Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and is present in up to 60% of patients with NCCP in the West. In Korea, GERD is reported to cause 41% of cases of NCCP, after a reasonable cardiac evaluation. In a recent prospective study in Korea, an empirical trial of a proton pump inhibitor (PPI) was diagnostic for patients with GERD-related NCCP, as elsewhere in the world, and its optimal duration was reported to be at least two weeks in Korea, which is unlike the situation in the West. The report of Choi et al. showed that about 40% of NCCP in non-erosive reflux disease patients had esophageal disorders, including GERD and esophageal motility disorders, and that the standard dose or a low dose of PPI was effective for managing GERD-related NCCP. However, the retrospective nature of the study has limitations, such as an insufficient systemized symptom analysis and the standardization of the dose and interval of the PPI. A large-scale prospective study is needed to assess the accurate diagnosis and effective treatment of NCCP.
Chest Pain ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Korea ; Proton Pump Inhibitors ; Proton Pumps ; Thorax

No abstract available.
Aged* ; Humans

BACKGROUND/AIMS: Microsatellite instability (MSI) reflects the defect in DNA mismatch repair (MMR) pathways and plays an important role in certain malignancies. However, the role of MSI in the development of gastric B-cell lymphomas remains unsettled. We aimed to investigate the clinical significance of MSI in patients with gastric B-cell lymphoma. METHODS: Seven micosatellite loci (BAT25, BAT26, D2S123, D5S346, D17S250, D14S50, IGF-IIR) were used for MSI analyses. Microsatellite genotypes were categorized as microsatellite stable (MSS, no positive marker), low frequency MSI (MSI-L, <40% positive marker) and high frequency MSI (MSI-H, >40% positive marker). Among the gastric B-cell lymphoma patients who underwent MSI analysis between September 2002 and May 2003, twenty-two patients were enrolled. Median follow-up duration was 23 months (6-32 months). RESULTS: Median age was 46 years (26-73 years). Male to female ratio was 1:1.4. Twelve patients (54.5%) underwent Helicobacter pylori (H. pylori) eradication and ten patients (45.5%) underwent chemoradiation therapy. No case presented MSI-H. MSI-L was observed in 40.9% (9/22). Between MSS group and MSI-L group, there was no significant difference in age, tumor stage, location, grade of large cell component, H. pylori infection, bulk of tumor and proportion of regression or recurrence. All positive markers belonged to the dinucleotide markers. CONCLUSIONS: The current study suggests that the role of MSI is questionable in the development of gastric B-cell lymphoma due to their low incidence.
Adult ; Aged ; Female ; Helicobacter Infections/genetics ; Helicobacter pylori ; Humans ; Lymphoma, B-Cell/*genetics ; Male ; Microsatellite Repeats/*genetics ; Middle Aged ; Stomach Neoplasms/*genetics

Neuroendocrine carcinoma of the colon is a very rare entity. However, this type of tumor is known to have aggressive progression and poor prognosis. A case of a 72-year-old male is presented in this report. A 3 cm sized tumor was found on the rectum with multiple liver metastases. The pathological findings including a positive immunohistochemical staining for synaptophysin and cytokeratin done with colonoscopic biopsy and liver biopsy confirmed the tumor as a neuroendocrine carcinoma. The nomenclature and definition of this disease still remains somewhat unclear, and not a small population of this disease may thus have been misdiagnosed and treated as other less aggressive entities, such as carcinoid tumor. The necessity to make an accurate differential diagnosis in such cases is thus emphasized because of different treatments and clinical courses. For its rarity and clinical significance, we report this case with a review of the literatures.
Aged ; Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Colon ; Diagnosis, Differential ; Humans ; Keratins ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Rectum* ; Synaptophysin

Neuroendocrine carcinoma of the colon is a very rare entity. However, this type of tumor is known to have aggressive progression and poor prognosis. A case of a 72-year-old male is presented in this report. A 3 cm sized tumor was found on the rectum with multiple liver metastases. The pathological findings including a positive immunohistochemical staining for synaptophysin and cytokeratin done with colonoscopic biopsy and liver biopsy confirmed the tumor as a neuroendocrine carcinoma. The nomenclature and definition of this disease still remains somewhat unclear, and not a small population of this disease may thus have been misdiagnosed and treated as other less aggressive entities, such as carcinoid tumor. The necessity to make an accurate differential diagnosis in such cases is thus emphasized because of different treatments and clinical courses. For its rarity and clinical significance, we report this case with a review of the literatures.
Aged ; Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Colon ; Diagnosis, Differential ; Humans ; Keratins ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Rectum* ; Synaptophysin

Abdominal pregnancy is a rare form of ectopic pregnancy, which has been classified as early and advanced abdominal pregnancies. In case of early abdominal pregnancy, we may miss the diagnosis because the symptoms and clinical characteristics are non-specific. However, recently, the early diagnosis is made because of the development of quantitative beta-hCG measurement, transvaginal ultrasonography and the development of laparoscopy. Omental pregnancy is a very rare form of abdominal pregnancy, which is hard to detect early. When ruptured, it accompanies with massive hemorrhage. So, early diagnosis and treatment is essential to prevent high morbidity, mortality and serious complications. Definite diagnosis is made by cytopathologic examination of tissue specimen after surgery. We have experienced a case of ruptured early omental pregnancy and reviewed it briefly.
Diagnosis ; Early Diagnosis ; Female ; Hemorrhage ; Laparoscopy ; Mortality ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Ultrasonography

PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results of internal fixation using multiple Kirschner wires (K-wires) for the fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively reviewed 14 patients with a displaced fifth metatarsal base fracture. We measured the distance of fracture displacement on the foot oblique radiograph pre- and post-operatively. We evaluated the clinical results using the visual analog pain scale at six weeks and three months postoperatively and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score at six months postoperatively. RESULTS: In our series, 10 cases were zone I fracture and four cases were zone II fracture. We achieved anatomical reduction and bony union in all of our cases. The average time to bone union was 43 days. The degree of pain around the fifth metatarsal base was significantly decreased after surgery. The average AOFAS score was 95 at six months postoperatively. CONCLUSION: Multiple K-wire fixation is a relatively simple fixation method for displaced fifth metatarsal base fractures. If we place a K-wire into the medial cortex of the fifth metatarsal, we could prevent proximal migration of the K-wire.
Ankle ; Bone Wires* ; Foot ; Humans ; Metatarsal Bones* ; Pain Measurement ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. MATERIALS AND METHODS: We retrospectively reviewed 12 feet of nine patients diagnosed as symptomatic bunionette and treated with diaphyseal oblique osteotomy. All patients were female and the average age at the time of surgery was 48 years. We checked the foot standing anteroposterior, oblique, and lateral images pre- and post-operatively. We measured the fourth intermetatarsal angle and fifth metatarsophalangeal angle and evaluated the clinical results using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scale preoperatively and six months postoperatively. RESULTS: Of the nine patients, hallux valgus was combined with symptomatic bunionette in seven feet of five patients. In all of our cases, the average AOFAS lesser MTP-IP scale showed improvement after surgery. Painful callosity around the fifth metatarsophalangeal joint disappeared after surgery in all of our cases. The fourth intermetatarsal angle improved from 12.7degrees to 3.1degrees and the fifth metatarsophalangeal angle improved from 16.6degrees to 2.3degrees. CONCLUSION: Diaphyseal oblique osteotomy of the fifth metatarsal appears to be a safe and satisfactory surgical procedure for treatment of symptomatic bunionette.
Ankle ; Bunion, Tailor's* ; Callosities ; Congenital Abnormalities* ; Female ; Foot ; Hallux Valgus ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy* ; Retrospective Studies

Gastroesophageal reflux disease (GERD) is the most common cause of noncardiac chest pain (NCCP) and is present in up to 60% of patients with NCCP in Western countries. In Korea, after a reasonable cardiac evaluation, GERD is reported to underlie 41% of NCCP cases. Typical reflux symptoms are frequent in Korean patients suffering from NCCP. Therefore, a careful history of the predominant symptoms, including heartburn and acid regurgitation, is relatively indicative of the GERD diagnosis in Korea. In Korea, in contrast to Western countries, patients aged 40 years and over who have been diagnosed with NCCP but who are without alarming features should undergo endoscopy to exclude gastric cancer or peptic ulcers because of the higher prevalence of peptic ulcer disease and gastric cancers in the region. In a primary care setting, in the absence of any alarming symptoms, a symptomatic response to a trial of a proton pump inhibitor (PPI) is sufficient for the presumptive diagnosis of GERD. In addition, the optimal duration of a PPI test may be at least 2 weeks, as GERD symptoms tend to be less frequent or atypical in Korean patients than in patients from Western countries. In patients diagnosed with GERD-related NCCP, long-term therapy (more than 2 months) with double the standard dose of a PPI is required to alleviate symptoms. Esophageal dysmotility is relatively uncommon, and pain modulators seem to offer significant improvement of chest pain control in non-GERD-related NCCP. Most traditionally available tricyclics or heterocyclics have many undesirable effects. Therefore, newer drugs with fewer side effects (for example, the serotonin - norepinephrine reuptake inhibitors) may be needed.
Aged ; Chest Pain ; Endoscopy ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Heartburn ; Humans ; Korea ; Norepinephrine ; Peptic Ulcer ; Prevalence ; Primary Health Care ; Proton Pumps ; Serotonin ; Stomach Neoplasms ; Stress, Psychological ; Thorax

OBJECTIVES: The post-tonsillectomy pain and post-tonsillectomy hemorrhage are the two main problems after tonsillectomy. The aim of this study was to investigate the beneficial effects of water soluble ethanol extract propolis on post-tonsillectomy patient. METHODS: One hundred and thirty patients who underwent tonsillectomy or adenotonsillectomy were randomly divided into the control and propolis groups, each including 65 patients. The propolis group was applied with propolis orally immediately after surgery and by gargle. The pain scores were assessed on post-tonsillectomy 0, 1st, 2nd, 3rd, and 7th–10th day using a visual analogue scale score. Postoperative wound healing was evaluated by scoring pinkish membrane of tonsillar fossae on postoperative days 3 and 7–10. The incidence of post-tonsillectomy bleeding was examined in each group. RESULTS: Post-tonsillectomy pain was significantly less in propolis group compared to control group on postoperative days 3 and 7–10. Post-tonsillectomy hemorrhage was significantly less in the propolis group compared to the control group (P < 0.05). The wound healing was significantly better in the propolis group compared to the control group on postoperative day 7–10 (P=0.002). CONCLUSION: Applying the propolis to post-tonsillectomy wound showed beneficial effect of reducing postoperative pain, preventing hemorrhage, and accelerating of wound healing of tonsillar fossae.
Ethanol ; Hemorrhage ; Humans ; Incidence ; Membranes ; Pain, Postoperative ; Propolis* ; Tonsillectomy* ; Water ; Wound Healing* ; Wounds and Injuries*