Hyeong-Rok Kim

Methylenetetrahydrofolate reductase C677T polymorphism in patients with gastric and colorectal cancer in a Korean population

BackgroundThis study was designed to investigate an association between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and the risk of gastric and colorectal cancer in the Korean population.MethodsWe conducted a population-based large-scale case-control study involving 2,213 patients with newly diagnosed gastric cancer, 1,829 patients with newly diagnosed colorectal cancer, and 1,700 healthy controls. Genotyping was performed with peripheral blood DNA for MTHFR C677T polymorphisms. The statistical significance was estimated by logistic regression analysis.ResultsThe MTHFR C677T frequencies of CC, CT, and TT genotypes were 35.2%, 47.5%, and 17.3% among stomach cancer, 34%, 50.5%, and 15.5% in colorectal cancer, and 31.8%, 50.7%, and 17.5% in the controls, respectively. The MTHFR 677TT genotype showed a weak opposite association with colorectal cancer compared to the homozygous CC genotype [adjusted age and sex odds ratio (OR) = 0.792, 95% confidence interval (CI) = 0.638-0.984, P = 0.035]. Subjects with the MTHFR 677CT showed a significantly reduced risk of gastric cancer compared whose with the 677CC genotype (age- and sex-adjusted OR = 0.810; 95% CI = 0.696-0.942, P = 0.006). We also observed no significant interactions between the MTHFR C677T polymorphism and smoking or drinking in the risk of gastric and colorectal cancer.ConclusionsThe T allele was found to provide a weak protective association with gastric cancer and colorectal cancer.

Massive gastrointestinal bleeding from jejunal varices.

Abstract: We report a patient with massive gastrointestinal bleeding from jejunal varices, confirmed by emergency laparotomy. A 54-year-old woman was admitted to Chonnam National University Hospital with a 5-day history of melena with hematochezia. Fifteen years previously, she had undergone cholecystectomy for gallstone. Seven years previously, she had undergone an operation because of possible common bile duct stone. The details of this operation were not known. Upper gastrointestinal endoscopy revealed no varices in the esophagus, stomach, and proximal duodenum. Colonoscopy demonstrated black-colored blood clots throughout the colon. A technetium-99m-labeled red blood cell (RBC) scan showed active proximal small bowel bleeding. Abdominal aortic angiography revealed mesenteric varices in the upper abdomen, but no active bleeding source was recognized. Because of the patients continued massive gastrointestinal bleeding despite medical therapy, emergency laparotomy was performed. We found evidence of micronodular cirrhosis of the liver and an apparent Roux-en-Y anastomosis. There were numerous collateral variceal vessels in the jejunal limb with the liver and abdominal wall. Segmental resection of the involved jejunum and end-to-end anastomosis were performed. Histologic examination revealed dilated submucosal veins with mucosal erosion.

Laparoscopy-Assisted Resection of Tailgut Cysts: Report of a Case

Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions, most commonly located in the retrorectal space, and are more common in women. We present a case of retrorectal tailgut cyst managed using a laparoscopic approach. A 36-year-old woman presented with incidentally detected retrorectal tumors during evaluation for a gallbladder polyp. Her past medical history revealed that she had undergone cesarean section twice. The tumor marker CA 19-9 level was 42.52 U/ml. CT of the pelvis with contrast and pelvic MRI revealed a 3.9 × 3.3 cm well-defined, homogeneous cystic mass in the right presacral area, and a 2.5 × 1.5 cm cystic mass in the precoccygeal space. The patient underwent laparoscopic exploration with a preoperative diagnosis of tailgut cysts based on radiological findings. The operative time was 90 min including 30 min of subsequent laparoscopic cholecystectomy without placement of additional trocars. The surgical specimens consisted of two fragments of fibrofatty tissues, unilocular cystic masses. The final pathologic diagnosis was tailgut cysts with no evidence of malignancy. Postoperative recovery was uneventful, and the patient was discharged after 3 days. In conclusion, surgical resection is recommended in the management of retrorectal tailgut cyst to establish a definite diagnosis and to rule out malignancy. The laparoscopic approach is a feasible and safe option.

Over-expression of Her-2 in colorectal cancer tissue, but not in serum, constitutes an independent worse prognostic factor

BackgroundCurrently, conflicting information exists regarding Her-2 over-expression and its clinicopathological implications in colorectal cancer (CRC). This study was undertaken to determine Her-2 over-expression in both serum and tumor tissue of CRC patients, and to assess its clinicopathological and targeted therapeutic implications.MethodsNinety five CRC patients and sixty healthy controls were prospectively enrolled. Her-2 expression status in serum and CRC tissue were examined by chemiluminescent immunoassay and immunohistochemical staining, respectively. The results were confirmed using fluorescent in situ hybridization. Clinicopathological parameters were analyzed according to Her-2 expression status.ResultsSerum Her-2 levels were found to be increased in CRC patients as compared to those of healthy controls. However, serum Her-2 levels were not found to be significantly associated with prognostic parameters. Her-2 expression analysis of CRC tissues revealed Her-2 over-expression in 23 patients (25%), i.e., 13 patients (14%) showed moderate over-expression and 10 patients (11%) showed strong over-expression. The overall survival of patients negative for Her-2 expression was significantly better than that of patients positive for Her-2 expression (P = 0.018). The disease-free survival of patients with Her-2 over-expression was significantly shorter than that of patients with no Her-2 expression (P = 0.021).ConclusionsHer-2 over-expression in CRC tissue, but not in serum, acts as a significant independent worse prognostic factor. Assessment of Her-2 expression status may be valuable for the targeted therapeutic management of CRC.

An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection.

