Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endo-scopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologi-cally confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results: The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the inten-tion to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, includ-ing ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI,57.3% to 69.1%), respectively. Conclusions Diagnostic per-formance based on the endoscopist’s intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study.

No abstract available.
Antibodies* ; Cerebellar Ataxia ; Guillain-Barre Syndrome* ; Humans

Fitz-Hugh-Curtis (FHC) syndrome is hepatitis characterized by severe right upper abdominal pain associated with pelvic inflammatory disease (PID), mimicking the symptoms of acute abdomen, such as in acute cholecystitis. FHC syndrome is becoming more common with the increasing incidence of PID in Korea. We treated eight patients with FHC syndrome, who visited our hospital with right upper quadrant abdominal pain. We emphasize the importance of spiral computed tomography (CT) in the diagnosis of right upper quadrant abdominal pain in sexually active young women.
Abdomen, Acute ; Abdominal Pain ; Chlamydia Infections ; Cholecystitis, Acute ; Female ; Hepatitis ; Humans ; Incidence ; Korea ; Pelvic Inflammatory Disease ; Peritonitis ; Tomography, Spiral Computed

No abstract available.
Muscular Dystrophy, Facioscapulohumeral

BACKGROUND AND OBJECTIVES: Because the mechanisms of the biological effects of statin and antiotensin converting enzyme inhibitor therapies differ, the vascular responses to these therapies were studied in hypercholesterolemic patients. MATERIALS AND METHODS: Simvastatin, 20 mg, placebo or ramipril, 10 mg, were administered daily for 2 months, with a 2 month washout, to 32 hypercholesterolemic patients. This was a randomized, double-blind, placebo-controlled, crossover in design study. RESULTS: Simvastatin alone, or in combination with ramipril, significantly changed the lipoproteins, and improved the percentage of the flow-mediated dilator response to hyperemia by 46+/-48% and by 59+/-66%, respectively, relative to the baseline measurements (both p<0.001). The plasma malondialdehyde levels were reduced, relative to baseline measurements, by 6+/-57% (p=0.045) and 13+/-47% (p=0.045 and p<0.001, respectively) and plasma levels of monocyte chemoattractant protein-1 by 3+/-27% and by 9+/-16%, respectively (p=0.113 and p=0.001, respectively). The C-reactive protein were also reduced, relative to baseline measurements, by 17+/-75% and by 17+/-37%, respectively (p=0.003 and p=0.001, respectively). However, simvastatin combined with ramipril changed, to a greater extent, but was statistically insignificant, the percentage of the flow-mediated dilator response to hyperemia, and the plasma monocyte chemoattractant protein-1 levels, than simvastatin alone. CONCLUSION: Compared with simvastatin alone, the addition of ramipril improved the endothelial function to greater extent, but was statistically insignificant, in hypercholes-terolemic patients.
C-Reactive Protein ; Chemokine CCL2 ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperemia ; Inflammation* ; Lipoproteins ; Malondialdehyde ; Nitric Oxide* ; Plasma ; Ramipril* ; Simvastatin*

Apoptosis has been implicated in the pathogenesis of neurodegenerative diseases such as stroke and Alzheimer's disease. Apo-1/Fas gene is one of the mediators of apoptosis in stroke. MvaI polymorphism is the first polymorphic marker identified in the Apo-1/Fas gene promoter, which was typed by PCR and followed by MvaI digestion and gel electrophoresis. DNA isolated from peripheral blood collected from 91 stroke patients and 103 healthy blood donors was used for genotypes of GG, GA and AA by sequence specific primer PCR. MvaI polymorphism was examined based on Fas gene promotor region by restriction fragment length polymorphism (RFLP). The Fas-GG genotype was the least frequent in patients with stroke and healthy controls (P = 0.57). In normal Korean controls the MvaI polymorphism GA, AA and GG were 48.6%, 34.9% and 16.5%. In stroke patients were 56.2%, 29.6% and 14.2% respectively. And the allelic frequencies of MvaI*2 (G) allele were less frequent than MvaI*1 (A) allele in patients with stroke and healthy controls (P = 0.76). In normal Korean controls MvaI*1 (A) and MvaI*2 (G) alleles were 59.2% and 40.8%. In stroke patients were 57.6% and 42.4%, respectively. Our results, pending confirmation in a larger study, indicate that the Fas genotype may not appear to be a risk factor for stroke in Korean stroke patients.
Adult ; Aged ; Antigens, CD95/*genetics ; Cerebral Infarction/*genetics ; Comparative Study ; Female ; Gene Frequency ; Genotype ; Human ; Korea ; Male ; Middle Aged ; *Polymorphism (Genetics) ; *Promoter Regions (Genetics)

