Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines / 대한소화기학회지

Background/Aims@#There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. @*Methods@#The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. @*Results@#Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). @*Conclusions@#More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

Immunomodulatory effect of the water extract of Aster tataricus through mitogen-activated protein kinase signaling pathway / 한국영양학회지

Purpose@#Aster tataricus (AT) is one of the Asteraceae perennial herbs used in traditional Chinese medicine. The herb contains various bioactive substances, such as flavonoids, isoflavonoids, and phenolic compounds in the roots, and exhibits a range of effects including anti-bacterial, anti-oxidant, and anti-inflammatory activities. This study compared the immunomodulatory effects of ethanol and water extracts of whole AT, except the roots, and analyzed the molecular mechanisms for the regulatory effects on cytokine secretion from THP-1 cells. @*Methods@#The effects of AT extract on the cell viability and proliferation of THP-1 cells were analyzed using the Cell Counting Kit-8 method. The concentrations of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the cell culture supernatant of the AT-treated THP-1 cells were measured using an enzyme-linked immunosorbent assay. The protein levels of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), inhibitor of nuclear factor kappa B (IκBα), and mitogen-activated protein kinase (MAPK) phosphorylation in the cell lysates were determined by western blotting. @*Results@#The water extract and the ethanol extract of AT did not affect the cell viability, and increased the proliferation of THP-1 cells significantly compared to the vehicle. The water extract increased the secretion of IL-1β from THP-1 cells in a dose-dependent manner, but the ethanol extract had no effect. The expression of COX-2 and iNOS protein and the phosphorylation of MAPK and Akt were induced in AT-treated cells. In addition, IκBα was degraded by AT in a concentration-dependent manner. IL-1β secretion by AT was reduced by extracellular-signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) inhibitors, while TNF-α secretion was decreased by inhibitors of ERK, p38 MAPK, and JNK.Interestingly, the p38 MAPK inhibitor increased the production of IL-1β by AT further. @*Conclusion@#The water extract of the above-ground parts of AT contains immunomodulatory bioactive substances that stimulate immune cells through the MAPK signaling pathway.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver / 대한소화기병학회잡지

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver / 대한소화기학회지

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Robot-assisted submandibular gland excision via modified facelift incision / 대한악안면성형재건외과학회지

BACKGROUND: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. CASE PRESENTATION: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. CONCLUSIONS: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. METHODS: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. RESULTS: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=-0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=-0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). CONCLUSIONS: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn.

Using Ultrasound to Diagnosis a Radio-lucent Soft Tissue Foreign Body - in Emergency Departments: A Preliminary Study Using a Swine Model -

PURPOSE: The purpose of this study is to estimate the accuracy of diagnosing a radio-lucent soft tissue foreign body with using ultrasound according to the different sizes and depth of the foreign bodies in an experimented model. METHODS: In the forefeet of swine, we made 45 incisions (4 in each forefeet) of 2 mm, 5 mm and 10 mm sized toothpicks at depths of 1 cm, 2 cm and 3 cm each. 15 incisions without foreign bodies were cannulated, simulating damage to the soft tissue made by a non captured foreign body. The twelve emergency physicians kept records not only for the presence or absence of a foreign body, but also for the depth of it. We then calculated the sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) according to the sizes of the toothpicks and the depths. RESULTS: The sensitivity, specificity, PPV and NPV of all the depths and sizes were under 80%. The results of the staff and residents were not significantly different. The result of a 3 cm depth was especially poor. CONCLUSION: In our model, ultrasound performed by emergency physicians was neither sensitive nor specific for diagnosing a soft tissue foreign body of various sizes and depths.

Immunosuppression of xenograft rejection in porcine kidney PK15 cells by porcine IL-18

Xenotransplantation, the transplantation of cells, tissues or organs between individuals of different species, would resolve the current shortage of organs, but rejection remains the major hurdle to successful xenotransplantation. In the present study, we analyzed mixed lymphocyte reactions (MLRs) and used 51Cr release assays in order to identify the proliferation and expansion of mouse CD8+ cytotoxic T lymphocyte cells against PK15, PK15/pIL-18 or PK15/mIL-18 cells. In addition, we identified T cell populations in mouse splenocytes and lymph node cells using two-color flow cytometry. It was found that the CD8+T cells of xenograft recipients proliferated extensively and that the survival rates of populations of PK15/mIL-18 or PK15/pIL-18 cells were higher than untransfected controls. Moreover, CD3+T cells were increased in mice injected with PK15 cells or PK15/pIL-18 cells but PK15/pIL-18 cell numbers were lower in lymph nodes than untransfected controls. CD8+T cells numbers were reduced in the lymph nodes of PK15/pIL-18 injected mice. These results suggest that porcine IL-18 regulates anti-pig cellular rejection in C57BL/6 mice.

