Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions.

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (±SD) of subjects was 60.9±10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.

[Clinicopathologic characteristics of superficial gastric cancer diagnosed at primary health care institutions in 2011].

BACKGROUND/AIMS: Stomach cancer is prevalent in Korea. The purpose of this study was to evaluate the characteristics of superficial gastric cancers detected at SOK Sokpeynhan Internal Medical Network, the nationwide primary health care institutions. METHODS: We prospectively analysed the clinicopathologic and endoscopic characteristics of 218 superficial gastric cancer patients diagnosed using gastric endoscopy at SOK network from January 2011 through December 2011. RESULTS: The mean age was 58.5 years old and male to female ratio was 1.7 : 1. Asymptomatic patients were most common (45.0%). The macroscopic classification revealed that simple types (63.8%) were more common than complex types (36.2%). The most common type was IIc (28.4%) and other types were as follows; IIb (16.1%), IIb+IIc (13.3%), IIa (10.6%), III (9.2%), IIa+IIc (7.3%), IIc+IIa (6.0%), IIc+IIb (5.0%). The most commonly involved sites were the body (53.1%) and greater curvature (32.6%) of the stomach. The size of lesion was less than 1 cm (69.3%) and less than 5 mm (33.5%) in diameter. The most common pathologic type was tubular adenocarcinoma (75.7%). Helicobacter pylori infection rate was 50.2%. Fifty five percent of the cases were diagnosed via endoscopy of National Health Insurance Corporation screenings. CONCLUSIONS: Superficial gastric cancers in 2011 at primary health care SOK network were different from those of previous reports. Type IIc was most common but type IIb was more prevalent and the body and greater curvature of the stomach were the most commonly involved sites. Therefore, careful observation of the proximal gastric mucosa and mucosal color change is needed.

The importance of vascular endothelial growth factor in the healing of acute tympanic membrane perforation.

PURPOSE: The purpose of this study was to determine the more important growth factor expression between basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in the healing of acute tympanic membrane (TM) perforation. MATERIALS AND METHODS: Bilateral perforations of the TM were created in 12 rats. The TM perforations in the right ears were treated with dexamethasone, and left ears were designated as the control group. The TM was examined for the growth factor expression immunohistochemically in the epithelial and fibrous layers according to the rate of TM perforation healing. RESULTS: The mean spontaneous healing time of the TM perforations was 11.0 +/- 2.0 days. However, dexamethasone-treated group showed no evidence of closure. The bFGF and VEGF expression were significantly correlated with the rate of healing of acute TM perforations. The VEGF expression was decreased both in the epithelial and fibrous layers, but bFGF expression was decreased only in the epithelial layer in the dexamethasone-treated group. The VEGF was expressed to a lesser degree than bFGF in the dexamethasone-treated group. CONCLUSION: Vascular endothelial growth factor is the more specific and important growth factor than bFGF in the healing of acute TM perforation.

Gastrointestinal stromal tumors of the stomach: endosonographic differentiation in relation to histological risk.

BACKGROUND AND AIM: The aim of this study was to determine the endosonographic characteristics of gastrointestinal stromal tumors (GISTs) of the stomach according to histological risk classification. METHODS: Twenty-four cases of histologically proven c-kit positive GISTs were divided into three groups according to histological risk: low risk (n = 14), intermediate risk (n = 7) and high risk (n = 3). Endoscopic ultrasonography (EUS) features recorded were: size, ulceration, regularity of marginal border, lobulation, shape of tumor, marginal halo, homogeneity, internal echogenic or cystic foci, and the presence of exophytic development. RESULTS: Significant differences were seen in size between the groups studied (P = 0.026). All tumors in the high risk group had mucosal ulceration, which was more commonly seen in the intermediate risk group compared to the low risk group (P = 0.014). All tumors in the high risk group had irregular borders, but only three cases out of 11 in the low risk group had irregular borders (P = 0.039). Thirteen cases in the low risk group and five cases in the intermediate risk group had an oval or round shape; however, only one case in the high risk group showed this (P = 0.043). The optimal size value for prediction of the intermediate and high risk group was 30 mm. Sensitivity and specificity with this value was 80% and 79%, respectively. CONCLUSIONS: Large, especially larger than 30 mm, GISTs of the stomach with irregular borders, mucosal ulceration and a non-oval shape on EUS suggest higher risk GISTs of the stomach. These criteria might aid in the clinical management of GISTs of the stomach.

