Comparison of Long-term Outcomes of Infliximab versus Adalimumab Treatment in Biologic-Naïve Patients with Ulcerative Colitis

Background/Aims@#The tumor necrosis factor-α inhibitors infliximab and adalimumab are standard treatments for moderate to severe ulcerative colitis (UC). However, there has been no headto-head comparison of treatment efficacy and outcomes between the two agents. The aim of this study was to compare the efficacy and long-term outcomes of infliximab versus adalimumab treatment in biologic-naïve patients with UC. @*Methods@#We retrospectively analyzed the records of 113 biologic-naïve patients with UC who were treated between September 2012 and December 2017 (the infliximab group [n=83] and the adalimumab group [n=30]). We compared remission and response rates between these groups at 8 and 52 weeks. We used Kaplan-Meier curves to compare long-term outcomes, and logistic regression analysis and Cox-proportional hazard regression models to assess factors affecting outcomes. @*Results@#The median follow-up duration was 25.8 months. Baseline clinical characteristics were similar between groups. There were no significant differences between the two groups in the rate of clinical remission or clinical response at 8 or 52 weeks. Multivariate analyses also showed that long-term outcomes were not significantly different (adjusted hazard ratio [HR], 1.45; 95% confidence interval [CI], 0.81 to 2.56; p=0.208). An elevated C-reactive protein level (greater than 5 mg/L) was a significant predictive factor for poor outcomes (adjusted HR, 2.25; 95% CI, 1.37 to 3.70; p=0.001). During the follow-up period, the rates of adverse event were not significantly different between the two groups (p=0.441). @*Conclusions@#In our study, infliximab and adalimumab had similar treatment efficacy and longterm outcomes in biologic-naïve patients with moderate to severe UC.

Endoscopic Submucosal Dissection of an Inverted Early Gastric Cancer-Forming False Gastric Diverticulum

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) that does not have any risk of lymph node or distant metastases. Here, we report a case of EGC resembling a diverticulum. Diverticular formation makes it difficult for endoscopists to determine the depth of invasion and to subsequently perform ESD. Because the false diverticulum does not have a muscular layer, this lesion can be treated with ESD. Our case was successfully treated with ESD. After ESD, the EGC was confined to the submucosal layer without vertical and lateral margin involvement. This is the first case in which ESD was successfully performed for a case of EGC that coexisted with a false gastric diverticulum. An additional, larger study is needed to determine the efficacy of ESD in various types of EGC, such as a false gastric diverticulum.

Massive barium sulfate aspiration during upper gastrointestinal contrast material study in an elderly patient with dysphagia / 영남의대학술지

Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.

Concomitant Statin Use Has a Favorable Effect on Gemcitabine-Erlotinib Combination Chemotherapy for Advanced Pancreatic Cancer

PURPOSE: Erlotinib-gemcitabine combined chemotherapy is considered as the standard treatment for unresectable pancreatic cancer. This study aimed to determine the clinical factors associated with response to this treatment. MATERIALS AND METHODS: This retrospective study included 180 patients with unresectable pancreatic cancer who received ≥2 cycles of gemcitabine-erlotinib combination therapy as first-line palliative chemotherapy between 2006 and 2014. "Long-term response" was defined as tumor stabilization after >6 chemotherapy cycles. RESULTS: The median progression-free survival (PFS) and overall survival (OS) were 3.9 and 8.1 months, respectively. On univariate analysis, liver metastasis (p=0.023) was negatively correlated with long-term response. Locally advanced stage (p=0.017), a history of statin treatment (p=0.01), and carcinoembryonic antigen levels <4.5 (p=0.029) had a favorable effect on long-term response. On multivariate analysis, a history of statin treatment was the only independent favorable factor for long-term response (p=0.017). Prognostic factors for OS and PFS were significantly correlated with liver metastasis (p=0.031 and 0.013, respectively). A history of statin treatment was also significantly associated with OS after adjusting for all potential confounders (hazard ratio, 0.48; 95% confidence interval, 0.26-0.92; p=0.026). CONCLUSION: These results suggest that statins have a favorable effect on "long-term response" to gemcitabine-erlotinib chemotherapy in unresectable pancreatic cancer patients. Statins may have a chemoadjuvant role in stabilizing long-term tumor growth.

Progression of Desmoid Tumors in Familial Polyposis: A Case Report

Multiple large bowel polyps are the hallmark of familial adenomatous polyposis (FAP), and many progress to colorectal cancer. Desmoid tumors are more common in patients with FAP than in other people, occurring, particularly, in those who have previously undergone prophylatic total colectomy. In such patients, desmoid tumors are a common cause of death. In an FAP patient without extracolic manifestation, who has undergone prophylatic surgery, multifocal desmoid tumors occur periodically. We report the serial radiologic findings of progressive desmoid tumors in FAP, drawing attention to the related findings of previous research.

