Expression of Cyclooxygenase-2 and p53 Protein in Colonic Adenoma with Malignant Change / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.

Patterns of Metachronous Adenoma after Colorectal Cancer Surgery / 대한소화기학회지

BACKGROUND/AIMS: After colorectal cancer surgery, colonoscopic surveillance should be done for prevention and early detection of secondary cancer. This study aimed to identify the group with high risk of developing colorectal adenoma after curative surgery of colorectal cancer. METHODS: We retrospectively investigated the medical records of the subjects of 130 patients who had been examined using colonoscopy before and after the curative surgery. RESULTS: The average age was 59.4 years. Synchronous adenomas were in 42 patients (32.3%). The occurrence rate was significantly high in men (38.8%) than women (22.0%). After the operation, the mean interval of examining colonoscopy was 11.6 months (3-24 months) and metachronous adenomas were detected in 26 patients (20.0%). The patients who have both metachronous and synchronous adenomas were observed in 13/42 (30.9%) and the patients of metachronous adenomas without synchronous adenomas were observed in 13/88 (14.8%). The occurrence rate of metachronous adenomas with synchronous adenomas was significantly high. The frequency of synchronous adenomas didn't increase with age. However, the frequency of metachronous adenomas increased with age: 0/9 (0%) under 40 years, 7/49 (14.3%) in 41-61 years and 19/72 (26.4%) over 61 years. The occurrence rate was higher in men (26.3%) than women (10.0%). CONCLUSIONS: The occurrence rate of metachronous adenomas after colorectal cancer surgery was higher in the patients with synchronous adenomas, male gender and old aged patients.

Clinical Significance of Transiently Elevated Serum AFP Level in Developing Hepatocellular Carcinoma in HBsAg Positive-Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC. METHODS: We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size. RESULTS: One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively. CONCLUSIONS: We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.

A Case of Kaposi's Sarcoma of the Stomach and Duodenum in an AIDS Patient / 대한소화기내시경학회지

Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. There is, however, an increased incidence in patients using immunosupressive drugs and with the acquired immunodeficiency syndrome (AIDS). Gastrointestinal Kaposi's sarcoma is usually asymptomatic, but may cause massive intestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodule. In Korea, 3 case's of gastrointestinal kaposi's sarcoma have been reported so far. We experienced a 45-year-old man, who was positive for human immunodeficiency virus (HIV) antibodiy and developed Kaposi's sarcoma. A case of gastrointestinal Kaposi's sarcoma treated with paclitaxel is herein reported with the endoscopic findings before and after chemotherapy.

Recent Changes of Organism and Treatment in Pyogenic Liver Abscess / 대한간학회지

BACKGROUND/AIMS: With the advance of antibiotics and the development of newer imaging techniques, marked changes in etiology, diagnosis, treatment and prognosis of liver abscess have been reported. METHODS: We reviewed the clinical data related to 94 patients with pyogenic liver abscess. RESULTS: Of the 94 patients in the study group, the male to female ratio was 1.4:1 and the peak incidence of liver abcess was in the 7th decade. About three quaters (74.5%) of the abcesses were of unknown origin. The predominant location was in the right lobe (70.3%). Single lesion was found in 80 patients and multiple lesions in 14 patients. Pathogens were identified in 67 patients, of which Klebsiella pneumoniae (65.7%) and E. coli (16.4%) were the most common. The modalities of treatment were percutaneous drainage with antibiotics (73.4%), percutaneous aspiration with antibiotics (16.0%), or antibiotics alone (8.5%). The case fatality rate, mainly from associated underlying diseases, was 9 cases (9.6%). Associated diseases were diabetes mellitus (14.9%) and malignancy (10.6%). CONCLUSIONS: Our study revealed that the most common organism was Klebsiella pneumoniae and percutaneous needle aspiration and/or catheter drainage were safe and effective treatment modalities for pyogenic liver abscess. Prognosis was determined by the underlying condition.

