Use of a Comprehensive Geriatric Assessment to Predict Short-Term Postoperative Outcome in Elderly Patients With Colorectal Cancer

PURPOSE: This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer. METHODS: Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA. RESULTS: A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168–3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346–4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications. CONCLUSION: A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial.

A Case of Nodular Regenerative Hyperplasia of the Liver Combined with Toxic Hepatitis / 대한소화기학회지

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.

Two Cases of Hodgkin's Lymphoma after Allogeneic Hematopoietic Cell Transplantation / 대한내과학회지

Hematopoietic cell transplantation recipients have a high risk of subsequent malignant neoplasms. Among post-transplantation lymphoproliferative disorders (PTLDs) after hematopoietic cell transplantation, Hodgkin's lymphoma is rare and distinct from the majority of other PTLDs because of its later onset and relatively good prognosis. It is known to be associated with exposure to the Epstein-Barr virus, and the mixed cellularity subtype is the most common. We herein describe two cases of Hodgkin's lymphoma that developed after allogeneic hematopoietic cell transplantation.

A Case of Human Herpes Virus-8 Unrelated Primary Effusion Lymphoma-Like Lymphoma Presented as Pleural Effusion / 결핵및호흡기질환

Primary effusion lymphoma (PEL) is a rare type of lymphoma that arises in the body cavity without detectable masses. It is associated with human herpes virus-8 (HHV-8), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). Recently, PEL unrelated to viral infection has been reported and it has been termed HHV-8 unrelated primary effusion lymphoma-like lymphoma (HHV-8 unrelated PEL-like lymphoma). Here, we report a case of HHV-8 unrelated PEL-like lymphoma in an 80-year-old woman. Chest X-ray and computed tomography revealed left-sided pleural effusion. Pleural effusion analysis and mediastinoscopic biopsy showed atypical cells that had originated from the B cells. The cells were positive for CD20 and bcl-2, but negative for CD3, CD5, CD21, CD30, CD138, epithelial membrane antigen, and HHV-8. Serological tests for HIV and EBV were negative. Considering the patient's age, further treatments were not performed. She has shown good prognosis without chemotherapy for more than 18 months.

Spontaneous Intramural Hematoma of the Sigmoid Colon Caused by Anti-platelet Agents / 대한소화기내시경학회지

A 71-year-old man presented at the emergency department with an acute onset of hematochezia and abdominal pain that had developed 1 day previously. He had no history of surgery and was taking aspirin (100 mg) and clopidogrel (75 mg). CT revealed a short segmental concentric lower density bowel wall thickening at the proximal sigmoid colon. Sigmoidoscopy showed blue-colored elevated lesions and ruptured intramural hematomas with submucosal bleeding in the sigmoid colon. These findings correspond to intramural hematomas of the sigmoid colon. His symptoms were reduced with conservative treatment stopping aspirin and clopidogrel for 20 days. Here we report a case of non-traumatic intramural hematoma of the colon in a patient receiving dual antiplatelet agents. This had never been reported.

A Case of Ovarian Microinvasive Mucinous Carcinoma and Co-existent Angiosarcoma

Primary ovarian angiosarcoma is very rare with only 27 cases reported so far in the medical literature. We report here on a rare case of ovarian microinvasive mucinous carcinoma that was coexistent with angiosarcoma in a 54-year-old woman. The tumor was a 26x19x10 cm-sized multilocular cystic mass with a 4x3 cm-sized solid hematoma-like nodule in the center. Microscopically, it was composed mostly of mucinous tumor of various grades from borderline to microinvasive carcinoma. The hematoma-like area turned out to be an angiosarcoma, composed of pleomorphic cells that formed slit-like spaces, spindle cells that formed short fascicles and anastomosing vascular channels with atypical endothelial cells. All these cells were positive for CD31, CD34 and factor VIII-related antigen. The patient developed peritoneal and pleural metastases, which were angiosarcoma and mucinous carcinoma, respectively. We believe this case is only the fourth example of an ovarian collision tumor of angiosarcoma and surface epithelial tumor.

