Expression of Urokinase-type Plasminogen Activator (uPA) and Plasminogen Activator Inhibitor-1 (PAI-1) in Gallbladder Carcinoma

BACKGROUND: There are evidences that uPA and its inhibitor play a key role in tumor spread. We studied whether uPA and PAI-1 expressions could serve as prognostic parameters along with clinical, gross and microscopic findings in gallbladder carcinomas. METHODS: We analyzed 42 cases of gallbladder carcinomas by immunohistochemical staining and clinicopathologic parameters. RESULTS: uPA and PAI-1 were more frequently expressed in the adenocarcinoma than in the normal or benign gallbladder tissue. The uPA expression in the glands of low grade adenocarcinoma was significantly correlated with both distant and lymph node metastases. The uPA expression in the stroma around the low grade adenocarcinoma was significantly correlated with either distant or lymph node metastasis. The PAI-1 expression was significantly correlated with lymph node metastasis only for both distant and lymph node metastases. In multivariate analysis, the lymphatic invasion was significantly related to poor survival (p= 0.0115). In univariate analysis, the cases without lymphatic invasion had prolonged survival. Positive expression of uPA in the glands of low-grade adenocarcinoma was significantly correlated with poor survival (p=0.0391). CONCLUSION: In conjunction with clinicopathologic findings, expressions of uPA and PAI-1 may be useful prognostic markers in gallbladder carcinomas.

An Outbreak of Acute Gastroenteritis Presenting with Metabolic Acidosis in Many Nurseries in Gyeonggi Province, Korea

PURPOSE: The hospital-acquired outbreak of acute gastroenteritis caused by a virus is currently one of major health problems among newbron nurseries in Korea. We report an outbreak of acute gastroenteritis with metabolic acidosis over a eight-month period in many nurseries in Gyeonggi-do, Korea. METHODS: We retrospectively evaluated 73 neonates who were admitted in Ansan Hospital, Korea University Medical Center, presenting with symptoms of acute viral gastroenteritis from March, 2001 to September, 2003. Epidemiologic, clinical and laboratory data for these neonates were reviewed. Enzyme-linked immunosorbent assay (ELISA) for rotavirus and enzyme immunoassay (EIA) for astrovirus, norwalk virus and enteric adenovirus were performed in 54 and 16 neonates, respectively. RESULTS: The mean age at admission was 9.5 +/- 3.9 days. The mean body weight was significantly decreased, compared with mean birth weight. The numbers of severe dehydration were 37 (50.7%) and severe metabolic acidosis (pH < 7.2) were 40 (54.8%). Although the symptoms and laboratory findings were all compatible with acute gastroenteritis caused by a virus, the positive results for ELISA for rotavirus and EIA for astrovirus, norwalk virus and enteric adenovirus were 8 (14.8%) for 54 neonates and none for 16 neonates, respectively. CONCLUSION: Recognizing an outbreak of viral gastroenteritis necessitates notification of local health officials, collection of appropriate specimen for diagnosis and prompt institution of infection control measures.

Polymorphisms of the 5'-Flanking Region of the Human Tumor Necrosis Factor-alpha Gene in Korean Patients with Crohn's Disease

PURPOSE: Recently, a key role of tumor necrosis factor (TNF) in the development of inflammatory bowel disease (IBD), especially Crohn's disease (CD), has emerged. In Japan, 3 single base pair polymorphisms in the 5'-flanking region of the TNF-alpha gene at position 1031, 863, and 857, which are related to high transcriptional promoter activity, have been identified in the Japanese CD patients. And the polymorphisms of the TNF-alpha gene at position 308, 238 have been reported in western CD patients. So, in order to find the same polymorphisms in Korean population and CD patients, the author evaluate the patients diagnosed with CD, ulcerative colitis (UC) and healthy controls (HCs). METHODS: Blood samples were obtained from 70 patients with CD, 72 patients with UC and 52 healthy controls. Polymorphisms in the TNF-alpha gene at their respective positions were analyzed by single strand conformational polymorphism (SSCP), and allele frequencies in CD and UC patients were compared with those in healthy controls. RESULTS: Allele frequencies of 1031C, 863A, and 857T in health controls were 18.3%, 8.7%, and 19.2%, respectively. Polymorphic allele frequencies of 1031C, 863A, 857T were 22.9%, 27.1%, and 24.3% in CD patients respectively. The frequencies at all 3 positions were higher in CD patients than in HCs. However, the frequency at 863A was statistically significant (P=0.000). The allele frequencies of 308A and 238A alleles were 0.7% and 3.6% in CD, 0.7% and 2.1% in UC, and 1.9% and 4.8% in HCs, respectively. The allele frequency of 1031C was significantly higher in B3 than in B2 (P=0.033). CONCLUSION: Polymorphisms of 5'-flanking region of the TNF-alpha at positions 1031 (T/C), 863 (C/A) and 857 (C/T) may be associated with susceptibility of CD.

