Clinicopathological Characteristics of Colon Cancer Diagnosed at Primary Health Care Institutions

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (+/-SD) of subjects was 60.9+/-10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.

Clinicopathologic Characteristics of Superficial Gastric Cancer Diagnosed at Primary Health Care Institutions in 2011 / 대한소화기학회지

BACKGROUND/AIMS: Stomach cancer is prevalent in Korea. The purpose of this study was to evaluate the characteristics of superficial gastric cancers detected at SOK Sokpeynhan Internal Medical Network, the nationwide primary health care institutions. METHODS: We prospectively analysed the clinicopathologic and endoscopic characteristics of 218 superficial gastric cancer patients diagnosed using gastric endoscopy at SOK network from January 2011 through December 2011. RESULTS: The mean age was 58.5 years old and male to female ratio was 1.7 : 1. Asymptomatic patients were most common (45.0%). The macroscopic classification revealed that simple types (63.8%) were more common than complex types (36.2%). The most common type was IIc (28.4%) and other types were as follows; IIb (16.1%), IIb+IIc (13.3%), IIa (10.6%), III (9.2%), IIa+IIc (7.3%), IIc+IIa (6.0%), IIc+IIb (5.0%). The most commonly involved sites were the body (53.1%) and greater curvature (32.6%) of the stomach. The size of lesion was less than 1 cm (69.3%) and less than 5 mm (33.5%) in diameter. The most common pathologic type was tubular adenocarcinoma (75.7%). Helicobacter pylori infection rate was 50.2%. Fifty five percent of the cases were diagnosed via endoscopy of National Health Insurance Corporation screenings. CONCLUSIONS: Superficial gastric cancers in 2011 at primary health care SOK network were different from those of previous reports. Type IIc was most common but type IIb was more prevalent and the body and greater curvature of the stomach were the most commonly involved sites. Therefore, careful observation of the proximal gastric mucosa and mucosal color change is needed.

The Effect of Second Look Endoscopy in Patients with Peptic Ulcer Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Performing second look endoscopy has been suggested in order to reduce recurrent bleeding. We assessed whether second look endoscopy reduces the risks of recurrent bleeding and the mortality rate for patients suffering with peptic ulcer bleeding. METHODS: From February 2003 to June 2004, we have performed a prospective, randomized, controlled study of 141 patients with bleeding peptic ulcers, and these patients had been admitted to Kyungpook National University Hospital. Seventy patients in the study group were randomized to receive scheduled second look endoscopy. Seventy one patients in the control group were observed closely. RESULTS: Seventeen of the admitted 141 patients were found to have rebleeding after initial therapeutic endoscopy. The overall rebleeding rate was 12.1%. Although the duration of the hospital stay was significantly lower for the study group than for the control group (p<0.05), the rebleeding rate was similar for both groups (p<0.05). The two groups were similar in respect to the mortality during the period of hospitalization, the volume of hypertonic saline epinephrine that was injected and the number of hemoclips that were used. CONCLUSIONS: From these results, we can conclude that scheduled second look endoscopy with retreatment did not reduce the risk of recurrent bleeding for patients with peptic ulcer bleeding. Therefore, scheduled second look endoscopy should be selectively performed for the patients who are at a high risk for peptic ulcer bleeding.

The association of elevated alanine aminotransferase activity with obesity in health screenig subjects / 대한내과학회지

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has recently been recognized to be one of the leading causes of chronic liver disease. Obesity and type 2 diabetes are associated strongly with NAFLD. Although often used to detect liver disease, sometimes the cause of elevated Alanine Transaminase (ALT) activity was unclear. In the absence of other causes, the author examined whether BMI and metabolic markers of NAFLD can explain the cause of abnormal ALT in Korean. METHODS: From April 2002 to November 2003, 9997 persons visited health promotion center of Kyungpook National University Hospital and took health screening. After excluding persons with excessive alcohol consumption, abnormal gamma-GTP, hepatitis B, hepatitis C, 8379 persons were included in this study. All patients underwent anthropometric measures, blood chemistry analysis and abdominal ultrasonographic exam. RESULTS: Elevated ALT levels were found in 10% (835 persons) of the all subjects. In univariate analysis, factors associated with elevated ALT levels (por=23 kg/m2) was 79% in abnormal ALT group. In multivariate logistic regression study, total cholesterol and blood pressure were eleminated but sex, BMI, triglyceride level, ultrasonographic fatty change were strongly associated with elevated ALT level (p<0.01). CONCLUSION: In this study, unexplained ALT elevation was strongly associated with obesity, adiposity and other features of metabolic syndrome, and thus may represent nonalcoholic fatty liver disease. However, more research is needed for the definite clinical determinants of nonalcoholic fatty liver disease in Korean.

