Various minimally invasive surgical techniques in some cases of early gastric cancer are becoming common practice. However, there are rare cases of advanced cancer with distant metastasis although the invasion of the gastric wall is limited to the mucosa and/or submucosa (defined as early gastric cancer according to UICC-TNM classification). We report two cases of early gastric cancer with distant metastasis (stage IV). Both tumors were defined as early cancer because they were confined to the submucosa. One was a type IIa early cancer, histologically classifiable as a signet ring cell carcinoma (according to the Japanese Classification of Gastric Carcinoma and UICC-TNM classification); the other was a surface spreading type IIb IIc, classifiable as a signet ring cell carcinoma, too. Stage IV factors were ovarian metastasis (Krukenberg tumor) in the former and N3 in the latter case.
Adult ; Carcinoma, Signet Ring Cell/*pathology/secondary ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms/*pathology

The clinical manifestations of intestinal tuberculosis are non-specific. But, abdominal pain, low grade fever, weight loss, anorexia, and diarrhea are major symptoms of intestinal tuberculosis. Massive bleeding has been reported as a rare manifestation of intestinal tuberculosis. Massive hematochezia from intestinal tuberculosis has rarely been reported in the medical literature. Also, most of them were treated with anti-tuberculosis medication only or with surgery. We treated a case of intestinal tuberculosis presenting massive hematochezia with colonoscopic coagulation therapy and anti-tuberculosis medication. Here, we report a Korean man who presented with massive hematochezia from ileal tuberculosis and treated by endoscopic coagulation therapy.
Adult ; English Abstract ; Gastrointestinal Hemorrhage/*etiology/therapy ; *Hemostasis, Endoscopic ; Humans ; Ileal Diseases/*complications/diagnosis ; Male ; Tuberculosis, Gastrointestinal/*complications/diagnosis

BACKGROUND/AIMS: Hepatolithiasis is a common disease in East Asia and presents as a histological feature of proliferative glands containing mucin. 5-10% of hepatolithiasis is known to be associated with cholangiocarcinoma. Recent studies reported that epidermal growth factor receptor (EGFR) could be activated through heparin binding- EGF cleavage by metalloproteinases. Matrix metalloproteinases (MMPs) which digest the extracellular matrix are required for cancer cell invasion and the expression of MMP-9 is known to be increased in cholangiocarcinoma. However, there has been few studies on the expressions and roles of EGFR and MMP in hepatolithiasis. This study was performed to clarify and compare the expressions of EGFR, erbB2 and MMP-9 in hepatolithiasis and cholangiocarcinoma. METHODS: Surgically resected liver tissues with hepatolithiasis (n=14), cholangiocarcinoma (n=20) and trauma (n=2 as controls) were included. The expressions of EGFR, erbB2 and MMP-9 in tissue samples were examined by immunohistochemistry using respective monoclonal antibodies. RESULTS: In traumatic livers, the expressions of EGFR, erbB2 and MMP-9 were all negative. The expression of EGFR was increased in hepatolithiasis group (79%, 11/14) compared with cholangiocarcinoma group (25%, 5/20) (p<0.05). The expression of erbB2 was detected only in cholangiocarcinoma (25%, 5/20). MMP-9 was increased in both hepatolithiasis (79%, 11/14) and cholangiocarcinoma (95%, 19/20) (p>0.05). CONCLUSIONS: EGFR expression appears to be the dominant component in periductular hyperplasia of hepatolithiasis and MMP-9 is upregulated not only in cholangiocarcinoma but also in hepatolithiasis. This study suggests that EGFR and MMP-9 are associated with cholangiocarcinoma and hepatolithiasis.
Adult ; Bile Duct Neoplasms/*metabolism ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*metabolism ; English Abstract ; Female ; Gelatinase B/*analysis ; Humans ; Lithiasis/*metabolism ; Liver Diseases/*metabolism ; Male ; Middle Aged ; Receptor, Epidermal Growth Factor/*analysis ; Receptor, erbB-2/analysis ; Up-Regulation

