BACKGROUND: Today, the eradication of H. pylori represents a generally accepted and beneficial therapeutic strategy for treatment and prevention of peptic ulcer relapse. Major factors that have affected H. pylori eradication are eradication rate of regimen, compliance of patients and complications of drugs. Recently, the combination of omeprazole, amoxicillin and clarithromycin has been accepted as one of the most effective treatment for the eradication of H. pylori. The primary aim of this study was to evaluate the efficacy of this therapeutic modality in Korean patients. METHODS: Two hundred twenty three patients with peptic ulcer and H. pylori infection were taken two types of triple therapy. Group A were treated with omeprazole 20 mg bid, amoxicillin 500 mg tid, clarithromycin 500 mg tid daily for 14 days. Group B were treated with omeprazole 20 mg bid, amoxicillin 1g bid, clarithromycin 500 mg bid daily for 7 days. Endoscopy with H. pylori tests was repeated 4 weeks after the end of treatment and then biopsy specimens were taken in antrum and body. CLO test and Warthin Starry silver stain were conducted concordantly. RESULTS: The H. pylori eradication rate was 92.5% in group A, 90.4% in group B. There was no significant difference in eradication rate. More than 50% of ulcer size reduction was observed 90.5% in group A, 86.3% in group B. There was no significant difference in ulcer healing(p > 0.05). The incidence of all side effects in both group were as follows; 22.6% in group A, 19.1% in group B. But major side effect was found only group A, of whom the symptom was too serious for the treatment to continue. CONCLUSION: We concluded that the seven days regimen was more favorable, because the eradication rate was almost the same as the 14 days regimen. And drug compliance and cost effectiveness were better than 14 days treatment regimen.
Amoxicillin* ; Biopsy ; Clarithromycin* ; Compliance ; Cost-Benefit Analysis ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Omeprazole* ; Peptic Ulcer ; Recurrence ; Silver ; Ulcer

Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver absceases. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris throagh a surgical choledochatomy and subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure. A 55-year-old woman with intermittent colicky right upper quadrant abdominal pain was admitted to out hospital. Abdominai sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with acoustic shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by sphinctetotomy and lithotripsy, then we directly extracted ascaris with a tripod forcep without any complication.
Abdominal Pain ; Acoustics ; Adult ; Ascariasis* ; Ascaris ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Colic ; Common Bile Duct* ; Female ; Hemobilia ; Humans ; Lithotripsy ; Liver ; Middle Aged ; Shadowing (Histology) ; Surgical Instruments ; Therapeutic Irrigation

BACKGROUND: Deep Hypothermic circulatory Arrest (DHCA) is widely used during heart surgery in neonates and infants and complicated surgeries in adults such as a pulmonary thromboendarterectomy (PTE). However safe limits of time and temperature during DHCA still remain controversial. Futhermore it's effects on neurologic outcome has been controversial. METHODS: On the postoperative 3 days, we examined the neurologic function of 12 patients who received a PTE. During the PTE, DHCA was done 2 or 3 times within 20 minutes. Between DHCAs the patients were perfused at a low flow rate with 18degreesC blood until their venous saturation returned to 90%. Neurologic evaluations included level of consciousness, Glasgow coma scale (GCS), and motor and sensory functions. RESULTS: Neurologic functions of all of the patients assessed on the 3 days postoperatively was grossly normal. All 12 patients were oriented to time, place, and person with normal gross motor and sensory functions. CONCLUSIONS: No significant neurologic complications were related to the technique of two or three times of short DHCA within 20 minutes, for a total not exceeding 60 minutes.
Adult* ; Brain* ; Circulatory Arrest, Deep Hypothermia Induced* ; Consciousness ; Endarterectomy ; Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Sensation ; Thoracic Surgery

Endomyocardial biopsy (EMB) is a valuable diagnostic procedure for the surveillance of cardiac allograft rejection. Interpretation of individual cases is still problematic due to variations of findings for grading of rejection and other associated lesions. We reevaluated an experience on endomyocardial biopsies to develop better diagnostic criteria for rejection and other complications. Immunohistochemical studies against cytokines were performed to assess the usefulness of the method for the diagnosis or researches. A total of 249 EMBs taken from 33 cardiac allograft recipients were reviewed. There were 25 males and 8 females. Dilated cardiomyopathy was present (24 cases) and valvular heart disease (4 cases), restrictive cardiomyopathy (3 cases) were also common conditions. We applied the grading system of the International Society for Heart Transplantation (ISHT) for the assessment of acute cellular rejection. Grades of 0, 1A, 1B, 2, 3A and 3B were 39.0%, 28.1%, 11.2%, 11.5%, 12.4% and 1.6% respectively, but 3.2% were inadequate. Thirty five episodes of grade 3A or 3B were present in 17 patients. The response to therapy was assessed using a next follow up biopsy, which revealed resolving or resolved rejection in 85% of patients. The intensity of immunohistochemical stains for IL-6 and TNF-alpha was increased in proportion to the histologic grade but Quilty lesion and cardiomyopathy also showed a positive reaction. The other pathologic findings were ischemic change, previous biopsy site, interstitial edema and fibrosis, and Quilty lesion. These findings showed usefulness of endomyocardial biopsy not only for the evaluation of cardiac allograft rejection but also for the diagnosis of associated cardiac lesions. Immunohistochemical study of the cytokines was related to the degree of inflammation rather than degree of rejection.
Allografts ; Biopsy* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Coloring Agents ; Cytokines ; Diagnosis ; Edema ; Female ; Fibrosis ; Follow-Up Studies ; Heart Transplantation* ; Heart Valve Diseases ; Heart* ; Humans ; Inflammation ; Interleukin-6 ; Male ; Tumor Necrosis Factor-alpha

