Background/Aims: Fexuprazan is a novel potassium-competitive acid blocker that could be of benefit to patients with gastric mucosal injury. The aim of this study was to assess the 2-week efficacy and safety of fexuprazan in patients with acute or chronic gastritis. Methods: In this study, 327 patients with acute or chronic gastritis who had one or more gastric erosions on endoscopy and subjective symptoms were randomized into three groups receiving fexuprazan 20 mg once a day (q.d.), fexuprazan 10 mg twice a day (b.i.d.), or placebo for 2 weeks. The posttreatment assessments were the primary endpoint (erosion improvement rate), secondary endpoints (cure rates of erosion and edema and improvement rates of redness, hemorrhage, and subjective symptoms), and drug-related adverse events. Results: Among the patients, 57.8% (59/102), 65.7% (67/102), and 40.6% (39/96) showed erosion improvement 2 weeks after receiving fexuprazan 20 mg q.d., fexuprazan 10 mg b.i.d., and placebo, respectively. Both fexuprazan 20 mg q.d. and 10 mg b.i.d. showed superior efficacy to the placebo (p=0.017 and p<0.001, respectively). Likewise, both fexuprazan 20 mg q.d. and 10 mg b.i.d. also showed higher erosion healing rates than the placebo (p=0.033 and p=0.010, respectively). No difference was noted in the edema healing rate and the improvement rates for redness, hemorrhage, and subjective symptoms between the fexuprazan and placebo groups.No significant difference was noted in the incidence of adverse drug reactions. Conclusions Fexuprazan 20 mg q.d. and 10 mg b.i.d. for 2 weeks showed therapeutic efficacy superior to that of placebo in patients with acute or chronic gastritis (ClinicalTrials.gov identifier NCT04341454).

Purpose: We report a case of neuroretinitis combined with external ophthalmoplegia in a patient who developed a cerebral venous sinus thrombosis after administration of a SARS-CoV-2 vaccine.Case summary: A 26-year-old woman who was on oral contraceptives was diagnosed with a cerebral venous sinus thrombosis 1 month after the first injection of a SARS-CoV-2 vaccine (BNT162b2, Pfizer-BioNTech). The levels of factors 8 and 9 were elevated on the blood test. The corrected visual acuities were 0.3 in both eyes. A complete limitation of abduction and esotropia were evident in the left eye. Both eyes exhibited optic disc swelling and hemorrhage and retinal nerve fiber layer swelling. Subretinal fluid was apparent in the right eye. Three weeks later, the optic disc swellings and hemorrhages had worsened and both eyes evidenced macular stars. After 10 months, the corrected visual acuities improved to 0.9 in both eyes. Ocular motor function and the esotropia also improved. However, the overall contraction of the visual field did not. Conclusions SARS-CoV-2 vaccination can trigger cerebral venous sinus thrombosis, neuroretinitis, and external ophthalmoplegia. In patients with risk factors for such thrombosis, the possibility of ophthalmic complications should be considered after administration of a SARS-CoV-2 vaccine.

Inflammatory bowel disease is associated with extraintestinal manifestations involving almost every organ system in the body. Crohn's disease (CD) appears to be more commonly associated with an inflammatory myopathy than ulcerative colitis. However, myopathy of the thigh in patients with CD is rare. We report an unusual site of necrotizing myositis in a patient with CD. A 23-year-old woman presented with swelling and pain at the left popliteal area that had lasted for 1 week. Twenty-two months before admission, she had presented with pyoderma gangrenosum on the left upper chest and was diagnosed with CD. A magnetic resonance imaging scan of her leg revealed diffuse swelling in the left semimembranous muscle and biceps femoris muscle that was compatible with myositis, and a cystic lesion in the distal portion of the semimembranous muscle. The findings from semimembranous muscle biopsy were also consistent with necrotizing myositis. In conclusion, myositis, although rare, can be an extraintestinal manifestation of CD.
Biopsy ; Colitis, Ulcerative ; Crohn Disease* ; Female ; Humans ; Inflammatory Bowel Diseases ; Leg ; Magnetic Resonance Imaging ; Muscles ; Muscular Diseases ; Myositis* ; Pyoderma Gangrenosum ; Thigh ; Thorax ; Young Adult

