Effects of Mesenchymal Stem Cells Treatment on Radiation-Induced Proctitis in Rats

Purpose@#There are no effective treatment methods with which to control complications of radiation proctitis with fistula or recurrent bleeding following radiation treatment for prostate, cervical, or rectal cancer. Mesenchymal stem cells (MSCs) can induce immune modification, resulting in tissue repair and regeneration. Therefore, we used a rat model of radiation-induced proctitis and observed the effects of using human placenta-derived (PD) and adipose tissue-derived (AD) MSCs. @*Materials and Methods@#Female Sprague Dawley rats were irradiated at the pelvic area with 25 Gy. We injected 1×10 6 cells of human PD-MSCs, human AD-MSCs, human foreskin fibroblasts, and control media into the rectal submucosa following irradiation. We sacrificed rats for pathologic evaluation. @*Results@#Fibrosis on the rectum was reduced in both MSC groups, compared to the control group. Mucosal Ki-67 indices of both MSC injected groups were higher than those in the control group. Although caspase-3 positive cells in the mucosa gradually increased and decreased in the control group, those in both MSC injected groups increased rapidly and decreased thereafter. @*Conclusion@#We demonstrated the effects of regional MSC injection treatment for radiation-induced proctitis in rats. MSC injection reduced fibrosis and increased proliferation in rat mucosa. Human AD-MSCs and PD-MSCs had similar effectiveness.

Fibrostenotic strictures in Crohn’s disease

The use of biologic agents including anti-tumor necrosis factor monoclonal antibodies followed by anti-integrins and anti-interleukins has drastically changed the treatment paradigm of Crohn’s disease (CD) by improving clinical symptoms and mucosal healing. However, up to 70% of CD patients still eventually undergo surgery mainly due to fibrostenotic strictures. There are no specific anti-fibrotic drugs yet. This review comprehensively addresses the mechanism, prediction, diagnosis and treatment of the fibrostenotic strictures in CD. We also introduce promising anti-fibrotic agents which may be available in the near future and summarize challenges in developing novel therapies to treat fibrostenotic strictures in CD.

Preoperative Colonoscopy for Detection of Synchronous Neoplasms after Insertion of Self-Expandable Metal Stents in Occlusive Colorectal Cancer: Comparison of Covered and Uncovered Stents

BACKGROUND/AIMS: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. METHODS: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. RESULTS: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. CONCLUSIONS: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.

Insertion of Self Expandable Metal Stent for Malignant Stomal Obstruction in a Patient with Advanced Colon Cancer

Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.

A case of acute hemorrhagic rectal ulcer syndrome / 대한내과학회지

Acute hemorrhagic rectal ulcer syndrome (AHRUS) is characterized by the sudden onset of painless, massive, fresh rectal bleeding in elderly or bedridden patients with serious underlying illnesses. With increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRUS has increased in Japanand Western countries in recent years. However, AHRUS remains a controversial disease entity and has not yet been documented in Korea. Here, we present a case of AHRUS to highlight this uncommon disease entity as a potential etiology of massive rectal bleeding in critically ill patients.

The Relationship of epicardial adipose tissue to metabolic syndrome and cardiovascular risk factors / 대한내과학회지

BACKGROUND: Increased adiposity is widely accepted as the main expression of obesity and an important risk factor for the development of cardiovascular and metabolic syndrome. The significance of epicardial adipose tissue (EAT), frequently observed during a transthoracic echocardiographic examination, is not well recognized. The purpose of this study was to investigate the relationship of EAT to metabolic syndrome and cardiovascular risk factors. METHODS: We collected clinical, biochemical, and anthropometric information from 289 consecutive and prospective patients (147 men; 59+/-11 years) who visited our hospital for a complaint of chest pain. EAT thickness was measured by transthoracic echocardiography on the free wall of the right ventricle in the parasternal long axis and short axis views at the base level during end-diastole. RESULTS: EAT thickness was significantly increased in 185 (64%) patients with metabolic syndrome as compared with patients without metabolic syndrome (4.3+/-2.5 mm vs. 3.6+/-2.8 mm, p=0.005). By a simple linear regression analysis, EAT was correlated to age (r=0.484, p<0.001), waist circumference (r=0.177, p=0.01), the level of HDL cholesterol (r=-0.182, p=0.001) and log CRP (r=0.268, p=0.012). Multivariate analysis showed that age and log CRP were the independent variables that correlated to EAT thickness. CONCLUSIONS: These results suggest that echocardiographic EAT should be considered as a new useful imaging indicator of visceral adipose tissue related to metabolic syndrome and cardiovascular disease.