Benefits of Stapled Hemorrhoidectomy Compared with Ultrasonic Dissector and Milligan's Hemorrhoidectomy

PURPOSE: Surgical hemorrhoidectomy has a reputation for being a painful procedure. Many surgical methods have been devised for reducing posthemorrhoidectomy pain. Nevertheless, the result are unsatisfactory. Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods. METHODS: A total of 150 consecutive patients with 3rd and 4th degree of prolapsed hemorrhoids underwent hemorrhoidectomy with stapler group (n=50) or hemorrhoidectomy with ultrasonic dissector group (n=50) or Milligan's hemorrhoidectomy using by diathermy (n=50) (by same surgeon between January and September 2001). We evaluated the difference among three techniques in operative time, postoperative pain, and patient satisfaction (using visual analogue scale). RESULTS: Mean operative time for hemorrhoidectomy with ultrasonic dissector was 19 minute; for stapler group, it was 18 minute; for Milligan's group, it was 23.6 minute (P<0.05). There was significant difference in operative time between stapler and Milligan's group. There were significant difference in pain measurement reported on immediate (5.8 for stapler, 7.2 for ultrasonic dissector, and 9.2 for Milligan's group, P<0.01), day 1 (4.3, 5.5, and 6.8, P<0.01), day 2 (3.7, 4.7, and 6, P<0.01), day 3 (3.0, 3.6, and 4.6, P<0.01), day 4 (3.1, 3.5, and 4.6, P<0.01), day 5 (2.5, 3.4, and 4.6, P<0.01), day 6 (2.0, 3.2, and 4.3, P<0.01), day 7 (1.8, 3, and 4.2, P<0.01), and defecation (4.0, 7.0, and 8.9, P<0.01). The mean analgesic (piroxicam 20 mg) requirement was 0.3 times for stapler, 1.9 for Ultrasonic dissector, and 3.1 for Milligan's group (P<0.01). Mean hospital stay was 1.6 days for stapler, 1.7 for ultrasonic dissector, 2.8 for Milligan's group (P<0.01). Patient satisfaction on day 7 was 8.2 for stapler, 6.2 for ultrasonic dissector, and 5.2 for Milligan's group (P<0.01). There was no difference in catheterization for urinary retention. It is probably due to spinal anesthesia. CONCLUSION: The study demonstrates significantly reduced postoperative pain and shorter hospital day after stapled hemorrhoidectomy compared among three groups. This resulted in an earlier return to working activities for stapled technique.

A Case of Turcot's Syndrome Combined with Colon Cancer in a 15-year-old Girl

Turcot's syndrome is a rare hereditary disease marked by the association of central nervous system neuroepithelial tumor with colonic polyposis. Authors report herein a case of a 15-year-old girl diagnosed as having Turcot's syndrome, otherwise known as brain tumor-polyposis syndrome, combined with sigmoid colon cancer. The patient was carried out craniostomy and brain tumor removal. The tumor was confirmed histologically to be oligodendroglioma. The patient visited the department of internal medicine for bloody diarrhea during 6 months. Colonoscopy and biopsy was done. The patient was diagnosed as having Turcot's syndrome combined with sigmoid colon cancer, and was then transferred to the department of surgery for treatment of sigmoid colon cancer. Total proctocolectomy and IPAA (ileal pouch-anal anastomosis) was carried out. Multiple polyps were found in the colon, two large masses were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. This case report describes the characteristic features of Turcot's syndrome presented by this patient.

