Association of Methylenetetrahydrofolate Reductase C677T, A1298C, and G1793A Polymorphism and the Risk of Colon Cancer

PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) is a critical enzyme regulating folate level, which affects DNA synthesis and methylation. MTHFR is highly polymorphic, and its variant genotypes result in decreased MTHFR enzyme activity and lower plasma folate level. Generally, a low folate level is known to be associated with a gastrointestinal neoplasm. Three common single nucleotide polymorphisms (SNPs) resulting in amino-acid changes (C677T, A1298C and G1793A) have been reported in MTHFR. We studied the relationship of MTHFR C677T, A1298C and G1793A polymorphisms between from colon cancer group and control group of Korean people. METHODS: We performed a case- control study to examine the relationship between MTHFR C677, A1298C, and G1793A polymorphisms and the risk of colon cancer. Two hundred seven (207) individuals with colon cancer and 288 healthy persons were analyzed. Blood sampling of each group was performed, and (PCR-RFLP) was analyzed; as a result, MTHFR polymorphism genotypes were obtained. RESULTS: The genotype frequencies of MTHFR C677T polymorphisms were 27.1% (CC), 48.3% (CT), 24.6% (TT), and 72.9% (CT+TT) in the patient group and 39.2% (CC), 36.8% (CT), 24.0% (TT), and 60.8% (CT+TT) in the control group. The genotype frequencies of MTHFR A1298C polymorphisms were 58% (AA), 35.7% (AC), 6.3% (CC), and 42% (AC+CC) in the patient group and 55.6% (AA), 40.3% (AC), 4.2% (CC), and 44.4% (AC+CC) in control group. The genotype frequencies of MTHFR G1793A polymorphisms were 83% (GG), 15.9% (GA), 1% (AA), and 16.9% (GA+AA) in the patient group and 85.8% (GG), 11.8% (GA), 2.4% (AA), and 14.2% (GA+AA) in the control group. The 677CT genotype was associated with a significantly increased risk for colon cancer (adjusted OR=1.90, 95% confidence interval: 1.25~2.90 in CT) than the 677CC genotype. The 1298CC, 1298AC, 1793AA, and 1793GA genotypes were not associated with a significantly increased risk for colon cancer. CONCLUSIONS: The MTHFR C677T polymorphism may influence colon cancer, but the MTHFR A1298C and G1793A polymorphisms need to be studied further for careful interpretation and confirmation in larger studies.

Micrometastasis of Sentinel Lymph Nodes in Gastric Cancer

PURPOSE: A lymph node metastasis is one of most important prognostic factors of a malignancy. There is a growing interest in the role of the sentinel node (SN) in the detection of lymph node metastasis. However, the high false negative rate of a sentinel lymph node biopsy limits its utility. The aim of this study is to evaluate a micrometastasis of a gastric cancer to the histologically negative sentinel lymph nodes using the usual stains. METHODS: The SN in 44 out of 57 patients revealed no lymph node metastasis with usual hematoxylin and eosin (H&E) staining. Those nodes were embedded in paraffin and 4-micrometer-thick sections underwent, H&E staining, and cytokeratin immunohisto-chemical (IHC) staining between March 2002 and December 2002. RESULTS: Micrometastases were detected in 3 of the 44 patients without a SN metastasis. All micrometastases were detected in the patients who had metastases to the non-SN without a SN metastasis (3 of 5, 60%). Micrometastases to the SN were significantly frequent in those patients with a metastasis to the non-SN than those without a metastasis (P<0.001). From the detection of micrometastases, the sensitivity and false-negative rate of a sentinel lymph node biopsy ranged from 72.2% (13/18) to 88.9% (16/18), and from 12.8% (5/39) to 4.9% (2/41), respectively. CONCLUSION: 3 cases of micrometastasis of the SN without a metastasis were detected, and this increased the sensitivity and decreased the false negative rate of a SN biopsy. Micrometastases of the SNs were detected only in patients with a skip metastasis of the lymph nodes in this study.