A Case of Intestinal Lymphangiectasia Improved with Antiplasmin and Octreotide Treatment / 대한소화기내시경학회지

Intestinal lymphangiectasia is characterized by protein- losing enteropathy, and is diagnosed by a small bowel biopsy demonstrating dilated lymphatics in the mucosa, submucosa and serosa in the absence of coexistent inflammation. We report a case of primary intestinal lymphangiectasia that occurred in a 2-year-6-month-old girl who was treated successfully with antiplasmin and octreotide. Initially, the patient was treated with a lipid restriction diet with medium chain triglyceride oil, but her symptoms were not relieved. This case shows that antiplasmin and octreotide therapy might be useful for treating refractory primary intestinal lymphangiectasia.

Outcome of Severe Aplastic Anemia Treated with Immunosuppressive Therapy Compared with Bone Marrow Transplantation

BACKGROUND: The response rates and survival following allogeneic bone marrow transplantation (BMT) or immunosuppressive treatment were compared in severe aplastic anemia (SAA) and the prognostic factors related with survival identified. METHODS: Medical data of SAA patients, treated with BMT or immunosuppressive therapy (IST) at the Ajou University Hospital, between January 1995 and December 2005, were retrospectively analyzed. RESULTS: A total of 43 patients were evaluable; 18 (41.9%) were treated with IST (antithymocyte globulin plus cyclosporine A plus steroid) and 25 (58.1%) with allogeneic BMT. In the IST group, the response rate was 77.8% (2 complete and 12 partial remissions), with two treatment failures. As later complications, acute myeloid leukemia developed in 1 patient and myelodysplastic syndrome developed in 2. In the BMT group, the response rate was 92.0% (18 complete and 5 partial remissions) (P<0.001). Six patients developed grade II to III acute graft-versus-host-disease (GVHD) and 3 developed chronic GVHD. The median survival time in all patients was 60.27 months, and the 5-year survival rates were 61.0 and 81.9% in the IST and BMT groups, respectively (P=0.144). The factors influencing the overall survival were an age under 40-years and a positive treatment response. CONCLUSION: This study shows that allogeneic BMT, compared to IST, resulted in good response andoverall survival rates in patients with SAA. However, the overall survival rate between the two groups was statistically insignificant. Our study suggests that younger age SAA patients, with HLA-matched BMT donors, may benefit more from allogeneic BMT.

A Case of Adult Intussusception of the Colon Caused by Cecal Neurofibroma in a Patient with Neurofibromatosis Type 1 / 대한소화기내시경학회지

Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disorder and it is characterized by neurofibromas and cafe-au-lait spots on the skin. NF-1 affects the gastrointestinal tract in 25% of the cases and the stomach and jejunum are the commonly involved sites. Yet the occurrence of colon NF is very unusual. Several cases of colon involvement of NF-1 have been reported on and their clinical manifestations were massive or occult bleeding, constipation and asymptomatic rectal or perianal nodules. There was a reported case of colon-to-colon intussusception via an isolated colonic neurofibroma. However, the best of our knowledge, there has been no reported case of colon-to-colon intussusception induced by NF-1. We encountered a case of NF-1 involving the cecum that resulted in colon-to-colon intussusception and secondary acute appendicitis. The patient showed the typical skin lesions and bony abnormalities of NF. We report on this case with a review of the literature.