Unexpected carcinoma of gallbaldder(GB) can be found in 1-2% of specimens after surgery of benign biliary disease. This study was designed to investigate the clinicopathological and radiological characteristics of unexpected GB cancer presumed benign biliary disease and compare with originally diagnosed GB cancer.

The modical records of nineteen patients(5 males and 14 females, mean age : 64±9 years) with unexpected GB cancer diagnosed postoperatively(Group 1 : cholecystitis, 12 cases ; GB empyema, 4 cases ; cholecystitis with bile duct stone, 3 cases) and thirty seven patients (12males and 25 females, mean age : 68±11 years) with originally diagnosed GB cancer(Group 2) were retrospectively reviewed at Ewha Womans university Mokdong hospital from October, 1993 to March, 1999.

Clinical findings including right upper quadrant pain, fever, and chilling were pre-dominant in group 1 and general weakness, anorexia, and weight loss were predominant in group 2. Ultrasonographic findings of the group 1 were not typical to detect GB cacer Diffuse thickened GB wall showed 47.3% and the gallstone showed 89.5% in group 1. The mass of thickened GB wall irregularly revealed in all and gallstone showed in 50% of group 2. The TMN stage of goup 1 revealed earlier stage than group 2. The curative resection was performed in 84.2% and 10% in group 1 and 2, respectively.

The stage of unexpected GB cancer revealed relatively early stage and the curative resection rate was higher than originally diagnosed GB cancer. Therefore, the careful and detail intraoperative histologic examination of considered in patient with clinical features of benign biliary disease to detect early and improve prognosis in the patients of GB cancer.

The aims of this study were to assess the clinical observation of outpatient who showed hematochezia, and to determine whether specific clinical symptoms associated with hematochezia were predictive of important gastrointestinal pathology.

Prospective study was carried out from July 1998 to July 1999 with sixty-five outpatients(35 males and 30 females with mean age, 43±11 years) who had no evidence of recent bleeding. Patients were interviewed by questionnaires about the amount and frequency of bleeding, change in bowel habits, weight loss, usage of aspirin/NSAIDs, and family history, prior gastrointestinal pathologic illness before colonoscopy. Based on this information, endoscopist were asked to predict whether the bleeding was from a benign perianal or other lesion. Important gastrointestinal pathology was defined as carcinoma, adenomas more than 1cm, active ulcerative colitis, and active tuberculosis by colonoscopy.

Colonoscopic findings were as follows : 27 cases of benign anorectal lesion ; 16 cases of polyps, 10 cases of normal ; 8 cases of acute colitis and nonspecific colitis ; 7 cases of coloerctal cancer, 7 cases of ulcerative colitis and intestinal tuberculosis ; and other cases. Important gastrointestinal pathology was 17 cases. Variables including duration, type and frequency of bleeding, weight loss and change in bowel habit did not predict the colonoscopic diagnosis. Of the 35 patients diagnosed clinically by endoscopist to begin anorectal lesion alone, 18 patients were found to have benign anorectal lesion, 2 patients had cancer, 2 patient had polyp(bigger than 1cm), and 1 patient had ulcerative colitis.

In outpatients with hematochezia, the incidence of colon cancer was 10.8%. Clinicians were unable to distinguish significant colonic lesions by history. Therefore accurate diagnostic workup is needed for this group of patients.

Helicobacter pylori(H. pylori) infection causes an active chronic gastritis and is an important etiological factor in developement of peptic ulcers. Successful treatment of this infection heals ulcers and reduces the risk of peptic ulcer relapse. We performed this study to assess the safety, tolerance and efficacy of a one week course of triple therapy with twice daily dosing using ranitidine bismuth citrate(RBC) with clarithromycin and amoxicillin for eradication of H. pylori.

H. pylori positive thirty-five patient(mean age 51.7±15.8 years, range : 16-74 years, Male : Female=27 : 9) with active peptic ulcer were enrolled in study. H. pylori infection was detected by CLO-test or histology, both antral and corpus biopsies. Patients were treated for 7 days with combination of RBC 400mg bid, clarithromycin 500mg bid, amoxicillin 1g bid. Eradication was defined as no evidence of H. pylori infection by Urea breath test performed at 4-6 weeks after the completion of therapy. Adverse events and compliance were assessed.

Twenty six out of 35 subjects completed the study. Patient's sex, age, smoking status, alcohol consumption, or history of ulcer had no significant effect on eradication of H. pylori. The per protocol and intention-to-treat eradication rate was 88.5%(23/26) and 65.7% (23/35), respectively. The per protocol eradication rate was 100%(10/10) for duodenal ulcer, 92.3%(12/13) for gastric ulcer, and 33.4%(1/3) for gastric and duodenal ulcer, respectively. Three patients experienced side effects during therapy, none that were considered severe.

Ranitidine bismuth citrate in combination with clarithromycin and amoxicillin in a one week b.i.d dosing regimen is well tolerated and effective in eradicating H. pylori infection.

Helicobacter pylori causes chronic gastritis, which progress to peptic ulcer, gastric atrophy, or gastric cancer. However, little is known about the role of Helicobacter pylori in reflux esophagitis. Corpus gastritis reduces the parietal cell mass and decreased peak acid output as a known risk factor for reflux esophagitis. So the relationship among reflux esophagitis and corpus gastritis and Helicobacter pylori needs to be clarified.

In prospective, controlled study of patients with reflux esophagitis without other gastrointestinal disease, the prevalence of Helicobacter pylori was assessed. Antral and corpus biopsy were performed and rapid urease test and Giemsa staining were taken for Helicobacter pylori status.

The prevalence of Helicobacter pylori was 43.8%(21/48) in reflux esophagitis and 67.5%(27/40) in reference group. The prevalence of Helicobacter pylori was significantly lower in patients compared with the reference group(p<O.O5). The corpus gastritis was no significant relationship with reflux esophagitis and Helicobacter pylory.

The prevalence of Helicobacter pylori infection in patients with reflux esophagitis is significantly lower than in the reference group, irrespective of corpus gastritis. It is suggested that Helicobacter pylori infection have a preventive role to reflux esophagitis, so we may be aware of balance between 'deleterious' and 'beneficial' effects of Helicobacter pylori eradication.