Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?

AIM: To investigate the correlation between the changes of pancreatic enzyme, the biochemical markers and the clinical results according to the Balthazar computer tomography (CT) grade. METHODS: Between July 2004 and July 2005, we reviewed the charts of 119 patients who were admitted to our hospital with acute pancreatitis. RESULTS: Eighty-three patients (69.7%) were male, and the mean age of the patients was 57 +/- 15.7 years. The biliary pancreatitis patients had an older mean age. Forty-nine patients (41.1%) had biliary pancreatitis and forty-six (38.6%) had alcoholic pancreatitis. Group 3 patients had a longer duration of pain (2.51 +/- 1.16 vs 3.17 +/- 1.30 vs 6.56 +/- 6.13, P < 0.001), a longer period of fasting (7.49 +/- 4.65 vs 10.65 +/- 5.54 vs 21.88 +/- 13.81, P < 0.001) and a longer hospital stay (9.17 +/- 5.34 vs 14.63 +/- 8.65 vs 24.47 +/- 15.52, P < 0.001) than the other groups. On the univariate analysis, the factors that affected the radiological grade were the leukocyte count at admission (P = 0.048), the hemoglobin (P = 0.016) and total bilirubin concentrations (P = 0.023), serum lipase (P = 0.009), the APACH II scores at admission (P = 0.017), the APACH II scores after 24 h (P = 0.031), the C-reactive protein (CRP) titer (P = 0.0001) and the follow up CRP titer (P = 0.003). But the CRP level (P = 0.001) and follow up CRP titer (P = 0.004) were only correlated with the radiological grade on multivariate analysis. According to the ROC curve, when we set the CRP cut off value at 83 mg/L, the likelihood ratio for a positive test was 3.84 and the likelihood ratio for a negative test was 0.26 in group 3. CONCLUSION: In conclusion, our study suggests that the CRP with the radiological severity may be used to estimate the severity of acute pancreatitis.

Efficacy and Safety of UI05MSP015CT in Functional Dyspepsia: A Randomized, Controlled Trial.

Background/Aims: To evaluate the efficacy and safety of a controlled release, once-daily formulation of mosapride (UI05MSP015CT) in patients with functional dyspepsia (FD). Methods: Patients with FD were randomly assigned (1:1) to receive either UI05MSP015CT (15 mg once a day, study group) or mosapride (5 mg three times a day, control group) and corresponding placebo for 4 weeks. The primary endpoint was a change in the gastrointestinal symptom score (GIS) evaluated at enrollment and after 4 weeks. Secondary endpoints were changes in the Nepean Dyspepsia Index-Korean version (NDI-K), rate of satisfactory symptom relief, and rate of adverse events. Results: A total of 138 patients were enrolled (female, 73.9%; mean age, 44.0±15.4 years). After excluding patients who violated the study protocol, 59 and 58 patients from the study and control groups, respectively, were included in the per-protocol analysis. No difference was observed in drug compliance between the control and study groups (97.07%±4.52% vs 96.85%±6.05%, p=0.870). Changes in GIS scores were -9.69±6.44 and -10.01±5.92 in the study and control groups. The mean difference in GIS change between groups was 0.33 (95% confidence interval, -1.75 to 2.41), demonstrating non-inferiority of UI-05MSP015CT (p=0.755). The rate of satisfactory symptom relief was not different between the study and control groups (39.0% vs 56.9%, p=0.053). No differences in change in NDI-K score (14.3 vs 16.9, p=0.263) or rates of adverse events (12.9% vs. 4.4%, p=0.062) were observed between the study and control groups. Conclusions: Once-daily mosapride is not inferior to conventional mosapride in efficacy and is safe in patients with FD.

[Docetaxel-cisplatin-5-FU combination chemotherapy as a first-line treatment in patients with metastatic or recurred gastric cancer].

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.

A Case of Endoscopically Complete Remission of Esophageal Neuroendocrine Tumors by Concurrent Chemoradiation Therapy.

