Background/Aims: The diagnosis of small bowel Crohn’s disease with negative ileocolonoscopic findings has been challenging. Fecal calprotectin (FC) has been used to detect colonic inflammation, but its efficacy for detecting small bowel inflammation is less established. We performed an updated meta-analysis to evaluate the diagnostic accuracy of FC to detect active small bowel inflammation observed during capsule endoscopy. Methods: We conducted a systematic literature search for studies that evaluated the correlation between small bowel inflammation and FC in patients with suspected/established Crohn’s disease. We calculated the pooled sensitivity, specificity, and diagnostic odds ratios (DORs) and constructed hierarchical summary receiver operating characteristic curves for FC cutoffs of 50, 100, and 200 µg/g. Results: Fourteen studies were eligible for the final analysis. The DORs of all FC cutoffs were significant. The highest DOR was observed at 100 µg/g (sensitivity, 0.73; specificity, 0.73; and DOR, 7.89) and was suggested as the optimal diagnostic cutoff. If we analyzed only studies that included patients with suspected Crohn’s disease, the DOR was 8.96. If we analyzed only studies that included patients with a Lewis score ≥135 as a diagnostic criterion for active disease, the DOR was 10.90. Conclusions FC has significant diagnostic accuracy for detecting small bowel inflammation, and an FC cutoff of 100 µg/g can be used as a tool to screen for small bowel Crohn’s disease.

Background/Aims: The diagnosis of small bowel Crohn’s disease with negative ileocolonoscopic findings has been challenging. Fecal calprotectin (FC) has been used to detect colonic inflammation, but its efficacy for detecting small bowel inflammation is less established. We performed an updated meta-analysis to evaluate the diagnostic accuracy of FC to detect active small bowel inflammation observed during capsule endoscopy. Methods: We conducted a systematic literature search for studies that evaluated the correlation between small bowel inflammation and FC in patients with suspected/established Crohn’s disease. We calculated the pooled sensitivity, specificity, and diagnostic odds ratios (DORs) and constructed hierarchical summary receiver operating characteristic curves for FC cutoffs of 50, 100, and 200 µg/g. Results: Fourteen studies were eligible for the final analysis. The DORs of all FC cutoffs were significant. The highest DOR was observed at 100 µg/g (sensitivity, 0.73; specificity, 0.73; and DOR, 7.89) and was suggested as the optimal diagnostic cutoff. If we analyzed only studies that included patients with suspected Crohn’s disease, the DOR was 8.96. If we analyzed only studies that included patients with a Lewis score ≥135 as a diagnostic criterion for active disease, the DOR was 10.90. Conclusions FC has significant diagnostic accuracy for detecting small bowel inflammation, and an FC cutoff of 100 µg/g can be used as a tool to screen for small bowel Crohn’s disease.

PURPOSE: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. METHODS: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. RESULTS: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. CONCLUSION: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.
Anti-Bacterial Agents ; Decision Making ; Education* ; Korea ; Professional Practice ; Resuscitation Orders ; Seoul ; Tertiary Care Centers

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.
Adult ; Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Histiocytes/pathology ; Histiocytosis, Sinus/*diagnosis/metabolism/pathology ; Humans ; Lymph Nodes/pathology ; Male ; Neck ; Pleural Effusion/*radiography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

