Green tea extracts for the prevention of metachronous colorectal polyps among patients who underwent endoscopic removal of colorectal adenomas: A randomized clinical trial.

OBJECTIVES: To determine the preventive effect of green tea extract (GTE) supplements on metachronous colorectal adenoma and cancer in the Korean population. MATERIALS AND METHODS: One hundred seventy-six subjects (88 per each group) who had undergone complete removal of colorectal adenomas by endoscopic polypectomy were enrolled. They were randomized into 2 groups: supplementation group (0.9 g GTE per day for 12 months) or control group without GTE supplementation. The 72-h recall method was used to collect data on food items consumed by participants at baseline and the 1-year follow-up during the past 48 h. Follow-up colonoscopy was conducted 12 months later in 143 patients (71 in control group and 72 in the GTE group). RESULTS: Of the 143 patients completed in the study, the incidences of metachronous adenomas at the end-point colonoscopy were 42.3% (30 of 71) in control group and 23.6% (17 of 72) in GTE group (relative risk [RR], 0.56; 95% confidence interval [CI], 0.34-0.92). The number of relapsed adenoma was also decreased in the GTE group than in the control group (0.7 ± 1.1 vs. 0.3 ± 0.6, p = 0.010). However, there were no significant differences between the 2 groups in terms of body mass index, dietary intakes, serum lipid profiles, fasting serum glucose, and serum C-reactive protein levels (all p > 0.05). CONCLUSION: This study of GTE supplement suggests a favorable outcome for the chemoprevention of metachronous colorectal adenomas in Korean patients (ClinicalTrials.gov number, NCT02321969).

Prospective randomized clinical trial of hydrophilic tapered implant placement at maxillary posterior area: 6 weeks and 12 weeks loading.

PURPOSE: Early loading of implant can be determined by excellent primary stability and characteristic of implant surface. The implant system with recently improved surface can have load application 4-6 weeks after installing in maxilla and mandible. This study evaluated the effect of healing period to the stability of hydrophilic tapered-type implant at maxillary posterior area. MATERIALS AND METHODS: This study included 30 patients treated by hydrophilic tapered-type implants (total 41 implants at maxilla) and classified by two groups depending on healing period. Group 1 (11 patients, 15 implants) was a control group and the healing period was 12 weeks, and Group 2 (19 patients, 26 implants) was test group and the healing period was 6 weeks. Immediately after implant placement, at the first impression taking, implant stability was measured using Osstell Mentor. The patients also took periapical radiographs after restoration delivery, 12 months after restoration and final followup period. The marginal bone loss around the implants was measured using the periapical radiographs. RESULTS: All implants were survived and success rate was 97.56%. The marginal bone loss was less than 1mm after 1 year postoperatively except the one implant. The stabilities of the implants were not correlated with age, healing period until loading, insertion torque (IT), the diameter of fixture and the location of implant. Only the quality of bone in group 2 (6 week) was correlated with the stability of implant. CONCLUSION: Healing period of 6 weeks can make the similar clinical prognosis of implants to that of healing period of 12 weeks if bone quality is carefully considered in case of early loading.

Clinical evaluation of sinus bone graft in patients with mucous retention cyst.

BACKGROUND: Mucous retention cyst refers to a cyst made by expansion due to the blockage of the salivary gland near the maxillary sinus, and it is surrounded by epithelial cells. Most of them are small; therefore, they cannot be found well and are frequently with antral polyp. The aim of this study was to evaluate the clinical prognosis of sinus bone graft in patients with mucous retention cyst. METHODS: This study was performed retrospectively on 23 patients who had sinus bone graft. Group 1 was 8 patients (10 sinuses) who had a mucous retention cyst, and group 2 was 15 patients (17 sinuses) who had no pathologic history about the maxillary sinus. For these patients, sinus bone graft was performed using the lateral approach technique. The total 51 implants were placed 6.22 weeks on the average after sinus bone graft. Sinus membrane perforation during operation, postoperative complications, marginal bone loss after restorative function, implant success rate, and survival rate were analyzed. RESULTS: There was no complication in group 1, and there were three complications in group 2. In group 2, two cases of implants failed. The types of postoperative complications consisted of two minor infections and one wound dehiscence. Two implants of total 51 implants were removed, and the survival rate of implants was 96.08 % (group 1 100 %, group 2 93.5 %). The total success rate of implants was 92.2 % (group 1 95 %, group 2 90.3 %). CONCLUSIONS: The clinical prognosis was not affected by the presence of mucous retention cyst.

A comparison of endoscopic treatments in rectal carcinoid tumors.