Non-Traumatic Colon Perforation

PURPOSE: Despite advances in surgery, antimicrobial therapy and postoperative intensive care, severe secondary peritonitis, caused by colonic perforation, remains a potentially fatal affliction. The appropriate surgical management of colonic perforation has always been a controversial issue, and one that continues to evolve. The differences in patient's characteristics, due to their medical problems, general conditions, peritonitis grade, or causes of perforation, influence both the surgical decision and the outcome. The aim of this study was to evaluate and compare the incidence, management and outcome of patients with different causes of non-traumatic colon perforation. METHODS: Between February 1993 and February 2002, 42 patients underwent emergency operations for non-traumatic colon perforations. We compared the morbidity and mortality with age, cause, perforation site, extents of peritonitis and surgical procedure. In patients with colorectal-cancer, we assessed the outcomes as perforation types; the perforation of the tumor itself, diastatic perforations proximal to an obstructing tumor and tumor stages. RESULTS: The causes of perforation were cancerous in 17 (40.5%), idiopathic in 7 (16.7%), diverticular in 5 (11.9%), colitis in 4 (9.5%), adhesion and strangulation in 4 (9.5%), stercoral in 3 (7%) and enema induced in 2 (4.8%). The morbidity and mortality in this study was high 76.2 and 26.2%, respectively. The morbidity and mortality was increased as the intra-abdominal fecal contamination increased (P<0.05). but there were no correlations between the complication rate, age, cause, perforation site or operation procedure. In patients with colorectal cancer, there were no correlations between the morbidity and mortality, perforation type or tumor stages. CONCLUSION: A non-traumatic colon perforation is associated with high morbidity and mortality. The prognosis of patients is determined by the grade of their peritonitis. Early diagnosis and prompt surgical management will result in better outcomes for patients with non-traumatic colon perforations.

Systemic Infection by the Gasric Candidiasis

Candida albicans is a saprophytic organism that frequently resides in the mouth, skin, gastrointestinal and vaginal mucosa. It is also an opportunistic pathogen in immune compromised individuals, diabetics, alcoholics, and where drugs have reduced gastric acid production, and in debilitated subjects treated with antibiotics, steroids, and immunosuppressive or antineoplastic drugs. Although the most common site of gastrointestinal involvement is the esophagus, gastric candidiais may occur in immunosuppressed patients, but is rarely apparent in healthy individuals. Systemic infection by gastric candidiasis is extremely rare. A case of gastric candidiasis, presenting with sepsis, was experienced in a 46-year-old male with diabetes mellitus. He underwent orthopedic surgery because of an intertrochanteric fracture of his femur. On day 6 of the postoperative period, the patient began suffering from an intermittent fever, epigastric pain, and vomiting. Day by day the patient's condition became debilitating and sepsis developed. An endoscopic examination revealed multiple whitish, or central necrotic, plaques in the body and antrum of the stomach. An endoscopic biopsy revealed budding yeast and pseudohyphae infiltrating through the ulcerated gastric wall. After the patient was treated with the fluconazole alternative, liposomal amphotericin B, the patient's condition and endoscopic finding improved. Here, a case of gastric candidiasis presenting with sepsis, in reported along with a review of the corresponding literature.

