Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The reported incidence is 1-6%. The most common thromboembolic complications are deep venous thrombosis of legs and pulmonary thromboembolism. Cerebral thrombosis, portal vein thrombosis, retinal venous thrombosis and arterial thrombosis were also reported. We experienced a case of ulcerative colitis complicated with pulmonary thromboembolism. The patient was a 70-year-old woman who was diagnosed as ulcerative colitis on colonoscopy. We used prednisolone and sulfasalazine for the treatment of ulcerative colitis. Twenty five days later, she complained of abrupt dyspnea and chest pain. Chest CT and ventilation-perfusion scan revealed a thromboembolism in both lung. After the treatment of heparin & warfarin therapy, follow-up chest CT showed much regressed pulmonary thromboembolism. We report a 70-year-old woman with ulcerative colitis complicated with pulmonary thromboembolism and treated with heparin & warfarin therapy successfully.
Aged ; Colitis, Ulcerative/*complications ; English Abstract ; Female ; Humans ; Pulmonary Embolism/*complications

BACKGROUND/AIMS: As a preliminary study to test the possibility of oral transmission of hepatitis C virus (HCV), many investigations in order to detect the extrahepatic localization of HCV have been performed. In this study, we examined the presence of HCV viral proteins in gastric mucosa. METHODS: Immunohistochemical staining to NS3 protein were done to detect the HCV virus in gastric mucosa. The results were compared with NS5a protein staining to confirm the NS3 protein staining. RESULTS: Total of 164 patient were included. 58 patients with anti-HCV (+) were designated to case group and 70 with anti-HCV (-) to control group. 36 were excluded in this study due to concomittent illness. Anti-HCV (+) group showed 50.0% (29/58) of positivity to NS3 protein staining and anti-HCV (-) group showed 12.6% (9/70) of positivity (p<0.001). Immunohistochemical staining to NS5a protein were done to validate the result of NS3 (+) staining in the anti-HCV (+) group (n=58). NS5a (+) staining were observed in 58.6% (34/58). The results of NS5a staining were consistent with that of NS3 in 70.7%. The reliability coefficients by Chronbach's Alpha for NS3 and NS5a stain test was 0.59. CONCLUSIONS: HCV can exist in gastric mucosal cell as an extrahepatic presence. In the future, this study may provide some fundamental data for the research of possible oral transmission route of HCV.
Aged ; English Abstract ; Female ; Gastric Mucosa/*virology ; Hepacivirus/*isolation & purification ; Hepatitis C Antigens/*analysis ; Humans ; Male ; Middle Aged

BACKGROUND/AIMS: X-linked inhibitor of apoptosis (XIAP) is the most potent member of the IAP family that exerts antiapoptotic effects. Recently, XIAP-associated factor 1 (XAF1) and two mitochondrial proteins, Smac/DIABLO and HtrA2, have been identified to negatively regulate the caspase-inhibiting activity of XIAP. We explored the candidacy of XAF1, Smac/DIABLO and HtrA2 as a tumor suppressor in colonic carcinogenesis. METHODS: Expression and mutation status of the genes in 10 colorectal carcinoma cell lines and 40 primary tumors were examined by quantitative PCR analysis. RESULTS: XAF1 transcript was not expressed or present at extremely low levels in 60% (6/10) of cancer cell lines whereas Smac/DIABLO and HtrA2 are normally expressed in all cell lines examined. Tumor-specific loss or reduction of XAF1 was also found in 35% (14/40) of matched tissue sets obtained from the same patients. XAF1 transcript was reactivated in all the low expressor cell lines by treatment with the demethylating agent 5-aza-2'-deoxycytidine. Moreover, bisulfite DNA sequencing analysis for 34 CpG sites in the promoter region revealed a strong association between hypermethylation and gene silencing. Restoration of XAF1 expression resulted in enhanced apoptotic response to etoposide and 5-flurouracil, whereas knockdown of XAF1 expression by siRNA transfection significantly inhibited chemotherapeutic drug-induced apoptosis. CONCLUSIONS: XAF1 undergoes epigenetic gene silencing in a considerable proportion of human colon cancers by aberrant promoter hypermethylation, suggesting that XAF1 inactivation might be implicated in colonic tumorigenesis.
Cell Line, Tumor ; Colonic Neoplasms/*genetics ; *DNA Methylation ; English Abstract ; Gene Expression Regulation, Neoplastic ; *Gene Silencing ; Humans ; Intracellular Signaling Peptides and Proteins/genetics ; Mitochondrial Proteins/genetics ; Neoplasm Proteins/*genetics ; Promoter Regions (Genetics) ; Serine Endopeptidases/genetics

