Journal of Yeungnam Medical Science

Case report

Severe congenital neutropenia mimicking chronic idiopathic neutropenia: a case report: Juhyung Kim, Soyoon Hwang, Narae Hwang, Yeonji Lee, Hee Jeong Cho, Joon Ho Moon, Sang Kyun Sohn, Dong Won Baek; J Yeungnam Med Sci. 2023;40(3):283-288. Published online July 28, 2022; DOI: https://doi.org/10.12701/jyms.2022.00353

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Abstract PDF Supplementary Material: Severe chronic neutropenia is classified as severe congenital, cyclic, autoimmune, or idiopathic. However, there is a lot of uncertainty regarding the diagnosis of severe congenital neutropenia (SCN) and chronic idiopathic neutropenia, and this uncertainty affects further evaluations and treatments. A 20-year-old man presented with fever and knee abrasions after a bicycle accident. On admission, his initial absolute neutrophil count (ANC) was 30/µL. He had no medical history of persistent severe neutropenia with periodic oscillation of ANC. Although his fever resolved after appropriate antibiotic therapy, ANC remained at 80/µL. Bone marrow (BM) aspiration and biopsy were performed, and a BM smear showed myeloid maturation arrest. Moreover, genetic mutation test results showed a heterozygous missense variant in exon 4 of the neutrophil elastase ELANE: c597+1G>C (pV190-F199del). The patient was diagnosed with SCN. After discharge, we routinely checked his ANC level and monitored any signs of infection with minimum use of granulocyte colony-stimulating factor (G-CSF), considering its potential risk of leukemic transformation. Considering that SCN can be fatal, timely diagnosis and appropriate management with G-CSF are essential. We report the case of a patient with SCN caused by ELANE mutation who had atypical clinical manifestations. For a more accurate diagnosis and treatment of severe chronic neutropenia, further studies are needed to elucidate the various clinical features of ELANE.

Original articles

Clinical implication of adjuvant chemotherapy according to mismatch repair status in patients with intermediate-risk stage II colon cancer: a retrospective study: Byung Woog Kang, Dong Won Baek, Eunhye Chang, Hye Jin Kim, Su Yeon Park, Jun Seok Park, Gyu Seog Choi, Jin Ho Baek, Jong Gwang Kim; J Yeungnam Med Sci. 2022;39(2):141-149. Published online December 22, 2021; DOI: https://doi.org/10.12701/yujm.2021.01571

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Background
The present study evaluated the clinical implications of adjuvant chemotherapy according to the mismatch repair (MMR) status and clinicopathologic features of patients with intermediate- and high-risk stage II colon cancer (CC).
Methods
This study retrospectively reviewed 5,774 patients who were diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The patients were enrolled according to the following criteria: (1) pathologically diagnosed with primary CC; (2) stage II CC classified based on the 7th edition of the American Joint Committee on Cancer staging system; (3) intermediate- and high-risk features; and (4) available test results for MMR status. A total of 286 patients met these criteria and were included in the study.
Results
Among the 286 patients, 54 (18.9%) were identified as microsatellite instability-high (MSI-H) or deficient MMR (dMMR). Although all the patients identified as MSI-H/dMMR showed better survival outcomes, T4 tumors and adjuvant chemotherapy were identified as independent prognostic factors for survival. For the intermediate-risk patients identified as MSI-low (MSI-L)/microsatellite stable (MSS) or proficient MMR (pMMR), adjuvant chemotherapy exhibited a significantly better disease-free survival (DFS) but had no impact on overall survival (OS). Oxaliplatin-containing regimens showed no association with DFS or OS. Adjuvant chemotherapy was not associated with DFS in intermediate-risk patients identified as MSI-H/dMMR.
Conclusion
The current study found that the use of adjuvant chemotherapy was correlated with better DFS in MSI-L/MSS or pMMR intermediate-risk stage II CC patients.

Citations

Citations to this article as recorded by

Behavioral and Neuroanatomical Consequences of Cell-Type Specific Loss of Dopamine D2 Receptors in the Mouse Cerebral Cortex
Gloria S. Lee, Devon L. Graham, Brenda L. Noble, Taylor S. Trammell, Deirdre M. McCarthy, Lisa R. Anderson, Marcelo Rubinstein, Pradeep G. Bhide, Gregg D. Stanwood
Frontiers in Behavioral Neuroscience.2022;[Epub] CrossRef
A pilot retrospective study of comprehensive nursing care on psychological disorder in colorectal cancer undergoing chemotherapy
Zhou-Yi Zhang, Rui Wang, Li Zhang, Ming-Li Gu, Xiu-E Guan
Medicine.2022; 101(28): e29707. CrossRef

Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study: Do-bin Lee, Seonhui Shin, Chun-Seok Yang; J Yeungnam Med Sci. 2022;39(2):133-140. Published online October 29, 2021; DOI: https://doi.org/10.12701/yujm.2021.01445

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Abstract PDF

Background
Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality.
Methods
A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.
Results
The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.
Conclusion
Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

Citations

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Colorectal Oncologic Emergencies
Joshua Sullivan, Alec Donohue, Shaun Brown
Surgical Clinics of North America.2024; 104(3): 631. CrossRef
Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis
Muhammad Hasaan Shahid, Faisal I Khan, Zain Askri, Arslan Asad, M. Azhar Alam, Danish Ali, Rabia Saeed, Aun Jamal, Tauseef Fatima, M. Farooq Afzal
Cureus.2022;[Epub] CrossRef
Risk factors for urgent complications of colorectal cancer
S. N. Shchaeva
Pelvic Surgery and Oncology.2022; 12(2): 28. CrossRef

Efficacy of ramosetron in combination with polyethylene glycol of preparing for a colonoscopy: Min Kyu Kang, Byung Ik Jang, Jun Suk Park, Kyeong Ok Kim; Yeungnam Univ J Med. 2019;36(2):99-104. Published online December 28, 2018; DOI: https://doi.org/10.12701/yujm.2019.00080

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Abstract PDF

Background
Because of its efficacy and safety, polyethylene glycol (PEG) is generally used to prepare for colonoscopy. However, the side effects of PEG, including nausea, vomiting, abdominal discomfort, pain, and general weakness, tend to decrease patient compliance and satisfaction. The aim of this study is to investigate the efficacy and safety of PEG with 0.1 mg ramosetron on colonoscopy patients who had difficulty taking PEG due to side effects or large volume.
Methods
From January to August in 2012, 28 patients who visited Yeungnam University hospital for a colonoscopy were prospectively enrolled. All enrolled patients were previous history underwent colonoscopy using PEG only in our hospital. The efficacy and safety of ramosetron were assessed through the use of a questionnaire, and compared previous bowel preparation.
Results
Compared to previous examination, the patients using the ramosetron reported less nausea, vomiting, abdominal discomfort, and abdominal pain, as well as a higher degree of compliance and satisfaction of the patient. There were no side effects reported with the use of ramosetron. However, overall bowel preparation quality was not better than the previous examination.
Conclusion
In case of the use of ramosetron in combination with PEG for bowel preparation, patients experienced a higher rate of compliance and tolerance. Looking forward, ramosetron may become an option of pretreatment for bowel preparation.

Citations

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Tolerance to colonoscopy preparation with Fortrans and predictors of negative effects
I. A. Matveev, B. K. Gibert, A. I. Matveev, M. P. Kozlov
Bulletin of Siberian Medicine.2021; 20(1): 83. CrossRef

Case Reports

Severe ileus after colonoscopy in a patient on peritoneal dialysis: Sang Un Kim, Su Hee Kim, So Yoon Hwang, Ryang Hi Kim, Ji Young Choi, Jang Hee Cho, Chan Duck Kim, Yong Lim Kim, Sun Hee Park; Yeungnam Univ J Med. 2017;34(1):119-122. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.119

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Abstract PDF: Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.

Successful removal of a foreign body by endoscopic balloon dilatation at the colonic stricture.: Chang Jo Im, Ji Hoon Na, Hyun Sik Kim, Sung Sam Ha, Yoo Li Lim, Ji Hyeon Lee, Hee Kyoung Choi, Hee Man Kim; Yeungnam Univ J Med. 2016;33(1):29-32. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.29

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Abstract PDF: Most ingested foreign bodies pass readily throughout intestinal tract if they reach the stomach. In some cases, foreign bodies may be impacted behind a luminal constriction but are rare in colon. Here, we report the case of a 59-year-old man who did laparoscopic anterior resection due to sigmoid colon cancer 2 years ago and ischemic colitis was repeated on the anastomosis site. He initially presented with symptoms of abdominal pain 3 months before and melena 1 day before admission. Abdomen computerized tomography showed a 3.2 cm segment of luminal narrowing of the proximal colon involving upstream foreign material stasis. Sigmoidoscopic approaches revealed near complete obstruction on the anal verge of 20 cm and scope passing failed. Balloon dilatations were done on the obstruction site four times all and a foreign body impacted above the obstruction site was removed by an alligator without any complications. The foreign body removed looks like plastic or a shell, about 20 mm in size.

