No abstract available.
Inflammation*

Death and dying is an ultimate process that every human being must experience. However, in these days we do not like to think or discuss about death and dying. Actually, hatred and denial is the usual feeling when we encounter death and dying. Dying is more than a biological occurrence. It is a human, social, and spiritual event, but the spiritual dimension of patients is too often neglected. Whether death is viewed as a "wall" or as a "door" can have significantly important consequences for how we live our lives. Near death experience is one of the excellent evidences to prove that there should be spiritual component being separated from the human physical body when we experience death. People have called it soul, spirit, or nonlocal consciousness. Caregivers need to recognize and acknowledge the spiritual component of patient care. Learning about death and dying helps us encounter death in ways that are meaningful for our own lives. Among the several learning tools, utilizing cinema with its audio and visual components can be one of the most powerful learning tools in death education.
*Attitude to Death ; Caregivers/education/psychology ; Health Personnel/*education/psychology ; Humans ; Psychodrama

The incidence of gastric cancer is very high in Japan, Korea, and China. Reducing the morbidity and mortality associated with gastric cancer requires early diagnosis, which can be facilitated by applying gastroscopy more frequently in high-risk groups. A strategy of population screening for gastric cancer is currently being adopted in Korea, Japan, and the Matsu region of Taiwan, but using different screening methods. In addition, the history of pepsinogen (PG) in research as a gastric cancer biomarker has varied, in that the use of serum levels of PGI and PGII and the PGI/PGII ratio as gastric cancer screening tools was introduced in Japan before 1990, but in Korea the first research results were only reported in 2008. This review first evaluates the physiology of PG, followed by the usefulness or limitations of serum PG testing with regard to the detection of gastric cancer. Finally, the factors affecting the efficacy of PG tests as a gastric cancer biomarker (i.e., Helicobacter pylori infection status, gender, histopathologic features, and cancer location and depth) are evaluated. It was found that the strategies used to increase the efficacy of PG tests should be individualized in each country according to the seroprevalence of H. pylori.
China ; Early Diagnosis ; Gastritis, Atrophic ; Gastroscopy ; Helicobacter pylori ; Incidence ; Japan ; Korea ; Mass Screening ; Pepsinogen A ; Seroepidemiologic Studies ; Stomach Neoplasms ; Taiwan

Carcinoid tumors originate from the neuroendocrine cells throughout the body and occur most frequently (74%) in the gastrointestinal tract. The clinical course is often indolent but can also be aggressive and resistant to therapy. Clinical manifestations are often vague or absent. Nevertheless, in approximately 10% of patients, the tumors secrete bioactive mediators which may engender various elements of characteristic carcinoid syndrome. In many instances, the neoplasms are detected incidentally at the time of surgery for other gastrointestinal disorders. The tendency for metastatic spread correlates with tumor size, and is substantially higher in lesions larger than 2.0 cm. Management of patients with carcinoid tumors requires an understanding of the disease process and a multimodality approach. Treatment consists of radical surgical excision of the tumor, although gastric (type I and II) and rectal carcinoids may be managed with local excision. However, advanced carcinoid tumor remains incurable.
*Carcinoid Tumor/diagnosis/therapy ; English Abstract ; *Gastrointestinal Neoplasms/diagnosis/therapy ; Humans

Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant inherited disease characterized by onset at a relatively early age, an excess of synchronous and metachronous tumors, and a variety of extracolorectal malignancies. Small bowel carcinoma reported, is included in the tumor spectrum of HNPCC, but the frequency of occurrence of this tumor in HNPCC patients is comparatively rare. In Korea, several cases of multiple primary cancers in patients with HNPCC have been reported, however, primary jejunal adenocarcinoma in conjunction with multiple primary cancers in the digestive tract has rarely been reported. Recently, we evaluated a 61-year-old male diagnosed with metachronous triple primary cancers of the jejunum, stomach, and colon. We report this rare case of primary jejunal adenocarcinoma as a part of metachronous triple cancers along with a review of the relevant literature.
Adenocarcinoma ; Colon ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Gastrointestinal Tract ; Humans ; Jejunal Neoplasms ; Jejunum ; Korea ; Male ; Microsatellite Instability ; Middle Aged ; Neoplasms, Multiple Primary ; Stomach

BACKGROUND/AIMS: Failure rates of Helicobacter pylori eradication treatment turned out to be exceeding 10%, causing recurrence of peptic ulcers. In the case of eradication failure, the Korean College of Helicobacter Research and Practice recommends quadruple therapy consisting of proton pump inhibitor, bismuth, tetracycline and metronidazole. Many reports regarding the eradication rates of quadruple therapy have been reported. However, most were limited by short follow-up periods. Hence, we evaluated the efficacy of the metronidazole containing quadruple therapy as a second line treatment from April, 1996 through July, 2004. METHODS: Sixty-three patients were enrolled. Treatment consisted of aforementioned quadruple therapy for 1 week. Four to six weeks after completion of treatment, biopsies and CLO tests were performed to detect the presence of H. pylori. The patients were then followed-up with upper endoscopy once every year. RESULTS: The efficacy of the quadruple therapy was 74.6% in intention-to-treat analysis and 83.9% in per protocol analysis. Eradication rates of the years 1996, 1999-2000, 2001, and 2002-2004 were 75.0%, 93.8%, 100%, and 72.7%, respectively. CONCLUSIONS: Our data can not reveal the evidence of decreasing trend for eradication rate quadruple therapy of H. pylori in 8 years. However, eradication rate of 72.7% in recent 2 years necessitates the development of more efficient eradication regimen.
Adult ; Antacids/administration & dosage ; Anti-Infective Agents/*administration & dosage ; Bismuth/administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Metronidazole/*administration & dosage ; Middle Aged ; Peptic Ulcer/microbiology ; Proton Pumps/antagonists & inhibitors ; Recurrence ; Tetracycline/administration & dosage