A Case of Transparent Cap-fitted Endoscopic Hemoclipping on a Bleeding Dieulafoy's Lesion in the Ampulla of Vater / 대한소화기내시경학회지

Dieulafoy's lesion is a rare cause of repetitive and massive gastrointestinal bleeding, and this is characterized by an isolated arteriole protruding through a small mucosal defect. Dieulafoy's lesion is generally found in the stomach within 6 cm of the gastroesophageal junction, and usually on the lesser curvature, but many lesions have been reported in extragastric locations, including the esophagus, small bowel and rectum. A Dieulafoy's lesion in the ampulla of Vater is extremely rare, and only one such case has been reported in the Korean population. We experienced a rare case of Dieulafoy's lesion in the ampulla of Vater with massive pulsatile bleeding, and this was successfully treated by transparent cap-assisted endoscopic hemoclipping. We report here on this case with a review of the relevant literature.

Current Trends in the Epidemiological and Pathological Characteristics of Gastrointestinal Stromal Tumors in Korea, 2003-2004

Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

Partial Duodenal Obstruction Caused by an Impacted Gastritis Cystica Polyposa / 대한소화기내시경학회지

Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the non-operated stomach. This malady is characterized by polypoid mucosal changes with hyperplasia and cystic dilatation of glands that infiltrate into the submucosal layer. We report here on a case of gastritis cystica polyposa that presented as a mass impacted in the duodenum in a 63-year-old male, and this patient had been admitted for evaluation of progressive epigastric fullness and dyspepsia. Esophagogastroduodenoscopy revealed that the partial duodenal obstruction was caused by impaction of a huge polypoid mass with a stalk that originated from the lower body of the stomach. We fished out the impacted mass with a forceps catheter while holding the neck with a snare catheter. Thereafter, an endoloop was applied to the stalk of mass, and this was followed by polypectomy using a snare catheter.

Sonographic Findings for Posttraumatic Pacinian Neuroma: A Case Report

Pacinian neuroma is a rare tumor characterized by hypertrophy and hyperplasia of preexisting pacinian corpuscles. This tumor most frequently presents as a small superficial mass affecting the hands and feet, which produces localized sharp pain. The etiology is unknown, but local trauma has been postulated as an important factor. Here we report a case of posttraumatic pacinian neuroma in a 24-year-old woman who presented with severe local pain in the palm. The clinical features, and the sonographic and pathologic findings of posttraumatic pacinian neuroma are discussed.

Liver Dysfunction due to Hepatic Glycogenosis in a Girl with Type 1 Diabetes / 대한소아내분비학회지

Hepatic glycogenosis is an under-recognized cause of hepatomegaly and elevated serum aminotransferase levels in patients with type 1 diabetes; further, most cases of hepatic glycogenosis are reported to be associated with poor glycemic control. In this report, we describe the case of a 12-year-old girl with hepatic glycogenosis, who presented with elevated liver enzymes. She was diagnosed with type 1 diabetes at the age of 6 years, and her diabetes was very "brittle" with recurrent episodes of hypoglycemic attacks. Her recent hemoglobin A1C (HbA1c) level was 8.4%, and the average HbA1c level during the last 2 years was 8.7%. Her aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were persistently elevated during the last year, up to 700 and 258 U/L, respectively. Her growth rate and pubertal development were normal. Her serum was negative for hepatitis viral markers, and the plasma levels of ceruloplasmin and ferritin were also normal. Ultrasound examination revealed hepatomegaly with increased hepatic echogenicity. Liver biopsy demonstrated irregular glycogen deposition in hepatocytes. Recurrent hypoglycemia was resolved with continuous subcutaneous insulin infusion, and after 3 weeks, her AST and ALT levels decreased to 47 and 33 U/L, respectively. We conclude that hepatic glycogenosis should be suspected as a cause of abnormal liver function tests in patients with poorly controlled or brittle type 1 diabetes. After excluding other causes of hepatic dysfunction, a 1-month trial for achieving improved glycemic control, while avoiding hypoglycemia, is recommended before proceeding with invasive investigation of the patient.