hMLH1/hMSH2 Protein Expression in Sporadic Colorectal Carcinoma and Its Clinicopathological Significance

PURPOSE: DNA replication errors (RERs) in repeated nucleotide sequences (microsatellite instability) is caused by defective mismatch repair (MMR) genes. Ninety percent of colorectal carcinomas in hereditary nonpolyposis colorectal cancer (HNPCC) patients and 10-15% of sporadic colorectal cancers show microsatellite instability. In the majority of colorectal cancers with microsatellite instability, the defective MMR gene is hMLH1 or hMSH2. The author examined immunohistochemical expression of hMLH1 and hMSH2 in 75 cases of colorectal carcinomas excluding HNPCC, based on Amsterdam criteria for investigating clinicopathological characteristics and prognosis in hMLH1/hMSH2 negative cases. METHODS: Formalin fixed, paraffin blocks obtained from tumors of 75 cases of colorectal cancers were stained with two monoclonal antibodies (hMLH1 and hMSH2). The correlation between hMLH1/hMSH2 negativity, and clinicopathological feature and prognosis were statistically analysed. RESULTS: Twelve cases (16.0%) showed hMLH1/hMSH2 negativity. Negative expression of hMLH1/hMSH2 was associated with early onset (under age 50), proximal location, multiplicity, mucinous histologic type and poor differentiation. There was a significant survival advantage in patients with hMLH1/hMSH2 negative colorectal carcinoma. CONCLUSIONS: This study shows that hMLH1/hMSH2 negative colorectal carcinomas have the same clinicopathological characteristics of colorectal carcinomas with microsatellite instability. The immunohistochemical test for hMLH1/hMSH2 protein can be a simple screening method routinely applicable. The result of this test is available for establishing guidelines for management, and an independent prognostic factor for sporadic colorectal cancers.

Clinical Trial Comparing Pain and Clinical Function after Conventional Semi-open Milligan Hemorrhoidectomy vs Open Ultrasonic Dissector Hemorrhoidectomy

PURPOSE:Hemorrhoidectomy is considered to be a painful operation, therefore some patients with symptomatic hemorrhoids conceal their symptoms to defer a much-needed surgical procedure. Patients who have undergone hemorrhoidectomy have experienced constipation or urinary retention due to postoperative pain. Several interventions have been used to relieve postoperative pain after hemorrhoidectomy. Nevertheless, the results are unsatisfactory. Hemorrhoidectomy with ultrasonic dissector have less thermal injury and can avoid ligation and suture. This study compared conventional semi-open Milligan hemorrhoidectomy with open ultrasonic dissector hemorrhoidectomy. METHODS:One hundred patients with prolapsed symptomatic hemorrhoids were randomly assigned to semi-open Milligan (n=50) or open ultrasonic dissector (n=50) hemorrhoidectomy. Operation time, postoperative complication, hospital stay, degree and duration of postoperative pain, pain on bowel movement, and urinary retention were recorded and analyzed. RESULTS:There was no significant difference in excised pile number. Operation time of open ultrasonic dissector hemorrhoidectomy was shorter than that of semi-open Milligan hemorrhoidectomy (P<0.05). The open ultrasonic dissector hemorrhoidectomy group resulted in less postoperative pain (P<0.05) and shorter duration of pain (P<0.05) and postoperative hospital stay (P<0.05) than semi-open Milligan hemorrhoidectomy. Urinary retention did not occur in both groups. CONCLUSIONS:Despite the higher cost, open ultrasonic dissector hemorrhoidectomy results in less postoperative pain, shorter operation time and hospital stay than the conventional hemorrhoidectomy.

Comparison of the Result of Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis in Familial Adenomatous Polyposis and Ulcerative Colitis

PURPOSE:The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). METHODS:Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy. RESULTS:One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC. CONCLUSIONS:FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.

