, Hee Jung Park, Chang Mo Moon, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim, Sung-Ae Jung, Min Sun Cho 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.
Citations
, Jae Jin Han, Claire Junga Kim, Hee Jung Choi, Joo Chun Yoon, Hye-Kyung Jung, Han Su Kim This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically.
We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development.
The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring.
Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.
, So-I Kim, Seong-Eun Kim, Hye-Kyung Jung, Tae-Hun Kim 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.
Citations
, Sun Young Yi, Hye-Kyung Jung, Seong-Eun Kim 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.
, Hye-Kyung Jung, Hyeon-Ju Kang, Yoon-Pyo Lee, Hye-Won Kang, Ki-Nam Shim, Sung-Ae Jung Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic
, Hye-Kyung Jung, Mi Yeon Kim, Min Sun Ryu, So Young Ahn, Hyoung Won Cho, In Sook Kang, Seong Eun Kim Antiphospholipid antibody syndrome (APS) is characterized by raised levels of antiphospholipid antibodies (aPL), in association with thrombosis, recurrent fetal loss, and thrombocytopenia. Development of APS is related with idiopathic origin, autoimmune disease, malignancy and, on rare occasions, infection. However, in secondary APS combined with bacterial infections, aPL is usually shown with low titer and rarely associated with thrombotic events. A 52-year-old male was admitted due to pneumonia and multiple hepatosplenic abscesses. He had been treated with proper antibiotics, but he presented ascites and sudden variceal bleeding because of portal vein thrombosis. The bleeding was controlled by endoscopic variceal ligation. Acute portal vein thrombosis was successfully managed by low molecular weight heparin and hepatosplenic abscesses were completely resolved by antibiotics. This case suggests that systemic bacterial infection in immunocompetent patients possibly develops into secondary APS.
, Hye-Kyung Jung, Min-Sun Cho, Min-Jin Lee, Myung-Eun Song, Da-Yeon Oh, Ha Eung Song Sunitinib an inhibitor of the vascular endothelial growth factor receptor, is highly effective against renal cell carcinoma and is now widely used in patients with metastatic disease. Gastroesophageal reflux disease (GERD) is rarely reported as a side effect of sunitinib. We report two cases of GERD with upper gastrointestinal bleeding related to sunitinib administration. Both cases responded well to conservative management. Microscopic findings in both cases showed cellular atypia such as hyperchromasia, increases in nuclear size, and multinucleation. The cellular atypia of the squamous mucosa appears to be associated with reparative processes.
Citations
, Soo Jeong Han, Sung-Kyun Hwang, Hye-Kyung Jung This report concerns a male patient suffered from refractory dysphagia after subarachnoid hemorrhage. A 49-year-old man admitted with severe headache followed by mental change. Imaging studies revealed that subarachnoid hemorrhage was located in basal cistern, and demonstrated ruptured vertebral dissecting aneurysm. After operation, the patient recovered well except severe dysphagia. Initial VFSS showed aspiration in fluid trial, penetration in semisolid bolus, and large amount of pharyngeal residue with poor relaxation of upper esophageal sphincter. For about 5 months, his symptom and several follow-up VFSS findings did not show marked improvement by various treatments. On magnetic resonance imaging for further evaluation of his brain lesion, an old infarction in right lateral side of medulla was found. He kept dysphagia rehabilitation more than one year, and his symptom improved to the level of oral feeding at last.
, Hye-Kyung Jung The Korean version of Bowel disease questionnaire (BDQ-K) was developed to evaluate the symptom items required to meet the definition of functional gastrointestinal disorders (FGIDs). We evaluated the test-retest reliability and validity of the self-reported BDQ-K and prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) according to the Rome-III criteria.
Sixty-nine patients participated in the test-retest reliability study, with a two week interval, and another 74 patients were enrolled to assess the self-reported questionnaire versus a doctor's interview (concurrent validity). A total of 3,325 subjects (mean age, 44±9 yrs; 58.3% male) presenting for an upper endoscopy responded to the BDQ-K at a health promotion center, but 797 subjects with organic diseases were excluded.
In the validity study of the BDQ-K, the median kappa value was 0.74 (0.36~1.0). The median kappa value for the test-retest was 0.56 (range 0.22~1.0), including abdominal pain (κ=0.51, P<0.001), pain onset before 6 months (κ=0.51, P<0.001), epigastric pain (κ=0.69, P<0.001), early satiety (κ=0.40, P<0.001), and postprandial fullness (κ=0.34, P<0.001). The prevalence of FD was 8.3% (209/2,528); epigastric pain more than once a week 4.4%, early satiety 2.5%, and postprandial fullness 6.1%. FD was more prevalent in women (P=0.001). The prevalence of IBS was 6.1% and IBS also predominated in women (7.1% vs 5.1% in men, P=0.032).
The BDQ-K is a reliable and valid instrument for identifying FGIDs. The prevalence of FD according to the Rome III criteria was 8.3% and that of IBS was 6.1%.
Citations
, Ki-Nam Shim, Hyoung Won Cho, Ju Young Choi, Shin A Lee, Min Jin Lee, Da Yeon Oh, Sun Hee Roh, Chung Hyun Tae, Seong-Eun Kim, Hye-Kyung Jung, Tae Hun Kim, Sung-Ae Jung, Sun Young Yi, Kwon Yoo, Il Hwan Moon Ingestion of corrosive substances can produce severe injury to the gastrointestinal tract and can even result in death in the acute phase. The extent and degree of damage depends on the type and amount of substances. There are occasional reports of severe contiguous injury to the esophagus and stomach caused by strong alkali ingestion in the acute phase. Usually the deaths occur within a couple of days due to multi-organ failure after ingestion of relatively much amount of agent for a suicidal attempt. But death due to late progression is very rare.
We have reported a case of 60-year-old female patient who was diagnosed as corrosive esophagitis after accidental ingestion of strong alkali. Initial endoscopic findings were compatible with IIa-IIa-0(according to Zargar's classification) in the esophagus, stomach and duodenum, respectively. After several weeks of supportive care, her subjective symptoms were much improved during she had been wating for the operation of colon interposition due to esophageal stricture. Metabolic acidosis and thrombocytopenia developed abruptly probably due to upper gastrointestinal tract necrosis and she died when 60 days had passed after the occurrence of initial esophageal injury.
Citations
, Hye-Kyung Jung, Joo Hee Hong, Hye Sook Park Gastro-esophageal reflux disease(GERD) is increasing in Asian countries, but the majority of patients does not present with endoscopic abnormalities, the assessment of the symptom severity and quality of life, and their response to treatment, have become increasingly important. Our objectives were to develop and evaluate a questionnaire about Health-related quality of lif (HRQOL) related with gastrointestinal symptoms in patients with GERD.
Eighty eight, consecutive patients with GERD and 174 healthy subjects were enrolled in the study. GERD was defined by the presence of reflux symptom that are heartburn and acid reflux with occurring more than once per week with/without endoscopic reflux esophagitis. All subjects were examined with endoscopy and performed self-reported questionnaires that were modified Korean form of gastrointestinal symptom rating scale(KGSRS), newly developed instrument, and KSF-36(Korean version of Medical Outcomes Study Short Form), a conventional one. We compared the score of KGSRS between response group and non-response group after 2-weeks omeprazole trial for evaluation of discriminative validity of KGSRS.
Internal consistency for the KGSRS scales range from 0.58-0.84. The repeatability was confirmed by test-retest results(Pearson's correlation coefficients=0.62-0.80, p<0.01). The KGSRS scale scores were significantly correlated with those of KSF-36. It revealed construct validity. The total score of KGSRS in patients with GERD was significantly lower than control(376.1±51.3 vs. 433.5±42.0, p=0.000). There were significant differences for 4 symptom complex except diarrhea between response group and non-response group.
The KGSRS has good reliability and construct validity and discriminates symptom severity and frequency of patients with GERD.
Citations
, Doe-Young Kim, Hye-Kyung Jung, Il-Hwan Moon, Sue-Yeun Shin, Jae-Jin Kwak Milk of calcium bile or limy bile is a rare disorder in which the gallbladder lumen is filled with a thick, paste-like, radio-opaque material. Churchman first reported a case of curious deposition of calcium salts within the gallbladder in 1911. Volkmann first used the term Kalkmilchgalle or milk of calcium bile in 1926. The radio-opaque material is almost entirely composed of calcium carbonate by weight. The mechanisms by which bile turns limy and radio-opaque or the time required for this biochemical alteration to occur are not well understood. The limy bile is found mostly in a gallbladder complicated by cholecystitis. Recently, we experienced a 33 year old woman who had a milk of calcium bile in the gallbladder lumen. We report this case with a review of literature.
First
Prev
