Strongylodiasis is universal in distribution but is most abundant in countries with a tropical climate. Although infestation by Strongyloides stercoralis is usually limited to the intestines, dessemination of this helminth in debilitated host can be lead to death with various clinical disorders. characterized by profound malabsorption, diarrhea, electrolyte imbalance, gram negative or opportunistic fungal sepsis, coma and death. Cell-mediated immunity contributing significantly to the control of helminthic infections, may be suppressed by carcinoma, immunosuppressive chemotherapy and use of corticosteroids. Diagnosis of Strongyloidiasis is achieved by an examination of samples of feces, duodenal aspirates and sputum of patients for Strongyloides stercoralis. Treatment of strongyloidiasis is twofold : correction of the immunosuppressive state by withdrawal of immunosuppressive drug, if possible, and vigorous treatment with thiabendazole. Testing for strongyloidiasis is especially recommanded before treating a patients should be monitored for infection by Strongyloides stercoralis and other opportunistic infection. We are reporting a case patient with Strongyloides stercoralis hyperinfection and pulmonary tuberculosis who had been. used corticosteroid for persisting polyarthritis.
Adrenal Cortex Hormones ; Arthritis ; Coma ; Diagnosis ; Diarrhea ; Drug Therapy ; Feces ; Helminths ; Humans ; Immunity, Cellular ; Intestines ; Opportunistic Infections ; Sepsis ; Sputum ; Strongyloides stercoralis* ; Strongyloides* ; Strongyloidiasis ; Thiabendazole ; Tropical Climate ; Tuberculosis, Pulmonary

No abstract available.
Blood Pressure* ; Child* ; Gwangju* ; Humans

BACKGROUND: Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. METHODS: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. RESULTS: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%.3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. CONCLUSIONS: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis.
Biopsy ; Diagnosis ; Digestive System Diseases ; Endoscopy ; Endosonography* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Lymph Nodes ; Neoplasm Metastasis ; Stomach* ; Ultrasonography

A 38-year-old man, with recurrent oral ulcers for 10 years, was admitted because of recent aggravation of odynophagia and sore throat. About 4 years earlier, he had been performed abdominal surgery for intestinal perforation. Gastrofiberscopic examination showed small round ulcers at hypiopharynx and 6cm sized longitudinal linear ulcer at mid esophagus. Biopsy specimens at mid-esophagus showed chronic inflammation. Besides oral ulcer, he had perianal ulcers and skin rashes. He was managed with steroid, colchicine and sulfasalazine under the diagnosis of esophageal involvement in Behcet's disease. After 3 months from discharge, esophagogram and gastrofiberscopic examination showed some improved appearance, but symptoms recurred for steroid tapering. He has been followed in much improved status for 8 months after discharge.
Adult ; Biopsy ; Colchicine ; Diagnosis ; Esophagus ; Exanthema ; Humans ; Inflammation ; Intestinal Perforation ; Oral Ulcer ; Pharyngitis ; Sulfasalazine ; Ulcer*

BACKGROUND: Interleukin-5 (IL-5), IL-3, and GM-CSF are known to prolong the survival of eosinophils, and IL-5 has the most potent effect on eosinophil survivaL It is also known that divergent signals induce apoptosis in different cells. But, There have been few reports on about the intracellular signals that trigger the effectors of apoptosis. Cyclic AMP (cAMP) can modulate apoptosis in many cells. But, the role of intracellular cAMP in the IL-5 induced eosinophil survival is still not completely understood. OBJECTIVES: This study was aimed to elucidate the role of intracellular cAMP in IL-5 induced eosinophil survival. MATERIAL AND METHOD: Eosinophils were isolated from peripheral blood of atopic patients. Eosinophil viability was measured by means of propidium iodine (PI) method and the number of viable cells was counted by FAC scan (Becton Dickinson, USA). Cells were cultured with or without IL-5, and also with various cAMP-elevating agents (dibutyryl cAMP, 8-bromo-cAMP, N6- benzoyl cAMP). The concentrations of cAMP were measured by cAMP enzyme immunoassay system(BiotrakTM, Amersham). Finally cAMP dependent protein kinase A inhibitor (H8) was added to eosinophils to examine the effect of decreased intracellular cAMP activity on the viability of eosinophils stimulated with IL-5. RESULTS: The percentage of viable eosinophils was reduced rapidly from 92.1+/-1.8% to 8.23+/- 3.41% without IL-5 (p<0.05; n=ll, 4-day incubation). Upon addition of IL-5, it was increased to 33.02+7.8% (p<0.05; n=ll). In the absence of IL-5, the addition of cAMP-elevating agent increased eosinophil viability in a dose-dependent manner. Upon addition of H8 (24 uM), the eosinophil viability increased by IL-5 (52.5+/-6.4%) was significantly reduced to 27.2+/-5.4% (p<0.05;n=7). Compared with tissue culture media (TCM) only, IL-5 produced persistent elevation of intracellular cAMP of eosinophils in a time and dose dependent manner.
8-Bromo Cyclic Adenosine Monophosphate ; Apoptosis* ; Culture Media ; Cyclic AMP ; Cyclic AMP-Dependent Protein Kinases ; Eosinophils* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunoenzyme Techniques ; Interleukin-3 ; Interleukin-5 ; Iodine ; Propidium

