The Clinical Significance of Microsatellite Instability in Patients with Right-sided Colorectal Cancer / 대한소화기학회지

BACKGROUND/AIMS: Colorectal cancer (CRC) with microsatellite instability (MSI) has a better prognosis than CRC with microsatellite stable (MSS). Recent studies have reported biological differences according to tumor location in CRC. In this study, we investigated the clinical significance of MSI in patients with right-sided CRC. METHODS: The medical records of 1,009 CRC patients diagnosed at our institute between October 2004 and December 2016 with MSI test results were retrospectively reviewed. The long-term outcomes of CRC patients with MSI were assessed with respect to tumor location using Kaplan-Meier curves and Cox regression models. RESULTS: The median follow-up duration for all 1,009 study subjects was 25 months (interquartile range, 15–38). One hundred twenty-four of the study subjects had MSI (12.3%) and 250 had right-sided CRC (24.8%). The patients with MSI and right-sided CRC had better disease-free survival (DFS) than those with MSS as determined by the log-rank test (p=0.013), and this result was significant in females (p=0.035) but not in males with right-sided CRC. Multivariate Cox regression analysis showed MSS significantly predicted poor DFS in patients with right-sided CRC (hazard ratio 3.97, 95% CI 1.30–12.15, p=0.016) and in female patients (hazard ratio 4.69, 95% CI 1.03–21.36, p=0.045). CONCLUSIONS: The study shows MSI is a useful predictor of DFS in patients with right-sided CRC, especially in female patients.

Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?

Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

BACKGROUND: In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension. METHODS: A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group. RESULTS: The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56–0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22–13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05–1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors. CONCLUSION: EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

Perception of Clinicians and Diabetic Patients on the Importance of Postprandial Glucose Control and Diabetes Education Status: A Cross Sectional Survey

BACKGROUND: Recent studies have shown the importance of postprandial glucose (PPG) in the development of diabetes complications. This study was conducted in order to survey the perceptions of clinicians and diabetic patients with respect to PPG management and the current status of diabetes education. METHODS: This was a cross-sectional study involving face-to-face interviews and an open questionnaire survey conducted in Korea. A total of 300 patients and 130 clinicians completed questionnaires, which included current education status, self monitoring of blood glucose (SMBG), criteria of diagnosis and management, and perceptions relating to PPG management. RESULTS: While there was a significantly higher perceived need for diabetes education, the sufficiency of the current education was considered to be severely lacking. Fasting plasma glucose (FPG), PPG, and glycosylated hemoglobin (HbA1c) were all important considerations for clinicians when making a diagnosis of diabetes, although PPG was considered less important than FPG or HbA1c in the treatment of diabetes. Most clinicians and patients were aware of the importance of PPG, but actual education on the importance of PPG was not actively being delivered. CONCLUSION: Our study showed that the current status of diabetes education is insufficient to meet the needs of the Korean population. A considerable gap was found to exist between awareness and what was actually taught in the current education program in regard to the importance of PPG. These results suggest that clinicians need to be more active in patient education, especially in regard to the importance of PPG.

What Is the Optimal Monotherapy in Korean Drug-Naive Type 2 Diabetic Patients?: The Practical Evidence of Antidiabetic Monotherapy Study

No abstract available.

The Association of Unintentional Changes in Weight, Body Composition, and Homeostasis Model Assessment Index with Glycemic Progression in Non-Diabetic Healthy Subjects

BACKGROUND: We performed a retrospective longitudinal study on the effects of changes in weight, body composition, and homeostasis model assessment (HOMA) indices on glycemic progression in subjects without diabetes during a four-year follow-up period in a community cohort without intentional intervention. METHODS: From 28,440 non-diabetic subjects who participated in a medical check-up program in 2004, data on anthropometric and metabolic parameters were obtained after four years in 2008. Body composition analyses were performed with a bioelectrical impedance analyzer. Skeletal muscle index (SMI, %) was calculated with lean mass/weightx100. Subjects were divided into three groups according to weight change status in four years: weight loss ( or =5.0%). Progressors were defined as the subjects who progressed to impaired fasting glucose or diabetes. RESULTS: Progressors showed worse baseline metabolic profiles compared with non-progressors. In logistic regression analyses, the increase in changes of HOMA-insulin resistance (HOMA-IR) in four years presented higher odds ratios for glycemic progression compared with other changes during that period. Among the components of body composition, a change in waist-hip ratio was the strongest predictor, and SMI change in four years was a significant negative predictor for glycemic progression. Changes in HOMA beta-cell function in four years was a negative predictor for glycemic progression. CONCLUSION: Increased interval changes in HOMA-IR, weight gain and waist-hip ratio was associated with glycemic progression during a four-year period without intentional intervention in non-diabetic Korean subjects.