A Case of Endoscopic Polypectomy Using a Hand-Made Detachable Snare Made of Nylon Fishing Line / 대한소화기내시경학회지

Hemorrhage is the most common complication of polypectomy. Though most bleeding stops spontaneously and can be managed with conservative therapies, some may necessitate intensive therapies. The detachable snare was firstly introduced in 1986. It has been reported that the use of detachable snare can effectively prevent both immediate and delayed bleeding. The detachable snare has been reformed, and now a commercial article is used in practice. But, it is expensive and cannot be used in larger polyps measuring over its fixed size of loop. A hand-made detachable snare made of nylon fishing line was introduced to prevent postpolypectomy bleeding in 2003. We have further improved it and experienced a case of successful removal of a large colonic polyp using our hand-made snare. The hand-made detachable snare is inexpensive and seems to be practical in ligating the polyp regardless of its size.

A Case of Tuberculosis Affecting Stomach and Duodenum Simultaneously, Mimicking Malignant Tumor / 대한소화기내시경학회지

Gastrointestinal tuberculosis has steadily decreased with the development of anti-tuberculous treatment, improvement of personal hygiene resulting from a rise in the standard of living, early diagnosis of pulmonary tuberculosis, and so forth. However, gastrointestinal tuberculosis can occasionally be found clinically in South Korea where the prevalence of tuberculosis is as much as 2.2%. Prevalence of gastric tuberculosis is low, compared with other gastrointestinal tuberculosis. While there have recently been several reports on the occurrence of gastric tuberculosis and duodenal tuberculosis assuming the form of malignancy, few cases have been reported of the tuberculosis affecting stomach and duodenum simultaneously. In this article we report the case in which tuberculosis affects both stomach and duodenum, which was initially misconceived as a double primary cancer.

A Case of Triple Synchronous Primary Colon Cancer Diagnosed by Colonoscopy before Operation / 대한소화기내시경학회지

Multiple primary colorectal carcinomas are not rare and occur more often than what can be ascribed to chance, but the frequencies on record vary. The tumors are usually classified as synchronous if they are present at the same time. It is often difficult to detect all these multiple lesions preoperatively:a correct diagnosis is frequently obtained only upon examination of the resected specimen. Triple synchronous primary colon cancer is an exceedingly rare disease. Despite of its rarity, multiple colon cancers should be investigated in the patients in whom clinical or laboratory evidence of colon cancer is suspected. Recently, we experienced one case of triple synchronous primary colon cancer diagnosed by colonoscopy before operation and report here with the review of the literature.

Microleakage and marginal hybrid layer of dentin adhesives / 대한치과보존학회지

The purpose of this study was to compare microleakage and marginal hybrid layer in class V restorations using two one-bottle adhesives and one self-etching adhesive. Class V cavity preparations with occlusal margins in enamel and gingival margins in dentin were prepared on buccal and lingual surfaces of 30 extracted human molar teeth. Prepared teeth were randomly divided into three treatment groups (n=30) and restored with three adhesives and composites: Single Bond/Filtek Z-250 (Group 1), Prime&BondNT/Esthet.X (Group 2), UniFil Bond/UniFil F (Group 3). For microleakage, samples were stored in room temperature water for 24 hours, thermocycled, stained with 2% methylene blue dye, sectioned into halves, scored and analysed using Mann-whitney test and Wilcoxon signed rank sum test. For marginal hybrid layer, samples were sectioned into halves, treated with 10% phosphoric acid for 5 seconds, stored in 5% NaOCL solution for 24 hours, dried and gold coated. Occlusal and gingival margins of each sample were inspected under SEM. The results of this study were as follows; 1. Microleakage at the occlusal margins was not evident in group 1 and group 2, but it showed in group 3 (p<0.05). 2. Microleakage in group 1 and group 3 was significantly lower than in group 2 at gingival margins (p<0.05). 3. Microleakage at gingival margins was greater than at occlusal margins in group 1 and group 2, but microleakage at occlusal margins was greater than at gingival margins in group 3 (p<0.05). 4. In group 1 and group 2, no gaps at occlusal margins showed. But gaps showed in group 3. Occlusal margins were free from a hybrid layer in all groups. 5. The thickness of the marginal hybrid layers was 2.5~5 microm thick in group 5 microm thick in group 2 and 1.5 microm thick in group 3. 6. There was no corelation between microleakage and thickness of marginal hybrid layer. In coclusion, the effect of dentin adhesives on microleakge in class V composite restorations was excellent when one-bottle adhesives were applied on enamel margin, and it was good when a self-etching adhesive was applied on dentinal margin. There was no corelation between microleakage and thickness of marginal hybrid layer.

