Abnormalities of liver function tests in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: Abnormalities of liver function tests are common in patients with hyperthyroidism and may reflect thyroid hormone status. The aim of our study was to analyze the frequency of abnormal liver function tests in the patients with hyperthyroidism at diagnosis and the association with the thyroid function state after antithyroid therapy. METHODS: Three hundred seventy eight patients with hyperthyroidism who visited Chungnam National University Hospital from June 2004 to May 2005 and had no other causes for abnormal liver function tests were examined. At diagnosis, 272 of 378 patients had various abnormalities seen on the liver function tests. Among 272 patients, 65 were followed up for liver function tests and were analyzed for sex, age, use of an antithyroid drug, and thyroid function tests after administration of an antithyroid drug. We analyzed the frequency of liver function abnormalities and the relevance between abnormalities of liver function and the thyroid function state. RESULTS: Abnormalities in AST, ALT, total bilirubin, alkaline phosphatase and GGT were observed in 16.4%, 31.0%, 3.2%, 48.7% and 26.9% of the 378 patients with hyperthyroidism, respectively. The level of alkaline phosphatase was the most common abnormal parameter. After antithyroid therapy, 48 (73.8%) of 65 patients had normalization of their liver function abnormalities. The normalization rate for AST, ALT, alkaline phosphatase and GGT were higher in the euthyroid status group than the sustained hyperthyoid status group. The normalization rate for ALT was significantly higher in the female group than in the male group, but the effect of antithyroid drug use and age on the normalization rate was not statistically significant. CONCLUSIONS: These findings indicate that abnormalities of liver function tests are common in patients with hyperthyroidism and these abnormalities are strongly associated with thyroid hormone status.

Amiodarone-induced Hepatitis and Polyneuropathy

Amiodarone chlorhydrate is a diiodated benzofuran derivative, and it is used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone, and symptomatic hepatic dysfunction occurs in fewer than 1% of the patients taking amiodarone. Cirrhosis is a rare complication that's been confirmed in 12 cases. Peripheral neuropathy occurs in 10% of patients taking aminodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity and peripheral neurotoxicity. A 75 year old man with normal liver function was given amiodarone for treating his atrial fibrillation and heart failure. He developed nausea, vomiting, muscle weakness and wasting after 17.8 months therapy with amiodarone (400 mg orally once per day). Liver biopsy showed the presence of foam cells in the hepatic sinusoids and Mallory bodies in the periportal hepatocytes on light microscopy. Sural nerve biopsy showed demyelination, and nerve conduction studies showed mixed sensorimotor polyneuropathy. These observations show the necessity of monitoring the hepatic function and conducting neurologic examination of the patients treated with amiodarone.

Docetaxel-Cisplatin-5-FU Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.

A case of limy bile accompanied with gallbladder stones and common bile duct stone / 대한내과학회지

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder. It has been known a cause of cholecystitis. Churchman firtst reported a case of curious deposition of calcium salts within the gallbladder in 1911. The etiology of limy bile is unclear. Recently we experienced a 32-year-old woman who had a limy bile in the gallbladder, right hepatic duct, common hepatic duct with multiple gallbladder stones and common bile duct stone. We report this case with a review of literature.

Usefulness of Percutaneous Transhepatic Cholangioscopy for Treatment of Intrahepatic Duct and Common Bile Stones and Diagnosis of Intrahepatic Duct Lesions with Biopsy / 대한소화기내시경학회지

BACKGROUND/AIMS: Despite several limitations, percutaneous transhepatic cholangioscopy (PTCS) has been useful in patients with intrahepatic stone, common bile duct stone or intrahepatic bile duct stricture. We investigated the usefulness and limitation of PTCS, and the recurrence rate after stone removal. METHODS: PTCS was performed on 49 patients with intrahepatic duct (IHD) stones or common bile duct (CBD) stones and 11 patients undergoing biopsy who visited Chung Nam university hospital between 1999 and 2003. RESULTS: Complete removal rate of patients with IHD and CBD stones was 75% (21/28) and 91% (19/21), respectively. Biopsy results by PTCS were in agreement with the final result in 86% (6/7). In patients with IHD stones, the PTCS complication rate was 29% (8/28). Bleeding was most common (21%) but was self limited. In patients with CBD stones, the PTCS complication rate was 9% (2/9). One case was bleeding and the other was death by aggravation of general condition. In patients with IHD stones, the recurrence rate was 29% (5/17). CONCLUSIONS: In conclusion, PTCS is useful to treat patients with IHD stones, as well as the few patients with failed CBD stone removal by ERCP and diagnosis of stricture in the bile duct.

Early duodenal carcinoma successfully resected by endosopic mucosal resection / 대한내과학회지

Primary duodenal adenocarcinoma is rare disease with a poorly defined natural history. It represents less than 0.35% of all gastrointestinal tract malignant neoplasms and accounts for up to 33 to 45% of small bowel cancers. Diagnosis is always late because of the non-specific symptoms, consequently leading to poor prognosis. Surgical resection is the only potentially curative treatment, but not all patients whose tumor is removed necessarily survive long term. Recent widespread use of endoscopy has increased early detection of duodenal adenocarcinoma. Thanks to early detection, duodenal adenocarcinoma can now be treated endoscopically, which allows the patient's quality of life to be maintained. We have experienced one case of the primary early duodenal adenocarcinoma of the first portion, which was diagnosed by biopsy with endoscopic examination as part of a routine medical evaluation and was resected by endoscopic mucosal resection technique. We report the first primary early duodenal adenocarcinoma successfully treated by EMR method in Korea.

