Laparoscopic Treatment of Intestinal Obstruction

PURPOSE: Open adhesiolysis has been the favored approach regarding surgical management of intestinal obstruction. Following the development of laparoscopic devices and necessary surgical techniques, laparoscopic treatment of intestinal obstruction and adhesion has been tried in highly selected cases. Our study was designed to investigate laparoscopic adhesiolysis to treat intestinal obstruction. METHODS: The clinicopathologic data and surgical outcomes of 14 patients who underwent emergency laparoscopy between January 2007 and April 2015 were retrospectively reviewed. RESULTS: Five patients had a history of abdominal surgery, and twelve patients had adhesive intestinal obstruction. The causes of adhesive intestinal obstruction included tuberculous peritonitis, periappendiceal abscess, serosal fibrosis and chronic inflammation of intestine, gastric volvulus by fibrotic band. Two patients had non-adhesive intestinal obstruction, caused by intussusception and small bowel ulcer with stricture. The mean surgical time was 98.5 minutes, with mean blood loss of 35 ml. One case was converted to open surgery (7.1%). The mean postoperative hospital stay was 6.5 days. The mean time to oral intake was 3.4 days. There were no postoperative complications or deaths. CONCLUSION: When the patients are selected carefully in accordance with the guidelines, in our experience laparoscopic adhesiolysis is safe and feasible.

Health Literacy of Elementary School Students

PURPOSE: The purpose of this study was to identify health literacy levels of elementary school students. METHODS: Participants were 331 fifth and sixth graders in nine elementary schools located in Gyeongsangnam-do. Instruments were 42 health-related words derived from fifth-grade textbook 'Health in Daily Life' for linguistic health literacy, modified Korean Health Literacy Assessment Tool (KHLAT) for numeracy section of functional health literacy, items from a snack box and newspaper article for reading comprehension section of functional health literacy. Data were collected from July 15 to August 15, 2013. RESULTS: The mean score for linguistic health literacy was 24.02+/-7.16 of 42 (57.2% were correct answers). The mean score for functional health literacy was 9.27+/-2.30 of 12 (77.3% were correct answers). There were significant differences in health literacy by grade and academic performance. CONCLUSION: This study results show that both linguistic and functional health literacy among elementary school students were not high enough to use health-related information and make appropriate health-related decisions. Therefore, it is important to develop strategies aimed at increasing health literacy levels, especially focused on underperforming students. It is also necessary that studies be done on the factors affecting the health literacy of elementary-school students.

Association of Immune Status with Recurrent Anal Condylomata in Human Immunodeficiency Virus-Positive Patients

PURPOSE: An anal condyloma is a proliferative disease of the genital epithelium caused by the human papillomavirus. This condition is most commonly seen in male homosexuals and is frequently recurrent. Some reports have suggested that immunosuppression is a risk factor for recurrence of a condyloma. Thus, we investigated the risk factors for a recurrent anal condyloma in human immunodeficiency virus (HIV)-positive patients. METHODS: We retrospectively analyzed 85 consecutive patients who were diagnosed with and underwent surgery for an anal condyloma from January 2007 to December 2011. Outcomes were analyzed based clinical and immunologic data. RESULTS: Recurrent anal condylomata were found in 25 patients (29.4%). Ten cases (40.0%) were within postoperative 3 months. At postoperative 6 months, the CD4 lymphocyte count in the recurrent group was lower than it was in the nonrecurrent group (P = 0.023). CONCLUSION: CD4-mediated immunosuppression is a risk factor for recurrent anal condylomata in HIV-positive patients.

Heart Rate Variability and Lipid Profile in Patients with Major Depressive Disorder / 수면정신생리

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.

A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

PURPOSE: Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA. METHODS: We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed. RESULTS: There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 +/- 1.2 vs. 3.5 +/- 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 +/- 2.3 vs. 5.8 +/- 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028). CONCLUSION: The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.

The Effect of Zinc Status on Salty Taste Acuity, Salty Taste Preference, Sodium Intake and Blood Pressure in Korean Young Adults

High sodium intake is one of the risk factors for the development of hypertension. According to 2007 Korean National Health and Nutrition Examination Survey, sodium intake of Korean was three times higher than adequate intake (1.5 g/day) recommended by Korean Dietary Reference Intakes. High sodium intake is related to high threshold and preference of salty taste. And zinc status is known to affect taste acuity. The hypothesis of this study is that zinc status is associated with salty taste acuity, preference, sodium intake and blood pressure. The subjects included in this study were 50 men and 41 women aged 20-29 y who did not smoke and not take supplements or medications regularly. Dietary intake data for 3 days were collected by 24-h recall for 1 day and dietary record for 2-days. Salty taste acuity and preference were determined by sensory test. Fasting serum concentration of zinc, height, weight, body composition and blood pressure data were collected. Salt taste preference in high zinc intake group (> or = estimated average requirement, EAR; men-8.1 mg/day, women-7 mg/day) was higher than that in low zinc intake group (< EAR). Salty taste preference was inversely correlated with serum zinc concentration in people with low concentration of serum zinc (<== 81microgram/dL)(r = -0.3520, p < 0.05). Diastolic blood pressure was higher in high sodium intake group than in low sodium intake group (p < 0.05), positively correlated with salty taste preference (r = 0.3866, p < 0.05) in subjects with daily zinc intake below the EAR. We conclude that low zinc status may be related to high salty taste preference and high blood pressure in Korean young adults.

Laparoscopically Assisted Total Colectomy with J-pouch Formation for Intractable Chronic Constipation due to Hypoganglionosis: A Case Report / 대한내시경복강경외과학회지

Chronic constipation has been successfully treated with specific medications and bio-feedback therapy. Surgical manipulation for this condition can be an option when non-surgical interventions fail. We report here on a patient who was diagnosed as having intractable chronic constipation with hypoganglionosis. The patient was a 60 year-old male with the history of seizure and diabetes. This patient did not gain any clinical benefits from non-surgical regimens. Therefore, we performed a laparoscopically assisted total colectomy with J-pouch ileorectal anastomosis on this patient. The patient recovered from the surgery without complications and he had normal bowel functions. The postoperative anatomical pathology revealed a hypogaglionosis. In conclusion, a laparoscopically assisted total colectomy for a patient with intractable chronic constipation with hypoganglionosis is a good option and it may be a curative method.

The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. MATERIALS AND METHODS: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. RESULTS: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. CONCLUSIONS: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.

The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. MATERIALS AND METHODS: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. RESULTS: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. CONCLUSIONS: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.

Early Experience with Laparoscopic Primary Closure of Peptic Ulcer Perforation / 대한내시경복강경외과학회지

PURPOSE: Among the surgeries that can be performed for patients with acute peptic ulcer perforation, the frequency of performing laparoscopic surgeries is gradually increasing and it is being reported that laparoscopic surgeries have many advantages over laparotomies. So we will examined if laparoscopic surgery has advantages as compared to open surgery for appropriately selected patients. METHODS: The subjects were 15 patients who were diagnosed with peptic ulcer perforation and they were operated on by a single surgeon between September 2007 and January 2009 at the National Medical Center. The subjects were divided into an LG and an OG. Statistical analyses were performed using two-tailed students T-tests. RESULTS: There were 6 patients in the LG and 9 patients in the OG. All the patients in the two groups were male. The time until fist flatulence was 1.6 days in the LG and 2.6 days in the OG. The time until the first oral intake was 3 days in the LG and 3.4 days in the OG. The time during which pain control was necessary was 2.6 (range: 2~4) days in the LG and 3.3 (range: 2~4) days in the OG. The number of days of the hospital stay after surgery was 5.6 days (range: 4~7) in the LG and 10 days (range: 6~26) in the OG. There were 2 cases of complications in the OG only, and all of them were wound infections. CONCLUSION: It is thought that laparoscopic surgeries can be performed relatively easily and safely for patients with peptic ulcer perforation by selecting appropriate patients.

The Expression and Clinical Correlations of Matrix Metalloproteinase-2, -7, -9, and -12 in Colorectal Cancer

PURPOSE: Tumor invasion and metastasis are multistep phenomina, involving proteolytic degradation of extracellular matrix (ECM) and alteration of cell adhesion. It is another oncologic therapeutic strategy to block tumor invasion and metastasis through analyzing the molecules which are involved in these processes. We examined the expressions of some of matrix metalloproteinases (MMPs) in colorectal cancer and analyze the correlation with clinical factors and survival. METHODS: Fifty-five patients with colorectal cancer who underwent surgical resection were included. The expressions of the MMP-2, -7, -9, and -12 in tumor tissue and normal mucosa using RT-PCR technique was carried out. We evaluated and analyzed the correlation among these molecules, clinical characteristics, and survival. RESULTS: Expressions of MMP-7, -9, and -12 were significantly higher in tumor tissue than in normal mucosa (P=0.00). The expressions of MMP-2 between cancer and normal mucosa had no significant difference but it had a significant difference according to the lymph node (LN) invasion (P=0.03) in tumor tissues. Three-year overall survival was worse in patient with high expression of MMP-2 compared to low expression. CONCLUSION: The expressions of MMP-7, -9, -12 in tumor tissue were higher than in normal mucosa and MMP-2 expression of tumor tissues had a significant difference according to LN invasion. MMP-2 overexpression seems to be a prognostic factor for 3-yr overall survival. But, large scale study with long term survival analysis will be needed for the prognostic significance of MMPs.

Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

PURPOSE: We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. MATERIALS AND METHODS: Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. RESULTS: Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. CONCLUSION: Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.

The Colorectal Cancer Risk of Meat Intake, Smoking, and CYP2E1 Polymorphisms: The Comparison of Colorectal Cancer Patients with Controls

PURPOSE: Genetic susceptibility for colorectal cancer is explained by polymorphisms of the drug-metabolizing enzymes. CYP2E1 activate the procarcinogens and they are involved in carcinogenesis. We analyzed the polymorphisms of CYP2E1 in colorectal cancer patients and the controls, and we examined the interaction between meat intake, smoking and CYP2E1 polymorphisms in colorectal cancer. METHODS: Polymerase chain reaction was performed for 96- bp insertion polymorphisms in 113 colorectal cancer patients and 110 controls. 80 cancer patients and 75 controls were interviewed for determining their meat intake and smoking behavior. We analyzed the clinical characteristics and the combined effect of meat intake, smoking and CYP2E1 polymorphisms on the susceptibility to colorectal cancer. RESULTS: The insert 0, insert 1 and insert 2 subtypes for the 96-bp insertion polymorphism were seen in 75 (66.4%), 35 (31.0%) and 3 (2.7%) cases, respectively, and in 82 (74.5%), 26 (23.6%) and 2 (1.8%), respectively. CYP2E1 polymorphisms didn't increase the colorectal cancer risk (OR: 1.5, 95% CI 0.3~10.1) in the insert 1 group and the insert 2 group. The combined effects of CYP2E1 polymorphisms, meat intake and smoking were not significant, (OR: 1.6, 95% CI: 0.4~4.7) in the low-meat intake group, the high-meat intake group, (OR: 0.4, 95% CI: 0.1~2.5) and in the smokers and ex-smokers (OR: 0.8, 95% CI: 0.3~2.3). CONCLUSION: The CYP2E1 polymorphisms, alone or combined with meat intake or smoking, did not increase the risk of colorectal cancer. Further well designed large scaled studies will be needed to determine the effects of CYP2E1 polymorphisms on colorectal cancer.

Distribution and Characteristics of Colorectal Polyps at Colonoscopy

PURPOSE: The screening test for colorectal polyp is important for the early detection and prevention of colorectal cancer. The aims of this study were to evaluate the characteristic findings and the anatomical distribution of colorectal polyps observed during colonoscopy and to determine proper screening candidates to undergo colonoscopy for colorectal cancer. METHODS: From March 1999 to February 2004, 3,454 asymptomatic individuals underwent total colonoscopy. The number, the location, and the histology of polyps were evaluated retrospectively in 634 patients who had colorectal polyps (453 males and 181 females). The relations among age, location, and histology were analyzed. RESULTS: The mean age was 60 years (range, 15 to 95). Four hundred and twenty-two patients (67%) had a single polyp, and 212 (33%) had two or more polyps. Left-sided polyps were observed in 422 patients (67%), right-sided polyps in 134 patients (21%), and synchronous both-sided polyps in 78 patients (12%). Adenomas were present in 387 patients (61%), and adenocarcinomas were detected in 47 patients (7.4%). There was no definite correlation between location and histology. However the prevalence of right-sided polyps increased with age (P<0.01). CONCLUSIONS: More than 30% of the polyps were located proximal to the splenic flexure. Thus, in the absence of left-sided lesions, an examination of the colon that is limited to the splenic flexure might miss 21% of such lesions. The increasing prevalence of right-sided polyps with age suggests that evaluation of the proximal colon is particularly important in the elderly, especially in those older than 60 years.

