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BACKGROUND/AIMS The quality of bowel preparation (QBP) is the important factor in performing a successful colonoscopy. Several factors influencing QBP have been reported; however, some factors, such as the optimal preparation-to-colonoscopy time interval, remain controversial. This study aimed to determine the factors influencing QBP and the optimal time interval for full-dose polyethylene glycol (PEG) preparation. METHODS A total of 165 patients who underwent colonoscopy from June 2012 to August 2012 were prospectively evaluated. The QBP was assessed using the Ottawa Bowel Preparation Scale (Ottawa) score according to several factors influencing the QBP were analyzed. RESULTS Colonoscopies with a time interval of 5 to 6 hours had the best Ottawa score in all parts of the colon. Patients with time intervals of 6 hours or less had the better QBP than those with time intervals of more than 6 hours (p=0.046). In the multivariate analysis, the time interval (odds ratio, 1.897; 95% confidence interval, 1.006 to 3.577; p=0.048) was the only significant contributor to a satisfactory bowel preparation. CONCLUSIONS The optimal time was 5 to 6 hours for the full-dose PEG method, and the time interval was the only significant contributor to a satisfactory bowel preparation.

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diagnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.

The incidence of hepatitis B has been reported to be high in dialysis centers. Dialysis patients are at increased risk of acquiring hepatitis B due to their immunodeficient state, which impairs elimination of the hepatitis B virus; chronic dialysis patients rarely clear hepatitis B surface antigen (HBsAg) spontaneously. Hepatitis B virus infection is associated with a high risk of hepatic complications. We report the case of a 66-year-old HBsAg-positive female patient who had undergone hemodialysis for 58 months due to end-stage renal failure and became HBsAg-negative followed by the development of hepatitis B surface antibody. (Korean J Med 2014;87:747-749)

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

Outcomes of Endoscopic Mucosal Resection for Large Sessile Polyps and LST of Colorectum Dae Hwan Kang, Hyung Wook Kim*, Cheol Woong Choi, Su Bum Park, Young Mi Hong, Jong Kun Ha, Ji Hoon Yoon, Min Dae Kim Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Internal Medicine, Bongseng Memorial Hospital, Busan, Republic of Korea Backgrounds and Aims: Recently, endoscopic submucosal dissection (ESD) developed as a procedure for en bloc removal of colorectal neoplastic lesions regardless of their localization or diameter. However, the ESD procedures are technically difficult and associated with more complication compared to conventional endoscopic mucosal resection (EMR). The aim of our study is to assess efficacy and safety of endoscopic resection techniques to remove large( 20mm in diameter) sessile polyps and Laterally spreading tumor. Methods: We have treated 66 large sessile polyp and laterally spreading tumors which were resected by endoscopically from February 2009 to March 2011. Among them 48 lesions were laterally spreading tumors (LSTs) and 18 lesions were sessile polyps over 20mm in diameter. We compared the rate of en bloc resection, residual tumor/recurrence and complications between EMR and ESD. Result: 66 patients were included (age: 61.4 11.4(30-82). M:41, F: 25). There were high incidence of advanced pathology (adenocarcinoma 30.3%, high grade dysplasia 36.4%) The number of patients allocated in EMR, EMR-P, ESD-S and only ESD were 9(13.6%), 41(62.1%), 9(13.6%), 7(10.6%) respectively. Overall en bloc resection rate was 50.0%(33/66) and en bloc resection rate appeared to be more observed in ESD group than other groups, but there were not significant differences (EMR 66.7%, EMR-P 43.9%, ESD-S 33.3%, ESD 85.7%, p 0.105). Perforation occurred in 3(4.5%)cases. During follow-up period, there was only 1(1.5%) recurrence Conclusion: Patients with large ( 20mm in diameter) sessile polyps and laterally spreading tumor have a high incidence of advanced pathology, but most of large colorectal neoplasia can be treated by conventional EMR technique. EMR methods with good feasibility may take a transitional role before initiating ESD method in the treatment of large colorectal neoplasia

Background/Aims: The aim of this study was to identify changes in left ventricular (LV) performance in patients with a myocardial bridge (MB) in the left anterior descending coronary artery during resting and in an inotropic state. Methods: Myocardial strain measurement by speckle-tracking echocardiography and conventional LV wall-motion scoring was performed in 18 patients with MB (mean age, 48.1 ± 1.7 years, eight female) during resting and intravenous dobutamine challenge (10 and 20 μg/kg/min). Results: Conventional LV wall-motion scoring was normal in all patients during resting and in an inotropic state. Peak re gional circumferential strain increased dose dependently upon dobutamine challenge. Longitudinal strains of the anterior and anteroseptal segments were, however, reduced at 20 μg/kg/min and showed a dyssynchronous pattern at 20 μg/kg/ min. Although there were no significant differences in radial strain and displacement of all segments at rest compared with under 10 μg/kg/min challenge, radial strain and displacement of anterior segments at 20 μg/kg/min were significantly re duced compared with posterior segments at the papillary muscle level (44.8 ± 14.9% vs. 78.4 ± 20.1% and 5.3 ± 2.3 mm vs. 8.5 ± 1.8 mm, respectively; all p < 0.001), and showed plateau (40%) or biphasic (62%) patterns. Conclusions: Reduced LV strain of patients with MB after inotropic stimulation was identified. Speckle-tracking strain echocardiography identified a LV myocardial dyssynchrony that was not demonstrated by conventional echocardiography in patients with MB.