The Effects of Gabexate Mesilate on the Ishemia-Reperfusion Injury in the Rabbit Liver

PURPOSE: Ischemia-reperfusion is an important pathologic process that leads to impairment of the liver after major surgery. Ischmia-reperfusion injury includes both hypoxia and an inflammatory response associated with reperfusion; the former is caused by the lack of microvascular perfusion and the latter is mediated by cytyokines and oxygen free radicals. In addition to inhibiting thrombin, plasmin, kalikrein, trypsin, and neutrophil elastase, gabexate mesilate also plays an important role in inhibiting cytokines and oxygen free radical production. The purpose of this study was to investigate the effects of gabexate mesilate on ischemia- reperfusion injury in the liver. METHODS: Twenty-four New Zealand white rabbits were divided into three groups. Clamping was not done in group A (n=8), although it was done in group B (n=8) and group C (n=8). Group C received intravenous infusion of gabexate mesilate (10 mg/kg/hr) continuously during the process of clamping. Serum alanine aminotrasferase (ALT) and purine nucleoside phophorylase (PNP) were measured immediately before clamping, following 30-minute ischemia, and after 60-minute reperfusion. Hepatic tissue adenosine triphophate (ATP), xanthine oxidase, and malondialdehyde (MDA) plus 4-hydroxyalcenals (4HA) were measured after reperfusion. RESULTS: Compared with group A, group B and group C demonstrated a significant increase in ALT and PNP levels following ischemia and reperfusion, as well as in xanthine oxidase and MDA plus 4HA levels following reperfusion. However, ATP levels showed no significant differences among the three groups. ALT levels were significantly lower in group C than in group B following reperfusion (P<0.01),although there was no significant differences in PNP levels between them. Xanthine oxidase and MDA plus 4HA levels were significantly lower in group C than in group B (P<0.05). The results suggest that gabexate mesilate inhibits an increase in ALT, xanthine oxidase, and MDA plus 4HA levels. CONCLUSION: Gabexate mesilate inhibits oxygen free radical production of xanthine oxidase, and results in a reduction of hepatic ischemia-reperfusion injury.

Role of Surgery in the Management of Primary Lymphoma of the Gastrointestinal Tract

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.

2 Cases of Metachronous Triple Primary Cancers

Multiple primary cancer for the colon and rectum was reported in numorous literature. Therefore, complete preoperative evaluation of patients presenting with colorectal cancer seems to be essential. In addition, it is fundamental that patients who have been treated for colorectal cancer require careful follow up evaluation. When symptoms and signs of tumor develop in a patient who has been treated for an initial colorectal cancer, the possibility of a localized and curable second, third primary cancer should be considered and evaluated. We report 2 cases of metchronous triple primary cancer with a review of literature.

Expression of Glucose Transporter Gene in Colorectal Cancer

PURPOSE: The primary metabolic characteristic of malignant cells is an increased uptake of glucose and its anaerobic glycolysis. Recent studies have demonstrated that facilitative glucose transport across the plasma membrane is mediated by a family of proteins, i.e., glucose transporters. PURPOSE: In order to evaluate the clinicopathologic correlations of glucose transporter genes expressed in colorectal cancer, the author studied the expression of glucose transporter genes in human colorectal cancer and analyzed their expression in normal and malignant colorectal tissues. METHODS: A reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to quantitatively determine the levels of the glucose transporter genes, GLUT1 and GLUT3, from Crohnes diseases (N=2), adenomatous polyps (N=4), and colorectal cancers (N=40) and their normal counterparts. RESULTS: The expresssion of the GLUT1 gene was detected in 50% of the inflammatory colonic mucosae and adenomatous polyp tissues, but the levels of expression were not significantly different from their normal counterparts. Among the 40 colorectal cancer patients, 23 patients (57.5%) showed GLUT1 gene expression and the levels of expression were increaed by 1.8 as compared to their normal counterparts (p<0.05). The expression of the GLUT3 gene was detected in almost all tissues examined, and the levels of expression were not significantly different from their normal counterparts. In colorectal cancers, there was correlation between GLUT1 expression, the extent of lymph node involvement and the stage of colorectal cancers (p<0.05). But, the correlation between the expressions of the GLUT3 gene and the clinicopathologic prognostic factors of colorectal cancers could not be determined because almost all tissues showed a GLUT3 gene expression. CONCLUSIONS: In conclusion, the GLUT1 glucose transporter expression in colorectal cancer was associated with high possibilities of lymph node metastases and poorer prognosis, and the assessment of GLUT1 expression in colorectal cancer would be useful in identifying high risk patients.

