Diagnostic Value of Carcinoembryonic Antigen in Ascites for Colorectal Cancer with Peritoneal Carcinomatosis / 대한소화기학회지

BACKGROUND/AIMS: Diagnostic tests for carcinoembryonic antigen (CEA) in ascites have been performed in various malignant cases, but there is only few data on the applicability of CEA for colorectal cancer (CRC) patients with peritoneal carcinomatosis. We aimed to determine the usefulness of CEA in ascites (aCEA) as a diagnostic parameter for CRC with peritoneal carcinomatosis. METHODS: Between January 2000 and May 2013, the medical records of 259 patients who underwent paracentesis for the evaluation of ascites were retrospectively reviewed. CRC patients with ascites (n=82) and patients with non-malignant ascites (n=177) were evaluated. Patients who had other malignancies, including gastric or ovarian cancer, with ascites were excluded. The optimal diagnostic cut-off value of aCEA for CRC with peritoneal carcinomatosis was determined using receiver operating characteristic curve analysis. The value of aCEA for predicting the occurrence of peritoneal carcinomatosis was evaluated using a logistic regression model. RESULTS: The optimal cut-off value of aCEA to diagnose CRC with peritoneal carcinomatosis was 3.89 ng/mL, and the area under the curve for aCEA was 0.996 (sensitivity 96.3%, specificity 100%, positive predictive value 100%, negative predictive value 98.3%). Multivariate logistic regression analysis showed that aCEA was an independent factor predicting the occurrence of peritoneal carcinomatosis. CONCLUSIONS: In this study, we showed that aCEA may be a useful parameter for diagnosing CRC with peritoneal carcinomatosis, and we propose an optimal aCEA cut-off value of 3.89 ng/mL. Further study that includes patients with other malignant ascites may be necessary to validate these findings.

A case of amebic colitis mimicking pseudomembranous colitis / 대한내과학회지

No abstract available.

A case of primary splenic lymphoma presenting as a splenic abscess / 대한내과학회지

Primary splenic lymphoma (PSL) is very rare, with a reported incidence of less than 1% of all malignant lymphomas. The differential diagnosis of a solitary splenic mass should include benign entities, such as hemangioma, hamartoma, simple cyst, and metastatic carcinoma, as well as abscess. We report a case of primary splenic lymphoma presenting as a splenic abscess. A 27-year-old man presented with left upper quadrant pain for 3 days. Abdominal computed tomography (CT) revealed a splenic mass, a well-defined hypodense lesion (4.5*4 cm) in the posterosuperomedial aspect of the spleen. The patient improved clinically with percutaneous drainage of the spleen cystic mass and antibiotic therapy. After 8 months, he presented again with left upper quadrant pain and fever. Abdominal CT revealed progression of the splenic mass (5*.5 cm) with some internal hemorrhage. The patient underwent splenectomy for a definitive diagnosis and treatment. At surgery, a splenic tumor was found with no evidence of it involving other sites, and it was confirmed pathologically as a diffuse large B cell lymphoma of the spleen.

A Case of Small Cell Carcinoma of the Rectum Associated with Ulcerative Colitis / 대한소화기내시경학회지

Small cell carcinoma associated with ulcerative colitis is a rare malignancy of the colon, so we report here on a case of small cell carcinoma (SCC) of the large bowel. A 60-yr-old woman had been diagnosed with ulcerative colitis about 10 years previously, and she was then continuously treated with 5-ASA. Colonoscopy was being done every two years for cancer surveillance. The last colonoscopy was done 16 months previously. At that time, colonoscopic finding was mild left side colitis. She was hospitalized because of severe abdominal pain and acute constipation that developed 2 weeks previously. During the colonoscopic examination, an obstructive mass was noted on the rectum. Pathology revealed small cell carcinoma. NSE (neuron specific enolase) and Synaptohpysin were strongly positive. Chromogranin and Cytokeratin were focally positive to a weak degree. So, the patients received a Hartmann's operation (T-colostomy). The mass had grossly invaded the adjacent peritoneum and serosa. Therefore, only the mass was removed. She then received chemotherapy with cisplatin and irinotecan for 2 cycles. She achieved a stable state 2 months after the operation. Only a few cases of colorectal SCC associated with ulcerative colitis have been reported, and its etiology remains unknown. Thus, we report here on a small cell carcinoma arising from ulcerative colitis.