당뇨병성 족부 궤양(diabetic foot ulcer, DFU)은 당뇨병에 동반되는 매우 심각한 합병증으로 당뇨병 환자의 사망률을 2배 이상 증가시키며 비외상성 하지 절단 원인의 절반 이상을 차지한다[1,2]. 뼈, 인대 등이 노출되는 DFU는 전신상태가 불량한 사람에서 주로 발생하며 하지 절단이 필요한 경우가 많다[2]. DFU는 병태생리적으로 신경병증, 하지 허혈, 감염, 변형의 여러 원인이 복합적으로 동반되고[2-4], 치료에 오랜 시간과 많은 비용이 소요되어 심각한 보건학적 및 경제적 문제를 야기한다. 만성적인 DFU를 효과적으로 치료하기 위한 다양한 치료법이 개발되어 왔으며 그 중 진공보조 봉합 (Vacuum-Assisted Closure, VAC)을 이용한 음압 창상 치료법(Negative-Pressure Wound Therapy, NPWT)은 매우 주목할 만한 방법이다[5]. 다기관 무작위 대조군 연구에서 VAC-NPWT가 심각한 DFU에서 고식적인 치료방법만큼 안전하면서, 상처 치유 속도를 개선시키고, 하지 절단율을 줄였다[6-8]. 컴퓨터 조절 진공 펌프와 드레싱용 스폰지, 부착성 드레싱 제재, 배기 튜브 등으로 구성된 상품화된 시스템(V.A.CRATS; KCI, San Antonio, Texas, U.S.A)이 있으나 높은 비용으로 국내에서는 난치성 만성 창상이나 욕창, 심각한 외상 후 창상 등에 제한적으로 사용되고 있다[9,10]. 최근 국내 논문에서 비용 문제를 해결하기 위해 컴퓨터-조절 진공 펌프 대신 벽흡인기(wall suction)를 이용한 변형된 방법으로 만성 창상을 치료한 결과를 보고하였다 [11-13]. 이에 저자들은 세 명의 심각한 DFU 환자에서 고가의 Abstract Original Articles & Case Reports

Received: 26 March 2011, Accepted: 12 July 2011 Corresponding author: Ji Hye Suk Department of Internal Medicine, Maryknoll Medical Center, 12 Daecheong-dong 4-ga, Jung-gu, Busan 600-730, Korea Tel: +82-51-461-2693, Fax: +82-51-465-7470, E-mail: Jihyesuk@gmail.com Ophthalmopathy Induced by Bilateral Carotid Cavernous Fistula in a Patient with Graves’ Disease Jong Kun Ha, Ji Hye Suk, A Ra Jo, Chan Woo Jung, Bong Jae Kim, Seong Oh Park, Sang Su Kim, Mi Kyung Kim Departments of Internal Medicine and Ophthalmology, Maryknoll Medical Center, Busan, Korea

Received: 26 October 2010, Accepted: 11 January 2011 Corresponding author: Ji Hye Suk Department of Internal Medicine, Maryknoll Medical Center, 4-12 Daecheong-dong, Jung-gu, Busan 600-730, Korea Tel: +82-51-461-2693, Fax: +82-51-465-7470, E-mail: Jihyesuk@gmail.com Central pontine myelinolysis (CPM) by complicating rapid correction of severe hyponatremia has been widely reported. Additionally, CPM was occasionally reported among patients with post-liver transplantation, burns, chronic renal failure with dialysis, or other diseases associated with or not associated with other electrolyte changes or hyperosmolarity. However, there have been a few reports of CPM occurring in diabetic patients without documented electrolyte changes. This report is, to the best of our knowledge, the first report of CPM in type 2 diabetic patients without electrolyte changes in Korea. A 40-year-old man with type 2 diabetes mellitus with abruptly developed dysarthria and ataxia was admitted to our facility. He suffered from poor glucose control and multiple diabetic complications. Brain magnetic resonance imaging (MRI) revealed a well-defined bilateral symmetric hyperintense lesion in the central portion of the pons on T2and diffusion-weighted images, which was consistent with CPM. After the patient’s blood glucose and blood pressure normalized, his dysarthria and ataxia improved. Six months after discharge, follow-up MRI showed a persistent, but greatly reduced symmetric lesion in the central pons. It is certainly possible for CPM to be overlooked clinically in diabetic patients, but more cases could be diagnosed if careful attention was paid to this syndrome. (Endocrinol Metab 26:263-267, 2011)

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the pancreas are very rare. We report a case of a 47-year old male who had a cholesterol granuloma of the pancreas. Abdominal CT showed 24 mm-sized cyst in the pancreas and peri-pancreatic regional mass infiltrating to the stomach. PET-CT revealed increased 18F-FDG uptake at the cyst and peri-pancreatic mass. Thus, Whipple's operation was done. The disease was confirmed by surgical pathologic examination of the tissue. Pathologic examination of resected specimen showed numerous cholesterol crystals surrounded by multinucleated foreign body giant cells. We report on this case and give a brief review of the literature.