Radiofrequency Ablation for Metastatic Hepatic Tumor in Colorectal Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to assess the efficacy and safety of radiofrequency ablation (RFA) to treat hepatic metastasis in patients with colorectal carcinoma. MATERIALS AND METHODS: Between May 1999 and July 2002, a total of 45 tumors in 24 patients with colorectal cancer were treated with RFA. Thirteen patients received systemic chemotherapy after the RFA procedure. The ablation was performed percutaneously under ultrasound guidance using cool-tip or expandable electrodes and an RF generator. The medical records as well as the CT scan results taken every 3 months were retrospectively reviewed. RESULTS: The median follow-up duration of the surviving patients was 11.7 months (4.6~32.2 months). Complete tumor necrosis was achieved in 17 patients (70.8%) on an immediate (<24 hrs) CT scan. The median survival was 17.1 months. The 1- and 2-year survival rates were 80.5 and 25.8%, respectively. In a univariate analysis, complete necrosis, tumor size and post-RFA chemotherapy were significant factors for survival. Nineteen of the 24 patients developed a recurrence or progressed (79.2%). The median progression free survival was 5.5 months. There were no treatment related deaths or serious adverse effects, with the exception of one case of respiratory failure. CONCLUSION: These results suggest that RFA is a well-tolerated and effective method to treat hepatic metastasis in colorectal carcinomas.

Effectiveness and Side Effects of Postoperative Pain Control Methods in Stomach and Colorectal Cancer Patients

PURPOSE: The goal of postoperative pain management is to provide safe, continuous, effective analgesia, free from unwanted side effects. In doing so, it is hoped that postoperative morbidity is reduced, facilitating recovery, and hasten discharge from hospital. However, the effects of patient-controlled analgesia (PCA) and complications after a major gastrointestinal operation are currently unclear. METHODS: Fifty four and 31 patients who had undergone an elective gastrectomy due to stomach cancer and elective colorectal surgery due to colorectal cancer, respectively, between August 2002 and April 2003 at the Hanyang University Hospital, were allocated to one of two groups; One received patient-controlled analgesia (PCA group), the other received preoperative fentanyl patch appliment (Patch group). The kind and amount of additional analgesics demanded, pain scale, clinical course, and side effects were analyzed. RESULT: After the stomach cancer surgery, the average postoperative pain scores (numeric scale+pain face scale) in the PCA and patch groups were 9.44 and 10.76, respectively (P=0.0325). After the colorectal cancer surgery, the average postoperative pain scores in the PCA and patch groups were 6.44 and 9.22, respectively (P=0.0072). The amount of additional analgesic agent required after gastrointestinal surgery was variable and unpredictable, but IV PCA resolved this problems and markedly reduced the need for additional analgesic agents. The clinical courses of the PCA and patch groups did not differ in terms of gas passing and resumption of diet. The complication rates of the two groups were similar. CONCLUSION: IV PCA after gastrointestinal surgery for stomach and colon cancers is better for the management of postoperative pain than other pain control methods, with similar complication rates.

Combination Chemotherapy of Oxaliplatin and Capecitabine in Patients with Metastatic Colorectal Cancer: a Pilot Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the efficacy and toxicity of oxaliplatin and capecitabine in patients with metastatic colorectal cancer. MATERIALS AND METHODS: Between December 2001 and April 2003, fourteen patients were enrolled in this study. Oxaliplatin, 80 mg/m(2), was administered intravenously on day 1, and capecitabine, 1, 250 mg/m(2) bid po (total daily dose 2, 500 mg/m(2)), was given on days 1~14 of 3 week cycles. RESULTS: The median age of the patients was 57 years (range: 41~74), and the most common sites of metastasis were liver, lung or lymph node. Of the 12 evaluable patients, the overall response rate was 41.7%, but with no complete response. The median response duration and median progression free survival of 12 patients were 42 and 24.4 weeks, respectively. The median overall survival was not reached. A median 6 (range: 1~9), and a total 80, cycles were administered to 14 patients. 80 cycles were evaluable for toxicity. The most common hematological toxicities were NCI grades I/II anemia (45%), leucopenia (33.75%) and thrombocytopenia (17.5%). The most common non-hematological toxicities were nausea/ vomiting (28.75/5%) and neurotoxicity (8.75%). Hand and foot syndrome was noted in only 3.75%. There was no life-threatening toxicity. CONCLUSION: Oxaliplatin and oral capecitabine combination chemotherapy showed significant activity and favorable toxicity in patients with metastatic colorectal cancer. Further studies, with larger numbers of patients and long-tern follow-up will be needed.