Clinical Significance of Occult Micrometastases in Colorectal Cancer

BACKGROUND: One of the most important prognostic factors in colorectal cancer is lymph node metastasis, which predicts a reduced survival time. Although lymph node metastases were not detected by a conventional hematoxylin-eosin stain technique, 20 to 30 percent of patients fail long-term survival on account of a local or systemic recurrence. Recurrent disease in these patients is believed to develop from occult tumor in lymph nodes. PURPOSE: The authors have conducted an immunohistochemical study with two different antibodies against cytokeratin to identify occult micrometastases in lymph nodes which were diagnosed as tumor negative by conventional histopathology. METHODS: Paraffin blocks of sixty-five patients with colorectal cancer (T2/3, N0, M0) after a curative resection between January 1991 and December 1993 at Kyung-Hee University Hospital were stained with avidin-biotin-peroxidase complex technique using two monoclonal antibodies (anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, DAKO, Hamburg, Germany). To assess the clinical correlation between micrometastasis in lymph node and patients survial, 5-year disease-free survival rates were calculated by Kaplan-Meier method and the significance of the differences was estimated by the log-rank test. P values <0.05 were taken to be significant. RESULTS: Of the sixty-five patients with 1133 lymph nodes, tumor cells detected by anti-cytokeratin AE1/AE3 and anti-cytokeratin No. 20, were 2.4 percent (27/1133) and 3.4 percent (38/1133), respectively. Micrometastases were detected in twenty-six patients (40.0 percent). The histologic stage of four cytokeratin positive cases was upstaged from T2, N0, M0 to T2, N1/2, M0, and twenty-two of T3, N0, M0 to T3, N1/2, M0. Cytokeratin-positive cases showed statistically significant recurrence rate (42.3 percent) compared to that of cytokeratin -negative cases (17.9 percent)(x2 test, p=0.032). With the median follow-up of 62 months, 5-year disease-free survival rates of the micrometastses negative and positive cases were 81.7 percent and 61.3 percent, respectively (p=0.0438). CONCLUSIONS: In conclusion, immunohistochemical technique to identify the occult micrometastases in lymph nodes overlooked in conventional histopathology is a useful staging method to anticipate a recurrence and a prognosis more precisely.

Preoperative Staging of Rectal Cancer by CT & MRI

Accurate staging of rectal cancer preoperatively is important to plan a proper treatment and to predict treatment results. For the preoperative staging of rectal cancer, computed tomography (CT), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI) have been used, but the role of them remains controversial. This research was intended to compare and analyze the accuracy of CT and MRI in the preoperative staging of rectal cancer. METHODS: From January 1998 to June 1999, sixty patients were studied by CT and MRI before their operations for rectal cancer in our institution, but two patients with local excision were excluded in N-staging as objects. The patients who had preoperative irradiation were also excluded in this study. Preoperative staging with CT and MRI were conducted by one radiologist according to 1997's TNM classification based on AJCC. On the results of pathological findings after operation, preoperative staging with CT and MRI were classified into T-staging and N-staging. Accuracy and agreement rate between pathological staging and preoperative staging by CT and MRI were compared and analyzed by Kappa value. RESULTS: The accuracy of CT was 68 percent in T-staging, and 58 percent in N-staging, MRI showed accuracy of 82 percent in T-staging and 64 percent in N-staging. In the T-staging, the agreement rate between pathological staging and CT staging was 0.54 (95% confidence interval), while the agreement rate was 0.70 in MRI staging, resulting in a higher agreement rate with MRI than with CT. In the N-staging, the agreement rate between pathological staging and CT staging was 0.38, with a relatively lower agreement rate, while the agreement rate was 0.56 in MRI staging. In our study, MRI showed a higher agreement rate than CT. CONCLUSIONS: In the future, more research should be conducted, but it can be conclued that in preoperative staging for rectal cancer, MRI using body arrayed coil has a better accuracy than CT. Subsequently MRI staging should be considered as a more useful investigation method before operation than CT.

