BACKGROUND/AIMS: This study aimed to investigate the prevalence and characteristics of small intestinal bacterial overgrowth (SIBO) in patients undergoing abdominal surgeries, such as gastrectomy, cholecystectomy, and hysterectomy. METHODS: One hundred seventy-one patients with surgery (50 hysterectomy, 14 gastrectomy, and 107 cholecystectomy), 665 patients with functional gastrointestinal disease (FGID) and 30 healthy controls undergoing a hydrogen (H₂)-methane (CH₄) glucose breath test (GBT) were reviewed. RESULTS: GBT positivity (+) was significantly different among the surgical patients (43.9%), FGID patients (31.9%), and controls (13.3%) (p<0.01). With respect to the patients, 65 (38.0%), four (2.3%), and six (3.5%) surgical patients and 150 (22.6%), 30 (4.5%), and 32 (4.8%) FGID patients were in the GBT (H₂)+, (CH₄)+ and (mixed)+ groups, respectively (p<0.01). The gastrectomy group had a significantly increased preference in GBT+ (71.4% vs 42.0% or 41.1%, respectively) and GBT (H₂)+ (64.3% vs 32.0% or 37.4%, respectively) compared with the hysterectomy or cholecystectomy groups (p<0.01). During GBT, the total H₂ was significantly increased in the gastrectomy group compared with the other groups. CONCLUSIONS: SIBO producing H2 is common in abdominal surgical patients. Different features for GBT+ may be a result of the types of abdominal surgery.
Breath Tests* ; Cholecystectomy* ; Gastrectomy* ; Gastrointestinal Diseases ; Glucose* ; Humans ; Hydrogen ; Hysterectomy* ; Prevalence

Lymphocytic interstitial pneumonia (LIP) is a rare benign lymphoproliferative disorder characterized by diffuse infiltration of the pulmonary parenchymal interstitium by polyclonal lymphocytes and plasma cells. LIP has been associated with a variety of clinical conditions; such as connective tissue disorders and other immune system abnormalities. Treatment usually involves administration of corticosteroids and other immunosuppressants. We report on a 38-year-old female patient who complained of shortness of breath, dry mouth, and dry eyes for more than 1 month, and was positive for Raynaud's phenomenon. Based on surgical biopsy, she was diagnosed as having LIP accompanied by Sjögren's syndrome. The patient was treated with high-dose steroids followed by maintenance therapy for approximately 2 years, and her condition improved.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Connective Tissue ; Dyspnea ; Female ; Humans ; Immune System ; Immunosuppressive Agents ; Lip ; Lung Diseases, Interstitial* ; Lymphocytes ; Lymphoproliferative Disorders ; Mouth ; Plasma Cells ; Steroids

IgG4-related disease is an immune-mediated fibro-inflammatory disease, characterized by lymphoplasmacytic infiltration composed of IgG4-positive plasma cells of various organs with elevated circulating levels of IgG4. This disease is now reported with increasing frequency and usually affects middle-aged men. Massive pleural effusion in children is an uncommon feature in IgG4-related disease. Here, we report a case of a 16-year-old male patient with extensive IgG4-related disease presenting with massive pleural effusion, mediastinal mass, and mesenteric lymphadenopathy.
Adolescent* ; Child ; Humans ; Immunoglobulin G ; Lymphatic Diseases* ; Male* ; Mediastinum ; Plasma Cells ; Pleural Effusion*

Sweet's syndrome is an uncommon reactive dermatoses characterized by fever, polymorphonuclear leukocytosis, painful erythematous plaques, and dense dermal infiltrate of neutrophils. Sweet's syndrome can be associated with several diseases, including infectious diseases, malignant tumors, and autoimmune diseases. However, no case of Sweet's syndrome associated with Sjogren's syndrome (SjS) has been reported in Korea. A 44-year-old woman presented with acute pustular rashes and fever. The patient had multiple papulopustular skin rashes, and complained of fever, chills, and headache. Our patient had the characteristic clinical and histopathological features of Sweet's syndrome, in association with SjS, diagnosed by salivary gland scan, positive anti-SS-A/SS-B antibody, and sicca symptoms simultaneously. Thus, we report on a case of a patient with Sweet's syndrome with concomitant diagnosis of SjS.
Adult ; Autoimmune Diseases ; Chills ; Communicable Diseases ; Diagnosis ; Exanthema ; Female ; Fever ; Headache ; Humans ; Korea ; Leukocytosis ; Neutrophils ; Salivary Glands ; Sjogren's Syndrome* ; Skin Diseases ; Sweet Syndrome*

