BACKGROUND/AIMS: Colorectal cancer is associated with different anatomical, biological, and clinical characteristics. We determined the impact of the primary tumor location in patients with metastatic colorectal cancer (mCRC). METHODS: Demographic data and clinical information were collected from 1,115 patients from the Republic of Korea, who presented with mCRC between January 2009 and December 2011, using web-based electronic case report forms. Associations between the primary tumor location and the patient's clinical characteristics were assessed, and factors inf luencing overall survival were analyzed using Cox proportional hazards regression models. RESULTS: Of the 1,115 patients recruited to the study, 244 (21.9%) had right colon cancer, 483 (43.3%) had left colon cancer, and 388 (34.8%) had rectal cancer. Liver and lung metastases occurred more frequently in patients with left colon and rectal cancer (p = 0.005 and p = 0.006, respectively), while peritoneal and ovarian metastases occurred more frequently in patients with right and left colon cancer (p < 0.001 and p = 0.031, respectively). The median overall survival of patients with tumors originating in the right colon was significantly shorter than that of patients whose tumors had originated in the left colon or rectum (13.7 months [95% confidence interval (CI), 12.0 to 15.5] vs. 18.0 months [95% CI, 16.3 to 19.7] or 19.9 months [95% CI, 18.5 to 21.3], respectively; p = 0.003). Tumor resection, the number of metastatic sites, and primary tumor location correlated with overall survival in the univariate and multivariate analyses. CONCLUSIONS: Primary tumor location influences the metastatic sites and prognosis of patients with mCRC.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Rectum ; Republic of Korea

PURPOSE: The peroxisome proliferator-activated receptor gamma (PPARgamma) is a nuclear receptor that regulates expression of mediators of lipid metabolism and the inflammatory response. Thyroid hormone receptor-associated proteins 220 (TRAP220) is an essential component of the TRAP/Mediator complex. The objective of this study was to clarify whether PPARgamma or TRAP220 are significant prognostic markers in resectable colorectal cancer (CRC). MATERIALS AND METHODS: A total of 399 patients who underwent curative resection for CRC were enrolled. We investigated the presence of PPARgamma and TARP220 in CRC tissues and adjacent normal tissues by immunohistochemistry. Correlation between the expression of these factors and clinicopathologic features and survival was investigated. RESULTS: Median age of the patients was 63 years (range, 22 to 87 years), and median follow-up duration 61.1 months (range, 2 to 114 months). PPARgamma and TRAP220 expression showed significant correlation with depth of invasion (p=0.013 and p=0.001, respectively). Expression of TRAP220 also showed association with lymph node metastasis and TNM stage (p=0.001). Compared with patients with TRAP220 negative tumors, patients with TRAP220 positive tumors had longer 5-year disease-free survival (DFS) tendency (p=0.051). Patients who were PPARgamma positive combined with TRAP220 positive had a better 5-year DFS (64.8% vs. 79.3%, p=0.013). In multivariate analysis expression of both PPARgamma and TRAP220 significantly affected DFS (hazard ratio, 0.620; 95% confidence interval, 0.379 to 0.997; p=0.048). CONCLUSION: TRAP220 may be a valuable marker for nodal metastasis and TNM stage. Tumor co-expression of PPARgamma and TRAP220 represents a biomarker for good prognosis in CRC patients.
Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lipid Metabolism ; Lymph Nodes ; Mediator Complex Subunit 1* ; Multivariate Analysis ; Neoplasm Metastasis ; Peroxisomes* ; PPAR gamma* ; Prognosis ; Thyroid Gland

BACKGROUND/AIMS: Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations. METHODS: From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying. RESULTS: Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (< or =0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups. CONCLUSION: Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.
Adenoma ; Adenomatous Polyps ; Cecum ; Colon, Ascending ; Colonoscopy ; Humans ; Indigo Carmine ; Polyps*

PURPOSE: To identify the recovery of joint movement and decrease in pain through the radiological findings after open synovectomy for the elbow with rheumatoid arthritis which was not cured by medication. MATERIALS AND METHODS: From 1997 to 2008, the research on open synovectomy for the elbow with rheumatoid arthritis was done in 19 patients with 21 cases whose average follow-up was 12 months. Despite the medical treatment, the indication of operation was towards the patients with Larsen grade I~III rheumatoid arthritis whose joint swelling and pain had not been improved. Also, the indication of operation included the patients with Larsen grade IV who rejected joint replacement or needed to postpone the operation due to young age. Main symptom was pain in all cases; Preoperative flexion contracture and flexion-extension movement on average was 29 degree and 86 degree, respectively.Postoperative radiological and physical examination were done; Visual analogue scale and Mayo elbow performance score were measured. RESULTS: Joint swelling recurred in two cases (9.5%). However, the size of swelling was mild compared to preoperative condition. Preoperative total mean flexion contracture was 29 degree (10~45 degree) and total mean flexion-extension movement was 86 degree (60~135degree). Last follow-up total mean flexion contracture was 18 degree (5~50 degree) and total mean flexion movement was 102 degree (35~150 degree). Statistically, the increase of range of joint movement was not significant. Radiologically, there were 11 cases(52.3%) showing no changes in preoperative and postoperative grade while there were 10 cases(47.6%) with increase in grade. As for VAS score, total mean preoperative score was 5 and postoperative score was 2.3(0~8) showing less pain than the past. After statistical analysis separated by Grade I, II, III and IV, last follow-up of VAS score, Mayo elbow performance score and elbow joint movement showed no statistical difference compared to Larsen grade (p=0.075). CONCLUSIONS: Open Synovectomy for elbow with rheumatoid arthritis can not stop radiological progress, and the increase in range of joint movement is not statistically meaningful. However the operation displays clinical improvement such as decrease in pain and increase in range of joint movement.
Arthritis, Rheumatoid ; Contracture ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Joints ; Physical Examination ; Synovitis

