Methylene blue (MB) based chromoendoscopy has been used for more than a decade to increase detection rates of specialized intestinal metaplasia, dysplasia, and esophageal adenocarcinoma. It is also used to detect anastomotic leakage after an operation. A 67-year-old man with no previous medical problems had complaints of jaundice and weight loss for 2 months. He was diagnosed with a Klatskin tumor and was referred to our hospital. An initial esophagogastroduodenoscopy (EGD) was performed before the operation. No abnormality was observed in the esophagus. MB solution was infused via an L-tube to check for leakage in the anastomosis. Subepithelial hemorrhagic and edematous mucosal changes with friability and a bluish mucosal discoloration were noted 2 days later from the mid to lower esophagus on EGD. Nine months later, an EGD revealed an unremarkable esophageal mucosa. MB solution is considered safe; however, a large volume or high concentration of MB solution might be harmful.
Adenocarcinoma ; Aged ; Anastomotic Leak ; Endoscopy, Digestive System ; Esophagus ; Humans ; Jaundice ; Klatskin's Tumor ; Metaplasia ; Methylene Blue ; Mucous Membrane ; Weight Loss

BACKGROUND/AIMS: Diffuse large B-cell lymphoma (DLBCL) in Koreans is frequently accompanied by extranodal (EN) disease at the time of autologous stem cell transplantation (ASCT). We sought to determine whether high EN involvement affected survival following ASCT in Koreans. METHODS: We reviewed 27 patients who had DLBCL with residual disease at ASCT: 13 with residual disease at nodal site(s) only and 14 with nodal and EN disease. RESULTS: Univariate analysis showed that disease status, lactate dehydrogenase (LDH), and performance status at ASCT were predictors of survival following ASCT. The number of EN sites, as categorized by the International Prognostic Index system, had no prognostic significance. When EN involvement at ASCT was classified as negative or positive, the 2-year overall survival for the negative group was 64%, significantly better than the 14% for the positive group (p=0.021), and the event-free survival for the negative group was 62%, significantly better than the 14% for the positive group (p=0.02). CONCLUSIONS: Patients who had DLBCL with residual EN involvement at ASCT showed worse outcomes following ASCT compared to those without EN disease.
Adolescent ; Adult ; Aged ; Cohort Studies ; Female ; Humans ; Korea ; Lymphoma, Large B-Cell, Diffuse/mortality/*pathology/*therapy ; Male ; Middle Aged ; Neoplasm, Residual ; Retrospective Studies ; *Stem Cell Transplantation ; Survival Rate ; Treatment Outcome ; Young Adult

Behcet's disease is an important cause of fatal vasculitis in young adult males and vascular involvement has been reported in more than 25% of patients. Pulmonary vascular involvement has been found in 1~7.7% of patients and is known to be related to poor prognosis. A incidence of fatal hemoptysis is high in patients whose Behcet`s disease is complicated by pulmonary artery aneurysm (PAA). The recurrence of hemoptysis in PAA of Behcet's disease may result from inadequate medical therapy and complications of surgical treatment. We report a case with Behcet's disease whose fatal hemoptysis has been successfully treated with bronchial artery embolization.
Aneurysm ; Bronchial Arteries* ; Hemoptysis* ; Humans ; Incidence ; Male ; Prognosis ; Pulmonary Artery ; Recurrence ; Vasculitis ; Young Adult

BACKGROUND: Primary gastrointestinal lymphoma is one of the most common extranodal lymphomas. The purpose of this study was to collect information on the clinical features and treatment of patients with primary gastrointestinal diffuse large B-cell lymphoma (DLBCL) at a single healthcare facility in Korea. METHODS: Between May 1998 and December 2003, 76 primary gastrointestinal DLBCL patients at Asan Medical Center were identified and evaluated. RESULTS: Male patients accounted for 40 cases. The median age was 53 years. A total of 38 patients had primary gastric DLBCL. With a median follow-up of 25 months, the five year overall survival (OS) rate was 61.4% and the five year event free survival (EFS) rate was 59.3%. B symptoms, performance status, LDH levels and involved sites did not affect survival. Twenty-seven patients who underwent primary surgical resection did not demonstrate a difference in survival when compared to patients who did not undergo surgery. However, for intestinal lymphoma, primary surgical resection had a significant influence on EFS (p=0.030). Age (p=0.038), sex (p=0.017), stage (p=0.048), and the number of extranodal sites (p=0.002) were significant factors for EFS. The three year EFS rate for each International Prognostic Index (IPI) risk group was as follows: 78.4% for low risk, 63.7% for low-intermediate risk, 30.0% for high-intermediate risk and 0% for high risk (p=0.002). Cox multivariate analysis revealed that the IPI was the only independent prognostic factor for EFS (p=0.002). CONCLUSIONS: Here we report on the unique pattern of clinical features of primary gastrointestinal DLBCL from a single healthcare center in Korea. The IPI system had prognostic value for primary gastrointestinal DLBCL.
B-Lymphocytes* ; Chungcheongnam-do ; Delivery of Health Care ; Disease-Free Survival ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Korea ; Lymphoma ; Lymphoma, B-Cell* ; Male ; Multivariate Analysis ; Prognosis

