BACKGROUND/AIMS: Fascin, an actin-bundling protein found in membrane ruffles, microspikes, and stress fibers, induces membrane protrusions and increases cell motility in normal and various transformed cells. The expression of fascin in epithelial neoplasms has only been described recently, and the role of fascin in colorectal carcinoma (CRC) is still unknown. METHODS: Paraffin sections of CRC from 79 patients were immunohistochemically investigated using monoclonal anti-fascin antibody. Staining of >5% of tumor cells was recorded as positive immunoreactivity. RESULTS: Overall, fascin immunoreactivity was detected in 63 of 79 patients (79.7%). Twenty-three patients were classified as 1+ (5-25% immunoreactive tumor cells) and 24 were 2+ (>25% immunoreactive tumor cells). In these patients, 16 had 3+ (>75% immunoreactive tumor cells) fascin immunoreactivity. Fascin immunoreactivity was increased according to the TNM stage (P<0.001), positive lymph node metastasis (P<0.001), budding (P<0.001), vessel invasion (P=0.001), perineural invasion (P=0.039), overall survival (P=0.012), and disease-free survival (P=0.016); however, fascin immunoreactivity was not correlated with recurrence or depth of tumor invasion. CONCLUSIONS: This study suggests that an increased expression of fascin was associated with a poor prognosis and the immunohistochemical detection of fascin provides useful information as one of the prognostic values in CRC.
Carrier Proteins ; Cell Movement ; Colorectal Neoplasms ; Disease-Free Survival ; Glycosaminoglycans ; Humans ; Immunohistochemistry ; Lymph Nodes ; Membranes ; Microfilament Proteins ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial ; Paraffin ; Prognosis ; Recurrence ; Stress Fibers

Small intestinal bacterial overgrowth (SIBO) syndrome is characterized by an imbalance of a complex microbiome in the gut. The underlying factors include anatomic abnormalities, (small intestinal obstruction, diverticular disease, fistulas, blind or afferent loops, and previous ileo-cecal resection), motility disorders (scleroderma, diabetic autonomic neuropathy, and ileus), and some conditions associated with failure of antibacterial defense mechanisms (achlorhydria, pancreatic exocrine insufficiency, and an immunosuppressed state). In recent studies, there is abundant evidence suggesting the relationship between SIBO and irritable bowel syndrome; however, it is not clear which disease is a primary factor to the other. Symptoms related to SIBO include diarrhea, bloating, malabsorption, weight loss, and anemia. The gold standard test for the diagnosis of SIBO is aspiration of jejunal fluid for culture. However, non-invasive hydrogen and methane breath tests are more widely used for the diagnosis, although they have several potential problems affecting the diagnostic accuracy. The treatment should be individualized, and usually consists of correction of the underlying predisposing disease, nutritional support, and cyclic or repeated courses of antimicrobials.
Anemia ; Breath Tests ; Defense Mechanisms ; Diabetic Neuropathies ; Diarrhea ; Fistula ; Hydrogen ; Intestinal Obstruction ; Metagenome ; Methane ; Nutritional Support ; Weight Loss

Clinicians are frequently challenged to interpret gastrointestinal symptoms in patients with inflammatory disease (IBD). Irritable bowel syndrome (IBS)-like symptoms are common in patients with IBD and the underlying mechanism is likely to be active or occult inflammation of the bowel rather than co-existing IBS. Biopsychosocial construct and mucosal inflammation, stress, alteration of the hypothalamic-pituitary-adrenal axis, and autonomic dysregulation are contributing factors to IBD-IBS. In particular, low-grade inflammation and immune activation are recent topics regarding the underlying mechanism. Some authors have claimed that inflammation could be a common pathophysiologic factor, in which IBS and IBD might represent the two ends of a wide spectrum of chronic inflammatory conditions. Mast cells, enteroendocrine cells, T cells, and B cells are main effector cells in immune responses. Differentiating IBS symptoms from exacerbation of IBD is important, thus preventing the use of excessive IBD medications, with the potential side effects, or narcotics. Medical treatments with anti-diarrheals, anti-spasmodics, anti-depressants, and anxiolytics can be helpful. However, abuse can lead to medication-dependency and bring about side effects. A healthy, balanced lifestyle, including diet and exercise, should be endorsed.
Anti-Anxiety Agents ; Axis, Cervical Vertebra ; B-Lymphocytes ; Colitis, Microscopic ; Diet ; Enteroendocrine Cells ; Humans ; Immunity, Mucosal ; Inflammation ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Life Style ; Mast Cells ; Narcotics ; T-Lymphocytes

No abstract available.