Two Cases of Adenocarcinoma Arising from Gastric Hyperplastic Polyp / 대한소화기내시경학회지

Epithelial gastric polyps can be categorized as being either hyperplastic or adenomatous. Hyperplastic polyps accounts for 75~90% of gastric polyps. In contrast to the adenomatous polyps, the potential of a malignant transformation of hyperplastic polyps was originally believed to be quite low (an incidence of 1.5~2.1%), which is considerably lower than that of an adenoma of the stomach. Most of reported cases of a hyperplastic gastric polyp with a transformation to adenocarcinoma were well differentiated histopathologically. There are few reports of a hyperplastic polyp in which malignant changes developed during the endoscopic surveillance. We report a rare case of a 1.2 cm sized moderately differentiated adenocarcinoma arising in a hyperplastic polyp on the cardia in the stomach with a brief review of the relevant literature.

Endoscopic Treatment of Foreign Bodies in the Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10~20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. METHODS: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. RESULTS: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2 : 1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. CONCLUSIONS: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required

Long-term Outcome of Endoscopic Mucosal Resection for Gastric Adenoma and Factors Related to Recurrence / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. It has been widely accepted as a useful method due to its minimal invasiveness, safety and satisfactory result. The purpose of this study was to identify the factors affecting the recurrence after EMR. METHODS: Three hundred twenty adenomas in 297 patients were treated by EMR from January, 1991 until July 2003. Among those, 197 lesions in 184 patients that could have been followed-up were analyzed retrospectively. RESULTS: The mean follow-up period was 15.0 (1~89) months. Of the 197 lesions, there were 35 recurrences (17.7%). The recurrence rate was higher in lesions associated with severe mucosal atrophy and intestinal metaplasia in surrounding mucosa (p=0.035). Other factors showed no statistically significant difference in recurrence rate. CONCLUSIONS: In this study, we concluded that the presence of intestinal metaplasia and severe atrophic background mucosa were related to the recurrence of gastric adenoma after EMR.

Expression of Cyclooxygenase-2 and p53 Protein in Colonic Adenoma with Malignant Change / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.

Clinical Significance of Transiently Elevated Serum AFP Level in Developing Hepatocellular Carcinoma in HBsAg Positive-Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC. METHODS: We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size. RESULTS: One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively. CONCLUSIONS: We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.

Retrospective Study on the Therapeutic Effects of an Etoposide, Adriamycin, Cisplatin-II (EAP- II) versus an Etoposide, Leucovorin, 5-Furorouracil (ELF) Combination Chemotheraphy in Unresectable Gastric Cancer

PURPOSE: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn`t duplicate the result. the purpose of this study was to evaluate the relative efficacy&toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. MATENRIALS AND METHODS: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/m2 IV for 1~5 days), adriamycin (20 mg/m2 IV for 1~5 days) and cisplatin (20 mg/m2 IV for 1~5 days) and Twenty-eight patients receieved ELF chemotherapy:etoposide (100 mg/m2 IV for 1~3 days), leucovorin (20 mg/m2 IV for 1~5 days) and 5-FU (500 mg/m2 IV for 1~5 days). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient: ELF means 4.1 cycles per patient RESULTS: Total respones rates were 5.4% in the ELF group and 3.6% in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value>0.05), and the median overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis&hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: 27.6% in ELF vs 54% in EAP-II; Leukopenia: 8.5% in ELF vs 19% in EAP-II; nausea&vomiting: 45.9% in ELF vs 67.8% in EAP-II. CONCLUSION: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer.

Retrospective Study on the Therapeutic Effects of an Etoposide, Adriamycin, Cisplatin-II (EAP- II) versus an Etoposide, Leucovorin, 5-Furorouracil (ELF) Combination Chemotheraphy in Unresectable Gastric Cancer

PURPOSE: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn`t duplicate the result. the purpose of this study was to evaluate the relative efficacy&toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. MATENRIALS AND METHODS: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/m2 IV for 1~5 days), adriamycin (20 mg/m2 IV for 1~5 days) and cisplatin (20 mg/m2 IV for 1~5 days) and Twenty-eight patients receieved ELF chemotherapy:etoposide (100 mg/m2 IV for 1~3 days), leucovorin (20 mg/m2 IV for 1~5 days) and 5-FU (500 mg/m2 IV for 1~5 days). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient: ELF means 4.1 cycles per patient RESULTS: Total respones rates were 5.4% in the ELF group and 3.6% in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value>0.05), and the median overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis&hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: 27.6% in ELF vs 54% in EAP-II; Leukopenia: 8.5% in ELF vs 19% in EAP-II; nausea&vomiting: 45.9% in ELF vs 67.8% in EAP-II. CONCLUSION: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer.