BACKGROUND: A clinical trial was done to evaluate the antihypertensive efficacy and side effects of captopril(Capril(R)), an angiotensin converting enzyme inhibitor, in patients with mild to moderate essential hypertension. METHOD: Captopril was given 25-50mg a day to 46 patients(mean age : 51.3+/-8.9 years, 21 males and 25 females) for 8 weeks. RESULT: The blood pressure dropped significantly in 2 weeks and well maintained throughout 8 weeks of study period(p<0.01). The mean pressure drop was 14.4/8mmHg at 8 weeks without any changes of heart rate. The blood pressure was not dropped in 13 cases(28.3%). There were no significant changes in CBC, urinalysis and blood chemistry(sugar, lipids, electrolytes, creatinine, protein, albumin, AST and ALT) during this trial. The side effects were observed in 20 cases(43.5%). The most frequent was cough(19 cases, 413%) and the others were dysgeusia, dry eyes and edema in each respectively. CONCLUSION: Captopril(Capril(R)) monotherapy with 25-50mg a day regimen was effective in patient with mild to moderate essential hypertension, but somewhat high episodes of cough were observed in this trial.
Blood Pressure ; Captopril ; Cough ; Creatinine ; Dysgeusia ; Edema ; Electrolytes ; Heart Rate ; Humans ; Hypertension ; Male ; Peptidyl-Dipeptidase A ; Urinalysis

Patients with cerebrovascular accidents often have abnormal electrocardiograms in the absence of known organic heart disease. In 1901 harvey Cushing has discovered sinus bradycardia in CVA patients. Burch, Myers and Abildskov were the first to report electrocardiographic abnormalities in CVA. Since then many reports have appeared in the literature. This study was done utilizing brain C-T scan to varify and localize the site of CVA, for purposes of correlation of the CVA with abnormalities of electrocardiogram. We obtained the following results. 1. Among 250 cases of CVA, 107 cases were excluded due to pre-existing cardiac disease, abnormal serum electrolyte and early death. 2. Among 143 cases, intracranial hemorrhage were 62.9% and brain infarction were 37.1%. 3. In intracranial hemorrhage, normal electrocardiographic finding were only 4.5%. Q-Tc prolongation revealed 64.5%. 4. In brain infarction, normal electrocardiographic finding was only 5.7%. Q-Tc prologation revealed 64%.
Bradycardia ; Brain ; Brain Infarction ; Electrocardiography* ; Heart Diseases ; Humans ; Intracranial Hemorrhages ; Stroke

Pseudoaneurysm is a rare life-threatening complication of chronic pancreatitis. It can be diagnosed by various imaging modalities including computerized tomography (CT), ultrasound, and angiography. Early diagnosis and radiologic or surgical treatment can promise better outcomes. However, pseudoaneurysm is not easily diagnosed. It can be misdiagnosed as a pseudocyst with secondary infection. Rarely, the correct diagnosis is made by an inadvertent trial with percutaneous drainage. The endoscopically identified hemosuccus pancreaticus is also a rare finding. Recently, we experienced two cases of pseudoaneurysm in patients with chronic pancreatitis. They did not have any evidence of bleeding in the initial endoscopy or evidence of pseudoaneurysms in the initial ultrasound and CT scan. In one case, the pseudoaneurysm was identified during a percutaneous drainage procedure, performed to diagnose and manage a cystic lesion which appeared to be an infected cyst. In the other case, the pseudoaneurysm was suspected after the hemosuccus pancreaticus was found during endoscopy performed due to recurrent hematemesis. Both cases were successfully treated with arterial embolization of the pseudoaneurysms.
Aneurysm, False* ; Angiography ; Coinfection ; Diagnosis ; Drainage* ; Early Diagnosis ; Endoscopy ; Hematemesis ; Hemorrhage ; Humans ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed ; Ultrasonography

A new technique and clinical experience of minimally invasive anterior lumbar interbody fusion(mini-ALIF) are reported. Despite its biomechanical advantages and high fusion rate, conventional ALIF needs a long skin incision and extensive dissection. Endoscopic approaches for ALIF seem to be associated with considerable technical difficulties, long operation time, and high complication rate even in collaboration with a laparoscopic surgeon. Mini-ALIF involves a standardized minimally invasive microsurgical retroperitoneal approach for L2-3 to L4-5, and transperitoneal approach for L5-S1. Mini-ALIF can be done through minimal skin incision(4-5cm) and blunt muscle dissection without abdominal muscle cutting. Between December 1995 and March 1997, 12 cases with various lumbar diseases underwent mini-ALIFs. The surgical indications were postoperative pseudarthrosis in 5 cases, degenerative spondylolisthesis in 4 cases, and iatrogenic postoperative instability in 3 cases. Seventy-five percent of patients including reoperation cases showed good outcome and high fusion rate on more than 6 months follow-up. There was no permanent technique-related complication. Mini-ALIF provided sufficient operation space for lumbar interbody fusion. Consequently, authors could reduce operation time, bleeding, and postoperative morbidity of ALIF.
Abdominal Muscles ; Bleeding Time ; Cooperative Behavior ; Follow-Up Studies ; Humans ; Microsurgery ; Pseudarthrosis ; Reoperation ; Skin ; Spinal Fusion ; Spondylolisthesis ; Surgical Procedures, Minimally Invasive

