Characteristics of Early Colon Cancer in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. METHODS: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. RESULTS: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9+/-6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p<0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. CONCLUSIONS: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low.

Colon Cancer and Amidated Gastrin: Correlation with Atrophic Gastritis and Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: It has recently been reported that non-amidated gastrin is associated with the development of colon cancer. However it is not known whether amidated gastrin, atrophic gastritis, and the status of Helicobacter pylori (H. pylori) infection are related to colon cancer. The aims of this study were to determine whether plasma level of amidated gastrin is elevated in patients with colon cancer compared with controls and to determine whether H. pylori infection and/or atrophic gastritis affect the relationship between amidated gastrin and colon cancer. METHODS: Twenty-two patients with colon cancer and twenty-two controls were enrolled in this study and their plasma amidated gastrin titers were measured by 125I radioimmunoassay. H. pylori infection was determined by histology. The degree of mucosal atrophy was determined by Sidney classification. RESULTS: Amidated gastrin levels were not different between the patients with colon cancer and controls. The status of H. pylori infection did correlate with amidated gastrin levels. Antral mucosal atrophy was not also correlated with amidated gastrin levels, but there was a tendency (p=0.074). CONCLUSIONS: Amidated gastrin is not related to the development of colon cancer.

Dose Ascites Mean More Severe Crohn's Disease? / 대한소화기학회지

BACKGROUND/AIMS: Ascites that can be induced by various causes is not a rare finding in Crohn's disease. The clinical implication of ascites in Crohn's disease remains unknown in the cases without any specific cause of ascites except Crohn's disease itself. The purpose of this study was to investigate the clinical implication and characteristics of ascites in Crohn's disease. METHODS: We reviewed the medical records of the patients with Crohn's disease who underwent abdominal CT scan. Patients were categorized into two groups: patients with ascites (22 cases) and without ascites (23 cases). We compared clinical features, disease activities and clinical courses of the two groups. RESULTS: Serum albumin level was significantly lower and the C-reactive protein level was significantly higher in the ascites group than in the control group. Harvey and Bradshaw index was significantly higher in the ascites group (8.32 +/- 2.51) than in the control group (6.09 +/- 2.07) (p=0.002). The average dose of prednisolone was higher in the ascites group. On the other hand, there was no significant difference in the number of cases requiring surgery due to complication between two groups. CONCLUSIONS: Our results suggest that the presence of ascites in Crohn's disease is associated with increased disease activity and inflammations requiring more aggressive treatment.

The frequency of thiamine deficiency in chronic alcoholics and in patients at a long-term care facility / 대한내과학회지

BACKGROUND: As socioeconomic status has improved, malnutrition has become rare in Korea and generally it is no longer considered as a serious problem in medical practice. However, contrary to the above general belief we managed four patients with beriberi in 1999 and it became apparent that malnutrition might remain a problem in certain groups of patients. In this study, we assessed the nutritional state, especially with respect to thiamine deficiency, in chronic alcoholics and in patients residing at a long-term care facility (LTCF). METHODS: Fourteen chronic alcoholic patients and twenty patients being hospitalized in a long-term care facility were assigned as the study groups. The subjects' mean ages and standard deviations were 48.9+/-10.2 and 50.6+/-6.7, respectively. Medical records were reviewed to determine other aspects of their nutritional status and their dietary patterns. Ten peoples who visited the health promotion center at Inha University Hospital, for routine check-ups were allocated to the control group. Blood total thiamine levels were measured by high-performance liquid chromatography. RESULTS: Body mass indices were significantly lower in chronic alcoholics and in patients at the LTCF than in the control group (p=0.0065). Serum albumin levels were within the reference range in all three groups, but were significantly lower in patients at the LTCF than in the control group (p=0.0013). Moreover, no difference was detected between the alcoholic group and the control group in terms of thiamine levels. However, the mean thiamine level in patients at the LTCF was statistically lower than that of the control group and four (20%) patients in the LTCF group showed subnormal blood thiamine levels. The thiamine level tended to decrease with age in both alcoholics and patients at the LTCF. No correlation was found between thiamine level and the other variables examined, namely, hospital stay, body mass index, and serum albumin level. CONCLUSION: A considerable portion of patients in a long term care facility showed thiamine deficiency, however, no evidence of thiamine deficiency was found among alcoholics. This result suggests that thiamine deficiency in patients at long-term care facility may be more prevalent and that thiamine supplementation may be warranted, especially for those with other thiamine deficiency risk factors.

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of Colon as Multiple Large Polypoid Lesions / 대한소화기내시경학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma of colon usually presents with a solitary lesion of polypoid appearance but may rarely present with multiple polypoid lesions. MALT lymphoma of colon presented as multiple polypoid lesions are not easy to differentiate from multiple lymphomatous polyposis. We experienced a case of MALT lymphoma of colon with a large mass in proximal ascending colon involving ileocecal valve and multiple polypoid lesions in entire colon.

Spontaneous Rupture of Mediastinal Teratoma into Adjacent Tissues / 결핵

Mediastinal teratomas are rare and represent less than 10 per cent of all mediastinal tumors. Almost all arise in the anterosuperior mediastinal compartment, and most symptoms, when present, result from compression of adjacent structures. They contain different tissues derived from all three germinal layers, with the prevalence of ectodermal elements which can include hair, teeth and sebaceous material. Benign teratomas may rupture into adjacent organs. Up to 36% of all mediastinal teratomas rupture, most frequently into the lung and bronchial tree, followed by the pleural space, pericardial space, or great vessels. The signs and symptoms of a ruptured teratoma vary with the structures involved. We report a case of mediastinal teratoma ruptured spontaneously in a 18 year old female who experienced 4 or 5 times of hemoptysis for 1 year and sudden onset of pleural effusion, pericardial effusion and pneumonia.