Long-term therapeutic effects of partial splenic embolization on secondary hypersplenism

Background: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. Methods: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. Results: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. Conclusions: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism.ope

Clinical outcomes and predictive factors for response after the first course of corticosteroid therapy in patients with Crohn's disease

BACKGROUND/AIMS: This study sought to determine the natural course of Crohn's disease (CD) and identify predictors that could indicate responsiveness to corticosteroid (CS) therapy. METHODS: Patients with active CD who were treated with oral CS at a single institution between August 1994 and February 2008 were retrospectively reviewed. The clinical outcomes at 1 month, 4 months, and 1 year after the treatment, as well as clinical and biochemical parameters at the time of CS initiation, were evaluated. RESULTS: A total of 96 patients with CD were enrolled. In this study, 37 patients achieved complete remission (38.5%), 49 achieved partial remission (51.0%), and 10 (10.4%) showed no response at 1 month after the initiation of CS treatment. At 4 months and 1 year after treatment, 66 (69.5%) and 47 (56.6%) patients showed prolonged response, 22 (23.2%) and 20 (24.1%) showed steroid dependency, and 7 (7.4%) and 16 (19.3%) showed refractoriness, respectively. Nonstricturing and nonpenetrating behaviors and a lower CD activity index demonstrated clinical significance for mid-term or mid- and long-term steroid responses, respectively. CONCLUSIONS: The short-term response rate to initial oral CS therapy in CD was considerably high, but responsiveness thereafter showed a tendency to decrease with time. Clinical parameters reflecting mild inflammation were associated with responsiveness after CS treatment.ope

Clinicopathologic features of colorectal cancer combined with synchronous and metachronous gastric cancer

Background/Aims: The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone. Methods: A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also. Results: Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted. Conclusions: Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.ope

A Case of Budd-Chiari Syndrome and Superior Mesenteric Vein Thrombosis in Ulcerative Colitis

Patients with inflammatory bowel disease are at increased risk for thromboembolic complications. Its prevalenceVrate ranges from 1% to 7% in clinical studies and reaches 39% in autopsy series. The cause of thrombotic complications in inflammatory bowel disease is generally considered to be associated with hypercoagulability. We experienced a case of ulcerative colitis associated with Budd-Chiari syndrome and superior mesenteric vein thrombosis. This rare complication of ulcerative colitis was successfully managed by conventional treatment for ulcerative colitis and anticoagulation therapy.ope

A Case of Ileal Mucormycosis in a Patient with Gastrointestinal Behcet’s Disease

Zygomycosis (mucormycosis) is a rare fungal infectious disease, usually found in association with an immunocompromised state. Gastrointestinal mucormycosis is extremely rare and fatal, thus it is important to detect and manage this disease at an early stage in an effort to improve survival. To date, no cases of mucormycosis superimposed on gastrointestinal Behcet’s disease have been reported. Herein we report a case in which gastrointestinal mucormycosis occurred in a 17-year-old-female with Behcet’s disease. The patient recovered from her disease after undergoing an ileocecectomyope

Efficacy of Individual Prediction Model for the Early Diagnosis of Hepatocellular Carcinoma

Background: Screening tests for hepatocellular carcinoma (HCC) in the high risk population can detect tumors at an earlier stage and thus confer a higher chance of receiving treatment. However, the usefulness, frequency and cost-effectiveness of screening for HCC may differ in different areas, possibly reflecting differences in risk factors. Last decade, we have identified risk factors for HCC in 4339 Korean patients. The aim of this study was to investigate the efficacy and usefulness of individual prediction model for the early diagnosis of HCC. Methods: We studied a total of 833 patients who visited Yonsei University Medical Center for regular check-up including ultrasonography and alpha-fetoprotein from January 1999 to December 2000. The patients were classified into a low risk group ( 15%) by the probability of HCC development according to individual prediction model (IPM). The patients who developed HCC during the follow-up periods were analyzed using IPM. All the detailed data of clinical parameters were obtained by our self-exploited data base system prospectively and analyzed by SAS program. Results: 44 (5.3%) out of 833 patients developed HCC during mean follow-up periods of 36 months. According to IPM, 2 (0.62%) of 324 patients in the low risk group, 20 (4.84%) of 413 patients in the intermediate risk group, and 22 (22.9%) of 96 patients in the high risk group were diagnosed as HCC. In 29 of 44 HCC patients (65.9%), initial presentation of tumor size was less than 3 cm in diameter. Conclusion: We confirmed the reliability of established IPM for screening of HCC and this model may help screening program to be done effectively by focusing high risk groups for HCCope

Clinical Efficacy of Nonsurgical Treatment of Crohn`s Disease-related Intraabdominal Abscess

Background/Aims: This study was conducted to compare the clinical efficacy between surgical and nonsurgical treatments for patients with Crohn`s disease-related intraabdominal abscess. Methods: A retrospective review of medical records was performed for patients admitted to a single institution due to Crohn`s disease-related intra-abdominal abscess from February, 1996 to February, 2008. Clinical outcomes were compared between surgical and nonsurgical groups in terms of treatment responses and recurrences. Results: A total of 47 episodes of intra-abdominal abscesses in 43 patients (12.7%) were identified from 339 patients with Crohn`s disease. Of these, initially, 18 cases (38.3%) underwent surgical treatment and 29 (61.7%) were treated medically (antibiotic treatments with or without percutaneous drainage). The overall treatment response rates of surgical and nonsurgical group were 100% versus 89.7% (p=0.11) and recurrence rates were 27.8% versus 30.8% (p=1.00). Three patients in nonsurgical group (10.3%) showed no response to therapy and ultimately received surgical drainages. The median length of hospitalization in nonsurgical group was shorter than in surgical group (12 and 29.5 days, respectively. p=0.02). Conclusions: Nonsurgical treatment might be as effective as surgical treatment for the treatment of Crohn`s disease-related intraabdominal abscess, especially considering shorter hospital stayope

Postradiation Malignant Fibrous Histiocytoma of the Colon: A Case Report

Post-radiation soft tissue sarcomas are recognized as rare complications of radiation therapy. The most common type of post-radiation soft tissue sarcoma is a malignant fibrous histiocytoma (MFH), which originates from mesenchymal cells with a predominance of histiocytes and fibroblasts. The two most common sites of occurrence for post-radiation soft tissue sarcomas are the chest wall and pelvic cavity. Post-radiation colorectal MFHs are extremely rare and all of the reported cases of post-radiation sarcomas have occurred ＞3 years after radiation therapy. Recently, we managed a case of colorectal MFH which developed in a 48-year-old male who had undergone a low anterior resection for rectal adenocarcinoma and had received chemoradiotherapy as adjuvant treatment. Twelve months after radiotherapy, a 4 cm mass was detected 8 cm superior to the anastomosis site on colonoscopic examination. A soft tissue sarcoma was suspected on pathologic examination of the biopsy specimen. Therefore, he underwent a Hartmann’s operation and the final pathologic finding revealed MFH with a storiform pattern of tumor cells composed of pleomorphic, multinucleated giant cells. This is the first case of MFH that had a latency period ＜3 years (i.e., 1 year) between the time of radiotherapy and diagnosisope