BACKGROUND/AIMS: Recent studies have shown that serum interferon gamma-inducible protein-10 (IP-10) concentration decreased after pegylated interferon and ribavirin therapy, and was associated with a sustained virologic response (SVR). The aim of this study was to investigate the clinical significance of the pretreatment IP-10 level and change in serum IP-10 level between 1 month before and after treatment and its association with various virologic responses in patients having chronic hepatitis C (CHC) with genotype 1 undergoing pegylated interferon and ribavirin therapy. METHODS: Thirty-six patients having CHC with genotype I undergoing pegylated interferon and ribavirin therapy who had available stored sera 1 month before and after treatment were enrolled retrospectively. Serum IP-10 levels were measured by ELISA. Serum HCV RNA was measured by RT-PCR (detection limit<50 IU/mL). RESULTS: The mean age of patients (n=36; 21 men) was 53.5 years, and the mean of pretreatment HCV RNA levels was 5.7 log10 IU/mL. The serum IP-10 level at 1 month after treatment significantly decreased from 432.2 to 306.5 pg/mL (p=0.033). The rate of rapid virologic response (RVR), early virologic response (EVR), end-of-treatment response (ETR), and SVR were 58%, 83%, 74%, and 57%, respectively. No significant difference in pretreatment IP-10 levels was observed between the patients with (RVR, EVR, ETR, and SVR) and without various virologic responses (p>0.05). The change in serum IP-10 between 1 month before and after treatment had no clinical meaning based on various virologic responses (p>0.05). CONCLUSIONS: The level of pretreatment IP-10 and change in IP-10 level between 1 month before and after treatment were not predictive factors of a SVR. Additional large-scale studies to determine the SVR-predicting role of serum IP-10 levels in patients with CHC are needed.
Enzyme-Linked Immunosorbent Assay ; Genotype ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Retrospective Studies ; Ribavirin ; RNA

BACKGROUND/AIMS: Elastic band ligation is a well-established method for the treatment of internal hemorrhoids. The aim of this study was to assess the treatment outcomes of flexible endoscopic rubber band ligation of internal hemorrhoids. METHODS: Using a flexible endoscope, 30 patients with symptomatic internal hemorrhoids were evaluated based on change in clinical symptoms (Goligher grade, bleeding score) and endoscopic classifications (range, size) before and after the procedure. RESULTS: Goligher grade and bleeding score showed significant improvement after the procedure (Goligher grade from 2.12 to 0.54, p<0.01, and bleeding score from 1.80 to 0.40, p<0.01). Endoscopic classification scores improved significantly after the procedure (range 3.03 to 1.55, p<0.01, and size from 1.80 to 0.85, p<0.01). As a complication, mild pain developed in 19 patients (90.5%) and severe pain in two patients (9.5%). Most (90.5%) were well controlled by conservative management, but one patient was operated on for hemorrhoidal thrombosis and in another patient the ligated rubber band had to be released promptly for pain relief. One patient (3.3%) experienced mild infection, which was relieved by medical treatment. During the 16.7+/-3.2-month period of follow-up, two patients relapsed, one was treated with additional endoscopic band ligation, and one underwent surgery. CONCLUSIONS: Flexible endoscopic band ligation is an effective and safe method of treatment in patients with symptomatic internal hemorrhoids.
Endoscopes ; Follow-Up Studies ; Hemorrhage ; Hemorrhoids ; Humans ; Ligation ; Rubber ; Thrombosis

BACKGROUND/AIMS: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. METHODS: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. RESULTS: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1beta was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-alpha and IL-6 did not differ between the two groups. CONCLUSIONS: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1beta expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed.
2-Pyridinylmethylsulfinylbenzimidazoles ; Alkaline Phosphatase ; Animals ; Bone Density ; Calcium ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Injections, Intraperitoneal ; Interleukin-6 ; Interleukins ; Mice ; Mice, Inbred ICR ; Osteocalcin ; Osteoclasts ; Osteogenesis ; Osteoporosis ; Phosphorus ; Proton Pump Inhibitors ; Proton Pumps ; RNA, Messenger ; Sample Size ; Tibia ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. METHODS: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. RESULTS: The mean tumor size was 42.5+/-14.3 mm (range, 30~78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5+/-60.7 min (range, 22~246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. CONCLUSIONS: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors.
Adenocarcinoma ; Adenoma ; Colon ; Colorectal Neoplasms ; Follow-Up Studies ; Hemorrhage ; Humans ; Medical Records

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage and is understood to represent a tiny submucosal defect with fibrinoid necrosis at its base, overlying a large, tortuous, thick-walled artery in the muscularis mucosa. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. Moreover, Dieulafoy's lesion of the terminal ileum is very rare. We herein report a case of a patient who presented with massive hematochezia from Dieulafoy's lesion of the terminal ileum which was successfully controlled with endoscopic treatment by utilizing electrocoagulation.
Arteries ; Colon ; Electrocoagulation* ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans ; Ileum* ; Mucous Membrane ; Necrosis ; Rectum ; Stomach

BACKGROUND/AIMS: Mirocam(R) capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam(R) capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam(R) capsule endoscopic studies. METHODS: We retrospectively analyzed 103 cases that were assessed with Mirocam(R) capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. RESULTS: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9+/-88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0+/-131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI=0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). CONCLUSIONS: In a Mirocam(R) capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield.
Abdominal Pain ; Anemia ; Capsule Endoscopy ; Humans ; Korea ; Male ; Retrospective Studies ; Stomach