The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with > or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.
Colectomy ; Colorectal Neoplasms/*pathology/surgery ; Endoscopy ; Female ; Humans ; Intestinal Polyps/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
Congenital Abnormalities ; Constriction, Pathologic* ; Deglutition Disorders ; Esophageal Neoplasms ; Esophagus ; Risk Factors ; Steroids ; Stomach ; Ulcer

BACKGROUND: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fatty acid-binding protein (H-FABP) in patients with chronic obstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome for COPD exacerbation. METHODS: Clinical variables, including serum GDF-15 and H-FABP levels were compared in prospectively enrolled patients with COPD exacerbation that did or did not experience an adverse outcome. An adverse outcome included 30-day mortality and need for endotracheal intubation or inotropic support. RESULTS: Ninety-seven patients were included and allocated into an adverse outcome (n=10) or a control (n=87) group. Frequencies of mental change and PaCO2>37 mm Hg were significantly higher in the adverse outcome group (mental change: 30% vs. 6%, p=0.034 and PaCO2>37 mm Hg: 80% vs. 22%, p<0.001, respectively). Serum GDF-15 elevation (>1,600 pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serum H-FABP level and frequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showed that an elevated serum GDF-15 and PaCO2>37 mm Hg were significant predictors of an adverse outcome (odds ratio [OR], 25.8; 95% confidence interval [CI], 2.7-243.8; p=0.005 and OR, 11.8; 95% CI, 1.2-115.3; p=0.034, respectively). CONCLUSION: Elevated serum GDF-15 level and PaCO2>37 mm Hg were found to predict an adverse outcome independently in patients with COPD exacerbation, suggesting the possibility that serum GDF-15 could be used as a prognostic biomarker of COPD exacerbation.
Disease Progression ; Growth Differentiation Factor 15 ; Humans ; Intubation, Intratracheal ; Mortality ; Multivariate Analysis ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive*

BACKGROUND: Pseudoepitheliomatous hyperplasia (PEH) is a reactive proliferation of surface epithelium and can be confused with invasive squamous cell carcinoma (SCC) in head and neck biopsy specimens. To distinguish PEH from invasive SCC, immunohistochemical staining for claudin-1, E-cadherin and p53 was performed. METHODS: Eighteen cases of PEH and 29 invasive SCC from head and neck lesions were immunostained and examined. RESULTS: The invasive SCC showed increased staining of claudin-1 (p<0.001) and p53 (p<0.001) and decreased staining of E-cadherin (p=0.005) compared to the PEH specimens. The combined score calculated by adding the positive sum of claudin-1 and p53 and subtracting E-cadherin was useful for the differentiation of SCC from PEH (89.7% sensitivity and 88.9% specificity, p<0.001). CONCLUSION: The combined immunostaining for claudin-1, p53 and E-cadherin may help differentiate PEH from invasive SCC. The results of this study suggest that the increased expression of claudin-1 and p53 and the decreased expression of E-cadherin maybe markers for the aggressive growth of invasive SCC.
Biopsy

PURPOSE: This study was a randomized single-blind trial of whole versus split-dose PEG solutions for colonoscopy preparation to compare the patient compliance, quality of bowel cleansing, and endoscopist's satisfaction. METHODS: The participants were recruited from outpatients who planned to receive colonoscopy of C hospital in Busan. Sixty participants were randomly assigned to receive either a spit-dose group(n=30) consuming 2 liter of PEG solution twice, or a whole-dose group(n=30), consuming 4 liter of PEG solution once. These participants completed the questionnaire to assess their compliance before colonoscopy. The quality of bowel cleansing was assessed using the Ottawa Scale with the endoscopist who was blinded to the type of preparation, and their satisfaction by using VAS. RESULTS: The participants who did not completely consume 4 liter of PEG solution were less in split-dose than in whole-dose group (0% vs 13.3%). The split-dose group complained less about abdominal pain(t=2.644, p=0.009) and abdominal bloating(t=2.802, p=0.013) with a statistical significance. For the quality of bowel preparation, there were no significant differences in the bowel cleansing scores and the endoscopist's satisfaction between two groups. CONCLUSION: Colonic preparation with split-dose of PEG solution could be a more useful method for better patient compliance, with no significant impact on bowel cleansing quality.
Busan ; Colon ; Colonoscopy* ; Compliance ; Enema ; Humans ; Outpatients ; Patient Compliance* ; Surveys and Questionnaires