Clinicopathological Study on Laterally Spreading Tumor (LST) / 대한소화기내시경학회지

BACKGROUND/AIMS: Laterally spreading tumors (LST) were growthed along the colonic wall. These tumors were high malignant potential compared to colon polyp. We analyzed clinicopathological characteristics of these tumors. METHODS: From June 1996 to June 2001, twenty nine patients were diagnosed by colonoscopy. These lesions were classificated macroscopic (granular type and nongranular type) and microscopic findings. RESULTS: 20 male and 9 female were enrolled (mean age, 68.1). Among the LST, 41.4% were 20~30 mm in diameter, and 7% were larger than 30 mm. According to macroscopic findings granular types were 72.4% (21/29) and nongranular types were 27.6% (8/29). In macroscopic findings, tubular types were 48.4% (14/29), malignant changes were 31.3% (9/29). Tumor size was only significant factor in malignant potential of LST (p=0.004). Endoscopic mucosal resection was performed in 72.4% (21/29), operation in 8 (27.6%). Rate of submucosal invasion in LST was 3.4% (1/29, sm1). Recurrent rate of endoscopic treatment group was 9.5% (2/21). CONCLUSIONS: Most of LST were good indication for endoscopic treatment, but larger tumor size and irregular surface of tumor were suspected to be submucosal invasion. Therefore these lesions were performed other procedures as endoscopic ultrasound or computerized tomography for invasion depth.

The Correlation of Bile Acid and Gastroduodenal Lesions in Hepatobiliary, Pancreas Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: Various gastric and duodenal lesions were observed in patients with obstructive biliary disease. Previously we knew that serum bile acid level may be correlated with gastric and duodenal lesion in obstructive biliary disease. Now we will confirm the correlation of the serum bile acid concentration and gastro-duodenal lesions. METHODS: A clinical analysis of the endoscopic finding and serum bile acid concentration was carried out in 120 patients with hepatobiliary and pancreas disease, from January 1999 to December 1999, in the department of Internal medicine, Chungnam National University Hospital. RESULTS: 1) In the 120 patients, sex distribution showed predominance in the males (84/36). 2) Disease profiles were included, liver cirrhosis (66.7%), hepatocellular carcinoma (38.3%), pancreatic cancer (15.8%). 3) The gastroduodenal lesions were erosive gastritis (33.3%), gastric ulcer (20.0%), duodenal ulcer (16.7%) in orders. 3) According to serum bile acid concentration, gastroduodenal lesions were more than in elevated bile acid concentration group. CONCLUSIONS: Gastroduodenal lesions in hepatobiliary and pancreas disease patients were related with serum bile acid concentration.

The Comparative Study of Ligation and Histoacryl(R) Injection in Gastric Varix Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The variceal bleeding has high rebleeding rate, and mortality rate was higher in gastrix varix. Managements of variceal bleeding were included such as drugs, endoscopic procedures, surgical management and radiological intervention. Recently histoacryl(R) injection method has been introduced. We have compared the effects of the endoscopic ligation and Histoacryl(R) injection therapy (HAI) in patient with gastric variceal bleeding. METHODS: We analyzed the effects of hemostasis, complications, rebleeding rates, and survival rates in gastric varix bleeding of 22 patients with Histoacryl(R) injection therapy and 20 patients with endoscopic ligation therapy, from January 1995 to March 1999. RESULTS: There were no difference in the complication rate between the 2 stretigies (12/14). Most common complication was chest pain in EVL group, but fever was common in HAI group. Also early and post rebleeding rates were not different in both groups. The main cause of death during follow up period was rebleeding in both groups. The survival rates were 65.0% in EVL group and 77.0% in HAI group (p>0.05, duration: 23+/-2, 28+/-4 month), and there was no difference in mortlity rate (p=0.77). CONCLUSIONS: There were no difference in the hemostatic effect, complications, rebleeding rate and survival rate in EVL group and HAI group. However, evaluation of larger numbers of patients and prospective studies were needed to define the effectiveness and complications of these therapies.