Myung-Whun Sung

Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease

BACKGROUND/AIMSnTo optimize management of nonalcoholic fatty liver disease (NAFLD), a simple screening tool is necessary. In this study, we aimed to devise a simple index of NAFLD.nnnSTUDYnA cross-sectional study with 10,724 health check-up subjects (5362 cases with NAFLD versus age- and sex-matched controls) was conducted. Study subjects were randomly assigned to a derivation cohort or a validation cohort.nnnRESULTSnMultivariate analysis indicated that high serum alanine aminotransferase (ALT) to serum aspartate aminotransferase (AST) ratio, high body mass index (BMI), and diabetes mellitus were independent risk factors of NAFLD (all P<0.001). Using these variables, a formula was derived by a logistic regression model: hepatic steatosis index (HSI)= 8 x(ALT/AST ratio)+BMI (+2, if female; +2, if diabetes mellitus). HSI had an area under receiver-operating curve of 0.812 (95% confidence interval, 0.801-0.824). At values of <30.0 or >36.0, HSI ruled out NAFLD with a sensitivity of 93.1%, or detected NAFLD with a specificity of 92.4%, respectively. Of 2692 subjects with HSI <30.0 or >36.0 in the derivation cohort, 2305 (85.6%) were correctly classified. HSI was validated in the subsequent validation cohort.nnnCONCLUSIONnHSI is a simple, efficient screening tool for NAFLD that may be utilized for selecting individuals for liver ultrasonography and for determining the need for lifestyle modifications.

Visceral Obesity and Insulin Resistance as Risk Factors for Colorectal Adenoma: A Cross-Sectional, Case–Control Study

OBJECTIVES:Colorectal adenoma is known to be associated with obesity, but the association between colorectal adenoma and visceral adipose tissue (VAT) area measured by abdominal computed tomography (CT) has not been documented clearly. In addition, the relationship between insulin resistance and colorectal adenomas, which underlies the mechanism that links obesity and colorectal adenoma, has not been studied extensively. The aim of this study was to examine VAT area and insulin resistance as risk factors of colorectal adenoma.METHODS:A cross-sectional, case–control study was conducted in Koreans that presented for health check-ups. Subjects underwent various laboratory tests, abdominal CT, and colonoscopy. VAT, subcutaneous adipose tissue (SAT), and homeostatic metabolic assessment (HOMA) index were evaluated as potential risk factors of colorectal adenoma in 2,244 age- and sex-matched subjects.RESULTS:According to univariate analysis, the prevalences of smoking, hypertension, metabolic syndrome, and family history of colorectal cancer were higher in the adenoma group than in the normal control group. In addition, body mass index, waist circumference, triglyceride, high-density lipoprotein cholesterol, and VAT and SAT areas were significantly different in the two groups. According to the multivariate analysis adjusted for multiple confounders, VAT area was independently associated with the risk of colorectal adenoma (odds ratio (OR)=3.09, 95% confidence interval (CI): 2.19–4.36, highest quintile vs. lowest quintile). Mean HOMA index was higher in the adenoma group than in the control group (OR=1.99, 95% CI: 1.35–2.92, highest vs. lowest quintile).CONCLUSIONS:Visceral obesity was found to be an independent risk factor of colorectal adenoma, and insulin resistance was associated with the presence of colorectal adenoma.

The Relation Between Non-Alcoholic Fatty Liver Disease and the Risk of Coronary Heart Disease in Koreans

OBJECTIVES:Non-alcoholic fatty liver disease (NAFLD) is known to be related to factors that predict the development of coronary heart disease (CHD), such as dyslipidemia, central obesity, and metabolic syndrome (MS). The aim of this study was to determine whether individuals with NAFLD have an elevated risk of CHD, as estimated using the Framingham risk score (FRS).METHODS:A total of 21,130 individuals who underwent a voluntary general health examination were recruited. NAFLD was diagnosed among these individuals on the basis of typical sonographic findings and a level of alcohol consumption of <20u2009g/day. Of the 21,130 individuals, 3,780 were excluded because they had known causes of liver disease (1,690 were alcoholics, 975 had hepatitis B virus, 242 had hepatitis C virus, 91 had other hepatitis history, and 593 were taking medication known to produce fatty liver) or a history of heart disease (189).RESULTS:NAFLD was diagnosed in 5,769 of the 17,350 individuals (33.3%). The 11,581 normal individuals constituted the control group. The 5,769 individuals with NAFLD were split into two groups on the basis of ultrasonographic findings, that is, into a mild NAFLD group (n=3,278) and a moderate–severe NAFLD group (n=2,491). Individuals with NAFLD had an elevated risk of CHD, as estimated using FRS. Multivariable regression analysis, adjusted for confounding factors, showed a strong association between a higher FRS and NAFLD.CONCLUSIONS:Individuals with ultrasonographically detected NAFLD have an elevated 10-year risk of developing CHD as estimated using FRS. Furthermore, NAFLD was found to be independently related to the risk of developing CHD, regardless of classical risk factors and other components of MS.

Adenoid Cystic Carcinoma of the Sinonasal Tract: Treatment Results

Objectives: Malignancies arising from the sinonasal tract, which includes the nose, paranasal sinuses, and nasopharynx, are uncommon. Although adenoid cystic carcinoma (ACC) is the second most common cancer occurring in the sinonasal tract, only few studies have been reported. This retrospective review was performed to identify the clinical features and treatment outcomes of sinonasal ACC.

Chemocauterization of the internal opening with trichloroacetic acid as first-line treatment for pyriform sinus fistula.