BACKGROUND: Iron is essential for life, but iron overload state cause potentially fatal health risk. There is growing evidence that only mildly increased amounts of hepatic iron can be damaging, particulary if combined with other hepatotoxic factors such as alcoholic or chronic viral hepatits B,C. The aim of this study was to assess the serum iron status of patients with various forms of hepatitis and cirrhosis of liver and to determine the correlation between the degree of hepatocyte damage (expressed as ALT activity) and status of serum iron parameters. METHODS: Our research involved 107 patients (69 male ranging in age from 27-67 and 38 female ranging in age from 32-62) diagnosed with chronic viral hepatitis B or type C, alcoholic hepatitis or cirrhosis of the liver. Serum iron parameters such as serum iron, ferritin, TIBC, and aminotransferase measured as necroinflammatory activity in Chronic hepatitis. RESULTS: There was no difference s-iron level between chronic hepatitis and cirrhosis but, significantly higher in alcoholic hepatitis and cirrhosis than viral hepatitis and cirrhosis respectively. s-Ferritin level was significantly higher in cirrhosis than hepatits group, and more higher in alcoholic hepatitis and cirrhosis than viral hepatitis and cirrhosis respectively. In chronic hepatitis groups, there are significant correlation between ALT and s-ferritin level regardness of etiology. CONCLUSION: Serum iron overload state was prominent in alcoholic hepatitis and cirrhosis than viral hepatitis and cirrhosis. High serum ferritin level can predict hepatocyte damage in chronic hepatitis.
Alcoholics ; Female ; Ferritins ; Fibrosis ; Hepatitis ; Hepatitis B ; Hepatitis, Alcoholic ; Hepatitis, Chronic ; Hepatocytes ; Humans ; Iron Overload ; Iron* ; Liver Diseases* ; Liver* ; Male

Coronary artery embolization is an extremely rare and potentially lethal complication of atrial myxomas. We observed of a case of left atrial myxoma associated with acute anteroseptal and inferior myocardial infarction. A transthoracic echocardiographic study revealed the presence of an echogenic, mobile mass, compatible with myxoma in the left atrium. Coronary angiography disclosed abrupt occlusions of the distal left anterior descending artery and the right coronary artery. The tumor was successfully removed surgically after medical treatment and the patient was doing well post operatively at 6-month follow-up.
Arteries ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Embolism ; Follow-Up Studies ; Heart Atria ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myxoma*

PURPOSE: Matrix metalloproteinase(MMP)-9 is known to breakdown the blood-brain barrier by degrading the extracellular matrix of the subendothelial basement membrane in meningitis. Tissue inhibitor of metalloproteinase(TIMP)-1, a known inhibitor of MMP-9, has been postulated to inhibit the proteolytic activity of MMP-9 by bindng to MMP-9, but their interaction has not been fully understood yet. So far, there have been some reports on the relationship of MMP-9 and TIMP-1 in bacterial meningitis, but few reports in viral meningitis. Furthermore, there has been no report on this in Korea. We investigated the concentrations of MMP-9 and TIMP-1 in cerebrospinal fluid (CSF) and serum of patients with viral meningitis and control subjects, and evaluated their relationship with other clinical parameters of meningitis. METHODS: CSF and blood were obtained from 25 subjects with viral meningitis and 14 control subjects. After centrifugation, supernatants were stored at -20 degrees C and we assayed concentrations of MMP-9 and TIMP-1 by the sandwich ELISA method. RESULTS: Concentrations of CSF MMP-9 and TIMP-1 were significantly elevated in patients with viral meningitis, when compared with those in control subjects. Their serum levels showed no differences between the two groups. MMP-9 levels were closely correlated with TIMP-1 levels in the CSF(rs=0.42, P<0.05). CSF MMP-9/TIMP-1 ratios were significantly higher in patients with viral meningitis than those in the control subjects(P<0.05). Both CSF MMP-9 and TIMP-1 levels positively correlated with CSF total leukocyte counts(rs=0.43, P<0.05, rs=0.48, P<0.05). TIMP-1 levels positively correlated with total protein concentrations in the CSF(rs=0.43, P<0.05). CONCLUSION: MMP-9 and TIMP-1 may play an important role in the breakdown and maintenance of BBB in viral meningitis, respectively.
Basement Membrane ; Blood-Brain Barrier ; Centrifugation ; Cerebrospinal Fluid* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Humans ; Korea ; Leukocytes ; Matrix Metalloproteinase 9* ; Meningitis ; Meningitis, Aseptic* ; Meningitis, Bacterial ; Meningitis, Viral ; Tissue Inhibitor of Metalloproteinase-1*

