A Case of Needle-Track Implantation of Hepatocellular Carcinoma in the Chest Wall after Laparoscopic Radiofrequency Ablation / 대한내과학회지

Radiofrequency ablation (RFA) is a popular technique and shows excellent local tumor control and acceptable morbidity. Although RFA is considered much safer than surgical treatment, it is not a complication-free procedure. The most common complications of percutaneous RFA areabdominal hemorrhage, abdominal infection (abscess), biliary tract damage, and ground-pad burns. Laparoscopic RFA (LRFA) is a safe, feasible treatment modality to achieve tumor destruction. LRFA has proven superior to the percutaneous approach for lesions that are difficult or impossible to treat percutaneously. Needle-track implantationafter LRFA is a rare complication in HCCs. We report a case of needle-tract implantation of HCC found in the chest wall, ribs,and diaphragm 11 months after LRFA in a 49-year-old man. Although treatment for needle-track implantation is not well established, the metastatic mass was surgically removed.

A Case of Mantle Cell Lymphoma with Meningioma / 대한소화기학회지

Mantle cell lymphoma (MCL) is an uncommon type of gastrointestinal lymphoma. MCL is a distinct subtype of B-cell non-Hodgkin lymphomas. The major subtype of MCL is characterized by the presence of multiple lymphomatous polyposis (MLP), in which multiple polyps are observed along the gastrointestinal tract. The malignant cells express pan B-cell marker and the T-cell marker cluster of differentiation 5. The chromosomal translocation t(11;14)(q13;q32) that causes cyclin D1 overexpression is commonly observed on the cytogenetic analysis of MCL. Survival improvement has recently been achieved for patient with MCL by the successful introduction of monoclonal antibodies and dose-intensified approaches for treatment, including autologous stem cell transplantation strategies. Some reports suggest that there is an increased incidence of second malignancies in patients with MCL or lymphoma. We report a case of MCL involving the colon; the patient was a 60-year-old man who complained of low abdominal discomfort during defecation. During the workup, a meningioma was unexpectedly discovered. On analysis, the tumor was found to be a t(11;14)-negative and non-MLP-type MCL.

Importance of Medication Adherence to Peginterferon-Ribavirin Combination Therapy in Patients with Chronic Hepatitis C / 대한소화기학회지

BACKGROUND/AIMS: The combination therapy with peginterferon and ribavirin is a standard treatment for patients with chronic hepatitis C. However, because of the long duration of the treatment and many complications, the reduction of adherence frequently occur. This study aimed to assess influences of reduced medication adherence in the combination therapy of chronic hepatitis C patients. METHODS: We retrospectively reviewed the medical records of 82 patients with chronic hepatitis C who received a combination therapy with peginterferon and ribavirin. The patients were categorized into 3 subgroups on the basis of medication adherence. Group 1 comprised patients who received > or =80% of the recommended dosage of both peginterferon and ribavirin. Group 2 comprised those patients who received > or =80% of the recommended dosage of only 1 drug. The patients of Group 3 received <80% of the recommended dosage of both the drugs. RESULTS: Sustained virologic response (SVR)s of patients in Group 1, 2 and 3 were 85.4% (41/48), 85.7% (18/21), and 38.5% (5/13), respectively (p=0.002). SVRs of genotype 1 patients in Group 1, 2 and 3 were 84.2% (16/19), 75% (9/12), and 14.3% (1/7) , respectively (p=0.003). SVRs of genotype non-1 patients in Group 1, 2 and 3 were 86.2% (25/29), 100% (9/9), and 66.7% (4/6), respectively (p=0.196). Furthermore are SVRs significantly differed with the degree of medication adherence to either peginterferon or ribavirin (p=0.003 and 0.021, respectively). In multivariate analysis, the peginterferon dose was a significant independent factor associated with SVR. CONCLUSIONS: Medication adherence of chronic hepatitis C patients to the combination therapy with peginterferon and ribavirin is very important for achieving SVR. In particular, we think that genotype 1 patients should maintain higher adherence than genotype non-1 patients.

A Case of a Retroperitoneal Schwannoma Presenting as Hypermetabolic Mass in PET-CT / 대한소화기학회지

Schwannoma is a benign neoplasm of the Schwann cells of the neural sheath. Most schwannomas occur in the head and neck, and extremities and rarely in the retroperitoneal space. The differentiation of a schwannoma from other malignant tumor or benign tumor is very difficult on a preoperative examination with ultrasonography, computed tomography or magnetic resonance imaging. Furthermore, the lesion with increased fluorodeoxyglucose uptake in PET-CT cannot exclude malignant tumor. Therefore, this lesion needs surgical excision and a histological examination with immunohistochemical staining. We report a case of schwannoma occuring in the retroperitoneal space that incidentally discovered by PET-CT for health-check up. Pathologic confirmation by laparoscopic excision was done.

