ABSTRACT
Colonic stenting has been suggested as an acceptable therapeutic option for the palliation of malignant colorectal obstruction or to achieve bowel decompression and preparation. It is effective as a bridge to surgery that is useful as an option to avoid emergency colostomy. However, it is associated with complications such as intestinal perforation, stent migration, bleeding, and failure of bowel decompression. Of all the complications, intestinal perforation and failure of bowel decompression are most serious and require surgical treatment. Here we report a case of abdominal compartment syndrome after stent insertion for obstructive colon cancer. The main causative factors for abdominal compartment syndrome were bowel distension associated with endoscopic gas inflation and failure to achieve bowel decompression.
Subject(s)
Colon , Colonic Neoplasms , Colostomy , Decompression , Emergencies , Hemorrhage , Inflation, Economic , Intestinal Perforation , Intra-Abdominal Hypertension , StentsABSTRACT
PURPOSE: Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy. METHODS: The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed. RESULTS: In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas. CONCLUSIONS: Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.
Subject(s)
Humans , Colon , Colon, Sigmoid , Colon, Transverse , Colonoscopy , Medical Records , Peritonitis , Rectovaginal Fistula , Rectum , Retrospective StudiesABSTRACT
Lumbar hernia is a relatively rare clinical phenomenon. They may be classified according to their anatomic location and they can be either congenital or acquired. These patients usually present with a protruding bulge in the posterolateral abdominal wall. Portions of the small and large intestine may be found in the sac. This may be asymptomatic or it can become incarcerated and strangulated. We report here on a rare case of secondary lumbar hernia combined with descending colon incarceration. The diagnosis of lumbar hernia was made by CT scan and barium enema. Excision of the sac was performed and the hernial defect in the fascia was repaired with polypropylene mesh reinforcement.
Subject(s)
Humans , Abdominal Wall , Barium , Colon, Descending , Diagnosis , Enema , Fascia , Hernia , Intestine, Large , Polypropylenes , Tomography, X-Ray ComputedABSTRACT
PURPOSE: The purpose of this study was to evaluate the clinicopathological significance of responders with metastatic colorectal cancer treated with oxaliplatin chemotherapy. METHODS: A total of 52 patients with unresectable metastatic colorectal cancer were enrolled for treatment between March 2000 and August 2005. Patients received first line chemotherapy consisted of oxaliplatin 85 mg/m2 or 130 mg/m2 as a 2-hour infusion on day 1, concurrently with leucovorin (LV) 20 mg/m2 as a bolus infusion on day 1~5, followed by continuous infusion of 5-fluorouracil (5-FU) 425 mg/m2 on day 1~5. This treatment was repeated in 2 or 3 week intervals. All responses were assessed after 4 cycles of therapy by independent radiologic experts and categorized into two groups: responder (major reduction of tumor) and non-responder group (no change or progression of the tumor. RESULTS: The response rate was 51.9 percent (27/52 patients). There were no significant differences in clinicopathologic parameters between two groups. The decrease of CEA value after chemotherapy was significantly more frequent in the responder group than in the non-responder group. CONCLUSIONS: We could not find any clinical differences between the two groups, but these results suggest that oxaliplatin chemotherapy has a beneficial effect on tumor shrinkage and serum CEA value can be an indicator for tumor response of oxaliplatin in advanced colorectal cancer.
Subject(s)
Humans , Colorectal Neoplasms , Drug Therapy , Fluorouracil , LeucovorinABSTRACT
Colorectal cancer and rectal prolapse occur more frequently in elderly patients. Although the relationship between complete rectal prolapse and colorectal cancer has not yet been clarified, when both diseases develop simultaneously in a patient, it may be due to just coincidence or to a promotion of prolapse due to accelerated constipation caused by cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. We report a case of complete rectal prolapse combined with early rectal cancer in a 75 year-old woman who was successfully treated with a perineal rectosigmoidectomy.
Subject(s)
Aged , Female , Humans , Colorectal Neoplasms , Constipation , Prolapse , Rectal Neoplasms , Rectal ProlapseABSTRACT
PURPOSE: The purpose of this research is to investigate the clinical usefulness of carcinoembryonic antigen (CEA) expression in colorectal cancer tissue. METHODS: We performed immunohistochemical staining of CEA on 64 surgically resected colorectal cancer tissues obtained during the period from May 2000 to May 2001. CEA expression was detected by immunohistochemistry using a CEA monoclonal antibody. The degrees of CEA expression in the tumor cell cytoplasm and the luminal secretion of the tumor gland were grouped into positive (strongly positive) and negative groups (weakly positive) by using the Sinicrobe method and were compared with clinicopathological variables. RESULTS: The expression rates were positive in 38 cases (59.4%) and negative in 26 cases (40.6%). The preoperative CEA level showed a higher trend in the positive group (8.23+/-13.7) than it did in the negative group (17.89+/-38.7 ng/ml), but the difference was not statistically significant. The relationships between the CEA expressions of the two groups and the clinicopathologic factors were not statistically significant. We observed CEA expression in the luminal secretion of the tumor gland in 41 cases. The expression rates in the luminal secretion were positive in 21 cases (51.2%) and negative in 20 cases (48.8%). No significant clinical difference were noted between the two groups. CONCLUSIONS: The results suggest that CEA expression may not play a role as a prognostic factor for colorectal cancer.
Subject(s)
Carcinoembryonic Antigen , Colorectal Neoplasms , Cytoplasm , Immunohistochemistry , PhenobarbitalABSTRACT
OBJECTIVE: The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrorelix) minimal stimulation protocol comparing with GnRH agonist combined with long stimulation protocol in male infertility patients. METHODS: From Jan 2002 to Jun 2003, 65 patients (65 cycles) were performed in controlled ovarian hyperstimulation by using GnRH antagonist and GnRH agonist for male infertility patients. GnRH antagonist combined with minimal stimulation protocol was administered in 30 patients (30 cycles, Study Group) and GnRH agonist long stimulation protocol was administered in 35 patients (35 cycles, Control Group). We compared the pregnancy rate/cycle, total hMG(A)/cycle, retrieved oocyte/cycle, and the incidence of ovarian hyperstimulation syndrome between the two groups. Student-t test was used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: The mean number of oocytes retrieved per cycle was 4.7 +/- 0.6 in the GnRH antagonist group and 8.4 +/- 1.8 in the GnRH agonist group. Fertilization rates were 82.5 +/- 17.7% and 79.4 +/- 20.2% in the GnRH antagonist and agonist group, respectively. The GnRH antagonist group used a lower dose of hMG (8.5 +/- 1.2 vs 39.4 +/- 10.7 ample/cycle) and none of them developed OHSS. Clinical pregnancy rates per cycle were 23.3% in GnRH antagonist group and 31.4% GnRH agonist group. CONCLUSION: GnRH antagonist protocol may be presented as a new controlled ovarian hyperstimulation protocol which has been applied to male-factor infertility undergoing ICSI.
Subject(s)
Female , Humans , Male , Pregnancy , Fertilization , Gonadotropin-Releasing Hormone , Incidence , Infertility , Infertility, Male , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy Rate , Reproductive Techniques, Assisted , Sperm Injections, IntracytoplasmicABSTRACT
PURPOSE: Although the 'No-touch' isolation technique was introduced by Turnbull et al. in 1967, the controversy over whether or not it reduces the risk of metastasis during surgery exists even today. The aim of this study was to evaluate the effect of the 'No-touch' isolation technique in primary colorectal cancer surgery. METHODS: The evaluation was done by comparing the levels of CEA and CEA m-RNA expression from the same draining vein before and after tumor mobilization. Blood samples from 25 patients with primary colorectal cancer were collected for analysis. At the time of surgery, the main draining vein from the tumor was isolated and ligated at the proximal end. The 1st blood samples were collected just prior to tumor mobilization, and the 2nd samples right after. Both samples were analyzed for serum CEA level and CEA mRNA expression by using reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The mean CEA value from draining veins after tumor mobilization (8.08+/-8.98 ng/ml) was significantly higher than it was before mobilization (4.17+/-4.98 ng/ml). CEA mRNA was detected in 16% (4/25) of the blood specimens post-mobilization, whereas it was detected in only 4% (1/25) of the pre-mobilization samples. CONCLUSIONS: The results suggest the validity of using the 'No-touch' isolation technique to reduce the risk of metastasis into the draining vein during mobilization.
Subject(s)
Humans , Carcinoembryonic Antigen , Colorectal Neoplasms , Neoplasm Metastasis , Reverse Transcriptase Polymerase Chain Reaction , RNA, Messenger , VeinsABSTRACT
OBJECTIVE: The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrotide) minimal stimulation protocol comparing with GnRH agonist combined long step down stimulation protocol in PCOS patients. MATERIALS AND METHOD: From Apr 2001 to May 2002, 22 patients (22 cycles) were performed in controlled ovarian hyperstimulation using by GnRH antagonist and GnRH agonist for PCOS patients. GnRH antagonist (Cetrotide) combined minimal stimulation protocol was administered in 10 patients (10 cycles, Study Group) and GnRH agonist long step down stimulation protocol was administered in 12 patients (12 cycles, Control Group). We compared the pregnancy rate/cycle, total FSH (A)/cycle, Retrieved oocyte/cycle, the incidence of ovarian hyperstimulation syndrome, multiple pregnancy rate between the two groups. Student-t test were used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: Group of GnRH antagonist (Cetrorelix) minimal stimulation protocol produced fewer oocytes (6.4 versus 16.3 oocytes/cycle) using a lower dose of FSH (22.2 versus 36.1 Ample/cycle) and none developed OHSS and multiple pregnancy. Although the trends were in favour of the GnRH antagonist (Cetrorelix) protocol, the differences did not reach statistical significance. This was probably due to small sample size. CONCLUSION: The use of GnRH antagonist reduce the risk of ovarian hyperstimulation and multiple pregnancy. We suggest that GnRH antagonist might be alternative controlled ovarian hyperstimulation method, especially in PCOS patients who will be ovarian high response.
Subject(s)
Female , Humans , Pregnancy , Gonadotropin-Releasing Hormone , Incidence , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy, Multiple , Reproductive Techniques, Assisted , Sample SizeABSTRACT
OBJECTIVE: The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrotide) minimal stimulation protocol comparing with GnRH agonist combined long step down stimulation protocol in PCOS patients. MATERIALS AND METHOD: From Apr 2001 to May 2002, 22 patients (22 cycles) were performed in controlled ovarian hyperstimulation using by GnRH antagonist and GnRH agonist for PCOS patients. GnRH antagonist (Cetrotide) combined minimal stimulation protocol was administered in 10 patients (10 cycles, Study Group) and GnRH agonist long step down stimulation protocol was administered in 12 patients (12 cycles, Control Group). We compared the pregnancy rate/cycle, total FSH (A)/cycle, Retrieved oocyte/cycle, the incidence of ovarian hyperstimulation syndrome, multiple pregnancy rate between the two groups. Student-t test were used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: Group of GnRH antagonist (Cetrorelix) minimal stimulation protocol produced fewer oocytes (6.4 versus 16.3 oocytes/cycle) using a lower dose of FSH (22.2 versus 36.1 Ample/cycle) and none developed OHSS and multiple pregnancy. Although the trends were in favour of the GnRH antagonist (Cetrorelix) protocol, the differences did not reach statistical significance. This was probably due to small sample size. CONCLUSION: The use of GnRH antagonist reduce the risk of ovarian hyperstimulation and multiple pregnancy. We suggest that GnRH antagonist might be alternative controlled ovarian hyperstimulation method, especially in PCOS patients who will be ovarian high response.
