Comparison of the hemostatic effect between argon plasma and heat probe for peptic ulcer bleeding / 대한내과학회지

BACKGROUND/AIMS: Endoscopic heat probe coagulation (HP) and argon plasma coagulation (APC) are considered to be safe and effective for the treatment of peptic ulcer bleeding. The aim of this study was to evaluate the efficacy and safety of APC and HP for treating bleeding peptic ulcer. METHODS: Between May 2004 and November 2006 we conducted a prospective randomized trial on 99 patients with peptic ulcer bleeding and for whom a visible vessel or active bleeding was identified. The patients were randomized into two groups: the APC group that was comprised of 56 patients who received argon plasma coagulation and HP group that was comprised of 43 patients who received heat probe coagulation. RESULTS: There were no significant differences between the study groups in terms of age, risk factors, the initial hemoglobin values, the number of patients who showed signs of hemodynamic impairment, the location of ulcer and the bleeding activity. The initial hemostatic rate was 89.3% in the APC group and 93% in the heat probe group (p=0.521). After successful initial endoscopic treatment, rebleeding was observed in 4 cases of the APC group (7.1%) and in 4 cases of heat probe coagulation group (9.3%). CONCLUSIONS: Argon plasma coagulation and heat probe coagulation are equally effective for controlling bleeding from peptic ulcer.

The crude incidence rate of stomach cancer in Chuncheon-si during 2000-2002 / 대한내과학회지

BACKGROUND: Stomach cancer is the most common cancer in Korea, and it can be easily diagnosed by performing endoscopy. Helicobacter pylori (H. pylori) is associated with stomach cancer, and there has been much recent interest in the epidemiology of stomach cancer. Therefore, we estimated the incidence of stomach cancer in Chuncheon-si during 2000-2002. METHODS: From July 1st, 2000 through June 30th, 2002, we investigated the subjects who were confined to be newly diagnosed cases living in Chuncheon-si. The data was collected from the medical records from all the medical facilities located in Chuncheon-si. RESULTS: The total number of cases of newly diagnosed stomach cancer during this period (2000-2002) was 186 (117 males and 69 females). The annual crude incidence rate of stomach cancer was estimated to be 37.0 per 100,000 persons overall, and 47.0 and 27.2 in the males and females, respectively. The annual age standardized incidence rate for the Korean population was 33.7 per 100,000 persons overall, and 42.2 and 25.1 for the males and females, respectively. The major symptoms of stomach cancer patients were epigastric pain (61.8%) and weight loss (31.2%). The proportion of early gastric cancer was 34.9% (60 among 172 persons) of the cases of stomach cancer. 64 patients (74%) were H. pylori positive. CONCLUSIONS: We report here on the estimated incidence rate of the stomach cancer and the characteristics of the stomach cancer patients in Chuncheon-si during 2000-2002. This study has generated basic epidemiologic data to identify the effect of H. pylori eradication on the future incidence rate of stomach cancer.

Prevention of Variceal Bleeding and Measurement of Hepatic Vein Pressure Gradient / 대한간학회지

No abstract available.

Correlation of p53 Mutations and Microvascular Invasions of Hepatocellular Carcinoma: A Possible Factor of Poor Prognosis Following Surgical Resection / 대한간학회지

BACKGROUND/AIMS: p53 mutations have been reported to be a poor prognostic indicator in patients with HCC treated by surgical resection because of the association with frequent recurrence and shorter survival periods. Although poor differentiation of tumor has been considered to be associated with p53 mutation more frequently, the exact causes of unfavorable prognosis have not been clarified. METHODS: To evaluate the relationship of p53 mutation and details of histological features, we examined 20 HCCs and surrounding liver tissues from the patients treated with surgical resection using direct sequencing of p53 gene at exons 5, 6, 7 and 8, and analyzed histopathologic features. We also analyzed the clinical, biochemical and radiological characteristics including the recurrences of tumor and survival periods in HCC patients with p53 mutant comparing to those with wild type p53 gene. RESULTS: p53 mutants were found in 9 (45%) out of 20 resected HCC tissues, none from any surrounding tissues. p53 mutations were all point substitutions of a base; 5 in exon 8, 4 in exon 5 and 1 in exon 7. Between patients with mutants and those with wild type of p53 gene, there were no differences in age, sex, serum ALT, albumin, bilirubin and AFP levels, and HBV-ositivity. HCCs with p53 mutants tended to be larger in size (14% in 5 cm; p=0.03) and multinodular in type (3/9 vs 0/11; p=0.07). p53 mutants tended to be found in poorly differentiated HCCs comparing to wild types. Even though there was no evidence of vascular or biliary invasion radiologically in all, 5 of 9 p53 mutant (+) (56%) and none of 11 p53-utant (- cases showed vascular invasions microscopically (p<0.01). However, there was no correlation between p53 mutations in tumor tissues and formation of capsules, biliary invasions or association with cirrhosis. During follow-p periods (median: 22;2 -8 mos) recurrences of HCC had been found in 6 of 9 patients with mutants (67%) in contrast to only 2 of 11 with wild types (18%)(p=0.07). Extrahepatic metastases were also common in patients with p53 mutant than those without it (56% vs 9%; p=0.05). Consequently, the 1 year cancer free survival rate of HCC patients with p53 mutant was significantly lower than that with wild type (44% vs 82%; p=0.02). CONCLUSIONS: Thus, it is suggested that p53 mutations tend to be commonly associated with microvascular invasions as well as poor differentiation microscopically, which may result in micrometastasis and frequent recurrences, and consequently shorter survival periods in HCC patents undergoing surgical resection.

Pancreatic Mucinous Cystic Neoplasm Presented as Recurrent Pancreatitis with Masquerading a Pseudocyst / 대한소화기내시경학회지

No abstract available.

A Case of Biliary Papillomatosis which Underwent Curative Resection / 대한소화기내시경학회지

Biliary Papillomatosis is an extremely rare pathologic entity. Only about 40 cases of intrahepatic or diffuse intra- and extrahepatic papillomatosis have been described since the first report in 1959 by Caroli. Although this is a histologically benign lesion, its course is unfavaurable because of its tendency to extend to the entire biliary tract, high recurrence rate following local excision and the probability of progression to malignancy. We described herein a case of biliary papillomatosis associated with diffuse bile duct dilatation. The patient, a 59-year-old male, was admitted to our hospital because of right upper abdominal pain and weight loss. Cholangiogram revealed multiple round filling defects in common hepatic duct with intrahepatic bile duct dilatation. The patient underwent Whipple's operation with right lobectomy. Grossly, multiple small pin-head sized polypoid masses were seen in common bile duct, common hepatic duct and right intrahepatic duct. Microscapically, papillary epithelial hyperplasia with moderate cellular atypia was seen and there was no evidence of stromal invasion. He is healthy with a follow-up for 7 months.