Gemcitabine and Infusional 5-Fluorouracil in Advanced Pancreatic Cancer: A Clinical Benefit Response-Oriented Phase II Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Gemcitabine and 5-fluorouracil (5-FU) are two compounds with reproducible activity against advanced pancreatic carcinomas. To evaluate the activity and feasibility of this combination chemotherapy, a multi-institutional phase II study was performed. MATERIALS AND METHODS: Twenty patients (male: female 15: 5, median age: 60.5 years), with histologically verified locally advanced or metastatic pancreatic carcinomas, were enrolled between April 2000 and March 2002. Gemcitabine was administered by intravenous injection at the doses of 1, 000 mg/m2 on days 1, 8 and 15, and 5-FU 800 mg/m2/day, was given by continuous intravenous infusion on days 1~5. The treatment was repeated every 4 weeks. The clinical benefit response (CBR) was a composite of the pain, Karnofsky performance status and body weight change measurement. RESULTS: Nineteen of the twenty patients were assessable for response. The median follow-up duration was 4.6 months (0.4~15.2 months). Five patients achieved a partial response and eight a stable disease. The overall response rate was 25.0%. The CBR was assessable in 12 patients. The overall CBR was 41.7% (5/12). The median survival of all the patients was 8.0 months. Grade 3~4 toxicities included neutropenia (9.3%) and thrombocytopenia (5.3%). CONCLUSION: This study suggested that gemcitabine, combined with infusional 5-FU, was well tolerated, and produced modest antitumor activity and symptomatic relief in advanced pancreatic cancer patients.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Recurrent Strangulated Obturator Hernia

An obturator hernia is a rare condition, occurring most frequently in elderly and debilitated women. The diagnosis is difficult, and delayed treatment is associated with serious complications. In most cases, it produces a small bowel obstruction with high morbidity and mortality. We experienced an unusual case of a left recurrent obturator hernia. The patient was a 76-year-old woman with atrial fibrillation, presented with intermittent generalized abdominal pain and distension. The patient underwent a laparotomy because of a left incarcerated obturator hernia 2 years ago. The abdominal plain X-ray showed evidence of a small bowel obstruction. A CT scan established a correct diagnosis. Consequently, the patient underwent an immediate laparotomy. There were a few necrotic foci on the herniated small bowel wall. Therefore, a segmental resection of the small bowel was performed. To prevent a recurrence, the hernial defect was closed with several interrupted sutures between the peritoneum and periosteum of the obturator foramen. As patients with an obturator hernia are almost elderly women, and often have multiple concurrent medical problems. An immediate CT scan of the abdomen, including the pelvic area, should achieve an early diagnosis. Early surgical intervention should be done without serious medical diseases. Besides definitive surgery is needed to prevent a recurrence.

New Operative Method for Transsphincteric Fistula

PURPOSE: The complications after surgery for trans sphincteric anal fistula are anal incontinence due to cutting of the external anal sphincter muscle and recurrent anal fistula. Several methods have been developed to alleviate this condition, but they still have many complications. We performed surgery for transsphincteric anal fistula by a new method with excellent results and therefore report this new method as another treatment modality for transsphincteric anal fistula. METHODS: We performed surgery for transsphincteric anal fistula on 12 patients at Hanyang University Kuri Hospital between March 1999 and December 2001. RESULTS: There were no recurrences in any of the 12 patients, all of whom kept continence after surgery. Our operative method involve coring out and fistulectomy, laying open, closure of the defected external sphincter muscle and partial closure of the skin of the external opening. CONCLUSION: Our simple and modified method for transsphincteric anal fistula showed excellent results, especially in terms of the rate of recurrence and fecal incontinence. We therefore recommended this easy and simple method for surgery for transsphincteric anal fistula.

Genetic Polymorphism of Xenobiotics Metabolizing Enzymes and Individual Susceptible Genes to Colorectal Cancer Patients in Korea