Association between Tardive Dyskinesia and Soft Neurological Signs / 대한정신약물학회지

OBJECTIVE: The goal of this study was to examine association between tardive dyskinesia and soft neurological signs in schizophrenic patients. METHODS: 35 schizophrenic inpatients who met the diagnostic criteria for tardive dyskinesia developed by Schooler and Kane and 30 schizophrenic inpatients without tardive dyskinesia were enrolled in this study. Tardive dyskinesia, soft neurological signs, and cognitive function were evaluated with Abnormal Involuntary Movement Scale (AIMS), Neurological Evaluation Scale (NES), and Mini-Mental State Examination (MMSE) independently by 2 psychiatrists, respectively. Data of the two schizophrenic groups were compared and also those of 31 normal controls. RESULTS: Total schizophrenics scored higher than normal controls in total mean scores of NES (p<0.01), and its three functional area scores, sensory integration (p<0.01), motor coordination (p<0.05), and sequencing of complex motor acts (p<0.05). Patients with tardive dyskinesia showed higher prevalence rates than those without in 5 items-left graphesthesia (p<0.05), right fist-ring test (p<0.05), right fist-edge-palm test (p<0.05), right synkinesis (p<0.05), and left synkinesis (p<0.05). The total scores of NES were not significantly related to the severity of tardive dyskinesia and cognitive dysfunction. CONCLUSION: Schizophrenics had more soft neurological signs than normal subjects. Five items of NES were more impaired in the patients with tardive dyskinesia than in those without tardive dyskinesia.

Antidepressant Effect of Ethaverine / 대한정신약물학회지

The effects of a L-type calcium channel blocker, ethaverine were investigated in the rat forced swimming test, after single and repeated administration. Ethaverine in doses of 20 mg/kg, 40 mg/kg after single and repeated administration reduced significantly the duration of immobility in the forced swimming test. Fluoxetine administered in a single dose of 40 mg/kg did not influence the duration of immobility, but fluoxetine in a dose of 40 mg/kg administered repeatedly reduced significantly the duration of immobility. Ethaverine in a dose of 10 mg/kg did not affect the immobility after single and repeated administration. Imipramine and fluoxetine in doses which were not effective by themselves, increased the immobilityreducing effect when administered concormitantly with ethaverine in a dose of 10 mg/kg. Imipramine in a dose of 20 mg/kg and fluoxetine in a dose of 80 mg/kg, administered alone reduced the immobility time. The reduction of immobility after the concormitant administration of ethaverine in a dose of 10 mg/kg and imipramine in a dose of 20 mg/kg, fluoxetine in a dose of 80 mg/kg was significantly greater than after imipramine or fluoxetine, administered alone. The anti-immobility effect of the ethaverine was significantly counteracted by haloperidol in a dose of 0.5 mg/kg. The effects of ethaverine on the levels of monoamines and their metabolites were also investigated in rat striatum, cerebral cortex, cerebellum, medulla oblongata, hypothalamus, midbrain, hippocampus. Treatment with ethaverine caused alterations on the levels of dopamine and its metabolite in rat striatum, cerebral cortex, hypothalamus, medulla oblongata, cerebellum, but not on the levels of norepinephrine and serotonin and its metabolite. The observed effects of ethaverine indicate that ethaverine may have an antidepressant activity and may interact with the brain dopaminergic system. The present results suggest that the concormitant administration of ethaverine and antidepressants may have a more potent therapeutic antidepressant effect and/or may permit reduction of the dose of antidepressant and thus diminish its side effects.

A Case of Malignant Coloenteric Fistula / 대한소화기내시경학회지

Malignant coloenteric fistula is a rare complication of colon cancer. Colon carcinoma is the most common etiology of this entity. Clinical features are diarrhea, weight loss, anemia and feculent vomiting. The diagnosis is most often made by barium enema examination. The primal therapy is operation. We present a case of a 51-year old male in whom a coloenteric fistula caused by transverse colonic carcinoma. He complained of abdominal pain, diarrhea and dizziness. UGI series demonstrated a fistulous track between colon and small bowel. On abdominal CT examination, a mass involving hepatic flexure of colon with a fistulous tract and metastatic nodules in right lobe of liver were found. Colonoscopy revealed a circumferential mass and the orifice of the fistula. The patient refused operation and expired one month after discharge.