Survey on Satisfaction of Ostomate according to Colostomy Irrigation

The colostomy may cause considerable discomfort as well as surgical, psychological and esthetic problems. The ostomates probably suffer most from fecal incontinence, even though many attempts have been made to eliminate the problems related to the spontaneous colonic emission. Hence the aims of this study are to survey ostomates' satisfaction with colostomy irrigation. METHODS: This medical survey attempts to assess the degree of satisfaction that ostomates are satisfied with the quality of their lives and the extent to which they are affected in doing their jobs and sexuality. The survey was conducted for 146 ostomates, who responded to the questionnaire at the 3rd & 4th Workshop for Stoma Rehabilitation for Ostomates in 1998 and 1999 developed by the Department of Surgery, Kyung Hee University Hospital. The irrigation group was formed with 66 cases (45.2%) and the non-irrigation group 80 cases (54.8%). In assessment of the satisfaction of sexuality, the irrigation group was composed of 37 cases (male: 22 cases, female: 15 cases) and the non-irrigation group 48 cases (male: 30 cases, female: 18 cases). RESULTS: It is found out that the ratio of male to female is 1.5:1 (97:59) and by the age distribution, the ostomates in their 50's and 60's constitute 67.1%: by the cause of stoma operation, malignancy consists of 133 cases (91.1%), Inflammatory Bowel Disease (IBD) 6 cases, the others 7 cases. As for the degree of the satisfaction of ostomates for their life quality, it is found that 52 cases (78.9%) of the irrigation group and 71 cases (88.8%) of the non-irrigation group (p0.05). As for the degree of the satisfaction of the ostomates for the sexuality in male, dissatisfaction is revealed in 13 cases (59.1%) of the irrigation group and in 23 cases (76.7%) of the non-irrigation group (p<0.05). In the case of female, the dissatisfaction is observed in 8 cases (53.3%) of the irrigation group and in 13 cases (72.2%) of the non-irrigation group (p<0.05). CONCLUSIONS: This medical survey clearly shows high dissatisfaction rates especially in the non-irrigation group, and the better significant satisfaction was shown in the quality of life and sexuality between the male and the female in the irrigation group. Therefore, colostomy irrigation may be an effective method for the management of colostomy.

Primary Aldosteronism

BACKGROUND: Management of primary aldosteronism has undergone dramatic changes in the past 40 years. This retrospective study was carried out to review our surgical experience and postoperative outcome and to identify the clinical charateristics of primary aldosteronism. METHODS: Twenty-five patients who underwent an adrenalectomy for primary aldosteronism from 1983 to 1997 were included in the study. All patients were operated on at the Department of Surgery, School of Medicine, Kyung-Hee University. We reviewed the records of 18 women and 7 men, ranging in age from 22 to 59 years. Data examined included clinical presentation, biochemical results, hormonal evaluation, localization studies, operative results, pathologic details, and postoperative outcome. The diagnosis of primary aldosteronism was based on a demonstration of hypertension, hypokalemia, elevated plasma aldosterone concentration, and suppressed plasma renin activity. Localization studies, including computed tomography (CT) and ultrasonography (US) were performed in all patients. A follow-up study was conducted by either reviewing clinical records, telephone contact, or examination of patients during return visits. RESULTS: Hypertension and hypokalemia were present in all patients. Serum potassium ranged from 1.4 to 3.2 mEq/L (2.3+/-0.5; mean+/-standard deviation {SD}mEq/L), and hypokalemia was considered an important diagnostic clue. We found the accuracy rate for CT results in our patients to be 96.0% (24 patients). An adrenal venous sampling was performed in one patient whose CT results were not confirmatory. A unilateral adrenalectomy was performed through posterior (22 patients), an anterior transabdominal (1 patient), or a lateral transabdominal laparoscopic (2 patients) approach. A laparoscopic adrenalectomy will minimize postoperative pain and hospital stay. The histological findings were 23 aldosterone-producing adenomas and 1 nodular hyperplasia. During a mean follow-up of 31.6 months, 22 (91.7%) of the 24 patients required no further antihypertensive treatment. CONCLUSION: Primary aldosteronism due to an aldosterone-producing adenoma can be diagnosed and localized expeditiously, and surgical treatment can be performed safely.

