Effects of cisplatin on photosensitizer-mediated photodynamic therapy in breast tumor-bearing nude mice

OBJECTIVE: This study aimed to evaluate the potential effects of cisplatin on photodynamic therapy (PDT) in breast cancer using a breast tumor-bearing mouse model. METHODS: In this study, breast tumor (experimental mammary tumour-6 cell)-bearing nude mice were used as experimental animals. Photolon® (photosensitizer, 2.5 mg/kg body weight [BW]) was injected intraperitoneally; after 2 hours, the tumors were irradiated (660 nm, 80 J/cm2) using a diode laser tool. Cisplatin (3 mg/kg BW) was injected intraperitoneally 1 hour before the Photolon® injection. RESULTS: Tumor volume increased over time in the control group and was not different from that in the cisplatin group. In the PDT group, the tumor volume increased on day 3, but not on day 7. In the cisplatin+PDT group, tumor volume increased on day 3 but decreased on day 7. There was no significant difference in the levels of thiobarbituric acid reactive substance (TBARS) in tumor tissues between the control and cisplatin groups. The levels of TBARS in the cisplatin+PDT group were higher (47%) than those in the PDT group. Analysis of tumor tissue transcriptomes showed that the expression of genes related to the inflammatory response including CL and XCL genes increased, while that of Fn1 decreased in the cisplatin+PDT group compared with the PDT group. CONCLUSION: These results suggest that cisplatin enhances the therapeutic effect of PDT in a breast tumor-bearing mouse model. However, further clinical studies involving patients with breast cancer is needed.

Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage

Uterine arteriovenous vascular malformation (UAVM) is a disease that causes excessive bleeding. The symptoms do not subside without proper treatment and this can lead to life-threatening situations. The correct diagnosis of UAVM can be complicated if the patient's uterus did not completely discharge everything during abortion (in broader terms, retaining remnants of the products of conception). In this case, Doppler ultrasonography and computed tomography angiography with 3-dimensional rendering were used to analyze the cause of bleeding and provide proper treatment of this patient. Then, uterine artery embolization, dilatation, and curettage were performed safely and successfully. The patient no longer had symptoms of vaginal spotting during the planned follow up care. UAVM is uncommon; however, if reproductive-age women show repeated abnormal vaginal bleeding after dilatation and curettage, a diagnosis of UAVM must be considered based on the medical history and examination.

Influence of Supplementary Vitamin D on Bone Mineral Density When Used in Combination with Selective Estrogen Receptor Modulators

OBJECTIVES: Vitamin D is regarded as one of the major nutrients that significantly influence bone metabolism. This study aims to look at the effect of supplementary vitamin D on bone mineral density (BMD) in female osteoporosis patients. METHODS: The retrospective hospital record review was performed on 282 patients who were diagnosed with osteoporosis and treated with selective estrogen receptor modulators (SERMs) between January 2015 and December 2016. Of these patients, 151 were treated with SERMs only while 131 were treated using both SERMs and vitamin D supplements. The BMD and any occurrence of osteoporotic fracture episode were investigated after one year. The result of two groups was compared to find the significance of vitamin D. RESULTS: Overall, improvement in BMD score was observed in 76% of the patients. The BMD of the SERMs only group improved by 3% in spine and 1% in the hip while that of the SERMs with vitamin D group improved by 6% and 1% respectively. Statistical significance was noticed in the spine only. One distal radius fracture and one single level vertebral fracture occurred in patients of SERMs group while two distal radius fractures occurred in SERMs with vitamin D group. There was no occurrence of around hip fracture in both groups. CONCLUSION: The result of the current study suggests that additional vitamin D may have some additive effect on improving BMD of the spine. Further study with the larger study population and the extended study period is recommended.

