The Clinical Significance of Specialized Intestinal Metaplasia in the Diagnosis of Barrett's Esophagus: Nationwide Prospective Multicenter Study

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

The Distribution of Endoscopic Gastritis in 25,536 Heath Check-up Subjects in Korea

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.

Clinical Analysis for Brain Tumor-Related Epilepsy during Chemotherapy for Systemic Cancer with Single Brain Metastasis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this prospective observational study was to determine the incidence, patterns, and predisposing factors for brain tumor-related epilepsy (BTRE) during chemotherapy for systemic cancer with single brain metastasis (BM). MATERIALS AND METHODS: Between February 2006 and June 2010, 103 patients who underwent chemotherapy for systemic cancer with single BM were enrolled. We compared the clinical factors of patients and BM between patients with and without BTRE. We determined the number of patients with BTRE attacks, and seizure-free survival according to the following comparative groups: presence vs. absence of a history of BTRE; high-risk vs. low-risk groups; and presence vs. absence of disease-progression of BM. RESULTS: Ninety-three of 103 patients (90.3%) remained seizure-free during chemotherapy. The seizure-free rates were 88.9% and 91.0% among patients with or without a history of BTRE, respectively (p=0.694), 87.8% and 92.6% among high- and low-risk patients (p=0.427), respectively, and 62.5% and 98.7% among patients with or without disease-progression of BM (p=0.001), retrospectively. Based on multivariate analysis, the significance of abnormal findings on electroencephalogram (EEG) (p=0.017), and the absence of disease-progression of BM (p=0.001) had an association with seizure-free survival. CONCLUSION: The significance of abnormal findings on EEG, and disease-progression of BM play important roles in the development of BTRE during chemotherapy for systemic cancer with BM.

Clinical Analysis for Brain Tumor-Related Epilepsy during Chemotherapy for Systemic Cancer with Single Brain Metastasis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this prospective observational study was to determine the incidence, patterns, and predisposing factors for brain tumor-related epilepsy (BTRE) during chemotherapy for systemic cancer with single brain metastasis (BM). MATERIALS AND METHODS: Between February 2006 and June 2010, 103 patients who underwent chemotherapy for systemic cancer with single BM were enrolled. We compared the clinical factors of patients and BM between patients with and without BTRE. We determined the number of patients with BTRE attacks, and seizure-free survival according to the following comparative groups: presence vs. absence of a history of BTRE; high-risk vs. low-risk groups; and presence vs. absence of disease-progression of BM. RESULTS: Ninety-three of 103 patients (90.3%) remained seizure-free during chemotherapy. The seizure-free rates were 88.9% and 91.0% among patients with or without a history of BTRE, respectively (p=0.694), 87.8% and 92.6% among high- and low-risk patients (p=0.427), respectively, and 62.5% and 98.7% among patients with or without disease-progression of BM (p=0.001), retrospectively. Based on multivariate analysis, the significance of abnormal findings on electroencephalogram (EEG) (p=0.017), and the absence of disease-progression of BM (p=0.001) had an association with seizure-free survival. CONCLUSION: The significance of abnormal findings on EEG, and disease-progression of BM play important roles in the development of BTRE during chemotherapy for systemic cancer with BM.

Submucosal Saline-Epinephrine Injection in Colonoscopic Polypectomy: What is the Proper Application? / 대한소화기내시경학회지

No abstract available.

Prognostic factors of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer / 부인종양

OBJECTIVE: The objective of this study was to identify the prognostic factors of secondary cytoreductive surgery on survival in patients with recurrent epithelial ovarian cancer. METHODS: The medical records of all patients who underwent secondary cytoreductive surgery between May 2001 and October 2007 at the National Cancer Center, Korea were reviewed. Univariate and multivariate analyses were executed to evaluate the potential variables for overall survival. RESULTS: In total, 54 patients met the inclusion criteria. Optimal cytoreduction to or =12 months vs. 24 months for PFS or =12 months. Secondary cytoreductive surgery should be offered in selected patients and large prospective studies are needed to define the selection criteria for secondary cytoreductive surgery.

