RESUMEN
The incidence and severity of Clostridium difficile infections (CDI) have increased in Western countries. However, there are limited data regarding the epidemiology of CDI in Eastern countries. This nationwide study was conducted in 17 hospitals to determine temporal trends in CDI incidence (from 2004 to 2008) in South Korea. The total incidence of CDI in Korea was 1·7 cases/1000 adult admissions in 2004, and 2·7/1000 cases in 2008 (P = 0·028). When analysing the clinical features of 1367 CDI patients diagnosed in 2008, oral metronidazole was effective as a first-line treatment for CDI (61·9%). Relapse rate was 8·9% and complicated CDI was only observed in 3·6%. The incidence of CDI increased significantly in Korea from 2004 to 2008. Although the clinical features were milder than in Western countries, the increasing burden of CDI needs ongoing surveillance systems.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/patología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/patología , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Femenino , Hospitales , Humanos , Incidencia , Corea (Geográfico)/epidemiología , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Recurrencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND STUDY AIM: Rectal carcinoids are low-grade malignancies that are usually treated by endoscopic resection. However, on pathologic examination, resection margins that are positive for carcinoid cells are frequently found. Patient outcomes were reviewed after endoscopic resection of rectal carcinoids and the clinical significance of possible residual disease, as defined by pathologic and endoscopic examination, was evaluated. PATIENTS AND METHODS: The medical records and endoscopic findings of 347 patients presenting with rectal carcinoids to 14 university hospitals in Korea between January 1999 and June 2007 were retrospectively analyzed. RESULTS: A total of 304 patients were treated with endoscopic resection, and 43 patents were treated with surgery. In the endoscopic resection group, the complete resection rate was 88.2% based on endoscopic appearance (CR-E) and 60.2% based on pathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (κ=0.192). No residual tumors were found in 77 of 85 patients (90.6%) who were CR-E but not CR-P and who had endoscopic biopsy taken at 24-month follow-up. The receiver-operating characteristic curve identified an optimal cut-off value of 10.5 mm, at which the sensitivity and the specificity for metastasis were 100% and 89%, respectively. The risk factors for metastasis by multivariate analysis were tumor size, increased mitotic rate, and lymphovascular invasion. CONCLUSIONS: Endoscopic resection is a safe and effective modality for treating well-differentiated rectal carcinoids smaller than 10 mm in diameter. Discrepancies were observed between CR-E and CR-P. The risk factors for metastasis were tumor size, increased mitotic rate, and lymphovascular invasion.
Asunto(s)
Tumor Carcinoide/patología , Tumor Carcinoide/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/patología , Tumor Carcinoide/diagnóstico por imagen , Colonoscopía , Toma de Decisiones , Endosonografía , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática , Vasos Linfáticos/patología , Masculino , Persona de Mediana Edad , Índice Mitótico , Invasividad Neoplásica , Metástasis de la Neoplasia , Neoplasia Residual , Curva ROC , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/secundario , Reoperación , Estudios Retrospectivos , Carga Tumoral , Adulto JovenRESUMEN
BACKGROUND: Although endoscopy is recommended for patients with iron deficiency anaemia, there is, currently, no consensus on the role of endoscopy for iron-deficient patients without anaemia. The goal of this study was to determine the prevalence of serious gastrointestinal (GI) lesions, identified by endoscopy in patients with iron deficiency and anaemia compared with patients with iron deficiency without anaemia. METHODS: One thousand five hundred and eighteen patients with a ferritin value of
Asunto(s)
Anemia Ferropénica/patología , Duodenoscopía/normas , Esofagoscopía/normas , Enfermedades Gastrointestinales/patología , Gastroscopía/normas , Deficiencias de Hierro , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/sangre , Anemia Ferropénica/diagnóstico , Duodenoscopía/métodos , Esofagoscopía/métodos , Femenino , Enfermedades Gastrointestinales/sangre , Enfermedades Gastrointestinales/diagnóstico , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/patología , Gastroscopía/métodos , Humanos , Hierro/sangre , Corea (Geográfico) , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND AND STUDY AIMS: Although capsule endoscopy has become a central diagnostic tool for small-bowel evaluation, retention of a capsule remains a major concern. This study attempted to investigate the incidence and clinical outcomes of capsule retention, and to determine the factors predictive of spontaneous capsule passage after retention. PATIENTS AND METHODS: Through a nationwide multicenter survey, we retrospectively reviewed the records of 1291 patients who had a capsule endoscopy between February 2002 and July 2006 in Korea. Clinical and procedural characteristics and postprocedural outcomes were analyzed for the cases with capsule retention. RESULTS: Capsule retention occurred in 2.5 % of total cases (32/1291). The major diseases accompanying capsule retention were Crohn's disease, malignant tumors, and tuberculous enterocolitis, in decreasing order. In 11 of the 32 patients (34.4 %), early surgical or endoscopic interventions were instituted for diagnosis or treatment of diseases before retention symptoms developed. The remaining 21 (65.6 %) patients initially received medical treatments. Of these, 10 (31.3 %) ultimately underwent surgical intervention due to the development of symptoms of intestinal obstruction or medical treatment failure. The other 11 (34.4 %) eventually passed the capsule. The presence of a larger lumen diameter (greater than two-thirds of the capsule diameter) at the stricture site was associated with spontaneous passage. CONCLUSIONS: Our large-scale study suggests that retention occurs infrequently during capsule endoscopy. Moreover, a retained capsule might indicate the best intervention for the offending pathology, or it may spontaneously pass in the long run, particularly in patients with less small bowel stricture.
