PURPOSE: This study aimed to determine the prognostic value of new quantitative parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), including metabolic tumor volume (MTV), in patients with locally advanced and metastatic gallbladder cancer (GBC). MATERIALS AND METHODS: In total, 83 patients initially diagnosed with locally advanced and metastatic GBC and who underwent 18F-FDG PET/CT at the time of initial diagnosis were retrospectively reviewed. The metabolic volume-based PET parameters of primary tumors and metastatic lesions were measured, including maximum and average standardized uptake values (SUV), MTV, and total lesion glycolysis. An overall survival (OS) analysis was performed using the Kaplan-Meier method with PET and clinical parameters. A Cox proportional hazards regression analysis was performed to determine independent prognostic factors. RESULTS: In univariate analysis, pathologic differentiation (p<0.001), performance status (PS; p=0.003), C-reactive protein (CRP) level (p=0.009), and PET-related SUVmt max (the highest SUV among the metastatic lesions) (p=0.040) and MTVtotal (the sum of the MTVs of both the primary and metastatic lesions) (p=0.031), were significant for OS. In multivariate analysis, MTVtotal (hazard ratio: 2.07; 95% confidence interval: 1.23–3.48; p=0.006) remained significant for the prediction of OS, as did differentiation (p=0.001), PS (p=0.001), and CRP (p=0.039). CONCLUSION: In locally advanced and metastatic GBC, volume-based PET/CT parameters of the total tumor burden of malignancy, such as MTVtotal, were found to be useful for the identification of patients with poor prognosis.
C-Reactive Protein ; Diagnosis ; Electrons ; Fluorodeoxyglucose F18 ; Gallbladder Neoplasms ; Gallbladder ; Glycolysis ; Humans ; Methods ; Multivariate Analysis ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Retrospective Studies ; Tumor Burden

BACKGROUND/AIMS: Providers may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients. METHODS: We retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age > or =65 years; mean 71.4+/-5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5+/-13.5; n=124; 177 DBEs). RESULTS: In both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548). CONCLUSIONS: DBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.
Aged* ; Double-Balloon Enteroscopy* ; Hemorrhage ; Humans ; Medical Records ; Retrospective Studies

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.
Anastomotic Leak ; Fistula ; Gastrointestinal Tract* ; Intestinal Perforation ; Natural Orifice Endoscopic Surgery ; Tertiary Care Centers*

This study examined the effects of calcium (Ca) gluconate on collagen-induced DBA mouse rheumatoid arthritis (CIA). A single daily dose of 200, 100 or 50 mg/kg Ca gluconate was administered orally to male DBA/1J mice for 40 days after initial collagen immunization. To ascertain the effects administering the collagen booster, CIA-related features (including body weight, poly-arthritis, knee and paw thickness, and paw weight increase) were measured from histopathological changes in the spleen, left popliteal lymph node, third digit and the knee joint regions. CIA-related bone and cartilage damage improved significantly in the Ca gluconate- administered CIA mice. Additionally, myeloperoxidase (MPO) levels in the paw were reduced in Ca gluconate-treated CIA mice compared to CIA control groups. The level of malondialdehyde (MDA), an indicator of oxidative stress, decreased in a dose-dependent manner in the Ca gluconate group. Finally, the production of IL-6 and TNF-alpha, involved in rheumatoid arthritis pathogenesis, were suppressed by treatment with Ca gluconate. Taken together, these results suggest that Ca gluconate is a promising candidate anti-rheumatoid arthritis agent, exerting anti-inflammatory, anti-oxidative and immunomodulatory effects in CIA mice.
Animals ; Arthritis ; Arthritis, Rheumatoid* ; Body Weight ; Calcium Gluconate* ; Calcium* ; Cartilage ; Collagen ; Humans ; Immunization ; Immunomodulation ; Interleukin-6 ; Knee ; Knee Joint ; Lymph Nodes ; Male ; Malondialdehyde ; Mice* ; Mice, Inbred DBA ; Oxidative Stress ; Peroxidase ; Spleen ; Tumor Necrosis Factor-alpha ; Water*