Individual susceptibility to cancers may result from several factors including differences in xenobiotics metabolism, DNA repair, altered oncogenes and suppressor genes, and environmental carcinogen exposures. To determine the frequencies of the genotypes of phase I (CYP1A1 and CYP2E1) and phase II (GSTM1 and NAT2) metabolizing enzymes and to identify the high-risk genotypes of these metabolic enzymes to colon cancer in Korean, we have analyzed 113 colorectal cancer patients and corresponding age and sex matched healthy controls using polymerase chain reaction-restriction fragment length polymorphi(PCR-RFLP). In analysis of phase I enzymes, m1/m2, m2/m2 and Val/Val genotypes in CYP1A1 enzyme polymorphisms and C1/C2 genotype in CYP2E1 polymorphism were associated with high relative risks to colorectal cancers (Odds ratio; 1.51, 1.59, 1.76 and 1.38, respectively). Among the phase II enzymes polymorphisms, GSTM (-) genotype of GSTM1 enzyme and slow acetylator (S/S) of NAT2 enzyme had 1.48 and 1.34 times of relative risks to colorectal cancers, respectively. In combined genotyping of phase I enzymes and GSTM1 polymorphisms, the patients with m1/m2 and GSTM (-), Val/Val and GSTM (-), and C1/C2 and GSTM (-) combined genotypes had higher relative risk than the patients with each baseline of combined genotypes (Odds ratio; 2.15, 5.81 and 2.20, respectively). In combined genotyping of phase I enzyme and NAT2 polymorphisms, the combined genotypes of m1/m2 with slow acetylator and C1/C2 with slow acetylator were more susceptible to colorectal cancer (Odds ratio; 3.5 and 4.5, respectively). These results suggest that the combined genotypes of Val/Val and GSTM (-), m1/m2 and slow acetylator, and C1/C2 and slow acetylator were more susceptible to colorectal cancer in Korean. And genotyping of xenobiotics metabolizing enzymes could be useful for predicting an individual susceptibility to colorectal cancer.

Primary Hepatic Malignant Fibrous Histiocytoma

Malignant fibrous histiocytoma (MFH) is a common sarcoma of the soft tissue, usually occurring in the extremities and less commonly in the retroperitoneal space, the abdominal cavity, or other site such as the skin or the head and neck resion. However, MFH of the liver is quite a rare neoplasm. This tumor has five distinct histological subtypes: storiform pleomorphic, myxoid, giant cells, inflammatory and angiomatoid. Recently, we experienced a case of primary MFH in a surgically removed liver. This case is reported with a review of the literature.

Hemosuccus Pancreaticus (Hemoductal Pancreatitis, Gastrointestinal Hemorrhage Due to Rupture of a Splenic Artery Aneurysm into the Pancreatic Duct)

Hemorrhage through the pancreatic duct into the duodenum is rare presentation of upper gastrointestinal bleeding. This condition is most commonly associated with inflammatory disorders of the pancrease with the bleeding originating from an area of hemorrhagic pancreatitis, abscess, or pseudocyst. A pseudoaneurysm of the splenic artery be can form as a result of erosion and autodigestion by the inflammatory process of this major blood vessel. More frequently, splenic artery aneurysms rupture into the greater or lesser peritoneal sacs, stomach, retroperitoneum, colon, or splenic vein. We experienced a patient with a prolonged history of upper gastrointestinal bleeding in which the diagnosis of hemosuccus pancreaticus secondary to a ruptured splenic artery aneurysm was diagnosed preoperatively. We report our experience with a review of the related literature.

Clinical Review of Carcinomas of the Extrahepatic Bile Ducts and Gallbladders

PURPOSE: The poor prognosis of surgery for extrahepatic bile duct and gallbladder carcinomas are at least partialy due to the inadequate extent of resection and the spreading characteristics of the tumor. This study was conducted to evaluate the benefit of a curative resection and extended surgery for extrahepatic bile duct cancer and GB cancer. METHODS: One hundred seventy five patients with extrahepatic bile duct cancer and GB cancer, who were diagnosed between January 1988 and December 1997 at the Hanyang University hospital, were retrospectively analyzed according to the TNM staging system and the extent of resection. RESULTS: A curative resection was performed in 51% of the extrahepatic bile duct cancer cases and 45% of the GB cancer cases. The cummulative survival rate after a curative resection was significantly higher than those after a palliative resection and no operation. The overall one year and three years survival rates were 74% and 48%, respectively after a curative resection compared to 12% and 0% after a palliative resection. Long term survival after a curative resection correlated with the stage of the disease. CONCLUSION: The result of this study shows that as extended curative resection of an extahepatic bile duct carcinoma and GB cancer was associated with a worthwhile improvement of long term survival.

Paraganglioma Arising from Retroperitoneum, Mediastinum

A paraganglioma that arises from the Retroperitoneum, mediastinum is an extra-adrenal form of pheochromcytoma. Extra-adrenal pheochromocytomas can occur at any site in the abdomen where chromaffin tissue is located and have been found in the paravertebral ganglia, the organ of Zuckerkandl, and the urinary bladder. An extra-adrenal pheochromocytomas can arise from a collection of para-aortic, paraganglion cells located at the origin of the inferior mesenteric artery, This collection of paraganglia was first described in fetuses by Zuckerkandl in 1901 and has subsequently been referred to as the organ of Zuckerkandl. Extra-adrenal pheochromocytoma generally secrete norepinephrine, not epinephrine, because there is an absence of the enzyme phenyl- ethanolamine-N-methyl transferase. Therefore symptoms are related to the production of norepinephrine. Extra-adrenal pheochromocytomas pursue a more aggressive course than their adrenal counterparts. It was found to metastasize in approximately 20% to 40% of cases, compared with only a 2% to 10% rate of metastasis in all adrenal tumors. We report on a three case of paragangliomas that had a functional and non-functional paraganglioma of the organ of Zuckerkandl and a case of a non-functional paraganglioma of the posterior mediastinum.

