BACKGROUNDS/AIM: Patients with liver cinhosis suffer from indigestion, abdominal discamfort, or dysphagia, but causes of these symptoms are unknown. Ascites, esophageal varix, fiequency of variceal ligatian, and poor residual liver function are considered as the causes, despite no consistent result. There has been no report about pogestaone known to decrease the pressure of lower esophageal sphincter at pregnancy in cirrhotic patients. We evaluated the factors affecting gastroesaphageal reflux and esophageal matility disarder in patients with cirrhosis. SUBJECTS AND METHODS: Between May 1997 and September 1998, 24 cinhotic patients(18 men and 6 women, mean age 51.8+/-9.7yr) were enrolloed. All patients were subjected to abdominal ultrasonography, esophageal manometry, ambulatary 24hr esophageal pH monitoring, esophagogastroduodenoscopy, and serum levels of esttogen and pogesterone. After ascites was conttolled, these studies were performed again in 5 patients. RESULTS: 1) Thae was no correlation between amount of ascites and esophageal motility disceder, gastroesophageal reflux. But, after ascites was controlled, lower esaphageal pressure tended to increase. 2) There was no correlation between grade of esophageal varix and esophageal manometric abnormalities. 3) There was inverse carrelation between frequency of esophageal variceal ligation and upper esophageal pessure. 4) There was invase correlation between lower esophageal pressure and serum level of esttogen, progesterone. 5) There was no correlation between severity of liver cirrhosis, age and esophageal motility disceders, pstroesophageal reflux. CONCLUSIONS: Factors affecting esophageal motility disorders in cirrhatic patients are ammout of ascites, frequency of esophageal variceal ligations, and serum levels of estrogen and progesterrone.
Ascites ; Deglutition Disorders ; Dyspepsia ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Esophageal Motility Disorders* ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Estrogens ; Female ; Fibrosis ; Gastroesophageal Reflux* ; Humans ; Ligation ; Liver Cirrhosis* ; Liver* ; Male ; Manometry ; Pregnancy ; Progesterone ; Ultrasonography

Henoch-Schonlein Purpura (HSP) is a systemic vasculitis involving small vessels with the deposition of immune complexes containing IgA and C3, which is characterized by associated skin, joint, renal, and gastrointestinal manifestations. Although there were several causes such as autoimmunity, infection, and drugs, it also can be presented as a form of vasculitidies associated with malignancies. We report a case of HSP developed during treatment for non-small cell lung cancer in a 66-year-old man. Multiple purpuric skin lesions occurred in both legs after the first cycle of chemotherapy, which was diagnosed as HSP by clinical and pathologic examinations. Due to the itching sensation, topical steroid was applied and the patient was improved 3 weeks later without a scheduled change in chemotherapy.
Aged ; Antigen-Antibody Complex ; Autoimmunity ; Carcinoma, Non-Small-Cell Lung ; Humans ; Immunoglobulin A ; Joints ; Leg ; Lung ; Lung Neoplasms ; Pruritus ; Purpura, Schoenlein-Henoch ; Sensation ; Skin ; Systemic Vasculitis ; Vasculitis

Background: We assessed the myocardial infarction (MI), stroke, and all-cause death risks during follow-up according to the low-density lipoprotein cholesterol (LDL-C) levels among older adults. Methods: The Korean National Health Insurance Service datasets (2002 to 2020) were used for this population-based cohort study. The hazards of MI, stroke, and all-cause mortality during follow-up were analyzed according to LDL-C level in individuals aged ≥65 years without baseline cardiovascular diseases (n=1,391,616). Results: During a mean 7.55 years, 52,753 MIs developed; 84,224 strokes occurred over a mean 7.47 years. After a mean 8.50 years, 233,963 died. A decrease in LDL-C was associated with lower hazards of MI and stroke. The decreased hazard of stroke in lower LDL-C was more pronounced in statin users, and individuals with diabetes or obesity. The hazard of all-cause death during follow-up showed an inverted J-shaped pattern according to the LDL-C levels. However, the paradoxically increased hazard of mortality during follow-up in lower LDL-C was attenuated in statin users and individuals with diabetes, hypertension, or obesity. In statin users, lower LDL-C was associated with a decreased hazard of mortality during follow-up. Conclusion Among the elderly, lower LDL-C was associated with decreased risks of MI and stroke. Lower LDL-C achieved by statins in the elderly was associated with a decreased risk of all-cause death during follow-up, suggesting that LDL-C paradox for the premature death risk in the elderly should not be applied to statin users. Intensive statin therapy should not be hesitated for older adults with cardiovascular risk factors including diabetes.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.