Pyriform sinus fistula is a rare brachial pouch anomaly. However, it is difficult and risky to remove the fistula tract completely. Circumferential chemocauterization of the internal opening with trichloroacetic acid (TCA) for pyriform sinus fistula is simple, reproducible, reliable, and causes less morbidity. The aim of this study was to determine the feasibility of TCA chemocauterization for pyriform sinus fistula.

Factors Related to Regional Recurrence in Early Stage Squamous Cell Carcinoma of the Oral Tongue

Objectives This study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END). Methods Retrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement. Results Five year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion ≥3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045). Conclusion We recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement.

Videostrobokymographic analysis of benign vocal fold lesions

Objectives—Videostrobokymography (VSK) has recently been introduced. The aim of this study was to analyze vibratory patterns and objective parameters in various benign vocal fold lesions using VSK and to examine the efficacy of VSK in clinical applications. Material and Methods—Using VSK, we analyzed the vibration patterns of normal vocal folds, various benign lesions such as nodules, polyps, cysts and Reinkes edema and cases of unilateral vocal fold paralysis. We also calculated the objective parameters open quotient and asymmetric index and compared them with their mean values in normal controls. Results—In nodules, polyps and cysts, the open quotient at the site of the lesion was similar to the mean value in the normal controls; however, on the other parts of the vocal folds, it was much larger than the normal mean value. In Reinkes edema, irregular and asymmetric vibrations were observed. The posterior area of the vocal folds showed larger open quotients than the anterior area. In unilateral vocal fold paralysis, irregular vocal fold vibration and incomplete closure of the vocal folds were documented. Much larger asymmetric indices were calculated for unilateral vocal fold paralysis than in normal controls or for other lesions. The asymmetric index may be a good quantitative parameter of vibration in patients with vocal fold paralysis. Conclusion—This study demonstrated that VSK could generate clear quantitative documentation of fine vibrations of vocal folds in many different types of benign lesion. VSK has the potential to be an effective tool for the quantitative analysis of vibratory patterns of vocal folds in clinical settings.

Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study

BackgroundThe accuracy of 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery.MethodsMedical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3xa0months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6xa0months after CRT.ResultsMaximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0xa0%, 83.8xa0%, 98.3xa0%, and 45.0xa0%, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6xa0%), with postSUVmax <4.4 in 58 (74.4xa0%). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7xa0%; Pu2009=u20090.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1xa0%; Pu2009<u20090.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6xa0%; Log-rank Pu2009=u20090.913).ConclusionPost CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings.

Excisional biopsy for management of lateral tongue leukoplakia

BACKGROUNDnLeukoplakia of the lateral tongue is frequently associated with the risk of malignancy. Although incisional biopsy is accepted as a standard technique for evaluation, the possibility of underdiagnosis, and therefore missed diagnosis of malignancy, remains at all times. The aim of this study was to determine the rate of underdiagnosis by incisional biopsy for leukoplakia of the lateral tongue and to elucidate the underlying cause of for underdiagnosis.nnnMETHODSnTwenty-two patients with leukoplakia in the lateral tongue who had undergone excisional biopsy for suspicion of malignancy were included in the study. Pathology was reviewed and classified into no dysplasia,dysplasia, and carcinoma. Underdiagnosis was defined as a change of diagnosis to a graver classification following excisional biopsy. To analyze the factors contributing to underdiagnosis, incisional and excisional biopsy specimens were re-evaluated.nnnRESULTSnOf the 22 patients with leukoplakia of the lateral tongue, 59.1% had coexistent malignancy, including nine squamous cell carcinomas and four verrucous carcinomas. Incisional biopsy resulted in underdiagnosis in 73.3% of the cases. Underdiagnosis was attributable to three common errors, which were mis-selection of sampling site within a large area of leukoplakia, error in pathology specimen preparation owing to small specimen size, and superficial biopsy frequently associated with punch biopsy.nnnCONCLUSIONnLeukoplakia of the lateral tongue is highly coexistent with malignancy, and incisional biopsy frequently leads to underdiagnosis. Therefore, complete excision with adequate margin is warranted for leukoplakia of the lateral tongue, preferably under general anesthesia, which could be performed with minimal morbidity and function preservation.

Synergistic anti-tumor effects with co-expression of GM-CSF and IFN-γ in murine tumors

We explored the potential therapeutic benefit of introducing GM‐CSF, IFN‐γ or a combination of both factors into CT26 tumor cells. CT26 cells secreting either GM‐CSF or IFN‐γ exhibited delayed tumorigenicity; however, cells expressing both GM‐CSF and IFN‐γ did not form tumors. Even when wild type CT26 cells were introduced into a distant site of mice that had been inoculated with CT26/GM‐CSF/IFN‐γ cells, no tumors were generated. Furthermore, when we injected GM‐CSF + IFN‐γ cells into animals bearing established tumors, the tumors were either rejected or their development was delayed, suggesting that synergistic effects were induced against these tumors via a systemic immune response. Histopathological examination of the tumors injected with cells expressing GM‐CSF and IFN‐γ combined showed necrosis and few signs of malignancy. The growth of tumors from mice treated with CT26/GM‐CSF/IFN‐γ cells exhibited a delay in tumor formation and no effects were seen in athymic nude mice, which are deficient in T lymphocytes, or in splenectomized nude mice, which are deficient in natural killer (NK) cells, respectively. Our data indicate a dual role for T and NK cells in mediating the anti‐tumor activity of this therapy. Our results suggest that transduction of tumor cells with both GM‐CSF + IFN‐γ results in a powerful synergistic effect of the 2 cytokines that is of greater therapeutic benefit than transduction with either cytokine alone. Int. J. Cancer 77:907–912, 1998.© 1998 Wiley‐Liss, Inc.