BACKGROUND/AIMS: The effects of curcumin on the growth of human colon cancer cell lines, HT-29 and WiDr cells were examined and the effects of 5-fluorouracil (5-FU) were also studied. METHODS: The growth of HT-29 and WiDr cells were examined by counting cell number on two and four days treatment with 1-40 micrometer of curcumin, and 0.1 microgram/mL, 0.3 microgram/mL of 5-FU. The reversibility of curcumin was examined on one day to seven days treatment with 10 micrometer curcumin after seeding to 2 10(4) cells/well. To examine the inhibitory effects of curcumin, cell cycle analysis was done on the HT-29 cells after four days treatment with 20 micrometer curcumin. RESULTS: Curcumin inhibited the growth of HT-29 and WiDr cells in a dose-dependent fashion. The growth rate of the group in which curcumin was removed by media change 24 hours after the treatment of curcumin was not different from that of control group. Curcumin combined with 5-FU markedly inhibited the growth of HT-29 and WiDr cells compared to curcumin or 5-FU alone. After four days treatment of HT-29 cells with 20 micrometer curcumin, the fraction of cells in G2-M phase was 35.3% in curcumin group, much higher than 13.8% of the control group. CONCLUSIONS: Curcumin significantly inhibited the growth of HT-29 and WiDr cells in a dose- dependent, reversible fashion.
Antineoplastic Agents/*pharmacology ; Cell Division/drug effects ; Cell Line, Tumor ; Colonic Neoplasms/*pathology ; Curcumin/*pharmacology ; English Abstract ; Flow Cytometry ; Fluorouracil/pharmacology ; HT29 Cells ; Humans

Hepatocellular carcinoma (HCC) is one of the most common malignancies world wide. Several experimental treatments have been tested against HCC. Those are chemotherapy, high dose proton beam radiotherapy, external beam radiotherapy, cyberknife, antibody-directed therapy and immunotherapy. Neither single nor combination therapy have demonstrated any clear reproducible benefit in terms of overall survival. Tamoxifen and antiandrogen therapy were not effective in prolonging survival when tested in randomized controlled trial. The modern radiation therapy concept such as intensity-modulated, image-guided, and stereotactic body radiation therapy may show promising effects on HCC. The increasing promise of targeted drug therapy in cancer needs to be particularly pursued in the treatment of HCC, in which cytotoxic agents are not usually effective. Other approaches include hormonal manipulation, immunotherapy, and specific inhibition of angiogenesis or growth factors. These issues stress the need for basic research in carcinogenesis in general and HCC in particular.
Carcinoma, Hepatocellular/*therapy ; English Abstract ; Humans ; Liver Neoplasms/*therapy

In spite of the nice screening program using the state-of-the-art imaging modalities, most patients with hepatocellular carcinoma (HCC) are not eligible for curative resection due to poor hepatic functional reserve and multiplicity of the tumors. Therefore they greatly rely on percutaneous interventional procedures. Among these, transcatheter arterial chemoembolization and local ablation therapies including ethanol injection therapy or radiofrequency (RF) thermal ablation have gained wider acceptance for the local treatment of unresectable HCC with growing evidence of survival gain. Although we need more prospective randomized trials to determine the definite role of these interventional therapies, the current consensus is that they are safe and effective for the local control of small HCC and have a potential to replace definitive surgical options. In this review, the basic principles and published clinical results including long-term survival rates and complications are reviewed. The benefits and limitations of each therapy are also discussed.
Carcinoma, Hepatocellular/radiography/*therapy ; Combined Modality Therapy ; English Abstract ; Humans ; Liver Neoplasms/radiography/*therapy ; *Radiography, Interventional