BACKGROUND/AIMS: Although the incidence of T-cell non-Hodgkin's lymphoma (NHL) is higher in Far East Asia than in Western countries, its incidence and clinical course in Korea are not well-defined. Therefore, we assessed the relative frequency and clinical features of T-cell NHL in Korea. METHODS: We performed a retrospetcive analysis of 586 patients with NHL. RESULTS: 101 (17.2%) had T-cell NHL. The most frequent subtypes of T-cell NHL were extranodal NK/T-cell lymphoma, nasal type (NASAL), peripheral T-cell lymphoma, unspecified type (PTCL-U), and anaplastic large cell lymphoma, T/null cell, primary systemic type (ALCL). The seven pathological subtypes could be classified into three prognostic subgroups. When patients with the three most frequent subtypes were grouped together, their survival was reflected in the International Prognostic Index (IPI) scores. Univariate analysis of IPI elements and other clinical features showed that clinical stage and extranodal sites were significant predictors of survival. Cox multivariate analysis showed that the number of extranodal sites was the only independent prognostic indicator. CONCLUSIONS: The relative frequency of T-cell NHL seems to be decreasing in Korea, although NASAL remains frequent. Korean patients with ALCL appear to have an unfavorable prognosis. Large-scale studies are warranted for Korean patients with T-cell NHL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Kaplan-Meiers Estimate ; Korea/epidemiology ; Lymphoma, Non-Hodgkin/ethnology/*mortality/*pathology ; Lymphoma, T-Cell/ethnology/*mortality/*pathology ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Time Factors ; Young Adult

PURPOSE: This study was conducted to develop Web-based multimedia contents for supporting student nurses' clinical practice on critical care, and to evaluate learners' responses. METHODS: Based on the steps of Assessment, Design, Development, Implementation, & Evaluation(ADDIE) model, a total of 13 self-directed learning modules including live lectures and real video clips were developed through faculty collaboration of nine nursing colleges in Gwangju and Chonnam province. The finally developed multimedia contents were published on the Web of the learning management system at a local e-learning center. RESULTS: The Web contents were evaluated after self-learning by 81 junior college nursing students who were encouraged to study it at their own pace during their two-week clinical practice at a medical or surgical intensive care unit of a university hospital and two hospitals. The knowledge (t = -27.66, p < .001) and self-evaluated clinical performance level(t = 7.54, p < .001) were significantly increased after learning of the Web contents and clinical practice, and satisfaction level that measured post-test only was 4.0 out of 5 point. CONCLUSION: The use of Web contents for critical care need to be extended as a complimentary material in a class room lecture or clinical practice of students to increase their self-learning ability and understandings of clinical knowledge and situation.
Computer-Assisted Instruction ; Cooperative Behavior ; Critical Care ; Humans ; Critical Care ; Learning ; Lectures ; Multimedia ; Students, Nursing

Familial adenomatous polyposis (FAP) is an inherited disease characterized by the development of hundreds of colorectal adenomas, leading to a 100% lifetime risk of colorectal cancer. A prophylactic colectomy is recommended for patients with FAP to prevent colorectal cancer. Four surgical strategies are available for patients with FAP: proctocolectomy with permanent ileostomy, colectomy with ileorectal anastomosis, proctocolectomy with Koch's pouch continent ileostomy (Koch), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Koch and IPAA, which make ileal pouch, have theoretical advantage of the elimination of the risk of colorectal cancer and adenomas and good functional outcome of reduced defecation frequency. However, recent reports have shown frequent development of adenomas and carcinomas in the ileal pouch after Koch or IPAA. We experienced 2 cases of multiple pouch adenomas after pouch surgery in FAP patients. Both patients were treated with endoscopic mucosal resection without complications. We report these 2 cases with a review of literatures.

