Trichobezoars are gastric concretions that are composed of hair or fibers. They are more common in children and adolescents and are usually associated with a pica, emotional disturbance, or mental retardation. Trichobezoar is quite rare in Korea. In most cases, trichobezoars tend to form a cast of the stomach. However, in rare cases, portions of the trichobezoar may separate from the gastric mass, migrate distally, and obstruct the small bowel. We report a case of small bowel obstruction due to multiple trichobezoars in a 14 year-old-girl who had a habit of swallowing hairs until 12 years of age. The patient was treated successfully surgically.
Adolescent ; Affective Symptoms ; Bezoars* ; Child ; Deglutition ; Hair ; Humans ; Intellectual Disability ; Korea ; Pica ; Stomach

Duodenal lipoma is relatively rare, and usually located in the second portion of the duodenum. Most lipomas of the small intestine are asymptomatic and incidentally found. However, epigastric pain, intussusception, ulcer, intestinal obstruction and rarely severe hemorrhage can occur depending on the size or location. Duodenal lipoma is mostly confirmed by surgical removal with histopathologic valuation because it is difficult to make a differential diagnosis of duodenal lipoma from malignant tumor or other submucosal tumor based only on the findings of radiology or endoscopy. Endoscopic ultrasonography can so help for the differential diagnosis of the submucosal tumor. We report a case of duodenal lipoma accompanied by upper gastrointesinal hemorrhage, treated by both endoscopic resection and surgical operation and confirmed by histopathologic diagnosis.
Diagnosis ; Diagnosis, Differential ; Duodenum ; Endoscopy ; Endosonography ; Hemorrhage* ; Intestinal Obstruction ; Intestine, Small ; Intussusception ; Lipoma* ; Ulcer

The authors present use of Viewing wand navigator for localization and clipping of an aneurysm of distal middle cerebral artery. This method significantly decreased the operative time and minimized unnecessary dissection for localization of distally located aneurysms in selected cases.
Aneurysm ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Operative Time

BACKGROUND: One of the major morphologic characteristics of hepatitis B is a hepatocellular regeneration which is induced by massive hepatocyte necrosis and associated with proliferative activity of hepatocytes. The purpose of this study is to document the proliferative activity of hepatocytes in various types of hepatitis B by immunohistochemical staining for proliferative cell nuclear antigen-labelling index (PCNA-LI) and electron microscopy. METHODS: We studied 83 patients with hepatitis B; 11 cases of acute viral hepatitis, 24 cases of mild chronic hepatitis, 34 cases of severe chronic hepatitis with early cirrhosis and 14 cases of severe chronic hepatitis. The PCNA was tested by immunohistochemical staining using anti-PCNA antibody. Furthermore we evaluated the ultrastructure of acinus-forming hepatocytes (AFH) by electron microscopy. RESULTS: The expression rate and labelling index of PCNA were 27.3% and 5.3 +/- 0.9% in acute viral hepatitis, 62.5% and 22.9 +/- 31.7% in mild chronic hepatits, and then 47.1% and 14.1 +/- 24.2% in severe chronic hepatitis with early cirrhosis, respectively (Figure 1). By contrast, no detectable PCNA expression was noted in AFH. Electron microscopic findings showed that hepatocytes forming a rosette underwent marked degenerative changes with sinusoidal capillarization and increased fine strands of collagen fiber in portal area. CONCLUSION: The proliferative acitivity of hepatitis B was significantly decreased in severe chronic hepatitis containing AFH. This result suggested that differences in proliferative activity was associated with hepatic cell necrosis and AFH.
Adolescent ; Adult ; Aged ; Cell Division ; Female ; Hepatitis B, Chronic/*metabolism/*pathology ; Hepatocytes/*metabolism/*ultrastructure ; Human ; Immunohistochemistry ; Male ; Microscopy, Electron ; Middle Age ; Proliferating Cell Nuclear Antigen/*metabolism

Eradication of Helicobacter pylori using first-line therapy is becoming less effective. Subjects who had been treated for H. pylori infection were prospectively enrolled through an on-line database registry from October 2010 to December 2012. Demographic data, detection methods, treatment indication, regimens, durations, compliance, adverse events, and eradication results for H. pylori infection were collected. Data of 3,700 patients from 34 hospitals were analyzed. The overall eradication rate of the first-line therapy was 73.0%. Eradication failure was significantly associated with old age, concomitant medication, and comorbidity. Regional differences in eradication rates were observed. The most common first-line therapy was proton pump inhibitor-based triple therapy (standard triple therapy, STT) for 7 days (86.8%). The eradication rates varied with regimens, being 73% in STT, 81.8% in bismuth-based quadruple therapy, 100% in sequential therapy, and 90.3% in concomitant therapy. The eradication rate in treatment-naïve patients was higher than that in patients previously treated for H. pylori infection (73.8% vs. 58.5%, P < 0.001). The overall eradication rate for second-line therapy was 84.3%. There was no statistical difference in eradication rates among various regimens. H. pylori eradication rate using STT is decreasing in Korea and has become sub-optimal, suggesting the need for alternative regimens to improve the efficacy of first-line therapy for H. pylori infection.
Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/*therapeutic use ; Databases, Factual ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy/microbiology ; Helicobacter pylori/isolation & purification ; Humans ; Internet ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Proton Pump Inhibitors/*therapeutic use ; Registries ; Republic of Korea ; Treatment Outcome

Eradication of Helicobacter pylori using first-line therapy is becoming less effective. Subjects who had been treated for H. pylori infection were prospectively enrolled through an on-line database registry from October 2010 to December 2012. Demographic data, detection methods, treatment indication, regimens, durations, compliance, adverse events, and eradication results for H. pylori infection were collected. Data of 3,700 patients from 34 hospitals were analyzed. The overall eradication rate of the first-line therapy was 73.0%. Eradication failure was significantly associated with old age, concomitant medication, and comorbidity. Regional differences in eradication rates were observed. The most common first-line therapy was proton pump inhibitor-based triple therapy (standard triple therapy, STT) for 7 days (86.8%). The eradication rates varied with regimens, being 73% in STT, 81.8% in bismuth-based quadruple therapy, 100% in sequential therapy, and 90.3% in concomitant therapy. The eradication rate in treatment-naïve patients was higher than that in patients previously treated for H. pylori infection (73.8% vs. 58.5%, P < 0.001). The overall eradication rate for second-line therapy was 84.3%. There was no statistical difference in eradication rates among various regimens. H. pylori eradication rate using STT is decreasing in Korea and has become sub-optimal, suggesting the need for alternative regimens to improve the efficacy of first-line therapy for H. pylori infection.
Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/*therapeutic use ; Databases, Factual ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy/microbiology ; Helicobacter pylori/isolation & purification ; Humans ; Internet ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Proton Pump Inhibitors/*therapeutic use ; Registries ; Republic of Korea ; Treatment Outcome