Effects of pegylated interferon and ribavirin in Korean patients with chronic hepatitis C virus infection / 대한간학회지

BACKGROUND/AIMS: We assessed the efficacy and safety of pegylated interferon (peginterferon) plus ribavirin and identified the predictors of a sustained virologic response (SVR) in Korean patients with chronic hepatitis C virus infection. METHODS: A total of 192 patients with chronic hepatitis C, treated with both peginterferon (n=141) or conventional interferon (n=51) and ribavirin, were analyzed retrospectively. Peginterferon alfa-2a (180 microgram/week) or -2b (1.5 microgram/kg/week) or interferon alfa-2a (3 MIU thrice weekly) was administered in combination with ribavirin at 1,000-1,200 mg/day for 48 weeks for genotype 1 and at 800 mg/day for 24 weeks for genotypes 2 and 3. RESULTS: The overall SVR rate was 80.9% (114/141) in the peginterferon group and 52.9% (27/51) in the interferon group (P=0.0001). The SVR rate in genotype 1 was 69.5% (41/59) in the peginterferon group and 31.6% (6/19) in the interferon group (P=0.0033), whereas in genotype 2 or 3 it was 89.0% (73/82) in the peginterferon group and 65.6% (21/32) in the interferon group (P=0.0032). The predictors of SVR in the peginterferon group were genotype, absence of cirrhosis, and early virologic response (P<0.05). CONCLUSIONS: In Korean patients with chronic hepatitis C, a regimen of peginterferon and ribavirin was more effective than a regimen of conventional interferon and ribavirin. This result is comparable to those from studies on Western patients as an initial treatment for chronic hepatitis C.

Gemcitabine/Cisplatin Combination Chemotherapy in Advanced non-Small Cell lung Cancer / 결핵

BACKGROUND: To evaluate the efficacy and safety of gemcitabine and cisplatin chemotherapy in advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Forty patients (21 men, 19 women ; age range, 37 to 73 years; median, 63 years) with unresectable stage IIIB to IV NSCLC were evaluated. Patients received cisplatin 60mg/m2 (Day 1), gemcitabine 1200mg/m2 (Day 1 and 8) every 21 days. Eighteen patients had stage IIIB disease and 22 had stage IV. There were 28 patients of adenocarcinoma (70.0%), 11 of squamous cell carcinoma (27.5%), and one of large cell carcinoma (2.5%). RESULTS: Of 40 patients, no patients showed complete response while 15(37.5%) showed partial response, 7(17.5%) had stable diseases, 18(45%) had progressive diseases. During a total of 195 courses of chemotherapy, grade 3 or more granulocytopenia and thrombocytopenia occured in 12.5% and 2.5% of patients respectively. Non-hematologic toxicity was mild and easily controlled. There was one case of treatment-related death by pneumomia. The median survival was 55 weeks (95% CI, 34~75weeks), and the time to progression was 19 weeks (95% CI, 16~23weeks). One year survival rate was 55% and 2 year survival rate was 10%. CONCLUSION: The efficacy of cisplatin and gemcitabine combination chemotherapy was acceptable in the treatment of advanced NSCLC.

A Case of Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis Involving Skeletal Muscles / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B cell-lymphoma characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. Unlike MALT-lymphoma, MLP has a strong tendency for histologically monomorphic character, extra-digestive localization, rare lymphoepithelial lesion and poor prognosis. The malignant cells of MLP share morphological, immunohistologic and cytogenetic similarities with cells of node-based mantle cell lymphoma. We report a case of mantle cell lymphoma presenting with MLP involving various segments of the gastrointestinal tract, skeletal muscles of the right thigh and bone marrow observed in a 71-year-old woman who complained of lower abdominal pain and a palpable right thigh mass.

A Case of Gastric Submucosal Tumor Suspected to be Caused by Anisakis / 대한소화기내시경학회지

Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature.

Esophageal Manometric Findings of 1,746 Patients with Esophageal Symptoms / 대한소화관운동학회지

BACKGROUND/AIMS: To evaluate the prevalence, relationship between symptoms and esophageal motility disorders, and the factors that could affect in esophageal motility, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms. METHODS: Records from 1746 patients referred to our manometric laboratory for evaluation of esophageal symptoms between September 1994 and September 2002 were enrolled. We used low compliance pneumohydraulic capillary infusion system to perform esophageal manometry. RESULTS: Among patients with abnormal esophageal motility, 390 cases of nonspecific esophageal motility disorder, 20 cases of nutcracker esophagus, 11 cases of achalasia, 4 cases of hypertensive lower esophageal sphincter, and 4 cases of diffuse esophageal spasm were present. The symptoms of 1746 patients were oropharyngeal dysphagia, esophageal dysphagia, non-cardiac chest pain or chest discomfort, substernal soreness or heartburn, regurgitation, and lump sensation. In multivariate analysis, age (OR=1.95; p=0.007) was an independent factor affecting esophageal motility. CONCLUSIONS: There are esophageal motility disorders in 24.6% of patients with esophageal symptoms, and various symptoms are present in them. The factor associated with the abnormal findings of esophageal manometry is age.

