The Comparison of Medical and Surgical Treatment for Gallbladder Dyskinesia

PURPOSE: The purpose of this study was to compare outcomes for surgical treatment with those for medical treatment of GB dyskinesia. METHODS: Retrospective analysis of medical records and telephone interviews of 67 patients diagnosed with GB dyskinesia was done at Pohang St. Mary's Hospital between January 2004 and December 2009. Group 1 (n=18) patients received laparoscopic cholecystectomy. Group 2 (n=49) patients received medical treatment. GB dyskinesia was the diagnosis if the patient had typical biliary colic symptoms without GB stones or other GI disease, and if the ejection fraction was less than 35% on Tc-99m-DISIDA scans. RESULTS: The average age of patients diagnosed with GB dyskinesia was 45.8 years old. The sex ratio was 15:52 (male:female). The average symptom duration was 25.4 days. All had RUQ and, or epigastric pain. There were no significant between group differences in age, sex ratio, symptom duration, symptoms, follow up period, and ejection fraction. In group 1, patient symptoms improved after treatment in 16 cases (88.9%); in group 2, patient symptoms improved in 19 cases (38.8%). Surgical treatment was significantly more effective than medical treatment. The reasons for choosing medical treatment were predominantly the preference of the doctors. CONCLUSION: Surgical treatment is a more effective treatment for GB dyskinesia than medical treatment. Therefore, laparoscopic cholecystectomy should be considered as the 1st line treatment of choice for GB dyskinesia.

A Comparative Study of Outcomes between Emergency and Elective Surgeries for Colon Cancer

PURPOSE: The purpose of this study was to compare the efficacy of curative emergency surgery for complicated colon cancer in terms of tumor recurrence and survival compared with that of elective surgery. METHODS: A total of 238 primary surgeries for colon cancer were performed. All patients were deemed to have undergone a curative resection. Patients were classified into an emergency surgery group for complicated colon cancers (n=40) and an elective surgery group for uncomplicated colon cancers (n=198). RESULTS: Emergency colonic cancers present at a more advanced stage (P=0.002). The postoperative mortality rate in the emergency group was significantly higher than it was in the elective group (15.0% vs. 2.5%, P= 0.004). There were differences between the two groups in tumor recurrence (32.5% vs. 13.1%, P=0.003), overall survival (52.5% vs. 71.7%, P=0.017), and disease-free survival (50.0% vs. 69.7%, P=0.016). However, after the patients were stratified according to tumor stage, no statistical differences were observed. CONCLUSIONS: When compared with uncomplicated colon cancers, complicated colon cancers present at a more advanced stage with a higher postoperative mortality and an overall worse prognosis. However, the difference decreases when patients are stratified according to the tumor stage. The negative prognostic efficacy of emergency surgery for complicated colon cancers appears to be confined to the perioperative period. Despite the more advanced stage of tumors in patients undergoing emergency surgery, the aim of the surgeon should be to offer a curative resection for better survival, if possible.

Clinical Significance of the Pecten Band in Hemorrhoids

PURPOSE: The pecten band can be defined as a fibrous tissue on the lowermost part of internal anal sphincter and may cause anal outlet obstruction, but its role is debatable. We evaluated the functional roles of the pecten band in hemorrhoids patients. METHODS: Three hundred sixteen hemorrhoids patients who underwent operations from January 1998 to April 2003 were analyzed for anal function according to presence or absence of a pecten band by using anorectal manometry and the constipation score. RESULTS: The numbers of males and females were 167 and 149. The overall pecten band positive was 63.6% (201/316), and pecten band positive was 84.6% (33/39) in patients who had previous anal surgery while it was 60.6% (168/277) in patients who had no history of surgery (P= 0.002). Pure hemorrhoids patients showed an 18.3% positive rate while patients with hemorrhoids and other conditions, such as anal fissure, fistula, or stricture, showed a 95.7% positive rate (P=0.00). Maximal resting anal pressures (mmHg, Mean+/-SD) and constipation score were 78.9+/-24.7 and 7.88+/-3.8 in the positive group and 67.1+/-22.2 and 4.55+/-2.8 in the negative group (P=0.00, 0.00). Postoperatively, the constipation score decreased significantly from 7.25 to 2.82 (P=0.003). CONCLUSIONS: The pecten band seems to be associated with anal outlet obstruction, and a pecten band releasing operation may be considered according to its presence or absence.

