No abstract available.

Eradication of Helicobacter pylori has contributed to the treatment of peptic ulcers and mucosa-associated lymphoid tissue lymphoma. Moreover, it has possibly decreased the prevalence of gastric cancer. However, eradication therapy is associated with various adverse effects, of which diarrhea is the most common. The incidence of diarrhea after eradication treatment varies from 8% to 48%. In particular, the incidence is higher in patients who receive first-line standard triple therapy compared with those who receive second-line therapy. Both antibiotics and proton pump inhibitors, components of eradication therapy, have short-term and long-term impacts on gut microbiota. The alterations of gut microbiota may not recover until 1 year after eradication therapy. Most cases of diarrhea that occur after eradication therapy are antibiotic-associated diarrhea caused by the destruction of the normal gut microbiota. In some cases, Clostridioides difficile-associated diarrhea occurs after eradication therapy. If bloody diarrhea occurs after eradication therapy and the Clostridioides difficile toxin is not detected, antibiotic-associated hemorrhagic colitis associated with Klebsiella oxytoca infection should be suspected. It is crucial to explain the possibility of diarrhea before initiating eradication therapy to increase compliance. Furthermore, probiotics may be administered to reduce diarrhea. If severe diarrhea or symptoms other than the usual antibiotic-associated diarrhea occur during or after eradication therapy, antibiotics should be discontinued. In addition, appropriate tests to determine the cause of diarrhea should be performed. This review summarizes the alteration of the gut microbiota, the causes of diarrhea after Helicobacter pylori eradication therapy, and its management.

Eradication of Helicobacter pylori has contributed to the treatment of peptic ulcers and mucosa-associated lymphoid tissue lymphoma. Moreover, it has possibly decreased the prevalence of gastric cancer. However, eradication therapy is associated with various adverse effects, of which diarrhea is the most common. The incidence of diarrhea after eradication treatment varies from 8% to 48%. In particular, the incidence is higher in patients who receive first-line standard triple therapy compared with those who receive second-line therapy. Both antibiotics and proton pump inhibitors, components of eradication therapy, have short-term and long-term impacts on gut microbiota. The alterations of gut microbiota may not recover until 1 year after eradication therapy. Most cases of diarrhea that occur after eradication therapy are antibiotic-associated diarrhea caused by the destruction of the normal gut microbiota. In some cases, Clostridioides difficile-associated diarrhea occurs after eradication therapy. If bloody diarrhea occurs after eradication therapy and the Clostridioides difficile toxin is not detected, antibiotic-associated hemorrhagic colitis associated with Klebsiella oxytoca infection should be suspected. It is crucial to explain the possibility of diarrhea before initiating eradication therapy to increase compliance. Furthermore, probiotics may be administered to reduce diarrhea. If severe diarrhea or symptoms other than the usual antibiotic-associated diarrhea occur during or after eradication therapy, antibiotics should be discontinued. In addition, appropriate tests to determine the cause of diarrhea should be performed. This review summarizes the alteration of the gut microbiota, the causes of diarrhea after Helicobacter pylori eradication therapy, and its management.

PURPOSE: This study was performed for investigation of epidemiology, clinical characteristics, and serial value of cardiac troponin level of patients who had myocardial injury due to Carbon monoxide poisoning. METHODS: This study reviewed 98 cases of Carbon monoxide poisoning patients who visited Emergency Department from January 1, 2008 to October 31, 2013. We categorized them by two groups, one with elevation of cardiac troponin level and the other with normal level. We had comparison between two groups data using statistical analysis. RESULTS: Among 98 patients of Carbon monoxide poisoning who were admitted to hospital, 10 patients were excluded. 88 patients who were included to our study, 70 patients with normal value of Troponin, and 18 patients with elevated troponin level. Of all patients, Carbon monoxide inhalation due to suicided trial patients has more higher proportion in elevated troponin level group compared with normal group (40 (57.1%) vs 15 (83.3%), P=0.041). Furthermore, corrected QT interval, length of hospital stay, number of ICU admission, also were showed higher value in elevated troponin level group. CONCLUSION: Carbon monoxide induced myocardial injury is associated with subside trial, prolongation of correted QT interval, length of hospital stay, and number of ICU admission.
Carbon Monoxide Poisoning ; Carbon Monoxide* ; Emergency Service, Hospital ; Epidemiology ; Humans ; Inhalation ; Length of Stay ; Reference Values ; Troponin ; Troponin I

PURPOSE: To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. MATERIALS AND METHODS: Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. RESULTS: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). CONCLUSION: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Papilloma ; Retrospective Studies

Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case of partial agenesis of dorsal pancreas was reported. This case was not associated with diabetes mellitus and pancreatic exocrine dysfunction, or abdominal pain. A 37-year-old man with chronic hepatitis B visited to our hospital due to further examination for chronic hepatitis B. Abdominal ultrasonography showed enlarged pancreatic head. Diagnosis was made by endoscopic retrograde cholangiopancreatography and computed tomography. Explor-laparotomy was not done.
Abdominal Pain ; Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Diagnosis ; Head ; Hepatitis B, Chronic ; Humans ; Pancreas ; Ultrasonography