대장암에서 cyclooxygenase-2 의존 및 비의존 경로를 통한 비스테로이드성 항염증제의 암줄기세포 억제효과

Dept. of Medicine/박사Cancer stem cell (CSC) model assumes that a small subset of cells in tumors have the ability to initiate and sustain tumor growth. CSCs are resistant to many current chemotherapeutic agents and play a pivotal role in cancer relapse. In this study, we aimed to identify the effective agents to increase the sensitivity to chemotherapeutic agents by suppressing CSCs in human colorectal cancer (CRC).Colosphere forming assay and flow cytometric analysis of CSC markers (CD133 and CD44) were performed to investigate the CSC suppressing effect of nonsteroidal anti-inflammatory drugs (NSAIDs), which are known having the activities of peroxisome proliferator-activated receptor γ (PPARγ) agonist and γ-secretase inhibitor as well as cyclooxygenase (COX) inhibitor. In vitro experiments using SW620 cells, CSC markers and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay were carried out after treatment of control, indomethacin, 5- fluorouracil (5-FU), and combination of 5-FU and indomethacin. We also carried out nude mice xenograft experiments using 5-FU resistant SW620 cells and the same drug combination with in vitro cell line experiments. To investigate the underlying mechanisms, we measured changes of CSC population after treatment of COX-2 selective inhibitor (celecoxib), other NSAIDs (sulindac and aspirin) and combination of indomethacin and prostaglandin E2 (PGE2), and performed reporter assay using PPAR-responsive element (PPRE)-Luc. In xenograft experiments, the expressions of HES1 (Notch signaling marker), PPARγ and COX-2 as well as CD133 and CD44 were evaluated by immunohistochemical (IHC) stain.As a result, NSAIDs, including indomethacin, sulindac and aspirin, celecoxib, γ-secretase inhibitor (DAPT), and PPARγ agonist (rosiglitazone) significantly decreased CD133+CD44+ cells and induced over 50% decrease in the number of colospheres compared to control of SW620 cells. Compared to the control (100%), the treatment of low dose indomethacin (12.5 μM) for 4 days significantly decreased CD133+CD44+ cells (72.1%, P = 0.014), treatment of low dose 5-FU (2.0 μM) for 4 days led to the significant increases of CD133+CD44+ cells (228.2%, P = 0.014), and this 5-FU induced increase of CD133+CD44+ cells was inhibited by combination with indomethacin for the same period (133.1%, P = 0.021). In MTT assay, there was no significant difference in cell survival between groups, and these CSC-inhibitory effects of indomethacin was reversed by PGE2 in a dose-dependent manner. Indomethacin treatment, as well as rosiglitazone, significantly increased PPRE transcriptional activity. In xenograft experiments, 5-FU treatment combined with indomethacin significantly reduced tumor growth compared to 5-FU alone treated group. In addition, the treatment of indomethacin alone and combination of 5-FU and indomethacin decreased the expression of CD133, CD44, COX-2 and HES-1, and increased PPARγ expression, compared to control and 5-FU alone treated mice, respectively.In conclusion, NSAIDs could selectively reduce the colon CSCs and suppress 5-FU induced increase of CSCs through COX-2-dependent and -independent pathways, such as PPARγ and Notch pathway. These suggest that NSAIDs could play an important role of adjunctive treatment with conventional chemotherapy in CRC.ope

Risk of developing advanced colorectal neoplasia after removing high-risk adenoma detected at index colonoscopy in young patients: A KASID study

Background and Aim: Advanced adenoma (>10mm in diameter, villous structure, or high-grade dysplasia) in young patients may have different characteristics and prognosis compared with those in older patients. We aimed to compare the incidence of colorectal neoplasms in young patients with older patients after removing high-risk adenoma (advance adenoma or >= 3 adenomas). Methods: A retrospective, multicenter study was conducted at 13 university hospitals in Korea. The 1479 patients who removed high-risk adenoma at index colonoscopy and followed by surveillance colonoscopy >= 2.5 years after were included. The cumulative incidence of overall and advanced colorectal neoplasms was compared according to the age groups (group 1:<50 years, group 2:50-70 years, and group 3:>= 70 years). Results: The prevalence of advance adenoma detected at index colonoscopywas significantly higher in group 1 than in groups 2 and 3 (85.4%, 78.1%, and 77.2%, respectively; P = 0.035). The 5 years cumulative incidence of overall and advanced colorectal neoplasms were 61.9%, 67.9%, and 74.7% (P < 0.001), and 11.7%, 17.9%, and 27.1% (P = 0.001) in groups 1, 2, and 3, respectively. In multivariate analysis, age >70 years was a significant risk factor for developing overall (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.12-1.82, P = 0.004) and advanced colorectal neoplasms (HR = 2.56, 95% CI 1.43-4.59, P = 0.002). Conclusion: The cumulative incidence of overall and advanced colorectal neoplasms was significantly higher in older patients than in young patient groups. Age was a significant risk factor for developing colorectal neoplasms after removing high-risk adenoma