크론병으로 인한 십이지장-대장 누공의 Endoloop과 Hemoclip을 이용한 수술 전 내시경적 결찰: 증례보고

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.ope

Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?

Background To assess factors affecting the prolongation of the international normalized ratio (INR) with concurrent warfarin and ciprofloxacin use. Methods A retrospective case-control study was performed at a single, 2,000-bed tertiary hospital between January 2007 and December 2009. Thirty-three patients who were on warfarin and ciprofloxacin concurrently were enrolled. Demographics and clinical data were collected from medical records. Results Nine patients were assigned to the case group (prolonged INR) and 19 patients to the control group (normal INR). Activities of daily living (ADL) and total number of classes of medications taken demonstrated significant differences between the groups (15.33 vs. 7.11, p<0.001; 7.11 vs. 5.47, p=0.041). No bleeding complications occurred during this study. Conclusion As ADL reflects patient performance status and general condition of an individual, we conclude that a poor general condition is associated with coagulopathy in persons concurrently using warfarin and ciprofloxacin.ope

성장호르몬 분비 뇌하수체 종양의 수술적 완치 후 발견된 지연형 자가면역 당뇨병 1예

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.ope

Factors predictive of high-risk adenomas at the third colonoscopy after initial adenoma removal.

Evaluating predictive factors for high-risk adenomas at the third colonoscopy based on two prior colonoscopies may help evaluate high-risk adenoma at the third colonoscopy. We analyzed clinical data of 131 patients at Severance Hospital from January 1997 to January 2011. All of them underwent two subsequent colonoscopies after removal of adenomas during an initial colonoscopy. Among 20 patients with high-risk adenoma at the first and second colonoscopies, 10 (50%) patients had high-risk adenoma at the third colonoscopy. Among the 67 patients who had high-risk adenoma only once at the first or second colonoscopy, 15 (22.4%) patients had high-risk adenoma at the third colonoscopy but among the 44 patients without high-risk adenoma at the first and second colonoscopies, only 1 (2.3%) patient had high-risk adenoma at the third colonoscopy (P < 0.001). A multivariate time dependent covariate Cox regression analysis confirmed that high-risk adenoma at the first and/or second colonoscopy (HR, 9.56; 95% CI, 2.37-38.54; P = 0.002) was independent predictor of high-risk adenoma at the third colonoscopy. Given these findings, data from two prior colonoscopies, not one prior examination, may help identify high-risk populations at the third colonoscopy who require careful colonoscopic surveillance.ope

Factors Influencing the Diagnostic Accuracy of Acoustic Radiation Force Impulse Elastography in Patients with Chronic Hepatitis B

BACKGROUND/AIMS: To determine factors predictive of discordance in staging liver fibrosis using liver biopsy (LB) and acoustic radiation force impulse (ARFI) elastography in patients with chronic hepatitis B (CHB). METHODS: Consecutive patients with CHB who underwent LB and ARFI elastography on the same day from November 2010 to March 2013 were prospectively recruited from three tertiary hospitals. RESULTS: We analyzed 105 patients (median age of 47 years). The F0-1, F2, F3, and F4 fibrosis stages were identified in 27 (25.7%), 27 (25.7%), 21 (20.0%), and 30 (28.6%) patients, respectively. The areas under the receiver operating characteristics curves for ARFI elastography in assessing ≥ F2, ≥ F3, and F4 was 0.814, 0.848, and 0.752, respectively. The discordance of at least one stage between LB and ARFI was observed in 68 patients (64.8%) and of at least two stages in 16 patients (15.2%). In a multivariate analysis, advanced fibrosis stage (F3-4) was the only factor that was negatively correlated with one-stage discordance (p=0.042). Moreover, advanced fibrosis stage was negatively (p=0.016) correlated and body mass index (BMI) was positively (p=0.006) correlated with two-stage discordance. CONCLUSIONS: Advanced fibrosis stage (F3-4) was a predictor of nondiscordance between LB and ARFI elastography; BMI also influenced the accuracy of ARFI elastography.ope

Discordance between Liver Biopsy and FibroTest in Assessing Liver Fibrosis in Chronic Hepatitis B

BACKGROUND AND AIMS: The FibroTest (FT) demonstrated excellent diagnostic performance in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Here, we aimed to identify predictors of discordance between FT and liver biopsy (LB) in Asian patients with CHB. METHODS: Consecutive patients with CHB who underwent both LB and FT on the same day between 2007 and 2010 were recruited from three medical institutes. Laboratory evaluations including specific parameters for calculating FT score, such as α2-macroglobulin, apolipoprotein A1, haptoglobin, γ-glutamyl transpeptidase, and total bilirubin levels, were obtained. The Batts and Ludwig scoring system was used for histological analysis. RESULTS: A total of 330 patients (200 male and 130 female) were analyzed. Discordances of at least two fibrosis stages between FT and LB were observed in 30 (9.1%) patients; using FT, fibrosis was underestimated in 25 patients and overestimated in 5 patients with reference to LB. Patients with discordance had a higher proportion of F3-4 (P<0.001) and F4 (P = 0.012) compared with those with nondiscordance. The discordance rate was significantly higher in those with F3-4 than those with F1-2 (15.4% vs. 3.0%, P<0.001). Multivariate analysis demonstrated F3-4 at LB as the only independent factor for discordance (P<0.001; odds ratio 5.95). After adjusting fibrosis stages, neither necroinflammatory activity on histology nor serum ALT level influenced FT values independently. CONCLUSION: Advanced fibrosis stage (F3-4) is the sole factor of discordance between FT and LB in Asian patients with CHB.ope