BACKGROUND: Stomach cancer is the most common cancer in Korea, and it can be easily diagnosed by performing endoscopy. Helicobacter pylori (H. pylori) is associated with stomach cancer, and there has been much recent interest in the epidemiology of stomach cancer. Therefore, we estimated the incidence of stomach cancer in Chuncheon-si during 2000-2002. METHODS: From July 1st, 2000 through June 30th, 2002, we investigated the subjects who were confined to be newly diagnosed cases living in Chuncheon-si. The data was collected from the medical records from all the medical facilities located in Chuncheon-si. RESULTS: The total number of cases of newly diagnosed stomach cancer during this period (2000-2002) was 186 (117 males and 69 females). The annual crude incidence rate of stomach cancer was estimated to be 37.0 per 100,000 persons overall, and 47.0 and 27.2 in the males and females, respectively. The annual age standardized incidence rate for the Korean population was 33.7 per 100,000 persons overall, and 42.2 and 25.1 for the males and females, respectively. The major symptoms of stomach cancer patients were epigastric pain (61.8%) and weight loss (31.2%). The proportion of early gastric cancer was 34.9% (60 among 172 persons) of the cases of stomach cancer. 64 patients (74%) were H. pylori positive. CONCLUSIONS: We report here on the estimated incidence rate of the stomach cancer and the characteristics of the stomach cancer patients in Chuncheon-si during 2000-2002. This study has generated basic epidemiologic data to identify the effect of H. pylori eradication on the future incidence rate of stomach cancer.
Endoscopy ; Epidemiology ; Female ; Gangwon-do* ; Helicobacter pylori ; Humans ; Incidence* ; Korea ; Male ; Medical Records ; Stomach Neoplasms* ; Stomach* ; Weight Loss

BACKGROUND: Endoscopic mucosal resection (EMR) is now widely accepted as a useful treatment method for gastric adenoma and early gastric cancer (EGC) because of its minimal invasiveness and satisfactory post-procedure results. The purpose of this study is to define the follow-up results and usefulness of EMR. METHODS: We analyzed 54 cases from June 2000 through September 2004. Endoscopy with histological examination was carried out every 3 months for 1 year after EMR. RESULTS: The patients consisted of 42 men and 12 women, and the mean age was 60 years old. The histological results were 42 gastric adenoma and 12 EGC cases. There were 9 cases that had the histological diagnosis changes after EMR. Complete resections was performed for 48 cases and the en block resections were 33 of 34 cases (97%) and piecemeal resections were done in 15 of 20 cases (75%). Recurrence was seen in 4 cases (7.1%), and the mean recurrence period was 7 months. There were 3 gastric adenomas of 42 cases (7.1%), one case of EGC of 12 cases (8.3%), one en block resection of 34 cases (2.9%) and three piecemeal resections of 20 cases (15%). CONCLUSIONS: EMR is a safe and useful treatment method for gastric adenoma and EGC. However, EMR has some limitations that EGC may have lymph node metastases or multiple tumors. So, periodic follow-up is very important. As we acquire more clinical experience, EMR may be accepted as the standard treatment method for gastric adenoma and EGC.
Adenoma* ; Diagnosis ; Endoscopy ; Female ; Follow-Up Studies* ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms*

BACKGROUND/AIMS: Upper gastrointestinal (UGI) bleeding is one of the most common and serious complications in major burns. However, the clinical features of UGI bleeding have rarely been studied, and no report of UGI bleeding after burn injury has been presented in Korea. The aim of this study was to evaluate the clinical features of the UGI bleeding after acute burn injury. METHODS: Among 2,340 patieats with acute burn injury who have admitted from January 2000 to June 2004, 33 patients had UGI bleeding. We retrospectively reviewed the medical records of these 33 patients. RESULTS: The causes of bleeding were gastric ulcer (45.5%), duodenal ulcer (36.4%), esophageal ulcer (6%), Mallory-Weiss tear (6%), hemorrhagic gastritis (3%), and gastric varix (3%). Endoscopic intervention and medical treatment were taken in 13 patients (39.4%), and 20 patients (60.6%) were managed with medical treatment only. Mortality rate of post-burn UGI bleeding patients was 30.3%. In logistic regression analysis, burn size (p=0.047) and Rockall score (p=0.019) were independent risk factors of mortality in patients with UGI bleeding. CONCLUSIONS: The most common cause of UGI bleeding in burn patients is peptic ulcer. Treatment of systemic complications of burn as well as UGI bleeding itself may be important in clinical course of UGI bleeding after burn. Large, randomized, and prospective study of prophylactic proton pump inhibitor for the prevention of post-burn UGI bleeding is needed.
Burns* ; Duodenal Ulcer ; Esophageal and Gastric Varices ; Gastritis ; Hemorrhage* ; Humans ; Korea ; Logistic Models ; Mallory-Weiss Syndrome ; Medical Records ; Mortality ; Peptic Ulcer ; Proton Pumps ; Retrospective Studies ; Risk Factors ; Stomach Ulcer ; Ulcer