Clinical Usefulness of Fecal Occult Blood Test as a Screening Method for Asymptomatic Patients with Colon Polyps / 대한소화기학회지

BACKGROUND/AIMS: Detection of asymptomatic benign colon polyp is increasing because colonoscopy is widely used as a screening and diagnostic method. Fecal occult blood test is usually performed for the selection of patients requiring colonoscopy as well as mass screening for colon cancer. The aim of this study was to investigate the usefulness of fecal occult blood test performed prior to colonoscopy as a screening method of benign colon polyps. METHODS: Clinical characteristics of patients with polyps were evaluated according to the fecal occult blood test results in patients who underwent one-day fecal occult blood test and colonoscopic polypectomies from May 2003 to October 2004, retrospectively. RESULTS: A total of 942 colonoscopic polypectomies in 288 patients were evaluated. Fecal occult blood tests were positive only in 32 patients (11.1%). In univariate analysis, there was a significant difference in polyp size (p=0.02) and location (p=0.03) according to the presence of positive fecal occult blood tests. In addition, age of the patient (p=0.046), polyp size (mean, p=0.04; largest, p<0.01) and the number of polyps (p=0.045) were significantly different. However, in multivariate analysis, only polyp size larger than 20 mm was significantly related with positive fecal occult blood test with estimated odds ratio of 4.71. CONCLUSIONS: Fecal occult blood test has limitations as a screening test in asymptomatic patients with colon polyps, except for colon polyps larger than 20 mm in size.

The role of endoscopy, 24 hour ambulatory esophageal pH monitor and bernstein test for gastroesophageal reflux disease and its relationship with symptom / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the diagnostic usefulness of endoscopy, 24 hour esophageal pH monitor and Bernstein test for GERD and its relationship with GERD symptom in the presence or absence of reflux esophagitis (RE). METHODS: This study was performed for 168 patients with GERD. Clinical symptoms and the results of endoscopy, 24 hour esophageal pH monitor, esophageal manometry with Bernstein test were analyzed. RESULTS: 168 (42%) of 403 patients who complained symptoms suggestive of GERD were diagnosed as GERD (65% as RE, 35% as nonerosive reflux disease) using diagnostic tools for GERD. The most chief complaint symptoms were heartburn (18.5%), regurgitation (18.5%), noncardiac chest pain (10.7%), cough (10.7%), laryngeal symptoms (11.3%), non specific dyspepsia (24.4%) and others (6%). When comparison of symptoms depending on RE among GERD patients was performed, laryngeal symptoms were significantly more frequent in patients without RE (p=0.001), and dyspepsia in patients with RE (p<0.001), respectively. Regarding diagnostic efficacy of each test depending on symptom, patients with heartburn showed higher positive rate of Bernstein test (p=0.035) and patients with laryngeal symptoms showed higher positive rate of 24 hour esophageal pH monitor (p=0.015), respectively. In addition, there was no correlation among endoscopy, 24 hour esophageal pH monitor and Bernstein test in the diagnosis of GERD by Kappa index. CONCLUSIONS: Typical reflux symptoms of GERD such as heartburn and regurgitation were found in 37% of GERD patients in Korea, lower than in Western countries. The lack of correlation among the diagnostic tools for GERD suggests that these tools are complementary to each other for the diagnosis of GERD.

Submucosal Saline-Epinephrine Injection in Colonoscopic Polypectomy: What is the Proper Application? / 대한소화기내시경학회지

BACKGROUND/AIMS: Indications for submucosal saline-epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI. METHODS: Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (8 mm) and gross morphology (pedunculated or sessile), also. RESULTS: Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5+/-4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had >8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology. CONCLUSIONS: SSEI should be performed in colonoscopic snare polypectomy for >8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician.

Clinical features and recent treatment trend of gastric cancer / 대한내과학회지

BACKGROUND: Gastric cancer is the most common malignancy in Korea. The purpose of this study is to evaluate the chronological changes of clinical feature and usefulness of recent treatment modalities such as laparoscopic assisted gastrectomy and endoscopic gastric mucosal resection (EMR). METHODS: We analyzed the clinical characteristics of the gastric cancer patients who were diagnosed as gastric cancer by pathology from May 2003 to May 2004 in Seoul National University Bundang Hospital. In addition, we classified the curable treatment modalities depending on whether it was early gastric cancer or advanced gastric cancer. RESULTS: The total number of patients was 231, and the proportion of early gastric cancer was 97 patients (42.0%). Forty three patients (18.6%) were diagnosed through health screening test. Curative treatment was performed in 169 patients (73.2%): that is, radical subtotal gastrectomy in 158 (68.4%), and EMR in 11 (4.8%). Among 158 patients who underwent curative radical surgery, 67 patients (42.4%) had been operated on laparoscopic gastrectomy (laparoscopic-assisted distal gastrectomy or laparoscopic wedge resection). There was no cancer recurrence in the early gastric cancer after curative treatment regardless of treatment modality during mean follow-up period of 15.9 months. CONCLUSIONS: These results seem to support the usefulness of health screening test for early detection of gastric cancer. Laparoscopic gastrectomy could be the primary choice for the early gastric cancer.

Clinical Features and Surgical Results of Brain Abscesses

OBJECTIVE: This study is undertaken to review the characteristics, risk factors and the surgical outcomes in long term follow-up of brain abscesses. METHODS: We had reviewed medical records and radiological findings in patients with brain abscess who underwent operations in our hospital from January 1992 to June 2003. RESULTS: Observed 11 cases were comprised of 8 men and 3 women with 42 years old average age ranging from 17 to 66. Lesions were located at frontal lobe in 5 cases, parietal in 4 cases, temporal in 1 case, and occipital in 1 case. The mean follow-up period was 23.8 months and ranged from 5 to 33 months. The microbial sources of infection had been found in 5 cases (45%). The organisms were identified by using the microbial culture obtained from the excisional biopsy. We had applied all cases with surgical excision. Empirical antibiotic treatment started soon after diagnosis in all cases. The mortality and morbidity of surgical excision were low. Nine patients were neurologically improved. One patient had died after the operation due to acute respiratory distress syndrome (ARDS). CONCLUSION: The single and large abscess located in an accessible lesion is a good candidate for surgical excision because of it's low morbidity, mortality, and favorable outcome after surgical excision. Further study is required to compare the surgical excision with other treatment modalities of brain abscess.

Clinical Features and Surgical Results of Distal Anterior Cerebral Artery Aneurysm

OBJECTIVE: Distal anterior cerebral artery(DACA) aneurysms are relatively uncommon, and have special aspects. We discuss clinical features and surgical results of DACA aneurysms with review of literatures. METHODS: Among 725 cases of intracranial aneurysms operated from 1989 to 2001 in our hospital, 38 cases of DACA aneurysms were studied retrospectively. The clinical presentations, neurological findings, operative approaches and outcome were analyzed. RESULTS: The incidence of the DACA aneurysm was 5.2% of total 725 aneurysms. Multiple aneurysms were found in 10 patients. Among the 38 patients, 15 were men and 23 were women. The mean age was 49.8 years. 2 aneurysms were located at frontobasal artery, 5 at the origin of frontopolar artery, 28 at the bifurcation between callosomarginal and pericallosal artery, 3 at the origin of pericallosal artery. 32 patients had good outcomes after surgery. 4 patients remained disabled, and 2 patients died. Postoperative complications were vasospasm, cerebral infarction, intracranial hemorrhage, pneumonia. CONCLUSION: The incidence of DACA aneurysm was relatively rare than other location. We think that unilateral interhemispheric approach is useful for aneurysm in most DACA, and approaches should be chosen according to the location of aneurysm and presence or absence of multiple aneurysms. The Glasgow Outcome Scale score was good in patient with low Hunt & Hess grade preoperatively. And early operation can reduce the rate of rebleeding and improve outcome of DACA aneurysms.

Effects of Hemodynamic Disturbance on Occurrence of Stroke in Patients with Internal Carotid Artery or Middle Cerebral Artery Occlusion

BACKGROUND: Previous studies suggest that impaired cerebral hemodynamics may play a relevant but unclear role in the occurrence of stroke in patients with carotid artery occlusion.. The purpose of the current study was to investigate the relationship between hemodynamic disturbances and cerebrovascular events in patients with major cerebral artery occlusions. METHODS: We examined hemodynamic disturbances as cerebrovascular reactivity (CVR) to acetazolamide (ACZ), judged with single-photon emission CT (SPECT) and an ACZ challenge in 21 patients with internal carotid artery or middle cerebral artery occlusions who had transient ischemic attacks/minor or asymptomatic infarctions. CVR was calculated by a regional cerebral blood flow (rCBF) ratio on pre-ACZ-SPECT minus the rCBF ratio on post-ACZSPECT. They were followed longer than 2 years and the mean follow-up duration was 36 months. We compared the hemodynamic disturbances and risk factors between the ipsilateral stroke recurrance group and a stable group. RESULTS: Eight patients had additional ischemic events during the follow-up period, and all but 2 events occurred ipsilaterally to the carotid artery occlusions. Two patients died of acute myocardial infarction and brainstem infarction, retrospectively. All patients with recurred stroke or death were noted to have symptomatic carotid artery occlusions. There was no significant difference of risk factors between the two groups. But the ipsilateral stroke recurrance group had worse CVR than the stable group (p<0.05). CONCLUSIONS: These data suggest impaired CVR was significantly associated with the risk of ischemic events in patients with carotid artery occlusions.

