Aluminum (Al) is the third most abundant element in the earth's crust and is omnipresent in our environment, including our food. However, with normal renal function, oral and enteral ingestion of substances contaminated with Al, such as antacids and infant formulae, do not cause problems. The intestine, skin, and respiratory tract are barriers to Al entry into the blood. However, contamination of fluids given parenterally, such as parenteral nutrition solutions, or hemodialysis, peritoneal dialysis or even oral Al-containing substances to patients with impaired renal function could result in accumulation in bone, parathyroids, liver, spleen, and kidney. The toxic effects of Al to the skeleton include fractures accompanying a painful osteomalacia, hypoparathyroidism, microcytic anemia, cholestatic hepatotoxicity, and suppression of the renal enzyme 25-hydroxyvitamin D-1 alpha hydroxylase. The sources of Al include contamination of calcium and phosphate salts, albumin and heparin. Contamination occurs either from inability to remove the naturally accumulating Al or from leeching from glass columns used in compound purification processes. Awareness of this long-standing problem should allow physicians to choose pharmaceutical products with lower quantities of Al listed on the label as long as this practice is mandated by specific national drug regulatory agencies.
Aluminum ; Anemia ; Antacids ; Calcium ; Eating ; Glass ; Heparin ; Humans ; Hypoparathyroidism ; Infant Formula ; Intestines ; Kidney ; Leeching ; Liver ; Osteomalacia ; Parathyroid Glands ; Parenteral Nutrition Solutions ; Peritoneal Dialysis ; Pharmaceutical Preparations ; Renal Dialysis ; Respiratory System ; Salts ; Skeleton ; Skin ; Spleen

OBJECTIVE: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, the proper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. METHODS: It was a retrospective study using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventy three patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and they were assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients (65≤age<80) and oldest-old patients (80≤age) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, total days of use and treatment outcome of initial therapy. RESULTS: Out of 73 patients aged over 65 years, four patients were excluded because they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. We were able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more risk of becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDI was generally fair, but vancomycin as initial therapy is more recommended than metronidazole. CONCLUSION: Although age, antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for these risk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updated guideline suggests the use of vancomycin as drug of choice for CDI.
Aged* ; Antacids ; Anti-Bacterial Agents ; Clostridium difficile* ; Clostridium* ; Comorbidity ; Cross Infection ; Electronic Health Records ; Humans ; Metronidazole ; Outpatients ; Retrospective Studies ; Risk Factors* ; Treatment Outcome ; Vancomycin

BACKGROUND/AIMS: Cholecystectomy is necessary for the treatment of symptomatic or complicated gallbladder (GB) stones, but oral litholysis with bile acids is an attractive alternative therapeutic option for asymptomatic or mildly symptomatic patients. This study was conducted to evaluate the efficacy of magnesium trihydrate of ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) on gallstone dissolution and to investigate improvements in gallstone-related symptoms. METHODS: A prospective, multicenter, phase 4 clinical study to determine the efficacy of orally administered magnesium trihydrate of UDCA and CDCA was performed from January 2011 to June 2013. The inclusion criteria were GB stone diameter < or =15 mm, GB ejection fraction > or =50%, radiolucency on plain X-ray, and asymptomatic/mildly symptomatic patients. The patients were prescribed one capsule of magnesium trihydrate of UDCA and CDCA at breakfast and two capsules at bedtime for 6 months. The dissolution rate, response rate, and change in symptom score were evaluated. RESULTS: A total of 237 subjects were enrolled, and 195 subjects completed the treatment. The dissolution rate was 45.1% and the response rate was 47.2% (92/195) after 6 months of administration of magnesium trihydrate of UDCA and CDCA. Only the stone diameter was significantly associated with the response rate. Both the symptom score and the number of patients with symptoms significantly decreased regardless of stone dissolution. Adverse events necessitating discontinuation of the drug, surgery, or endoscopic management occurred in 2.5% (6/237) of patients. CONCLUSIONS: Magnesium trihydrate of UDCA and CDCA is a well-tolerated bile acid that showed similar efficacy for gallstone dissolution and improvement of gallstone-related symptoms as that shown in previous studies.
Adult ; Aged ; Antacids/*administration & dosage ; Chenodeoxycholic Acid/*administration & dosage ; Cholagogues and Choleretics/*administration & dosage ; Drug Administration Schedule ; Drug Combinations ; Female ; Gallstones/*drug therapy ; Humans ; Magnesium Hydroxide/*administration & dosage ; Male ; Middle Aged ; Prospective Studies ; Severity of Illness Index ; Solubility/drug effects ; Ursodeoxycholic Acid/*administration & dosage