Expression of Cyclooxygenase-2 and Bcl-2 in Human Gastric Adenomas

BACKGROUND: Cyclooxygenase (COX) -2 is the rate-limiting enzyme in prostaglandin synthesis. An increased expression has been implicated in the development and progression of human gastric cancers and colorectal adenomas and cancers. This study aimed to determine the involvement and association of COX-2 and Bcl-2 in precancerous gastric adenomas. METHODS: Seventy-nine gastric polyps were obtained by endoscopic mucosal resection or polypectomy from January, 2000 to July, 2003. Immunohistochemical expression of COX-2 and Bcl-2 was observed, and their relationships with various clinicopathological factors were analyzed. RESULTS: Histologically, 13 hyperplastic polyps and 66 tubular adenomas, of which 17 showed high-grade dysplasia, were observed. Increased COX-2 expression was observed in low-grade and high-grade tubular adenomas compared to hyperplastic polyps (p=0.004 and p=0.001, respectively). COX-2 expression was significantly higher in larger (> 1 cm) compared with smaller (< or=1 cm) tubular adenomas (p=0.034), but no relation was observed in hyperplastic polyps. While Bcl-2 expression differed significantly according to histology, increased Bcl-2 expression was observed especially in COX-2 positive low-grade tubular adenomas. CONCLUSION: COX-2 expression increased in a size-dependent manner in tubular adenomas, suggesting a role in polyp growth. The increased expression of Bcl-2 in tubular adenomas, especially in COX-2 positive tubular adenomas, suggests that COX-2 action may be related to Bcl-2 expression.

Cyclooxygenase-2 Expression according to Size and Location of Gastric and Colorectal Tubular Adenomas / 대한소화기학회지

BACKGROUND/AIMS: Recent studies have shown that cyclooxygenase-2 (COX-2) may be involved in the process of invasion, growth and apoptosis in colorectal carcinoma and in the growth and tumorigenesis in familial adenomatous polyposis. This study was conducted to determine the significance of the expression of COX-2 in gastric and colorectal adenomas. METHODS: Forty-nine samples of gastric adenoma and fifty-seven samples of colorectal adenoma were obtained by endoscopic mucosal resection or polypectomy from 106 patients from January 2000 to July 2003. COX-2 expression was determined by immunohistochemistry. Correlation between COX-2 expression and several clinical factors were compared in each gastric and colorectal adenomas. RESULTS: The expression of COX-2 in epithelial cells was significantly higher in the group with large adenoma (>1 cm) compared with the group with small adenoma (

Clinical Efficacy of AST/ALT Ratio and Platelet Counts as Predictors of Degree of Fibrosis in HBV Infected Patients without Clinically Evident Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Hepatic fibrosis is an important prognostic factor in chronic hepatitis B. Liver biopsy is a gold standard diagnostic tool but an invasive procedure, so it cannot be done on all patients. We evaluated the clinical efficacy of AST/ALT ratio and platelet counts as predictors of fibrosis in chronic hepatitis B. METHODS: We reviewed retrospectively clinical records of 323 patients, who visited Kyungpook National University Hospital for chronic hepatitis B and underwent liver biopsy from September 1998 to May 2002. Correlation with laboratory parameters with hepatic fibrosis stage was identified. RESULTS: Of 323 patients, there were 278 male patients with mean age 27 (9~59). Platelet counts showed a significant correlation (r=-0.343, p=0.000), and AST/ALT ratio showed a weak but significant correlation (r=0.137, p=0.013) with fibrosis stage. Patients with severe fibrosis or cirrhosis (stage 3 and 4) can be identified to have AST/ALT ratio > 1 and platelet counts 1 in combination with platelet counts. However, its sensitivity is too low to replace liver biopsy.