Original Article

High levels of carcinoembryonic antigen and smoking might be markers of colorectal adenoma in Korean males aged 40-49 years.: In Cheol Yoon, Jeong Hyeon Cho, Heejin Choi, Young Hoon Choi, Kyu Min Lim, Sung Hwa Choi, Jae Ho Han, Hyeon Ju Jeong, Hong Sub Lee; Yeungnam Univ J Med. 2016;33(1):13-20. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.13

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Abstract PDF: BACKGROUND
Prevalence of adenoma in males aged 40-49 years in Korea was higher than expected. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in males aged 40-49 years. METHODS: Total 1,902 asymptomatic subjects with a mean age of 47.9±6.7 years, who underwent a screening colonoscopy in a health promotion center of Myongji Hospital from 2010 to 2013 were enrolled in this study. We conducted a case-control study to determine the risk factors for adenoma. The subjects were classified into two groups (adenoma vs. controls). To validate the diagnostic value of carcinoembryonic antigen (CEA) for adenoma, area under the receiver operating characteristic curve (AUROC) was calculated. RESULTS: At least one colorectal adenoma was identified in 385 subjects (20.2%). Among these 385 subjects, 372 subjects were found to have a non-advanced adenoma, 13 subjects had an invasive adenoma. One subject had cancer. Male sex, age, smoking, metabolic syndrome, and elevated CEA level were significantly associated with a colorectal adenoma in univariate analysis. However, metabolic syndrome was not significant in multivariate analysis. In the male group, the AUROC of CEA for colorectal adenoma was 0.600 (0.543 to 0.656) in non-smokers under 50 years of age, and 0.615 (0.540 to 0.690) in smokers under 50 years of age. CONCLUSION: Male sex, smoking, and high levels of CEA seem to be associated with colorectal adenoma. High levels of CEA and smoking may be diagnostic markers for any colorectal adenoma in Korean males aged 40-49 years.

Case Reports

Solitary schwannoma of the ascending colon.: Myeong Su Chu, Hyun Mo Kang, Hyeong Ju Sun, Dong Min Kim, Hyong Jong Kwak; Yeungnam Univ J Med. 2016;33(1):37-39. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.37

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Abstract PDF: Schwannomas are uncommon neoplasms arising from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare, accounting for 1% of all malignant gastrointestinal tumors. Colonoscopic biopsy with immunohistochemical (IHC) staining is useful for confirming this tumor. We report on a patient with schwannoma arising from the ascending colon, which was detected by colonoscopy and endoscopic submucosal dissection was attempted. A 41-year-old man presented with abdominal discomfort. The patient was diagnosed with a subepithelial tumor on colonoscopy. He underwent endoscopic submucosal dissection. Histopathology and IHC staining confirmed that the colonic lesion was a benign schwannoma. However, the resection margin was positive. Therefore, laparoscopic ileocolectomy was performed.

An Unusual Cause of Gastrointestinal Hemorrhage: Gastrocolic Fistula Caused by Colon Cancer Invasion.: Jeong Hyeon Cho, In Tae Kim, Jin Yi Choi, Song Wook Chun, Beo Deul Kang, Sang Kyun Bae, Hee Man Kim, Ji Sun Song; Yeungnam Univ J Med. 2013;30(1):43-46. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.43

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Abstract PDF: Gastrocolic fistula is a fistulous communication between the stomach and the colon. It is a passage between the gastric epithelium and the colonic epithelium. This uncommon complication is caused by benign and malignant diseases of the stomach or the colon. Its clinical manifestations include weight loss, diarrhea and fecal vomiting; occasionally, anemia, poor oral intake, fatigue and dizziness; and very rarely, gastrointestinal bleeding. In this paper, an unusual case of gastrocolic fistula accompanied by hematochezia, which was revealed to have been caused by colon cancer invasion, is described.

Colon Cancer with a Nonspecific Inflammatory Colonoscopic Finding.: Jae Hyun Park, Byung Ik Jang, Ho Chan Lee, Sung Joon Kim, Jun Seok Park; Yeungnam Univ J Med. 2009;26(2):114-119. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.114

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Abstract PDF: Colon cancer is the second most common malignancy in Korea. It is classified as superficial type, the mass type, the ulcerative type, the ulceroinfiltrative type, the diffuse infiltrative type and the unclassified type according to the colonoscopic findings. We report here on a case of colon cancer that was initially misdiagnosed as acute infectious colitis at the initial presentation. A 64-year-old man visited to Yeungnam University Hospital for watery diarrhea and lower abdominal pain. Colonoscopy revealed long segmental edematous mucosa and hyperemic mucosa with stenosis in the transverse colon. He was diagnosed as having acute infectious colitis according to the colonoscopic finding. However, two days later after colonoscopy, he visited the emergency room for hematochezia. We performed computerized tomography(CT) and obtained blood samples to find the origin of the bleeding. We found thickening of the transverse colon lumen and ascites on the CT finding and an elevated level of tumor markers; we also obtained the results of the colonoscopic biopsy that was done via colonoscopy. He was finally diagnosed as having colon cancer with carcinomatosis, a poorly differentiated adenocarcinoma.