PURPOSE: To document post-excision recurrence rates for epidermal cysts of the foot and ankle by location. MATERIALS AND METHODS: The authors retrospectively reviewed epidermal cysts confirmed histologically by excisional biopsy in 37 patients (male 20, female 17) from 2004 to 2011. Cyst locations and sizes were analyzed and preoperative and postoperative pain levels were compared using a visual analogue scale (VAS). Rates of recurrence and patient satisfaction levels were also measured. RESULTS: Epidermal cysts occurred most commonly on the 1st toe (15 cases, 40.6%), followed by the ankle (7 cases, 18.9%), 2nd toe (6 cases, 16.2%), 3rd toe (4 cases, 10.8%), 4th toe (1 case, 2.7%), 5th toe (2 cases, 5.4%), and heel (2 cases, 5.4%). Average cyst size in 35 cases was 15.5x15.0x7.9 mm. VAS reduced from 6.5 preoperatively to 1.0 postoperatively. Cysts recurred in 7 cases (18.9%); on the 1st toe in 5 and on the 2nd toe in 2. Thirty patients (81.0%) were very satisfied with treatment results, 2 patients (5.4%) were satisfied, and 5 (13.5%) were not satisfied. Recurrence occurred in 4 cases, and in one of these cases the cyst recurred after second excision. CONCLUSION: The excision of epidermal cysts in the foot and ankle area was found to have an 18.9% recurrence rate. To achieve good results, the precise location of cysts should be determined by imaging study before excision, and cysts must be excised completely.
Animals ; Ankle ; Biopsy ; Epidermal Cyst ; Female ; Foot ; Heel ; Humans ; Pain, Postoperative ; Patient Satisfaction ; Recurrence ; Retrospective Studies ; Toes

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.
Airway Management ; Analgesia ; Anxiety ; Child ; Conscious Sedation ; Delivery of Health Care ; Dislocations ; Humans ; Immobilization ; Informed Consent ; Korea ; Oxygen ; Parents ; Pediatrics ; Spinal Puncture ; Writing

Steroid sulfatase (STS) is responsible for the hydrolysis of aryl and alkyl steroid sulfates and has a pivotal role in regulating the formation of biologically active estrogens. STS may be considered a new promising drug target for treating estrogen-mediated carcinogenesis. However, the molecular mechanism of STS expression is not well-known. To investigate whether tumor necrosis factor (TNF)-alpha is able to regulate gene transcription of STS, we studied the effect of TNF-alpha on STS expression in PC-3 human prostate cancer cells. RT-PCR and Western blot analysis showed that TNF-alpha significantly induced the expression of STS mRNA and protein in a concentration- and time-dependent manner. Treatment with TNF-alpha resulted in a strong increase in the phosphorylation of Akt on Ser-473 and when cells were treated with phosphatidylinositol (PI) 3-kinase inhibitors such as LY294002 or wortmannin, or Akt inhibitor (Akt inhibitor IV), induction of STS mRNA expression by TNF-alpha was significantly prevented. Moreover, activation of Akt1 by expressing the constitutively active form of Akt1 increased STS expression whereas dominant-negative Akt suppressed TNF-alpha-mediated STS induction. We also found that TNF-alpha is able to increase STS mRNA expression in other human cancer cells such as LNCaP, MDA-MB-231, and MCF-7 as well as PC-3 cells. Taken together, our results strongly suggest that PI 3-kinase/Akt activation mediates induction of human STS gene expression by TNF-alpha in human cancer cells.
Blotting, Western ; Fluorescent Antibody Technique ; Humans ; Male ; Phosphatidylinositol 3-Kinase/genetics/*metabolism ; Phosphorylation/drug effects ; Prostatic Neoplasms/genetics/*metabolism ; Proto-Oncogene Proteins c-akt/genetics/*metabolism ; RNA, Messenger/genetics ; Real-Time Polymerase Chain Reaction ; Recombinant Proteins/genetics/isolation & purification/metabolism ; Signal Transduction ; Steryl-Sulfatase/genetics/*metabolism ; Tumor Cells, Cultured ; Tumor Necrosis Factor-alpha/*pharmacology