OBJECTIVES: Corticotropin releasing factor (CRF) plays a primary role in coordinating the neuroendocrine, autonomic, immune and behavioral responses to stress. CRF exerts its action through two major receptors, corticotropin-releasing factor 1 Receptor (CRF-R1) and corticotropin-releasing factor 2 receptor (CRF-R2). Using two types of chronic stress models, we investigated the changes of CRF-R1 mRNA and CRF-R2A mRNA expressions and CRF mRNA in the stress related brain circuit areas. METHODS: Male Sprague-Dawley rats were exposed to either immobilization stress or variable intermittent unpredictable stress for 10 days and then in situ hybridization histochemistry was used to quantify CRF expression in the brain. RESULTS: 1) CRF1 receptor mRNA expressions were decreased in bed nucleus stria terminalis (BNST) following stressors. 2) CRF2A receptor mRNA expressions were increased in lateral septum following stressors. 3) CRF mRNA expressions were increased in central nucleus of amygdala (CeA) and BNST. CONCLUSION: The increased CRF mRNA of CeA and BNST may be related with anxiety response in the repeated stress. Down-regulation of CRF-R1 mRNA expression in BNST may represent a compensatory adaptation to chronic stress and may be involved in the anxiety response, whereas up-regulation of CRF-R2A mRNA expression in lateral septum may represent an anxiety response or impaired learning but the functional meaning is uncertain.
Adrenocorticotropic Hormone* ; Amygdala ; Anxiety ; Brain ; Corticotropin-Releasing Hormone* ; Down-Regulation ; Humans ; Immobilization ; In Situ Hybridization ; Learning ; Male ; Rats, Sprague-Dawley ; Receptors, Corticotropin-Releasing Hormone ; RNA, Messenger ; Up-Regulation

Unstable hemoglobins (Hb) are variants of adult Hb that tend to precipitate and form insoluble inclusions (Heinz bodies) within red blood cells (RBC) and RBC precursors. More than 100 structurally different unstable Hb variants showing broad spectrum of manifestations from asymptomatic to severe hemolytic anemia and dyserythropoiesis have been discovered. Hydroxyurea is a potent ribonucleotide reductase inhibitor and have been proposed as a new therapy for beta chain hemoglobinopathies through activation of gamma chain synthesis. We treated two patients (A : son, B : father) with highly unstable Hb diagnosed as Hb Madrid [Beta 115(G17)Ala->Pro] by direct DNA sequencing and restriction enzyme analysis. Our patients received hydroxyurea in dosages varying from 0.75g to 1.3g daily for 89 weeks. We could not show the clinical and hematological improvements after hydroxyurea therapy in thses patients. Optimization of dosage and long term side effects of hydroxyurea should be studied further.
Adult ; Anemia, Hemolytic ; Erythrocytes ; Hemoglobinopathies ; Humans ; Hydroxyurea* ; Restriction Mapping ; Ribonucleotide Reductases ; Sequence Analysis, DNA