• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7567-7573
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• 2015

Background: Catastrophic effects of mustard gas as a chemical warfare agent have always been a major problem for those exposed to this agent. In this meta-analysis it was tried to evaluate carcinogenesis, ocular, cutaneous and respiratory complications of mustard gas exposure among Iranians who had been exposed to this agent during the Iran-Iraq war. Materials and Methods: In this meta-analysis, the required data were collected using keywords "mustard gas", "sulfur mustard", "cancer", "neoplasm", "respiratory complications", "ocular complications", "lung disease", "chronic complication", "eye", "skin", "cutaneous complication", "carcinogenesis" and their combination with keywords "Iran", "Iranian", "prevalence", "mortality" and their Farsi equivalent terms from the databases of SID, Iranmedex, Magiran, Pubmed, Science Direct, Google Search engine, Gray Literature and Reference of References. To determine the prevalence of each complication and perform meta-analysis, CMA: 2 (Comprehensive Meta-Analysis) software with a randomized model was used. Results: Of the 542 articles found, 7 national articles, consistent with the aims of this study were selected. Meta-analysis of seven papers revealed that cancer risk, especially cancer of the respiratory system was elevated, so that the relative risk (RR) of cancer role of mustard gas was inconsistent from 2/1 to 4 in this survey. Also prevalence of delayed skin disorders due to sulfur mustard was 94.6%, pulmonary complications 94.5% and ocular complications 89.9%. The incidence of various cancers in victims exposed to mustard gas was 1.7% worldwide where the rate was 2.2% in Iranian victims of the Iraq-Iran war. Conclusions: Based on present study the prevalence of delayed mustard gas related cutaneous, pulmonary and ocular complications is above 90% and risk of carcinogenesis is higher in comparison to worldwide statistics. This may suggest need for long-term and persistent follow-up and rehabilitation procedures for populations exposed to this agent.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5385-5388
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• 2015

Background: Gastric cancer is the most common gastrointestinal cancer and a leading cause of cancer mortality in Nepal. Survival of gastric cancer patients depends on the stage at which diagnosis is made. The aim of this study was to analyze the presentation and outcomes of gastric cancer patients treated at a tertiary care hospital in Nepal. Materials and Methods: A retrospective analysis of 140 consecutive histologically proven gastric adenocarcinoma cases managed at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for the period of January 2009 to December 2013 was carried out. Results: One hundred forty out of the total 186 patients with histologically proven gastric adenocarcinoma, were admitted for surgery. The mean age was $59.6{\pm}12.4yrs$ (range 29 to 78 yrs) and the male: female ratio was 2:1. Sixty three (45%) patients featured Tibeto-Burman descent though this ethnic group accounts for only 18% of the Nepalese population. Two-thirds or more patients presented with abdominal pain, anorexia, weight loss and/or vomiting. In 86 (61.5%) of the patients the tumor was located in the lower $3^{rd}$ of the stomach and in only 15% of the patients the tumor was located at the upper $3^{rd}$. Early gastric cancer was diagnosed postoperatively in only 4%. In 54%, the disease was locally advanced and metastatic lesions were found in 14% of the patients. Subtotal (73) or total (11) curative gastrectomies (D1, D1+ or D2) were performed in 84 (60%) patients with average lymph node retrieval of $16.6{\pm}8.2$. Palliative gastrectomies or procedures were performed in 23% of the patients and no intervention (open & close/biopsy) was employed in 15% of the patients. Perioperative morbidity was seen in 10% and mortality in 4%. Three, four and five year survival rates up to the recent follow-up were 17.9%, 11.9% and 8.3%, respectively. Conclusions: Gastric cancer in Nepal is usually diagnosed at an advanced stage and has a poor prognosis. Thus, early detection is the key to improve the survival of gastric cancer patients.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.21-24
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• 2011

Xerostomia is subjective feeling of dry mouth, a symptom that may or may not be accompanied by hyposalivation, an objective decrease in salivary flow. There are many causes induced xerostomia like drugs, salivary gland diseases, radiation therapy to the head and neck region, Sjogren syndrome, emotional stress etc. Insufficient salivary flow creates complications with oral candidiasis, dental caries, periodontitis, halitosis, dysgeusia. So finally, these complications lead to an overall decline in quality of life. Managements of xerostomia are eliminating or alterating the etiologic factors, relieving symptoms, preventing or correcting the consequences of salivary dysfunction, treating underlying disease and stimulating salivation. One of the salivation stimulation agents studied to treat xerostomia was the pilocarpine muscarinic agonist. Pilocarpine is one of salivation stimulants, a parasympathomimetic drug and non-selective muscarinic receptor agonist. Systemic pilocarpine has been used to stimulate salivary secretion. But systemic administration of pilocarpine has limitations such as increased risk of side effects and contraindications. Side effects of systemic pilocarpine administration are sweating, urinary and gastrointestinal disturbance, risk of cardiovascular and pulmonary disorders. This drug must be used carefully by patients with controlled asthma, chronic bronchitis, pulmonary or cardiac disease. Patient with acute asthma, narrow angle glaucoma, iritis should not use pilocarpine. Like this, systemic pilocarpine has many limitations. So, many investigators also have looked at the effectiveness of topical pilocarpine. Here we present patients with xerostomia which was relieved by pilocarpine mouthwash.

• The Korean Journal of Community Living Science
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• v.17 no.1
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• pp.123-139
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• 2006

The purpose of this study is to search how to promote health and improve nutrition and health care of the elderly people in rural area. Behaviors for health promotion and habits against health risk were surveyed. Dietary management was analyzed for surveyed nutrient intake by 24 hr -recall method. 242 subjects were collected in 12 cities or counties in Gyeonggi Province and 20 elderly people (10 male and 10 female) were selected out of 1 village in each district. Questionnaire for health behavior and dietary management was carried out by trained interviewers. Statistical analyses were made by SAS (version 8.1) and Chi-square tests and General Linear Models were used. Characteristics of the elderly people were 61-74 year-olds (68.2%), elementary school educated (78.4%), with spouse (51.7%), monthly living cost of 500-1,000 thousand won(43.4%), and monthly pocket money of 50-100 or 100-200 thousand won(33.5%, 26.5%). 41.4% of the subjects checked up medical examination regularly. The alcohol drinking status was significantly different according to gender: high no-drink rate of female (52.5%) and low no-drink rate of male (25.6%). Kinds of disease were different according to gender: higher proportion of cardiovascular disease(46.3%) and diabetes mellitus(8.1 %) in male and joint lumbago neuralgia(44.4%) and osteoporosis(8.6%) in female. Gastrointestinal complaints were nausea (69.0%) and chronic indigestion (17.8%). Constipation (12.0%) and vomiting (4.3%) were more frequent in female. Dietary management was good (3 meals per day: 93.4%., dining with family: 72.4%, regular mealtime: 72.4%, and 3-4 times of snacks per week: 44.9%) except side dish taking of 3-4 kinds only. However, almost one-third of the female elderly ate alone (30.6%) which was well compared with one-fifth of the male (19.7%). And food and nutrients intake were not significantly different according to gender except that male elderly's intake of energy and protein was lower than that of female's. The surveyed subjects had no difficulties in Activities of Daily Living (ADL), but some female elderly had some difficulties with Instrumental Activities of Daily Living (IADL) like working at home, using transport, and going shopping. These results suggest that low quality of life linked with low economic status of the rural elderly and that congregate meal at village hall would be required for the female elderly eating alone. For the undernourished male elderly, it would be needed to provide snacks and to establish nutrition and health surveillance system.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.177-182
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• 2009

Purpose: Colitis is a condition associated with a spectrum of altered morphologic changes and cellular adhesion. E-cadherin plays a key role in the establishment and maintenance of epithelial tissue structure and cell-cell adhesion. The purpose of this study is to evaluate E-cadherin expression in colonic epithelium of various colitis in children. Methods: The expressions of E-cadherin were examined in 39 cases of colonic mucosal biopsy specimen using immunohistochemical staining. When more than 50 percent of cells exhibited uniformly the same intensity and pattern of immunostaining as the adjacent normal mucosa, the antigen expression was considered normal. Abnormal expression was defined when less than 50 percent of cells stained, when cells showed a heterogeneously weak or altered distribution, or when complete absence of staining was observed. Results: Fifteen cases with non-specific colitis (38.5%), 7 cases of with Crohn's disease (17.9%), 5 cases of infectious colitis and milk protein sensitive proctocolitis (12.8%), 3 cases of ulcerative colitis (7.7%), 2 cases of Henoch-Schonlein purpura colitis (5.1%), one case of Behcet's disease and ischemic colitis (2.6%) were included in this study. E-cadherin expression was decreased in all kinds of colitis. Reduced expression of E-cadherin was observed in 77 percent of cases. E-cadherin was weaker or no expression in reparative epithelium and "ulcer associated cell lineage". Conclusion: Altered expression of E-cadherin occurs during mucosal inflammation in any kinds of colitis. These changes may be involved in promoting cell migration during epithelial restitution of the gastrointestinal mucosa.