Cystic Lymphangioma of the Colon: Diagnosed by Endoscopic Ultrasonography / 대한소화기내시경학회지

Lymphangioma occasionally occurs in gastrointestinal tract, small intestine and mesentery. Cystic lymphangioma is a rare cause of colonic submucosal mass. Endoscopic ultrasonography is very valuable in differential diagnosis of colonic submucosal masses. A 61-year old woman visited our hospital due to lower abdominal pain for two months. In the colonoscopic examination, cystic mass which had smooth mucosal surface was noted at the ascending colon. Endoscopic ultrasonography showed anechoic, multicystic mass confined to the submucosa. The underlying muscularis propria was intact. Endoscopic resection, using a ligating device, was performed for histopathologic diagnosis and treatment. On the histopathologic examination, the cystically dilated spaces lined by endothelium and separated by fibrous septa were present in the submucosa. The histological diagnosis was cystic lymphangioma of the colon.

Correction of Cleft Lip Nasal Deformity using Refined Reverse-U Incision and V-Y Plasty

Forty-five patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. Thirty-five were followed up. Among them, 31 patients had unilateral cleft lip nasal deformities and 4 had bilateral cleft lip nasal deformities. The age range of the patients was from 3 to 56 years old. Reverse-U incision and V-Y plasty were used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. Bilateral reverse-U incisions and transcolumella incisions were used in 4 patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were performed to make firm contact between the nasal skin and the redraped reverse- U flap. Ancillary procedures included correction of the laterally displaced alar base, lip scar revision, cartilage graft for tip augmentation, iliac bone graft for correcting hypoplasia of the maxilla or an alveolar cleft, corrective rhinoplasty, and composite graft for columella lengthening. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 to 26 months, with an average of 18 months. Final results were evaluated based on the degree of symmetry of both nostrils, conditions of the redraped alar-columella web, and exposure of the nostril. Good results were obtained in 29 patients where alar-columella web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was acquired. Four patients showed fair results, and 2 poor. In conclusion, these results suggest that the reverse-U incision and V-Y plasty are useful methods for creating a symmetry of the nostrils in cases of cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.

Laparoscopic and Percutaneous Ultrasound Guided Radiofrequency Ablation for Hepatocellular Carcinoma: a Preliminary Study / 대한간학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is emerging as a new therapeutic method in the management of hepatocellular carcinoma (HCC). We report the results of 64 patients with a follow-up interval of 3 to 19 months. METHOD: Sixty-four patients with 82 nodules underwent ultrasound guided RFA. The mean tumor diameter was 2.5+/-1.0 cm. Laparoscopic ultrasound guided RFA was performed in 38 cases, and percutaneous ultrasound guided RFA in 26 cases. The therapeutic efficacy was evaluated by means of three-phase dynamic abdominal computed tomography (CT) performed within at least one week after ablating. The recurrence was evaluated after treatment by means of abdominal CT and alpha fetoprotein every 3 months. We calculated cumulative recurrence rates, survival rates of patients, and found out complication of RFA. RESULTS: Cumulative recurrence rates in 3, 6, 12 months after RFA was 8.8%, 15.8%, 25.9%. 12 cases were recurred during follow-up. Among them, intrahepatic recurrences were noted in 11 cases, local recurrences in 3 cases. Cumulative survival curves indicated that survival rate was 95% at the third month, 94% at the sixth month, 81% at the twelfth month. After RFA, the alpha fetoprotein level was decreased significantly after 1 month (p<0.05), and serum transaminase levels were transiently elevated (p<0.01) but returned to normal within one week. Complications of RFA were not serious, and resolved spontaneously. CONCLUSION: RFA can be considered a useful new treatment for HCC. Laparoscopic RFA is a useful procedure for the treatment of HCC regardless of its location.

Effect of a traditional korean very-low-calorie diet on obese patients / 대한내과학회지

BACKGROUND: There is increasing interest in the use of a very low calorie diet (VLCD) as a treatment regimen for weight loss in obese subjects. This study was designed to investigate the effects and safety of a traditional Korean very-low-calory diet. METHODS: Twelve hospitalized obese patients at Dong Eui hospital in Busan city from May 1998 to December 1998 were selected. Height, body weight, blood lipids, blood insulin level, body fat, lean body mass, subcutaneous fat and visceral fat were measured. A traditional Korean VLCD was supplied for 14 days. RESULTS: Patient's body weight was significantly decreased from 83.8 kg to 78.6 kg, body fat from 32.2 kg to 28.6 kg, lean body mass from 32.2 kg to 28.6 kg, and BMI from 31.4 to 29.5, respectively (p<0.05). Total fat was significantly decreased from 807 cc to 659 cc, subcutaneous fat from 567 cc to 473 cc, visceral fat from 273 cc to 185 cc, respectively. However there were no significant changes in minerals. After VLCD intervention, total cholesterol was significantly decreased from 199 mg/dL to 166 mg/dL, HDL-cholesterol from 42 mg/dL, to 35 mg/dL, triglyceride from 158 mg/dL, to 75 mg/dL (p<0.05). The insulin area under the curve was also significantly decreased from 205 micro International-Unit/mL x 2hr to 168 micro International-Unit/mL x 2hr (p<0.05). CONCLUSION: Above findings suggested that a traditional Korean VLCD is effective and safe for short term use in terms of reducing body fat and improving insulin resistance in obese patients.

Clinical Review of Reduction Malarplasty using Various Incision Techniques

No abstract available.

Comparison of Magnetic Resonance Cholangiopancreatography with Endoscopic Retrograde Cholangiopancreatography in the Evaluation of the Biliary Tract Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan creatography (ERCP). METHODS: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test. RESULTS: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 98.2% and 98.6%, respectively, and those of ERCP's were all 100%. For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. CONCLUSIONS: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis.

Correction of Severe Cleft Lip Nasal Deformity Using Composite Graft

Correction of the severe cleft lip nasal deformity is challenging and we used the composite graft to correct the cleft lip nasal deformity with severe tissue deficiency or severe nostril asymmetry. A total of 19 patients, who were born with complete cleft type, was operated between 1995 and 1999. Among them, 10 patients were men and nine were women. Age distribution was seven to 35 years old. In nine patients with unilateral cleft lip nasal deformity and six patients with bilateral cleft lip nasal deformity, columella lengthening was performed using composite graft taken from the helix in 14 cases and contralateral alar rim in one case. In four patients with severe asymmetric nostrils due to a short alar rim in unilateral cleft lip nasal deformity, the ear helix was used in two cases. while in the other two cases the alar rim of the unaffected side was transferred to the affected side to make symmetric nostril by reducing the length of the alar on the affected side. Follow up periods ranged from one to three years, and results were as follows: 1. Four days after the graft, the composite tissue exhibited a pinkish color. Complete survival was confirmed after seven days. The absorption rate observed was about 10 percent and color mismatch became minimal with time. 2. Composite tissue taken from the ear was found to be useful for a full layer reconstruction of the alar and columella due to its stiffness, thin nature, and similarity. Composite tissue from the alar rim of the contralateral side was also determined as good material for a full layer reconstruction of the deficient alar.

The Effect of the Periosteum for the New Bone Formation into Bone Substitutes

To investigate the effect of the periosteum for the new bone formation into bone substitutes, artificial full thickness calvarial bone defects were made in diameter of 6mm in 45 New Zieland white rabbits and the defects were filled with Medpor(R) and Biocoral(R) as bone substitutes and with Surgicel(R) as control material. Each group was then divided into three sub-groups: non-periosteal group, periosteal flap group and periosteal graft group. Bone formation was investigated morphologically, radiologically and histologically and the degree of bone formation was calculated with scanner(Scanmaker III, Microtek Co.)and image processing program. In the non-periosteal group, there was no bone formation in all artificial bone substitutes 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 3.58 +/- 1.70%, 0.00%, 2.11 +/- 1.73% respectively 6 weeks after experiment, and 27.43 +/- 11.92%, 15.72 +/- 5.47% and 3.59 +/- 2.18% respectively 3 months after experiment. In the periosteal flap group, there was no bone formation in Medpor(R) and Surgicel(R) but 6.84 +/- 3.21% of the bone formation in Biocoral(R) 6 weeks after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 41.83 +/- 11.32%, 20.72 +/- 6.53% and 22.32 +/- 5.85% respectively 3 months after experiment. In the periosteal graft group, there was cartilage formation in Biocoral(R) and Medpor(R) 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 25.38 +/- 6.49%, 17.16 +/- 4.03%, 7.95 +/- 3.17% respectively 6 weeks after experiment and 80.87 +/- 11.24%, 41.20 +/- 8.87%, 44.93 +/- 16.48% respectively 3 months after experiment. In conclusion, the periosteum played an important role for the bone formation into bone substitutes of Biocoral(R) and Medpor(R). The amount of bone formation was the greatest in the periosteal graft group among three groups and greater in Biocoral(R) than in Medpor(R).

