A Case of Penetration of Mesh after Rectopexy and This Was Found by Colonoscopy / 대한소화기내시경학회지

Rectal prolapse is a protrusion of the rectum beyond the anal canal. Since rectal prolapse is a surgical disease, it is mostly diagnosed and treated at the surgical department. However, when surgical complications occur or they are suspected after an operation for colorectal disease, colonoscopy may now have a role in diagnosing the actual status of the problem. We present here the case of penetration of mesh at the distal rectum that was incidentally diagnosed by colonoscopy and the patient had previously undergone presacral rectopexy for rectal prolapse. Only one such case has been reported abroad and there has been no such case report in Korea. We report here on a case for which colonoscopy had a crucial role in diagnosing an occult complication after a colorectal operation that used a prosthesis.

Clinical analysis of malignant gastrointestinal obstruction in terminal cancer patients / 대한내과학회지

BACKGROUND: Untreated malignant gastrointestinal obstruction is rapidly fatal and causes various symptoms and malnutrition, and so decreases the quality of life and shortens the survival. We reviewed clinical characteristics and analyzed prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction. METHODS: We retrospectively reviewed the medical records of 63 patients with malignant gastrointestinal obstruction who had been confirmed by endoscopy or colonoscopy, upper gastrointestinal series or barium study and proper radiologic study at Sam Anyang hospital from May in 2002 to December in 2004. We excluded patients with palliative tumor resection. We analyzed prognostic factors for overall survival and symptom-free survival. RESULTS: There were 30 males (48%) and 33 females (52%), and median age of 63 patients was 64 years. The cause of malignant gastrointestinal obstruction was colorectal (26 patients, 41%), stomach (19, 30%), pancreas (4, 6%) and others (14, 23%). Twenty one patients (33%) had Eastern Cooperative Oncology Group (ECOG) performance status of 2 score and 42 patients (67%) 3 or 4 score. Forty two patients (67%) have been performed palliative procedures and 21 patients (33%) have not. Median survival of patients with palliative procedure was significantly higher than that of patients who have not been performed palliative procedures (144 days v 45 days, p=0.0001). By mutivariate analysis, palliative procedures and performance status were independent prognostic factors. However, age, gender, primary cancer, site of obstruction, and previous chemotherapy were not independent prognostic factors. Performance status was only independent prognostic factor that improves symptom free survival in patients with palliative procedures (p=0.014) and median symptom free survival was 90 days. There was no mortality on palliative procedures. CONCLUSIONS: We confirmed that palliative procedures and performance status are significant independent prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction.

Intestinal Obstruction Due to a Torsional Huge Meckel's Diverticulum

Meckel's diverticulum is an uncommon cause of acute abdominal pain and small bowel obstruction in adults. We present a case of a 28-yr-old man with acute pain for whom the diagnosis of Meckel's diverticulum was not suspected until exploratory laparotomy was performed. The procedure revealed a huge gangrenous Meckel's diverticum that was torsioned, and it gave rise to ileal obstruction.

Clinical Significance of DAX-1 Expression using Immunihistochemical Staining in Breast Cancer / 한국유방암학회지

PURPOSE: There have been some reports that DAX-1 (Dosage-sensitive sex reversal, Adrenal hypoplasia critical region, on chromosome X, gene 1) can modify the estrogen receptor-beta and the progesterone and androgen receptors. Therefore, the aims of this work were to evaluate the expression pattern of DAX-1 in human breast cancer and its relationship to the steroid hormone receptors and other prognostic factors. METHODS: A retrospective analysis was performed using the clinical records of 161 patients diagnosed with invasive breast cancer, and who underwent surgical treatment and hormonal therapy between 1994 and 2004. We evaluated the presence and distribution of DAX-1 expressions in breast cancers using immunohistochemical staining. RESULTS: DAX-1 was expressed in 57 (35.4%) of the 161 cases. Also, the DAX-1 expression showed significant correlations with the size and nodal metastasis. In the androgen receptor positive cases (85 cases), the DAX-1 positive cases were statistically younger than the DAX-1 negative cases. In the progesterone receptor positive cases (81 cases), a statistical significance was noted between the DAX-1 expression and nodal metastasis. CONCLUSION: We conclude that DAX-1 can modulate the steroid hormone receptors including the progesterone and androgen receptors, in breast cancer. It could also be assumed that the influence of DAX-1 on the prognosis of breast cancer is different according to the kind of steroid hormonal receptor expressed.

Clinical Significance of DAX-1 Expression using Immunihistochemical Staining in Breast Cancer / 한국유방암학회지

PURPOSE: There have been some reports that DAX-1 (Dosage-sensitive sex reversal, Adrenal hypoplasia critical region, on chromosome X, gene 1) can modify the estrogen receptor-beta and the progesterone and androgen receptors. Therefore, the aims of this work were to evaluate the expression pattern of DAX-1 in human breast cancer and its relationship to the steroid hormone receptors and other prognostic factors. METHODS: A retrospective analysis was performed using the clinical records of 161 patients diagnosed with invasive breast cancer, and who underwent surgical treatment and hormonal therapy between 1994 and 2004. We evaluated the presence and distribution of DAX-1 expressions in breast cancers using immunohistochemical staining. RESULTS: DAX-1 was expressed in 57 (35.4%) of the 161 cases. Also, the DAX-1 expression showed significant correlations with the size and nodal metastasis. In the androgen receptor positive cases (85 cases), the DAX-1 positive cases were statistically younger than the DAX-1 negative cases. In the progesterone receptor positive cases (81 cases), a statistical significance was noted between the DAX-1 expression and nodal metastasis. CONCLUSION: We conclude that DAX-1 can modulate the steroid hormone receptors including the progesterone and androgen receptors, in breast cancer. It could also be assumed that the influence of DAX-1 on the prognosis of breast cancer is different according to the kind of steroid hormonal receptor expressed.

Laparoscopic Splenectomy for Splenic Tumors

PURPOSE: Laparoscopic splenectomy (LS) is the procedure of choice in treating hematologic diseases, however there are controversies concerning malignancy and splenomegaly. This study was performed in order to examine the safety and efficacy of LS and hand-assisted laparoscopic splenectomy (HALS) in the management of patients with various splenic tumors and splenomegaly. METHODS: Fifteen patients who had undergone laparoscopic splenectomy for suspected splenic tumors between May, 1998 and December, 2000 were evaluated. We conducted a review, recording previous abdominal surgery, diagnostic work up, size of spleen, accessory spleen, type of surgery, morbidity, mortality, and length of hospital stay. A retrograde analysis was conducted using the medical records of the patients. RESULTS: The average splenic length was 22.4 cm (range, 14~37 cm), and the average weight was 1,210 gm (range, 210~3,700 gm). There were two types of operations performed. LS was accomplished in 7 cases and HALS in 8 cases. All operations were completed without any conversion to open surgery. The average intraoperative blood loss was 153.5 ml (range, 45~830 ml). The average postoperative stay was 5.2 days (range, 3~9 days). Only one complication (subphrenic abscess) developed (7%), which was resolved by percutaneous drainage. No deaths occurred. The pathologic findings were lymphoma (4), hemangioma (4), islet cell tumor (2), lymphangioma (3), myelofibrosis (1), and hematoma (1). CONCLUSION: LS and HALS are safe and feasible procedures for the treatment of most neoplastic splenic diseases with splenomegaly. HALS is an alternative approach for overcoming the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis and hilar lymphadenopathy. As the indications for LS including HALS are expanded, the role of LS and HALS in various splenic tumors will become more clearly defined.

Comparison between a Pylorus-Preserving Pancreatoduodenectomy and a Classical Pancreatoduodenectomy Nutritional status and quality of life

BACKGROUND: This study was performed to prove whether a pylorus-preserving pancreatoduodenectomy (PPPD), now widely used in the treatment of not only positive tumors but also negative tumors, is advantageous for recovering the nutritional status and the quality of life of patients with pancreatic cancer and periampullary regions compared with a classical pancreatoduodenectomy (PD). METHODS: A retrospective study of the nutritional status and the quality of life of 200 patients who had undergone a PPPD (n=92) and a PD (n=118) from January 1993 to July 1998 was performed. The nutritional status was measured by using Broca's index, cholesterol, total protein, and albumin. The quality of life was assessed by one question on how the patients felt about their quality of life. RESULTS: The PD was preferred in advanced stages and had a higher recurrence rate. The PPPD had a shorter operative time, less transfused blood, a longer duration of nasogastric tube drainage, and a shorter postoperative hospital stay. In the PPPD, the nutritional status was improved compared with that in the PD. There were no significant differences in operative mortality or morbidity, gastrointestinal symptoms, and the quality of life between patients having a PPPD and a PD. CONCLUSIONS: This study suggests that there are no differences in postoperative subjective symptoms and the quality of life between patients having a PPPD and those having a PD. However, preserving the pylorus allows a better recovery of nutritional status than a pylorus resection dose. The PPPD hasa survival rate similar to that of the PD. Therefore, the PPPD can be recommended for the procedure in the surgical treatment of diseases of the periampullary regions.

A Prospective Study on the Relationship between Postoperative Urinary Retention and Amount of Infused Fluid during Surgery of Benign Anal Diseases under Spinal Anesthesia

PURPOSE: Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid. METHODS: Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups. RESULTS: There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group. CONCLUSIONS: A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.