Usefulness of Real-time Measurement of Colonoscopy Withdrawal Time during Fellow Training / 대한소화기내시경학회지

BACKGROUND/AIMS: Attempts to increase colonoscopy withdrawal time have been the topic of several recent publications. We assessed whether the real-time measurement of withdrawal time affected the withdrawal time and polyp detection rate. METHODS: Real-time colonoscopy withdrawal time was measured in 197 subjects in a study group and 184 subjects comprised a control group without real-time measurements. Colonoscopies were performed by four endoscopy specialists and three fellows during their first year of training. Withdrawal time, clinical features, bowel preparation, and polyp detection rates were comparatively analyzed. RESULTS: No significant differences in age, gender, bowel preparation, or polyp history were found in the two groups. Withdrawal time was significantly higher in the study group than that in the control group when a fellow performed the withdrawal. However, polyp detection rate did not significantly increase in the study group, regardless of physician. CONCLUSIONS: Real-time measurement of colonoscopy withdrawal time did not increase polyp detection rate, but the withdrawal time was significantly higher when a fellow performed the withdrawal phase than when a specialist performed withdrawal. Therefore, the real-time measurement of colonoscopy withdrawal time seems to be a useful tool for fellow training.

Pregnancy Outcomes of the Patients with Inflammatory Bowel Disease in Korea

BACKGROUND/AIMS: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. METHODS: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. RESULTS: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. CONCLUSIONS: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD.

Pregnancy Outcomes of the Patients with Inflammatory Bowel Disease in Korea

BACKGROUND/AIMS: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. METHODS: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. RESULTS: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. CONCLUSIONS: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD.

Analysis of Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease / 대한소화기학회지

BACKGROUND/AIMS: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. METHODS: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. RESULTS: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn's disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. CONCLUSIONS: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.

Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding / 대한소화기학회지

BACKGROUND/AIMS: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). RESULTS: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3+/-10.6 vs. 7.2+/-5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). CONCLUSIONS: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients.

Factors favoring survival in elderly patients with colorectal cancer / 대한내과학회지

BACKGROUND/AIMS: Colorectal cancer occurs predominantly in the elderly, and whether to operate on these patients is a dilemma. This study compared clinical parameters and evaluated factors favoring survival in elderly patients with colorectal cancer according to the treatment modality. METHODS: The study evaluated 213 patients who were older than 75 years and diagnosed with colorectal cancer between 1995 and 2005. Survival rate and clinical parameters were compared between the surgical and conservative treatment groups. Demographics, underlying conditions, and cancer and treatment-related factors were evaluated for survival using multivariate analysis in the conservatively treated patients and separately in the surgery group. RESULTS: The surgery group consisted of 143 (67.1%) patients and the conservative group consisted of 70 (32.9%) patients. Fewer patients had a high ASA class in the surgery group than in the conservative group (p<0.05). The survival rate in the surgery group was higher than in the conservative group (p<0.05) even when compared for the same cancer stage, ASA class, and age (p<0.05). In the surgery group, the absence of history of diabetes mellitus, lower cancer stage, elective surgery, and curative surgery all favored survival (p<0.05). CONCLUSIONS: The 5-year survival rate in the surgery group was higher than that in the conservative group. Surgery is recommended for elderly patients with colorectal cancer who are in good physical shape and have a lower stage, a resectable tumor, and a non-emergency condition

Acute Pseudodiverticular Bleeding from a Tuberculous Scar of the Terminal Ileum / 대한소화기내시경학회지

Acquired ileal diverticuli are an uncommon condition and the diagnosis is often difficult when bleeding occurs from this source. Tuberculosis mainly involves the terminal ileum and has associated complications such as obstruction, perforation, stricture and bleeding, but rarely presents with pseudodiverticuli with a fistula. A 42-year-old man presented with massive hematochezia for three days. The patient had a history of pulmonary tuberculosis with complete recovery two times. Emergency sigmoidoscopy, esophagoduodenoscopy and computed tomography of the abdomen could not detect the bleeding focus. The next day, colonoscopy was performed, which demonstrated the opening of pseudodiverticuli at the terminal ileum. There was an exposed vessel in one of the pseudodiverticuli. The patient was treated successfully with epinephrine and ethanol sclerotherapy. A subsequent colonoscopy showed that the exposed vessel was completely healed seven days later. We report a case of acute pseudodiverticular bleeding from a tuberculous scar of the terminal ileum with a review of the relevant literature.

A Case of Pylephlebitis of the Inferior Mesenteric Vein and Portal Vein

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.

