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ABSTRACT: The classic Dieulafoy lesion is a minute gastric mucosal defect which bleeds massively from an exposed artery. The typical endoscopic appearance of this lesion is a single, round mucosal defect with an artery protruding from its base in the absence of surrounding ulceration. We encountered an 89-year-old man who developed sudden massive fresh rectal bleeding. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a Dieulafoy lesion situated in rectum. Hemostasis was achieved successfully with epinephrine injection and endoscopic hemostatic clipping.
Journal of Clinical Medicine Research 12/2012; 4(6):439-41.
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ABSTRACT: Lateral spreading tumors (LST) are relatively large flat lesions with diameters exceeding 10 mm in length. Endoscopic mucosal resection (EMR) is a commonly used technique for removing LST. We aimed to evaluate the risk factors for incomplete resection and complications of EMR for LST.
Between January 2004 and December 2010, 497 patients who underwent EMR for LST were retrospectively reviewed. Risk factors for endoscopic and histopathological complete resection, complications, and clinical outcomes were investigated.
Risks for incomplete resection by piecemeal resection and en bloc resection of a lesion ≥ 30 mm were higher than for en bloc resection of a lesion <30 mm (OR=2.688, CI 1.036-6.993; OR=4.982, CI 1.894-13.101). Risks of post-EMR bleeding for piecemeal resection and en bloc resection for a lesion ≥ 40 mm were higher than for en bloc resection of a lesion <40 mm (OR=15.231, CI 1.816-127.744; OR=43.043, CI 4.306-430.314).
We found risk factors of EMR for LST and tentatively suggest a protocol for EMR adapted to the size of LST and resection methods. (i) Following piecemeal resection and en bloc resection for LST ≥ 40 mm, hospitalize patients for 36 h and note risk for incomplete resection and delayed bleeding. (ii) After en bloc resection for 40 mm>LST ≥ 30 mm, hospitalize patients for 12 h and note risk for incomplete resection. (iii) Following en bloc resection for LST<30 mm, hospitalize the patient for 12 h and expect complete resection.
Digestive Endoscopy 07/2012; 24(4):259-66. · 1.19 Impact Factor
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Gyu Jin Lee,
Moo In Park,
Sangeon Gwoo,
Hyun Joo Jung, Joo Hoon Kim,
Seun Ja Park,
Won Moon,
Hyung Hun Kim,
Yang Soo Kim,
Sung Dal Park,
Tae Sig Jeong
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ABSTRACT: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer.
A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis.
The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively.
These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 04/2012; 59(4):282-8.
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Gastrointestinal endoscopy 02/2012; 75(2):462-3. · 6.71 Impact Factor
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ABSTRACT: Irritable bowel syndrome (IBS) is prevalent in general population. This study investigates the prevalence of IBS in medical college students in Korea as well as the influence of dietary habits and nutritional intake on IBS.
This study is a cross-sectional study of 319 students (239 males and 80 females, age 22.3 ± 2.5 years) from the 6 grade levels of the Medical College in Korea. All students filled out a self-reported questionnaire for ROME III criteria. They also completed a questionnaire to validate dietary habits and food frequency in Korean.
The overall prevalence of IBS was 29.2% without correlation to age, body mass index and grade level in Medical School. However, the prevalence was significantly higher in females than males (33/80 vs 60/239, P = 0.007). There were no significant differences between the IBS-group and the non-IBS group in aspect of nutrition. Not only the diet habits, but also the daily nutritional intake, and even the breakdown into the 12 micronutrients, yielded no significant differences between the 2 groups.
Twenty-nine percent of the medical college students have IBS with a greater prevalence in females. The dietary habits and nutritional intake of the students might not be associated with IBS.
Journal of neurogastroenterology and motility 07/2011; 17(3):294-9.
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ABSTRACT: To assess the efficacy of autologous serum eye drops (AS) in enhancing conjunctivalization over a scleral patch graft on exposed porous polyethylene orbital implant (Medpor(®)).
Eighteen rabbits were underwent evisceration, implantation of Medpor(®) and homologous scleral patch graft. The conjunctival edge was sutured leaving 5 mm-diameter circular defect. In group A, 20% AS were applied 8 times a day and only balanced salt solution was applied in group B. Digital anterior segment photography was obtained 1, 3, 7, 10, 14, and 21 days after surgery and analyzed with Image Pro Plus(®) software.
In the early postoperative period, the average conjunctival growth rate (mm(2)/day) was faster in group A, but failed to show statistical significance (3.79 vs. 3.03, p = 0.26 in 1~3days, 2.39 vs. 1.80, p = 0.59 in 4- days, 0.03 vs. -0.02, p = 0.94 in 7-10 days, Mann-Whitney test). The complete healing rate was higher (67% vs. 56%, p = 0.5, Fisher's exact test) and the mean elapsed time for complete healing (days) was shorter in group A (17.3 vs. 18.2, p = 0.83, Mann-Whitney test), but did not show a statistically significant difference.
In a rabbit model, 20% AS did not appear to facilitate the healing of small conjunctival defects of exposed porous orbital implant.
Orbit (Amsterdam, Netherlands) 03/2011; 30(2):83-7.