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) has been characterized by a wide spectrum of liver damages that span from steatosis to cryptogenic liver cirrhosis and even to hepatocellular carcinoma (HCC). The aims of this study were to determine whether the prevalence of HCC arising from cryptogenic cirrhosis has increased during the last ten years and to characterize the clinical features of cryptogenic HCC in Korea. METHODS: A retrospective and hospital-based analysis of the clinical data was done in 1,145 HCC patients; group A (Jan. 1993-Dec. 1995), group B (Jan. 2000-Dec. 2002). The etiologies of HCC with liver cirrhosis in group A and group B were analyzed. The risk factors of NAFLD such as obesity, type 2 diabetes mellitus, hypertriglyceridemia and hypertension between cryptogenic HCC and HCC with well-defined etiologies were compared. RESULTS: The major leading causes of HCC in each group were hepatitis B virus infection, followed by alcohol, hepatitis C virus and cryptogenic. There was a significant increase in the proportion of cryptogenic HCC in group B (A: 2.3%, B: 5.4%, p<0.05). In the case of HCV, it was 5.3% in group A and 9.9% in group B (p<0.05). Although the prevalence of cyptogenic HCC was significantly increased at an interval of seven years apart, there was no significant difference in the proportions of risk factors of NAFLD between cryptogenic HCC group and well-defined etiology group. CONCLUSIONS: The prevalence of cryptogenic HCC was significantly increased in Korea during the last decade. Although statistically insignifcant, there was a trend toward the higher proportion of risk factors with NAFLD in patients with cryptogenic HCC. This suggests that increased proportion of risk factors associated for NAFLD may have contributed to the development of cryptogenic HCC.
Aged ; Carcinoma, Hepatocellular/*epidemiology/etiology ; English Abstract ; Fatty Liver/complications ; Female ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Incidence ; Korea/epidemiology ; Liver Diseases, Alcoholic/complications ; Liver Neoplasms/*epidemiology/etiology ; Male ; Middle Aged

BACKGROUND/AIMS: In chronic inflammatory conditions such as ulcerative colitis (UC), the migration of granulocytes and monocytes/macrophages from the circulation into the colonic mucosa is especially important in maintaining inflammation. The aim of this trial was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with moderate-to-severe UC refractory to conventional drug therapies. METHODS: Twenty-seven patients with moderate (55.6%) to severe (44.4%) active UC refractory to conventional drug therapies who had no changes in their conventional therapy regimen in the past two weeks before the recruitment were enrolled in an open-label trial. Concomitant medications were allowed, and steroids were tapered down according to the clinical activity during the course. We used an adsorptive type extracorporeal column (Adacolumn(R); JIMRO, Takasaki, Japan), which selectively adsorb granulocytes and monocytes. Patients took five apheresis sessions, each with 60 minutes duration for 5 consecutive weeks. The primary efficacy variables were clinical disease activity, short inflammatory bowel disease questionnaire (SIBDQ), C-reactive protein (CRP), and endoscopic scores. These variables were scored at regular intervals, and analyzed at week 7 on an intention-to-treat (ITT) principles. RESULTS: At 7 weeks, 70.4% of patients showed overall improvement. Clinical disease activity (p<0.0001), endoscopic score (p<0.001), and the quality of life as assessed by SIBDQ (p<0.0001) were significantly improved after the therapy. In 56.3% of concomitant steroid users, tapering down or discontinuation of steroids was possible. Treatment was well tolerated, and no severe adverse events were observed. CONCLUSIONS: Adacolumn was very efficacious in patients with moderate-to-severe active UC refractory to conventional drug therapy, but further assessment is needed.
Adult ; Colitis, Ulcerative/*therapy ; English Abstract ; Female ; *Granulocytes ; Humans ; *Leukapheresis ; Male ; *Monocytes

BACKGROUND/AIMS: Evidence for the effect of dietary factors on colorectal carcinogenesis is yet inconsistent. Few studies have been conducted to investigate whether dietary factors were associated with the developement of colorectal adenoma-carcinoma sequence in Korea. We evaluated the relationship between the intake of vegetables and fruits and the degree of dysplasia of the colorectal adenoma and cancer. METHODS: For this study, 539 cases with histopathologically confirmed incidental colorectal adenoma, 162 cases with colorectal cancer and 2,576 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea during 1994-1999. Informations on demographic characteristics, life style habits and dietary intake were obtained by interviewed questionnaire before the colonoscopy. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by using polytomous logistic regression model. RESULTS: In female, the high intake of raw green and yellow vegetables were found to be negatively associated with the risk of colorectal cancer (adjusted OR: 0.54, 95% CI=0.32-0.93) and the high intake of persimmon, mandarin and strawberry among fruits were negatively associated with the risk of adenoma with mild dysplasia (adjusted OR: 0.43, 95% CI=0.20-0.94). In male, the high intake of banana, pear, apple and watermelon among fruits were negatively associated with the risk of colorectal cancer (adjusted OR: 0.36, 95% CI=0.16-0.84). CONCLUSIONS: These findings suggest that the intake of vegetables and fruits may act differently in developmental steps of colorectal adenoma-carcinoma sequence.
Adenoma/*prevention & control ; Adult ; Aged ; Carcinoma/*prevention & control ; Colorectal Neoplasms/*prevention & control ; *Diet ; English Abstract ; Female ; *Fruit ; Humans ; Male ; Middle Aged ; *Vegetables

In Korea, gastric cancer ranks second among all the causes of death from cancer, and is the most frequently diagnosed cancer. Surgery is the only possible curative treatment, and results of gastrectomy have improved throughout the years with respect to survival, morbidity, and postoperative mortality. Extent of gastric resection and type of reconstruction can affect the survival and postoperative quality of life (QOL) in gastric cancer patients. Various kinds of reconstruction, especially after total gastrectomy, has been applied to improve the QOL. Eastern, especially Korean and Japanese, surgeons differ in their approaches to lymph node dissection during surgery for stomach cancer compared to Western surgeons. D2 lymph node dissection has not gained widespread popularity in the West, because improved survival has never been demonstrated in randomized trials. However, Korean surgeons believe that D2 dissection is not a dangerous procedure if done by specialists in specialized centers. It is still a matter of question if chemoradiotherapy after D2 dissection can improve the results of D2 dissection alone. However, the more urgent issue is to establish the standard adjuvant chemotherapy protocol after the good local control by surgery (D2 or more).
English Abstract ; Gastrectomy ; Humans ; Lymph Node Excision ; Quality of Life ; Stomach Neoplasms/*surgery

Recently, the detection of early gastric cancer (EGC) has increased because of the development of diagnostic techniques. Accordingly, new surgical procedures with minimal invasiveness including laparoscopic gastrectomy have been developed. Since the first laparoscopic-assisted distal gastrectomy (LADG) for EGC was performed, various new laparoscopic procedures, such as laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) have been developed for the treatment of EGC. Laparoscopic approaches to gastric cancer provide for minimal invasion, early recovery and decreased morbidity and mortality according to several short-term results. In the future, laparoscopic procedures for gastric cancer will be widely accepted in Korea, if the advantages of laparoscopic approaches are confirmed in randomized controlled trials of long-term outcomes.
English Abstract ; *Gastrectomy/methods ; Humans ; *Laparoscopy/methods ; Stomach Neoplasms/*surgery

Endoscopic mucosal resection (EMR) has come to play an increasingly important role in treatment of early cancer in gastrointestinal tract. Recent advances in EMR are very remarkable. These allow minimally invasive treatment of diseases that would otherwise require major surgery. The most important factors of EMR are accuracy and safety. Further improvement in both staging and resection technologies, as well as safety and short procedure time will ultimately conspire to make this an even more effective tool in the management of early cancer in gastrointestinal tract. EMR must prove to be safe for the majority of patients when performed by competent endoscopist. The new techniques will continue to solve the limitations of endoscopic treatment and its use will also continue to expand increasingly. Also, further studies are required to refine and standardize EMR. As EMR technology becomes more complex, necessitating the use of multiple accessories simultaneously, technical ease may be enhanced by simple adjunct devices. The future of EMR depends on extending its boundaries safely in a controlled setting of prospective clinical trials. I believe that current EMR techniques and devices are only the beginning of a new age in therapeutic endoscopy, the age of minimal invasive endosurgery, the next frontier.
English Abstract ; Gastric Mucosa/*surgery ; *Gastroscopy ; Humans ; Stomach Neoplasms/*surgery

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.
Adenocarcinoma/complications/diagnosis/*secondary ; Aged ; English Abstract ; Humans ; Ileal Diseases/diagnosis/*etiology ; Ileal Neoplasms/complications/diagnosis/*secondary ; Intestinal Fistula/diagnosis/*etiology ; Male ; *Neoplasms, Unknown Primary ; Subphrenic Abscess/diagnosis/*etiology