Clinical Features and Surgical Results of ICA Bifurcation Aneurysms

OBJECTIVE: The aneurysms developed at internal carotid artery(ICA) bifurcation can be different from other aneurysms because there are many perforating arteries and the hemodynamic changes are characteristic. In this report, we present our cases of ICA bifurcation aneurysms and discuss the clinical features and surgical outcomes of these aneurysms. METHODS: From January 1989 to May 2001, total 808 patients(982 aneurysms) were operated for intracranial aneurysms at our hospital. Among them, twenty two patients(2.7%) had aneurysms at ICA bifurcation. We discussed clinical features according to mental status at admission, size, direction and multiplicity of aneurysms, presence of intracranial hemorrhage and rupture of ICA bifurcation aneurysms. And we also discussed the surgical results of operations depending on pre-operative Hunt-Hess grade and size of aneurysms. RESULTS: Mean age was 43.4 years old and 10 cases(45.5%) were below 40 years old. Six patients(27.2%) had large or giant aneurysms. Fifteen(68.2%) out of 22 patients had good results, 1 fair, 1 poor and 5 dead. CONCLUSION: In our ICA bifurcation aneurysm cases, we conclude that their onset is relative in younger age, and they has a higher incidence of multiple(34.6%) and larger aneurysm(27.2%) than other anterior circulatory aneurysm. And the surgical results of ICA bifurcation aneurysm are relatively poor.

A Case of Akinetic Mutism Caused by Volume Change of Cerebral Ventricles

Akinetic mutism is a syndrome caused by various etiologies, and characterized by silent immobility and preserved alertness. The repetitive ventriculoperitoneal shunt for the recurrent hydrocephalus can be a forerunner of that. We present a man with akinetic mutism following two times of ventriculoperitoneal shunt revision. Akinetic mutism of the patient may be caused by the damage on the ascending dopaminergic projections. Symptoms were not alleviated by the normalization of ventricular size but by a large dose of bromocriptine.

Solitary Dural Plasmacytoma: Case Report

The authors present a case of solitary dural plasmacytoma. A 43-year-old woman was admitted our department due to headache. Brain magnetic resonance(MR) image showed homogeneous enhanced lesion at the left occipital area. We performed surgical excision and it was confirmed plasmacytoma, histologically. The solitary dural plasmacytomas are exceedingly rare. Before this case report, only 17 cases had been reported in the literature

Post-Traumatic Tension Pneumocephalus of Delayed Onset: Case Report

The authors present a case of post-traumatic tension pneumocephalus of delayed onset. A 23-year-old man fell down and was admitted to our hospital with initial diagnosis of basal skull fracture associated with small amounts of pneumocephalus on brain computerized tomography(CT). At admission, the consciousness was alert without focal neurological deficit. During conservative therapy, headache was slowly progressive and consciousness became drowsy on 13th day after admission. The brain follow-up CT showed huge low air density lesion in the right frontal area. We performed unilateral subfrontal craniotomy with duroplasty for removal of air and dural repair with galea aponeurotica and abdominal fat. Postoperatively, the condition was recovered.

Tc-99m HMPAO Brain Perfusion SPECT Findings in Acute Cerebellitis

Acute cerebellitis is an uncommon neurological complication that may occur following childhood viral infections, and is rarely reported in adults. Imaging studies show no abnormalities in the majority of cases. We experienced three cases of acute cerebellitis, which showed no abnormal findings on MRI, but revealed diffusely increased cerebellar per-fusions on brain perfusion SPECT, which normalized 5~6 months later. Therefore, brain perfusion SPECT is consid-ered to be useful in identifying acute cerebellitis and in monitoring its clinical course.

A Case of Purple Glove Syndrome

Purple glove syndrome is a complication of the intravenous infusion of phenytoin. It is characterized by progressive distal edema, discoloration and pain. The mechanism of purple glove syndrome is poorly understood, but the chemical properties of intravenous phenytoin and the extravasation of that are possible causes. We present a woman with purple glove syndrome, whose symptoms were subsided gradually with conservative management.