Due to recent rapid advances in imaging modalities, there has been a marked increase in the early diagnosis of hepatocellular carcinoma (HCC). Also, the emergence of effective local treatment methods has lead to the necessity for a wider selection of therapeutic modalities depending on the individual characteristics of each patient, such as tumor factors and hepatic factors, rather than a single uniform approach. At present, accurate preoperative liver function evaluation is available, and in addition, increased knowledge of the liver anatomy through liver transplantation, and advances in postoperative patient care has subsequently decreased the morbidity and mortality rates significantly after surgery. Such newly developed techniques and acquired knowledge has allowed the surgical option to expand from the classical hepatic lobectomy to systematic subsegmentectomy. Not only for early HCC, but also for intermediate HCC and advanced HCC, hepatectomy has shown the best results in each stage of disease with regard to treatment goals. It is therefore thought that hepatectomy should always be considered as the main treatment method in the multimodality treatment of HCC, as long as the liver function reserve permits, to enhance the quality of life, increase survival, and to cure disease. The authors present here a summary of the role of surgical approaches in HCC with respect to recent increases in the detection of early stage disease, new therapeutic modalities, and a new staging system for HCC.
Carcinoma, Hepatocellular/*surgery ; English Abstract ; Hepatectomy/methods ; Humans ; Liver Neoplasms/*surgery

In patients with chronic liver disease, hepatocelluar carcinomas are developed from regenerative nodule via dysplastic nodule and early hepatocellular carcinoma to advanced hepatocellular carcinoma during multistep hepatocarcinogenesis. In this article, imaging findings of various imaging modalities are described pertaining to the above mentioned hepatocellular nodules occurring in the cirrhotic liver, correlating with pathologic findings.
Carcinoma, Hepatocellular/*diagnosis ; Diagnostic Imaging ; English Abstract ; Humans ; Liver Neoplasms/*diagnosis

In recent years, growing number of literatures have supported the concept that large nodules usually found in cirrhotic livers represent premalignant lesions in the setting of chronic liver disease. With the use of advanced imaging techniques, nodules suspicious for malignancy have often been identified and resected. While some resected lesions were found to be small hepatocellular carcinomas (HCCs), others were not. Some of these non-malignant nodules were devoid of atypia, some had architectural or cytological atypia insufficient for a diagnosis of HCC though they are suggestive of a premalignant state, while others contained microscopic subnodules of HCC. In follow-up studies and series of explants from liver transplant centers, the occasional finding of microscopic foci of HCC in the nodules was confirmed and significant associations with HCC elsewhere in the same liver were established. Such findings suggested that these nodular lesions, which are referred as "dysplastic nodules" (or adenomatous hyerplasia), are probably a frequent pathway in human hepatocarcinogenesis. We discuss the pathological characteristics of dysplastic nodules and small HCCs.
Carcinoma, Hepatocellular/*pathology ; English Abstract ; Humans ; Liver Neoplasms/*pathology

Hepatocellular carcinoma (HCC) is a highly malignant, generally fatal neoplasm arising from hepatocytes. HCC accounts for over 80% of all primary liver cancers which ranks fourth among the organ-specific causes of cancer-related deaths worldwide. HCC is particularly prevalent in Korea where the age standardized incidence rate is 46.5 per 100,000 population. Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) or presence of liver cirrhosis are important risk factors for HCC development globally. Infection with HBV is the most important risk for HCC in Asia except Japan. The high incidence rate of HCC in Korea is thought to be related to the high carrier rate (5-6%) of HBV, which is currently being fought via a nationwide vaccination program. Although progress has been made in the management of HCC including chemoembolization and local ablation therapy, there has been little overall reduction in HCC mortality during the past 20 years. Recently, five year survival rate of primary liver cancer is 9.6% in Korea. Such poor prognosis of HCC results from the late detection of cancer, an aggressive tumor biology and underlying chronic liver diseases. Only a limited proportion of patients are candidates for potentially curative forms of treatment. Therefore efforts should be directed toward an effective surveillance program. The early detection of HCC is the important approach in reducing HCC mortality in the short term. Because almost eighty percent of HCC is diagnosed in late stage, we launched a nationwide surveillance program to screen high risk groups (HBV or HCV carriers or liver cirrhosis, over 40 years old) and formulated the Korean practice guideline for the diagnosis and treatment of HCC with special emphasis on advanced stage of HCC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*epidemiology ; English Abstract ; Female ; Humans ; Incidence ; Korea/epidemiology ; Liver Neoplasms/*epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors