Superficial Esophageal Cancer Treated with Multidisciplinary Care: A Case Report / 대한소화기암학회지

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

Superficial Esophageal Cancer Treated with Multidisciplinary Care: A Case Report / 대한소화기암학회지

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

Delayed Transfer of Major Trauma Patients Under the Current Emergency Medical System in Korea

PURPOSE: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. METHODS: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. RESULTS: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. CONCLUSION: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

A Case of Superior Mesenteric Venous Thrombosis Due to Protein C Deficiency in a Patient with Duodenal Ulcer Bleeding / 대한소화기학회지

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.

Cowden's Disease Detected by Gastric Polyposis during Endoscopy in a Routine Check Up: A Case Report / 대한소화기내시경학회지

Cowden's disease, a rare autosomal dominant disorder characterized by benign hamartomatous overgrowth of various tissues, increases the risk of cancer of the thyroid, breast, endometrium, prostate, and possibly other organs. Generally, germline mutations in the coding sequence for PTEN are found in 80% of patients with Cowden's disease. Here we report a rare case of incidentally discovered gastric polyposis during esophagogastroscopy for medical screening in a patient with a history of surgery for breast and thyroid cancer. Identifyng the mutation in the PTEN gene to a diagnosis of Cowden's disease.

Current State and Problem of the Transfer of Severely Injured Patients in One Regional Emergency Medical Center

PURPOSE: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. METHODS: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggi-do. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. RESULTS: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). CONCLUSION: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

Transhiatal Esophagectomy in Cardia and Esophageal Cancer

PURPOSE: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy (THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. MATERIALS AND METHODS: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. RESULTS: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P0.05). CONCLUSION: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus.