Effects of a Group Coaching Program on Depression, Anxiety and Hope in Women with Breast Cancer Undergoing Chemotherapy

PURPOSE: The purpose of this study was to examine the effect of a group coaching program (GCP) on depression, anxiety, and hope in women breast cancer patients undergoing chemotherapy. METHODS: A total of 152 patients were enrolled and randomly assigned to an experimental group receiving the GCP (N=76) and an untreated control group (N=76). Data collection consisted of three measurements of depression, anxiety, and hope (pre, post, and 3weeks later). The intervention was a one-time GCP consisting of 5 subparts for 30~40 minutes for a group of 3~4 people, conducted by a single nurse. RESULTS: The scores of depression, anxiety, and hope changed significantly over time (p<.001, p<.001, p<.001). Depression, anxiety, and hope changes were significantly different between the experimental and control groups (p<.001, p<.001, p<.001). There was a difference in depression, anxiety, and hope among the groups according to the implementation of the GCP (p<.001, p<.001, p<.001). In the experimental group, depression, anxiety, and hope level were significantly different between the pre- and post-test (p<.001), pre- and 3weeks later-test (p<.001), but not in the control group. CONCLUSION: The GCP for women breast cancer patients receiving chemotherapy was effective in reducing depression and anxiety, and increasing hope.

A case of generalized peritonitis secondary to a perforated pyometra in a patient with cervical cancer / 대한산부인과학회지

Spontaneous perforation of the uterus and subsequent generalized peritonitis is an extremely rare complication of pyometra. Although generalized peritonitis secondary to perforated pyometra is rare in patients with an acute abdomen, this condition should be considered in the differential diagnosis. We report a case of a spontaneous uterine perforation of a pyometra in a patient with cervical cancer with brief review of the literature.

Hepatocellular Carcinoma Presenting as Uterine Metastasis / Journal of the Korean Cancer Association, 대한암학회지

Metastatic extragenital cancer that spreads to the uterus is rare. When it occurs, the extragenital primary disease is often in the breast or gastrointestinal tract. We report here on a case of hepatocellular carcinoma (HCC) that metastasis to the uterus. The patient was admitted for evaluation of a pelvic mass. The serum alpha-fetoprotein level was highly elevated. Magnetic resonance imaging of the abdomen and pelvis showed hepatic and uterine masses. The patient underwent surgical treatment. The histopathologic findings and immunohistochemical staining results of the uterine mass were characteristics of metastatic HCC. The endometrium and both ovaries were free of tumor. Up to now, there have been only two cases of uterine metastasis from HCC reported in the English literature. This case is the first documented instance of a metastatic uterine tumor from HCC that spared both ovaries.

A case of primary retroperitoneal undifferentiated endometrial stromal sarcoma after concurrent chemoradiation therapy for cervical cancer / 부인종양

Endometrial stromal sarcoma (ESS) is a relatively rare uterine sarcoma, especially extrauterine ESS. Furthermore, retroperitoneal ESS are extremely rare. Up to now, there are only four cases of primary retroperitoneal ESS reported in the literature. We report one case of primary retroperitoneal undifferentiated endometrial stromal sarcoma after concurrent chemoradiation therapy for cervical cancer with a brief review of the literature.

Management of Colonic Perforation during Colonoscopic Procedure / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonic perforation appears to be the most dangerous complication during colonoscopy. This study was designed to determine the optimal management for this infrequent accident. METHODS: We reviewed the medical records of 17,510 colonoscopies which were performed during recent one-year period and found eightcolonic perforations (0.05%). RESULTS: Six perforations (0.04%) related to 16,695 diagnostic procedures, whereas two (0.25%) occurred from therapeutic procedures (p=0.05). Operative measures were applied in six (75.0%) patients showing signs of peritonitis. Five patients received primary closure without diversion, and resection with primary anastomosis was performed in one patient who had underlying tuberculous colitis. In addition, one patient was treated conservatively with bowel rest and intravenous antibiotics. Endoscopic clipping was applied in one patient with rectal perforation. Seven patients recovered uneventfully, and one 69-year-old male patient died of cardiogenic shock after the operation. CONCLUSIONS: Although colonic perforation occurs infrequently during colonoscopy, it may sometimes results in a fatal outcome. Primary closure without diversion appears to be appropriate in most cases without comorbid colonic disease.