Endoscopic Ligation Therapy for Gastric Angiodysplasia / 대한소화기내시경학회지

Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd:YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date.

A Case of Meckel's Enterolith / 대한소화기내시경학회지

The term enterolith refers to concretions formed within the gastrointestinal tract. Enteroliths are thought to result from stasis and are usually found proximal to an area of stricture or within diverticulum. Meckel's diverticulum occurs in 1% to 3% of the population at autopsy and is the most common congenital anomaly of the gastrointestinal tract. Common complications of Meckel's diverticulum include hemorrhage, infection, inflammation, and intussusception. However, enterolith formation in a Meckel's diverticulum, which referred to as Meckel's enterolith, is rare. A 58-year-old female who experienced constipation and low abdominal pain for 20 years, was admitted due to severe low abdominal pain for 3 days. A 3 2 cm sized, lozenge-shaped radiopaque stone with peripheral dense calcification and radiolucent center, located between two areas of stricture in the distal ileum, was observed in abdominal radiograph, abdominal sonogram, small bowel study, and CT scan. Pathologic findings after surgery reveal an enterolith in Meckel's diverticulum without ectopic gastric mucosa. The case of Meckel's enterolith is herein reported.

A Case of Hydrogen Peroxide Induced Colitis / 대한소화기내시경학회지

Hydrogen peroxide has been used for various medical purposes and also recommended in the disinfection process for endoscopes. However, hydrogen peroxide as a cause of chemical colitis or disinfectant colitis has been infrequently reported. The endoscopic findings of hydrogen peroxide induced colitis revealed pseudomembranous-like enteritis such as white plaques, erythema, foamy liquid, patchy, granularity, and ulcerations, resulting from effervescence caused by the release of oxygen from the breakdown of hydrogen peroxide. A 36 year-old single male, who had 30 ml of 3% hydrogen peroxide inserted into his anus the day before due to sexual reasons, was hospitalized as a result of suffering from hematochezia, tenesmus, and lower abdominal pain. Colonoscopy revealed discrete or confluent white plaques adherent to the colonic mucosa, severe erythema on the surrounding mucosa, patchy granularity, and scattered ulcerations up to 28 cm from the anal verge. Pathologic finding revealed inflammatory cells infiltration, variable sized vacuoles, vascular congestion, hemorrhage, fibrin deposition and ulcerations with regenerating epithelium in the lamina propria, consistent with acute mucosal injury caused by hydrogen peroxide. A case of hydrogen peroxide induced colitis is herein reported.

A Case of Spindle Cell Carcinoma of the Esophagus / 대한소화기내시경학회지

Spindle cell carcinoma of the esophagus containing both carcinomatous and sarcomatous elements is rare, accounting for approximately 1- 2% of all esophageal neoplasms. Terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous squamous cell carcinoma and spindle cell variant of squamous cell carcinoma. Spindle cell carcinomas were originally classified as carcinosarcomas or pseu- dosarcomas, depending on the morphology and bilologic behavior of the particular lesian. However, pseudosarcoma and carcinosarcoma appear to be the same pathologic entity with varying degrees of anaplastic spindle cell metaplasia of the carcinomatous portion of the tumor. Thus, these lesions have been clsssified together as spindle cell carcinomas. A 59 year-old man who experienced weight loss for 4 months was hospitalized as a result of suffering from dysphagia for 2 months. A diffuse bulky protruding mass with superficial ulceration and easy friability on 25 to 35 cm from the incisors, which invaded the right intermediate bronchus and involved the right paratracheal and subcarnial lymph nodes, were obsetved in esophagogram, endoscopy and chest CT. Pathologic finding, including immunoreactivity to cytokeratin and vimentin, was consistent with spindle cell carcinoma. We report a case of spindle cell carcinoma of the esophagus.

A Case of Gastric Anisakiasis Causing Mallory - Weiss Syndrome / 대한소화기내시경학회지

Anisakiasis is an infection in humans caused by larval nematodes of the family Anisakidae and is encountered in people who eat inadequately prepared raw, salt-water fish or "sashimi". This clinical syndrome is characterized by severe cramping abdominal pain, nausea, and vomiting. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but the incidences of upper gastrointestinal bleeding caused by anisakiasis has been very rare. The present case is a 30 year-old male Admitted with an episode of hematemesis. A gastrofibroscopy revealed a mucosal laceration and the larva of Anisakis on the esophagogastric junction. We report one case of Mallory-Weiss Syndrome due to gastric Anisakis larva, confirmed by an endoscopy.