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ABSTRACT: The use of warfarin is growing for the prevention or treatment of cardiovascular or cerebrovascular diseases. The risk of haemorrhagic side effects is increased in patients taking warfarin.
To evaluate risks related with withholding and resuming anticoagulation in patients with upper gastrointestinal bleeding (UGIB) while on warfarin therapy and the role of the second-look endoscopic examination (SEE).
Records of 58 patients with native valvular heart diseases who presented with non-variceal UGIB during chronic anticoagulation with warfarin were retrospectively reviewed. Age- and gender-matched patients with non-variceal UGIB during aspirin therapy because of ischaemic heart disease were recruited as the control group.
Development of both recurrent bleeding and thromboembolic events were more frequent in warfarin group than in control group (7.0% vs. 0% with p = 0.03 and 16.7% vs. 2.4% with p < 0.01, respectively). One of four cases of recurrent bleeding in warfarin group was found by SEE performed in an asymptomatic patient. There were six thromboembolic events which occurred on the 21st, 27th, 28th, 31st, 58th and 75th day from the presentation out of 36 patients who ceased anticoagulation. In contrast, only one from 41 in whom aspirin was discontinued experienced myocardial infarction. There was no difference in the failure of endoscopic haemostasis necessitating angiographic embolisation or surgery, hospital stay, the need of transfusion and overall mortality.
Anticoagulation is recommended to be resumed before the 20th day from the cessation to prevent thromboembolic events. A routine SEE before resuming anticoagulation might be helpful to detect asymptomatic recurrent bleeding.
International Journal of Clinical Practice 01/2012; 66(1):64-8. · 2.41 Impact Factor
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ABSTRACT: This study aimed to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with that of conventional endoscopy for staging depth of invasion (T staging) in early gastric cancer.
A total of 955 patients with suspected early gastric cancer were prospectively registered. EUS staging was carried out prospectively by a single endoscopist using either miniprobe or radial EUS depending on the endoscopic appearance of the tumor. Conventional endoscopy staging was performed retrospectively by consensus between two endoscopists who were blinded to the EUS staging. Conventional endoscopy staging was conducted on the basis of endoscopic features such as surface nodularity and fold convergence. Patients underwent either surgical (n = 586) or endoscopic resection (n = 369) with curative intent. The staging accuracy of each test was compared with the pathological staging of the resected specimen.
The presence of a T1m tumor was histologically confirmed in 644 cases (67.4 %) and that of a T1sm tumor in 311 cases (32.6 %). The overall accuracy of EUS staging was 67.4 % (644 / 955) and that of conventional endoscopy staging was 73.7 % (704 / 955) ( P < 0.001). The accuracy of miniprobe EUS was significantly higher than that of radial EUS (79.5 % vs. 59.6 %, P < 0.001), but did not differ significantly from that of conventional endoscopy (79.0 %).
EUS does not substantially impact on pretreatment T staging of patients with early gastric cancer compared with conventional endoscopy. Therefore, EUS may not be necessary routinely, and conventional endoscopy may be sufficient for determining the optimal therapeutic strategy, especially in relation to endoscopic resection for early gastric cancer.
Endoscopy 09/2010; 42(9):705-13. · 5.21 Impact Factor
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Mathematica Scandinavica 01/2008; 103:97-110. · 0.47 Impact Factor
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ABSTRACT: A series of studies has shown that Helicobacter pylori eradication induces remission in most patients with low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, there have been few reports about the effect of bacterial treatment on the gastric MALT lymphoma in Korea, a well-known H. pylori endemic area. A total of 111 H. pylori-infected patients were prospectively enrolled in Seoul National University Hospital and 99 among them were completely followed up according to our protocol. After H. pylori eradication, tumoural response was evaluated by endoscopy and histopathology every 2-3 months till complete remission (CR) and every 6 months after achieving CR. Median follow-up period was 41 months (range, 11-125 months). Helicobacter pylori was successfully eradicated in all 99 patients and CR was obtained in 84 (84.8%) of 99 patients. The median time to reach CR was 3 months and 94% of CR is in continuous complete remission. Five patients with CR relapsed after 10-22 months without the evidence of H. pylori reinfection. Cumulative recurrence rate was 2.3, 7.7 and 9.3% at 1, 2 and 3 years, respectively. Tumours were mainly located in distal stomach (67.7%) and tumours in distal stomach were associated with more favourable response than those in proximal stomach (P=0.001). Majority of patients with low-grade gastric MALT lymphoma treated by exclusive H. pylori eradication have a favourable long-term outcome, offering a real chance of cure. Tumour location could be a predictive factor for remission following H. pylori eradication.
