ABSTRACT
Primary Sjogren's syndrome (pSS) is characterized by chronic inflammation and dysfunction in exocrine organs; however, it also has protean clinical features, including neuropsychiatric symptoms. A major neurological manifestation is peripheral neuropathy and involvement of the central nervous system is uncommonly described in pSS. A 52-year-old female was admitted because of depression, dysarthria, gait abnormality, and memory disturbance, which had developed over two months, and was diagnosed as pSS. She was treated successfully with high-dose glucocorticoid and cyclophosphamide pulse therapy without recurrence during the follow-up period of two years. Herein, we describe the first Korean case of pSS presenting with rapidly progressive cognitive impairment along with a review of the literature.
Subject(s)
Female , Humans , Middle Aged , Central Nervous System , Cyclophosphamide , Depression , Dysarthria , Follow-Up Studies , Gait , Inflammation , Memory , Neurologic Manifestations , Peripheral Nervous System Diseases , Recurrence , Sjogren's SyndromeABSTRACT
Anal outlet obstruction(AOO), which was caused by various anal diseases, presented symptoms like acute or chronic constipation, obstipation, painful defecation and bleeding. We retrospectively reviewed these patients to identify underlying diseases, corresponding surgical treatment and outcome. From July 1989 to December 1995, 132 patients were operated for AOO at Asan Medical Center. Colonic inertia and other pelvic outlet obstructions such as rectocele, rectal intussusception, or Paradoxical puborectalis conraction were excluded from this study by history taking, physical examination, colon transit time study, manometry, and defecography. Male to female ratio was 1 : 1.2 and mean age was 45 and 44, respectively. Among 132 Patients, 57 cases(43%) had sing1e disease and remained 75 cases had combined two or more diseases. Hemorrhoids(90 cases) was the most common associated disease and then were anal stricture(59 cases), chronic anal fissure(29 cases), internal sphincter hypertonia(25 cases) and anal fistula(6 cases) in decreasing order. Either single or combined hemorrhoidectomy was performed in 85 cases, lateral internal sphincterotomy in 65 cases, anoplasty in 35 cases, rubber band ligation in 13 cases, manual anal dilatation in 10 cases. Postoperative complications were 7 cases of wound infection and one case of gas incontinence, that were subsided by conservative management. 119 patients(90%) showed complete improvement and twelve patients were partially improved from AOO. Only one patient did not respond surgical treatment due to anismus. As AOO is a comprehensive disease entity of frequent anal diseases, adequate surgery for respective patients mandatory to relieve discomfort.
Subject(s)
Female , Humans , Male , Colon , Constipation , Defecation , Defecography , Dilatation , Hemorrhage , Hemorrhoidectomy , Intussusception , Ligation , Manometry , Physical Examination , Postoperative Complications , Rectocele , Retrospective Studies , Rubber , Time and Motion Studies , Wound InfectionABSTRACT
The surgical stapling technique has been recognized as an indispensable tool in rectal cancer surgery. A personal experience in one-hundred patiens is presented for the purpose of appropriate use of the surgical staplers. Three anastomotic techniques used were end-to-end anastomosis in 75 cases, double-stapling in 11 cases, and side-to-end anastomosis in 14 cases. In 88 cases, level of anastomosis was below the peritoneal reflection. Eight cases of stapling errors were found during operation. Among them, 5 cases of instrumental failure were 2 cases of blade defect and each one of difficult extraction, misfiring or tearing over trocar. The other 3 cases of surgical errors come from uneven perirectal excision causing one incomplete doughnut and 2 deficient anastomosis. Distal resection margin was closely related to the location of tumor(p < 0.01), but local recurrence did not associated with it. Two cases of postoperative hematochezia showed self-limiting. Anastomotic leakage occurred in 3 female patients and they were converted into resection. Excluding one leakage from skipped proximal foci, 2 cases occurred in the ultra-low anastomosis. Postoperative stricture was found in 5 cases and they were not associated with internal diameter of circular stapler. They were treated by manual dilatation and bulk-forming laxatives without surgical intervention. Bowel frequency or inability of deferrment was found in 9 cases on 1 month and 5 cases on 6 months postoperatively. They were not related to anastomotic level or stapling method. In conclusion, the stapling technique in rectal cancer surgery is a safe as well as a comfortable technique whenever complication can be amenable to the surgeon.
