Cancer stem cells are defined as focal cluster of cells within a tumor that possess the capacity for self-renewal and differentiation into phenotypically heterogeneous cells. Cluster of differentiation 44 (CD44) is considered one of the gastric cancer stem cell markers. We aimed to investigate how the expression of CD44 varies according to the clinicopathologic characteristics in gastric cancer.

For this study, 157 patients who received an operation due to gastric cancer between May 1998 and December 2009 were selected. CD44 immunohistochemistry was reviewed using the semi-quantitative scoring of intensity and proportion. The sum of the intensity and proportion scores was calculated, and a score of 2 or less was deemed ‘CD44-negative’ and 3 or more as ‘CD44-positive.’

Among the final 143 subjects, 69 (48.3%) were CD44 positive. Older age, intestinal type gastric cancer, lymphatic invasion, and lymph node metastasis were significantly correlated with expression of CD44. In the multivariate analysis, older age was the only independent factor associated with CD44 expression (P=0.028). CD44 expression was correlated with overall survival, 5-year survival, and disease-free survival. In the multivariate analysis, older age, male gender, and lymphatic invasion were independent predictors of poor overall survival. Also, older age and lymphatic invasion were significant factors in 5-year survival, and lymphatic invasion was an independent factor of poor disease-free survival.

Older age (≥60 years) was independently associated with CD44 expression in gastric cancer patients. Also, CD44 expression was correlated with poor prognosis in gastric cancer patients.

The prevalence of constipation is high after stroke. Multiple factors such as long-term bed-ridden status, comorbidity, medical illnesses are combined in this condition. However, the change of bowel movement during the early stage of stroke remains uncertain.

Patients with first stroke who admitted in a single institute from 2008 to 2009 were reviewed retrospectively and 36 patients were enrolled. As a control group, 47 consecutive orthopedic patients needing bed rest without surgery in the same period were enrolled. Data of stroke associated factors, frequency of BM (bowel movement) during 5 weeks, use of gastrointestinal medications, and outcomes were collected from the medical records.

The cumulative incidence of decreased (<3/week) and severely decreased BM (<1/week) were 80.6% and 69.4% in stroke patients and 53.2% and 14.9% in control group (P<0.05). The cumulative incidence of increased BM (>3/day) was 38.9% in stroke and 14.9% in control group. In acute stroke, 58% of patient showed severely decreased BM in first week, and the proportion was rapidly decreased below 15% from second week. However, laxative use increased with hospital days. The occurrence of severely decreased BM in stroke patients was associated with National Institutes of Health Stroke Scale (NIHSS; P=0.004). Severely decreased BM was not associated with poor outcomes including death, morbidity, and stroke recurrence.

Decreased BM is common in acute stroke. The occurrence of severely decreased BM is associated with NIHSS. However, the severe manifestation occurred mainly in the first week, and considered to be well controlled by laxatives.

The purpose of this study was to compare the safety and efficacy of midazolam sedated Endoscopic retrograde cholangiopancreatography (ERCP) with unsedated ERCP in patients 70 years of ages and older.

Seventy elderly patients 70 years of age or older who underwent ERCP were divided into two groups: midazolam sedated group (n=43) and unsedated group (n=27). Procedure time, success rate, complications related with ERCP procedure, satisfaction score were analyzed between two groups.

Mean procedure time was 20.6 minutes for sedated group and 21.0 minutes for unsedated group (P=0.88). Success rate was 87.5% for sedated group and 100% for unsedated group (P=0.07). Incidence of complications from ERCP procedure showed no significant differences between the sedated and unsedated groups (P=0.10). There was no mortality in both groups related to the sedation or post-ERCP complication. Compared to the unsedated procedure, the sedated ERCP procedure was associated with higher patient satisfaction (P<0.001) and better repeat compliance (P=0.004).

There was no significant difference in success rate and complications at sedated and unsedated ERCP in patients 70 years of age and older. Unsedated ERCP showed 66.6% satisfaction score compared to sedated ERCP.

This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer.

Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively.

1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(p=0.087). 3) Type of stigmata including non-bleeding visible vessels and adherent clots were associated with an increased rate of recurrent bleeding(p=0.01). 4) When modified estimated costs were calculated, group III could be treated at the lowest cost(p<0.05).

In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effectiveness.

In Lynch syndrome II, colon cancer was associated with endometrial and ovarian cancer. The aim of this study was an evaluation for the clinicopathologic characteristics of rectosigmoid adenomas on preoperative sigmoidoscopy in gynecologic cancer patients.

A total 187 gynecologic cancer patients(139 cervical, 35 ovarian, 13 endometrial cancer) and 58 normal controls were reviewed sigmoidscopic finding and pathologic reports retrospectively from September 1993 to March 2001.

The mean age of gynecologic cancer patients was 54(38-82) year-old and normal controls was 50(20-68) year-old. Total 26 adenomas were in 21 patients(11.2%) and 3 adenomas were in 3 normal controls(5.2%). The incidence of adenomas was 9.4% in cervical cancer, 8.6% in ovarian cancer and 38.5% in endometrial cancer. Multiple adenomas were in 5 gynecologic cancer patients and 0 normal controls. The incidence of advanced adenoma was 12.5% in cervical cancer, 25.5% in ovarian cancer, 83.5% in endometrial cancer and 33.3% in normal controls. The location of adenoma was 23.1% in rectum and 76.9% in sigmoid colon.

The incidence of adenomas and multiple adenomas were higher in gynecologic cancer patients than normal controls but not significantly. The incidence of advanced adenoma and adenomas were significantly higher in endometrial cancer than normal controls. Colonoscopic evaluation of whole colon will be recommanded in gynecologic cancer than sigmoidoscopy.

Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital.

We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class II. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8.

Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36cm² before PMV to 2.06±0.33cm² after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GIII) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful.

The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.