The purpose of this study was to compare the marginal fit of provisional restorations by differentiating the removal time and setting temperature during resin polymerization. After mixing autopolymerizing methyl metharcrylate resin, the material was placed in a preformed resin shell crown. The crown was seated on a die with 1mm shoulder margin. Crowns were removed after 3,4,5,6 minutes and polymerization was continued under the following conditions : 25degrees C air,30degrees C, 40degrees C, 50degrees C,60degrees C,70degrees C water. After polymerization, the crown was sectioned. The marginal & occlusal discrepancies were measured. The mean marginal discrelpancies at 3 minutes, 4 minutes, 5 minutes and 6 minutes of removing time were 96.6micrometer,84.6micrometer, 86.7micrometer and 105.6micrometer.The mean occlusal discrepancies at 3 minutes, 4 minutes, 5 minutes and 6 minutes of removing time were 106.7micrometer, 89.3micrometer, 98.6micrometer and 127.7micrometer.There was significant difference between 4 minutes group and 6 minutes group in occlusal discrepancies. The mean marginal & occlusal discrepancies for crowns polymerized in 25degrees C air were 98.2micrometer and 124.1micrometer. The crowns polymerized in 50degrees C water demonstrated the smallest marginal & occlusal discrepancies. The mean value of marginal & occlusal discrepancies in 50degrees C water were 73.1micrometer and 77.5micrometer. These values were smaller than that of 25degrees C air.There were significant differences in the occlusal discrepancies between 25degrees C air and water conditions of 50degrees C water (alpha=0.05) but, no significant differences in marginal discrepancies. There was no significant difference in the interaction between time and temperature. 4 minutes waiting time & 50degrees C water polymerizing condition produces the best fit at the margin of the provisional crown.
Crowns* ; Polymerization* ; Polymers* ; Shoulder ; Water

Both duodenal ulcer and gastric cancer are common, and it is well known that the pathophysiology of the two is different. The presence of a duodenal ulcer is believed to protect against the development of a gastric malignancy. However gastric cancer may occur in the presence of active or chronic duodenal ulcer disease. Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician must be alert to the strange association of duodenal ulcer and gastric cancer. Here, we present 3 cases with coexistence of duodenal ulcer and gastric cancer, diagnosed by endoscopy.
Duodenal Ulcer* ; Endoscopy ; Incidence ; Stomach Neoplasms*

BACKGROUND: Helicobacter pylori (H. pylori) infection may cause systemic inflammation and increase the production of tumor necrosis factor-alpha, interleukin-1, and interleukin-6. Unfortunately, bone mineral density also may be affected by these cytokines. This study aimed to evaluate the association between bone mineral density and H. pylori infection. METHODS: A cross-sectional study evaluated 1,126 men undergoing a comprehensive health screening in a private Korean screening center. Subjects' sera were tested for H. pylori antibodies (immunoglobulin G) using an enzyme-linked immunosorbent assay, and bone mineral densities (g/cm2) of the lumbar spine, femoral neck, and total femur were obtained using dual-energy X-ray absorptiometry. To evaluate the difference in bone mineral density according to H. pylori infection status, the adjusted mean bone mineral densities at each site were compared after adjusting for potential confounders, including age, sex, body mass index, smoking, alcohol consumption, and exercise. RESULTS: H. pylori infection was associated with a significant decrease in mean lumbar bone mineral density (H. pylori-positive, 1.190 g/cm2; H. pylori-negative, 1.219 g/cm2; P=0.006), which was greatest among men who were > or =50 years old (H. pylori-positive, 1.193 g/cm2; H. pylori-negative, 1.233 g/cm2; P=0.006). However, no significant association was observed in the bone mineral densities of the total femur and femoral neck. CONCLUSION: In men, H. pylori infection was negatively associated with lumbar bone mineral density. This association may be useful in the early detection, prevention, and management of male osteoporosis.
Absorptiometry, Photon ; Alcohol Drinking ; Antibodies ; Body Mass Index ; Bone Density ; Cross-Sectional Studies ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Femur ; Femur Neck ; Helicobacter pylori* ; Helicobacter* ; Humans ; Inflammation ; Interleukin-1 ; Interleukin-6 ; Male ; Mass Screening ; Osteoporosis ; Risk Factors* ; Smoke ; Smoking ; Spine ; Tumor Necrosis Factor-alpha

