs, EP receptor agonists were used: Butaprost (1muM), EP2 receptor agonist, reduced the spontaneous inward current frequency and amplitude in cultured ICCs (n=5). However sulprostone (1muM), a mixed EP1 and EP3 agonist, had no effects on the frequency, amplitude and resting currents of pacemaker currents (n=5). SQ-22536 (an inhibitor of adenylate cyclase; 100muM) and ODQ (an inhibitor of guanylate cyclase; 100muM) had no effects on PGE2 actions of pacemaker currents. These observations indicate that PGE2 alter directly the pacemaker currents in ICCs, and that the PGE2 receptor subtypes involved are the EP2 receptor, independent of cyclic AMP- and GMP-dependent pathway.
Adenylyl Cyclases ; Dinoprostone* ; Gastrointestinal Tract ; Guanylate Cyclase ; Interstitial Cells of Cajal* ; Intestine, Small* ; Membranes ; Muscles ; Neurotransmitter Agents ; Patch-Clamp Techniques ; Periodicity ; Prostaglandins

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Demography ; Eczema/pathology ; Face/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/pathology ; Male ; Middle Aged ; Psoriasis/pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Tinea/*diagnosis/microbiology ; Trichophyton/isolation & purification ; Young Adult