Asunto(s)
Endoscopios en Cápsulas/efectos adversos , Endoscopía Capsular/efectos adversos , Cuerpos Extraños/epidemiología , Enfermedades Intestinales/diagnóstico , Obstrucción Intestinal/epidemiología , Intestino Delgado , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía Capsular/métodos , Falla de Equipo , Femenino , Cuerpos Extraños/etiología , Encuestas de Atención de la Salud , Humanos , Incidencia , Obstrucción Intestinal/etiología , Corea (Geográfico) , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Estudios Retrospectivos , Medición de RiesgoRESUMEN
BACKGROUND: Proteolytic shedding of the ectodomain of a variety of transmembrane proteins, including cell-to-cell adhesion molecules, has been observed in solid cancers. We have investigated whether extracellular cleavage of E-cadherin mediated by matrix metalloproteinase-7 (MMP-7) is involved in hepatocyte growth factor (HGF) induced in vitro invasion in stomach cancer cells. METHODS: The effects of HGF on the expression of E-cadherin/beta-catenin and MMP-7 at both the protein and mRNA levels were assessed in stomach cancer cells, NUGC-3 and MKN-28, and in cells in which the expression of MMP-7 was downregulated by transfection with a MMP-7 short hairpin RNA plasmid. RESULTS: Treatment with HGF increased the extracellular cleavage of E-cadherin and the release of MMP-7 and reduced the level of E-cadherin in a dose- and time-dependent manner. HGF treatment repressed the phosphorylation of beta-catenin in a Triton-soluble fraction, but enhanced this phosphorylation in a Triton-insoluble fraction. The association of E-cadherin with beta-catenin was decreased by HGF treatment in the Triton-soluble fraction. In addition, treatment of MMP-7 short hairpin RNA transfected NUGC-3 cells with HGF resulted in no extracellular cleavage of E-cadherin and also decreased the in vitro cell invasion. CONCLUSIONS: These results suggest that incubation with HGF mediated the release of MMP-7, resulting in extracellular cleavage of E-cadherin from stomach cancer cells. This might be a key mechanism in HGF-induced in vitro invasion and metastasis.
Asunto(s)
Adenocarcinoma/metabolismo , Cadherinas/metabolismo , Factor de Crecimiento de Hepatocito/farmacología , Metaloproteinasa 7 de la Matriz/metabolismo , Neoplasias Gástricas/metabolismo , Adenocarcinoma/patología , Línea Celular Tumoral , Detergentes , Activación Enzimática/efectos de los fármacos , Espacio Extracelular/enzimología , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Humanos , Técnicas In Vitro , Metaloproteinasa 7 de la Matriz/genética , Mutagénesis , Invasividad Neoplásica/patología , Octoxinol , Fosforilación/efectos de los fármacos , Solubilidad , Neoplasias Gástricas/patología , beta Catenina/metabolismoRESUMEN
BACKGROUND: A newly developed device that enables easy intraoperative colonic irrigation and subsequent colonoscopy was introduced recently. METHODS: To evaluate the efficacy of the single-stage procedure with a new device and the significance of on-table colonoscopy, 112 patients with obstructive left colon cancer were recruited. RESULTS: Primary anastomosis after tumor resection was performed in 104 cases. The volume of saline used for irrigation averaged 13.5 l over 12.1 min. Subsequent colonoscopic examination added an average of 10.4 min to the operative time. There were three anastomotic leaks, two wound infections, four acute renal failures, and two operative mortalities. On-table colonoscopy resulted in extended resection in 17 cases. CONCLUSIONS: The new device enabled safe, simple, and time-saving, single-stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment and recognition of synchronous bowel pathology.
Asunto(s)
Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Neoplasias del Colon/complicaciones , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Irrigación Terapéutica/instrumentaciónRESUMEN
A 26-year-old male patient who had an 8 years history of recurrent peripheral edema with diarrhea and hypoproteinemia was evaluated. Endoscopic jejunal and ileal biopsy revealed markedly dilated mucosal lymph vessels with no evidence of inflammation. 99mTc-labeled human serum albumin (HSA) scintigraphy showed significant activity accumulating in the gastrointestinal tract to represent 99mTc-HSA leakage into the bowel lumen. A diagnosis of protein losing enteropathy and intestinal lymphangiectasia could be made. After treatment with a high protein and fat restricted diet, his symptoms subsided and the serum protein level was normalized.