Local Excision for Rectal Cancer

PURPOSE: Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers. METHODS: We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%). RESULTS: The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection. CONCLUSION: Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.

Extramammary Paget's disease with aggressive behavior: a report of two cases

Extramammary Paget's disease (EMPD) is an intraepithelial neoplastic disorder which is included as a rare malignant condition. However, it sometimes shows aggressive behavior of local recurrence and coexisting malignancy. We had experienced nine cases of EMPD involving the scrotum for seven years. Two cases of them presented metastasis. The first case presented extensive inguinal lymph node metastasis with underlying adnexal adenocarcinoma one year after wide local excision. The second case initially presented multiple metastasis to the liver and in the lymph node. The latter, showing fulminant progression with liver metastasis, may be only the second case reported in English literature. EMPD is considered as a malignant neoplasm with aggressive behavior from initial presentation. Because wide local excision of the lesion alone may be occasionally insufficient, a careful follow-up must be done to detect recurrence or internal malignancy.

The Efficacy of Endorectal Ultrasonography in the Preoperative Staging of Rectal Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: The precise preoperative staging of rectal cancer is of great im-portance for the selection of an appropriate treatment. Endorectal ultrasonography (EUS) has been proven as an efficient tool for staging in rectal cancer. Moreover, its technical advancement has been enhancing resolution and applications. We evaluated the accuracy of preoperative staging using EUS in rectal cancer and examined whether staging by EUS was an efficient procedure. METHODS: EUS was performed in 79 patients with rectal cancer diagnosed by colonoscopic biopsy from January to December, 1996. Endoscopic examina-tion was used with Olympus, GF-UM20 and Br?l and Kjaer type 2001 Scanner. The staging by EUS was based on UICC classification. RESULTS: Preoperative staging by EUS was equal to pathologic staging in 70.9% (56/79) of cases. Overstaging was found in 17.7% (14/79) and downstaging in 11.4% (9/79). The prediction of lymph node metastases was accurate in 50 of 79 cases (63.3%). CONCLUSION: EUS seems to be an efficient diagnostic method to assess rectal cancer staging. More accurate imaging and further experience in the interpretation is needed to improve the efficacy of EUS.

A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods / 대한소화기내시경학회지

BACKGROUND AND AIMS: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. METHODS: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. RESULTS: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +/- 3.0 mEq/L), potassium ( -0.3 +/- 0.3mEq/L), calcium ( -0.5 +/- 0.5 mg/dL), phosphorus ( +3.9 +/- 2.2 mg/dL) and osmolarity ( +10.1 +/- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +/- 2.3 kg) than with PEG ( -1.2 +/- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). CONCLUSIONS: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

Extensive colonic stricture due to pelvic actinomycosis

A 36-year-old woman presented with a palpable tender mass at the left lower quadrant of the abdomen. She had suffered from constipation for five years and had a previous history of intrauterine device-use for one year. Preoperative barium enema and abdominopelvic CT showed a compatible finding of rectosigmoid colon cancer or left ovary cancer. She underwent segmental resection of the sigmoid colon along with the removal of left distal ureter, left ovary and salpinx. Pathologic examination revealed actinomycotic abscesses containing sulfur granules. Thereafter, she took parenteral ampicillin (50mg/kg/day) for one month and oral amoxicillin (250mg, tid) for 2 months consecutively. The patient has no specific problems for 6 months after surgical resection and long-term antibiotic therapy. This report may be the first of intrauterine device-associated pelvic actinomycosis involving both sigmoid colon and rectum extensively.