Background/Aims: Fluoroquinolone-containing triple eradication therapy could be considered an alternative regimen for the second- line treatment of Helicobacter pylori infection. This study aimed to investigate the changes in the eradication efficacy of fluoroquinolone- containing triple therapy from 2003 to 2018 in Korea. Materials and Methods: Patients with a history of first-line eradication therapy failure were consecutively enrolled at Seoul National University Bundang Hospital from 2003 to 2018. All patients took moxifloxacin-containing triple therapy as the second-line eradication therapy. The treatment regimen comprised a three-drug combination comprising a proton pump inhibitor, amoxicillin, and moxifloxacin. Data on age, sex, endoscopic diagnosis, eradication results, compliance, and adverse outcomes were acquired and analyzed. Results: In total, 824 participants were enrolled during the study period, of whom, 46 were lost to follow-up. Finally, 778 participants were included in the per-protocol (PP) analysis, of whom, 72.1% received moxifloxacin-containing triple therapy for 14 days. The eradication rate of moxifloxacin-containing triple therapy was 72.1% (594/824) in the intention-to-treat analysis and 76.3% (594/778) in the PP analysis. A decline in eradication efficacy was observed, especially in the PP analysis (P=0.046). Diarrhea was the most commonly observed adverse event, accounting for 19.6% (41/209) of recorded adverse events. Conclusions Moxifloxacin-containing triple therapy has shown suboptimal eradication efficacy as the second-line eradication therapy. In addition, there is a concern that eradication rate will decrease due to increase in antimicrobial resistance.

N,N-dimethylformamide (DMF), a widely used solvent in the chemical industry, is known to induce toxic hepatitis. However, there have been no reported cases of DMF-associated autoimmune hepatitis. A 31-year-old healthy man working at a glove factory since July 2015 had intermittently put his bare hands into a diluted DMF solution for his first 15 days at work. After 2 months, he felt nausea, fatigue, and hand cramping, and a jaundice followed. His laboratory findings showed positive autoantibodies and elevated immunoglobulin G (IgG), and his liver biopsy pathology was typical of autoimmune hepatitis (AIH). Prednisolone and azathioprine therapy began, and he recovered rapidly without adverse events. Though his liver chemistry was normalized, the IgG level remained persistently upper normal range. His 2nd liver biopsy performed in April 2019 showed mild portal activity, and he was well under a low dose immunosuppressive therapy up to April 2020. This case warns of the hazard of occupational exposure to DMF, and clinicians should be aware of DMF-related AIH for timely initiation of immunosuppressive therapy.

Capsule endoscopy is being increasingly recognized as a gold standard for diagnosing small bowel disease, but along with the increased usage, capsule retention is being reported more frequently. We report a case of capsule endoscopy retention in a diverticulum of the duodenal proximal third portion, which we treated by esophagogastroduodenoscopy. A 69-year-old male visited hospital with hematochezia. He had hypertension and dyslipidemia for several years, and was taking aspirin to prevent heart disease. CT and colonoscopy revealed a diverticulum in the third portion of the duodenum, rectal polyps, and internal hemorrhoids. Capsule endoscopy was performed but capsule impaction occurred. The capsule was later detected by CT in the diverticulum. Endoscopy was performed a day later and the capsule was removed using a net. A small bowel series was conducted after capsule removal, and no stenosis was found. The patient fully recovered and no recurrence of hematochezia was observed at his one month exam. This is the first case in Korea of capsule retention in a duodenal diverticulum, with successful removal by endoscopy.
Abdomen/diagnostic imaging ; Aged ; Capsule Endoscopy ; Diverticulum/*diagnosis/diagnostic imaging ; Endoscopy, Digestive System ; Humans ; Male ; Tomography, X-Ray Computed

BACKGROUND: We performed a prospective clinical study to evaluate the ultrastructural integrity of the myocardium after using Histidine-Tryptophan-Ketoglutarate (HTK) solution in comparison with blood cardioplegic solution during congenital heart surgery. MATERIAL AND METHOD: Twenty two patients with acyanotic heart disease, who were scheduled for elective open heart surgery, were randomized into two groups. The HTK Group (n=11) received HTK cardioplegic solution; the blood group (n=11) received conventional blood cardioplegic solution during surgery. The preoperative diagnoses included ventricular septal defect (n=9) and atrial septal defect (n=2) in each group. A small biopsy specimen was taken from the right ventricle's myocardium, and this was processed for ultrastructural examination at the end of 30 minutes of reperfusion. Semiquantitative electron microscopy was carried out "blindly" in 4 areas per specimen and in 5 test fields per area by 'random systematic sampling' and 'point and intersection counting'. The morphology of the mitochondrial membrane and cristae were then scored. The interstitial edema of the myocardium was also graded. RESULT: The semiquantitative score of the mitochondrial morphology was 19.65+/-4.75 in the blood group and 25.25+/-5.85 in the HTK group (p=0.03). 6 patients (54.5%) in the blood group and 3 patients (27.3%) in the HTK group were grade 3 or more for the interstitial edema of the myocardium. CONCLUSION: The ultrastructural integrity was preserved even better with HTK solution than with conventional blood cardioplegic solution.
Biopsy ; Cardioplegic Solutions* ; Diagnosis ; Edema ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Microscopy, Electron ; Mitochondrial Membranes ; Myocardial Reperfusion ; Myocardium ; Prospective Studies* ; Reperfusion ; Thoracic Surgery