Apoptosis has been implicated in the pathogenesis of neurodegenerative diseases such as stroke and Alzheimer's disease. Apo-1/Fas gene is one of the mediators of apoptosis in stroke. MvaI polymorphism is the first polymorphic marker identified in the Apo-1/Fas gene promoter, which was typed by PCR and followed by MvaI digestion and gel electrophoresis. DNA isolated from peripheral blood collected from 91 stroke patients and 103 healthy blood donors was used for genotypes of GG, GA and AA by sequence specific primer PCR. MvaI polymorphism was examined based on Fas gene promotor region by restriction fragment length polymorphism (RFLP). The Fas-GG genotype was the least frequent in patients with stroke and healthy controls (P = 0.57). In normal Korean controls the MvaI polymorphism GA, AA and GG were 48.6%, 34.9% and 16.5%. In stroke patients were 56.2%, 29.6% and 14.2% respectively. And the allelic frequencies of MvaI*2 (G) allele were less frequent than MvaI*1 (A) allele in patients with stroke and healthy controls (P = 0.76). In normal Korean controls MvaI*1 (A) and MvaI*2 (G) alleles were 59.2% and 40.8%. In stroke patients were 57.6% and 42.4%, respectively. Our results, pending confirmation in a larger study, indicate that the Fas genotype may not appear to be a risk factor for stroke in Korean stroke patients.
Adult ; Aged ; Antigens, CD95/*genetics ; Cerebral Infarction/*genetics ; Comparative Study ; Female ; Gene Frequency ; Genotype ; Human ; Korea ; Male ; Middle Aged ; *Polymorphism (Genetics) ; *Promoter Regions (Genetics)

Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.
Abdomen ; Abdominal Pain ; Aged ; Diagnosis ; Humans ; Lymphoid Tissue ; Male ; Pancreas* ; Pancreatectomy ; Physical Examination ; Splenectomy

Low-grade gastric MALT lymphoma arises from long-standing Helicobacter pylori(Hp) infection. High remission rates for these lymphoma have been observed after H. pylori eradication. There was debates on the optimal treatment of low-grade gastric MALT lymphoma. The purpose of this study is to investigate clinical and endoscopic characteristics of primary low-grade gastric MALT lymphoma and to assess short-term clinical outcome of various modalities of treatment. METHODS: 30 patients(14 male, 16 female, mean age 44.9 years, range 26-76, mean follow-up 22.9 months) with primary low-grade gastric MALT lymphoma, diagnosed at the Samsung Medical Center from March 1995 to September 1998, were evaluated in a retrospective study. We evaluated patient's presenting symptoms, endoscopic finding, Hp status, staging by Musshoff system, and recurrence rate according to treatment mordalities. RESULTS: The most common symptom is epigastric discomfort or pain(36.7%). Endoscopic appearances of gastric MALT lymphoma shows the wide variation from mucosal thickening to overt malignancy. The most common site of gastric MALT lymphoma is the gastric antrum and lower body(9 and 6 patients). Histologically, 70% were found to be Hp infected. Of 21 Hp(+) patients, 11 patients were clinical stage IE and received Hp eradication by PPI-based triple regimens. 81.8%(9/11) showed complete remission. Among 11 patients, 6 patients studied by PCR. After Hp eradication, 5 in 6 patients showed persistent IgH rearangement by PCR. The mean follow-up time is 22.8 months(range 3 to 36 months), One patient, who showed complete histologic regression during second endoscopy, relapsed MALT lymphoma after 6 months. The other one patient showed no change of lymphoma and underwent surgery. 12 patients underwent surgical treatment and showed no evidence of relapse. The mean follow-up time is 35.9 months. 2 patients received chemotherapy with CHOP regimen and showed complete remission. The mean follow-up time is 6.7 months. 2 patients received radiotherapy and showed no evidence of relapse. The mean follow-up time is 15 months. CONCLUSION: Our study shows that complete remission rate after Hp eradication is as high as some studies recently reported. This suggest that Hp eradication may be considered as first-line therapy of low-grade gastric MALT lymphoma of stage IE.
Drug Therapy ; Endoscopy ; Female ; Follow-Up Studies ; Helicobacter ; Humans ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Polymerase Chain Reaction ; Pyloric Antrum ; Radiotherapy ; Recurrence ; Retrospective Studies

OBJECTIVES: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. METHODS: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hematology/ oncology Department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, ID numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5 categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others. RESULTS: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4 performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. CONCLUSION: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4 times at initial trial.
Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Chungcheongnam-do ; Drug Therapy ; Fluid Therapy ; Hematoma ; Hemodynamics ; Hemothorax ; Humans ; Intensive Care Units ; Internship and Residency ; Korea ; Parenteral Nutrition, Total ; Patients' Rooms ; Pneumothorax ; Prospective Studies* ; Punctures ; Skin ; Veins