BACKGROUND/AIMS: Bismuth-containing quadruple and moxifloxacin-based triple regimens are recommended as second-line therapy for Helicobacter pylori infection. The aim of this study was to compare the efficacy of each regimen. METHODS: From August 2004 to October 2012, a total of 949 patients (mean age, 54.32+/-12.08 years; male, 49.4%) who failed H. pylori eradication with a standard triple regimen were included. Patients treated with a bismuth-containing quadruple regimen for 7 and 14 days were designated as 7-BMT and 14-BMT, respectively, and those treated with a moxifloxacin-based triple regimen for 7 and 14 days were designated as 7-MA and 14-MA, respectively. H. pylori eradication was confirmed using the 13C-urea breath test, rapid urease test or histology. RESULTS: The eradication rates by 7-BMT, 14-BMT, 7-MA, and 14-MA were 66.4% (290/437), 71.1% (113/159), 53.1% (51/96), and 73.5% (189/257), respectively, by intention-to-treat analysis (ITT) and 76.5% (284/371), 83.8% (109/130), 55.6% (50/90), and 80.6% (187/232), respectively, by per-protocol analysis (PP). The eradication rates were higher in 14-BMT than 7-BMT by the ITT and PP analyses (p=0.277 and p=0.082, respectively). The 14-BMT and 14-MA treatments showed similar efficacies by ITT and PP (p=0.583 and p=0.443, respectively). CONCLUSIONS: The 7-BMT, 14-BMT, and 14-MA treatments showed similar and suboptimal efficacies. In both regimens, extending the duration of treatment may be reasonable considering the high level of antibiotic resistance in Korea.
Adult ; Aged ; Amoxicillin/administration & dosage ; Antacids/*administration & dosage ; Anti-Infective Agents/*administration & dosage ; Bismuth/*administration & dosage ; Drug Administration Schedule ; Drug Therapy, Combination/methods ; Female ; Fluoroquinolones/*administration & dosage ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Intention to Treat Analysis ; Male ; Metronidazole/administration & dosage ; Middle Aged ; Proton Pump Inhibitors/administration & dosage ; Retrospective Studies ; Tetracycline/administration & dosage ; Treatment Outcome

BACKGROUNDThe controversy on the treatment strategy for severe acute pancreatitis (SAP) has never stopped for the past century. Even now surgical procedures play a decisive role in the treatment of SAP, especially in managing the related complications, but the rational indications, timing, and approaches of surgical intervention for SAP are still inconclusive.

METHODSClinical data of 308 SAP patients recruited during January 2000-January 2013, including 96 conservatively treated cases plus 212 surgically intervened cases, were comparatively analyzed. Based on the initial surgical intervention time, the surgical intervention group was split into two: early intervention group (within 2 weeks) 103 cases, and late intervention group (after 2 weeks) 109 cases.

RESULTSIn the conservative treatment group, the cure rate was 82.29% (79/96), the death rate was 13.54% (13/96), and 4 cases self-discharged, while in the surgical intervention group, the cure rate was 84.43% (179/212) and the death rate was 10.85% (23/212) with 10 cases self-discharged. The difference was of no statistical significance between these two groups (P > 0.05). In surgical intervention group, the death rate 15.53% (16/103) in the early surgical intervention group was higher than that of late surgical intervention group 6.42% (7/109), and the difference was statistically significant (P < 0.05).

CONCLUSIONSBoth conservative treatment and surgical intervention play important roles in the treatment of SAP, and the indication, timing, and procedure should be strictly followed. Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications, such as multiple organ failure, which does not improve despite active treatment, and in those who develop abdominal compartment syndrome.

Adult ; Aged ; Antacids ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatitis, Acute Necrotizing ; drug therapy ; surgery ; therapy ; Retrospective Studies ; Somatostatin ; therapeutic use

No abstract available.
Alginates/*therapeutic use ; Aluminum Hydroxide/*therapeutic use ; Antacids/*therapeutic use ; Female ; Gastroesophageal Reflux/*drug therapy ; Humans ; Male ; Silicic Acid/*therapeutic use ; Sodium Bicarbonate/*therapeutic use

INTRODUCTIONThe use of an additional biopsy from the gastric body may help improve the detection of Helicobacter pylori during endoscopy. This study aimed to determine whether such an additional biopsy is necessary in routine rapid urease test (RUT), and whether acid suppression and antibiotic therapy affect RUT results.

METHODSPatients recruited had two gastric mucosal biopsies taken - one from the gastric antrum and the other from the gastric body. Each biopsy was placed into separate RUT kits. Information on previous or current use of proton-pump inhibitors, H2 receptor antagonist, bismuth and antibiotics was obtained. Patients on any of those drugs one week prior to endoscopy were considered to have a positive drug history (PDH).