Clinical Results of Lower Extremity Trauma Accompanied with Popliteal Artery Injury

PURPOSE: Although popliteal artery injuries are uncommon, the consequent lack of management protocols may contribute to the high level of outcome morbidity. METHOD: We retrospectively reviewed the records of popliteal artery trauma treated at our institution in the past 5 years. RESULT: In 15 patients [male 13, female 2, median age 45.9 (15-73)] there were 13 cases of blunt trauma, mainly motorcycle accident. Most patients presented with severe signs of ischemia when they arrived at the emergency unit. Most commonly skeletal injury was accompanied (fracture 13, nerve injury 7). Some delays occurred between injury and treatment in every cases. Bypass using the contralateral long saphenous vein was the predominant procedure for arterial injury. Our limb salvage rate was 66.7% (10/15), but all patients needed more than two additive operations, and finally had persistent neurologic disability. CONCLUSION: Popliteal artery injury, especially in Korean urban society, was mainly caused by blunt trauma from traffic accidents and the results remain challenging.

Hormonal Treatment of Intestinal Cavernous Hemangioma Report of 2 cases

Cavernous hemangioma in the gastrointestinal tract is a rare benign vascular lesion, which can produce massive or persistent blood loss. Herein, we present two cases of gastrointestinal hemangiomas that could not be resected completely and were treated with estrogen because of multiple involvement of the gastrointestinal tract and viscera, including the anal canal. A 49-year-old male presented with unknown chronic melena and anemia. Preoperative work-up could not reveal the definite cause of bleeding. During exploration, hemangioma scattered in whole small bowel was identified and feeding vessel ligation was performed. Postoperative recurrent bleedings were controlled by additional estrogen therapy. A 25-year-old young woman had suffered from painless anal bleeding with subsequent anemia since her youth. She had diffuse carvernous hemangioma in the large intestine involving the anal canal and uterus. Total proctocolectomy and ileal-pouch anal anastomosis was performed, however the uterine hemangioma was left intact because the patient wanted to be pregnant. She was also treated with estrogen, postoperatively. It is suggested that estrogen may be a good alternative treatment modality for gastrointestinal hemangioma that can not be removed completely.

Lymphatic, Vessel, and Neural Invasions in Gastric Cancer and Its Significance in Prognosis

PURPOSE: This study was undertaken to investigate the prognostic significance of lymphatic invasion (LI), vessel invasion (VI), and neural invasion (NI) in gastric cancer and their correlations with other standard prognostic variables, such as the TNM stage. METHODS: The case histories of 100 gastric adenocarcinoma patients who had undergone a curative resection from 1992 to 1996 at Taegu Hyosung- Catholic University Hospital, Taegu, Korea were analyzed retrospectively. The Chi-Square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rate were assessed using the log-rank test. The cox regression method was used for evaluation of independent prognostic significance. RESULTS: The 2-year survival rate was significantly lower (p<0.05) in LI (+) and NI (+) cases. The correlation between the T stage and LI, VI, and NI was statistically significant. Also, the correlation between the N stage and LI, VI, and NI was statistically significant. In the lymph node (+) group (n=43), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but this result was not statistically significant. In the lymph node (-) group (n=57), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but only the result for the NI (-) group was significant. Multivariate analysis demonstrated that LI, VI, and NI were not significant factors influencing the prognosis, although they were significant in the univariate analysis. CONCLUSION: This study identifies LI, VI, and NI as possible prognostic factor in gastric adenocarcinoma cases, but more careful research is needed.

In Vitro Chemosensitivity Test for the Evaluation of Efficiency of Hyperthermia in Gastrointestinal Cancer Cell Lines / 대한암학회지

PURPOSE: This study was designed to establish the experimental background of intra- peritoneal hyperthermo-chemotherapy in gastrointestinal cancer. MATERIALS AND METHODS: We established stomach cancer cell lines; KATO-III, MKN45, AMC1 and colon cancer cell lines; AMC5, AMC6, CloneA, CCL188, C106, KM-12C. We performed chemosensitivity test by using MTT assay and calculated ICso of each chemotherapeutic agent. We confirmed antitumor effect of hyperthermia at 40C and 43C and antitumor synergistic effect with each chemotherapeutic agent at 40C and 43C. RESULTS: The ICso was calculated in 7 (78%) of 9 cell lines for 5-FU, 6 (67%) for MMC, 5 (56%) for ADM, 1 (11%) for CDDP and VP-16. Antitumor effect of hyperthermia at 40C was not found, but, that at 43C was found except KATO-III and AMC6. In stomach cancer cell lines, antitumor synergistic effect of hyperthermia with anticancer drugs at 43C was found in VP-16 for MKN45 and KATO-III and in all of 5 drugs for AMC1. In colon cancer cell lines, this effect at 43C was found in all of 5 drugs for CCL188, in S-FU, CDDP, ADM for AMC5, in 5-FU, MMC, ADM, VP-16 for CloneA, KM-12C, and in 5-FU, CDDP, MMC, ADM for C106. CONCLUSION: Hyperthermia itself had antitumor effect at 43C. Hyperthermo-chemotherapy had antitumor synergistic effect, especially at 43C.

