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The implications of anti-Saccharomyces cerevisiae antibody for the diagnosis and the clinical course of Crohn's disease have been reported in Western countries, but rarely in Korea with its very different environmental and genetic backgrounds. We aimed to evaluate whether anti-S. cerevisiae antibody expression is associated with diagnostic findings, stratified Vienna classification phenotypes, disease activity and clinical course in Korean patients with Crohn's disease.One hundred and fifteen patients with Crohn's disease, diagnosed and treated between 1990 and 2004 at Severance Hospital, Yonsei University and followed for at least 2 years, were included in this study. Anti-S. cerevisiae antibody was detected by an indirect immunofluorescence assay using EUROIMMUN kits. Information collected during treatment included demography, Vienna classification phenotype, clinical manifestation, laboratory tests, treatment modality and surgery rate. Disease activity was measured monthly using the Harvey-Bradshaw index.The anti-S. cerevisiae antibody prevalence was 38.3% in Crohn's disease patients. There was no difference in anti-S. cerevisiae antibody expression between genders. The mean age at diagnosis was younger for the anti-S. cerevisiae antibody positive group than the negative group (25.3 years versus 29.7 years, p0.05). Clinical manifestations and laboratory tests at diagnosis did not differ between the groups. The anti-S. cerevisiae antibody positive group had increased fibrostenosis (B2) and penetration (B3) compared to negative group, as determined by the Vienna classification (75.0% versus 53.5%, p0.05). Anti-S. cerevisiae antibody positive patients were admitted to the hospital more frequently than anti-S. cerevisiae antibody negative patients (p0.05). The yearly cumulative Harvey-Bradshaw index score was higher in the anti-S. cerevisiae antibody positive group than in the negative group during the follow-up period (p0.05). In addition, steroid (72.7% versus 52.1%, p0.05) and immunosuppressive (45.5% versus 23.9%, p0.05) treatments were more frequently given to the anti-S. cerevisiae antibody positive group.Our data demonstrate that anti-S. cerevisiae antibody positive Crohn's disease patients had a more severe clinical course and thus often required more aggressive medical treatment.

BACKGROUND AND STUDY AIMS The factors that more accurately predict the detection of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm (CRN), including colorectal cancer, in a group of patients undergoing colonoscopy. PATIENTS AND METHODS The 17 468 patients were enrolled in this study between July 2003 and March 2004, from 11 tertiary medical centers in Korea. They were recruited according to 11 itemized colonoscopic indications. The term "advanced adenoma" refers here to tubular adenomas of diameter of 11 mm or more, or to tubulovillous, villous, or severely dysplastic adenomas, irrespective of their size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced CRN was defined as advanced adenoma or invasive cancer. RESULTS Advanced CRN was found in 1227/17 307 patients (1176 advanced adenomas plus 51 carcinomas, 7.1 %). According to univariate and multivariate analysis, the factors associated with advanced CRN included age >60 years (odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.8 - 2.4, P < 0.0001), male gender (OR 2.1, 95 %CI 1.7 - 2.7, P < 0.0001), referral for colonoscopy from primary care physician (OR 3.1, 95 %CI 2.5 - 3.7, P < 0.0001), and several other indications (OR 1.8, 95 %CI 1.5 - 2.3, P < 0.001). The yield of colonoscopy for advanced CRN was lower (2.2 %) than expected in patients with iron-deficiency anemia (OR 0.5, 95 %CI 0.2 - 0.9, P = 0.03). CONCLUSIONS Age, gender, and referral for colonoscopy from primary care physician constituted important independent predictors of advanced CRN in patients undergoing colonoscopy.

Right-sided heart failure with clinical manifestation is only occasionally seen in patients with Graves' disease (GD). Recent studies revealed that pulmonary hypertension (PHT) detected by echocardiography was not rare in patients with GD. We performed this study to investigate the prevalence of PHT in patients with GD before and after antithyroid treatment, and to assess potential mechanisms from the relationship with clinical and echocardiographic features.Serial echocardiographic examinations were performed in 64 patients with newly diagnosed GD before and after antithyroid treatment to measure cardiac factors, such as pulmonary artery systolic pressure (PAPs), cardiac output, total vascular resistance, left ventricular filling pressure and right ventricular (RV) function. PHT was defined as PAPs of at least 35 mmHg.The prevalence of PHT in untreated GD patients was 44% (28 out of 64 patients). The presence of systemic hypertension was associated with PHT, especially with pulmonary venous hypertension. GD patients with PHT showed reduced RV function represented by higher RV myocardial performance index without difference of pulmonary vascular resistance, RV wall thickness and peak systolic velocity of free wall side of tricuspid annulus. Follow-up echocardiography was performed in 20 out of 28 GD patients with PHT, and PHT disappeared in all except one patient.PHT is a frequent and reversible complication in patients with GD. Our study suggests that PHT in GD may not be related to underlying autoimmune process and increased pulmonary blood flow from thyrotoxicosis might contributes to the pathogenesis of PHT related to GD.

