Inverse Prognostic Relationships of ¹⁸F-FDG PET/CT Metabolic Parameters in Patients with Distal Bile Duct Cancer Undergoing Curative Surgery / 대한핵의학회잡지

PURPOSE: As there were few previous studies with a small number of subjects, the purpose of this was to evaluate the prognostic significance of ¹⁸F-FDG PET/CT in patients with distal bile duct cancer undergoing curative surgery.METHODS: The study included 40 patients (M/F = 24:16; age 68.0 ± 8.0 years) who underwent preoperative ¹⁸F-FDG PET/CT followed by curative surgical resection. The participant's age, sex, Eastern Cooperative Oncology Group performance-status score, baseline serum CA 19-9 level, stage, pathologic T and N stages, tumor size, tumor grade, tumor growth pattern, R0 resection, and adjuvant therapy were included as clinicopathological variables for predicting overall survival. The PET variables were maximum standardized uptake value (SUV(max)), average SUV (SUV(avg)), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the tumor. The Kaplan-Meyer method and Cox proportional hazards model were used for the survival analysis.RESULTS: A total of 15 of 40 patients (37.5%) died during the follow-up period. In univariate analysis, low SUVmax (≤ 2.7, p = 0.0005) and low SUV(avg) (≤ 2.6, p = 0.0034) were significant predictors of poor overall survival. In multivariate analyses, only low SUV(max) (HR = 6.7016, 95% CI 1.9961–22.4993, p = 0.0047) was an independent prognostic factor associated with poor overall survival.CONCLUSION: The SUVmax of the primary tumor measured by ¹⁸F-FDG PET/CT was an independent significant prognostic factor for overall survival in patients with distal bile duct cancer. However, different results from a previous study warrant further large sample-sized study.

Inverse Prognostic Relationships of ¹⁸F-FDG PET/CT Metabolic Parameters in Patients with Distal Bile Duct Cancer Undergoing Curative Surgery / 대한핵의학회잡지

PURPOSE@#As there were few previous studies with a small number of subjects, the purpose of this was to evaluate the prognostic significance of ¹⁸F-FDG PET/CT in patients with distal bile duct cancer undergoing curative surgery.@*METHODS@#The study included 40 patients (M/F = 24:16; age 68.0 ± 8.0 years) who underwent preoperative ¹⁸F-FDG PET/CT followed by curative surgical resection. The participant's age, sex, Eastern Cooperative Oncology Group performance-status score, baseline serum CA 19-9 level, stage, pathologic T and N stages, tumor size, tumor grade, tumor growth pattern, R0 resection, and adjuvant therapy were included as clinicopathological variables for predicting overall survival. The PET variables were maximum standardized uptake value (SUV(max)), average SUV (SUV(avg)), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the tumor. The Kaplan-Meyer method and Cox proportional hazards model were used for the survival analysis.@*RESULTS@#A total of 15 of 40 patients (37.5%) died during the follow-up period. In univariate analysis, low SUVmax (≤ 2.7, p = 0.0005) and low SUV(avg) (≤ 2.6, p = 0.0034) were significant predictors of poor overall survival. In multivariate analyses, only low SUV(max) (HR = 6.7016, 95% CI 1.9961–22.4993, p = 0.0047) was an independent prognostic factor associated with poor overall survival.@*CONCLUSION@#The SUVmax of the primary tumor measured by ¹⁸F-FDG PET/CT was an independent significant prognostic factor for overall survival in patients with distal bile duct cancer. However, different results from a previous study warrant further large sample-sized study.

Is Health Screening Beneficial for Early Detection and Prognostic Improvement in Pancreatic Cancer?

BACKGROUND/AIMS: The aim of this study was to evaluate the usefulness of health screening for early detection and improved prognosis in pancreatic cancer. METHODS: Between 1995 and 2008, 176,361 examinees visited the Health Promotion Center (HPC). Twenty patients diagnosed with pancreatic cancer were enrolled. During the same period, 40 patients were randomly selected from 2,202 patients diagnosed with pancreatic cancer at the Out Patient Clinic (OPC) for comparison. RESULTS: Within the HPC group, 10 patients were initially suspected of having pancreatic cancer following abnormal ultrasonographic findings, and 9 patients had suspected cases following the detection of elevated serum CA 19-9. The curative resection rate was higher in the HPC group than in the OPC group (p=0.011). The median survival was longer in the HPC group than in the OPC group (p=0.000). However, there was no significant difference in the 3-year survival rate between the two groups. Asymptomatic patients (n=6/20) in the HPC group showed better curative resection and survival rates than symptomatic patients. However, the difference was not statistically significant. CONCLUSIONS: Health screening is somewhat helpful for improving the curative resection rate and median survival of patients with pancreatic cancer detected by screening tests. However, the benefit of this method in improving long-term survival is limited by how early the cancer is detected.

