Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy. METHODS: We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed. RESULTS: The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59+/-2.35 mm vs. 4.82+/-2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007). CONCLUSIONS: Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.

A case of an API2-MALT1 translocation-positive gastric MALT lymphoma resistant to Helicobacter pylori eradication / 대한내과학회지

About 90% of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphomas are strongly related to Helicobacter pylori infection. The eradication of the H. pylori by antibiotics leads to complete regression of the gastric MALT lymphoma in 80%of cases, and this is currently recommended as the first-line treatment for this tumor. However, no standard treatment for H. pylori-negative and H. pylori-eradication-resistant gastric MALT lymphomas has yet been devised. The association between H. pylori- negative MALT lymphoma and the t(11;18)(q21;q21) translocation, resulting in an API2-MALT1 chimera gene, was reported, and is now considered one of the possible causes of and a reliable predictive marker for unresponsiveness to H. pylori-eradication treatment in patients with low-grade gastric MALT lymphoma. We report a case of H. pylori-eradication-treatment-resistant low-grade gastric MALT lymphoma that was treated successfully with radiotherapy after recognizing the API2-MALT1 chimera gene.

Percutaneous Management of a Bronchobiliary Fistula after Radiofrequency Ablation in a Patient with Hepatocellular Carcinoma

Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.

VPDL Chemotherapy for T-cell Lymphoblastic Lymphoma (T-LBL) in Adults: Comparison with Upfront Autologous Stem Cell Transplantation in a Single Center / 대한혈액학회지

BACKGROUND: Treatment of T-cell lymphoblastic lymphoma (T-LBL) with CHOP or CHOP-like chemotherapy has resulted in poor long-term outcomes. High-dose chemotherapy followed by ASCT has been applied for this dreaded disease. However, the efficacy is still controversial. T-LBL is considered the nodal/extranodal presentation of acute lymphoblastic leukemia. Favorable results with VPDL chemotherapy have been reported in the setting of adult lymphoblastic leukemia. We, therefore, treated T-LBL patients with modified VPDL chemotherapy and compared the outcomes with those achieved using upfront ASCT. METHODS: We retrospectively reviewed the outcomes of 24 T-LBL patients treated either with upfront ASCT (n=11) or VPDL chemotherapy without ASCT (n=13) between January 1996 and October 2005. RESULTS: The median follow-up duration for surviving patients was 17 months (range, 5~109 months). The two-year event-free survival (EFS) rates were 83.1% in the VPDL group and 27.3% in the upfront ASCT group (P=0.008). The two-year overall survival (OS) rates were 83.9% in the VPDL group and 27.3% in the upfront ASCT group (P=0.006). CONCLUSION: This study suggests that VPDL chemotherapy is very effective and may be superior to upfront ASCT in the treatment of T-LBL patients.

Primary Granulocytic Sarcoma with Multiple Organ Involvement / 대한혈액학회지

We report here a case of primary granulocytic sarcoma that involved multiple organs simultaneously and simulated clinical features of lymphoma at initial presentation. A 55 year-old man was referred to our center for the treatment and evaluation of lymphoma, which was diagnosed for nasal and colonic polyps in a local hospital. In our center, brain MR imaging showed multiple soft tissue lesions in brain and the whole body PET demonstrated multiple hypermetabolic lesions. Immunohistochemical staining of biopsy specimen on nasal and colonic polyp showed negativity of all lymphoma markers and positivity of myeloid markers, and final pathologic diagnosis was granulocytic sarcoma. Cytogenetic analysis of malignant cells in CSF showed chromosomal abnormalities of t(16;16)(p13.1;q22). Bilateral bone marrow examination was done with no evidence of abnormal cell infiltration and with normal cytogenetics. Complete remission was induced with 5 cycles of anti-leukemic chemotherapy, intrathecal chemotherapy and whole brain irradiation. However, leukemia relapsed in blood and bone marrow three months after the completion of treatment and the patient died 11.5 months after initial diagnosis of primary granulocytic sarcoma. In conclusion, immune-histochemical staining is necessary to obtain accurate pathologic diagnosis of granulocytic sarcoma. Pathogenetic role of t(16;16) in granulocytic sarcoma should be evaluated and appropriate treatment of primary granulocytic sarcoma should be defined in the future studies.

A Case of a Carcinoid Tumor of the Ampulla of Vater / 대한소화기내시경학회지

Carcinoid tumors involving the Ampulla of Vater are very rare lesions which may result in painless jaundice. The preoperative diagnosis of a carcinoid tumor is difficult because the carcinoid tumor of the Ampulla of Vater is frequently located in the submucosa and rarely presents an ulcerative lesion on the surface mucosa. In contrast to patients with intestinal carcinoid tumors, patients with carcinoid tumor of the Ampulla of Vater are frequently free of clinical and laboratory findings that hint to the carcinoid syndrome. The natural history of this disease entity has not been well established; however, the prognosis is generally believed to be good. In this study, we report a case of a carcinoid tumor of the Ampulla of Vater with an ulcerative lesion, which was diagnosed preoperatively and treated by surgical excision.