British Journal of Cancer 06/2007; 96(9):1324-8. · 5.04 Impact Factor
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ABSTRACT: Acid suppressing agents are widely used to treat the iatrogenic ulcers following endoscopic mucosal resection for gastric neoplasms. However, the relative merits of proton pump inhibitor or histamine(2)-receptor antagonist for endoscopic mucosal resection-induced ulcers are not known.
To prospectively compare omeprazole and famotidine for the healing of endoscopic mucosal resection-induced ulcers and for bleeding control.
After endoscopic mucosal resection, patients were randomly assigned to omeprazole (20 mg/day) or to famotidine (40 mg/day) group for a 28-day treatment period. The ulcer sizes and stages, bleeding rates and ulcer-related symptoms were compared.
A total of 100 patients were randomized equally to each group. Forty-one patients in each group were finally compared. The two groups were comparable in terms of baseline characteristics. Twenty-eight days after treatment, the two groups were not different with respect to ulcer stage (P = 0.137) or ulcer reduction ratio (P = 0.380). No difference was observed with respect to ulcer-related symptoms (P = 0.437) and no bleeding episode occurred in any of the 82 patients. In subgroup that underwent endoscopic submucosal dissection, fewer patients in the omeprazole group showed active ulcers than those in the famotidine group (P = 0.035).
Our results demonstrate that omeprazole may be superior to famotidine for iatrogenic ulcers following endoscopic mucosal resection, especially for large ulcers.
Alimentary Pharmacology & Therapeutics 10/2006; 24(5):837-43. · 3.77 Impact Factor
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Digestive Diseases and Sciences 06/2006; 51(5):906-8. · 2.12 Impact Factor
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ABSTRACT: Few reports are available on the use of intraoperative gastroscopy for gastric surgery.
The details of 33 patients (25 early gastric cancers and eight gastric submucosal tumors) who underwent intraoperative gastroscopy from June 2003 to June 2004 were analyzed. The type of operation or resection margin was determined by evaluating both sides of the stomach simultaneously by combined operative and gastroscopic methods.
Preoperative endoscopic clipping was done preferentially for early gastric cancer. However, when precise localization was needed, intraoperative gastroscopy was used. Curative gastric resection was possible in 25 early gastric cancer patients after accurate lesion localization. Laparoscopic wedge resections of submucosal tumors were performed in seven patients without stenosis by combined laparoscopic and gastroscopic methods.
Intraoperative gastroscopy can be used effectively during gastric surgery for early gastric cancer or submucosal tumors and can be regarded as a modern stethoscope to gastric surgeons.
Surgical Endoscopy 11/2005; 19(10):1358-61. · 4.01 Impact Factor
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ABSTRACT: Tuberculosis has increased in parallel with the acquired immunodeficiency syndrome epidemic and the use of immunosuppressive therapy, and the growing incidence of extra-pulmonary tuberculosis, especially with intestinal involvement, reflects this trend. However, the duration of anti-tuberculous therapy has not been clarified in intestinal tuberculosis.
To compare the efficacy of different treatment durations in tuberculous enterocolitis in terms of response and recurrence rates.
Forty patients with tuberculous enterocolitis were randomized prospectively: 22 patients into a 9-month and 18 into a 15-month group. Diagnosis was made either by colonoscopic findings of discrete ulcers and histopathological findings of caseating granuloma and/or acid-fast bacilli, or by clinical improvement after therapeutic trial. Patients were followed up with colonoscopy every other month until complete response or treatment completion, and then every 6 months for 1 year and annually. Complete response was defined as a resolution of symptoms and active tuberculosis by colonoscopy.
Complete response was obtained in all patients in both groups. Two patients in the 9-month group and one in the 15-month group underwent operation due to intestinal obstruction and perianal fistula, respectively. No recurrence of active intestinal tuberculosis occurred during the follow-up period in either group.
Tuberculous enterocolitis can be managed by 9-month chemotherapy without disease recurrence. Further investigations are needed in immunocompromised patients.
Alimentary Pharmacology & Therapeutics 08/2003; 18(1):85-91. · 3.77 Impact Factor
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ABSTRACT: Helicobacter pylori eradication has become the standard treatment for duodenal ulcer. However, there is no relevant evidence for antibacterial treatment of the white scar stage of duodenal ulcer (duodenal ulcer scar) in patients with no past history of duodenal ulcer.
To investigate whether H. pylori eradication could decrease duodenal ulcer recurrence in patients with duodenal ulcer scar and no past history of duodenal ulcer.
We prospectively enrolled 66 patients with duodenal ulcer scar: 53 were H. pylori-positive and 13 were H. pylori-negative. H. pylori-positive patients were randomly assigned into two groups (two-to-one allocation): 36 patients were assigned to the treatment group and 17 to the follow-up group. Thirteen H. pylori-negative patients were followed up according to the study protocol. Follow-up endoscopy was performed to evaluate ulcer scar changes and H. pylori status 6 weeks after anti-H. pylori treatment and then every 6 months for up to 30 months.
Active duodenal ulcer recurrence was identified in seven of 23 H. pylori-positive/non-cured patients (30%). There was no duodenal ulcer recurrence in 43 H. pylori-negative/cured patients (0%), which was significantly different in terms of duodenal ulcer recurrence (P=0.001).
H. pylori eradication is effective at preventing active duodenal ulcer recurrence in patients with duodenal ulcer scar and no past history of duodenal ulcer.
Alimentary Pharmacology & Therapeutics 03/2002; 16(2):275-80. · 3.77 Impact Factor
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H N Kim, S G Kim,
H K Lee,
H Ohrr,
S K Moon,
J Chi,
E H Lee,
K Park,
D J Park,
J H Lee,
S W Yi
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ABSTRACT: Presbycusis, a bilateral sensorineural hearing loss caused by changes in the inner ear, is related to multiple factors such as noise exposure and otologic disease. In institute-based studies, we tried to determine the incidence of presbycusis in Korean populations living in Seoul, Kyunggi and Kangwon provinces by gender and age groups. The subjects were people who had visited health promotion centers. Pure tone audiometry was done over 20 years on 6,028 subjects. In a community-based study, the subjects were elderly residents of Kanghwa-do area. There were no obvious factors that could cause hearing impairment in the subjects. For the pure tone audiometry, hearing threshold was obtained by using the six-dimension method. The incidence of presbycusis for subjects aged 65 years and older was 37.8% and 8.3% for > or = 27 dB HL criterion and > or = 41 dB HL criterion, respectively. The incidence increased with age. A statistically significant difference in the hearing threshold was found between men and women aged 65 years or older. No differences were found between the community-based study and the institute- based studies. There was a high incidence (about 40%) of presbycusis among Koreans aged 65 years or older (for > or = 27 dB HL criterion). With an aging population, we anticipate that this report could be used to provide a basic data for the study of presbycusis.
Journal of Korean Medical Science 11/2000; 15(5):580-4. · 0.99 Impact Factor
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ABSTRACT: We show that continuous bilinear forms on spaces of continuous functions can be approximated by norm attaining bilinear forms.
Glasgow Mathematical Journal 08/1998; 40(03):359 - 365. · 0.57 Impact Factor
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ABSTRACT: A series of aminophenylsilsesquioxanes were prepared from octaphenylsilsesquiox-ane (OPS), dodecaphenylsilsesquioxane (DPS) and two polyphenylsilsesquioxanes, one a low molecular weight LMW oligomer (PPS) and the other a high molecular weight (HMW) PPS (Mn of 1.3×103, PPS) and two polyhedral materials. LMS and HMW PPS were obtained by polycondensation of PhSi(OEt)3 to form oligomeric, incompletely-condensed frameworks. The oligomer was used as is for nitration to produce LMW polynitrophenylsilsesquioxane (PNPS). However, optimization of hydrolysis and condensation processes using KOH as catalyst, led to a route to HMW PPS (Mn of 2.5×104, Mw of 6.1×104), which was best prepared in EtOH.OPS, DPS, LMW PPS (Mn of 1.3×103), and HMW PPS (Mn of 2.5×104), were nitrated using 90% fuming HNO3, and then reduced using triethylamine, formic acid, and 5% Pd/C in THF. The products were characterized using 1H, 13C, and 29Si NMR, GPC, FT-IR, and TGA. Amino groups (NH2) were introduced primarily in meta and ortho positions in a 70:25 ratio with the remainder being para. It was determined that little or no OPS or DPS cage cleavage occurred coincident with nitration or reduction if the latter process was run at 40 °C, whereas the MW of HMW PPS decreased to 1.6×103 after nitration and reduction. The Mn suggests that for both LMW and HMW PPS, the same PAPS product forms, which consists of monomer, dimer, and trimer species.
Polymer.