A case of metastatic ovarian carcinoma originated from small cell lung carcinoma / 대한산부인과학회지

Approximately 5% to 22% of malignant tumors involving the ovary are metastases, and the carcinomas of the gastrointestinal tract are responsible for 81% to 88% of these cases. A lung cancer, one of the most common malignancies and well known to metastasize widely, rarely metastasize to the ovary. There has been no report on small cell lung cancer metastasized to the ovary in Korea. Recently, we experienced a case of metastatic ovarian cancer originated from small cell lung cancer in 46-year-old Korean woman with which is confirmed with the immunohistochemistry. Herein we report the case with brief review of literature.

A Case of Spontaneous Hemothorax in a Maintenance Hemodialysis Patient / 대한신장학회잡지

The 55 years old male patient, undergoing maintenance hemodialysis, was admitted on our department because of painful swelling on left knee joint. At 19th hospital day, he complained of severe dyspnea. He had a large amount of pleural effusion of the left chest that was shown to be hemothorax by thoracentesis. After closed thoracostomy, about amount of 3,000 mL of blood was drained and bleeding was sustained from pleural cavity, and then emergency thoracotomy was done. We cannot find any bleeding focus in thoracic cavity, but oozing blood was seen on entire inner thoracic cavity. He had no previous invasive procedure or history of trauma before 6 months. We think that hemothorax may be developed because of defected coagulopathy and increased bleeding tendency due to platelet dysfunction in renal failure patient. Immediately thoracotomy and cryoprecipitate were helpful for this patient. We report a rare case of spontaneous hemothorax in a maintenance hemodialysis patient with literature review.

A Case of Idiopathic Megacolon Associated with Sigmoid Volvulus

Megacolon is an uncommon condition in which the bowel is persistently of increased diameter and it is always associated with long-standing constipation. Two main groups are recognized according to whether or not ganglia are present in the intermuscular plane of the rectal wall. Their complete absence, even along a short segment of rectum, denotes Hirschspurung's disease. If ganglia are present, the dilated bowel may be secondary to some predisposing factor such as a stricture, a congenital anorectal abnormality, a cauda equina lesion etc. In other instances, however, there may be no apparent organic reason as to why the bowel should be so dilated. This latter condition is termed "idiopathic megacolon". We report the case of one female patient with idiopathic megacolon. During medical treatment, she was complicated with a sigmoid volvulus, we performed subtotal colectomy and cecorectal anastomosis and she improved without any complication.

A Case of Nutcracker Esophagus Associated with Chest Pain and Antidepressant Treatment / 대한소화관운동학회지

Nutcracker esophagus is thought to be a common cause of noncardiac chest pain although has not been clearly established, and the effective treatment is lacking. The usual forms of therapy for noncardiac chest pain by nutcracker esophagus have been directed traditionally toward reducing esophageal hypermotility and muscle tone such as nitrate and calcium channel blocker. However, the results of this treatment in the long term care of patient with esophageal symptoms have been generally disappointing and often unsatisfactory. Recently, psychosomatic aspect of esophageal motility disorder including antidepressant treatment has been accepted in the treatment of noncardiac chest pain. We report a 48 year old female with nutcracker esophagus associated chest pain by ambulatory 24 hour esophageal manometry who failed diagnosis by conventional manometry. The symptoms of chest pain, quality of life, and depression of the patient were improved after antidepressant medication.

A Case of Menetrier's Disease / 대한소화기내시경학회지

Menetrier's disease is a form of hypertrophic gastropathy occurring primarily in middle-aged males. Patients generally present clinically with dyspepsia and, on occasion, with hypoproteinemic edema and anemia. The latter feature, when combined with the radiographic appearance of the stomach in Menetrier's disease, can lend to confusion with carcinoma and malignant lymphoma. A 45-year-old male was admitted with chief complaint of epigastric dscomfort. Endoscopic examination revealed the appearance of enlarged gastric folds involving the body and fundus of the stomach with relative sparing of the antrum and endoscopic ultrasonography (EUS) reveals characteristic thickening with enhanced echogenicity of the second layer. Biopsies revealed foveolar hyperplasia with cystic dilatation of the glands, compatible with Menetrier's disease. We report a case of Menetrier's disease with brief review of literatures.