Clinicopathologic Features of Colorectal Cancer Combined with Synchronous and Metachronous Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone. METHODS: A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also. RESULTS: Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted. CONCLUSIONS: Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.

Predictive Capability of Anorectal Physiologic Tests for Unfavorable Outcomes Following Biofeedback Therapy in Dyssynergic Defecation

The purpose of this study is to evaluate the predictive capability of anorectal physiologic tests for unfavorable outcomes prior to the initiation of biofeedback therapy in patients with dyssynergic defecation. We analyzed a total of 80 consecutive patients who received biofeedback therapy for chronic idiopathic functional constipation with dyssynergic defecation. After classifying the patients into two groups (responders and non-responders), univariate and multivariate analyses were performed to determine the predictors associated with the responsiveness to biofeedback therapy. Of the 80 patients, 63 (78.7%) responded to biofeedback therapy and 17 (21.3%) did not. On univariate analysis, the inability to evacuate an intrarectal balloon (P=0.028), higher rectal volume for first, urgent, and maximal sensation (P=0.023, P=0.008, P=0.007, respectively), and increased anorectal angle during squeeze (P=0.020) were associated with poor outcomes. On multivariate analysis, the inability to evacuate an intrarectal balloon (P=0.018) and increased anorectal angle during squeeze (P=0.029) were both found to be independently associated with a lack of response to biofeedback therapy. Our data show that the two anorectal physiologic test factors are associated with poor response to biofeedback therapy for patients with dyssynergic defecation. These findings may assist physicians in predicting the responsiveness to therapy for this patient population.

Clinical Study of Malignancies after Allograft Renal Transplantation / 대한신장학회잡지

OBJECTIVE: The aim of this retrospective analysis was to study the incidence, clinical course, treatment, prognosis of malignancy in immunosuppressed renal transplant recipients. METHODS: The object were 38 cases of cancer that occured in 1,130 transplant recipients between 1969 and 1997 at Kangnam CUMC. Mean follow-up periods was 61.6+/-41.8 months. The incidence of cancers was compared to the number expected in age-matched general population. This allows the calculation of a "risk ratio". We used international cancer registry for comparison. RESULTS: Thes incidence of de novo malignancy in 1,130 renal transplant recipients was 3.3% for 5years of mean follow-up period and there was no difference between sex. The most common cancer was stomach cancer in case of male and cervix cancer for female. This distribution was same as general population. The incidence of malignant lymphoma and Kaposi's sarcoma was higher in renal transplanted patients than the general population. Cancers with the most striking increased risk(IR) were lymphoma(IR 167), and Kaposis sarcoma. It took 55 months for the malignant lymphoma to be occurred and it developed faster than other cancer. CsA caused faster breakout of cancer than Aza did. CONCLUSION: The features of malignancy in renal transplant recipients are different from those of general population.

Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptic Ulceration: Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection / 대한소화기내시경학회지

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.

Diabetic Ketoacidosis after Steroid Administration for Minimal Change Disease / 대한신장학회잡지

Although diabetic ketoacidosis is relatively common in primary diabetes mellitus, it is very rare in diabetes mellitus secondary to steroid therapy. We here present a case of diabetic ketoacidosis after steroid administration for minimal change nephrotic syndrome. A 29-year-old man was first admitted with generalized edema and massive proteinuria. He had no past history of diabetes mellitus. Kidney biopsy revealed minimal change disease and he was treated with prednisolone(1mg/kg). Eight weeks after steroid treatment, proteinuria disappeared completely and steroid dose was decreased by 10mg in a week. Nine weeks after steroid treatment, diabetes mellitus newly develped and it was well controlled with insulin therapy. As prednisolone dose was decreased, insulin requirement also diminished. When he was taking 30mg of prednisolone, insulin therapy was stopped because of good glycemic control. He complained of vomitting and abdominal pain, and tachypnea a week after withdrawl of insulin. Laboratory findings revealed severe diabetic ketoacidosis. Steroid was stopped and he was treated with fluid, insulin and potassium. Now he is beibg successfully treated with 20 unit of NPH insulin without relapse of nephrotic syndrome.