BACKGROUND/AIMS: Although colonoscopy is often used to diagnose and treat acute lower gastrointestinal bleeding, there have been few reports on outcomes of the management of colonic diverticular bleeding in Korea. This study evaluated the utility of colonoscopic hemoclipping for the control of diverticular bleeding. METHODS: We retrospectively reviewed the medical records of 13 patients with acute diverticular bleeding treated using endoclips at Uijeongbu St. Mary's Hospital between January 2004 and December 2009. RESULTS: Of the 13 patients, four had an actively bleeding vessel visible at colonoscopy, while nine had a non-bleeding vessel. Hemostasis with hemoclipping was successful in all patients without procedural complications. One patient (7.7%) had early recurrent bleeding and additional colonoscopic hemoclipping was successful. During a median follow-up of 34 months, late recurrent bleeding occurred in one patient (7.7%). CONCLUSIONS: Colonoscopic treatment of acute diverticular bleeding using endoclips is safe and effective, with high rates of immediate and long-term success.
Colon ; Colonoscopy ; Diverticulum ; Follow-Up Studies ; Glycosaminoglycans ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Korea ; Medical Records ; Retrospective Studies

BACKGROUND/AIMS: The incidence of treatment failure or recurrence of Clostridium difficile-associated diarrhea (CDAD) following metronidazole treatment has increased recently. We studied the treatment failure, recurrence rate, and risk factors predictive of treatment failure and recurrence after metronidazole treatment for CDAD. METHODS: We retrospectively identified consecutive patients who were admitted and treated for CDAD at a single tertiary institution in Korea over a recent 10-year period (i.e., 1998-2008). RESULTS: Metronidazole was administered as the initial treatment to 111 of 117 patients (94.9%) with CDAD. Fourteen patients (12.6%) had no clinical response to the metronidazole treatment, and in 13 patients (13.4%) CDAD recurred after successful metronidazole treatment. Diabetes mellitus (p=0.014) and sepsis (p=0.002) were independent risk factors for metronidazole treatment failure. Patients who had received surgery within 1 month before CDAD developed were more likely to experience a recurrence after metronidazole treatment (p=0.032). Vancomycin exhibited a higher response rate after treatment failure, and metronidazole showed a reasonable response rate in the treatment of recurrence. Treatment failure and recurrence rates increased with time after metronidazole treatment for CDAD over the 10-year study period. CONCLUSIONS: Our data suggest that diabetes mellitus and sepsis are independent risk factors for metronidazole treatment failure, and that operation history within 1 month of development of CDAD is a predictor of a recurrence after metronidazole treatment.
Clostridium ; Diabetes Mellitus ; Diarrhea ; Humans ; Incidence ; Korea ; Metronidazole ; Recurrence ; Retrospective Studies ; Risk Factors ; Sepsis ; Treatment Failure ; Vancomycin

BACKGROUND: It has been shown that defects in mitochondrial function are involved in the induction of neuronal cell injury. Prostanoids such as prostaglandin E2 (PGE2) are thought to play an important role in inflammation and neurologic disorders. However, the effect of PGE2 on cholesterol-oxidation-product-induced neuronal cell injury remains uncertain. METHODS: The effect of PGE2 on toxicity of 7-ketocholesterol (7-KCS) was assessed in PC12 cells that were differentiated following treatment with nerve growth factor. The mitochondria-mediated apoptotic process was evaluated by examining the inhibitory effect of PGE2 on 7-KCS-induced toxicity. RESULTS: 7-KCS induced BID cleavage, increased the production of proapoptotic Bax protein, decreased antiapoptotic Bcl-2, increased p53, and promoted cytochrome c release in the cytosolic fraction, which subsequently elicited the activation of caspase-3, DNA fragmentation, and cell death. Treatment with PGE2 inhibited this 7-KCS-induced apoptotic process and cell death. CONCLUSIONS: The results show that PGE2 inhibits 7-KCS-induced toxicity in differentiated PC12 cells by suppressing the mitochondria-mediated apoptotic process. PGE2 may protect against cholesterol-oxidation-product-induced neuronal cell injury.
Animals ; bcl-2-Associated X Protein ; Caspase 3 ; Cell Death ; Cytochromes c ; Cytosol ; Dinoprostone ; DNA Fragmentation ; Inflammation ; Ketocholesterols ; Mitochondria ; Nerve Growth Factor ; Nervous System Diseases ; Neurons ; PC12 Cells ; Prostaglandins

BACKGROUND: The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. METHODS: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. RESULTS: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). CONCLUSION: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists.
Nicotine ; Sensitivity and Specificity ; Smoke ; Smoking ; Tobacco Products ; Tobacco Use Disorder

PURPOSE: The authors conducted a multicenter study to evaluate the efficacy and safety of combination chemotherapy with Padexol(R) and cisplatin for treating patients with advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From November 2003 to April 2005, 42 chemo-naive patients with advanced NSCLC were enrolled into this study from 4 hospitals. The treatment consisted of Padexol(R) 175 mg/m2 as a 3-hr infusion, and this was followed by cisplatin 75 mg/m2 administered as an intravenous infusion with standard premedication. The treatment was repeated every 3 weeks. RESULTS: Among the 42 patients (pts), 33 pts were evaluable for response. On the per protocol analysis, 1 patient (pt) (3.0%) achieved complete response (CR), 17 pts (51.5%) achieved partial response (PR), 6 pts (18.2%) achieved stable disease (SD), and 9 pts (27.3%) progressed; therefore, the overall response rate was 54.6% (95% CI: 37.6~71.5%). On the intention-to-treat analysis, 1 pt (2.4%) achieved CR, 18 pts (42.9%) achieved PR, 11 pts (26.2%) achieved SD, and 9 pts (21.4%) progressed; therefore, the overall response rate was 45.2% (95% CI: 30.2~60.3%). The response, as evaluated by the investigators, was independently reviewed by 2 external radiologists and it was as follows; 13 PR (43.3%), 14 SD (46.7%) and 3 progressive disease (10%). The median duration of response was 5.9 months. The median follow-up duration was 10.3 months (range: 1.3 to 22.1 months). The median time to progression was 5.8 months (95% CI: 4.7 to 7.4 months). The median survival time on the intention-to-treat analysis was 10.5 months (95% CI: 8.1 to 18.8 months). The most common grade 3 or 4 hematologic toxicities were neutropenia (26/180 cycles, 14.4%), anemia (7/180 cycles, 3.9%) and febrile neutropenia (2/180 cycles, 1.1%). The most frequent grade 3 or 4 non-hematologic toxicities were nausea (14/42 patients, 14.3%), anorexia (3/42 patients, 7.1%) and myalgia (3/42 patients, 7.1%). CONCLUSION: The authors observed that Padexol(R) was as good as the other paclitaxel (Taxol(R) or Genexol(R)) formulations when combined with cisplatin for treating patients with advanced NSCLC.
Anemia ; Anorexia ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Febrile Neutropenia ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Myalgia ; Nausea ; Neutropenia ; Paclitaxel ; Premedication ; Research Personnel

Purpose: Aim of this study is to review the simultaneous pancreas and kidney transplantation (SPK) cases performed in Seoul National University Hospital for DM nephropathy patients. Methods: Medical records of the SPK recipients from April 2002 to February 2006 were reviewed and analyzed retrospectively. Results: There were 10 cases of SPK transplantation in SNUH from April 2002 to February 2006, which were composed of 8 type II DM patients and 2 type I DM patients. We experienced 1 operative mortality case and 3 acute rejection cases. All the acute rejection cases were recovered by steroid pulse therapy. We performed two graft pancreatectomy operations due to CMV infection followed by duodenal perforation and severe graft pancreatitis with pancreatic leakage. With the exception of 1 mortality case and 2 graft loss cases, all 7 patients stopped insulin and oral hypoglycemic agent and are keeping blood glucose level within normal range. Conclusion: Although patient follow-up is limited up to four years, SPK recipients are free from insulin use and show good graft functions. SPK could be a good treatment modality for insulin dependent type II DM nephropathy patients.
Blood Glucose ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Insulin ; Kidney Transplantation* ; Kidney* ; Medical Records ; Mortality ; Pancreas Transplantation ; Pancreas* ; Pancreatectomy ; Pancreatitis, Graft ; Reference Values ; Retrospective Studies ; Seoul* ; Transplants