Utilizing Intrabolus Pressure and Esophagogastric Junction Pressure to Predict Transit in Patients With Dysphagia

BACKGROUND/AIMS: High-resolution manometry (HRM), with a greatly increased number of recording sites and decreased spacing between sites, allows evaluation of the dynamic simultaneous relationship between intrabolus pressure (IBP) and esophagogastric junction (EGJ) relaxation pressure. We hypothesized that bolus transit may occur when IBP overcomes integrated relaxation pressure (IRP) and analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP in patients with dysphagia. METHODS: Twenty-two dysphagia patients with normal EGJ relaxation were examined with a 36-channel HRM assembly. Each of the 10 examinations was performed with 20 and 30 mmHg pressure topography isobaric contours, and findings were categorized based on the Chicago classification. We analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP. RESULTS: Twenty-two patients were classified by the Chicago classification: 1 patient with normal EGJ relaxation and normal peristalsis, 8 patients with intermittent hypotensive peristalsis and 13 patients with frequent hypotensive peristalsis. A total of 220 individual swallows were analyzed. There were no statistically significant relationships between peristalsis pattern and the discrepancy between IBP and IRP on the 20 or 30 mmHg isobaric contours. CONCLUSIONS: Peristalsis pattern was not associated with bolus transit in patients with dysphagia. However, further controlled studies are needed to evaluate the relationship between bolus transit and peristalsis pattern using HRM with impedance.

Hepatitis C virus (HCV) genotypes and the influence of HCV subtype 1b on the progression of chronic hepatitis C in Korea: a single center experience

BACKGROUND/AIMS: There is some controversy regarding whether or not hepatitis C virus (HCV) subtype 1b is more influential than non-1b subtypes on the progression of chronic hepatitis (CH) C to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). METHODS: We retrospectively analyzed 823 patients with chronic HCV infection, including 443 CH patients, 264 LC patients, and 116 HCC patients, who were HCV RNA positive and HBsAg negative. These patients had not received any prior treatment with either interferon alone or a combination of interferon and ribavirin. RESULTS: HCV subtypes 1b (51.6%) and 2a/2c (39.5%) were the two most common genotypes. The proportions of genotypes 2 (2a/2c, 2b, and 2) and 3 were 45.8% and 1.1%, respectively. One case of genotype 4 was found. HCV subtype 1b (47.3%) was less common than the non-1b subtypes (52.7%) in non-LC patients, but its proportion (56.9%) was higher than that of non-1b subtypes (43.1%) in LC patients (P=0.006). The proportions of patients with HCV subtype 1b did not differ significantly between the LC (55.3%) and HCC (60.3%) groups. Older age, male gender, and the relative progression of liver damage (non-LC vs. compensated LC vs. decompensated LC) were significant risk factors for HCC, with odds ratios of 1.081 (95% confidence interval [CI], 1.056-1.106), 5.749 (95% CI, 3.329-9.930), and 2.895 (95% CI, 2.183-3.840), respectively. HCV subtype 1b was not a significant risk factor for HCC (odds ratio, 1.423; 95% CI, 0.895-2.262). CONCLUSIONS: HCV subtypes 1b and 2a/2c were the two most common HCV genotypes. HCV subtype 1b seemed to be more influential than non-1b subtypes on the progression of CH to LC, but not on the development of HCC from LC.

The Natural Course of Early Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Early gastric cancer (EGC) has a relatively long natural course compared to advanced gastric cancer (AGC). But, few studies about the natural course of EGC are currently available in the literature. In this study we investigated the natural course of EGC in patients who did not receive any treatment. METHODS: All patients diagnosed with gastric cancer on endoscopy at Kosin University Gospel Hospital between January 2001 and December 2010 were reviewed. Those among them who had EGC and did not receive any treatment were enrolled, and an analysis was performed. RESULTS: Twenty seven patients were enrolled. Nine of the enrolled patients were women and the median age was 73 years (range, 38-95). Initial endoscopic findings revealed 11 cases of protruded type, 16 cases of flat and depressed type. Histopathologic analysis indicated that there were 14 cases of well and moderately differentiated adenocarcinoma, 6 cases of poorly differentiated adenocarcinoma and signet ring cell carcinoma. Twelve patients underwent follow-up endoscopy and three of them developed AGC within a mean of 9.6 months (range, 5-12 months). Overall median survival time was 40 months and the 5-year survival rate was 45%. CONCLUSIONS: Although there were some differences in EGC progression, patients who did not receive any treatment progressed eventually. We were unable to identify specific factors predictive of median survival time in these patients.