Xanthogranulomatous Inflammation of Transverse Colon: Sang Hun Jung; Yeungnam Univ J Med. 2007;24(2 Suppl):S725-730. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S725

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Abstract PDF: Xanthogranulomatous inflammation is an uncommon benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells) that usually presents with tumor-like appearance. The clinical and radiological findings are suggestive of advanced carcinoma of involved organ. A 66-year-man presented fever, upper abdominal mass during 10 days. By computed tomography, barium enema and PET-CT, his case suspected transverse colon malignancy. A laparotomy was performed. On operation, huge mass originated from mid-transverse was identified and transverse colectomy was performed. The pathologic report demonstrated xanthogranulomatous inflammation in transverse colon.

Black Pigmentation of Terminal Ileum after Long Term Ingestion of Charcoal: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim, Joon Hyuk Choi; Yeungnam Univ J Med. 2007;24(2 Suppl):S623-626. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S623

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Abstract PDF: Isolated pigmentation of the terminal ileum is rare incidental finding when performing a colonoscopic examination. The common substances that cause gastrointestinal pigmentations are lipofuscin, iron sulphide(FeS), hemosiderin, and other exogenous materials such as silicates and titanium. In most cases, pigmentation of the terminal ileum has no subjective symptoms, so it is found in autopsy or incidental colonoscopic examination. The cause of pigmentation has not been clearly identified. We experienced a case of pigmentation of terminal ileum associated with long term charcoal ingestion. This finding supports that the source of ileal pigmentation is ingested material.

Colon Cancer in Behcet's Disease.: Ji Eun Lee, Jang Won Sohn, Kyu Hyung Lee, Youn Sun Park, Kook Hyun Kim, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim; Yeungnam Univ J Med. 2006;23(1):124-130. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.124

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Abstract PDF

Behcet's disease has rarely been reported in association with malignant diseases. In most cases the autoimmune nature of the disease itself or immunosuppressive drug use has been blamed for malignant transformation. Solid tumors in addition to lymphoid and hematological malignancies are also seen during the course of Behcet's disease. We present here a case of colon cancer in a 40-year-old man with Behcet's disease. A near total colectomy was performed and postoperative chemotherapy and radiotherapy was administered to treat visceral peritoneal invasion. Recurrent evidence was not found. We present the clinical details of this rare case of colon cancer with Behcet's disease.

Citations

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Cancer colique au cours de la maladie de Behçet
S. Bouomrani, H. Baïli, K. Souid, I. Kilani, M. Beji
Journal Africain d'Hépato-Gastroentérologie.2016; 10(1): 1. CrossRef
Morbidity of Solid Cancer in Behçet's Disease: Analysis of 11 Cases in a Series of 506 Patients
So Young Na, Jaeyoung Shin, Eun-So Lee
Yonsei Medical Journal.2013; 54(4): 895. CrossRef

Original Article

The Significance of Small Polyp of colon in Koreans.: Soon Uk Kwon, Eun Ju Lee, Jong Ryul Eun, Sun Taek Choi, Hak Jun Lee, Byeong Ik Jang, Tae Nyeun Kim, Moon Kwan Chung; Yeungnam Univ J Med. 2000;17(1):39-48. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.39

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Abstract PDF

BACKGROUND
There are two theories in the development of colon cancer. One is the adenoma-carcinoma sequence theory and the other is the de novo cancer theory. Western countries believe in the adenoma-carcinoma sequence theory, however there are many recent reports from Japan about cancers developing from small adenomas. METHODS: The present study analyzed 408 polyps from 508 cases that were taken by colonoscopic polypectomy at the Departmant of Internal Medicine, Yeung-Nam University Hospital. RESULTS: The percentage of patients who have polyp was 41.3%(210cases out of 526cases) and the peak incidence was noted in patients in their 50's and 60's. There was no difference between the sexes, but we noted significant increase in the incidence of polyps in patients over age of thirty. We found 395 polyps below 1cm and 13 polyps above 1cm. Among 408 polyps, 5 cases cancerous polyps and 3 cases showed polyp size of less than 1cm each. The first case was a polyp of 0.4cm in size with elevated mucosa at the ascending colon. The second was 0.5cm in size with round elevation and hyperemic mucosa in the rectum. The third polyp was 0.6cm in size with tubular elevation at the hepatic flexure. CONCLUSIONS: colon polyp is common disease in Koreans. even small polyps can have cancer tissue, which should be removed if discovered during colonoscopy. We believe that not all colon cancer originates in the manner described by the adenoma-carcinoma sequence theory. However further studies with a larger sample population are needed to determine the exact role colon polyps plays in the development of colon cancer.

Citations

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Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice
Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim
Intestinal Research.2018; 16(3): 475. CrossRef

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