A Case of Hyperkeratotic Seborrheic Keratosis of the External Auditory Canal / 대한이비인후과학회지

A seborrheic keratosis is a very common benign lesion of the skin in elderly people. However, the incidence of seborrheic keratosis in the external auditory canal is very rare and there have been only a few reports of it in the literature. We have experienced a case of hyperkeratotic seborrheic keratosis of the external auditory canal in a 47-year-old male, who first presented with a dome-like brownish mass with a greasy surface and a bloody discharge from right external auditory canal. Because seborrheic keratosis partly mimics malignant lesions such as basal cell carcinoma and squamous cell carcinoma macroscopically, the correct diagnosis should be required. The biopsy and surgical resection were necessary steps in correct diagnosis and treatment.

Secretory Carcinoma of the Breast: A Case Report

A secretory carcinoma of the breast is a rare, but clinically and histologically a distinct variant of the invasive ductal carcinoma, which has a slow growth pattern and a favorable prognosis. Few studies have reported the radiologic findings involved in a secretory carcinoma of the breast. We report the imaging findings of a secretory carcinoma of the breast in a 48-year-old woman, which were similar to those of a benign mass found on a mammography and sonography.

Human Mesenchymal Stem Cell Transplantation Induces Sympathetic Nerve Sprouting and Reduces the Gap Junction With Potential Proarrhythmias in Dogs

BACKGROUND AND OBJECTIVES: Although human mesenchymal stem cell (hMSC) transplantation has been known to improve ventricular function, the potential proarrhythmic effects have not yet been studied. MATERIALS AND METHODS: We monitored the heart rhythm of 6 dogs for 4 weeks after transplantation of hMSC (1x10(7), epicardial injection) (hMSC group) and in 5 Sham dogs after the injection of the vehicle alone. Cardiac sympathetic nerve sprouting {nerve growth factor (NGF)-beta; tyrosine hydroxylase (TH)} and gap junction expression {connexin (Cx) 43} were evaluated in 10 dogs (5 hMSC and 5 Sham) that survived longer than 4 weeks. RESULTS: The hMSC group expressed higher levels of NGF-beta messenger ribonucleic acid (mRNA) (56.0+/-66.8 fold; p<0.01) with TH+ sympathetic nerves (0.51+/-0.40 vs. 0.15+/-0.13% area; p<0.03) than the Sham control. In contrast, the hMSC group expressed lower levels of Cx43 mRNA (0.59+/-0.29 fold, p<0.001) and Cx43+ (1.64+/-1.79 vs. 2.12+/-1.07% area, p<0.001) than the Sham control. The incidences of ventricular fibrillation were 33.3% and 0% in the hMSC group and Sham control, respectively. One of the dogs with ventricular fibrillation (VF) in the hMSC group died suddenly. CONCLUSION: hMSC transplantation may be proarrhythmic since NGF-beta expression increased with cardiac sympathetic hyperinnervation and the expression of Cx43 and the gap junction decreased.

The Usefulness of Angiotensin Converting Enzyme in the Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis

BACKGROUND: Since the pathologic findings of Crohn's disease (CD) and intestinal tuberculosis (IT) overlap to a large degree, the development of other biomarkers will be of great help for making the differential diagnosis of these 2 diseases. The aim of the present study is to examine the clinical efficacy of using the tissue angiotensin converting enzyme (ACE) assay in making the differential diagnosis between CD and IT. METHODS: Tissue specimens were obtained from 36 patients who were diagnosed with CD or IT by the colonoscopic biopsy, as well as by the clinical findings. The expression of tissue ACE was detected by immunohistochemical staining. The optimal cut-off value of the immunoreactive scoring (IRS) system we used to differentiate CD from IT was determined by analysis of the ROC curve and AUROC. RESULTS: Granuloma was present in 15 of 19 patients with CD (78.9%) and in 15 of 17 patients with IT (88.2%). ACE was present in the cytoplasm of the epithelioid cells in the granulomas from 13 of 15 patients with CD and in 14 of 15 patients with IT. The IRS scores of ACE were greater in the patients with CD than that of the patients with IT (8.07+/-4.38 vs. 4.13+/-2.47, respectively, p=0.006). In differentiating CD from IT, the AUROC curve for the IRS of ACE was 0.767 with a sensitivity of 66.7%, a specificity of 93.3% and the cut-off point was 7.5. CONCLUSIONS: The results of our study suggest that the assessment of the tissue ACE expression can be helpful for making the differential diagnosis between CD and IT.

Detection of Apoptosis by M30 Monoclonal Antibody in Non-small Cell Lung Carcinomas / 대한흉부외과학회지

BACKGROUND: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. MATERIAL AND METHOD: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were performed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. RESULT: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; 61.7+/-26.8 cells vs. p53 negative group; 45.6+/-29.6 cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, AI > or =1) on M30 staining (p53 positive group; 52.4% [11/21] vs. p53 negative group 16.7% [4/24], p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and AI showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% CI 1.886~29.678; p=0.004) and the risk of recurrence almost 3.8-fold (R.R 3.795; 95% CI; 1.184~12.158; p=0.025) in the high AI (> or =1) compared to the low AI (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. CONCLUSION: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.

Genetic and Epigenetic Alterations of the Wnt/beta-catenin Signaling Pathway in Cancer of the Ampulla of Vater

BACKGROUND: Carcinoma of the ampulla of Vater is rare and its pathogenesis is unclear. The role of epigenetic changes in the APC or CDH1, in the Wnt pathway, has not been reported in ampullary carcinomas. METHODS: We performed immunohistochemistry on 73 sporadic ampullary carcinomas to identify Wnt-related molecules (APC, beta-catenin, E-cadherin, c-erbB2, cyclin D1) and examined mutations in the CTNNB1, loss of heterozygosity of 5q21, and the methylation status of the CpG island of APC and CDH1. RESULTS: Thirteen tumors (17.8%) showed abnormal nuclear localization of beta-catenin; this was more prominent in the intestinal type than in the pancreaticobiliary type (p=0.01). The loss of APC correlated with the loss of beta-catenin or c-erb B2 (p<0.01). The prognosis was worse in the group with APC loss than when APC was maintained (p<0.05). There was no mutation identified in CTNNB1. Six (24%) out of 25 informative cases had 5q21 allelic loss. CpG island methylation in APC and CDH1 was detected in 33 (45.2%) and 29 (31.5%) cases, respectively. CONCLUSIONS: The absence of mutations in CTNNB1 and the epigenetic alteration of APC and CDH1, might be characteristic changes in the Wnt/beta-catenin signaling pathway during the carcinogenesis of ampullary carcinomas.

A Comparison of Conventional Cytology and ThinPrep Cytology of Bronchial Washing Fluid in the Diagnosis of Lung Cancer / 결핵및호흡기질환

Background: A ThinPrep(R) Processor was developed to overcome the limitations of conventional cytology and is widely used to diagnose various cancers. This study compared the diagnostic efficacy of conventional cytology for lung cancer with that of the ThinPrep(R) cytology using the bronchial washing fluid. Methods: The bronchial washing fluid of 790 patients from Jan. 2002 to Dec. 2006, who were suspected of gaving a lung malignancy, was evaluated. Both ThinPrep(R) and conventional cytology were performed for all specimens. Result: Four hundred forty-six men and 344 women were enrolled in this study, and 197 of them were diagnosed with cancer from either a bronchoscopic biopsy or a percutaneous needle aspiration biopsy. ThinPrep(R) cytology showed a sensitivity, specificity, positive predictive value, negative predictive value and false negative error rate of 71.1%, 98.0%, 92.1%, 91.1%, 8.9%, respectively. The conventional cytology showed sensitivity, specificity, positive predictive value, nagative predictive value and false negative error rate of 57.9%, 98.0%, 90.5%, 87.5%, 12.5%, respectively. For central lesions, the sensitivity of conventional cytology and ThinPrep(R) were 70.1% and 82.8%, respectively. Conclusion: ThinPrep(R) cytology showed a higher sensitivity and lower false negative error rate than conventional cytology. This result was unaffected by the histological classification of lung cancer. Therefore, ThinPrep(R) cytology appears to be a useful method for increasing the detection rate of lung cancer in bronchial washing cytology test.

