No abstract available.
Colorectal Neoplasms*

Gas-bloat syndrome is a characteristic disease that developed in patients who had symptoms severe enough to warrant surgery for refractory refiux esophagitis. During the first few months, most of patients have significant symptoms and gradually have been improved except some cases. Although the underlying pathophysiology is uncatain, too tense fundoplication could result in an one-way valve peventing most patients from belching or vomiting. This syndrome has been reported in western country for many years but not yet in Korea. We report a case of gas-bloat syndrome after fundoplication for sevete reflux esophagitis and hiatal hemia.
Eructation ; Esophagitis ; Esophagitis, Peptic ; Fundoplication ; Gastroesophageal Reflux ; Humans ; Korea ; Transcutaneous Electric Nerve Stimulation ; Vomiting

Symptomatic muscular rings are extremely rare, and some authors have even disputed their existence. The lower esophageal muscular ring, or A ring, located about 2cm proximal to the squamocolumnar junction and are covered by squamous epithelium. These rings consist of an annular narrowing of hypertrophic muscular tissue in the esophageal body. Recently, we experienced 2 cases of symptomatic muscular ring of the esophagus and the findings. Case 1) A 52 year-old male with dysphagia, chest pain and regurgitation for several years, had esophagogram, endoscopy, esophageal motility studies and chest CT. Under the diagnosis of esophageal muscular ring, the patient had pneumatic baUoon dilatation (3.0 cm in diameter, Rigiflex), under which the patient experienced perforation of the lower esophagus and required surgery. We confirmed muscular ring of the esophagus as shown by a thickened muscularis propria layer, without other pathologic findings. Case 2) A 60 year-old male complaining of intermittent dysphagia, had esophagogram, endoscopy, esophageal motility studies and EUS. Under the diagnosis of esophageal muscular ring, he is now being treated with calcium channel blocker and nitrate, and has experienced minimal symptom improvement. We report 2 cases of symptomatic muscular ring of low esophagus with review of literature.
Calcium Channels ; Chest Pain ; Deglutition Disorders ; Diagnosis ; Dilatation ; Endoscopy ; Epithelium ; Esophagus* ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

Laparoscopic cholecystectomy has become the choice procedure for surgical removal of symptomatic gallbladder stones. However, with the introduction and use of this technique, unusual complications can be expected. Among them, the surgical clip has become a nidus for common bile duct (CBD) stone formation; it is a rare complication of laparoscopic or open cholecystectomy. We recently experienced a case of surgical clip migration into the CBD in a patient who underwent laparoscopic cholecystectomy. A 46-year-old woman was admitted due to right upper quadrant pain which had persisted for 1 week. A year earlier, she had undergone a laparoscopic cholecystectomy for acute cholecystitis due to gallbladder stones. On admission, physical examination revealed normal findings except subicteric sclera and minimal right upper quadrant tenderness. Laboratory evaluation determined abnormal liver functioning. Abdominal sonography revealed an echogenic density with acoustic shadows within a mildly dilated CBD. Endoscopic retrograde cholangiogram revealed a single CBD stone with two metallic surgical clips forming a nidus. The stone with clips was easily removed through the dilated ampulla of Vater orifice using a Dormia basket. There were no post-ERC complications and the patient was reportedly doing well.
Acoustics ; Ampulla of Vater ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Common Bile Duct* ; Female ; Gallbladder ; Humans ; Liver ; Middle Aged ; Physical Examination ; Sclera ; Surgical Instruments*

We report here the results of surveys for External Quality Assessment (EQA) of blood bank tests carried out in 2013. The proficiency testing specimens were prepared at Ajou University Hospital and sent to 548 and 545 institutes participating in the 1st and 2nd trial, respectively. Test items for the surveys were ABO grouping, RhD typing, crossmatching, direct antiglobulin test (DAT), antibody screening test, and antibody identification test. The response rates for the 1st and 2nd trials were 94.3% and 96.0%, respectively. No answers were considered incorrect answers, and the average accuracy rates of different test items of the survey were as follows: ABO grouping, 98.9% to 100%; RhD typing, 98.4% to 99.2%; crossmatching, 94.4% to 100.0%; DAT using polyspecific reagent, 94.5% to 99.7%; DAT using IgG monospecific reagent, 94.7% to 98.8%; DAT using C3d monospecific reagent, 91.3% to 98.6%; unexpected antibody screening test, 90.9% to 100%; and antibody identification test, 87.3% to 100.0%. Overall, we obtained excellent survey results for the EQA of blood bank tests carried out in 2013, and the number of participating institutes was higher in 2013 than in 2012.
Academies and Institutes ; Blood Banks* ; Coombs Test ; Immunoglobulin G ; Korea ; Laboratory Proficiency Testing ; Mass Screening

