Ok Suk Bae

A new strategy for the diagnosis of MAGE-expressing cancers

The expression of melanoma antigen gene (MAGE), coding for tumor antigens recognized by cytotoxic T cell, is highly specific to cancer cells, but their use in the detection of a few cancer cells by reverse transcription-polymerase chain reaction (RT-PCR) has been limited by the low frequency of expression of individual MAGE genes. In order to increase MAGE detection rate in RT-PCR assay, here, we designed multiple MAGEs recognizing primers (MMRPs) that can bind to the sequences of cDNA of MAGE-1, -2, -3, -4a, -4b, -5a, -5b and-6 (MAGE 1-6) together. The nested RT-PCR assay using MMRPs, MAGE 1-6 assay, detected MAGE messages of 1 to 5 SNU484 cells in a background of 10(7) SNU638 cells. MAGE detection rate of MAGE 1-6 assay in cancers was higher than that of nested RT-PCR that detects single MAGE gene expression. The expressions of MAGE genes was detected by MAGE 1-6 assay in 70.4% (19/27) of head and neck cancer tissues, 91.7% (11/12) of breast cancer tissues, 75% (9/12) of lung cancer tissues. However, they were not detected in 18 benign lesions and 20 normal head and neck tissues and 30 blood samples from healthy donor. In conclusions, MAGE 1-6 assay can detect any cancer cells that express at least one of eight MAGE subtype genes, and this method may be very useful for the diagnosis of MAGE-expressing cancers.

Risk Factors for the Development of Clostridium difficile -associated Colitis after Colorectal Cancer Surgery

Purpose Clostridium difficile (C. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. Several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. The purpose of this study was to determine the clinical features of and factors responsible for C. difficile-associated colitis after colorectal cancer surgery. Methods The medical records of patients who had undergone elective resection for colorectal cancer from January 2008 to April 2010 were reviewed. Cases that involved procedures such as transanal excision, stoma creation, or emergency operation were excluded from the analysis. Results Resection with primary anastomosis was performed in 219 patients with colorectal cancer. The rate of postoperative C. difficile-associated colitis was 6.8% in the entire study population. Preoperative metallic stent insertion (P = 0.017) and aged sixty and older (≥ 60, P = 0.025) were identified as risk factors for postoperative C. difficile-associated colitis. There were no significant differences in variables such as preoperative oral non-absorbable antibiotics, site of operation, operation procedure, and duration of prophylactic antibiotics. Conclusion Among the potential causative factors of postoperative C. difficile-associated colitis, preoperative metallic stent insertion and aged sixty and older were identified as risk factors on the basis of our data. Strategies to prevent C. difficile infection should be carried out in patients who have undergone preoperative insertion of a metallic stent and are aged sixty and older years.

Reduced-port robotic anterior resection for left-sided colon cancer using the Da Vinci single-site(®) platform.

Single‐Site® port plus one conventional robotic port, a reduced‐port robotic surgery (RPRS) for left‐sided colorectal cancer, can enable lymphovascular dissection using the Endowrist® function; this allows safe rectal transection through an additional port and maintains the cosmetic advantage of single‐incision laparoscopic surgery.

Perforated appendicitis caused by foreign body ingestion.

Most ingested foreign bodies pass through the gastrointestinal tract without any incident. However, foreign bodies lodged in the appendix can cause an inflammatory reaction with or without perforation. Here, we present a case of a 54-year-old woman with perforated appendicitis who consumed wild game containing a shot pellet. Five months before admission, she had eaten the meat of a pheasant that had been shot with a shotgun. Abdominal computed tomography confirmed the diagnosis of perforated appendicitis with abscess due to a foreign body. Subsequently, a laparoscopic appendectomy was performed. Follow-up radiographs obtained after the surgery did not identify the foreign body. Histolopathologic examination confirmed appendiceal perforation with focal inflammation secondary to a foreign body.

A case with Some Components of Cronkhite-Canada Syndrome in a Family with Peutz-Jeghers Syndrome

A case with some components of Cronkhite-Canada syndrome such as onycholdystrophy, a large amount of diarrhea, hypoproteinemia and hypoalbuminemia in a 16 year-old man with Peutz-Jeghers syndrome was studied. His family members were conirmed to have Peutz-Jeghers syndrome by biopsy of polyps in the rectum and duodenum. This is the first case report of Peutz-Jeghers syndrome associated with some components of Cronkhite-Canada syndrome.

Influence of old age on the postoperative outcomes of obstructive colorectal cancer surgery after the insertion of a stent

Purpose In some patients more than 70 years of age with obstructive colorectal cancer, their concerns about the postoperative complications lead them to refuse surgery after the insertion of a stent. This study aimed to compare the postoperative outcomes between obstructive colorectal cancer patients aged less than 70 years and those aged 70 years and more who underwent surgery after the insertion of a colonoscopic stent. Methods Patients with obstructive colorectal cancer who underwent surgery after the insertion of a colonoscopic stent between March 2004 and March 2014 were reviewed retrospectively by using medical records. The patients were divided into two groups: 22 patients were aged less than 70 years (group A) and 30 patients were aged more than 70 years (group B). Results Although no significant difference in comorbidity was noted between the two groups, the American Society of Anesthesiologists (ASA) score was higher in group B. There was no significant difference in cancer location, stage, or the time from the insertion of the stent to operation. The perioperative results including operation time, blood loss, and length of stay were not significantly different between the groups. The postoperative complications were also not significantly different. Conclusion The surgical outcomes of elderly patients were similar to those of younger patients, despite higher ASA scores. These results indicate that surgery can be performed safely in elderly patients with obstructive colorectal cancer after the insertion of a stent.

Endoscopic management of delayed perforation of the rectum caused by a peritoneal dialysis catheter.

Bowel perforation caused by a peritoneal dialysis (PD) catheter is an uncommon complication. It occurs mostly at the time of insertion of a catheter. Delayed perforation of the bowel by a PD catheter can also occur, but is even more uncommon. The ideal management of perforation of the colon by a PD catheter remains to be established because of its very low incidence. Definite surgery is the usual treatment. Here, we report on a 50-year-old male patient who presented with severe watery diarrhea owing to delayed rectal perforation caused by a PD catheter. A computed tomography scan revealed that the catheter tip was inside the lumen of the rectum. This was further confirmed by colonoscopy after bowel preparation. The PD catheter was removed via the original abdominal incision and the rectal perforation was closed using 3 endoscopic clips. The patient made an uneventful recovery.

Additional Chemotherapy During Resting Periods After Preoperative Chemoradiotherapy in Patients With Rectal Cancer

See Article on Page 192-197 The advantages of preoperative chemoradiotherpy are tumor downstaging and to minimize seeding of tumor cells during surgery, but it has two problems awaiting solution. The first problem is low rate of complete response. Rectal cancer is known to be radioresistant compared with anal cancer. If a higher response rate is to be obtained, a concomitant chemotherapy method is needed because chemotherapy sensitizes tumor cells to radiation. The second problem is the long treatment time, including the resting time after completion of chemoradiation, because surgery is performed approximately after 6 weeks following the completion of chemoradiotherapy. Because cancer will not be treated during the resting time, some are apprehensive about the dangers of cancer being aggravated and metastatic lesions from remnant cancer occurring during the resting time. I support the conclusion that additional chemotherapy is one of the methods to resolve these problems in spite of these demerits. If additional chemotherapy can downstage a tumor more than conventional chemoradiation, it will be a very useful treatment method for rectal cancer patients. In this article, authors report that they tried an additional four weeks of chemotherapy with capecitabine during resting periods. They did not obtain a visibly better result; nonetheless, this article bears prospective meanings [1]. Fontana [2] reported encouraging results for preoperative 5-FU-oxaliplatin chemoradiation therapy in locally advanced rectal cancer. In the near future, new drugs and molecular studies will be developed, and these may lead to much better results [3]. Therefore, additional study will be needed to realize improvements in preoperative control for rectal cancer. I envisage that future patients with rectal cancer will get much benefit from additional chemotherapy and that a small number of them will be cured without surgery.