Antiviral efficacies of currently available rescue therapies for multidrug-resistant chronic hepatitis B

Background/Aims: The incidence of multidrug-resistant (MDR) chronic hepatitis B (CHB) during sequential lamivudine (LAM) and adefovir dipivoxil (ADV) treatment is increasing. We investigated the antiviral efficacies of various rescue regimens in patients who failed sequential LAM-ADV treatment. Methods: Forty-eight patients (83.3% of whom were HBeAg-positive) who failed sequential LAM-ADV treatment were treated with one of the following regimens: entecavir (ETV) (1 mg) monotherapy (n=16), LAM+ADV combination therapy (n=20), or ETV (1 mg)+ADV combination therapy (n=12). All patients had confirmed genotypic resistance to both LAM and ADV and were evaluated every 12 weeks. Results: The baseline characteristics and treatment duration did not differ significantly among the study groups. During the treatment period (median duration: 100 weeks), the decline of serum HBV DNA from baseline tended to be greatest in the ETV+ADV group at all-time points (week 48: -2.55 log10 IU/mL, week 96: -4.27 log10 IU/mL), but the difference was not statistically significant. The ETV+ADV group also tended to have higher virologic response rates at 96 weeks compared to the ETV monotherapy or LAM+ADV groups (40.0% vs. 20.0% or 20.0%, P=0.656), and less virologic breakthrough was observed compared to the ETV monotherapy or LAM+ADV groups (8.3% vs. 37.5% or 30.0%; P =0.219), but again, the differences were not statistically significant. HBeAg loss occurred in one patient in the ETV+ADV group, in two in the ETV monotherapy group, and in none of the LAM+ADV group. The safety profiles were similar in each arm. Conclusions: There was a nonsignificant tendency toward better antiviral efficacy with ETV+ADV combination therapy compared to LAM+ADV combination therapy and ETV monotherapy for MDR CHB in Korea, where tenofovir is not yet available.ope

다약제 내성 만성 B형 간염 환자에서 항바이러스 병합 치료의 효과

Dept. of Medicine/석사BACKGROUND: The incidence of multidrug-resistant (MDR)-chronic hepatitis B (CHB) during sequential lamivudine (LAM) and adefovir dipivoxil (ADV) treatment is increasing. We investigated the antiviral efficacies of various rescue regimens in patients who failed sequential LAM-ADV treatment.METHODS: A total of 48 patients (83.3% HBeAg-positive) who failed sequential LAM-ADV treatment were treated with one of the following regimens: entecavir (ETV) 1mg monotherapy (n=16), LAM+ADV combination therapy (n=20), or ETV(1mg)+ADV combination therapy (n=12). All patients had confirmed genotypic resistance to both LAM and ADV. Patients were evaluated every 12 weeks. RESULTS: There was no significant difference in the baseline characteristics and treatment duration among study groups. During treatments (median duration: 100 weeks), the decline of serum HBV DNA from baseline tended to be greatest in the ETV+ADV group at all-time points (week 48: -2.55 log10IU/ml, week 96: -4.27 log10IU/ml), but there was no statistical significance. The ETV+ADV group tended to have higher virologic response rates at 96 weeks compared to the ETV monotherapy or LAM+ADV groups (40.0% vs. 20.0% or 20.0%, p=0.656) and less virologic breakthrough was observed compared to the ETV monotherapy or LAM+ADV groups (8.3% vs. 37.5% or 30.0%, p=0.219), but there were no statistical significances. HBeAg loss occurred in one patient in the ETV+ADV group, two in the ETV monotherapy group, and none in the LAM+ADV group. Safety profiles were similar between each arm.CONCLUSIONS: ETV+ADV combination therapy tended to have a better antiviral efficacy compared to LAM+ADV or ETV monotherapy for MDR-CHB in Korea, where tenofovir is not yet available.restrictio

Design and production of repetitive polypeptides applying for ELP and DNA microseparation

학위논문(석사) --서울대학교 대학원 :화학생물공학부,2007.Maste

Effects of yoga exercise program on the middle-aged womens the response of stress, physical fitness and self-esteem

학위논문 (박사)-- 서울대학교 대학원 : 간호학과, 2011.8. 김금순.Docto