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ABSTRACT: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer composed of cells with histopathologic features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). Because of its low incidence, the information on clinical outcomes of cHCC-CC is very limited and there are no published reports describing non-surgical treatment options for cHCC-CC. We report a case of cHCC-CC exhibiting a favorable response to systemic chemotherapy with doxorubicin and cisplatin. A 62-year-old man who recurred after a right lobectomy for cHCC-CC received sorafenib for palliative systemic therapy, but follow up imaging studies showed disease progression. He received 2nd line chemotherapy with doxorubicin at 60 mg/m(2) together with cisplatin at 70 mg/m(2). After 2 cycles of chemotherapy, a computed tomography scan of the chest showed markedly decreased size and number of the multiple lung metastases. After completing 8 cycles of 2nd line therapy, we changed the regimen to a fluorouracil (5-FU) mono therapy because of the toxicities associated with doxorubicin and cisplatin. To date, the patient has completed his 15th cycle of 5-FU mono therapy with the disease status remaining stable during 18 months of follow-up.
Cancer Research and Treatment 12/2010; 42(4):235-8.
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Joo Hoon Kim,
Sun Young Rha,
Chan Kim,
Gun Min Kim,
Sang Hyun Yoon,
Ki Hyang Kim,
Min Jae Kim,
Joong Bae Ahn,
Hyun Cheol Chung,
Jae Kyung Roh,
Hyo Song Kim
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ABSTRACT: We investigated the clinicopathologic information of patients with gastric cancer with multiple primary cancers (GC-MPC) of three or more sites.
Between 1995 and 2009, 105,908 patients were diagnosed with malignancy at Severance Hospital, Yonsei University Health System. Of these, 113 (0.1%) patients with MPC of three or more sites were registered, and 41 (36.3%) of these were GC-MPC. We retrospectively reviewed the clinical data and overall survival using the medical records of these 41 GC-MPC patients. We defined synchronous cancers as those occurring within 6 months of the first primary cancer, while metachronous cancers were defined as those occurring more than 6 months later.
Patients with metachronous GC-MPC were more likely to be female (p=0.003) and young than patients with synchronous GC-MPC (p=0.013). The most common cancer sites for metachronous GC-MPC patients were the colorectum, thyroid, lung, kidney and breast, while those for synchronous GC-MPC were the head and neck, esophagus, lung, and kidney. Metachronous GC-MPC demonstrated significantly better overall survival than synchronous GC-MPC, with median overall survival durations of 4.7 and 14.8 years, respectively, and 10-year overall survival rates of 48.2% and 80.7%, respectively (p<0.001).
Multiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intent.
Cancer Research and Treatment 12/2010; 42(4):217-24.
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ABSTRACT: The proper dose and schedule of sunitinib have yet to be established for patients with metastatic renal cell carcinoma (RCC) on hemodialysis. We reviewed two patients with metastatic RCC on hemodialysis who had been treated with sunitinib in Yonsei Cancer Center, Yonsei University College of Medicine. Fifty milligrams of sunitinib was administered intermittently after each hemodialysis session (3 or 4 times a week). Overall responses were partial response in both cases. Progression-free survivals were 16 and 6 months, respectively, at the time of reporting (April 2010). Both subjects tolerated the treatment.
Cancer Research and Treatment 09/2010; 42(3):180-4.
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ABSTRACT: With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke's encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer.
This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE.
A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment.
It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.
Cancer Research and Treatment 06/2010; 42(2):77-81.
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ABSTRACT: The aim of this study was to investigate the suppressing effects of systemically administered ursodeoxycholic acid (UDCA) and tauroursodeoxycholic acid (TUDCA) on choroidal neovascularization (CNV) in a laser-treated rat model.
CNV was induced by argon laser photocoagulation in the right eye of each animal. UDCA 500 mg/kg, TUDCA 100 mg/kg, or vehicle was intraperitoneally injected at 24 h before and daily after laser treatment. Fourteen days after laser treatment, fluorescein angiography was performed to evaluate leakage from CNV and eyes were enucleated for histologic evaluation. Vascular endothelial growth factor (VEGF) levels in the retina were measured using enzyme-linked immunosorbent assay at 3 days after laser treatment and were compared between the UDCA, TUDCA, and control groups.
The proportion of CNV lesions showing clinically significant fluorescein leakage was lower in the UDCA and TUDCA groups (42%, P = 0.0124; and 46%, P = 0.0292) than in the control group (67%). CNV lesion dimensions including CNV area and CNV/choroid thickness ratio were also significantly reduced in the UDCA and TUDCA groups (7,664 +/- 630 microm(2), P < 0.001 and 8,558 +/- 570 microm(2), P < 0.001; 2.35 +/- 0.16, P = 0.026 and 2.27 +/- 0.15, P = 0.003) compared with the control group (12,147 +/- 661 microm(2) and 3.10 +/- 0.27). The VEGF level in the retina after laser treatment was lower in the TUDCA group than that in the control group (9.0 +/- 2.7 pg/mg vs. 29.4 +/- 8.2 pg/mg, P = 0.032), whereas the UDCA group showed no difference.
The systemic administration of UDCA and TUDCA suppressed laser-induced CNV formation in rats, which might be associated with anti-inflammatory action. The result indicates that UDCA and TUDCA are potential candidate drugs for the treatment of many CNV-related retinal diseases, including age-related macular degeneration.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 06/2010; 26(3):223-9. · 1.46 Impact Factor
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Circulation Cardiovascular Imaging 05/2009; 2(3):e15-6. · 5.94 Impact Factor
