Clinical Significance of Screening Colonoscopy in Elderly: A KASID Multi-center Study

BACKGROUND/AIMS: Currently, screening colonscopy is widely performed in the medical field. The initial time of screening is recommended at an age of 50 years, but the age to cease screening is unknown. Accordingly, we have investigated the diagnostic yield of colonoscopy according to indications in the elderly, and we evaluated if screening colonoscopy is useful in the elderly. METHODS: We recruited asymptomatic individuals undergoing screening colonoscopy according to age (2830 subjects aged 50-74 years and 111 subjects > or =75 years-old), The colonoscopy findings of the study subjects were compared. In addition, colonoscopy findings of asymptomatic subjects more than 75 years-old were compared with the findings of symptomatic subjects with the same age. RESULTS: The yield for overall neoplasia and advanced adenoma was higher in the group of subjects > or =75 years-old than in the 50-74 years age group (overall adenoma: 49.54% versus 24.98%, p or =75 years-old than in symptomatic subjects > or =75 years-old (49.54% versus 28.19%, p or =75 years-old. The lack of a decline in the frequency of adenoma, including advanced adenoma, justifies continuing screening colonoscopy in the elderly.

Comparison of Laparoscopy-Assisted by Conventional Open Distal Gastrectomy and Extraperigastric Lymph Node Dissection in Early Gastric Cancer

PURPOSE: A laparoscopy-assisted gastrectomy with lymph node dissection for gastric cancer is considered technically more complicated than the open method. To evaluate the short-term surgical validity, the surgical outcome of the laparoscopy-assisted distal gastrectomy (LADG) with extraperigastric lymph node dissection was compared with that of the conventional open distal gastrectomy (CODG) in patients with early gastric cancer. METHODS: One hundred and forty-seven patients with early gastric cancer received a radical distal gastrectomy during 2002 and 2003, where a LADG was performed on 71 patients. The clinicopathological characteristics, postoperative outcomes and courses, and the postoperative morbidities and mortalities were compared between the two groups. Data were retrieved from the stomach cancer database at Dong-A University Medical center. RESULTS: Baseline characteristics, including gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, tumor size, T stage, and lymph node metastasis, were similar between the two groups. No significant differences were found between these groups in terms of the number of retrieved lymph nodes with respect to D1+(D1+no. 7) and D1+beta (D1+no. 7, 8a, and 9) lymphadenectomies. In the LADG group, the wound size was smaller (P <0.0001), but the operation time was longer (P=0.0001) than in the CODG group. The perioperative recovery was faster in the LADG than in the CODG group, as reflected by the shorter hospital stay (P=0.0176) and less additional analgesics (P=0.0370). The serum albumin level in the LADG was higher (P=0.0002) on day 7 than that in the CODG group, and the leukocyte count in the LADG lower (P=0.0445) on day 1 than that in the CODG gruop. There were no significant differences in the postoperative morbidities and mortalities between the two groups. CONCLUSIONS: Our data confirmed that a LADG with an extraperigastric (no. 7, 8, and 9) lymph node dissection was a feasible and acceptable surgical technique for early gastric cancer. From a surgical point of view, a LADG with an extraperigastric lymph node dissection is suggested to be a preferred surgical option for patients with early gastric cancer. Its oncological validity awaits larger and prospective multicenterd trials.

Results of Operative Treatment of Distal Femoral Fracture

PURPOSE: To evaluate the result of comparative study about the cases in the fracture of the distal femur treated with plate and screw, dynamic condylar screw, blade plate, retrograde intramedullary nail and external fixator. MATERIALS AND METHODS: The AO classification system was used. 84 cases who were preformed operation during the period from March 1996 to May 2002, were included in this study. The mean duration of follow-up was 25 months. According to Sachatzker criteria, we classified the following results to excellent, good, fair and poor. RESULTS: Type A were excellent or good result when treated with plate and screw, dynamic condylar screw and retrograde intramedullary nail. Type B were excellent or good result when treated with cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate. CONCLUSION: We conclude that the most important thing in operation is firmly internal fixation and to obtain this, accurately anatomical reduction and the choice of suitable instrument for the type of the fracture are needed. cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate.

Isolation of Enterotoxin - positive Strains of Clostridium perfringens Type A in Korea

Clostridium perfringens is an anaerobe responsible for a wide range of diseases in animals and humans. Symptoms associated with C. perfringens food poisoning are caused by enterotoxin expressed only during sporulation of C. perfringens. It has been known that only 6% of global C. perfringens isolates carry the enterotoxin gene. We found 2 strains of enterotoxigenic C. perfringens out of 33 strains isolated from various sources in Korea using PCR. It was also found that these two strains were both type A that were strongly associated with food poisoning by checking the presence of four major lethal toxins (a-, B-, e-, l-toxin) using PCR. These results suggest that foodborne illness caused by C. perfringens may be common in Korea and that public education is necessary to prevent contamination of foods by this organism.

A Case of Colonic Tuberculosis Cured by Secondary Anti - Tuberculosis Medicine / 대한소화기내시경학회지

Tuberculosis is common disease in developing countries manifested by multi-organ involvement. Although the incidence of tuberculosis has been reducing recently due to the advancement of anti-tuberculosis chemotherapy, improvement of public health, and early diagnosis, the rate is still higher in developing countries. The diagnasis of colonic tubcrculosis is difficult due to its frequency, vague manifestation, and difficulty in confirming the disease process. Fortunately, the advent of flexible colonoscopy has provided an opportunity to confirm the diagnosis of colonic tuberculosis, however biopsy can frequently leveal false negative results. A-27-year-old man was admitted with a 2 week history of rectal bleeding. He complained of anorexia, abdominal pain, and weight loss. Routine laboratory tests and chest X-ray findings were within normal limits, with the exception of left pleural thickening. A colonoscopy showed irregular and small, multiple, and shallow polypoid mucosal lesions in the ascending colon and multiple ulcers in the transverse colon. Multiple colonic biopsies suggested tuberculosis. After three months of prirnary anti-tuberculosis medica tion, the patient showed slightly improved coiono- scopic findings. Follow-up colono- scopic findings revealed more aggrevation and chest X-ray findings showed multiple patch consolidation in the left lung field. Primary anti-tuberculosis medication was stopped and substituted for secondary anti-tuberculosis medication. When clinical and colonoscopic methods are found to be compatible with intestinal tuberculosis in countries with a high prevalence of colonic tuberculosis, a therapeutic trial with an antituberculosis agent is usually considered. In a failed therapeutic trial, considerations must be made not only to other inflammatory bowel diseases such as crohn's disease, but also to multi-drug resistance tuberculosis.