BACKGROUND: Pneumonectomy for inflammatory lung disease has been of major concern because of its associated morbidity and mortality, particularly with respect to pleuropneumonectomy. The purpose of this study is to evaluate the surgical outcomes, and identify the risk factors contributing to postoperative complications in patients undergoing pleuropneumonectomy. MATERIAL AND METHOD: Ninety-eight patients underwent pneumonectomy for benign inflammatory lung disease were retrospectively analyzed. Pleuropneumonectomy (Group A) was done in 48 patients and standard pneumonectomy (Group B) was done in 50 patients. Clinical characteristics, postoperative complications were examined and compared between 2 groups. In pleuropneumonectomy group, postoperative risk factors affecting morbidity were evaluated. RESULT: There was one in-hospital death. Twenty-three major postoperative complications occurred in 21 patients (21.4%). The common complications were empyema and bronchopleural fistula (BPF) in 8 (8.4%), re-exploration due to bleeding in 8. At least one postoperative complication occurred in 14 of 48 patients from Group A (29.2%) and in 7 of 50 patients from Group B (14%). In Group A, empyema and BPF encountered in 6 and re-exploration for bleeding in 6 were the most common complication. In univariate analysis, right pneumonectomy, completion pneumonectomy, large amount of blood loss (>1,000 mL), and intrapleural spillage were risk factors contributing to postoperative complications in Group A. In multivariate analysis, intrapleural contamination during operation was a risk factor of postoperative complication. CONCLUSION: The morbidity and mortality rates of pneumonectomy for chronic inflammatory lung disease are acceptably. However, we confirm that pleuropneumonectomy is a real technical challenge and a high-risk procedure and technically demanding. Meticulous surgical techniques are very important in preventing serious and potentially lethal complications.
Empyema ; Fistula ; Hemorrhage ; Humans ; Lung Diseases* ; Lung* ; Mortality ; Multivariate Analysis ; Pneumonectomy ; Postoperative Complications ; Retrospective Studies ; Risk Factors

PURPOSE: The optimal surgical approach for aortic arch anomaly associated complex intracardiac defects is not universally agreed upon. We reviewed our recent experience of one-stage repair for the aortic arch anomaly associated with complex intracardiac defects. METHODS: We retrospectively analyzed the medical records of 15 consecutive patients with arch anomaly associated with complex intracardiac defects underwent going a one-stage repair through median sternotomy between September 2000 and May 2004. Transposition of the great artery or Taussig-Bing was associated in 9 patients, truncus arteriosus in 2, Shone' complex in 2, aorticopulmonary window in 1, and double outlet right ventricle in 1 patient. Aortic arch anomalies were coartation in 9 patients and interruption in 6. Age at operation ranged from 3 days to 23.4 months (median 12.5 days) and body weight ranged from 2.3 to 10.3 kg (mean 3.7+/-1.9 kg). RESULTS: There were 2 early deaths (13.3%) in the patients with Taussig-Bing anomaly and Shone's complex respectively. The causes of deaths were sepsis with right heart failure and pulmonary edema respectively. There were 2 late deaths. A patient with truncus arteriosus died suddenly of unknown cause and the other patient with Taussig-Bing anomaly died of ventricular dysfunction. One of 2 patients who died lately underwent balloon aortoplasty with success. There was no residual or recurrent coarctation in the rest of the patients. A patient required reoperation for left pulmonary artery stenosis. All survivors were in NYHA functional class I. CONCLUSION: One-stage repair of aortic arch with complex intracardiac defects can be performed with acceptable operative mortality. This procedure is strongly recommended as considering their grave prognosis and adverse effects of staged repair.
Aorta, Thoracic* ; Arteries ; Body Weight ; Cause of Death ; Constriction, Pathologic ; Double Outlet Right Ventricle ; Heart Failure ; Humans ; Medical Records ; Mortality ; Prognosis ; Pulmonary Artery ; Pulmonary Edema ; Reoperation ; Retrospective Studies ; Sepsis ; Sternotomy ; Survivors ; Truncus Arteriosus ; Ventricular Dysfunction