BACKGROUND: Physicians should try to achieve an optimal cure rate with their initial Helicobacter pylori (H. pylori) eradication therapy. Most physicians tend to use the same combination of drugs. There have been several reports that H. pylori infection in patients with peptic ulcer disease (PUD) is more likely to be cured than that in patients with non-ulcer dyspepsia (NUD). However, there is no report in Korea about that issue. The aim of this study was to evaluate the difference of eradication rates of H. pylori between patients with PUD and patients with NUD in Korea. METHODS: 297 patients who underwent upper gastrointestinal endoscopy, treated with seven-day triple therapy (proton pump inhibitor+amoxicillin+clarithromycin), and then performed follow-up urea breath test were reviewed retrospectively. RESULTS: 237 of 297 patients were PUD (98 gastric ulcers, 167 duodenal ulcers, 28 both ulcers), and 60 of 297 patients were NUD. The eradication rates were 85.7% (95% CI 80.6~89.6%) and 73.3% (95% CI 61.0~82.9%), respectively. The eradication rate of NUD group was lower than that of PUD group (p=0.032). CONCLUSIONS: Seven-day triple therapy showed lower eradication rate in patients with NUD than patients with PUD. Therefore, extention of treatment duration or use of more potent regimen may be needed for eradication of H. pylori in patients with NUD.
Breath Tests ; Duodenal Ulcer ; Dyspepsia* ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Peptic Ulcer* ; Retrospective Studies ; Stomach Ulcer ; Urea

The clinical manifestations of intestinal tuberculosis are non-specific. But, abdominal pain, low grade fever, weight loss, anorexia, and diarrhea are major symptoms of intestinal tuberculosis. Massive bleeding has been reported as a rare manifestation of intestinal tuberculosis. Massive hematochezia from intestinal tuberculosis has rarely been reported in the medical literature. Also, most of them were treated with anti-tuberculosis medication only or with surgery. We treated a case of intestinal tuberculosis presenting massive hematochezia with colonoscopic coagulation therapy and anti-tuberculosis medication. Here, we report a Korean man who presented with massive hematochezia from ileal tuberculosis and treated by endoscopic coagulation therapy.
Adult ; English Abstract ; Gastrointestinal Hemorrhage/*etiology/therapy ; *Hemostasis, Endoscopic ; Humans ; Ileal Diseases/*complications/diagnosis ; Male ; Tuberculosis, Gastrointestinal/*complications/diagnosis

Hepatocellular carcinomas (HCCs) in patients with Crohn's disease (CD) without underlying chronic hepatitis or liver cirrhosis are extremely rare. Previously reported cases occurred in patients who had developed CD at a young age and had been treated with immunosuppressive agents long-term. We herein report the first case of HCC in a 34-year-old patient with CD in Korea. The patient was treated with azathioprine for 14 years and had undergone repeated surgeries for CD. During the follow-up period, the patient was hospitalized for colon perforation and pericolic abscess formation. Computed tomography showed a liver mass, and HCC was diagnosed based on liver biopsy. The patient underwent right hemicolectomy for colon perforation and transcatheter arterial chemoembolization followed by radiofrequency ablation for the HCC. The present case is similar to previously reported cases with the exception of the liver pathology findings, which exhibited neither primary sclerosing cholangitis nor focal hepatic glycogenolysis.
Abscess ; Adult ; Azathioprine ; Biopsy ; Carcinoma, Hepatocellular* ; Catheter Ablation ; Cholangitis, Sclerosing ; Colon ; Crohn Disease* ; Follow-Up Studies ; Glycogenolysis ; Hepatitis, Chronic ; Humans ; Immunosuppressive Agents ; Korea ; Liver ; Liver Cirrhosis ; Pathology ; Infliximab

PURPOSE: Endoscopic mucosal resection (EMR) for early colorectal cancer (ECC) is increasing, but in Korea, little is known about long-term results of this treatment, especially in cases of incomplete resection. In this study, we reviewed the records of patients with ECC who underwent EMR, and we analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of EMR. METHODS: From May 1995 to December 2003, 45 patients underwent EMR for ECC at Seoul National University Hospital and followed for over 10 months. Their medical records were reviewed retrospectively. RESULTS: 45 patients with average age of 62 accounted for 47 ECCs out of 164 colon mucosal lesions. En-bloc resection rate was 78.7%. Submucosal invasion was found in 10 cases (21.3%). De novo cancer rate was 12.8% and relatively high in submucosal cancer (40%). The complete resection rate was 70.2%. During the mean follow-up period of 25 months, residual tumor growth occurred in 3 out of 14 incompletely resected cases, and that was related to piecemeal resection. One of those 3 patients underwent surgical resection due to submucosal invasion, and the other two were treated endoscopically with no additional abnormal findings. No tumor recurred in completely resected cases. CONCLUSIONS: A complete en-bloc resection was a prerequisite for prevention of tumor recurrence. In cases of incomplete resection, especially those performed using piecemeal method, within 3 months after the resection and within 1 year thereafter, follow-ups are essential for the early detection of tumor regrowth, and additional endoscopic treatment can achieve complete removal of residual tumor, despite initial incomplete resection.
Colon ; Colorectal Neoplasms* ; Follow-Up Studies* ; Humans ; Korea ; Medical Records ; Neoplasm, Residual ; Recurrence ; Retrospective Studies ; Seoul