A Case of Ventricular Tachycardia Induced by Amitriptyline in a Patient with Painful Diabetic Neuropathy / 대한내분비학회지

Diabetic neuropathy is one of the most common complications of diabetic mellitus and has myriad clinical presentations. Amitriptyline is an effective drug for painful diabetic neuropathy, but has a wide variety of cardiovascular effects. We report a case of amitriptyline-induced ventricular tachycardia in a patient with painful diabetic neuropathy. A 48-year-old man with no history of heart disease was treated with amitriptyline for the past 2 months. The dosage of this drug was gradually increased and the maximal dose was 170 mg per day. Prior to administration of this drug, his chest X-ray and electrocardiogram were normal. On admission he complained of chest discomfort and palpitation for 3 days, but his vital sign was stable. The electrocardiogram showed a wide QRS complex with a rate of 170 beats per minute. The ventricular tachycardia was successfully treated with electrical cardioversion.

Acute Allograft Pyelonephritis Following Renal Transplantation / 대한내과학회지

OBJECTIVE: Urinary tract infections are mostly benign, but allograft pyelonephritis may induce renal dysfunction or acute rejection. The purpose of this study was to evaluate the frequency of acute allograft pyelonephritis and its influence on graft function and induction of allograft rejection. METHODS: We reviewed the medical records of 1167 renal transplant recipients retrospectively. The allograft pyelonephritis was defined as pyuria with overt clinical manifestations such as fever and graft tenderness. In cases of poor response to antibiotics, abdominal CT and/or graft biopsy were done. RESULTS: During mean follow-up period of 60.9+/-46.8 months, there were 100 episodes of acute allograft pyelonephritis in 65 patients(5.6%). Seventeen patients (26.2%) had recurrent pyelonephritis. Primary renal disease and recipient sex were important predisposing factors for acute allograft pyelonephritis. In patients whose primary renal disease was chronic pyelonephritis or polycystic kidney disease, the prevalance was 30.8% and 18.2% respectively, while in patients with other primary diseases the prevalance ranged from 3.8% to 5.7% (p<0.05). In female patients, the prevalance of pyelonephritis was 14%, which was much higher than that in male patients(2%) (p<0.01). Thirty one out of 100 cases showed deterioration of renal function defined as an increase in serum creatinine by more than 50% of baseline. In twenty five out of 31 cases, grafted kidney biopsy was performed. In 9 cases(36%), the biopsy showed acute rejection together with pyelonephritis, which was mainly manifested by tubulitis. Renal dysfunction occurred mostly in patients who had septicemia or whose previous serum creatinine was higher than 1.2 mg/dl. Renal CT, which was performed in 34 cases, showed findings consistent with acute focal bacterial nephritis (AFBN) in 13 cases (38.2%). Voiding cystourethrogram was performed in 11 patients and six patients (54.5%) were found to have vesicoureteral reflux. E.Coli was the most frequent causative organism (63.6%). CONCLUSION: Acute allograft pyelonephritis was frequently associated with acute focal bacterial nephritis and graft rejection. Imaging study and graft biopsy were helpful for accurate diagnosis and proper management of acute allograft pyelonephritis in cases of renal dysfunction. In patients who have acute rejection together with pyelonephritis, rejection therapy including methylprednisolone pulses in addition to antibiotic therapy for pyelonephritis is recommended.

A Case of Emphysematous Pyelonephritis in Which Intrarenal Gas Persistently Appeared over 1 month: Experience of Successful Management by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and life-threatening necrotizing infection of the renal parenchyma that requires prompt diagnosis and early treatment. It is associated with gas-forming coliform bacteria, and is characterized by the presence of gas within the renal parenchyma. The clinical picture and gas pattern should be monitored carefully before a surgical desion is made. If there is persistence of gas on serial x-rays despite aggressive therapy, prompt surgical therapy is recommended. We herein present 1 diabetic patient with emphysematous pyelonephritis who responded to medical treatment alone. The presence of gas was confirmed by CT scan and Escherchia coli was isolated in both urine and blood cultures. The patient was treated with antibiotics alone. Although the clinical signs and laboratory findings were improved, intrarenal gas persistently appeared over 1 month. CT scan 2 month after medical treatment revealed absence of gas in the renal parenchyma.