Benign versus Malignant Lymphadenopathy: The Usefulness of Color Doppler Sonography

PURPOSE: To evaluate the vascular pattern of lymph nodes, and the usefulness of color Doppler sonogaphy indifferentiating benign from malignant superficial lymphadenopathy. MATERIALS AND METHODS: Twenty-six patientswere pathologically and clinically confirmed to be suffering from benign reactive lymphadenitis and tuberculosis(n=16) or lymphoma and malignant lymphadenitis (n=10). Lymph node shape was assessed by the ratio of longitudinaldiameter to transverse diameter(L/T), and patients were thus assigned to one of two groups : L/T >or =2, or L/Tor =2,and 3 L/T<2. while in nine of the ten malignant nodes, L/T<2 was noted. Among 16 benign reactive nodes, hilarvascularity was central in 13, eccentric in one, and absent in two. Among the ten malignant nodes, thecorresponding totals were nil, four, and Six. The hilar vascular pattern showed statistically significantdifferentiation between malignant and benign node (p<.05). Among 16 benign reactive nodes, 13 were grade 0, twowere grade I, and one was grade II, while among ten malignant nodes, two were grade 0 and eight were grade I. Onthe basis of vascular pattern, the difference between benign and malignant nodes was statistically significant(p<.05). CONCLUSION: L/T ratio<2, absent or eccentric hilar vascularity, and the presence of peripheralvascularity are suggestive of malignant lymph node. The shape of LN and pattern revealed by an analysis of nodalvascularity using color Doppler sonography are useful in differential diagnosis of benign and malignantlymphadenopathy.

Ultrasonographic and CT findings of Cervical Ectopic Thymus of an Infant

We report a case of ectopic thymus in the left submandibular area of a two-month-old boy. On US and CT scans, a well-marginated, 3 x 2cm-sized solid mass along the left carotid sheath, anteromedial to the sternocleidomastoid muscle and posterior to the submandibular gland, was seen. CT attenuation of the mass showed that it was similar to that of normal thymus in the anterior mediastinum. Although a rare disease, ectopic thymus should be included in the differential diagnosis of cervical masses along the carotid sheath in infants.

Neuro-Behcet's Disease: Initial and Follow-up MR Imaging Findings

PURPOSE: The purpose of this study was to evaluate initial and follow-up MR imaging(MRI) findings ofneuro-Behcet's disease. MATERIALS AND METHODS: MRI of seven clinically diagnosed cases of neuro-Behcet's diseasewere retrospectively analysed in terms of involved site, pattern, signal intensity, contrast enhancement patternand changes seen on follow-up. Using a 0.35T or 1.0T unit T2- and T1-weighted spin-echo contrast-enhanced imageswere obtained in six patients. Follow-up MRI after steroid therapy lastion between two weeks and 16 months wasperformed in six patients. RESULTS: Lesions involved the midbrain(6/7), pons(5/7), thalamus(4/7), medullaoblongata(3/7), tegmentum(3/7), internal capsule(3/7), middle cerebellar peduncle(2/7), dentate nucleus(1/7),basal ganglia(1/7) and temporal lobe(1/7). They were 1-3cm in size, and their shape was ill-defined and patchy.Inhomogeneous high and low signal-intensity was seen on T2-weighted and T1-weighted images, respectively. In twoof six cases there was focal mild patchy enhancement. Euring follow-up lasting for between two weeks and 16 monthsafter steroid therapy, the lesions decreased in extent(n=5) or disappeared(n=1), and in the brainstem, focal brainatrophy occurred in three cases. CONCLUSION: Although MRI findings of neuro-Behcet's disease are nonspecific,common involvement of the brainstem, tegmentum and internal capsule, as well as improvement on follow-up MRI, maybe helpful diagnostic indicators of this condition.

Statistical Observation for Admitted Patients during the Years of 1974 to 1977 at Ped. Dept. of Han-Il Hospital

Statistical analysis according to W.H.O. classification for the patients admitted the Ped. Dept. of Han-Il Hospital was carried out during 4 years from Jan. 1974 to Dec. 1977. The following results were observed. 1. Total No. of patient during 4 years period were 1955, of which 1199 were male(61.33%, 756 were female(38.67%) and male to femal ratio was 1.57:1. 2. There was no significant variation. 3. According to age, preschool aged group as the most frequent group consistin of 488 cases(24.49%), school aged group and adolescent in the order of frequency. 4. On monthly distribution, there was no significant variation 5. Most frequent diseases in pediatric age group were respiratory tract one, 851 cases(39.29%) : infectious and parasitic ones, 553(25.53%) and neonatal disease, 204 cases(9.42%) in the order of frequency. 6. Among respiratory tract disease, pneumonia was the most frequent one, 587 cases(27.10%). 7. Among infectious and parasitic disease group, gastrointestinal infectious one was the most frequent, 224 cases(10.34%) : other viral disease and tuberculosis in the order of frequency. 8. Among neonatal diseases, prematurity was the most frequent one, 82 cases(3.79%).

A Case of Achondroplasia(Thanatophoric dwarfism)

We experienced a case of thanatophoric dwarfism with a relatively large head and shortened limbs. The diagnosis was confirmed by clinical features, radiologic examinations and autopsy. A review of literature was made briefly.