PURPOSE: Our goal was to compare resuscitation outcomes, 24 hour survival, and survival discharge between patients resuscitated with an AutoPulse compression device vs. those resuscitated using manual compression in adult, out-of-hospital non-traumatic cardiac arrest patients. METHODS:We retrospectively reviewed cases of out-of-hospital cardiac arrest that occurred between July 2005 and June 2008. We included, 267 non-traumatic patients who had. We compared characteristics between 93 patients who had AutoPulse compression and 174 patients who had manual compression. Characteristics included resuscitation outcomes (return of spontaneous circulation [ROSC], 24 hour survival and resuscitation outcomes according to the initial ECG. RESULTS: The rate of ROSC was 43.1% for AutoPulse compression and 50.57% for manual compression; the difference was not significant (p=0.294). Survival rates at 24 hours were, respectively, 33.3% and 31.6% (p=0.88). Survival discharge proportions were, 8.6% and 11.5%, respectively (p=0.599). CONCLUSION: There are no statistically significant differences in resuscitation outcomes between AutoPulse and manual compression in adult, out-of-hospital, non-traumatic, cardiac arrest patients.
Adult ; Cardiopulmonary Resuscitation ; Electrocardiography ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Retrospective Studies ; Survival Rate

BACKGROUND: The aims of our study were to determine the correlation of the strain variation and degree of homogeneity of infecting Helicobacter pylori (H. pylori) with their disease outcomes, and the relevance of duodenal H. pylori expression of cagA and/or vacA gene to the development of duodenal ulcer in Korean patients. METHODS: One hundred and twenty bacterial colonies isolated from different anatomical sites of the stomach and duodenum were used. The study population was consisted of 40 Korean patients, 21 with duodenal ulcer, 7 with gastric ulcer, 3 with combined gastric and duodenal ulcer, and 9 with chronic gastritis. Genomic characteristics of each strain were analyzed by random amplified polymorphic DNA (RAPD) fingerprinting. The cagA and vacA genes were detected by polymerase chain reaction (PCR). RESULTS: PCR-based RAPD was proved to be a reliable method for the discrimination of individual bacterial genomic characteristics. Genomic fingerprinting showed a varying degree of inter- and intra-patient variation. Thirteen patients (32.5%) were colonized by a single strain throughout the corpus, antrum and duodenum, whereas the other 27 (67.5%) harbored multiple H. pylori strains. Thirty-six isolates (90.0%) each from the corpus and antrum, and 34 (85.0%) from the duodenum, expressed the cagA gene. The prevalence of duodenal H. pylori expression of the cagA gene was not different between patients with chronic gastritis and those with duodenal ulcer. All isolates were positive for both genes vacA s1 and vacA s1a. CONCLUSION: These results suggested that many of the H. pylori-infected Korean patients were actually colonized with mixed populations of different H. pylori strains and that the prevalence of duodenal H. pylori expression of the cagA and/or vacA gene was not correlated with the development of duodenal ulcer in Korean patients.
Adolescent ; Adult ; Aged ; Antigens, Bacterial/*analysis/genetics ; Bacterial Proteins/*analysis/genetics ; DNA, Bacterial/*analysis ; Female ; Genome, Bacterial ; Helicobacter Infections/epidemiology/*microbiology ; Helicobacter pylori/*genetics/isolation & purification ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Peptic Ulcer/*microbiology ; Prevalence ; Random Amplified Polymorphic DNA Technique ; Support, Non-U.S. Gov't