It is becoming increasingly clear that human gingival fibroblasts(HGF) may play a role in regulating immune responsiveness in inflammatory periodontal lesions. Stimulation of HGF with locally-secreted T cell cytokine IFNgamma induces human leukocyte antigen class II(HLA II) expression on HGF, which is one of the characteristic feature of professional antigen presenting cells(pAPC). However, IFNgamma-treated HGF and other nonprofessional antigen presenting cells(npAPC) are known to be ineffective or less effective antigen presenter to resting T cells. This study, therefore, was undertaken in an effort to elucidate the differences in expression of cell surface molecules between npAPC in periodontal tissues, such as HGF and periodontal ligament fibroblasts(PDLF), and pAPC such as monocytes/macrophages. Using flow cytometry, the levels of cell surface expression of HLA-D, ICAM-1, LFA-3, and B7-1, which are involved in antigen presentation, were determined in HGF, PDLF and human myelomonocytic cell line THP-1. IFNgamma clearly induced HLA-D expression on both of fibroblasts and monocytes dose dependently. However, expression level on monocytes were 4 to 5 times higher than that on fibroblasts, and induction rate was faster in monocytes than in fibroblasts. The levels of ICAM-1 expression on fibroblasts and monocytes were enhanced by IFNgamma in a dose dependent manner. On the other hand, the expression of LFA-3 molecule, which could be detected in fibroblasts and monocytes without cytokine stimulation, was no more enhanced by addition of IFNgamma. B7-1, important costimulatory molecule in T cell activation and proliferation, was not detected on both of fibroblasts and monocytes even when stimulated with IFNgamma, except on monocytes fully differentiated by pretreatment of PMA and treated by IFNgamma. These results suggest that delayed expression of HLA-D and absence of B7-1 on IFNgamma -treated fibroblasts may at least in part be involved in the ineffectiveness of fibroblasts as primary APC. And it is postulated that although periodontal fibroblasts may not serve as primary APC in normal periodontium, sustained expression of HLA II on ubiquitous fibroblasts in inflammatory lesions may perpetuate immune responses and produce chronic inflammation and tissue injury.
Antigen Presentation ; Antigens, CD58 ; Cell Line ; Fibroblasts* ; Flow Cytometry ; Hand ; HLA-D Antigens ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interferons* ; Leukocytes ; Monocytes ; Periodontal Ligament* ; Periodontium ; T-Lymphocytes

We studied retrospectively on clinical assessment of treatment in myasthenic patients who visited on our department regularly since 1985. They were divided as a group based on therapeutic modalities such as a thymectomy, steroid therapy. Combined therapy(steroid and thymectomy), plasma exchange. And whole body irradiation. We evluated clinical effectiveness of these therapeutic modalities and come up with following conclusions. Alltherapeutic modalities showed effectiveness. In steroid therapy, thymectomy and the combined therapy. W needed at least 6-24 months for clinical improvement. In thymectomy, rognosis was depend on the number of germinal centers. In whole body irradiation. Effectiveness was shown at 5h week and continued to 6th to 12th months. We also noted that symptomatic improvement was correlated with decreased lymphocyte counts. The effect of plasma exchange was rapid but only short duration.
Germinal Center ; Humans ; Lymphocyte Count ; Myasthenia Gravis* ; Plasma Exchange ; Retrospective Studies ; Thymectomy ; Whole-Body Irradiation

PURPOSE: The purpose of this study was to understand the principle of percutaneous nephrolithotomy(PNL), toincrease its success rate, and to base the radiologic approach on preoperative interventional tract dilatation. MATERIALS AND METHODS: Twenty-six patients(male, 19, female, 7) with staghorn or pelviocalyceal calculi who hadundergone PNL were included in this study. After percutaneous nephrostomy(PCN) was performed in each patient, thetract was dilated to 30F with Amplatz dilators using coaxial techniques or a 30F, 10cm high-pressure tractdilatation balloon. One day before the calculi were fragmented and removed by PNL, a 30F Amplatz sheath wasinserted under local anesthesia. The time required for tract dilatation, complications, and surgery was analyzed. RESULTS: Percutaneous tract dilatation were successful in all patients, and forceps, a nephrolithotome and anephroscope were successfully introduced into the pelvocalyceal system. The average procedure time was 19.5minutes ; a double J stent was replaced in the pelvocalyceal system of 13 of 26 patients (50%) ; because ofimproper catheter direction or/and bleeding, the Amplatz sheath was replaced in three. After PNL, complicationsinvolving renal hematoma occurred in one patient. This did not affect the patient's prognosis, however. CONCLUSION:Owing to its short procedure time and low complication rate, interventional preoperative tract dilatation forPNL is thought to be an effective technique for patients with staghorn or pelvocalceal calculi.
Anesthesia, Local ; Calculi ; Catheters ; Dilatation* ; Female ; Hematoma ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Prognosis ; Stents ; Surgical Instruments