BACKGROUND: The aims of this study were to evaluate the diagnostic value of pancreatic elastase-1(PE-1) in patients with pancreatic diseases and compare the significance of PE-1 with that of pancreatic exocrine function test by pure pancreatic juice (PPJ) collection. METHODS: For evaluation of PE-1, seventy nine patients with pancreatic diseases were examined. For evaluation of exocrine pancreatic function by PPJ, twenty three patients with Chronic pancreatitis(CP) were examined. PPJ was collected by endoscopic cannulation of main pancreatic duct under the intravenous bolus injection of secretin (0.25 CU/kg body weight) and cholecystokinin (CCK, 40 ng/kg body weight). RESULTS: Pancreatic exocrine functions were significantly decreased in patients with CP showing moderate and severe ductal changes on pancreatogram. The mean concentration of fecal PE-1 was significantly decreased in patients with CP and pancreatic cancer, but not in patients with acute pancreatitis. When we analyzed the PE-1 concentration according to Cambridge classification, the concentration of fecal PE-1 was significantly decreased only in patients with moderate and severe CP. With a cut off of 200 ug fecal PE-1/g, the sensitivity of PE-1 was 25%, 60%, and 100%, respectively, for mild, moderate and severe CP, and the specificity was 88.1%. The mean concentration of serum PE-1 was increased both in patients with acute and chronic pancreatitis, but there was no difference between both group. CONCLUSION: Fecal PE-1 is useful for diagnosis of pancreatic exocrine insufficiency in patients with CP, especially in moderate and severe grade of pancreatic exocrine insufficiency. The diagnostic value of fecal PE-1 was also similar to secretin-CCK test in pancreatic exocrine insufficiency.
Catheterization ; Cholecystokinin ; Classification ; Diagnosis ; Humans ; Pancreatic Diseases* ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Secretin ; Sensitivity and Specificity

BACKGROUND/AIMS: Lamivudine has demonstrated a potent suppression of viral replication and a substantial histologic improvement in many patients with chronic hepatitis B. This study is intended to evaluate the effects of lamivudine and the breakthrough rate in patients with HBV associated chronic liver diseases including decompensated liver cirrhosis, and to investigate the clinical factors closely related with these events. METHODS: A total of 58 patients(chronic hepatitis 21, cirrhosis 37) showing abnormal serum levels of aminotransferase and detectable serum HBV DNA for at least 6 month received 150 mg of lamivudine once a day for 3-27 months (median 13). The Kaplan-Meier methods and the Cox regression model were used for statistic analysis. RESULTS: The one-year cumulative incidences of the negative conversion of serum HBV DNA, normalization of aminotransferase, and seroconversion of HBeAg were 98.3%, 86.2% and 20.6%, respectively. Eighteen-month and 2-year cumulative breakthrough rates were 24% and 47%, respectively. The Child-Pugh scores were improved (p<0.001) in patients with decompensated liver cirrhoses(n=21). The negative conversion of HBV DNA, breakthrough rates and seroconversion were not significantly associated with the progression of disease, mutation in pre-core region and previous treatment with interferon. The pre-treatment aspartate aminotransferase (AST) level was associated with a higher rate of seroconversion(p<0.03). CONCLUSION: Despite a higher breakthrough rate, 2-year lamivudine treatment has induced the seroconversion of HBeAg in 26% of patients, and improved the clinical manifestations in decompensated cirrhotic patients.
Aspartate Aminotransferases ; DNA ; Fibrosis ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Incidence ; Interferons ; Lamivudine* ; Liver Cirrhosis ; Liver Diseases* ; Liver*