Pancreaticoduodenectomy and Pancreatic Resection in Chronic Pancreatitis

PURPOSE: Chronic pancreatitis is difficult to cure because relapse is common. In particular the removal of stone is very difficult in pancreatolithiasis (pancreatic stone), and is associated with pancreatic duct stenosis. We attempted to evaluate the risk and the outcome of pancreatic resection in chronic pancreatitis. METHODS: We retrospectively reviewed the clinical records of twelve patients with chronic pancreatitis who had undergone pancreatic resection at our hospital between January, 1991 and December, 2000. RESULTS: Pancreaticoduodenectomy was performed in nine cases and distal pancreatectomy in three cases. In the nine cases of pancreaticoduodenectomy, five cases were associated with pancreatolith and four cases were suspected malignancy. In one case of distal pancreatectomy, a pigtail drain was inserted due to postoperative pancreatic leakage. Additionally, one patient who underwent distal pancreatectomy was readmitted one year later due to recurred pancreatitis. The remaining ten patients were discharged without complications and followed up without pain. CONCLUSION: According to two complementary theories (visceral compartment syndorme and neural inflammatory theory), pancreatic resection is better than more conservative treatment, ensuring the elimination of pain. If performed by an expert surgeon, pancreatic resection is a safe and effective treatment for chronic pancreatitis.

A Clinical Review of 20 Initial Cases of Laparoscopic Adrenalectomy

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Case of Anal Fistula Which Has an External Opening in Thigh

Infection of the anal glands is the most common cause of anorectal abscess. Ductal obstruction may result in stasis, infection, and abscess formation. Drainage of the abscess through the perianal skin, whether spontaneous or operative, may lead to a fistula. the fistula in the fascial or fatty planes, especially within the intersphincteric space, located between the internal and the external sphincter extending into the ischiorectal fascia. Fistulas are usually divided into four main anatomic categories as described by Parks and colleagues in 1976.(1,2) The most commonly occurring is the intersphincteric fistula, constituting 70% of all anal fistulas. The infectious process starting from its origin passes directly downward to the anal margin, but there are some variants of these type of fistulas that are less common and more complex to treat. Transsphincteric (25%), suprasphincteric (4%), and extrasphincteric (1%) fistulas constitute the remaining 30% of other anal fistulas those are not intersphincteric. Extrasphincteric fistula is rare and difficult to treat. It begins from the perineal skin penetrating directly downward to the rectal wall above the levator ani. The tract it forms is completely outside the sphincteric apparatus. There are numerous causes to anal fistulas, including trauma, carcinoma, and Crohn's disease. We report a rare case of a 46 year old male patient with anal fistula which has a long abnormal course and an external opening in thigh. The patient suffered from pain on the external opening for 3 years, with dirty discharge.

Clinical experiences of Duct-to-Mucosa Pancreaticojejunostomy and PTBD in Pancreaticoduodenectomy(personal experiences of 93 cases) / 한국간담췌외과학회지

BACKGROUND: Pancreaticoduodenectomy is well established in the armamentarium of the surgeon treating periampullary carcinoma and benign lesion. With refinement of operative technique and more enlighting management during the postoperative period, the morbidity and mortality of this procedure have reduced significantly. Leakage of the pancreaticojejunal anastomosis has been a major complication after this procedure, frequently reported in an incidence of 5 percent to 15 percent. Therefore, authors retrospectivly reviewed about clinical experience of duct-to-mucosa anastomosis and PTBD in pancreaticoduodenectomy. OBJECTS & METHODS: The authors retrospectively reviewed the medical records of 93 patients who had undergone a pancreaticoduodenectomy with the duct-to-mucosa method between 1994 and 2000 by one surgeon. RESULTS: The male-to female ratio was 2.1:1(63:30) and mean age was 57 years old(range from 26 to 77). Thirty patients(32.6%) of 93 patients were distal common bile duct cancer, 22 patients(24%) were pancreatic head cancer, 21 patients(23%) were Ampulla of Vater cancer, 5 patients(5.4%) were chronic pancreatitis, 3 patient(3.3%) were duodenal cancer. The operative morbidity was 35.8%, and there was three perioperative mortality(3.2%). The mean operative time was 8.8 hours. A pancreatic fistula was diagnosed in 6 of the 93 patients(6.5%) and surgical intervention was done in 1 of the 6 patients. A PTBD for preoperatively biliary drainage was done 64 cases and complication related PTBD was 3 cases(4.7%, hemobilia). CONCLUSIONS: Even if this anastomotic technique requires a little more time and attention by the surgeon, we experienced that the low incidence of pancreatico-jejunal anastomosis related complication represents a validation of the method, and a motivation to adapt this anastomotic technique. But, this method is not absolute because surgeon's preference is most important factor in operation.

Clinicopathological Characteristics of Recurred Gastric Cancer Patients after Curative Surgery

PURPOSE: More than half of the gastric cancer patients are diagnosed at an advanced stage, and many of them recur in spite of curative surgery. Because of that fact, analysis of the characteristics of recurrence and development of a more effective treatment are urgent problems. METHODS: One hundred gastric cancer patients who recurred after curative surgery were enrolled for this study, and 518 patients living without recurrence were used as a control group. Various clinicopathological factors were compared between the recurred and the non-recurred groups. RESULTS: Among the 100 recurred patients, peritoneal seeding (P/S) was found in 46 patients, hematogenous spread (H-S) in 20 patients, loco-regional recurrence (LR-R) in 15 patients mixed type in 19 patients. Depth of invasion, lymph node metastasis, incidence of total gastrectomy, preoperative CA19-9 level, lymphatic and venous invasion, and tumor size were significantly different between the recurred and the non-recurred groups. In cases with P/S and H-R, undifferentiated tumors were more frequent than differentiated tumors to the contrary differentiated tumors were more common in LR-R. More than 80% of the recurrences were emerged within 2 years after surgery. At the time of recurrence, the serum levels of CEA and CA 19-9 were positive of 45% and 45% of the patients respectively. In P/S, patients with operative treatment survived longer than patients receiving other kinds of treatment (p=0.019), and chemotherapy effectively lengthened the survival in mixed type recurrence (p=0.018). CONCLUSION: The two years following surgery was the most important period for recurrence, and lymphatic invasion was related to such early recurrence with a statistical significance. Measurement of the serum levels of tumor markers was useful for the detection of recurrence. Operative treatment or chemotherapy was effective for lengthening the period of survival after recurrence in some types of recurrence.

NAT2 Polymorphism and Individual Genetic Susceptibility to Colorectal Cancer Patients in Korea

To determine the frequencies of the genotypes of NAT2 gene in healthy Korean populations and to identify the high-risk genotypes of NAT2 gene in colorectal cancer patients, 115 healthy controls and 109 cancer patients were analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). The distribution of NAT2 polymorphism in healthy Korean was found to be 7.8% of S/S genotype, 48.7% of S/F genotype, and 43.5% of F/F genotype. And the frequency of phenotypes was 8% of slow acetylator and 92% of rapid acetylator. S/S genotype of colorectal cancer patients was slightly more frequent than that of healthy controls(11.9% vs 7.8%). The relative risk of S/S genotype to colorectal cancer was estimated to be 1.41, taking the risk of F/F genotype as a baseline(1.00). These results suggest that the distribution of frequencies of NAT2 genotypes is very unique in Korean characterized by extremely low frequency of slow acetylator geno type(S/S) in comparison to the other ethnic groups. And the slow acetylator genotype(S/S) in Korean was found to be more susceptible to colon cancer. Therefore, S/S genotype may have a certain role an colonic carcinogenesis in Korean.

Clinical Effects of Venitol(R) on Complications after Hemorrhoidectomy Prospective Randomized and Placebo-controlled Trial

Fifty four patients who received closed hemorrhoidectomy were randomized into two parallel groups and treated with Venitol(R)(a micronized flavonoidic fraction containing diosmin 450 mg and hesperidin 50 mg) (group 1) or placebo (group 2). Venitol(R) was administered at the dosage of three toblets b.i.d. the first four days and two tablets b.i.d following three days. Postoperative analgesia and laxative prescription as well as hospital stay were same in two groups. Though there is no difference of symptoms at D1, improvement of symptoms of complications was greater in group 1 than in group 2 at D18. The clinical severity of postoperative spot-bleeding, pain and anal discharge diminished in both groups but to a greater extent in group 1 (P<0.005). There was no side-effects in using Venitol(R). In summary, Venitol(R) is effective in reducing complications after hemorrhoidectomy.