Comparison of the Toxicities and Efficacies of the Combination Chemotherapy Regimens in Advanced Gastric Cancer Patients Who Achieved Complete Response after Chemotherapy / 대한소화기학회지

BACKGROUND/AIMS: We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy. METHODS: We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute's common toxicity criteria before each chemotherapy cycle. RESULTS: Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluorouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8-59.5), 15 months (range, 2.9-31.2) and 10 months (range, 2.0-39.5), and the median survival times were 48 months (range, 5.9-74.0), 37 months (range, 14.0-86.0), and 30 months (range, 6.0-50.0), respectively. Grades 3-4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3-4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens. CONCLUSIONS: All 3 regimens (FOLFOX, DCF and FOLFIRI) were active and tolerable. Their efficacies and toxicities were not significantly different.

Clinical Outcomes of Endoscopic Submucosal Dissection for Undifferentiated or Submucosal Invasive Early Gastric Cancer

BACKGROUND/AIMS: Early gastric cancer (EGC) that is undifferentiated or shows submucosal invasion has not been generally accepted as an indication for endoscopic treatment. But recently, experiences with endoscopic submucosal dissection (ESD) for undifferentiated EGC or submucosal invasive (SM) EGC have increased. The aim of this study was to evaluate clinical outcomes of ESD for EGC with undifferentiation or submucosal invasion. METHODS: Between August 2005 and August 2009, among 210 EGCs treated using ESD at our hospital, 18 lesions were diagnosed as undifferentiated gastric cancer and 41 as SM gastric cancer. A retrospective analysis was done on the medical records of these patients. RESULTS: Mean follow-up periods were 19.39+/-11.2 months. During the follow-up period, local recurrence was noted in 4 lesions. Local recurrence rates of the EGC groups (group 1, mucosal cancer with undifferentiation; group 2, SM cancer with differentiation; group 3, SM cancer with undifferentiation) were 10%, 4.5%, and 50%, respectively. Groups 1 and 2 were not significantly different in local recurrence rates compared to the mucosal cancer with differentiation group (p=0.061, p=0.125, respectively). The undifferentiated EGC group was significantly lower in curability using ESD than the differentiated EGC group (55.6% vs. 89.6%, p=0.000). The curability of the SM EGC group was lower than the mucosal EGC group (36.6% vs. 98.9%). CONCLUSIONS: Complete resection using ESD is difficult in undifferentiated and SM gastric cancers. SM cancer with undifferentiation should be treated immediately by salvage operation. For mucosal cancer with undifferentiation or SM cancer with differentiation, one should consider careful short-term follow-up.

A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as Panperitonitis by Perforation of Stomach / 대한소화기학회지

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.

Recurrent Renal Leiomyosarcoma Mimicking a Colonic Submucosal Tumor: A Case Report

A primary leiomyosarcoma of the kidney is a rare, but highly aggressive, neoplasm, accounting for only 0.1% of all invasive renal tumors. Local or systemic recurrence is common, but a leiomyosarcoma is difficult to diagnose preoperatively. We recently encountered an interesting case of an unusual recurrence of a renal leiomyosarcoma. A 57-year-old woman visited our hospital complaining of lower abdominal pain. Four years previously, she had undergone a left nephrectomy. She had a primary leiomyosarcoma of the kidney that had been misdiagnosed as a renal cell carcinoma. Colonoscopy revealed the presence of a lesion similar to a submucosal tumor in the descending colon. Postoperative pathologic examination confirmed that the mass was a recurrent leiomyosarcoma. We report this unusual case and present a review of the literature.

A Case of Gastric Undifferentiated Carcinoma with Choriocarcinomatous and Hepatoid Carcinomatous Differentiation / 대한소화기내시경학회지

Here we report a case of a patient with gastric undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. A 62-year-old man was referred after a healthcare screening gastroscopy. Gastroscopy revealed an approximately 3x3 cm ulcerofungating mass in the posterior wall of the antrum. Biopsy results revealed a moderately differentiated adenocarcinoma. The initial serum alpha-FP levels were above 350 ng/mL. An abdominal CT scan revealed focal wall thickening along the greater curvature of the gastric antrum, with perigastric fat invasion and enlarged multiple perigastric lymph nodes. He underwent a palliative radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. Immunohistochemical staining revealed that the tumor cells were positive for human chorionic gonadotropin (hCG), alpha-FP, and anti-hepatocyte antibody.

Regulation of Inhibitors of Differentiation Family Proteins by Thyroid-Stimulating Hormone in FRTL-5 Thyroid Cells

Members of the inhibitors of differentiation (Id) family of helix-loop-helix (HLH) proteins are known to play important roles in the proliferation and differentiation of many cell types. Thyroid-stimulating hormone (TSH) regulates proliferation and differentiation by activating TSH receptor (TSHR) in thyrocytes. In this study, we found that Id2, one of the Id family proteins, is a major target for regulation by TSH in FRTL-5 thyroid cells. TSH rapidly increases the Id2 mRNA level in FRTL-5 thyroid cells but the Id2 protein showed biphasic regulatory patterns, being transiently reduced and subsequently induced by TSH treatment. Transient reduction of Id2 protein was noted within 2 hr of TSH treatment and was mediated by proteasomal degradation. Moreover, reduced Id2 expression correlated with the activity of the phosphatidylinositol 3 kinase pathway, which is activated by TSH. Although TSH increases the activity of the Id2 promoter, TSH-induced activation of this promoter was independent of c-Myc. Id2 did not alter TTF-1- and Pax-8-mediated effects on the regulation of the Tg promoter. Thus, in summary, we found that TSH regulates Id2 expression, but that Id2 does not alter the expression of thyroid-specific genes, such as Tg, in FRTL-5 thyroid cells.

SIADH closely related to a non-functioning pituitary adenoma: case report / 대한내과학회지

We present a case of severe hyponatremia in a 64-year-old man who had a pituitary tumor. He had nausea and recurrent vomiting with a severe headache, and was admitted to Chungnam National University Hospital for further evaluation. On physical examination, he was alert, and had bitemporal hemianopsia. There was no indication of dehydration or edema. Laboratory data showed a serum sodium level of 126 mEq/L, plasma osmolality of 259 mOsm/kg, and urinary osmolality of 544 mOsm/kg. The plasma argipressin level was 2.88 pg/mL, despite marked hyposmolality. Otherwise, pituitary function was normal. Brain magnetic resonance imaging showed a pituitary macroadenoma measuring 25x16x13 mm and no visible normal pituitary stalk or gland in the sella turcica. After the adenomectomy, the serum sodium level maintained normal without treatment. Histology showed the presence of a pituitary adenoma. These findings indicate that a non-functioning pituitary tumor may cause the exaggerated secretion of argipressin, resulting in inappropriate antidiuretic hormone syndrome.

A Study on Nursing Needs of Patients in the Recovery Room / 기본간호학회지

PURPOSE: The purpose of the study was done to identify the nursing care needs of patients in the recovery room. METHOD: The subjects in this study were 127 patients in a recovery room between 6/9/2001 and 24/9/2001. The instrument used for this study was the descriptive questionnaire developed by Shin Hyun-Jin (1999). The data was analysed by frequency, percentage, mean, standard deviation, t-test, ANOVA, and factor analysis using the SPSS program. RESULT: 1) Kaiser-Meyer-Olkin sample appropriateness was 0.799 and Bartlett's test of sphericity significant probability was 0.000. 2) The mean score for nursing care need of patients in the recovery room was 4.17+/-.51 of a total possible score of 5. The score of nursing need for different parameters was as follows: Educational need (4.31+/-.49), physical need (4.27+/-.47), emotional need (4.11+/-.52), environmental need (3.99+/-.56). 3) Differences in the needs for nursing care according to the demographics were significant for gender, marital status, operation experience, and departments consulted. General characteristic variables significantly related to nursing need were as follows: Physical need significantly related to the departments consulted (F=2.23, p=.036). Educational need significantly related to the marital status (F=2.55, P=.012), departments consulted (F=2.30, p=.031). Emotional need significantly related to the marital status (F=2.22, p=.028). Environmental need significantly related to the gender (t=-2.44, p=.016), marital status (F=2.01, p=.046), operation experience (t=-1.99, p=.048). CONCLUSION: Nursing care needs of patients in the recovery room are significantly related to educational need, physical need, emotional need and environmental need. Intervention plans and program need to be developed to improve strategies to meet nursing needs of patients in the recovery room.