A 27-year-old woman presented with epigastric pain. Abdominal computed tomography revealed an irregular ulcer with circumferential thickening of the gastric antral wall. An endoscopy suggested advanced gastric cancer or gastric lymphoma. Biopsy of the lesion showed an inclusion body of the cytomegalovirus and positive immunohistochemical staining of the infected cell for cytomegalovirus. A thorough evaluation of her immune system revealed no abnormality. General supportive treatment for gastric ulcer did not relieve her symptoms. Intravenous infusion of ganciclovir improved her symptoms and healed the ulcer. We report a case of cytomegalovirus-associated gastric ulcer mimicking malignancy in an immunocompetent woman.
Adult ; Biopsy ; Cytomegalovirus* ; Endoscopy ; Female ; Ganciclovir ; Humans ; Immune System ; Inclusion Bodies ; Infusions, Intravenous ; Lymphoma ; Stomach Neoplasms* ; Stomach Ulcer* ; Ulcer

BACKGROUND/AIMS: To compare efficacy and tolerability of rabeprazole (RAB) 10 mg versus omeprazole (OME) 20 mg in patients with duodenal ulcer. METHODS: This randomized, comparative, multicenter study was conducted at 10 centers in Korea, from February to September in 1999. Patients with active duodenal ulcer as proven by endoscopy were randomized to RAB (n=123) or OME (n=123) groups. One hundred-twenty-three patients received RAB 10 mg once daily, and 123 patients received OME 20 mg once daily for 2 or 4 weeks. Primary efficacy parameter was complete healing by endoscopy and secondary parameter was the improvement in the severity of clinical symptoms after the therapy. RESULTS: After 2 weeks, complete healing was achieved in 81.7% (85/104) of patients given RAB 10mg and in 81.1% (77/95) of patients given OME 20 mg (p=0.902). After 4 weeks, complete healing was documented in 97.1% (101/104) of patients given RAB 10 mg and in 93.7% (89/95) of patients given OME 20 mg (p=0.315). The percentages of patients resolved daytime pain and night-time pain at Day 4 were 87.5% and 90.1% in RAB group and 79.0% and 80.5% in OME group (p=0.138 and p=0.087 for day-time k night-time pain, respectively). No clinically meaningful changes or other between-group differences were observed in laboratory parameters and adverse events which were evaluated to be related with medication. CONCLUSIONS: In this study, rabeprazole 10 mg produced healing rates and symptom relief equivalent to omeprazole 20 mg at weeks 2 and 4 in patients with active duodenal ulcer and provided a tendency of faster symptom relief than omeprazole 20 mg, although it didn't reach statistical significance. Both the treatments were well tolerated.
Duodenal Ulcer* ; Endoscopy ; Humans ; Korea ; Omeprazole* ; Rabeprazole*

OBJECTIVE: To define the pathologic changes underlying the mechanism of shrinkage of uterine leimyoma in patients treated with goserelin. METHODS: Retrospective evaluation of pathologic changes seen in leiomyoma removed by hysterectomy or myomectomy in treated and untreated patients was done. Microscopic review of all cases was performed without knowledge of the therapeutic history. Each leiomyoma was assessed for hyalinization, hydropic change, lymphocytic infiltrate, nuclear atypia, and hypercellularity. RESULTS: Hyaline degeneration and hydropic changes were found significantly more frequent in patient treated with goserelin (P<0.05). The differences between treated and untreated groups in lymphocytic infiltrate, nuclear atypia, and hypercellularity were not statistically significant. The ultrastructural features of variable numbers of the treated muscle cells showed large vacuole, marked swelling of mitochondria, and compound lysosomal structures presumed to have been formed from damaged intracellular organelles. CONCLUSION: It appears that the rapid decrease in size of the leiomyoma treated with goserein occurs as the smooth muscle tissue undergoes hydropic change and hyaline degeneration. It seems that other cellular degenerative changes may be involved in the mechanism shrinkage of uterine leiomyoma.
Gonadotropin-Releasing Hormone* ; Goserelin* ; Humans ; Hyalin ; Hysterectomy ; Leiomyoma* ; Mitochondria ; Muscle Cells ; Muscle, Smooth ; Organelles ; Retrospective Studies ; Vacuoles