Purpose: This study aimed to evaluate the safety and feasibility of laparoscopic sleeve gastrectomy with duodenojejunal bypass (SDJB) surgery in Korean patients. Materials and Methods: This was a retrospective study analyzing SDJB surgery with a 200-cm biliopancreatic limb; the surgery was performed between January 2019 and August 2020 in 56 Koreans with morbid obesity. All demographic, clinical, operative, and follow-up data were documented and analyzed for weight loss and diabetes remission efficacy. Safety and feasibility were analyzed in terms of perioperative and postoperative complications. A decrease in the HbA1c value and discontinuation or reduction of anti-diabetics were considered as indicators of improvement in diabetes. Results: The median operation time was 180.0 min (105-210 min), and the median postoperative hospital stay was 5.0 days (3-35 days). Postoperative complications occurred in two patients who were managed by conversion to Roux-en-Y gastric bypass surgery. Meaningful weight loss was 3.5%, 27.7%, and 54.9% at the 1-month, 3-month, and 6-month follow-ups, respectively. Of the 56 patients, 46 had type 2 diabetes. Among those patients, at the 1-month follow-up, 4/31 patients (12%), at the 3-month follow-up, 22/41 patients (53.6%), and at the 6-month follow-up, 31/42 patients (73.8%) were found to show improvement. Of the patients who received anti-diabetics or insulin therapy, only three (9%) patients continued to receive reduced treatment of diabetes, and the other thirty (91%) discontinued the anti-diabetics. Conclusion SDJB surgery with a 200-cm biliopancreatic limb was a safe and effective procedure to treat morbid obesity and diabetes.

PURPOSE: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. METHODS: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. RESULTS: Representative values were compared between survivors and non-survivors : RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. CONCLUSION: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage.
Emergencies ; Hemorrhage ; Humans ; Hypotension ; Lactic Acid ; Multiple Trauma ; Prognosis ; Resuscitation ; Retrospective Studies ; Survivors

OBJECTIVES: The stress response involves the activation of the hypothalamic-pituitary-adrenal(HPA) axis and the sympathetic nervous system. Corticosteroids have been clearly demonstrated to cause anti-inflammatory and/or immnosuppressive effects in man including granulocytosis in part by decreasing migration into tissue, especially damaged tissues(myocardium), and circulating relative lymphocytopenia. To test whether automated measurements of the the increased serum cortisol-induced hematologic changes in the leukocyte differential significance or not in the initial differential diagnosis of acute myocardial infarction in acute chest pain syndromes. METHODS: 101 consecutive patients with myocardial infarction or myocardial ischemia presenting to the emergency room of Seoul Adventist Hospital with acute chest pain from January 1993 to August 1995(Retrospective group) and from December 1995 to March patients compatible with exclusion criteria in myocardial infarction were excluded. We measured automated leukocyte differential and serial CK-MB level in both groups, and the intial serum cortisol levels in prospective infarction group. RESULTS: 1) Total leukocyte and granulocyte counts were increased in acute myocardial infarction(p<0.01). 2) In acute myocardial infarction group, lymphocyte counts were slightly increased(p<0.05), but relative lymphocytes percentage more significantly decreased(p<0.01). 3) Serum cortisol levels are significantly raised early in the course of the acute myocardial infarction and prior to the elevation of the specific cardiac enzymes on the basis of analytic results of prospective infarction group. 4) Cortisol-induced changes in leukocyte differential were noted with time passes into reverse approximately 4 days later in our study. 5) The leukocyte differential does not shows significant changes in the retrospective myocardial ischemia group, so we arrive in careful conclusion that serum cortisol level seems does not increase. 6) No sexual differences were noted in leukocyte differential. CONCLUSIONS: The serum cortisol level and cortisol-induced leukocyte differential are helpful for initial differential diagnosis of acute myocardial infarction in acute chest pain sysdrome.
Adrenal Cortex Hormones ; Axis, Cervical Vertebra ; Chest Pain* ; Diagnosis, Differential* ; Emergency Service, Hospital ; Granulocytes ; Humans ; Hydrocortisone* ; Infarction ; Leukocytes* ; Lymphocyte Count ; Lymphocytes ; Lymphopenia ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Retrospective Studies ; Seoul ; Sympathetic Nervous System ; Thorax*

PURPOSE: The majority of electrical injuries coming to emergency department are low voltage injuries cases. Therefore this study was designed to investigate the clinical characteristics and the treatment outcomes of patients with low voltage electrical injury in one emergency center. METHODS: We, retrospectively, reviewed the medical records of the patients who visited emergency department between July, 2007 and May, 2012. We noted demographics, entrance and exit point of burn injuries, associated injuries and symptoms, electrocardiograms, laboratory results, results of treatment, and so on. RESULTS: There are 103 patients enrolled. Sixty-eight (66%) patients were men with a mean age of 24 years. Pediatric patients (< or =15) were 41 (40.0%). The right upper extremity was the most common entry point, and exit point was unclear in almost cases. There were no lethal complications, except 1 case. The case with lethal complication was 57 year old man who survived from out-of hospital cardiac arrest. He was injured by 220 V electric current during 2 minutes and total arrest time was 20 minutes. He was applied with mild therapeutic hypothermia and later, discharged with favorable neurologic outcome (Cerebral Performance Categories scale 2). Overall rate of discharge, admission and transfer were 67.0%, 28.2% and 4.9%, respectively. Among the discharged patients, no patient re-visited to emergency department with severe complication. After admission, all patients discharged without severe complication. CONCLUSION: There were neither unexpected complications nor delayed complication in our study. Therefore, ED physicians might consider discharge if patients had only minor complications that can manage out-patients follow up at the initial evaluation.
Arrhythmias, Cardiac ; Burns ; Demography ; Electric Injuries ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Heart Arrest ; Humans ; Hypothermia ; Male ; Medical Records ; Outpatients ; Retrospective Studies ; Upper Extremity