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

PURPOSE: To evaluate the therapeutic activity and safety of paclitaxel and cisplatin combination chemotherapy in patients with advanced or metastatic gastric cancers that are unresponsive to primary chemotherapy. MATERIALS AND METHODS: Advanced or metastatic gastric cancer patients unresponsive to first line chemotherapy were entered into this trial. The treatment regimen consisted of paclitaxel, 175 mg/m(2) by 3-hour infusion on day 1, and cisplatin, 60 mg/m(2) by 1 hour infusion on day 1, with the treatment repeated every 3 weeks. RESULTS: 37 patients were entered in this study, with 32 fully evaluable for response. 4 (13%), 13 (40%) and 15 (47%) patients achieved a partial response, stable disease and progressed, respectively. The median time to progression was 4.0 months (95% CI: 2.0~6.0 months), and the median overall survival was 12.6 months (95% CI: 5.5~19.7 months), with a 1-year survival rate of 54%. Of a total of 135 cycles of chemotherapy, grades 3 and 4 hematological toxicities were neutropenia (14%) and anemia (3%). Grade > or =2 neuropathy was observed in 6 patients (17%). CONCLUSION: The combination of paclitaxel and cisplatin is an effective and tolerable salvage treatment modality for advanced gastric cancer.
Anemia ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Neutropenia ; Paclitaxel* ; Salvage Therapy* ; Stomach Neoplasms* ; Survival Rate

Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.
Alkalies ; Child ; Dilatation ; Eating* ; Esophageal Stenosis* ; Esophagus ; Humans ; Inflammation ; Lye* ; Middle Aged ; Mitomycin* ; Mucous Membrane ; Stents*

BACKGROUND: There has been changed in estimation of the stem cell content of the graft for several decades. However, there is not always correlating the transplanted cell dose with hematologic recovery, and there are few reports in human leukocyte antigen (HLA)-matched sibling allogeneic bone marrow transplantation (AlloBMT) in Korea. The purpose of this study is to report the influence of number of transplanted cell dose on hematologic recovery and the clinical outcomes in HLA-matched sibling AlloBMT. METHODS: Between June 1999 and March 2004, 31 AlloBMT from HLA-matched sibling donor was done in patients with hematologic malignancy. All patients were conditioned with busulfan and cyclophosphamide. Short course methotrexate and cyclosporine regimen was used for prophylaxis of graft-versus-host disease. We analyzed hematologic recovery time and clinical outcomes according to transplanted cell dose. RESULTS: There were 16 male and 15 female patients, with a median age of 34 years (range, 16~48). Underlying diseases were 17 acute myeloid leukemia, 4 acute lymphoblastic leukemia, 3 myelodysplastic syndrome (high-risk), and 7 chronic myelogenous leukemia. The median number of total nucleated cell (TNC), mononuclear cell (MNC) and CD34+ cell infused was 3.95x10(8)/kg (range, 1.67~7.30x10(8)/kg), 0.65x10(8)/kg (range, 0.11~2.50x10(8)/kg), and 2.32x106/kg (range, 0.35~7.45x106/kg), respectively. The median days of neutrophil and platelet engraftment (ANC>500/microliter and platelet > 20,000/L without transfusion) were 15 (range, 10~19), 16 (range, 7~37), respectively. Relationship between the rate of neutrophil engraftment and the number of infused TNC was only statistically significant (P=0.038, R2=0.328). This study showed survival benefit with the increment of CD34+ cell dose without significance statistically (P=0.082). CONCLUSION: Although the dose of the number of transplanted MNC and CD34+ cells had no influence on granulocyte or platelet recovery, the number of TNC had only a beneficial effect on neutrophil recovery. The transplanted dose of CD34+ cells, rather than those of TNC and MNC may be related with better survival.
Blood Platelets ; Bone Marrow Transplantation* ; Bone Marrow* ; Busulfan ; Cyclophosphamide ; Cyclosporine ; Female ; Graft vs Host Disease ; Granulocytes ; Hematologic Neoplasms ; Humans ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Leukocytes ; Male ; Methotrexate ; Myelodysplastic Syndromes ; Neutrophils ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Siblings* ; Stem Cells ; Tissue Donors ; Transplants

Waldenstrom macroglobulinemia, which is characterized by elevation of serum monoclonal IgM paraprotein, has recently been responsible for the treatment of purine analogues. Fludarabine, one of purine analogues, has been associated with autoimmune hemolytic anemia in patient with chronic lymphocytic leukemia. However, autoimmune hemolytic anemia after fludarabine treatment for Waldenstrom macroglobulinemia has not been reported. We experienced a case of autoimmune hemolytic anemia after fludarabine treatment for Waldenstrom macroglobulinemia. In this case, hemolytic anemia with positive direct Coombs' test occurred at 20 months after the first administration of fludarabine, relapsed at 5 days after re-administration. This anemia responded to steroid therapy. Autoimmune hemolytic anemia associated with fludarabine therapy can be severe and fatal, especially if a patient is re-treated with this drug after a previous episode of hemolytic anemia.
Anemia ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; Coombs Test ; Humans ; Immunoglobulin M ; Leukemia, Lymphocytic, Chronic, B-Cell ; Waldenstrom Macroglobulinemia*