OBJECTIVE: To evaluate the clinicopathologic variables that are important for predicting residual disease after cervical conization in hysterectomy specimens. METHODS: We performed retrospective review of 125 patients who had undergone cervical conization and endocervical curettage followed by subsequent hysterectomy. Pathologic findings of the cone margins, endocervical curettage samples, and residual lesions in the postcone hysterectomy specimens were recorded for analysis. RESULTS: The prevalence rates of positive cone margins increased with higher severity of cervical neoplasia. There was a statistically significant difference in the prevalence of residual disease in hysterectomy specimens between patients with positive endocervical margins on cone biopsy(67.3%) and those with negative margins(11.8%) (p<0.01). Most residual lesions in the postcone hysterectomy specimens were similar to cone pathology, however the possibility of more advanced lesions in the uterus was present in patients with positive cone margins. Residual disease was significantly more frequently found in patients with positive endocervical curettage(82.4%)(p<0.01). Especially, when both the endocervical margin and endocervical curettage were positive, residual disease was present in 25 of 28 (89.3%) hysterectomy specimens. CONCLUSIONS: From these results, we concluded that the status of endocervical margin and endocervical curettage have significant predictive value with respect to the presence or absence of residual disease, and final decision in regard to subsequent management should be based on histologic finding of the cone margins and endocervical curettage as well as the patient's age and desire to retain reproductive capability.
Conization* ; Curettage ; Humans ; Hysterectomy ; Pathology ; Prevalence ; Retrospective Studies ; Uterus

OBJECTIVE: The pathogenesis of endometriosis is generally accepted that retrograde menstruation and alterations in the local pelvic immune environment. This study was performed to help elucidate what kind of role various cytokines might play in the pathogenesis of endometriosis. METHOD: Concentrations of peritoneal fluid cytokines were compared in 7 women with normal pelvic finding and 23 women with endometriosis by enzyme-linked immunosorbent assay(ELISA). The patterns of cytokine mRNA expression in 8 ovarian endometrioma and 12 superficial pelvic endometriosis lesions were investigated by reverse transcription-polymerase chain reaction(RT-PCR) amplification method. RESULT: Both IL-6 and IL-10 levels in peritoneal fluid specimens with endometriosis tended to be higher than normal. However, there were no significant differences between peritoneal fluid concentrations of IFN-gamma, TNF-alpha, IL-1beta, and IL-5 of women with and without endometriosis. The levels of IL-6 and IL-10 were significantly higher in peritoneal fluid of women with severe endometriosis compared to women with mild endometriosis. IL-1beta mRNA was expressed in all of 8 deep and 12 superficial endometriosis lesions. IL-5 and IL-6 mRNA were expressed in only two black lesions respectively, however, both were not expressed in the all deep lesions. Expressions of IL-10 mRNA occurred in one red and one black lesion while this was expressed in only one of the deep lesions. TNF-alpha mRNA was expressed in one red and one black lesion of 12 superficial lesions compared with four of the deep lesions. There was the difference between kinds of increased cytokines in the peritoneal fluid and those of expressed cytokines in the endometriotic lesions of patients with endometriosis. CONCLUSION: This study supports the concept that local immunologic factors may be important in the pathogenesis and pathophysiology of endometriosis. The pattern of cytokine mRNA expression of endometriotic lesions would seem to indicate that proinflammatory cytokines such as IL-1beta and TNF-alpha are responsible for the development or progression of endometriosis.
Ascitic Fluid ; Cytokines ; Endometriosis* ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunologic Factors ; Interleukin-10 ; Interleukin-5 ; Interleukin-6 ; Menstruation Disturbances ; RNA, Messenger* ; Tumor Necrosis Factor-alpha