Results of Endoscopic Mucosal Resection for Early Gastric Cancer: Factors Influencing Complete Resection / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study is to evaluate the results of endoscopic mucosal resection (EMR) for early gastric cancer (EGC) and to investigate the factors with influence the complete resection. METHODS: We retrospectively analyzed 109 lesions from 108 patients with EGC treated by EMR at Samsung medical center from November 1994 to June 2003. We compared completely resected group with incompletely resected group with regards to size, location, histologic types before and after EMR, methods of procedure, and complication. RESULTS: The mean size of lesions was 11.3+/-6.5 mm. Eighty two of them were located in the antrum and angle, twenty six in the body, and one in the cardia of stomach. Endoscopically elevated lesions (type I, IIa) were 52 cases and depressed lesions (type IIc) were 40 cases. Histologically curative resection was done in 74 of 109 cases (67.9%). All but one cases have been observed without recurrence for a mean period of 11.1 months. Histologically incomplete resection in 35 cases included 9 positive cancer cell in resection margin, 25 submucosal cancer infiltration, 2 reconstruction failure, 1 lymphatic involvement and 1 signet ring cell type cancer. Complications related to EMR included 9 cases of bleeding and 3 cases of perforation. In comparison of two groups, complete resection rate was significantly higher when tumor was located in the antrum or angle than body or cardia of stomach (p=0.006). CONCLUSIONS: Our results show that EMR is one effective curative treatment modality in highly selected patient with EGC and location of lesion is an important factor influencing the success of complete resection.

A recurrent intracardiac thrombosis in a patient with Behet's disease / 대한내과학회지

Behet's disease is a systemic disorder presenting with recurrent oral and genital ulcerations as well as uveitis often leading to blindness. Although vascular lesions are common complications of this disease, cardiac involvement is extremely rare. A 34-year-old man was admitted to the hospital with intermittent low-grade fever 8 months ago. At that time, the echocardiographic examination revealed a right atrial wall mass that was initially thought to be a vegetation, and surgical excision was performed. Histological finding was consistent with organizing thrombus. The patient was readmitted to the hospital with fever, chill and sore throat for about 4 weeks. His past medical history included recurrent oral and genital ulcerations and uveitis for 5 years. Right atrial mass was seen again on echocardiographic examination. On the basis of the clinical course and the presence of recurrent cardiac thrombus, a diagnosis of Beh?et's disease with recurrent intracardiac thrombosis was made. The patient was treated with prednisolone, colchicine, cyclosporine, and aspirin. Medical therapy resulted in complete resolution of his symptoms and disappearance of the right atrial thrombus.

A Case of Poststreptococcal Reactive Arthritis

Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A beta-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.

A Case of Poststreptococcal Reactive Arthritis

Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A beta-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.

Successful conservative management of perforation in stomach caused by endoscopic mucosal resection (EMR) / 대한내과학회지

The serious complication after endoscopic mucosal resection (EMR) was bleeding and perforation. Most of bleedings could be controlled by endoscopic procedure. However, the strategy of treatment for perforation was not established. A 60-year-old man was admitted to our center for EMR of gastric adenomatous lesion. After EMR, perforation in stomach was detected by peumoperitoneum on plain upright chest X-ray. We treated with conservative management such as withholding of oral intake, administration of broad-spectrum antibiotics, parenteral nutrition and close monitoring. There were no worsening clinical sings of peritoneal inflammation except mild leukocytosis during the in-hospital course. On the third hospital day after EMR, the patient resumed oral intake. The seventh hospital day, he was discharged. Our experience showed that selected small microperforation in stomach after EMR could be treated by not endoscopic procedures or surgical interventions but conservative management.

Role of NT-proBNP in Evaluation of Functional Status in Congestive Heart Failure

BACKGROUND AND OBJECTIVE: NT-proBNP, a sensitive and specific marker of congestive heart failure (CHF), is also useful in monitoring the effectiveness of treatment and in predicting prognosis. However, the usefulness of NT-proBNP for measuring the functional capacity as a component of the quality of life (QoL) in patients with CHF remains to be discovered. The Korean Activity Scale/Index (KASI) is a Koreanized tool for measuring the functional capacity in patients with cardiac diseases during daily activities, thus representing the physical domain of the QoL. The purpose of this study was to evaluate the relationship between NT-proBNP and the KASI. SUCJECTS AND METHODS: Between July, 2003 and September, 2003, the NT-proBNP levels were measured in 76 patients with CHF that visited the OPD or who were hospitalized. They were asked to fill out a self-administered questionnaire, from which their KASI scores were obtained. NYHA Fc and Heart Failure scores were also obtained from a history taking and physical examination conducted by the investigator. RESULTS: The level of NT-proBNP increased with increasing NYHA Fc (p<0.001 by Kruskall-Wallis test). The Spearman correlation coefficient between NT-proBNP and the KASI score was -0.730 (p<0.001), which was higher than that between the HF and KASI scores (rho=-0.557, p<0.001). The level of NT-proBNP also had a positive correlation with the HF score (rho=0.706, p<0.001). CONCLUSION: The level of NT-proBNP has a strong negative correlation with the KASI score, reflecting the functional capacity during daily activities. This suggests that NT-proBNP is useful in measuring the functional capacity as an element of the QoL in patients with CHF.