Anthropometric Study of the Upper Lip and Nose in Infants Younger than One Year Old

The face is a variable part of the body and characterized not only by each part but also by the interrelation of the parts. Because facial image is very complex, it is very difficult to standardize the facial profile. However, it is necessary to establish the facial anthropometry in the infant. We perforrned an anthropometric study of the linear length of soft tissue in 13 places of the nasolabial area using a spreading caliper and ruler for the purpose of establishing normal interrelationship of regional profile in newborns and 2, 4, 6 month old babies. Each age group was composed of 40 normal babies. Followings are our results in the order of newborn, 2, 4, 6 months old. Widths of columella were 3.2 mm, 3.5 mm, 3.7 mm, 3.8 mm, respectively. Heights of columella were 4.7 mm, 4.9 mm, 5.2 mm, 5.3 mm. Distances between medial alar bases were 13.7 mm, 14.4 mm, 17.4 mm, 17.6 mm. Lengths from alar to tip of Cupid's bow were 9.5 mm, 10.0 mm, 10.5 mm, 10.6 mm. Lengths from columella base to tip of Cupid's bow were 8.4 mm, 9.9 mm, 10.2 mm, 10.5 mm. Lengths from columella base to center of Cupid's bow were 8.3 mm, 9.5 mm, 9.8 mm, 9.9 mm. Lengths of one limb of Cupid's bow were 2.7 mm, 3.1 mm, 3.4 mm, 3.5 mm. Lengths from tip of Cupid's bow to commissure were 13.4 mm, 14.7 mm, 16.4 mm, 16.9 mm. Intercommissural distances were 26.8 mm, 30.3 mm, 30.8 mm, 32.5 mm. Widths of philtral column at columella base were 3.1 mm, 3.6 mm, 3.7 mm, 4.0 mm. Distances between philtral columns(mid portion) were 3.7 mm, 4.6 mm, 4.6 mm, 4.6 mm. Heights of nasal tip protrusion were 8.7 mm, 11.0 mm, 11.7 mm, 12.1mm. Widths of nose were 20.7 mm, 23.7 mm, 25.3 mm, 25.9 mm. As the treatment of cleft lip should be performed within 6 months of age, the exact data for the face are very important, especially in the nasolabial area. We expect our data to be useful as a guideline for the management of cleft lip patient under one year old.

Osteodistraction of Midface Using Rigid External Distraction Device

We treated a total of 4 patients with midfacial hypoplasia, aged 12 to 19 years, using distraction osteogenesis between January 1998 and June 1999. In 3 patients with severe maxillary hypoplasia, we used rigid external distraction device developed by Dr. Polley. The distraction was performed from 5 days after Le Fort I osteotomy at a rate of 1 mm/day for 10 to 15 days. After distraction was completed, the device was left in place for another 6 weeks for bony consolidation. And then, an orthodontic face mask was used with elastic traction for 2 months. In one patient with partial hypoplasia of the midface, the osteotomized zygoma and a part of the maxilla was distracted selectively using rigid external distraction device a total of 15 mm. In the degree of SNA, mean value improved from 75.0(75.5, 75.0, 74.5) to 81.8(81.5, 83.0, 81.0) after 6 months later. In relapse rate, distracted length decreased from 10 mm to 6 mm, 15 mm to 8 mm, 13mm to 7 mm at 6 months later resulting in relapse rate of 44.3%. The follow-up period was from 7 to 26 months. Advantages of rigid external distraction device are highly effective technique of maxillary distraction, easy control of vector of distraction and no additional surgical procedure for removal of the device. In conclusion, the external distraction device is very useful for midface distraction.