Subject(s)
Female , Humans , Pregnancy , Gonadotropin-Releasing Hormone , Incidence , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy, Multiple , Reproductive Techniques, Assisted , Sample SizeABSTRACT
Mesenteric panniculitis is a rare inflammatory condition of mesenteric adipose tissue in which the mesentery is replaced with fibrosis. The frequent symptoms of mesenteric panniculitis are palpable mass, abdominal pain and gastrointestinal obstructive symptoms. In the majority of cases, its course is self-limiting and the prognosis is favorable. 3 cases of mesenteric panniculitis are described that presented with obstructive symptoms of gastrointestinal tract, which occurred in 2 weeks following colectomy of colonic tumors. And reviewed the symptomatology, pathology, treatment, and outcome of this disorder.
Subject(s)
Abdominal Pain , Adipose Tissue , Colectomy , Colon , Fibrosis , Gastrointestinal Tract , Mesentery , Panniculitis, Peritoneal , Pathology , PrognosisABSTRACT
PURPOSE:Tumor cells can be shed into a venous blood stream by manipulation of tumor during surgery, resulting metastasis to distant organs from the primary tumor. In order to elucidate the effect of early lymphovascular dissection prior to tumor mobilization, we studied the difference in carcinoembryonic antigen (CEA) values of tumor draining veins before and after tumor mobilization. METHODS:Blood samples were taken from the tumor draining veins of sixteen patients during operations. The lymphovascular dissection was performed before the tumor mobilization, and the main draining vein from the tumor was isolated and the proximal end was ligated and blood samples were taken, then the tumor mobilization was made. Just before the removal of the tumor, we took the second sets of blood samples from the same sites. RESULTS:There were no significant differences in CEA values between peripheral blood (1.8+/-1.2 ng/mL) and tumor draining veins before the tumor mobilization. The mean CEA value of draining veins after the tumor mobilization (14.3+/-11.9 ng/mL) was significantly higher than that of draining veins before the mobilization (2.2+/-2.1 ng/mL)(P<0.001). CONCLUSIONS:Theses results suggest that early lymphovascular dissection procedures before tumor mobilization can reduce the opportunity of tumor cell dissemination into draining vein.
Subject(s)
Humans , Carcinoembryonic Antigen , Colorectal Neoplasms , Neoplasm Metastasis , Rivers , VeinsABSTRACT
BACKGROUND: A desmoid tumor is a rare neoplasm of a mature fibroblast within an extensive collagen matrix. These tumors are classified pathologically as aggressive fibromatosis with local invasiveness, showing recurrences after surgical treatment, although they do not metastasize. Complete surgical excision without leaving a remnant tumor seems to be the primary treatment option, but these tumors often recur after resection. Therefore, alternative treatment strategies, including radiation therapy, nonsteroidal anti-inflammatory agents, anti-estrogen compounds, and cytotoxic chemotherapy, have been employed. METHOD: The authors report the clinical characteristics and prognoses after treatment for seven patients who were diagnosed as having desmoid tumors and who underwent surgical excision for therapy during the ten-year period from 1986 to 1997 at Keimyung University Dongsan Medical Center. RESULTS: There were two males and five females. The most common chief complaint was a slowly growing painless mass. The duration of the symptom before diagnosis was quite different from patient to patient. The locations in the trunk were scattered diffusely: the shoulder, the chest wall, the abdominal wall, the retroperitoneum, and the pelvic cavity. The tumors were well visualized by imaging techniques such as ultrasonograms, CT scans, and MRI. Four of the seven patients experienced recurrent tumors after surgical excision; two are dead. The tumors in the recurrent patients were excised incompletely at initial surgery. CONCLUSION: Although the uncommon, solid desmoid tumors which develop in the musculoaponeurosis of the trunk are benign pathologically, they were recurrent after surgical excision when the resection margin is incomplete. Therefore, complete excision is the only curative therapeutic modality.
Subject(s)
Female , Humans , Male , Abdominal Wall , Anti-Inflammatory Agents, Non-Steroidal , Collagen , Diagnosis , Drug Therapy , Fibroblasts , Fibroma , Fibromatosis, Aggressive , Magnetic Resonance Imaging , Prognosis , Recurrence , Shoulder , Thoracic Wall , Tomography, X-Ray Computed , UltrasonographyABSTRACT
No abstract available.