Background and study aims Intestinal Behcet's disease and Crohn's disease are chronic inflammatory bowel diseases that are difficult to distinguish from each other. We investigated their colonoscopic features and identified simple and valuable strategies for differential diagnosis. Patients and methods Between 1995 and 2006, 250 consecutive patients with ulcers on colonoscopy (115 Behcet's, 135 Crohn's cases) were reviewed. All patients with Behcet's fulfilled the criteria of the International Study Group for Behcet's Disease or of the Behcet's Disease Research Committee of Japan, while Crohn's disease was confirmed by clinicopathological data. Patients were randomly allocated to a training set (70 %) or a validation set (30 %). Ulcer shapes, distributions, numbers, margins, and border contours, and the presence of aphthous, cobblestone, perianal, and strictured lesions were compared, in the training set. Univariate and multivariate analysis were performed, using the X2-test and logistic regression. In addition, a classification and regression tree (CART) was then used to generate simplified algorithms for differential diagnosis. Results Round shape, five or fewer in number, focal distributions, and absence of aphthous and cobblestone lesions were significantly dominant features in Behcet's disease, according to multivariate analysis of the training set. The CART-generated algorithms proposed sequential use of shape (round, irregular/geographic, or longitudinal) and distribution (focal single/focal multiple, or segmental/diffuse). Diagnosis of Behcet's disease in the validation set produced sensitivity, specificity, and negative and positive predictive values of 94.3 %, 90.0 %, 94.7 %, and 89.2 %, respectively. Using the CART model, we made the correct diagnosis of intestinal Behcet's disease or Crohn's disease in 69 of 75 patients (92 %). Conclusion It was determined that round and longitudinal ulcers are suggestive of Behcet's disease and Crohn's disease, respectively. Irregular/geographic-shaped ulcers and focal distributions are suggestive of Behcet's disease, while segmental/diffuse lesions suggest Crohn's.

Although almost all primary colorectal lymphomas are of B-cell lineage in Western countries, primary colorectal T-cell lymphomas are not uncommon in the East. The aim of this study was to review the clinical characteristics and treatment outcomes of primary colorectal lymphomas, with special emphasis on the differences between T-cell and B-cell lymphomas. Ninety-five cases of primary colorectal lymphomas that satisfied Dawson's criteria were identified from the clinical databases of 13 university hospitals in Korea. The mean age at the time of presentation was 51.1 years and the male:female ratio was 64:31. The clinical information, including endoscopic and histological characteristics, was retrospectively analyzed. Of the primary colorectal lymphomas, 78 cases (82.1%) were of B-lineage and 17 cases (17.9%) were of T-cell lineage. Patients with T-cell lymphomas presented at a younger age than patients with B-cell lymphomas (42.8 vs 52.9 years, respectively; P = 0.016). The most common presenting symptom was abdominal pain (87.1%) for B-cell lymphomas, whereas hematochezia or night fever was more common for T-cell lymphomas (52.9% and 35.3%, respectively). The most common endoscopic type was fungating mass (54.0%) for B-cell lymphomas and ulcerative/ulcero-infiltrative lesions (80.0%) for T-cell lymphomas. Intussusception was more common in B-cell lymphomas than in T-cell lymphomas (30.8% vs 5.9%, respectively; P = 0.035), but perforation was more common in T-cell lymphomas than in B-cell lymphomas (23.5% vs 3.8%, respectively; P = 0.005). The prognosis was significantly worse for T-cell lymphomas than for B-cell lymphomas (P = 0.002). Primary colorectal T-cell lymphomas are characterized by multifocal ulcerative lesions in relatively young patients, a high rate of hematochezia, fever, or perforation, and a poor prognosis even for cases of localized disease.

The inactivation of the renal H+/organic cation antiporter by the covalent carboxyl reagent N,N'-dicyclohexylcarbodiimide (DCCD) was studied by measuring tetraethylammonium (TEA) uptake in brush border membrane vesicles isolated from rabbit renal cortex. Pretreatment of membrane vesicles with DCCD resulted in an irreversible inhibition of H+ gradient-dependent TEA uptake in a dose-dependent manner with IC50 of 10 microM. The inhibition was not due to the disruption of the vesicles or a faster collapse of an imposed H+ gradient. The transport system was significantly protected from DCCD inhibition by substrates, TEA, choline and amiloride, but not by N1-methylnicotinamide. Kinetic analysis indicated that the inhibition by DCCD was due to an increase in Km and a decrease in Vmax. The hydrophilic carbodiimides, 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide and 1-cyclohexyl-3-(2-morpholinoethyl)-carbodiimide and another carboxyl reagent N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline also inhibited the H(+)-dependent TEA uptake with a lower potency than did DCCD. These results suggest that carboxyl groups are essential for the H+/organic cation antiport and that they may be located at or near the substrate (organic cation) binding sites of the transporter in rabbit brush border membranes.

Korea's long term population goal is to achieve replacement fertility by 1991. To do this, Korea seeks to maintain the present rate of natural increase of 1.6 through 1981 at which time 1.3 will be optimal. The government has sought to improve operations of the national family planning program, broadening overall efforts by adding other population measures, such as education. Population education is now taught throughout the country to school children of all ages. In 1977 various women's groups were organized into a single group -- the Saemaul Women's Organization. This group was created by the government to provide leadership and to avoid duplication of services. Similarly, services of the Korean Institute for Family Planning and the Planned Parenthood Federation of Korea have been incorporated into the Korean Association for Voluntary Sterilization. Expenditures on family planning have increased directly in proportion to the expanding of the national program. Tables show high spending increases since 1976 and in 1979 private physicians were reimbursed for providing birth control services. Vital rates show a 40 - 49% decline in fertility among women aged 20 - 24. This is due to delayed marriage trends which occurred with the onset of modernization. Until 1976 the IUD was the principal method of birth control provided. Now female sterilization is gaining widespread popularity. Incidence of induced abortion is high and is increasing. As government continues to expand national efforts to incorporate more and more programs fertility should continue to decline.