BACKGROUND: Various endoscopic techniques for rectal carcinoid tumors have been developed recently. In this study, we compared the outcomes of conventional endoscopic mucosal resection (EMR), strip biopsy, and EMR after circumferential precutting (EMR-P). METHODS: From March 2004 to July 2014, the medical records of 188 patients (190 rectal carcinoid tumors) who were treated with an endoscopic procedure for rectal carcinoid tumors were investigated retrospectively. The characteristics of the patients and tumors, the selection of the treatment method, the rate of complete resection, and the rate of complications were analyzed retrospectively. RESULTS: Forty-seven, 75 and 68 cases of EMR, strip biopsy and EMR-P were performed, respectively. The mean procedure time was not significantly different between the EMR, strip biopsy and EMR-P cases (5.6, 6.5 and 7.4 min, respectively, P = 0.119). En bloc resection was achieved in most of the cases (97.8, 98.7 and 95.5 % in the EMR, strip biopsy and EMR-P cases, respectively). However, histologic examination showed positive lateral or deep resection margins in 57 out of 190 cases (30.0 %). Multivariate analysis showed that the strip biopsy and EMR-P methods were independent factors for pathologic complete resection (negative in both lateral and deep resection margins), with odds ratios for margin involvement of 0.20 and 0.43 with 95 % confidence intervals from 0.08 to 0.47 and 0.19 to 0.96, respectively. In all the follow-up cases (81 of 190, 42.6 %), no local recurrence or distal metastasis was found. CONCLUSIONS: Compared to conventional EMR, strip biopsy and EMR-P had a lower risk of incomplete resection. The procedure time and complication rate did not differ between the three groups, and no recurrence was detected during the follow-up period. Strip biopsy and EMR-P are safe and effective methods for the treatment of rectal carcinoid tumors.

A case of severe coronary spasm associated with 5-fluorouracil chemotherapy.

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.

A case of Leclercia adecarboxylata endocarditis in a woman with endometrial cancer.

Leclercia adecarboxylata, a motile, gram-negative bacillus of the enterobacteriaceae family, is rarely recovered as a pathogen. We report an exceptionally rare case of L. adecarboxylata endocarditis complicated by embolization of the kidney and spleen in a 48-year-old woman with endometrial cancer. After 4 weeks of antimicrobial treatment, she recovered without sequelae.

Spontaneous rupture of idiopathic thymic abscess with a markedly increased CA-125 level.

We report a rare case of spontaneous rupture of idiopathic thymic abscess into the pleural cavity. A 64-year-old woman was admitted to hospital with pleuritic retrosternal chest pain. Chest roentgenograms disclosed a small amount of bilateral pleural effusion, the examination of which exposed a sterile serous exudate with a markedly increased CA-125 level. Chest computed tomography revealed a large anterior mediastinal cystic mass with bilateral pleural effusions. Following complete resection of the mass, the histological examination revealed cavitary lesion with necrotic thymic tissue and inflammatory infiltrate surrounded by fibrous wall. The immunohistochemical staining for CA-125 displayed strong positivity at the Hassall's corpuscles. Cyst fluid also revealed a highly elevated CA-125 level. Her serum CA-125 concentration two months after surgery had fallen to 28 IU/L. She is now doing well without recurrence of the cyst five months after surgery.

Right-sided myxomas with extramedullary hematopoiesis and ossification in Carney complex.

The authors report the case of multiple right-sided myxomas in a 42-year-old man with Carney complex. He had previously been diagnosed as Cushing's syndrome and undergone resection of pituitary adenoma at the age of 21. After 10 years, bilateral adrenalectomy had been performed with recurrence of Cushing's syndrome. Recently, he complained of palpitation and intracardiac masses were detected. On physical examination, he had nevi on the lips and in the oral cavity. A tiny eyelid nodule was noted and histopathological analysis confirmed the diagnosis of skin myxoma. Thyroid ultrasonography revealed multiple hypoechoic nodules, which were confirmed pathologically as follicular adenomas. Scrotal ultrasonography also revealed small multiple testicular tumors. Echocardiography demonstrated intracardiac masses in right atrium and right ventricle. Right atriotomy revealed a right atrial mass attached to the annulus of the tricuspid valve and another mass arising from the interatrial septum. In right ventricle, a polypoid mass arose from the anterior leaflet of the tricuspid valve. Also, there were multiple tiny to small masses on the interatrial septum. The masses were completely excised and the tricuspid valve was repaired with annuloplasty. Histopathological analysis confirmed myxomas with foci of extramedullary hematopoiesis and ossification.