Clinical Predictors Associated with the Severity of Colonic Diverticulitis

BACKGROUND/AIMS: Colonic diverticular diseases are increasing in Korea due to aging of the population and westernization of people's lifestyle. The aim of this study was to investigate the clinical predictors associated with the severity of colonic diverticulitis in Korea. METHODS: We retrospectively reviewed the medical records of 107 patients who were hospitalized with diverticulitis and underwent abdominopelvic computerized tomography at Dankook University Hospital between March 2002 and August 2011. The severity of colonic diverticulitis was evaluated by using Modified Hinchey classification, stage 0 to stage Ia were classified as mild group and stage Ib to stage IV were classified as severe group. Patients??records were assessed for age, sex, underlying diseases, history of diverticulitis, associated symptoms, location of diverticulitis, white blood cells, and C-reactive protein (CRP). RESULTS: Male to female ratio was 1.6:1 with the mean age of 43.1 years. Eighty-three patients (77.6%) were in the mild group and 24 patients (22.4%) were in the severe group. In multivariated analysis, the clinical predictors associated with the severity of colonic diverticulitis were left location (odds ratio [OR], 7.268; P=0.030), duration of symptoms (> or =3 days; OR, 4.174; P=0.022), and elevated CRP (> or =5 mg/dL; OR, 4.576; P=0.018). CONCLUSIONS: Left location, duration of symptom, and elevated CRP were the meaningful predictors for severity of colonic diverticulitis. When confronting with patients with these risk factors, we should keep in mind about the possibility of severe diverticulitis.

A Case of Yersinia enterocolitica Enterocolitis Accompanied by Colonic Adhesion after Surgery for Uterine Myoma in an Adult Patient / 대한내과학회지

Yersinia enterocolitica infection in adults in Korea is reported rarely. Therefore, the possibility of Yersinia infection as a cause of abdominal pain may be overlooked. Because its clinical features are similar to those of acute appendicitis or other diseases that require operations, Yersinia enterocolitis should be diagnosed before surgery. We recently experienced a case of Y. enterocolitica enterocolitis accompanied by postoperative colonic adhesion. A 39-year-old female patient with a 5-year history of asymptomatic uterine myoma underwent transabdominal hysterectomy due to abdominal pain. However, the pain worsened. On CT, diffuse swelling of the right colon and adhesion of the sigmoid colon with luminal narrowing were found. Colonoscopy showed multiple aphthous ulcers with mucosal hyperemia from the cecum to the sigmoid colon. Multiplex PCR with stool specimens, a hemagglutination test for Y. enterocolitica O:3, and tissue culture were positive for Y. enterocolitica. After fluids and antibiotic therapy, her symptoms were relieved.

Analysis of prognostic factors and 5-year survival rate in patients with hepatocellular carcinoma: a single-center experience / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC), which is the third most common cancer in Korea, has a very poor prognosis. However, only a few studies have performed a comprehensive survival-related analysis in all patients who were consecutively diagnosed and treated over a given period of time. The aim of this study was to determine the 5-year survival rate and its prognostic factors among HCC patients. METHODS: In total, 257 patients who were consecutively diagnosed with HCC between January 2000 and December 2003 were followed until death or until December 2008. We analyzed their survival outcomes according to their clinical characteristics, tumor staging, and treatment modalities, and determined the independent prognostic factors affecting survival. RESULTS: The patients were aged 59+/-10 years (mean+/-SD). During the follow-up period, 223 patients (86.8%) died and the overall median survival was 10.8 months; the 1-, 3-, and 5-year survival rates were 44.4%, 21.0%, and 12.1%, respectively. The outcomes in patients with tumor node metastasis (TNM) stage I or II and Child-Pugh class A or B were significantly better with surgical resection than with other treatment modalities (P<0.01). Patients who underwent supplementary transcatheter arterial chemoembolization as a second-line treatment after surgical resection had better outcomes than those who underwent surgical resection alone (P=0.02). Initial symptoms, Child-Pugh class, serum alpha-fetoprotein, tumor size, portal vein thrombosis, and TNM stage were found to be independent prognostic factors for survival among HCC patients. CONCLUSIONS: This retrospective cohort study elucidated survival outcomes and prognostic factors affecting survival in HCC patients at a single center.

Investigations of Samwhang-sasimtang Extracts on Biological Activities In Vitro and Vivo / 한국실험동물학회지

In this study, we investigated the in vitro antioxidative effects, antimicrobial activities and single oral dose toxicity of the extracts from Samwhang-sasimtang to evaluate its use as a functional ingredient in cosmetics. In the antioxidative effect, the ethanol extract from Samwhang-sasimtang (SSE) had higher antioxidant values of 91.9% at 1,000 microgram/mL than that of water extract from Samwhang-sasimtang (SSW, 77.0%) when evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity. 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical cation decolorization of SSE was 82.2%, higher than that of the SSW (55.0%) and the antioxidant protection factors (APF) of SSW and SSE were 1.64 and 1.62 at 1,000 microgram/mL in concentration, respectively. This study was also undertaken to test the in vitro antimicrobial activity with the extracts of Samwhang-sasimtang. In general, the SSE showed the significant antimicrobial activity against Staphylococcus aureus and Staphylococcus epidermidis. In single oral dose toxicity study, there were no differences in vivo were observed between control and treated groups in clinical signs, body weight gains, and gross finding. The results indicated that SSE did not show any toxic effects at 10 mL/kg in mice, and the LD50 of SSE was found to be higher than 10 mL/kg in this experiment. In conclusion, the extracts from Samwhang-sasimtang may act as a natural subsistence for functional cosmetics.

Inhibitory Effect of Luteolin Liposome Solution by Animal Model for Atopic Dermatitis in NC/Nga Mice / 한국실험동물학회지

Atopic dermatitis is a common chronic inflammatory skin disease, associated with marked inflammatory cells (of mast cells and eosinophils) and severe itching, which leads to clinical problems in the pediatric population. This study was designed to investigate the inhibitory effects of luteolin liposome solution, that is entrapped the hydrophobic luteolin (one of the flavonoids) into ethosome to improve its stability, by using hapten-induced atopic dermatitis animal model (NC/Nga mice).The luteolin liposome treated mice showed anti-inflammatory effect as evidenced by the lowering of erythema and edema in clinical observation, reduction of inflammatory cell infiltration and epidermal thickness in histopathological examination, when compared with TNCB induced controls. Luteolin liposome solution also reduced the serum IgE level which played important roles in the atopic dermatitis model. These results suggest that luteolin liposome solution has some merit in this formulation showing inhibitory effects for the atopic dermatitis.

Biological Activity and Single Oral Dose Toxicity of Dansam-samultang / 한국실험동물학회지

In this study, we investigated the in vitro antioxidative effects, antimicrobial activities and single oral dose toxicity of the extracts from Dansam-samultang to evaluate its use as a functional ingredient in cosmetics. In the antioxidative effect, the ethanol extract from Dansam-samultang (DSE) had higher antioxidant values of 92.0% at 1,000 microg/mL than that of water extract from Dansam-samultang (DSW, 86.0%) when evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity. The superoxide dismutase-like activity of DSW and DSE were 16.3% and 21.3% at 1,000 microg/mL in concentration, respectively. Xanthine oxidase inhibition activity of the DSE was higher 51.5% than that of the DSW (21.4%). This study was also undertaken to test the in vitro antimicrobial activity with the extracts of Dansam-samultang. In general, the DSE showed the significant antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermiders and Escherichia coli. In single oral dose toxicity study, in vivo, there were no differences between control and treated groups in clinical signs, body weight gains, and gross finding. The results indicated that DSE did not show any toxic effects at 10 mL/kg in mice, and the LD50 of DSE was found to be higher than 10 mL/kg in this experiment. In conclusion, the extracts from Dansam-samultang may act as a natural subsistence for functional cosmetics.

Aspectual Comparison of the Skin Changes in Hairless Mice According to the Aging Type / 한국실험동물학회지

The purpose of this study was to compare the skin changes in female SKH-1 hairless mice between UVB irradiated photo-aged group and endogenous aged group. The UVB irradiation and endogenous aged groups showed poor skin conditions when compared with normal (N) group in terms of the skin erythema, water content and TEWL (transepidermal water loss). For the changes in gross observation and replica image analysis on wrinkle of the skin tissue, UVB irradiation group showed thicker, wider and deeper wrinkles than the changes seen in N group, whereas endogenous aged group showed thinner, narrower and shallower wrinkles than that of UVB irradiation group. In histopathological findings, UVB irradiation group and endogenous aged group showed thickened epidermis, increased dermal inflammatory cells, decreased collagen and elastic fiber content, increased number of degranulated dermal/subcutaneous mast cells, and lower expression quantity of TGF-beta in dermal layer when compared with N group, but to a lesser extent in aged group than the changes in UVB irradiation group. UVB irradiation group and endogenous aged group showed significantly higher xanthine oxidase activity, lower superoxide dismutase and catalase activities, and higher expression of MMP-3 mRNA in skin than N group. Therefore, aspectual comparison of the skin change in hairless mice between photo-aged and endogenous aged groups showed different each other, and these results will be useful for skin aging research.

A gastric bezoar treated with an endoscopic urokinase injection / 대한내과학회지

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract. Treatment options include dissolution with enzymes, endoscopic removal or aspiration, and surgery. The outcome differs according to the treatment method. A 57-year-old man was admitted with a 1-month history of epigastric pain. On gastrofiberscopy, an approximately 2-cm deep ulcer was seen on the lesser curvature of the antrum and three huge bezoars were found. In order to remove the first one, we injected Coca-Cola into it directly. It took 20 minutes to cut up and 1 hour to remove completely. To decrease the procedure time, we changed the injection fluid to urokinase for the remaining two bezoars. It took 9 and 10 minutes to cut up the second and third bezoars, respectively, and 1 hour to remove them completely. We report a case of phytobezoars treated successfully by endoscopic injections of Coca-Cola and urokinase.

A Case of Malignant Gastrointestinal Stromal Tumor of Ileum with Liver Abscess / 대한소화기학회지

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.

A Case of Early Gastric Adenocarcinoma Mimiking a Submucosal Tumor / 대한소화기내시경학회지

Early gastric adenocarcinoma with the endoscopic features resembling a submucosal tumor is extremely rare and is characterized by erythema, central depression and erosion on the surface of the lesion, which can be distinguished from submucosal tumor. When a tumor is completely covered with normal mucosa, it is extremely difficult to obtain endoscopic biopsy specimens from the underlying lesion. EUS alone is not necessarily diagnostic. Various techniques have been advocated to overcome this problem, including US-guided biopsy, partial removal by an endoscopic snare excision, endoscopic mucosal resection as well as EUS with FNA. We encountered a case of an early gastric adenocarcinoma with well differentiation, presenting as a submucosal tumor. The early gastric adenocarcinoma was evaluated by endoscopy and EUS, and was confirmed by a surgical resection. We report this case with a review of the relevant literature.