BACKGROUND/AIMS: Focally enhanced gastritis (FEG) has been suggested as a specific diagnostic marker for patients with Crohn's disease (CD). However, the usefulness of FEG for distinguishing CD from ulcerative colitis (UC) is uncertain and the incidence or prevalence of FEG for inflammatory bowel disease (IBD) patients in Korea has not been defined yet. In this study, we investigated the frequency of FEG and other gastric histological abnormalities in Korean patients with CD and UC. METHODS: We evaluated 37 patients with known CD, 43 patients with UC and 41 non-IBD control group; all underwent upper gastrointestinal endoscopy followed by biopsy from the antrum and the body. The pathology of the gastric biopsy specimens and the presence of Helicobacter pylori (H. pylori) were evaluated. FEG was characterized by a focal perifoveolar or periglandular inflammatory cell infiltrates. RESULTS: H. pylori positive gastritis was found in 10 of 37 (27.0%) of CD patients, in 16 of 43 (37.2%) of UC patients, and in 22 of 41 (53.7%) of non-IBD control group (p=0.054). In H. pylori-negative patients, FEG was found in 8 of 27 patients (29.6%) of CD patients, 6 of 27 (22.2%) patients with UC, and 2 of 9 (10.5%) of non-IBD control group (p=0.324). CONCLUSIONS: In H. pylori-negative patients, there was no statistically significant difference in the occurrence of FEG among CD, UC and control groups in Korea.
Adult ; Colitis, Ulcerative/*diagnosis/etiology/pathology ; Crohn Disease/*diagnosis/etiology/pathology ; Female ; Gastritis/epidemiology/*pathology ; Gastroscopy ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Upper Gastrointestinal Tract/pathology

We designed a randomized, double blinded, 3-months controlled prospective clinical study to investigate effects of oral uridine on the ocular surface in dry eye patients. Twenty-seven patients who diagnosed as dry eye with lower than 5 mm of wetting in the Schirmer strip, with corneal epithelial erosion and who completely followed-up till 3 months were enrolled. Corneal-conjunctival fluorescein staining, non-anesthetic Schirmer test, impression cytology, and Ocular Surface Disease Index (OSDI) were evaluated in the experimental and placebo groups at the baseline, 1 and 3 months after start of medication in a double blinded manner. Fluorescein stain score of the cornea was markedly decreased in oral uridine group compared to the placebo group at 3 months after medication (P=0.032, Mann-Whitney U test). The Schirmer wetting score for the oral uridine group was significantly increased (P=0.001, Wilcoxon signed rank test) at 3 months and its difference between two groups was statistically significant (P=0.030, Mann-Whitney U test). OSDI scores were significantly decreased at 1 and 3 months in treatment group. Oral uridine is effective in treatment of dry eyes.
Administration, Oral ; Adolescent ; Adult ; Aged ; Conjunctiva/pathology ; Cornea/pathology ; Double-Blind Method ; Dry Eye Syndromes/*drug therapy ; Female ; Fluorescent Dyes/pharmacology ; Humans ; Male ; Middle Aged ; Severity of Illness Index ; Uridine/administration & dosage/*therapeutic use

To examine diseases of the small intestines, the use of different methods including a small bowel series and push type enteroscopy have been employed, but these procedures are restrictive and have a low diagnostic accuracy rate. Recently, the use of double balloon enteroscopy has been introduced, and it is expected that this procedure will be of great value for research of diseases of the small intestine as it enables one to obtain a biopsy tissue sample and to perform diagnostic and therapeutic endoscopy while examining small intestine visually. We report as case of a patient that visited our institution complaining of abdominal pain, and the patient was diagnosed as suffereing from an intestinal obstruction due to a bezoar. The patient was treated by surgery after an investigation with the aid of a double balloon enteroscope.
Abdominal Pain ; Bezoars ; Biopsy ; Double-Balloon Enteroscopy ; Endoscopy ; Humans ; Intestinal Obstruction ; Intestine, Small