Miller-Dieker syndrome is a multiple malformation syndrome characterized by severe lissencephaly and characteristic facial abnormalities at birth. It is associated with visible or submicroscopic deletions within chromosome 17p13.3 including PAFAH1B1 (LIS1) gene. We report a six-month-old boy who presented with spasm and generalized myoclonic seizures. The patient was born at 40 weeks' gestation to a 36-year-old woman and showed developmental delay without microcephaly or prominent facial abnormality. Magnetic resonance imaging of the brain showed a few gyrus (lissencephaly). High resolution cytogenetic analysis from peripheral blood showed a normal karyotype. However, fluorescence in situ hybridization (FISH) of the metaphase chromosome using Miller-Dieker/ILS probe (Oncor, Gaithersburg, Maryland, USA) revealed only one signal of probe, indicating a microdeletion of 17pl3.3 region including PAFAH1B1 (LIS1) gene. We suggest that FISH 17p13.3 studies should be performed in addition to a standard metaphase analysis in patients with lissencephaly even if facial anomaly is not noted. A confirmatory diagnosis using FISH would be helpful in terms of leading to allow genetic counseling and availability prenatal diagnosis to the family.
Adult ; Brain ; Classical Lissencephalies and Subcortical Band Heterotopias* ; Cytogenetic Analysis ; Diagnosis ; Female ; Fluorescence ; Genetic Counseling ; Humans ; In Situ Hybridization ; Karyotype ; Lissencephaly ; Magnetic Resonance Imaging ; Male ; Maryland ; Metaphase ; Microcephaly ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Seizures ; Spasm

BACKGROUND: Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. METHODS: From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and 200muM CoCl2 were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. RESULTS: 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-1alpha (HIF-1alpha)was also induced by 2% oxygen. CONCLUSION: Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.
Acute Lung Injury ; Anoxia ; Blood-Air Barrier ; Cell Proliferation ; Immunohistochemistry ; Lung* ; Microscopy ; Microvessels ; Oxygen ; Pericytes* ; Permeability ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A

BACKGROUND: The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patients in the our nation with high incidence of tuberculoma. We could not exclude whether the SPN was benign or malignant by the change of the size at chest radiograph and findings of chest CT. Recently, positron emission tomography(PET) have been tried as the differential diagnostic method of SPN. We evaluated the efficacy of PET for differentiating malignant from benign SPN and the relationship between standardized uptake values(SUV) of PET and serum glucose. METHODS: Between January 2001 and July 2002, sixty-one patients with pulmonary nodule were examined by the chest CT and PET. The SPN has been finally diagnosed by the transthorasic needle aspiration and biopsy, bronchoscopic biopsy, and open lung biopsy. RESULTS: Forty eight patients had a malignant nodule(23 squamous cell lung carcinoma, 16 adenocarcinoma, 9 small cell lung cancer) and thirteen patients had a benign nodule(3 tuberculoma, 9 inflammatory granuloma, 1 cryptococcosis). The mean size of malignant and benign nodule was 40.6 mm and 20.0 mm, respectively. All malignant nodules showed a marked increase in 18 fluorodeoxyglucose (FDG) uptake. Mean SUV of malignant was 9.52+/-5.20 and benign nodule was 1.61+/-3.60. There were false positive cases with an increase in 18-FDG uptake (2 tuberculoma, 1 inflammatory granuloma). The SUV of malignant nodule in diabetes patients has no difference in non diabetes patients(9.10+/-4.51 vs 9.65+/-5.46). The sensitivity and specificity of the PET scan for SPN were 100%, 77%, respectively. The positive and negative predictive values were 94% and 100%. CONCLUSION: PET scanning showed highly accurate result in differentiating the malignant and benign SPN. There were no significant differences between the SUV and serum glucose in the patients with lung cancer.
Adenocarcinoma ; Biopsy ; Blood Glucose* ; Electrons ; Glucose ; Granuloma ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Needles ; Positron-Emission Tomography ; Radiography, Thoracic ; Solitary Pulmonary Nodule* ; Tomography, X-Ray Computed ; Tuberculoma