The Clinical Characteristics and Outcomes of Biofeedback Treatment for Patients with Nonrelaxing Puborectalis Syndrome

PURPOSE: Biofeedback treatment is thought to be appropriate for patients with nonrelaxing puborectalis syndrome (NRPR). The aim of this study is to analyze the physiologic characteristics and to assess the outcomes of biofeedback treatment for patients with NRPR. METHODS: Forty-six (46) patients with NRPR were evaluated with anorectal physiologic studies, including colonic transit time (n=26), anorectal manometry (n=41), defecography (n=46), anal sphincter EMG (n=28), and colonoscopy or barium enema (n=33). The treatment consisted of a training program with EMG-based biofeedback for 30 minutes once a week and routine supportive care, including Kegel practice. RESULTS: The mean age was 52.8 years, and the sex ratio was 1 male to 0.6 female. A delayed colonic transit time was noted in 5 patients (19.26%). In the NRPR group, the maximal voluntary contraction and the mean squeezing pressure were higher than they were for other patients with pelvic outlet obstructive disease. Also, the perineal descents and the dynamic change of anorectal angle were shorter. Polyps were observed in 6 patients (18.2%), melanosis coli in 4 patients (12.1%), and diverticula in 3 patients (9.1%). The rectoanal inhibitory reflex (RAIR) was negative in 3 patients (7.3%). The patients underwent a mean of 4.0 sessions, and the mean follow-up was 7.4 months. Twenty-three (23) patients (82.1%) experienced improved of symptoms or EMG findings. The patients (17.9%) who did not improve had several abnormal findings: neuro-psychologic disease with delayed colonic transit time in 2 cases, negative RAIR in 2 cases, and melanosis coli in one case. CONCLUSIONS: We think that biofeedback training is an effective treatment for patients with NRPR. In addition, several factors, such as neuro-psychologic diseases, delayed colonic transit time, negative RAIR, or melanosis coli may influence the prognosis for biofeedback treatment, so further large-scaled studies will be needed to confirm these findings.

Delayed Presentation of Right-sided Traumatic Diaphragmatic Hernia

The diaphragmatic injury is often associated with thoracic or abdominal trauma. This injury has wide spectrum of symptoms from minimal discomfort to strangulation of the herniated organ. Herein we report a case of delayed presentation of traumatic diaphragmatic hernia treated surgically. The case was discovered about five years later after fall down accident. The patient complained intermittent chest discomfort and pain at the first visit of our department. On physical examination, slightly decreased breathing sound was noted in right lower lung field. The thoracic CT and MRI findings were suggestive of right side diaphragmatic injury with herniation of liver. Under general anesthesia, we confirmed diaphragmatic hernia through thoracoscopic evaluation of right thorax. Unfortunately it was too hard to put liver back into peritoneal cavity through the thoracoscopic procedures. Then we performed abdominal laparotomy and the herniated liver was reduced. The patient was tolerated well and recovered without complications.

Safety of a One-stage Operation for an Obstructed Left Colon Carcinoma

PURPOSE: For a left-sided colonic obstruction, the traditional method of a staged defunctioning colostomy and resection has been performed. Recently, there has been a trend towards a one-stage primary resection and anastomosis. The aim of this study was to assess the safety and the efficacy of a one-stage resection and anastomosis for obstructed left colon cancer. METHODS: We retrospectively reviewed the records of 29 patients who had been diagnosed as having an obstructed left-sided colon cancer during the period from January 1995 to December 2003 at Ewha Womans University Hospital. We compared two techniques, a one-stage operation (10 cases) and a staged operation (13 cases). RESULTS: The mean age of the one-stage group was 58.5+/-16.1, and that of the staged operation group was 65.0+/-13.4. Both groups had similar co-morbidities, TNM stages, and tumor locations. In the one-stage operation group, a subtotal colectomy (n=3), a resection and anastomosis with intraoperative lavage (n=5), and a resection and anastomosis following stent insertion (n=2) had been performed. Patients who had undergone a colostomy as the first operation, resection and anastomosis (n=3), and a resection and anastomosis following a defunctioning colostomy (n=10) were included in the staged operation group. The mean postoperative hospital stay showed no significant differences between the two groups. One patient who had undergone a one-stage operation presented with an intestinal partial obstruction five months later. There were no anastomotic leakages, intraabdominal absceses, and wound infections, nor were there any mortalities. CONCLUSIONS: A one-stage resection and primary anastomosis for obstructed left-sided colon cancer can be done safely without significant morbidity.