• Journal of Gastric Cancer
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• v.5 no.1
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• pp.47-51
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• 2005

Eosinophilic gastroenteritis is a rare clinicopathologic entity of unknown etiology with a variety of digestive symptoms. The pathogenesis is poorly understood. Diagnostic criteria include demonstration of eosinophilic infiltration of the affected bowel wall, lack of evidence of extraintestinal disease, and exclusion of various disorders that could mimic similar conditions. The disease might involve any area of the gastrointestinal tract from the esophagus to the rectum, but the stomach and the proximal small bowel are most commonly affected. The clinical features depend on which layer and site are involved. We report the case of a 59-year-old male patient with a 3-week history of post-prandial vomiting with malnutrition and weight loss. An abdominopelvic CT showed a gastric outlet obstruction with diffuse wall thickening, as with linitis plastica. Three gastrofiberscopic biopsies showed chronic gastritis. We carried out a radical total gastrectomy with D2 lymph node dissection. The pathologic report revealed a mural type eosinophilic gastritis with a marked hypertrophic scar formation at the proper muscle layer. We report this case with a brief review of the literature. (J Korean Gastric Cancer Assoc 2005;5:47-51)

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.132-144
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• 2017

Purpose: To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. Materials and Methods: We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. Results: Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. Conclusions: The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.

• Advances in pediatric surgery
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• v.8 no.2
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• pp.113-118
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• 2002

The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowel motility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also playa role in the meconium obstruction of neinates.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.383-386
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• 2008

An elevated serum CA19-9 level is an indication of pancreatic and biliary tract cancer. However, it has recently become known that nonmalignant gastrointestinal diseases and a variety of nonmalignant respiratory diseases, such as idiopathic interstial pneumonia, collagen vascular disease associated lung diseases, diffuse panbronchiolitis and bronchiectasis, can also show an elevated serum CA19-9 level. We recently encountered a case of bronchiectasis with persistently elevated serum CA19-9, but without any evidence of malignant disease in endoscopic retrograde pancreatocholangiography, abdominal computed tomography, and positron emission tomography. After serial follow-up of 3 years and 10 months, there was still no evidence of cancer. It is believed that the elevated serum CA19-9 level was due to bronchiectasis. An elevated serum CA19-9 level should be interpreted carefully with the patients' clinical condition.

• Journal of Acupuncture Research
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• v.25 no.4
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• pp.81-94
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• 2008

Rheumatoid arthritis(RA) is a general, chronic, inflammatory and auto-immune disease and it can lead to joint edema, pain, stiffness which are caused by an inflammation in synovium covering our joints. Ulmus davidiana Planchon is a traditional herb used for the treatment on various inflammations, gastrointestinal trouble, ENT(ear, nose, and throat) disease, edema, cancer etc. and it works effectively on arthritis as well. In these study to search for the treatment efficacy of Ulmus davidiana Planchon in RA, I measure manifestation of cytokine gene in synoviocyte treated with Ulmus davidiana Planchon herbal acupuncture and in EL-4 cell, manifestation of cytokine gene cell related to T-cell. And after Ulmus davidiana Planchon herbal acupuncture treatment in Collagen induced arthritis(CIA) which has been known by a general model of RA, DBA mice, I observed foot thickness, general shape of synovium, early cytokine induce CIA and, generation and mutation of cytokine related to the control of T-cell specialization. It comes to conclusion as belows. 1. In synovium treated with Ulmus davidiana Planchon herbal acupuncture, there was the decrease in MIF mRNA does-dependently. Incase of CIA mice treated with Ulmus davidiana Planchon herbal acupuncture, there were the decrease in the damage in synovium and generation of the MIF which is related to induction of the early RA cytokine and IL-6 proinflammatory cytokine. 2. In case of EL-4 treated with Ulmus davidiana Planchon herbal acupuncture, there were decrease in the manifestation of the IL-2 mRNA, but the increase in the manifestation of the IL-4 does-dependently. 3. In the synovium of CIA mice treated with Ulmus davidiana Planchon herbal acupuncture, there were the decrease in generation of IL-2, IL-12 and CD-28, but the increase in generation of IL-4. These result suggest that Ulmus davidiana Planchon can block the process of the early RA by Inhibiting MIF activation, and mitigate Rheumatoid Arthritis by controlling Tcell specialization.