BACKGROUND AND OBJECTIVES: We report our initial experience with percutaneous transvenous closure of atrial septal defects (ASD). MATERIALS AND METHOD: Between September 1997 and May 2000, we attempted transcatheter closure of ASD in 18 patients using CardioSEALTM (8), STARFlexTM (4) and Amplatzer septal occluder (6). The ages of patients ranged from 4.5-64.8 (mean 32.8) years, body weight ranging from 16-76 (mean 51) kg, Qp/Qs ratio from 1.3-3.4 (mean 2.2). RESULTS: Embolization of device occurred in two patients; right pulmonary artery in one and left atrium in the other. In one patient, the device slipped into the right atrium before detachment. After retrieval of the device, the defect seemed too large for transcatheter closure. There were no other complications apart from a transient aggravation of pre-existing atrial premature beats in two patients. There was no significant size difference between the data measured by transthoracic and transesophageal echocardiography. The stretched ASD diameter was larger (5.1 3.2 mm) than the size measured by transesophageal echocardiography. In the remaining 15 patients, complete closure of defects was confirmed by transthoracic echocardiography on the 1 day or 1 month follow-up. During the same period, transcatheter closure of patent foramen ovale(PFO) was also attempted in 7 patients with stroke. The guidewire could not be passed in 2 of the patients. In the other 5 patients, transcatheter closure was successfully performed without any problems. Though the follow-up period may have been short, no patients were found with further stroke attack. CONCLUSION: Transcatheter closure of ASD can be performed with high efficiency and safety if patient selection is adequate. The indication for ASD closure can be extended to patients with larger defects. Transcatheter closure of PFO is an easy and safe procedure, but the indications of PFO closure in patients with stroke is still unclear. Further evaluation is necessary for long-term results.
Body Weight ; Cardiac Complexes, Premature ; Echocardiography ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Patient Selection ; Pulmonary Artery ; Septal Occluder Device ; Stroke

OBJECTIVE: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis. METHOD: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups. RESULTS: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p<0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p<0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p<0.05). CONCLUSION: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.
Densitometry* ; Diabetes Mellitus* ; Diabetic Foot ; Diagnosis* ; Female ; Foot* ; Humans ; Male ; Mass Screening ; Osteoporosis*

OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate.
Cost of Illness ; Critical Pathways ; Hepatitis A* ; Humans ; Incidence ; Korea ; National Health Programs ; Republic of Korea ; Vaccination ; Young Adult

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. METHODS: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. RESULTS: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. CONCLUSIONS: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.
Bile Ducts ; Catheters ; Cholestasis ; Common Bile Duct* ; Constriction, Pathologic ; Decompression ; Diagnosis ; Female ; Fistula ; Humans ; Palliative Care ; Stents

Phytobezoar is rare disease in the stomach and small bowel of the patient without underlying previous gastroenterologic pathology. Because it usually occurs secondarily to peptic ulcer surgery, poor mastication, diabetes mellitus, hypothyroidism and connetive tissue disease. In morden medicine, phytobezoars found in the stomach and/or intestines in humans, are known to be associated with considerable morbidity and even mortality. Patients with gastric bezoar present with chronic postprandial epigastic pain, nausea, and vomitihg. It is diagnosed by endoscopic examination or radiologic study and treated by surgical removal or non-surgical methods including conservative treatment, enzymatic dissolution, and endoscopic removal. We have experienced a case of small intestinal obstruction due to a fragment of gastric bezoar of the patient without underlying etiologic cause. So we report the case with a brief review of literatures.
Bezoars ; Diabetes Mellitus ; Humans ; Hypothyroidism ; Intestinal Obstruction* ; Intestines ; Mastication ; Mortality ; Nausea ; Pathology ; Peptic Ulcer ; Rare Diseases ; Stomach