BACKGROUND: A prospective randomized comparative observation was performed to assess the benefit of prophylactic antimicrobials in autologous stem cell transplantation (ASCT). METHODS: Forty consecutive patients, with multiple myelomas (MM, 28 patients) or a non-Hodgkin's lymphoma (NHL, 12 patients), were stratified by disease and randomly allocated to receive (prophylaxis group, 21 patients) or not receive (control group, 19 patients) prophylactic antimicrobials. The prophylactic antimicrobials consisted of ciprofloxacin (500mg twice daily p.o.), fluconazole (100mg twice daily p.o.) and acyclovir (400mg every 8 h p.o.), starting 1 day before high-dose chemotherapy (high-dose melphalan for MM and BEAM for NHL), and continuing until neutrophil engraftment or the occurrence of infection. RESULTS: At least one episode of fever occurred in 15 of the 19 (79%) patients in the control group, compared with 12 of the 21 (57%) in the prophylaxis group (P=NS). Microbiologically or clinically documented infections occurred in 4 patients (21%) in the control group, but none occurred in the prophylaxis group (P=NS). The documented infections in the control group included 3 staphylococcal bacteremias and 1 herpes skin infection. No deaths, invasive fungal infections or serious adverse events occurred in either group. The median duration of fever (9 days in the control group and 11 days in the prophylaxis group), therapeutic antimicrobial therapy (9 days in the control group and 11 days in the prophylaxis group) and hospital stay after ASCT (19 days in both groups) did not differ between the groups. CONCLUSION: This small-sized prospective randomized comparative observation showed no beneficial effects of antimicrobial prophylaxis in ASCT.
Acyclovir ; Bacteremia ; Ciprofloxacin ; Drug Therapy ; Fever ; Fluconazole ; Humans ; Length of Stay ; Lymphoma, Non-Hodgkin ; Melphalan ; Multiple Myeloma ; Neutrophils ; Prospective Studies* ; Skin ; Stem Cell Transplantation* ; Stem Cells*

BACKGROUND: The remission status prior to autologous stem cell transplantation (ASCT) influences the transplantation outcome in patients with relapsed or primary refractory diffuse large B cell lymphoma (DLBCL), a complete response (CR) generally being more favorable than a partial response (PR). This study investigated whether the addition of rituximab to the ESHAP chemotherapy regimen (R-ESHAP) could improve the CR rate in patients with relapsed or primary refractory DLBCL. METHODS: Retrospective analysis was performed with DLBCL registry data. RESULTS: Sixteen patients who had previously received one course of chemotherapy were administered R-ESHAP (median 3 cycles; range 1~6). The overall response rate of 75% (CR=50%; PR=25%), was significantly better than that achieved with ESHAP alone in 13 historical controls (31%; P=0.027). The toxicity was tolerable, with two febrile neutropenia episodes in 51 treatment cycles. Seven of the 12 responders to R-ESHAP underwent ASCT with BEAM. After a median follow-up of 17 months, the median survival endpoints have not been reached. CONCLUSION: R-ESHAP appears to induce high CR rates in relapsed or refractory DLBCL with acceptable toxicity.
Drug Therapy ; Febrile Neutropenia ; Follow-Up Studies ; Humans ; Korea* ; Lymphoma, B-Cell* ; Retrospective Studies ; Stem Cell Transplantation ; Rituximab

BACKGROUND: Although high dose chemotherapy coupled with an autologous stem cell transplantation (ASCT) is widely accepted as effective therapy for multiple myeloma (MM), few reports are available in Korea, especially in the area of double ASCT. We present the results of an institutional retrospective study of 12 patients with MM treated by double ASCT. METHODS: Eligible patients received induction therapy using vincristine, adriamycin, dexamethasone (VAD), and mobilization was performed using cyclophosphamide plus lenograstim. High-dose melphalan (total 200 mg/m2) was used to condition the ASCT. RESULTS: The median interval from diagnosis to ASCT was 6 months (range, 1.8-15.3 months). The median interval between the 1st and 2nd ASCT was 4.4 months (range 2.1-48.7 months). The median follow up was 18.3 months (range 8.1-50.5 months) for the nine surviving patients. No therapy-related mortality occurred. Following induction chemotherapy, two patients experienced CR. Following double ASCT, eight patients experienced CR. The 5 year OS was 59%. The median duration of event free survival was 2.13 years (95% CI, 0.84-3.42). CONCLUSION: Although the results of study did not demonstrate the advantage of double ASCT, this is the first report to outline the outcome of double ASCT for Korean MM patients.
Vincristine/administration & dosage ; Transplantation, Autologous ; *Stem Cell Transplantation ; Retrospective Studies ; Recombinant Proteins/administration & dosage ; Multiple Myeloma/drug therapy/*therapy ; Middle Aged ; Male ; Korea ; Humans ; Granulocyte Colony-Stimulating Factor/administration & dosage ; Female ; Doxorubicin/administration & dosage ; Dexamethasone/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Antineoplastic Agents/*therapeutic use ; Aged ; Adult