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Light microscopic and microbiological studies of 222 consecutive endoscopic biopsy specimens were performed. Endoscopic and histological findings showed evidence of normality in 11 specimens, chronic gastritis in 169 specimens, gastric ulcer in 24 specimens, and duodenal ulcer in 18 specimens. Of these, 131 who indicated evidence of gastritis (77.6%) contained C.pylori. of the 11 normal specimens, only one specimen (9.1%) contained this bacteria (p$lt;0.05). The C.pylori bacteria were found to be confined to the surface of the epithelial cells and just under the layer of mucus, but were rarely found inside the epithelial cells. the presence of C.pylori is significantly associated with gastritis and peptic ulceration. But there is not a significant difference between gastritis and peptic ulceration. Further studies are needed to determine if there is a causal relationship or merely an association between the occurrence of C. pylori and gastritis. However, it seems C,pylori is not the primary cause of the peptic ulceration. We reviewed the patients who were diagnosed as infective endocarditis from January 1984 to September 1988, The total number of patients was one hundred and sixteen. Seventy-six were male and forty were female. The mean age was 37.5 years. Rheumatic heart disease was the most common predisposing heart disease with fifty-five cases l47.4%), followed by congenitai heart disease with eighteen cases (15.5%), prosthetic valve endocarditis with sixteen (18.8%) and cardiac pacemaker with one case. Culture was positive in sixty-eight cases (58.6%). Alpha hemolytic streptococci were the most commonly isolated micrroorganisms (51.5%), followed by S. aureus (16.2%). Fungus was also isolated (1case). Vegetations were found in seventy-nine cases an echocardiographic examination (68.1%). These were found more frequently on the aortic valve (48.1%) than on the mitral valve (32.9%). Fifty-nine cases (50.8%) developed congestive heart failure and twenty-seven cases (23.3%) had embolic complications. Out of 116 patients, 27 died and the overall mortality was 23.3%. Main causes of death were congestive heart failure and embolic complications. Surgical traeatment was performed in thirty-nine patients (33.6%). Operation was indicated more frequently in patients with prosthetic valve endocarditis ar in patients with vegetation.
The incidence of transient bacteremia following esophageal variceal sclerotherapy (EVS) was evaluated in 29 patients. These 29 patients underwent a total of 83 sclerotherapy sessions.Prior to EVS, all instruments were sterilized. Blood cultures were drawn pre-EVS and post-EVS.All pre-EVS and post-EVS blood cultures were negative. In conclusion, it was found bacteremia following sclerotherapy is not easily developed, if a vigorous approach of using well cleaned equipment is used. Unless there is a cardiac prothesis or valvular heart disease, antibiotic prophylaxis is not warranted.
1986년 11월에서 1989년 10월까지 상부위장관 출혈증세로 내원한 환자중 응급내시경검사상 출혈하고 있거나, 재출혈의 위험성이 많은 소화성궤양과 Mallory-Weiss tear 환자 161명을 대상으로 hypertonic saline-epinephrine 용액을 반복 국소주사하여 지혈효과 및 재출혈 방지효과에 대해 조사하여 다음과 같은 결과를 얻었다. 1) 출혈부위는 위궤양 93예, 십이지장궤양 62예, Mallory-Weiss tear 5예, 변연부궤양 1예였다. 2) 내시경으로 관찰된 출혈 양상은 활동성 출혈이 64예였고, 최근 출혈 흔적이 있는 경우가 97예였으며, 활동성 출혈은 spurting하는 경우가 30예(arterial jet-ting 14예, pulsating 16예), oozing하는 경우가 34예였고, 최근 출혈 흔적이 있는 경우는 궤양 기저부의 혈관노출이 53예이고 혈괴부착은 44예였다. 3) 활동성 출혈이 있는 경우는 전예에서 hypertonic saline-epinephrine 혼합용액 국소주사 후 지혈시킬 수 있었다. 4) 영구 지혈을 위해서 arterial jetting 2.8회, pulsating 2.4회, oozing 1.5회, 궤양 기저부의 혈관노출인 경우 1.9회, 혈괴부착인 경우 2회의 hypertonic saline-epinephrine 혼합용액 국소주사가 요구되었다. 5) 재출혈은 spurting bleeding 30예중 5예(16.7%) oozing 34예중 3예(8.8%), 궤양 기저부에 혈과노출이 되어 있는 53예중 1예(1.9%), 혈관부착되어 있는 44예중 5예(11.4%)에서 발생하였다. 6) 재출혈한 14예중 9예는 반복 hypertonic saline epinephrine 용액 국소주사로 영구 지혈이 되었지만 spurting bleeding 2dP, oozing 1예, 궤양 기저부에 혈괴부탁 2예는 지혈 실패로 수술하였다. 7) 지혈실패한 5예중 1예는 간기능이 심하게 저하된 경우였고 그외 4예는 반복적인 궤양으로 인해 충분한 양의 hypertonic saline epinephrine solution을 국소주사 할 수 없었던 경우였다. 8) Hypertonic saline-epinephrine solution을 국소 주사를 이용한 지혈요법을 시행하지 않았던 1985년 11월부터 1986년 10까지 소화성 궤양과 Mallory-Weiss tear로 인한 출혈로 응급실로 내원한 65예중 25예(38.5%)에서 지혈과 재출혈을 예방하기 위해 수술요법이 요구되었지만 국소주사로 지혈요법을 시행한 후에는 수술요법 빈도를 1.9∼2.4%로 줄일 수 있었다. 이상의 결과로 보아 처치방법이 간단하고 경제적 부담이 많지 않은 hypertonic saline-epinephrine 용액을 이용한 국소주사가 출혈하고 있거나 재출혈의 위험성이 높은 소화성궤양 출혈과 Mallory-Weiss tear 환자에서 출혈을 지혈시키고 재출혈을 예방하는데 효과적인 치료의 한 방법으로 사료된다. We have assessed the efficacy of local kepeated injections with hypertonic saline-epinephrine solution in the clinical management of patients, who have an actively bleeding peptic ulcer Mallory-Weiss tear, exposed vessel or blood clot on ulcer bed. Over 36 months 161 patients, 64 with an actively bleeding ulcer or Mallory-Weiss tear and 97 with blood clot or exposed vessel on ulcer bed were subjected to endoscopic injection therapy with hypertonic saline epinephrine solution. Initial hemostasis was achieved in all patients with actively bleeding peptic ulcer or Mallory-Weiss tear (100%). In 8 of 64 patients with active bleeding and 6 of 97 patients with inactively bleeding pepitc ulcer and Mallory-weiss tear, recurrent episodes of bleeding occurred. Permanent hemostais was achieved in 61 patients (95.3%) with 2 sessions of repeated injections to prevent or control rebleeding and in the group of 97 patients with blood clot or exposed vessel on ulcer bed, permanent hemostasis was acieved in 95 patients (97.9%) with 1.9 sessions of repeated injections to prevent or control bleeding. No significant local or systemic complication was observed. We believe that endoscopic injection therapy with a hypertonic saline-epinephrine solution is a safe simple effective and inexpensive treatment option in control-ling active bleeding or preventing rebleeding peptic ulcer or Mallory-Weiss tear.
Many reports have been made concerning underlying and associated conditions causing pseudomembranous colitis and it has been documented that occurrence of pseudomembranous colitis is related with antibiotics administration. Recent study showed that Clostridium difficile produced enterotoxin by colonization in intestinal wall and leading into pseudomembranous colitis. Diagnosis is based on positive culture of Clostridium difficile, positive test of Clostridium difficile toxin and specific histological findings after observation of whitish plaque on colonoscopic or sigmoidoscopic examination. Authors have experienced one case of pseudomembranous colitis developing after long term ampicillin administration in a case with colon cancer associated with diarrhea and diagnosis was confirmed by typical pseudomembrane on biopsy following classical whitish plaque absevation on sigmoidoscopic examination. Symptoms have been ameliorated by discontinuation of antibiotics and administration of metron-idazole in four days and disappearance of whitish plaque on repeated sigmoidoscopic examination and improvement of clinical symptoms after 9 days of medication.