Clinical Findings of Upper Gastrointestinal Bleeding and Risk Factors for Early Rebleeding in Patients with Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: Upper gastrointestinal (UGI) bleeding may have serious complications. Endoscopic therapy is effective in the hemostasis of active bleeding. We analysed the causes of UGI bleeding and evaluated risk factors and rate of rebleeding in patients with bleeding peptic ulcer. METHODS: Records from 326 patients admitted with upper gastrointestinal bleeding between January 1998 and December 2002 were reviewed. We retrospectively analyzed clinical findings and rebleeding risk factors of peptic ulcers. RESULTS: Common causes of UGI bleeding were esophageal varix (38.0%), peptic ulcer (36.9%), Mallory-Weiss tear (13.8%), stomach cancer (6.4%). Early rebleeding of bleeding peptic ulcer after hemostasis occurred in 23 cases (19.2%). On the basis of univariate analysis, significant predictive factors for early rebleeding were old age (>65) (p=0.034), size of ulcer (>2 cm) (p=0.002), number of ulcer (>1) (p=0.059). In multivariate analysis, old age (odds ratio, OR=2.3), size of ulcer (OR=3.3), number of ulcer (OR=2.6) were independent risk factors of rebleeding. CONCLUSIONS: Common causes of UGI bleeding are esophageal varix, peptic ulcer, Mallory-Weiss tear. Predictive risk factors for early rebleeding in bleeding peptic ulcer may be old age, size of ulcer and number of ulcer.

Expression of MAGE in the Induced Sputum of Lung Cancer Patients / 결핵

BACKGROUND: Tumor associated antigens, which are produced specifically by tumor cells, are promising targets for the early diagnosis and immunotherapy. Among the tumor associated antigens, MAGE (a melanoma antigen), BAGE, GAGE, PRAME and NY-ESO were named as cancer/testis specific antigens since they are detected exclusively in the testis or cancer cells. If MAGE is easily detectable in the sputum, it would become a convenient method for diagnosing lung cancer. This study was undertaken to investigate MAGE expression in the induced sputum obtained from lung cancer patients. METHOD: In 14 control patients and 30 lung cancer patients, the induced sputum was collected after inhaling 3% saline(5 cc) delivered by nebulizer for approximately 5 minutes after a mouth rinse and bronchodilator inhalation. The induced sputum was placed in a conservative-mixed solution (guanidinium isothiocyanate, Triton X-100). The total cellular mRNA was extracted from the cells and RT PCR and nested PCR were run in 30 and 35 cycles respectively, with two different types of primers specially designed to detect six subtypes of MAGE DNA simultaneously. RESULTS: MAGE expression was not detected in the 14 controls, but in the 30 cancer patients, MAGE was found in 24 patients (80%, p=0.001). In the cancer patients, there were no differences in the expression level according to the tissue types (squamous cell cancer 13/17, adenocarcinoma 7/9, and small cell cancer 4/4, p=0.56). Among the 24 MAGE-positive patients, the tumor was not visible on a bronchoscopy in 11 patients (45.8%). CONCLUSION: A study of MAGE in induced sputum appears to be a useful and complementary method in the diagnosis of lung cancer. A further prospective study with more patients is recommended.

A Case of Ig A Nephropathy Associated with Polycythemia Vera / 대한신장학회잡지

Secondary polycythemia is occasionally associated with renal diseases such as renal tumors, cysts, hydronephrosis, renal transplantation, renal artery stenosis and Bartter's syndrome and is rarely associated with nephrotic syndrome, nephrosclerosis, pyelonephritis, chronic gromerulonephritis and membranous nephropathy. The association of polycythemia vera and Immunoglobulin A nephropathy (IgAN) is well not known, and there are only a few isolated reports presenting the concomitance of polycythemia vera and IgAN. We report one patient with concomitant polycythemia vera and Ig A nephropathy. A 53 year-old male visited our hospital because of elevated hemoglobin level. Blood value of hemoglobin was 22.1 g/dL. Isotopic blood studies with radioactive chromium (51Cr)-labelled red blood cells revealed a total blood volume of 90 mL/kg and total red cell volume of 61.8 mL/kg. The concentration of serum erythropoietin measured by radioimmunoassay was 14.29 mIU/mL (normal 10.2-25.2 mIU/mL). Bone marrow aspirate revealed hypercellularity and panmyelosis, characteristically. Renal biopsy specimens showed moderate mesangioproliferative lesions with mesangial IgA and C3 deposition. Treatment with phlebotomy, hydroxyurea and oral prednisolone (1 mg/kg/day) was done. There was no decrease of urinary protein following treatment of phlebotomy and hydroxyurea. But urinary protein decreased and hemoglobin level normalized following combination treatment of phlebotomy, hydroxyurea and oral prednisolone.