[A case of an intraluminal duodenal diverticulum managed with endoscopic incision and ligation using needle-knife and detachable snare].

An intraluminal duodenal diverticulum (IDD) is a rare congenital anomaly consisted of a sac-like mucosal projection within the second portion of the duodenum. Even though most of cases are asymptomatic, patients may develop recurrent abdominal pain, pancreatitis, and gastrointestinal bleeding. We report a case of symptomatic IDD which presented as acute pancreatitis and obscure gastrointestinal bleeding. Diagnosis was made by typical findings of upper GI series and coronal reformatted CT images. Although surgical resection is the treatment of choice, endoscopic incision and ligation with detachable snare was performed which led to a good result.

[A case of cholestatic hepatitis induced by epstein-barr virus infection].

Acute viral hepatitis in human can be caused by a large number of viruses with a wide range of clinical manifestations and laboratory findings. EBV is a rare causative agent of an acute hepatitis, during the course of infectious mononucleosis. Hepatic manifestations of EBV are usually mild and resolve without serious complications. EBV is rather uncommonly confirmed as an etiologic agent in acute viral hepatitis of adults and it rarely causes cholestatic hepatitis. We report a case of EBV hepatitis with cholestatic feature that was verified through serum viral marker and liver biopsy.

[The factors related to the prognosis of solitary hepatocellular carcinoma after radiofrequency ablation].

BACKGROUND/AIMS: Several risk factors, such as size and location, are related to local recurrence after radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC). The objectives of this study were to clarify factors related to prognosis. METHODS: From October 1999 to December 2002, we performed RFA for 107 consecutive patients with solitary HCC. We evaluated spiral computed tomography and serum alpha-fetoprotein level every 3 months after RFA. Seven possible factors for prognosis were analyzed using the Cox proportional hazards regression model: tumor size, tumor location, age, sex, etiology, platelet count, and Child-Pugh classification. Overall survival and disease free survival rate were estimated using the Kaplan-Meier method, and differences between two groups were compared using the log rank test. RESULTS: The Kaplan-Meier estimates of overall survival after radiofrequency ablation were 90.5% at 12 months, 67.4% at 24 months and 46.4% at 36 months and disease free survival were 71.4%, 46.7% and 20.9%, respectively. Using the Cox proportional hazards regression model, it was shown that with regard to overall survival and disease free survival, Child-Pugh classification (P=0.001, P=0.026) and platelet count (P<0.001, P=0.002) were statistically significant factors. The other factors did not have a statistically significant relationship to overall survival and disease free survival. CONCLUSIONS: The size and location known as local recurrence factors were not statistically significant with regard to survival and disease free survival. The Child-Pugh classification and platelet count, that reflect the liver function at the time of RFA, were significant factors for prognosis.

N-nitration of secondary amines with 4-chloro-5-methoxy-2-nitropyridazin-3-one.

N-Nitration of 4-chloro-5-substituted-pyridazin-3-one with copper nitrate trihydrate in acetic anhydride gave the corresponding 4-chloro-2-nitro-5-substituted-pyridazin-3-one. 4-Chloro-5-alkoxy-2-nitropyridazin-3-ones such as 5-methoxy (2b) and 5-ethoxy (2d) derivatives showed excellent nitro group transfer potentiality. N-Nitration of some secondary amines with 2b gave the corresponding N-nitramines under mild neutral condition in good yields.