Pedigree of the Specific Family of the FAP in Specific District of Korea and Psychologic Distress

Familial Adenomatous Polyposis (FAP) is a rare and autosomal dominantly inherited disorder characterized by the development of hundreds to thousands of colorectal polyps. Korean Polyposis Registry was established in July, 1990 for early detection and management of the FAP patient. Recently, we have experienced in our institution a case of the FAP family kindred living in Jeju Island of Korea. Their relatives have been managed for the past 20 years and are listed in the Korean polyposis registry. Pathologic diagnosis of our proband was stage III (T3N1M0) rectal cancer with thousands of colonic polyps. Intrafamilial strife and psychologic distress was significant due to the late detection and progression to rectal cancer. Therefore, we reviewed our case of the FAP family with literature regarding the psychologic distress and the role of the regional registry.

Comparison of CT & MRI Findings in the Staging of Rectosigmoid Carcinoma According to New AJCC Classification

PURPOSE: To evaluate the diagnostic accuracy of computed tomography(CT) and magnetic resonance imaging(MRI)in the staging of rectosigmoid carcinoma according to the new AJCC classification. MATERIALS AND METHODS: BetweenAugust 1997 and October 1998, 36 patients with pathologically proven rectosigmoid carcinoma who underwent preoperative CT and MRI were evaluated. CT scans were performed with spiral CT in 27 cases and with conventional CT in nine. In all cases, MR images were obtained using a 1.5T unit and a body arrayed coil. T1- and T2-weightedimages were obtained in axial, sagittal, and coronal planes. On the basis of the results of CT scanning and MRI,tumor stage was determined by two radiologists using the AJCC cancer staging manual(1997). They reached aconsensus and compared their results with the pathologic stage. The T-stage was T1 in three cases, T2 in two, T3in 26, and T4 in five. The N-stage was N0 in 16 cases, N1 in seven, and N2 in 13. RESULTS: In the case of CT, thediagnostic accuracy of T-staging was 67%, and that of N-staging, 44%. For MRI, the corresponding figures were 83%and 67%. For T-staging, MRI was more accurate than CT(P=0.006), but for N-staging, the diagnostic accuracy of CT and MRI was statistically equivalent (P>0.05). CONCLUSION: MRI using a body arrayed coil is a useful preoperative diagnostic tool for the local staging of rectosigmoid carcinoma.

Management of Hypothyroidism in Childhood / 대한소아내분비학회지

No abstract available.

A Clinical Analysis of 604 Cases of Varicose Veins

PURPOSE: We reviewed 604 cases of varicose veins managed in our hospital and the clinical feature and the results were analyzed between injection sclerotherapy and operative method. METHODS: Retrospective review of clinical records was done from January 1990 to June 1998. All of them were diagnosed as primary varicose veins of lower extremities. Sclerosing agents used were ethanolamine oleate, most commonly, hypertonic saline, sodium tetradecyl sulfate and sclerodex. Injections of the sclerosants were 1 to 5 times as the clinical courses. Then, elastic stocking was applied for 2 weeks. Operations were done under the spinal or general anesthesia and postoperatively remnant varicoses were managed by injection sclerotherapy. Student t-test was used in statistics. RESULTS: The distribution of age were 5th decade (36.8%), 6th decade (24.0%), 4th decade (22.2%) in order of frequency, and the mean age was 44.3 year and the male to female ratio was 1:4.0. The mean duration of illness was 12.6 year, and it was longer in female than male (13.2 vs. 8.7, p=0.02). The most common presumed predisposing factor was longstanding occupation (82% of all) and pregnancy was the 2nd in female (12.0%). Chief complaint was only cosmetic problem in 73% of patients and the others complained varicose induced symptoms and complications. Both lower extremities were involved in 41.9% and right leg was in 26.0%, left leg was in 32.1%. The locations of lesions were calf (41.4%), greater saphenous vein (34.6%), lesser saphenous vein (15.0%). Sclerotherapy was done in 48.0%, operation with sclerotherapy in 23.7%, operation only in 17.2%. The mean duration of illness in sclerotherapy group was significantly shorter than operation group (8.8 vs 14.7 year, p=0.0001). Operation methods were stab avulsion only (48.1%), greater saphenous vein stripping (37.3%) and perforator ligation (11.8%) and others. CONCLUSIONS: Injection sclerotherapy method is very effective and sufficient treatment modality in the management of lower extremity varicose vein with low recurrence and complication rate, especially in the early treated cases.