Docetaxel, Cisplatin, 5-FU Combination Chemotherapy as a First-Line Treatment in Patients with Advanced Gastric Cancer / 대한내과학회지

BACKGROUND/AIMS: This study investigated the efficacy and safety of docetaxel/cisplatin/5-fluorouracil (DCF) combination chemotherapy as a first-line treatment in patients with advanced gastric cancer. METHODS: The study enrolled 48 patients diagnosed with unresectable pathologically proven gastric cancer who received DCF combination chemotherapy between April 2006 and August 2009. The dose administered was docetaxel 75 mg/m2 for 1 h and cisplatin 75 mg/m2 for 90 min on day 2, and 5-FU 750 mg/m2 for 24 h on days 1-5, every 3 weeks. The response was assessed every three cycles. The toxicity was evaluated for every chemotherapy course according to the National Cancer Institute (NCI) toxicity criteria ver. 2.0. RESULTS: The median age of the patients was 58 years (range 31-78 years). The median overall survival was 11.5 months (2.3-28.2 months) and the median time to progression was 5.5 months (0.3-18.9 months). No complete remission occurred. Of the patients, 56% achieved a partial response, 21% stable disease, and 10% progressive disease. The overall response rate was 56%. During a total 292 cycles, anemia worse than NCI toxicity grade 3 occurred in 2%, leukopenia in 33.1%, neutropenia in 67.1%, and thrombocytopenia in 4.4%. Neutropenic fever occurred in 33 cycles (11.3%), dose reduction due to side effects in 165 cycles (56.5%), and a regimen change due to side effect in five cycles (1.7%). CONCLUSIONS: Combination chemotherapy with docetaxel, cisplatin, and 5-FU is efficacious, but has relatively high toxicity. A DCF protocol that maximizes its efficiency, while minimizing toxicity, would be more useful as a first-line treatment in patients with advanced gastric cancer.

Clinical Features of Advanced Non-Small Cell Lung Cancer in Never-Smokers / 대한내과학회지

BACKGROUND/AIMS: Smoking is major cause of lung cancer. However, the prevalence of lung cancer in never-smokers increasing recently. This study investigated the clinical characteristics of advanced lung cancer in never-smokers. METHODS: We anlyzed the clinical characteristics including demographics, bronchoscopic features, stage, and serum tumor markers, of never smokers with lung cancer seen at Kosin University Hospital from January 2001 to December 2008. RESULTS: There were 105 never smokers with lung cancer (mean age 61 years, 82 females), comprising 83 (79%) adenocarcinomas, 9 (8.6%) squamous carcinomas, and 13 (12.4%) undifferenciated carcinomas. The overall median survival time (MST) was 18.7 months. The MST was longer in females (21.6 vs. 13.7 months, p = 0.03), patients younger than 60 years (19.2 vs. 17.5 , p = 0.019), and those with adenocarcinoma (21.6 vs. 8.8 months, p = 0.038), and a neuron-specific enolase level of less than 15 ng/mL (22.4 vs. 13.4 months, p = 0.014). CONCLUSIONS: We analyzed the clinical characteristics of advanced lung cancer in never smokers. A more comprehensive study is need to compare never-smokers and smokers with lung cancer and to determine the appropriate treatment for non-smokers.

Serum Carcinoembryonic Antigen as an Index of the Therapeutic Effect of EGFR-TKIs in Patients with Advanced Non-Small Cell Lung Cancer

PURPOSE: For treating advanced non-small cell lung cancer (NSCLC), epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are known to be very effective in nonsmokers, women, Asian and person with EGFR mutations. The efficacy of EGFR-TKI was analyzed based on the radiologic studies and the serum levels of carcinoembryonic antigen (CEA) to evaluate whether serum CEA can be used as a predicative marker of the response to EGFR-TKI therapy. MATERIALS AND METHODS: Forty-one patients with NSCLC treated with gefitinib at Kosin Medical Center from January 2007 to August 2009 were the subjects of this study. We assayed the serum CEA levels before and after gefitinib therapy with concomitant assessments of the tumor response by serial chest X-ray and chest computer tomograms (CT). RESULTS: The median age of the patients was 62.6 years (range, 32~77 years), 29 patients were women, 36 had adenocarcinoma (87.8%) and the baseline serum CEA was equal or above 5 ng/mL in 31 patients (75.6%). These 31 patients were more responsive to the gefitinib therapy (p=0.021). The overall response rate of the patients was 51.2%, the median survival time was 21.9 months and the time to progression was 8.3 months. Among the 21 responding patients, the serum CEA was decreased after 2 months in 17 (80.9%), and among the 14 progressed patients, the serum CEA was increased in 12 (85.7%) (p=0.000). CONCLUSION: The changes of serum CEA at 2 months after gefitinib therapy were closely related to the radiologic changes. The serum CEA could be used as a complimentary tool for monitoring the tumor response to EGFR-TKI in the advanced NSCLC patients.

A Case of Successful Allogeneic Stem Cell Transplantation for Chemotherapy-refractory Hepatosplenic gamma delta-T Cell Lymphoma / 대한혈액학회지

Hepatosplenic T-cell lymphoma is a rare histologic type of peripheral T-cell lymphoma, which is characterized clinically by predominant involvement of the liver and spleen, with little or no adenopathy, and an often aggressive course. We experienced a case of a 44-year-old female who was diagnosed with hepatosplenic gamma delta T-cell lymphoma with bone marrow involvement. The patient was treated with multi- agent chemotherapy with Bortezomib plus CHOP (cyclophosphamide, vincristine, prednisone, doxorubicin), Alemtuzumab plus DHAP (dexamethasone, cisplatin, cytarabine), and IMVP-16 (Ifosfamide, MTX, etoposide); however, she failed to achieve partial remission. After salvage chemotherapy (GemOx: Gembicine, oxaliplatin, dexamethasone), she underwent allogeneic stem cell transplantation from an HLA sibling donor with one mismatch . The patient is currently living and has remained in complete remission for 6 months since transplantation.