Cancer of the Colorectum: Analysis of Prognosis

To evaluate the several clinicopathological factors and the expression of P-glycoprotein that influence the survival rate of the patients with colorectal cancer, 168 patients with colonic adenocarcinoma, who were operated in Wonkwang University Hospital from January, 1982 to July 1992 were reviewed. The staging of the tumors were performed according to Astler Coller modification of Dukes classification of colon carcinoma. Immunohistochemical staining for P-glycoprotein test was performed with the specimen of Dukes B2 and C of patient who were received postoperative chemotherapy(ACNU+5FU intravenously or oral 5FU) and/or immunotherapy(PSK or OK-432) over 4 months. P-glycoprotein positive was defined when the tumor cells more than 20% showed red dot in the cytoplasm. Statistical analyses were carried out using SPSS for windows and cumulative survival rate was calculated using the Kaplan-Meier method. 1) Age: under 60 years(n=76) 80.2%, over 60 years(n=61) 72.8%(P>0.05). 2) Sex: male (n=67) 83.2%, female(n=70) 70.7%(P>0.05). 3) The duration of symptoms: under 3 months(n=67) 74.9%, over 3 months(n=70) 79.0% (P>0.05). 4) The location of tumor: left colon(n=45) 85.7%, right colon(n=33) 75.5%, rectum(n=59) 71.7%(P>0.05). 5) The histologic types: well differentiated(n=116) 77.0%, poor differentiated(n=21) 76.2%(P>0.05%). 6) Lymph node metastasis: negative nodes(n=98) 82.7%, positive nodes(n=39) 62.2%(P0.05). 8) Chemotherapy +/- Immunotherapy: In stsge B2, receiving group(n=47) 82.6%, not receiving group(n=17) 74.3%(P>0.05). In stage C, receiving group(n=27) 65.8%, not receiving group (n=11) 53%(P>0.05). 9) P-glycoprotein: In stage B2 and C1, positive expression(n=15) 66.7%, negative expression (n=26) 84.6%(P>0.05). Multivariate analysis indicated that the positive lymph node was independendently correlated with survival. We think that the prognosis of colonic adenocarcinoma are related with lymph node metastasis and the further prospective study are needed for evaluation of the relationship between the prognosis and p-glycoprotein expression.

5 Cases of Surgically Treated Colonic Inertia

We reviewed the cases of five patients with colonic inertia who were treated with total abdominal colectomy and ileorectal anastomosis at the Wonkwang University Hospital from June 1994 to november 1995. All of the 5 patients with chronic constipation underwent, a colon study, colonoscopy, anorectal manometry, defecography, balloon expulsion test, and a study of the total and segmental colonic transit of radioopaque markers to diagnose the colonic inertia. The ratio of male to female was 1:4, the mean age 58 years, the average duration of symptom 41.8 months, and the average time between bowel movements 18.4 days. There was no specific operative morbidity and mortality and the average hospital stay was 14 days. At follow-up ranging from 3 months to 20 months they had excellent stool control and 1-2 bowel movements per 1-2 days. All were satisfied with the procedure.

The Prognostic Significnce of p53 Protein Overexpression in Gastric Carcinoma

To evaluate prognostic significance of p53 gene mutation and p53 protein overexpression, 83 cases of primary gastric carcinoma (stage 1b, II, and III) were analyzed. Immunohistochemical assay using labeled streptavidine biotin method and mouse Anti-P53 was done on paraffin embedded tissues. The overall 5-year survival rate was 54.2%. Depth of invasion, lymph node metastasis, and stage were the prognostic factors (p<0.05). p53 was positive in 33 cases(39.8%). There were no significant association between p53 expression and other parameters such as age, sex, tumor location, size, gross finding, histologic type, depth of invasion, lymph node metastasis, and stage. The 5-year survival rates of p53 positive and negative groups were 62% and 42.4% respectively (p=0.0657). Survival distribution for p53 adjusted for location and depth of invasion showed significant difference. Five-year survival rates were 55%, 25%, 0% in p53 positive groups and 65.4%, 65%, 28% in negative groups at the lower, middle, and upper portion of the stomach, and 53.9%, 36.9%, 0% in p53 positive and 77.3%, 53%, 0% in negative groups in t2, t3 and t4. In comparison of 5-year survival rates of p53 positive and negative groups in the same stage, p53 positive groups showed worse prognosis than the negative, but they were not significant statistically. There were 57.1%, 92.9% in stage 1b (p=0.0678), 50%, 61.1% in stage II, 42.9%, 42.9% in stage IIIa, and 14.3%, 25% in stage IIIb respectively. So overexpression of p53 protein has little prognostic significance.

Experimental study of gastric pacing in terms of EGG and intragastric pressure in rats

No abstract available.

Primary closure after choledochotomy

No abstract available.

An analysis of treatment in intussusception

No abstract available.