Clinical outcome of endoscopic mucosal resection for treating early gastric cancer / 대한내과학회지

BACKGROUND: Endoscopic mucosal resection (EMR) has been widely accepted as a curative treatment for those cases of early gastric cancer (EGC) that have a low probability of lymph node metastasis. The aim of this study was to evaluate the clinical outcome of EMR for the treatment of EGC. METHODS: We retrospectively analyzed the medical records of 50 patients who were finally confirmed to have EGC among the 214 patients who were treated with EMR at Kangnam St. Mary's Hospital from January 1999 through December 2004. The mean age of patients was 67.1 years (range: 47~83), and the male to female ratio was 7:3 (35/15). The mean follow-up period was 20.5 months (range: 1~72). RESULTS: The mean size of the lesions was 16.6+/-7.4 mm. Forty-two cases (84%) were located in the lower third of the stomach. There were 28 cases (56%) of endoscopically detected elevated lesions (type I, IIa). Complete resection was achieved in 40 cases (80%). The complete resection rate was higher when the lesions had a diameter not exceeding 30 mm, when they were located in the lower third of the stomach and when they were the elevated macroscopic type. The en bloc resection rate was the highest for endoscopic submucosal dissection. Of the 40 cases with complete resection, 6 cases (15%) developed local recurrence after a mean follow-up period of 12.3 months (range: 2~22). Of these 6 cases, 4 cases developed at previous EMR sites and 2 cases developed at other sites. CONCLUSIONS: EMR is an effective method as a curative treatment for EGC with a high complete resection rate, but some cases that are completely resected by EMR will experience recurrence. It is necessary to perform follow up at established intervals for a long time after EMR.

A Case of Photodynamic Therapy as a Curative Treatment of Early Esophageal Cancer / 대한소화기내시경학회지

Although the surgical treatment of early esophageal cancer is a well-known curative modality, less invasive endoscopic methods have attracted significant attention recently on account of the fewer postoperative complications, better quality of life and preservation of the integrity of the esophagus. Among the various endoscopic techniques employed, photodynamic therapy (PDT) has been used to allow the selective destruction of malignant tissue through a photochemical effect after the administration of a photosensitizer for curative and palliative treatment purposes. This report describes a case of a 73-year-old man with early esophageal cancer, which had been diagnosed by fluorodeoxyglucose-positron emission tomography (FDG-PET) and endoscopy and a long history of chronic pulmonary diseases such as emphysema and radiation fibrosis. The patient was cured successfully with photodynamic therapy using porfimer sodium as the photosensitizer.

A case of adrenal adenoma with concurrent Cushing's syndrome and hyperaldosteronism / 대한내과학회지

Cushing's syndrome is produced by the hypersecretion of adrenal glucocorticoids and is characterized by moon face, central obesity, disappearance of diurnal variation of plasma cortisol and unsuppressibility of plasma cortisol by low-dose dexamethasone. On the other hand, hyperaldosteronism is produced by the hypersecretion of aldosterone and is characterized by hypertension and hypokalemia. We report a rare case of adrenal adenoma with concurrent hypercortisolism and hyperaldosteronism manifestated with hypertension, cushingoid appearance, left adrenal mass with low-normal plasma potassium. Laparoscopic unilateral tumor excision was performed and hypertension disappeared after the operation.

Detection of disseminated tumor cells using reverse transcriptase PCR for cytokeratin 20 in peripheral blood isolates from gastric cancer patients / 대한내과학회지

BACKGROUND: The development of metastasis in cancer is one of the main problems after primary tumor resection. The identification of metastases is only possible in the follow-up investigation when there is already a solid tumor mass. Subclinical tumor cell dissemination can be detected by immunocytological staining of cells or by other molecular biological methods, like PCR. We investigated 22 peripheral blood isolates from gastric cancer patients with a cytokeratin (CK) 20 specific nested reverse transcriptase PCR (RT-PCR) for the detection of disseminated tumor cells at the time of diagnosis. METHODS: Fresh heparinized peripheral bloods (about 10 mL) were obtained from 22 gastric cancer patients and 10 healthy doctors as controls. Nucleated cells were isolated by a density gradient method. RNA was isolated and then subjected to RT-PCR with CK 20 specific primers. RESULTS: In gastric cancer, 3 of 22 (13.6%) peripheral blood isolates yielded a CK 20 mRNA positive result in a stage undependent manner. CONCLUSION: We detected disseminated tumor cells in the peripheral blood isolated using CK 20 specific nested RT-PCR method. Studies on a larger scale are needed for further investigation on the relationship between positive rates of CK 20 mRNA and survival rates of stomach cancer, according to cancer stages.

Fatal Pneumomediastinum and Subcutaneous Emphysema in a Patient with Dermatomyositis / 대한류마티스학회지

Dermatomyositis is a clinical entity characterized by a distinctive cutaneous rash and inflammatory myopathy. In this disorder, the pneumomediastinum is quite a rare complication and is assumed to result from air leakage due to vasculitis, lung fibrosis or rarely after bronchoscopic lung biopsy and pulmonary function test. We describe patient with dermatomyositis who developed pneumomediastinum, pneumothorax and massive subcutaneous emphysema after pulmonary function test. She died due to respiratory failure. We think that careful observation is required in performing PFT in dermatomyositis patients with presumed interstitial lung diseases.