The aim of this retrospective study of laparoscopic low anterior resection was to compare splenic flexure mobilization (SFM) carried out by an extended medial to lateral approach with that by a lateral approach.

Application of bone marrow samples for discrimination of acute promyelocytic leukemia from other types of acute leukemia using the routine automated hematology analyzer

Unreported parameters produced by automated blood cell counter, particularly large unstained cells (LUC) and delta neutrophil index (DNI), indicated the presence of immature and possibly abnormal cell populations in white blood cell population. The purpose of this study was to investigate the laboratory performance for discrimination of acute promyelocytic leukemia (APL) cells from other types of leukemia cells and clinical value of LUC and DNI parameters in bone marrow (BM) samples of patients with acute leukemia.

Mitochondrial DNA minisatellites as new markers for the quantitative determination of hematopoietic chimerism after allogeneic stem cell transplantation

Mitochondrial DNA minisatellites as new markers for the quantitative determination of hematopoietic chimerism after allogeneic stem cell transplantation

Clinicopathological characteristics of T1 colorectal cancer without background adenoma

Background adenoma (BGA) is defined as benign adenomatous tissue contiguous to resected carcinomas, and the absence of BGA in a tumour is considered a histological criterion of de novo cancers. The present study aimed to identify the clinicopathological characteristics of T1 colorectal cancer (CRC) without BGA.

Distinctive hematological abnormalities in East Asian neonates and children with down syndrome

Introduction:  Neonates with Down syndrome (DS) are predisposed to developing transient abnormal myelopoiesis (TAM) and acute myeloid leukemia (AML) associated with DS. However, there is a paucity of data on hematological aberrations and GATA1 mutations in neonates with DS in East Asian populations.

Complete Mesocolic Excision With Central Vascular Ligation for the Treatment of Patients With Colon Cancer

The colonic mesentery or mesocolon contains the vascular and the lymphatic drainage systems of the colon, so adequate clearance is necessary for colon cancer to have the same oncologic benefit as a total mesorectal excision for the treatment of patients with rectal cancer. In 2009, Hohenberger et al. [1] introduced a new concept trying to translate survival advantages to patients with colon cancer. This new concept of a complete mesocolic excision (CME) with a central vascular ligation (CVL) in the management of patients with colon cancer represents a kind of evolution in operative technique. The concept of a CME as a surgical technique with sharp dissection of the visceral plane from the retroperitoneal (parietal = somatic) one aims to avoid any breaching of the visceral fascia layer, which potentially may lead to tumor spread within the peritoneal cavity. With this procedure, the origin of the colonic arteries can be well exposed and tied centrally at their origins to ensure maximal harvesting of regional lymph nodes. CME and CVL surgery remove more tissue compared with standard surgery in terms of the distance between the tumor and the highly vascular region, the length of large bowel and ileum removed, and the area of the mesentery. In addition, CME and CVL surgery are associated with more mesocolic plane resections and greater lymph node yields [2, 3]. In terms of oncologic outcomes, Hohenberger et al. [1] reported excellent cancer-specific survival rates after CME surgery (stage I, 99.1%; stage II, 91.4%; and stage III, 70.2%) [1]. Moreover, CME surgery is associated with better disease-free survival than is a conventional colon cancer resection for patients with a stage I–III colon adenocarcinoma: the 4-year disease-free survivals were 85.8% after CME and 75.9% after non-CME surgery (P = 0.0010). The 4-year disease-free survival for patients with Union for International Cancer Control (UICC) stage I disease in the CME group was 100% compared with 89.8% in the non-CME group (P = 0.046). For patients with UICC stage II disease, the 4-year disease-free survival was 91.9% in the CME group compared with 77.9% in the non-CME group (P = 0.0033), and for patients with UICC stage III disease, it was 73.5% in the CME group compared with 67.5% in the non-CME group (P = 0.13). After propensity score matching, the disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survivals of 85.8% (95% CI, 81.4–90.1) after CME and 73.4% (95% CI, 66.2–80.6) after non-CME (P = 0.0014) [4]. The mean operative times ranged from 156 to 178 minutes [57], with the operative times for CME surgery being longer than those for non-CME surgery [5, 6]. The postoperative morbidity rates ranged from 11% to 28% [1, 5-7], but did not differ between the CME and the non-CME groups [7, 8]. Similarly, no significant differences in outcomes between the CME (4.5%) and the standard (4.8%) colectomy groups regarding postoperative mortality were reported by 2 studies [4, 9]. In particular, the rates of anastomotic leakage were also similar in 2 studies (CME surgery, 8.6% and 4.4%; standard surgery, 7.6% and 5.2%) [4, 5]. Applying laparoscopy to a CME for patients with colon cancer is difficult, mainly due to vascular dissection and splenic flexure mobilization [10]. Various laparoscopic and open techniques have been introduced in the literature for performing a CME with a CVL for patients with right-sided colon cancer. The laparoscopic approach is performed under the same CME principle as a laparotomy. Accordingly, skepticism exists as to whether the favorable outcomes of an open CME can be reproduced with a laparoscopic CME [11-14]. In a recent randomized trial, a laparoscopic D3 lymphadenectomy for patients with colon cancer showed shortterm surgical safety and clinical benefits when compared to the patients who had undergone open surgery. Yamamoto et al. [15] performed a randomized controlled trial comparing laparoscopic (n = 533) and open D3 (n = 524) dissections for patients with Correspondence to: Hyeong-Rok Kim, M.D. Division of Colorectal Surgery, Department of Surgery, Chonnam National University Medical School, 160 Baeksuh-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-61-379-7643, Fax: +82-61-379-7661 E-mail: drkhr@jnu.ac.kr ORCID code: https://orcid.org/0000-0003-2737-0485