Discovery of Differentially Overexpressed Genes in Immortalized Cells and Human Pulmonary Non-small Cell Carcinomas

PURPOSE: Our aim of research is to find novel genes that overexpressed in various samples such as cell lines and tissues that infinitely proliferate; so-called immortalized cells, cancer cells and tissues. In this study, we obtained a gene from immortalized cell line (WI-38 VA13) then identified it from various cell lines and human lung tissues. MATERIALS AND METHODS: Using suppressive subtractive hybridization (SSH) method, we obtained many genes and selected a novel gene of them. And then the novel gene fragment was amplified by PCR and ligated in T easy vector for sequencing. And finally we found a differentially expressed gene in cell lines and tissues when it was performed by reverse transcriptase-PCR (RT-PCR). RESULTS: As the result of transformation of genes that we gained using SSH, we obtained about 150 clones. And then we certificated several genes by DNA prep and confirmed it by sequencing. We examined whether the gene sequences are novel or known genes by genome homology search and we confirmed the gene expressions by RT-PCR. As a result, we identified a differentially overexpressed gene (named "clone 58") in immortalized cells, cancer cell lines and lung squamous cell carcinomas. CONCLUSION: The "clone 58" mRNA was significantly up-regulated in various human cell lines and also human lung cancer tissues compared to the normal. We suppose that this gene can carry out a specific role related to the induction of cancer and/or the mechanism of the changeover of a normal cell to an immortalized cell. In short, the discovery of our gene has an importance in the point that they are thought to have a connection with immortalization and carcinogenesis of human cells and tissues.

The clinical feature of the muscle cramps and the effects of eperisone hydrochloride in treatment for the muscle cramps of the patients with liver cirrhosis / 대한내과학회지

BACKGROUND: Muscle cramps in cirrhotic patients are not serious symptoms but have frequently bad effect on their quality of life. We have evaluated the effectiveness of treatment with eperisone hydrochloride, an antispastic agent, on muscle cramps in cirrhotic patients. METHODS: Sixty five cirrhotic patients (cramps 35, no cramps 30) were included in our study. Thirty five patients with muscle cramps were questioned about the frequency and localization of muscle cramps. All patients were evaluated a physical findings and blood chemistry at the beginning of the study and after one month. Eperisone hydrochloride 50 mg per day were given orally to the patients with muscle cramps. RESULTS: There were significant differences for the number of diuretics use (p=0.019), hemoglobin (p=0.005), platelet (p=0.007), total bilirubin (p=0.003), albumin (p=0.000), total calcium (p=0.0001) and Na+ (p=0.001) between with and without muscle cramps. Muscle cramps were found to occur in calf muscles (60%) and hands (54%), to occur several times a week (76%), mainly during sleep (73%) and to last for several minutes (53%). After a month, muscle cramps completely disappeared in 7 patients (20%), decreased in frequency in 18 patients (51%) and were unaltered in 10 patients (29%). Side effects were observed in 7 patients (epigastric discomfort in five, fatigue in two) but any patients were not stopped. CONCLUSIONS: Eperisone hydrochloride was significantly effective in treatment for the muscle cramps of the patients with liver cirrhosis. In addition, this agents was well tolerated without any serious adverse effects in the majority of the patients.