Clinicopathological Analysis of Suspicious Attenuated Adenomatous Polyposis Coli

Familial adenomatous polyposis (FAP) is an inherited autosomal dominant syndrome caused by germ-line mutations of the adenomatous polyposis coli (APC) gene. Clinical diagnosis of familial adenomatous polyposis is usually based on the presence of >100 colonic adenomas, which, if left untreated, progress to colorectal cancer, typically at age under 40 years. Attenuated adenomatous polyposis coli is a variant of familial adenomatous polyposis and also has been described as "hereditary flat adenoma syndrome". Attenuated adenomatous polyposis coli is recognized by the occurrence of or =5 or > or =10) colonic adenomas. It is tend to be located proximal to splenic flexure and a later onset of colorectal carcinoma than familial adenomatous polyposis. PURPOSE: This study was performed to analyze the clinicopathologic features of suspicious attenuated adenomatous polyposis coli, to document the occurrence of colorectal carcinoma, and to assess the definition of attenuated adenomatous polyposis coli. METHODS: From June 1989 to June 1998, we reviewed 773 cases of colonic adenomas and compared with three groups (Group I, II, III) at Asan Medical Center. Median follow-up period was 16.4 months (range, 1 to 102 months). RESULTS: The incidence of suspicious attenuated adenomatous polyposis coli (Group II) was 4.9%. The most common symptom was anal bleeding (36.9%). Median size and number of adenomas were 1.0 cm (0.2 to 7.5 cm), 2 (1 to 43), respectively.Location of adenoma was prevalent at right colon in Group II (P<0.05). In respect to the occurrence of carcinoma in situ (CIS), it was more frequently presented in Group II (13.5%) and Group III (13.6%) whereas 4.1% in Group I (P<0.05). Recurrence rates within 12 months after polypectomy or surgery in Group II was 13.5% whereas 5.6% in Group I (P<0.05). CONCLUSIONS: Histopathology revealed suspicious attenuated adenomatous polyposis coli with villous component to be relatively correlated with occurrence of colorectal carcinoma. In suspicious attenuated adenomatous polyposis coli (Group II), the interval of the recurrence of the polyps was shorter than the control group with right colonic predominancy. These findings might be associated with genetic codominance of APC gene or other mutator genes.

Tailgut Cyst A case report

Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.

A Clincial Analysis of Acalculous Cholecystitis

Acalculous cholecystitis is an inflammation of the gallbladder in the absence of gallstones. Diagnosing this condition is often difficult because of the patient's debilitated medical condition and because of the limitation of biliary imaging technique. Nonetheless, its recognition and therapy are critically important, for if left untreated, many patients will die. During 10 years and 6 months from January 1986 to June 1996, 52 patients underwent assessment and treatment for acalculous cholecystitis at the Department of Surgery, Kyungpook National University Hospital. A clinical analysis of those patients was done and the following results were obtained: The incidence rate was 3.5%. The most prevalent age group was the seventh decade (13cases), and the male-to-female ratio was 1.4 : 1. Possible etiologic factors were found in 25 cases (48.1%). These factors were surgery in 5 cases (9.6%), trauma in 5 cases (9.6%), sepsis in 5 cases (9.6%), clonorchiasis in 5 cases (9.6%), and others in 5 cases(9.6%). Neither Ascariasis nor Salmonellosis was found as a predisposing factor in this study.The main cardinal symptoms and physical signs were similar to those of calculous cholecystitis. The sensitivities of diagnostic imaging by ultrasonography and computed tomography were 88.4% and 100%, respectively. Of the 52 patients, 46 cases underwent cholecystectomy, and 6 cases were initially treated by percutaneous transhepatic cholecystostomy. Of these 6 cases, two patients had cholecystostomies during subsequent abdominal operations for other conditions. Two patients had the cholecystostomy tube removed 2 months after an uneventful recovery and have had no further biliary problems. The other two patients died. The operative findings were cholecystitis only in 26 cases (56.5%), cholecystitis with localized peritonitis in 18 cases (39.1%), and cholecystitis with generalized peritonitis in 2 cases (4.3%). Postoperative complications occurred in 16 cases (34.8%), and wound infection was the most common complication (62.5% of all complications).The overall mortality was 9.6%. Conclusively, acalculous cholecystitis had high morbidity and mortality in this study. Once the diagnosis of acalculous cholecystitis is made, the gallbladder should be drained or removed. A decision as to the best approach depends on the specific situation and will require close cooperation between the internist, the surgeon, and the radiologist.