Predictive factors of contrast-enhanced ultrasonography for the response to transarterial chemoembolization in hepatocellular carcinoma

BACKGROUND/AIMS: The predictive role of contrast-enhanced ultrasonography (CEUS) before performing transarterial chemoembolization (TACE) has not been determined. We assessed the possible predictive factors of CEUS for the response to TACE. METHODS: Seventeen patients with 18 hepatocellular carcinoma (HCC) underwent TACE. All of the tumors were studied with CEUS before TACE using a second-generation ultrasound contrast agent (SonoVue(R), Bracco, Milan, Italy). The tumor response to TACE was classified with a score between 1 and 4 according to the remaining enhancing-tumor percentage based on modified response evaluation criteria in solid tumors (mRECIST): 1, enhancing tumor or =75%). A score of 1 was defined as a "good response" to TACE. The predictive factors for the response to TACE were evaluated during CEUS based on the maximum tumor diameter, initial arterial enhancing time, arterial enhancing duration, intensity of arterial enhancement, presence of a hypoenhanced pattern, and the feeding artery to the tumor. RESULTS: The median tumor size was 3.1 cm. The distribution of tumor response scores after TACE in all tumors was as follows: 1, n=11; 2, n=4; 3, n=2; and 4, n=1. Fifteen tumors showed feeding arteries. The presence of a feeding artery and the tumor size (< or =5 cm) were the predictive factors for a good response (P=0.043 and P=0.047, respectively). CONCLUSIONS: The presence of a feeding artery and a tumor size of less than 5 cm were the predictive factors for a good response of HCC to TACE on CEUS.

Functional Gastrointestinal Disorders in Young Military Men

BACKGROUND/AIMS: To estimate the prevalence and evaluate the associated psychological factors of functional gastrointestinal disorders (FGIDs) in males in their twenties who are currently enrolled in military service. METHODS: A total of 1,073 men in the Korean army were asked to complete questionnaires based on the Rome III criteria and Symptom Checklist-90-revised (SCL-90R). The prevalence of FGIDs was estimated, and the associated psychological factors were evaluated. RESULTS: A total of 967 men participated. The total prevalence of FGIDs was 18.5% (age-adjusted prevalence, 18.1%; 95% confidence interval [CI], 15.3% to 20.8%). The total SCL-90R scores were higher in men with FGIDs than men without FGIDs (24 [interquartile range, 13 to 44] vs 13 [5 to 28], p<0.001) and higher in men with overlapping syndromes than in those with single FGIDs (31 [18 to 57] vs 14 [5.75 to 29], p<0.001). Somatization (odds ratio [OR], 1.141; 95% CI, 1.09 to 1.20; p<0.001), obsessive-compulsive behaviors (OR, 1.084; 95% CI, 1.03 to 1.14; p=0.002) and depression (OR, 0.943; 95% CI, 0.90 to 0.99; p=0.020) were identified as independent predictive factors for FGIDs. CONCLUSIONS: FGIDs are common among men in their twenties who are fulfilling their military duty. Somatization and obsessive-compulsive features from the tense atmosphere are associated with the development or progression of FGIDs. Patients who exhibit overlapping syndromes require greater attention given their more severe psychopathology.

Feasibility of the Mucosa-Tracking Technique in Precut Papillotomy with the Iso-Tome as an Alternative to the Needle-Knife Technique

BACKGROUND/AIMS: The aim of this study was to evaluate whether the mucosa-tracking technique is effective for improving precutting-related pancreatitis and the sustained failure of bile duct cannulation in precut papillotomy (PP) with the Iso-Tome (MTW Endoskopie). METHODS: From September 2004 to June 2006, PP was performed with the Iso-Tome if biliary cannulation failed by conventional methods for approximately 5 minutes. The pink intrapapillary mucosa (PIPM) exposed by PP was tracked and classified into four groups: fully exposed and oriented to the direction of the bile duct (group A) or the pancreatic duct (group B), partially exposed (group C), or unexposed (group D). The success rate of bile duct cannulation (SRBC), the procedure time required for successful bile duct cannulation (PTBC), and the complications in the first session were compared between the mucosa-exposed groups (MEGs; group A, B, and C) and the mucosa-unexposed group (MUEG; group D). RESULTS: A total of 59 patients (25 females, 34 males) with a mean age of 65.2 years were enrolled. The MEGs and MUEG comprised 52 (88.1%) and 7 (11.9%) patients, respectively. SRBC in the first session was 86.4% (51/59) in total and 92.3% (48/52) in the MEGs, compared to only 42.9% (3/7) in the MUEG (p=0.005). The mean PTBC in the MEGs and MUEG was 8.7 minutes and 16.3 minutes, respectively (p=0.23). Complications occurred in 6.8% of the patients (4/59; all pancreatitis); there were no differences between the MEGs (5.8%, 3/52) and MUEG (14.3%, 1/7; p=0.41). All four patients with pancreatitis were managed medically. CONCLUSIONS: The mucosa-tracking technique in PP with the Iso-Tome is a feasible and useful method of enhancing SRBC. PIPM is an important endoscopic landmark for successful PP.

A Case of Lymphangiomatosis Arising in the Colon / 대한소화기내시경학회지

Lymphangioma is a benign vascular lesion that shows the characteristics of subepithelial tumor, which can proliferate in the lymphatic system. Only a few cases of multiple lymphangimas of the colon, the so called "colonic lymphanigomatosis", have been currently reported on the medical literature. Because lymphangioma is absolutely a benign tumor, it does not require any specific treatment, except for rare disease-related symptoms or complications such as anemia, intussusception and protein-losing enteropathy. Endoscopic resection for this tumor has sometimes been performed for both diagnostic and therapeutic purposes. We recently experienced a case of multiple colonic lymphangomas that arose in the ascending colon of a 46-year-old male patient and these lesions were found during performance of colonoscopy. The final diagnosis was confirmed by a pathologic examination of the specimen that was obtained via endoscopic resection. Follow-up colonoscopy at 1 year after the initial examination showed complete resolution of the previously noted lesions without any specific treatment. We report here on a very rare case of colonic lymphangiomatosis along with a brief review of the relevant literature.

Clinical Features of Ischemic Colitis in Patients with Chronic Kidney Disease / 대한신장학회지

PURPOSE: Hemodialysis patients are at an increased risk of ischemic colitis because of accelerated arterial vascular disease rate and hypotension during dialysis. But few data exist on the clinical features of ischemic colitis in patients with chronic kidney disease including dialysis patients in Korea. The aim of this study is to identify the clinical features of ischemic colitis in patients with chronic kidney disease (CKD). METHODS: We retrospectively reviewed total 68 patients (63.9+/-16.2 years) with ischemic colitis. We analyzed medical history, colonoscopic findings, clinical characteristics, and compared them according to kidney function. RESULTS: Twenty-two (33.9%) patients had CKD stage > or =3 at diagnosis of ischemic colitis. Prevalence of hypertension and diabetes was higher in patients with CKD than those with normal kidney function. High leukocyte count and low hemoglobin level were demonstrated at diagnosis in CKD patients. In addition, duration of hospitalization in patients with CKD was longer than patients with normal kidney function. However, there was no significant difference in right colonic involvement, cardiovascular diseases, surgical intervention, and mortality. Hospitalization days was positively correlated with increased leukocyte count (p=0.015) and decreased albumin level (p=0.002), while that was negatively correlated with age-adjusted estimated glomerular filtration rate (p=0.002). CONCLUSION: Ischemic colitis in patients with CKD had longer hospitalization than in those with normal kidney function. However, there was no significant difference in surgical intervention and mortality.