A Case of Endometriosis with Chylous Ascites / 대한소화기내시경학회지

Chylous ascites is the extravasation into the peritoneal cavity of milky chyle that is rich in triglycerides. Sixty to seventy percent of chylous ascites cases are caused by cirrhotic liver disease, congestive heart failure, or malignancy. The most common malignancy associated with chylous ascites is lymphoma. Rarely, tuberculosis has been reported as a cause of chylous ascites. Appropriately, lymphoma, ovarian cancer or tuberculosis is considered first in the differential diagnosis when a young woman of reproductive age presents with chylous ascites. Recently, we examined a 26-year-old woman who visited our hospital because of abdominal distension. Ascites tapping, esophagogastroduodenoscopy, colonoscopy and diagnostic laparoscopic biopsy led to a diagnosis of intraperitoneal endometriosis with chylous ascites. To date, some cases of endometriosis complicated by massive ascites have been reported. However, endometriosis complicated by chylous ascites has not been previously reported. The case was successfully treated using a gonadotropin-releasing hormone agonist and diuretics.

A Case of Inferior Vena Cava Thrombosis and Acute Pancreatitis in a Patient with Ulcerative Colitis / 대한소화기학회지

A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, antithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postulated that IVC thrombosis occurred due to hypercoagulable status of UC and intra-abdominal inflammation caused by mesalazine-induced pancreatitis.

Comparison of the Eradication Rates of Quadruple Therapy between Non-ulcer Dyspepsia and Peptic Ulcer Disease as a Second-line Treatment for Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: Initial PPI-based triple therapy for a Helicobacter pylori (H. pylori) infection is less effective in patients with non-ulcer dyspepsia (NUD) than in those with peptic ulcer disease (PUD). However, there are no reports of the effects of second-line treatment. We retrospectively analyzed the difference in the eradication rates of second-line quadruple therapy between NUD and PUD patients. METHODS: Between June 2003 and September 2005, patients who failed to respond to the initial PPI-based triple therapy, received seven days bismuth-based quadruple therapy as a second-line treatment. Four to six weeks after completing the schedule, a 13C-urea breath test was performed to detect H. pylori. RESULTS: A total of 87 patients received second-line quadruple therapy. Of these, 43 patients had NUD and 44 patients had PUD (19 with gastric ulcers, 23 with duodenal ulcers, 2 with both ulcers). The eradication rates were 76.7% (33/43) and 90.9% (40/44) in the NUD and PUD groups, respectively. The eradication rates in the NUD group were significantly lower than those in the PUD group (p=0.034). CONCLUSIONS: The seven days bismuth-based second-line quadruple therapy for H. pylori infection appears to be less effective in patients with NUD than in those with PUD. Therefore, an extension of the treatment duration for quadruple therapy or a more potent regimen may be needed as a second-line therapy for NUD patients.

No Evidence of Association of Interleukin 1A(-889) Genetic Polymorphism with Alzheimer's Disease in Koreans

To examine whether the IL-1A(-889) polymorphism associates with a risk for Alzheimer's disease(AD) and acts interactively with the apolipoprotein(APOE) epsilon 4 in the development of AD, we performed genotype analyses of the IL-1A and the APOE of the 102 Korean AD patients and 200 Korean non-demented controls. We failed to detect a significant difference in genotypic and allelic frequencies of IL-1A between the AD group and control group. No overexpression of the IL-1A C/T genotype and IL-1A T allele was found when we analyzed the late-onset and early-onset patients, separately. There was no significant genetic interaction between IL-1A polymorphism and the APOE polymorphism. In conclusion, the IL-1A polymorphism did not contribute to the development of AD independently or interactively with the APOE epsilon4 allele in Koreans.