MUC8 as a Ciliated Cell Marker in Human Nasal Epithelium / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To examine the MUC8 mRNA expression patterns according to the mucociliary differentiation of the normal human nasal epithelial (NHNE) cells, and to investigate the localization of the MUC8 proteins in the nasal polyps. MATERIALS AND METHODS: The passage-2 NHNE cells were cultured using an air-liquid interface technique and nasal polyp specimens. On the 2, 7, 14, and 28 days after confluence, the ciliated cells were counted using cytospin slide immunostaining using H6C5 and beta-tubulin, and the MUC8 mRNA levels were determined using real-time quantitative PCR. After synthesizing the polyclonal anti-MUC8 peptide antibodies, MUC8 immunostaining was preformed using the nasal polyps. The MUC8 mRNA and protein levels were determined with the NHNE cells treated with IL-1beta (10 ng/ml for 24 hours) using RT-PCR and Western blot analysis. RESULTS: The increasing pattern of the number of ciliated cells as well as the MUC8 gene expression level with increasing culture time in the NHNE cells was quite similar. MUC8 was expressed in the ciliated cells of the human nasal polyps. The MUC8 protein level as well as the mRNA level was up-regulated as a result of the IL-1beta treatment. CONCLUSIONS: This study indicates that the MUC8 protein is expressed in ciliated cells from the human nasal epithelial cells and is up-regulated by the IL-1beta treatment. These results suggest that the MUC8 gene and protein expression levels might be used as a ciliated cell marker in the human nasal epithelium.

Treatment Outcomes and Pattern of Failure in the Surgically Treated Squamous Cell Carcinoma of Floor of the Mouth / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma involving the floor of the mouth remains one of the most aggressive neoplasms of the head and neck. Its propensity to invade the mandible and to involve the lymphatic beds of both necks often makes local and regional control exceedingly difficult. This study reports the oncologic results of the surgically treated squamous cell carcinoma of the floor of mouth. SUBJECTS AND METHOD: From July 1992 to September 2001, 27 previously untreated floor of the mouth squamous cell carcinoma patients were treated with surgery with or without postoperative radiotherapy at Severance Hospital. Survival rates and factors affecting survival were studied using standard statistical analysis to determine statistical significance. RESULTS: The 2 year and 3 year disease-specific free survival rate in early staged carcinomas (stage I and II) were 85% and 77%, respectively, and in advanced staged carcinomas, 75% and 60%, respectively. Significantly decreased survival was seen in the patients with positive pathologic lymph nodes (p=0.001). However, there was no statistical significance for the effects of cT stage (p=0.56), performance of mandibular resection (p=0.755), mandibular invasion (p=0.688), and positive margins (p=0.98) on survival. Thirty-three percent of patients had recurrence. Recurrence was highest at the primary site, followed by the neck, and these were the most common sites of treatment failure. Two cases (67%) of nodal recurrence occurred in the anterior lymphatic chain (level VI). Distant metastasis was noted in 7.4% of the patients. CONCLUSION: Treatment with radical surgery of primary lesions and elective neck dissection including the anterior neck lymphatic chains may improve survival of patients with squamous cell carcinoma of the floor of mouth.

The Relationship between Tobacco Price Rises and Willingness to Quit Smoking among University Students / 한국역학회지

BACKGROUND: The smoking rate of adult male is 68.2% in Korea and that of adolescent and women has risen recently. Ministry of Health and Welfare plans to raise the price of cigarettes by 1,000 Won per pack this year in hopes of securing funds to aid the underprivileged and discourage excessive smoking. In this study, we tried to find the relationship between tobacco price increase and willingness to quit smoking among university students, and the factors associated with willingness to quit smoking. METHOD: The data were collected by questionnaire survey from 225 university students living in Seoul. The questionnaire contained items on age, sex, smoking history, economical status and the intention to quit smoking when the tobacco price be raised. RESULT: The proportion of smokers who has the intention to quit smoking if the price of tobacco be raised by 3,000 Won was 46.2%. The factors associated with willingness to quit smoking were age of initiating smoking, opinion for price of cigarette, self efficacy scores, current plans to quit smoking, and viewpoint of changes in the rate of smokers. CONCLUSION: The results showed that tobacco price rises will increase willingness to quit smoking among university students.