A Case of Pylephlebitis of the Inferior Mesenteric Vein and Portal Vein

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.

Clinical Characteristics of Primary Epiploic Appendagitis

BACKGROUND/AIMS: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. METHODS: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. RESULTS: Twenty-three patients (7 females and 16 males; average age, 42+/-14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. CONCLUSIONS: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan.

A Case of Cystic Lymphangioma of Small Bowel Mesentery Presented with Small Bowel Volvulus

A cystic lymphangioma is a rare benign tumor that arises in an organ with a large number of lymphatics. It arises in patients of all ages and has variable presentations. An abdominal cystic lymphangioma most commonly occurs in the intestinal mesentery, with the retroperitoneum being the second location of choice, and it causes abdominal pain, hematochezia, intussusceptions and protein-losing enteropathy. If the cystic lymphangioma presents with symptoms, surgical excision is required for treatment and diagnosis. We report here a case of cystic lymphangioma of the small bowel mesentery that presented with a small bowel volvulus, along with a brief review of the literature.

Hyponatremia with Seizure and Mental Change after Oral Sodium Phosphate Bowel Preparation: Report of Two Cases / 대한소화기내시경학회지

Oral sodium phosphate is known to be safe and it is widely used as a colon cleansing agent for colonoscopy. Yet several complicated cases with the development of electrolyte imbalance have been reported. We report here on 2 interesting cases: after administration of oral sodium phosphate, one patient presented with hyponatremia (Na, 122 mEq/L) with seizure and the other patient presented with hyponatremia (Na, 120 mEq/L) with a confused mentality. Brain imaging and electroencephalography showed no evidence of other causes for the seizure and mental change. We report here on two cases of hyponatremia with neurologic side effects, and this was all caused by oral sodium phosphate. We also include a review of the relevant literature.

A Prospective Trial Comparing 4 L-Polyethylene Glycol with 2 L-Polyethylene Glycol Plus Bisacodyl Tablets for Colon Preparation / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study was to prospectively compare low-volume PEG plus 20 mg bisacodyl with the standard 4 L PEG with regards to the adequacy of bowel preparation, patient compliance and the side effects. METHODS: From September 2007 to January 2008, 59 patients who had previously undergone screening colonoscopy with 4 L PEG and had been diagnosed with colonic polyps were admitted for polypectomy. The colonoscopists, who were unaware of the preparation that was administered, evaluated the adequacy of the bowel cleansing. Detailed questionnaires were also used to assess patient compliance, the difficulty of bowel preparation, side effects and patient preference. RESULTS: The physician's evaluation of the colon cleansing showed better adequacy with 4 L PEG than with 2 L PEG plus bisacodyl (p<0.05). There was no difference in patient compliance between the 2 bowel preps. The patients in the 2 L PEG plus bisacodyl group tolerated the bowel preparation more easily than the patients in the 4 L PEG (81.4% vs. 15.3%, respectively). Moreover, the scores of the visual analog scale for the difficulty of bowel preparation were 5.8+/-2.3 in the 4 L PEG group and 3.2+/-1.9 in the 2 L PEG plus bisacodyl (p<0.01). The majority (89.8%) of the patients preferred 2 L PEG plus bisacodyl (p<0.001). The 2 L PEG plus bisacodyl group revealed less nausea, vomiting and sleep discomfort (p<0.05), but they had more abdominal pain (p<0.01). CONCLUSIONS: 2 L PEG plus bisacodyl is not as effective as the standard 4 L PEG for colon cleansing. However, 2 L PEG plus bisacodyl can be used for patients who have difficulty drinking a large amount of PEG.

Role of Anti-secretory Treatment in Addition to Helicobacter pylori Eradication Triple Therapy in the Treatment of Peptic Ulcer / 대한소화기학회지

BACKGROUND/AIMS: It is not clear whether the anti-secretory therapy should be continued for symptomatic relief and ulcer healing before or after the eradication of H. pylori in patients with peptic ulcer disease. The aim of this study was to evaluate the effectiveness of additional anti-secretory therapy before or after H. pylori eradication in peptic ulcer disease. METHODS: Thirty eight patients with H. pylori-positive active peptic ulcer were included. Patients were randomly allocated into 3 groups; standard 1-week triple therapy followed by omeprazole (20 mg, qd) for 3 weeks (group A), standard 1-week triple therapy only (group B), and omeprazole (20 mg, qd) for 3 weeks followed by 1-week triple therapy (group C). Endoscopy with the rapid urease test and histology for H. pylori was performed 4-8 weeks after the completion of treatment. The symptom was scored by a visual analog scale. RESULTS: Of the 38 patients, 10 were excluded from the per-protocol analysis of this study. The H. pylori eradication rates were 87.5% (group A), 80.0% (group B) and 90.0% (group C) respectively. The peptic ulcer healing rates were 100% in group A, 70.0% in group B, and 90.0% in group C. There was no difference in H. pylori eradication rates and ulcer healing rates among three groups (p>0.05). Symptom score differences between pre-treatment and post-treatment group were not significantly different (p>0.05). CONCLUSIONS: The standard one week triple therapy with or without 3-weeks anti-secretory treatment with omeprazole before or after the therapy does not affect H. pylori eradication rates, peptic ulcer healing rates, and symptom score improvement.

Efficacy of Levofloxacin-based Triple Therapy as Second-lineHelicobacter pylori Eradication / 대한소화기학회지

BACKROUND/AIMS: Bismuth-based quadruple therapy for second-line eradication treatment achieves the eradication rate ranging from 70% to 81% due to antimicrobial resistance and poor compliance. The aim of this study was to compare the eradication rate of levofloxacin-based triple therapy with that of bismuth-based quadruple therapy in second-line Helicobacter pylori (H. pylori) eradication therapy. METHODS: Seventy-six outpatients with persistent H. pylori infection after first-line triple therapy were enrolled in this prospective randomized trial. The subjects were randomized to receive levofloxacin 300 mg, amoxicillin 1 g, and pantoprazole 20 mg, given twice daily for 7 days (LAP group), or metronidazole 500 mg twice, tetracycline 500 mg four times, and pantoprazole 20 mg twice, bismuth subcitrate 600 mg twice daily for 7 days (MTPB group). Eradication was confirmed with 13C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Among Seventy-six patients initially included, eleven were lost during follow-up. The eradication rates, expressed as intention to treat (ITT) and per protocol (PP) analyses, were 51.6% and 53.3% in the LAP group, and 48.9% and 62.9% in the MTPB group, respectively. There was no significant difference in H. pylori eradication rates between the two groups (p=0.815 by ITT, p=0.437 by PP). LAP regimen was better tolerated than MTPB regimen with lower incidence of side effects (10.0% versus 31.4%, p=0.03). CONCLUSIONS: H. pylori eradication rates of levofloxacin-based triple therapy and bismuth-based quadruple therapy were not significantly different in second-line H. pylori eradication therapy, and low incidence of side effects was observed in levofloxacin-based triple therapy.

Sigmoid Diverticular Bleeding Detected by Capsule Endoscopy / 대한소화기내시경학회지

Colonic diverticulosis is small outpouching from the lumen of the colon, and this caused by mucosal herniation. Most patients are asymptomatic, but 5~15% of those affected manifest diverticular bleeding. Because most of them stop bleeding spontaneously, the source of the bleeding can not be found by colonoscopy in 15% of these cases. We report here on a case of sigmoid diverticular bleeding that detected by capsule endoscopy in a 68-year old woman who presented with acute obscure gastrointestinal bleeding.

Primary Esophageal Adenoid Cystic Carcinoma

Adenoid cystic carcinoma (ACC) is common in the salivary glands but rare in the esophagus. Routine esophagogastroscopy performed in a 54-year-old woman as part of a medical check-up revealed a submucosal tumor (1.5x1.0 cm) at the mid-esophagus. Endoscopic ultrasonography revealed a lesion with mixed echogenicity in the submucosal layer. The submucosal mass was removed by incisional endoscopic enucleation, and pathological analysis revealed epithelial cells with small hyperchromatic angular nuclei in tubular and cribriform patterns. The lesion was pathologically confirmed as an ACC of the esophagus.