A newborn girl with a partial anomalous pulmonary venous connection, coarctation of the aorta, and ventricular and atrial septal defects underwent a complete repair successfully at 19 days of age. In this case, the left upper pulmonary vein was connected to the left innominate vein via an atypical vertical vein.
Aortic Coarctation* ; Brachiocephalic Veins ; Female ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular* ; Humans ; Infant, Newborn ; Pulmonary Veins ; Veins

BACKGROUND: One-stage repair of aortic arch anomalies and intracardiac defects through median sternotomy has been recently adopted by many institutions since it is known to be safer than the staged repair. The early and midterm results of the one-stage repair of aortic arch anomalies and intracardiac defects were retrospectively evaluated. MATERIAL AND METHOD: 45 patients who underwent one-stage repair of aortic arch anomalies and intracardiac defects performed by one surgeon from January 1996 to July 2003 were included in this retrospective study. The median age of repair was 16 days (range, 3 days~23.7 months) and the mean weight was 3.62+/-1.30 kg. Thirty one (68.9%) had coarctation and 14 (31.1%) had interrupted aortic arch. Associated intracardiac anomalies were VSD in 31 patients (VSD group), TGA or Taussig-Bing anomaly in 10 (TGA group), and others in 4 (ASD in 1, aortopulmonary window 1, truncus arteriosus 1, aortic and mitral stenoses 1, miscellaneous group). The arch obstruction was repaired with end-to-side anastomosis in 23 patients and end-to-end anastomosis in 22. RESULT: Overall postoperative hospital mortality was 22.2% (10/45); 16.1% (5/31) in VSD group, 40% (4/10) in TGA group, and 25% (1/4) in miscellaneous group. There was no mortality in VSD group since 1998, and the mortality in TGA group has remarkably reduced since technical modification for coronary transfer was adopted (75% vs 16.7%). There was no postoperative seizure or other neurological complications. Postoperative aortic restenosis occurred in 5 patients (5/35, 14.3%). Two patients underwent balloon aortoplasty with successful results. There was no reoperation. There was one late death caused by pneumonia 5 months after the operation. Two-year actuarial survival rate including operative death was 72.9%. CONCLUSION: The operative mortality of one-stage repair has been reduced with time and aortic restenosis rate was also acceptable. We concluded that this procedure is a reproducible procedure for aortic arch anomalies associated with intracardiac defects.
Aorta, Thoracic* ; Double Outlet Right Ventricle ; Hospital Mortality ; Humans ; Mitral Valve Stenosis ; Mortality ; Pneumonia ; Reoperation ; Retrospective Studies ; Seizures ; Sternotomy* ; Survival Rate ; Truncus Arteriosus

BACKGROUND: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital. MATERIAL ANDMETHOD: For this analysis, forty nine patients (male 26, female 23, mean age 49.0+/-16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. RESULT: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81.4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. CONCLUSION: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration. In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.
Endocarditis, Subacute Bacterial ; Female ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Mortality ; Papillary Muscles* ; Rupture* ; Survival Rate

BACKGROUND: Anatomic correction of the transposition of the great arteries (TGA) or Taussig-Bing anomaly by means of the arterial switch operation is now accepted as the therapeutic method of choice. This retrospective study was conducted to evaluate the risk factors for operative deaths and the efficacy of technical modification of the coronary transfer. MATERIAL AND METHOD: 85 arterial switch operations for TGA or Taussig-Bing anomaly which were performed by one surgeon from 1994 to July 2002 at Dong-A university hospital were included in this retrospective study. Multivariate analysis of perioperative variables for operative mortality including technical modification of the coronary transfer was performed. RESULT: Overall postoperative hospital mortality was 20.0% (17/85). The mortality before 1998 was 31.0% (13/42), but reduced to 9.3% (4/43) from 1998. The mortality in the patients with arch anomaly was 61.5% (8/13), but 12.5% (9/72) in those without arch anomaly. In patients who underwent an open coronary reimplantation technique, the operative mortality was 28.1% (18/64), but 4.8% (1/21) in patients undergoing a technique of reimplantation coronary buttons after neoarotic reconstruction. Risk factors for operative death from multivariated analysis were cardiopulmonary bypass time (> = or 250 minutes), aortic cross-clamping time (> = or 150 minutes), aortic arch anomaly, preoperative event, and open coronary reimplantation technique. CONCLUSION: Operative mortality has been reduced with time. Aortic arch anomaly and preoperative events were important risk factors for postoperative mortality. However atypical coronary artery patterns did not work as risk factors. We think that the technical modification of coronary artery transfer played an important role in reducing the postoperative mortality of arterial switch operation.
Aorta, Thoracic ; Arteries ; Cardiopulmonary Bypass ; Coronary Vessels ; Double Outlet Right Ventricle ; Hospital Mortality ; Humans ; Mortality ; Multivariate Analysis ; Replantation* ; Retrospective Studies ; Risk Factors*