Prognostic Significance of Ki-67 Expression in Patients Undergoing Surgical Resection for Gastrointestinal Stromal Tumor / 대한소화기학회지

BACKGROUND/AIMS: Assessment of malignant potential in gastrointestinal stromal tumor (GIST) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth. The aim of this study was to investigate the prognostic value of Ki-67 in GIST. METHODS: We retrospectively reviewed the medical records of 32 patients with GIST who underwent surgical resection at Inje University Seoul Paik Hospital. We analyzed their Ki-67 expression, histologic finding, and prognosis. RESULTS: According to the tumor size and mitotic count, 4 patients were classified as very low risk, 9 patients as low risk, 14 patients as intermediate risk and 5 patients as high risk. The average Ki-67 index was 5.56+/-4.48%. The median follow-up duration was 35.72+/-29.04 months, and local/distant recurrences were observed in 6 (18.7%) patients. The overall cumulative disease free survival rates in patients with Ki-67 index 5% were at 1 year, 2 years, and 5 years were 82.1%, 70.3%, and 46.9%, respectively. There was significant relationship between elevated Ki-67 and disease free survival rate (p=0.007). CONCLUSIONS: Our study suggests that Ki-67 index >5% confers a higher risk of relapse in patients with GIST. Future work should focus on standardization of Ki-67 assessment and specification of its role in making treatment decisions.

Miniprobe Endoscopic Ultrasonography Has Limitations in Determining the T Stage in Early Colorectal Cancer

BACKGROUND/AIMS: Mini-probe endoscopic ultrasonography (mEUS) is a useful diagnostic tool for accurate assessment of tumor invasion. The aim of this study was to estimate the accuracy of mEUS in patients with early colorectal cancer (ECC). METHODS: Ninety lesions of ECC underwent mEUS for pre-treatment staging. We divided the lesions into either the mucosal group or the submucosal group according to the mEUS findings. The histological results of the specimens were compared with the mEUS findings. RESULTS: The overall accuracy for assessing the depth of tumor invasion (T stage) was 84.4% (76/90). The accuracy of mEUS was significantly lower for submucosal lesions compared to mucosal lesions (p=0.003) and it was lower for large tumors (> or =2 cm) (p=0.034). The odds ratios of large tumors and submucosal tumors affecting the accuracy of T staging were 3.46 (95% confidence interval [CI], 1.05 to 11.39) and 6.25 (95% CI, 1.85 to 25.14), respectively. When submucosal tumors were combined with large size, the odds ratio was 14.67 (95% CI, 1.46 to 146.96). CONCLUSIONS: The overall accuracy of T stage determination with mEUS was considerably high in patients with ECC; however, the accuracy decreased when tumor size was >2 cm or the tumor had invaded the submucosal layer.

Clinical Features of Intestinal Tuberculosis in Recent Ten Years (2001-2010)

BACKGROUND/AIMS: Intestinal tuberculosis (ITB) evades early diagnosis due to non-specific clinical manifestations and difficulties in confirming the disease process. In the current study, we determined the diagnostic appearance and clinical manifestations of ITB in recent 10 years according to diagnostic guidelines, as proposed by the IBD Study Group of Korean Association for the Study of the Intestinal Diseases (KASID). METHODS: Fifty-six patients with ITB who were diagnosed at Seoul Paik Hospital between January 2001 and August 2010 were retrospectively reviewed. The diagnosis of ITB was defined as definite or probable in accordance with the diagnostic guidelines and the clinical features were analyzed in comparison with previous studies involving ITB in Korea. RESULTS: The mean age at the time of diagnosis was 45+/-15 years (range, 17-71 years). Definite and probable diagnoses were obtained in 29% and 71% of the patients, respectively. Twenty-three percent of the patients had synchronous active pulmonary TB and 14% of the patients had other forms of abdominal TB, such as TB mesenteric lymphadenitis or peritonitis. The most common symptoms were abdominal pain (43%), followed by diarrhea (30%), weight loss (14%). Twenty-seven percent of the patients (15 cases) were asymptomatic and diagnosed on comprehensive health care or post-operative surveillance. Only 2 patients (3.6%) underwent surgery for complications, such as intestinal obstruction and perforation. CONCLUSIONS: ITB is still prevalent in Korea; however, in the recent 10 years the symptoms of ITB have been milder than previously reported. In addition, the complication rates of ITB were remarkably decreased, suggesting that early diagnosis of ITB was increased.

A Case of Chronic Intestinal Pseudo-obstruction Accompanied by Parkinson's Disease / 대한소화기학회지

No abstract available.

A Case of Diffuse Infiltrative Lymphocytosis Syndrome Associated with Human Immunodeficiency Virus Infection / 결핵및호흡기질환

Diffuse infiltrative lymphocytosis syndrome is an autoimmune syndrome that is characterized by the oligoclonal expansion of CD8+ T-lymphocytes in response to human immunodeficiency virus (HIV) antigens. The clinical manifestations include bilateral enlargement of the parotid glands, lymphocytic interstitial pneumonitis, lymphocytic hepatitis, neurological involvement and systemic lymphadenopathies. In addition to a positive HIV test, the diagnostic histopathological findings are CD8+ T-lymphocytic infiltrations in the lymphnodes, liver, lung, muscle and the salivary or lacrimal glands without granulomatous or neoplastic involvement. We report a case of pulmonary involvement of diffuse infiltrative lymphocytosis syndrome that was associated with a human immunodeficiency virus infection.

Licorice-nduced Hypokalemia and Myopathy / 대한신장학회잡지

Chronic ingestion of licorice or licorice-like compounds induces a syndrome with typical findings of mineralocorticoid excess such as hypertension, hypokalemia, metabolic alkalosis, low plasma renin activity. The only unique feature is that plasma aldosterone concentration is decreased. We described a 79-year-old woman who, with a plasma K+ 1.75 mEq/L, showed a paralysis and severe rhabdomyolysis after the habitual comsumption of licorice in the form of a herbal medication. Following potassium replacement therapy and discontinuation of licorice ingestion, complete clinical recovery was observed within ten days. It is important for physicians to keep licorice consumption in mind as a cause for hypokalemic paralysis and rhabdomyolysis.