Clinical Predictors Associated with the Severity of Colonic Diverticulitis

BACKGROUND/AIMS: Colonic diverticular diseases are increasing in Korea due to aging of the population and westernization of people's lifestyle. The aim of this study was to investigate the clinical predictors associated with the severity of colonic diverticulitis in Korea. METHODS: We retrospectively reviewed the medical records of 107 patients who were hospitalized with diverticulitis and underwent abdominopelvic computerized tomography at Dankook University Hospital between March 2002 and August 2011. The severity of colonic diverticulitis was evaluated by using Modified Hinchey classification, stage 0 to stage Ia were classified as mild group and stage Ib to stage IV were classified as severe group. Patients??records were assessed for age, sex, underlying diseases, history of diverticulitis, associated symptoms, location of diverticulitis, white blood cells, and C-reactive protein (CRP). RESULTS: Male to female ratio was 1.6:1 with the mean age of 43.1 years. Eighty-three patients (77.6%) were in the mild group and 24 patients (22.4%) were in the severe group. In multivariated analysis, the clinical predictors associated with the severity of colonic diverticulitis were left location (odds ratio [OR], 7.268; P=0.030), duration of symptoms (> or =3 days; OR, 4.174; P=0.022), and elevated CRP (> or =5 mg/dL; OR, 4.576; P=0.018). CONCLUSIONS: Left location, duration of symptom, and elevated CRP were the meaningful predictors for severity of colonic diverticulitis. When confronting with patients with these risk factors, we should keep in mind about the possibility of severe diverticulitis.

A Case of Yersinia enterocolitica Enterocolitis Accompanied by Colonic Adhesion after Surgery for Uterine Myoma in an Adult Patient / 대한내과학회지

Yersinia enterocolitica infection in adults in Korea is reported rarely. Therefore, the possibility of Yersinia infection as a cause of abdominal pain may be overlooked. Because its clinical features are similar to those of acute appendicitis or other diseases that require operations, Yersinia enterocolitis should be diagnosed before surgery. We recently experienced a case of Y. enterocolitica enterocolitis accompanied by postoperative colonic adhesion. A 39-year-old female patient with a 5-year history of asymptomatic uterine myoma underwent transabdominal hysterectomy due to abdominal pain. However, the pain worsened. On CT, diffuse swelling of the right colon and adhesion of the sigmoid colon with luminal narrowing were found. Colonoscopy showed multiple aphthous ulcers with mucosal hyperemia from the cecum to the sigmoid colon. Multiplex PCR with stool specimens, a hemagglutination test for Y. enterocolitica O:3, and tissue culture were positive for Y. enterocolitica. After fluids and antibiotic therapy, her symptoms were relieved.

Analysis of prognostic factors and 5-year survival rate in patients with hepatocellular carcinoma: a single-center experience / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC), which is the third most common cancer in Korea, has a very poor prognosis. However, only a few studies have performed a comprehensive survival-related analysis in all patients who were consecutively diagnosed and treated over a given period of time. The aim of this study was to determine the 5-year survival rate and its prognostic factors among HCC patients. METHODS: In total, 257 patients who were consecutively diagnosed with HCC between January 2000 and December 2003 were followed until death or until December 2008. We analyzed their survival outcomes according to their clinical characteristics, tumor staging, and treatment modalities, and determined the independent prognostic factors affecting survival. RESULTS: The patients were aged 59+/-10 years (mean+/-SD). During the follow-up period, 223 patients (86.8%) died and the overall median survival was 10.8 months; the 1-, 3-, and 5-year survival rates were 44.4%, 21.0%, and 12.1%, respectively. The outcomes in patients with tumor node metastasis (TNM) stage I or II and Child-Pugh class A or B were significantly better with surgical resection than with other treatment modalities (P<0.01). Patients who underwent supplementary transcatheter arterial chemoembolization as a second-line treatment after surgical resection had better outcomes than those who underwent surgical resection alone (P=0.02). Initial symptoms, Child-Pugh class, serum alpha-fetoprotein, tumor size, portal vein thrombosis, and TNM stage were found to be independent prognostic factors for survival among HCC patients. CONCLUSIONS: This retrospective cohort study elucidated survival outcomes and prognostic factors affecting survival in HCC patients at a single center.

Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma

Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a two-week interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.

Prognostic Index for Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Treated with Radiation Therapy

We performed a retrospective review of 281 hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with radiation therapy (RT) between 1998 and 2008 to develop a prognostic model for those patients. Of the 281 patients, PVTT and intrahepatic main masses completely disappeared in 10 patients (3.6%), and shown a partial response in 141 patients (50.2%). The median survival was 11.6 months. Patients who had more than PR have shown significantly longer survival than the others (22.0 months vs 5.0 months, P < 0.001). On the multivariate analysis, pre-treatment poor prognosticators for overall survival were ECOG performance status, Child-Pugh class, multiple tumors, main PVTT, complete portal vein occlusion, lymph node metastasis, and primary tumor size. Prognostic index of RT for PVTT of HCC (PITH) scores were defined as the number of pre-treatment poor prognostic factors. PITH scores correlated well with overall survival. In the analysis of 1 and 2 yr overall survival rate, patients who had PITH scores of 3 or greater showed a significantly lower rate of overall survival than the others (33.0%, 17.3% vs 70.1%, 40.8%, respectively, P < 0.001). The PITH scoring model, proposed in the current study in HCC patients with PVTT, reliably predict overall survival.

A Case of Malignant Gastrointestinal Stromal Tumor of Ileum with Liver Abscess / 대한소화기학회지

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.

A Small Rectal Carcinoid Tumor with Multiple Liver Metastases / 대한소화기내시경학회지

Rectal carcinoid tumors are relatively uncommon and make up 1~2% of tumors found in the rectum. Approximately 50% of the tumors are asymptomatic and are found incidentally. In most cases, the tumors are slowly growing in nature and thus have a favorable outcome. Anywhere from 66 to 80% of rectal carcinoid tumors are smaller than 1 cm and rarely metastasis. However, malignant behavior, such as invasion to the muscle wall, and metastasis to a distant organ, may be seen infrequently with tumors greater than 2 cm in size. The liver is the most common site of a metastasis. We experienced a case of a 1 cm sized small rectal carcinoid tumor with multiple liver metastases.

A Case of Early Gastric Adenocarcinoma Mimiking a Submucosal Tumor / 대한소화기내시경학회지

Early gastric adenocarcinoma with the endoscopic features resembling a submucosal tumor is extremely rare and is characterized by erythema, central depression and erosion on the surface of the lesion, which can be distinguished from submucosal tumor. When a tumor is completely covered with normal mucosa, it is extremely difficult to obtain endoscopic biopsy specimens from the underlying lesion. EUS alone is not necessarily diagnostic. Various techniques have been advocated to overcome this problem, including US-guided biopsy, partial removal by an endoscopic snare excision, endoscopic mucosal resection as well as EUS with FNA. We encountered a case of an early gastric adenocarcinoma with well differentiation, presenting as a submucosal tumor. The early gastric adenocarcinoma was evaluated by endoscopy and EUS, and was confirmed by a surgical resection. We report this case with a review of the relevant literature.