RESULTSOf the 400 patients recruited, 311 had negative RUTs and 89 had at least one positive RUT. Between the PDH and negative drug history (NDH) groups, there was a significant difference in the distribution of the location of the biopsies that yielded positive RUTs (p = 0.023). The NDH group had a higher proportion of patients who had positive RUTs for both locations, whereas the PDH group had a higher proportion of patients who had positive RUTs for only one location.

CONCLUSIONAs RUT results are significantly affected by the use of acid suppression and antibiotic therapies, biopsies for RUT should be taken from both the gastric antrum and body to minimise false negative results.

Adult ; Aged ; Antacids ; pharmacology ; Anti-Bacterial Agents ; pharmacology ; Endoscopy ; Endoscopy, Gastrointestinal ; Female ; Gastric Mucosa ; microbiology ; pathology ; Gastrointestinal Diseases ; diagnosis ; epidemiology ; microbiology ; Helicobacter Infections ; diagnosis ; Helicobacter pylori ; drug effects ; isolation & purification ; History, Ancient ; Humans ; Middle Aged ; Singapore ; epidemiology ; Urease ; analysis

BACKGROUNDLeukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.

METHODSWe conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features.

RESULTSAll cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients.

CONCLUSIONChoosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.

Antacids ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Budesonide ; therapeutic use ; Female ; Humans ; Laser Therapy ; Leukoplakia ; classification ; diagnosis ; drug therapy ; surgery ; Male ; Neoplasm Recurrence, Local ; classification ; diagnosis ; drug therapy ; surgery ; Retrospective Studies ; Vocal Cords

In 2010, a Korean guideline for the management of gastroesophageal reflux disease (GERD) was made by the Korean Society of Neurogastroenterology and Motility, in which the definition and diagnosis of GERD were not included. The aim of this guideline was to update the clinical approach to the diagnosis and management of GERD in adult patients. This guideline was developed by the adaptation process of the ADAPTE framework. Twelve guidelines were retrieved from initial queries through the Appraisal of Guidelines for Research & Evaluation II process. Twenty-seven statements were made as a draft and revised by modified Delphi method. Finally, 24 consensus statements for the definition (n=4), diagnosis (n=7) and management (n=13) of GERD were developed. Multidisciplinary experts participated in the development of the guideline, and the external review of the guideline was conducted at the finalization phase.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Barrett Esophagus/complications/diagnosis ; Databases, Factual ; Diet ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Gastroesophageal Reflux/complications/*diagnosis/drug therapy ; Histamine Antagonists/therapeutic use ; Humans ; Peptic Ulcer/complications/diagnosis ; Proton Pump Inhibitors/therapeutic use ; Stomach Neoplasms/complications/diagnosis

BACKGROUND/AIMS: Recent studies suggest that the prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. However, studies on risk factors for GERD have yielded inconsistent results. The aims of this study were to compare clinical features between symptomatic syndromes without esophageal injury (=non-erosive disease [NED]) and syndromes with esophageal injury (=erosive disease [ED]), and to determine risk factors associated ED. METHODS: A total of 450 subjects who visited gastroenterology clinics of six training hospitals in Daegu from March 2008 to April 2010 were consecutively enrolled. The subjects were asked to complete a questionnaire which inquired about gastroesophageal reflux symptoms. The questionnaire also included questions about smoking, alcohol drinking, consumption of coffee, use of drugs, exercise, and other medical history. The subjects were subdivided into NED and ED groups. RESULTS: The proportion of subjects in each NED and ED group was 172 (38.2%) and 278 (61.8%). Male gender, smoking, alcohol drinking, consumption of coffee, large waist circumference, infrequent medication of antacids, aspirin and NSAIDs, infrequent and mild GERD symptoms were all significantly associated with ED on univariate analysis. Age, hiatal hernia, diabetes mellitus, body mass index, change in weight during 1 year, and number of typical GERD symptoms were not independent risk factors for ED. However, the association between ED and alcohol drinking, infrequent medication of antacids, mild typical GERD symptoms remained as strong risk factors after adjustments on multivariate logistic analysis. CONCLUSIONS: Independent risk factors associated with ED were alcohol drinking, infrequent medication of antacids and mild typical GERD symptoms.
Adolescent ; Adult ; Aged ; Alcohol Drinking ; Antacids/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Barrett Esophagus/complications/diagnosis ; Body Mass Index ; Coffee ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/complications/*diagnosis ; Female ; Gastroesophageal Reflux/complications/*diagnosis ; Humans ; Logistic Models ; Male ; Middle Aged ; Questionnaires ; Republic of Korea ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Waist Circumference