The Clinical and Physiologic Characteristics of Patients with Pelvic Outlet Obstructive Disease

PURPOSE: With recent anorectal physiologic studies, functional etiologies of pelvic outlet obstructive disease were evaluated in detail. The current study was designed to assess the clinical and the physiologic characteristics of patients with pelvic outlet obstructive disease. METHODS: one hundred two (102) patients with pelvic outlet obstructive disease were evaluated with anorectal physiologic studies, including the colonic transit time (n=66), anorectal manometry (n=88), defecography (n=102), anal sphincter EMG (n=50), and colonoscopy or barium enema (n=77). The patients were categorized as group I (nonrelaxing puborectalis syndrome), group II (rectocele), group III (sigmoidocele), and group IV (rectoanal intussusception). The clinical and the physiologic characteristics were compared between the groups. RESULTS: The mean age was 51.9 years, and the sex ratio was 1:1.9. the populations of the groups were group I 45.1% (n=46), group II 36.3% (n=37), group III 5.9% (n=6), and group IV 9.8% (n=10). In group II and group III, co-existing etiologies were more, and the incidences of female patients was higher (P<0.05). Delayed colonic transit time was noted in 11 patients (17%). Diverticula was observed in 6 patients (8%), polyps in 12 patients (16%), and melanosis coli in 14 patients (18%). On anorectal manometry, group I showed higher maximal voluntary contraction and mean squeezing pressure than the other groups (P<0.05). On defecography, group I had a shorter perineal descent at rest and a smaller anorectal angle at push (P<0.05). CONCLUSIONS: The current study showed the clinical and the physiologic characteristics of the each functional etiology in patients with pelvic outlet obstructive disease. These results provide fundamental data for diagnosis of and tailored therapy for pelvic outlet obstructive disease.

Investigation of Defecographic Findings in Patients with Pelvic Outlet Obstructive Disease

PURPOSE: Defecography is a dynamic investigation which can influence clinical decision making in patients with pelvic outlet obstructive disease (POOD). The current study was designed to establish defecographic findings in patients with POOD. Specifically, we sought to assess the physiologic characteristics of categorized types by using anorectal physiologic tests. METHODS: One hundred seven patients (disease group; 45 men, 62 women) with POOD were retrospectively categorized as type I [non-relaxation of puborectalis (NRPR) only, n=19], type II [NRPR and rectocele, n=20], type III [NRPR, rectocele, and dynamic perineal descent (PD), n=17], type IV [deformed rectocele, mild-to-moderate fixed PD, and absence of NRPR, n=29], and type V [rectocele, severe fixed PD, and absence of NRPR, n=20] on the bases of defecographic findings. The ability to evacuate, the frequency/degree of intarectal intussusception (IRI), and the size of the rectocele were evaulated in these defecographic types of POOD. Age, duration of symptoms, and the physiologic findings of anal manometry and EMG/PNTML were compared for the five types. Eighteen healthy volunteers who had no defecation difficulty were used to estimate the normal findings of defecography. RESULTS: The age and the sex showed no significant differences among the types. The duration of symptoms was gradually lengthened from type I to V (P<0.01). The ability to evacuate in patients with POOD was significantly worse (failed to effectively evacuate) compared to that in the healthy volunteers (P<0.01). The frequency of IRI was increased more and more from type I to V (P<0.01). The size of the rectocele was significantly increased in types V compared to the other types (P<0.01). Manometric and neurologic findings, including EMG/PNTML, revealed no significant differences among the types. CONCLUSIONS: Even though there were no specific differences in the findings of the anal manometric and neurologic tests, the evacuation dynamics; were different in the five defecographic categories of patients with POOD. Specifically, these differences were relevants to the presence of NRPR, rectoceles, IRI, and perineal descent.

Diffuse Colonic Infarction due to Multiple Mesenteric Embolism

Acute mesenteric ischemia and infarction is emergent situation associated with high mortality, arising from sudden loss of blood supply to mesenteric vessels. Most of all, the patients has cardiovascular insufficiency such as arrhythmia, recent myocardial infarction or valvular heart diseases. Acute abdominal pain is a main symptom and abdominal distension, rigidity, nausea and/or vomiting, and diarrhea are frequently observed. Delayed diagnosis and management are usually due to the nonspecific symptom and sign and lack of accurate diagnostic modality. A patient with acute abdominal pain having a history of cardiovascular disorders should be meticulously evaluated considering to exclude mesenteric vascular emergency. This dismal disease is mostly segmental ischemia of small bowel or colon due to occlusion of one mesenteric vessel, but occasionally multiple occlusions is are possible. We report a 67 years old female patient with diffuse colonic infarction due to multiple mesenteric embolism with review of literatures.