Neuroendocrine tumors (NETs) of the esophagus are extremely rare, aggressive and have a poor prognosis. Combined therapy using chemotherapy, radiotherapy and/or surgery appear effective. Here, we present a patient with a complaint of dysphagia who was diagnosed with this rare tumor. Upper gastrointestinal endoscope of a 46-year-old female revealed a localized ulcerative lesion in the middle esophagus. Histologic exam of biopsy specimens indicated a neuroendocrine carcinoma. The tumor cells were arranged in microtubular structures, with small and round cells containing scanty cytoplasm. They were positive for synaptophysin and chromogranin A on immunohistochemical staining. A computed tomography scan showed an esophageal tumor with enlarged superior mediastinal lymph nodes and about 1.2 cm sized liver metastasis, similar to findings in PET-CT scanning. The patient was prescribed chemotherapy consisting of etoposide and cisplatin, which led to regression of disease on follow-up imaging study. She continues under clinical observation. We seek to increase awareness of this exceedingly rare but hazardous disease by sharing our unexpected finding.

Successful treatment of a gastric plasmacytoma using a combination of endoscopic submucosal dissection and oral thalidomide.

We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.

[Comparison of clinical characteristics and prognostic factors between gastric lymphoepithelioma-like carcinoma and gastric adenocarcinoma].

BACKGROUND/AIMS: Gastric lymphoepithelioma-like carcinoma (LLC) is a rare cancer that presents with a unique histologic pattern that is characterized by poorly differentiated malignant cells infiltrating the background stroma along with massive lymphocyte infiltration. Many studies have shown that gastric LLC is associated with better prognosis than other gastric malignancies. However, the reason for better prognosis has not been clarified and the underlying mechanism remains to be elucidated. Therefore, we attempted to determine the clinical characteristics of gastric LLC and identify its prognostic factors related to improved survival. METHODS: A total of 18 patients were diagnosed with gastric LLC after resection from 2005 to 2012 at Department of Gastroenterology in Chungnam National University Hospital. The data of these patients were compared with 36 age- and sex-match-ed patients with poorly differentiated gastric adenocarcinoma who also underwent resection during the same study period. RESULTS: Postoperative recurrence or metastasis tended to occur less frequent in gastric LLC than in poorly-differentiated gastric adenocarcinoma. Among prognostic factors, only the number of lymph node metastases showed significant difference, with gastric LLC being associated with a smaller number of lymph node metastases. Regarding the disease free and overall survival rate, both were higher for gastric LLC than for poorly-differentiated gastric adenocarcinoma, albeit not statistically significant (p=0.089 and p=0.159, respectively). CONCLUSIONS: Poorly differentiated gastric adenocarcinoma was associated with a higher number of lymph node metastases at diagnosis than gastric LCC. Other potential factors affecting prognosis were not significantly different between the two cancer types.

[A case of angiographic embolization of aortoenteric fistula caused by endovascular stent grafting for an abdominal aortic aneurysm].

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.

Adenocarcinoma occurring in a gastric hyperplastic polyp treated with endoscopic submucosal dissection.

Gastric hyperplastic polyps are generally considered benign lesions, although rare cases of adenocarcinoma have been reported. Although, the underlying mechanism of carcinogenesis in gastric hyperplastic polyps is still uncertain, most malignant polyps are seen to originate from dysplastic epithelium rather than from hyperplastic epithelium. Herein, we report the case of a woman diagnosed with adenocarcinoma that originated from a hyperplastic gastric polyp that was successfully removed by endoscopic submucosal dissection. In this case, we observed adenomatous changes around the cancerous component.

Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection.

AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Re-endoscopy was examined in 142 cases and biopsy was performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type IV (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027). CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.

Amiodarone-induced hepatitis and polyneuropathy.

Amiodarone chlorhydrate is a diiodated benzofuran derivative, and it is used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone, and symptomatic hepatic dysfunction occurs in fewer than 1% of the patients taking amiodarone. Cirrhosis is a rare complication that's been confirmed in 12 cases. Peripheral neuropathy occurs in 10% of patients taking aminodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity and peripheral neurotoxicity. A 75 year old man with normal liver function was given amiodarone for treating his atrial fibrillation and heart failure. He developed nausea, vomiting, muscle weakness and wasting after 17.8 months therapy with amiodarone (400 mg orally once per day). Liver biopsy showed the presence of foam cells in the hepatic sinusoids and Mallory bodies in the periportal hepatocytes on light microscopy. Sural nerve biopsy showed demyelination, and nerve conduction studies showed mixed sensorimotor polyneuropathy. These observations show the necessity of monitoring the hepatic function and conducting neurologic examination of the patients treated with amiodarone.