No abstract available.
Colitis* ; Cytomegalovirus*

No abstract available.
Diarrhea* ; Humans

Lymph node metastasis is rare in small (i.e., <10 mm) rectal neuroendocrine tumors (NETs). In addition to tumor size, pathological features such as the mitotic or Ki-67 proliferation index are associated with lymph node metastasis in rectal NETs. We recently treated a patient who underwent endoscopic treatment of a small, grade 1 rectal NET that recurred in the form of perirectal lymph node metastasis 7 years later. A 7-mm-sized perirectal lymph node was noted at the time of the initial endoscopic treatment. The same lymph node was found to be slightly enlarged on follow-up and finally confirmed as a metastatic NET. Therefore, the perirectal lymph node metastasis might have been present at the time of the initial diagnosis. However, the growth rate of the lymph node was extremely low, and it took 7 years to increase in size from 7 to 10 mm. NETs with low Ki-67 proliferation index and without mitotic activity may grow extremely slowly even if they are metastatic.
Diagnosis ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Rectum

Anorectal melanoma is a rare neoplasm that accounts for less than 1-4% of anorectal malignant tumors. The main therapeutic modality for anorectal melanoma is surgical treatment, with abdominoperineal resection or wide local excision being the most common approaches. A 77-year-old male with a history of cerebral infarction and hypertension presented with anal bleeding. Here, we report a case of anorectal melanoma treated by endoscopic mucosal resection with adjuvant interferon therapy rather than surgical resection. The patient has been disease-free for 5 years after endoscopic treatment.
Aged ; Cerebral Infarction ; Hemorrhage ; Humans ; Hypertension ; Interferon-alpha ; Interferons ; Male ; Melanoma*

Behcet's disease (BD) is a systemic vasculitis, while myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematologic disorders characterized by ineffective hematopoiesis. Some studies suggest a relationship between MDS and BD, especially intestinal BD, and trisomy 8 seems to play an important role in both diseases. There are several reports on patients with BD comorbid with MDS involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapies. Tumor necrosis factor (TNF)-alpha is strongly involved in the pathophysiology of several autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and BD. In addition, TNF-alpha plays an important role in the pathophysiology of MDS by inhibiting normal hematopoiesis and inducing the programmed cell death of normal total bone marrow cells and normal CD34+ cells. Recent clinical reports demonstrate the favorable effect of TNF-alpha antagonists in patients with refractory intestinal BD and in those with MDS. We present the case of a patient with intestinal BD and MDS involving trisomy 8 who was successfully treated with adalimumab.
Adalimumab ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Behcet Syndrome ; Bone Marrow Cells ; Cell Death ; Hematopoiesis ; Humans ; Inflammatory Bowel Diseases ; Myelodysplastic Syndromes* ; Systemic Vasculitis ; Trisomy* ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Among the many complications that can occur following therapeutic endoscopy, bleeding is the most serious, which occurs in 1.0-6.1% of all colonoscopic polypectomies. The aim of this study was to identify risk factors of delayed post-polypectomy bleeding (PPB). METHODS: We retrospectively reviewed the data of patients who underwent colonoscopic polypectomy between January 2003 and December 2012. We compared patients who experienced delayed PPB with those who did not. The control-to-patient ratio was 3:1. The clinical data analyzed included polyp size, number, location, and shape, patient' body mass index (BMI), preventive hemostasis, and endoscopist experience. RESULTS: Of 1,745 patients undergoing colonoscopic polypectomy, 21 (1.2%) experienced significant delayed PPB. We selected 63 age- and sex-matched controls. Multivariate logistic regression analysis showed that polyps >10 mm (odds ratio [OR], 2.605; 95% confidence interval [CI], 1.035-4.528; P=0.049), a pedunculated polyp (OR, 3.517; 95% CI, 1.428-7.176; P=0.045), a polyp located in the right hemicolon (OR, 3.10; 95% CI, 1.291-5.761; P=0.013), and a high BMI (OR, 3.681; 95% CI, 1.876-8.613; P=0.013) were significantly associated with delayed PPB. CONCLUSIONS: Although delayed PPB is a rare event, more caution is needed during colonoscopic polypectomies performed in patients with high BMI or large polyps, pedunculated polyps, or polyps located in the right hemicolon.
Body Mass Index ; Colonoscopy ; Endoscopy ; Hemorrhage* ; Hemostasis ; Humans ; Logistic Models ; Polyps ; Retrospective Studies ; Risk Factors*