Subject(s)
Female , Humans , Anastomotic Leak , Constriction, Pathologic , Dilatation , Gastrointestinal Hemorrhage , Laxatives , Medical Errors , Rectal Neoplasms , Recurrence , Surgical Instruments , Surgical Staplers , Surgical StaplingABSTRACT
We compared the recurrence rate, survival and functional results of 159 low rectal cancer patients retrospectively, who had been performed 75 sphincter saving resections (SSR) and 84 abdomino-perineal resections(APR) during July 1989 to December 1994. The local recurrence rate was 9.3% in SSR and 8.3% in APR group, while systemic recurrence rate was 20.5% and 16.7%, respectively(p>0.05). Three year survival rate was 70% in SSR and 85% in APR group. Comparing with Dukes'stage, it was 69%, 89% in Dukes'B and 63%, 84% in Dukes'c stage, respectively(p>0.05). In respect to the number of metastatic lymph node,3 year survival rate was 80%,95% in Nl group( OR =4 metastatic lymph nodes), respectively(p>0.05). According to the distal resection margin(DRM), it was 100% in group 1(1 cm OR = 3 cm), respectively(p>0.05). Voiding dysfunction was developed 36.0% of SSR and 28.6% of APR postoperatively. Erectile and ejaculatory dysfunction rate was 33.3%, 66.7% of SSR and 58.8%, 88.3% APR group respectively, There were no significant differences in recurrence rate, survival rate and functional results Between SSR and APR group. Conclusively, sphincter saving resection in low rectal cancer surgery did not seem to affect survival or recurrence. A good functional outcome in the SSR suggests it to be a procedure of choice, if possible.
Subject(s)
Humans , Rectal Neoplasms , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: Unresectable hepatic metastases of colorectal cancer does not seem to be amenable to the various treatment modalities. We modified hepatic intraarterial chemotherapy by different installation of port and regimen. MATERIALS AND METHODS: Between July 1989 to December 1995, 27 patients of colorectal cancer with unresectable liver metastases were randomly allocated into either hepatic intraarterial (HA, 11 patients) or systemic intravenous (IV, 16 patients) chemotherapy after primary tumor resection. Chemo-port was installed with preservation of hepatic arterial flow. One cycle of HA regimen included 5-fluorouracil (5-FU) and mitomycin-C (MMC) with or without leucovorin (LV) for 14 days every month. The IV regimen included 5-FU and LV for 5 days every month. Both HA and IV chemotherapy were continued from 6 to 12 cycles. RESULTS: The response exceeding partial remission was experienced in six patients (55%) among 11 patients in the HA group, while only two (13%) patients showed response among sixteen patients in the IV group. One year survival was not different between two groups. Although lethal toxicity was not found, patients showed marked increase of the performance scale (ECOG) in both groups. CONCLUSION: Although survival benefit was not prominent, higher response rate with tolerable complication was found in the HA group. Prudent selection of effective drugs and combination of systemic chemotherapy are needed to improve the survival with minimal complication.
Subject(s)
Humans , Colorectal Neoplasms , Drug Therapy , Fluorouracil , Leucovorin , Liver , Mitomycin , Neoplasm MetastasisABSTRACT
Postoperative colonoscopy is an effective tool for management of colonic adenomas. Authors analyzed the pattern of colonic adenomas detected during follow-up colonoscopy after colorectal cancer surgery and evaluated the characteristics of adenornas, risk groups, and effective fo1low-up schedule. Study group were 222 patients and colonoscopy was performed 389 times. Patterns of adenornas were analyzed by variables as age, sex, preoperative serum CEA level, location of primary colorectal cancer, Borrmann type, Duke's stage, histologic differentiation, DNA ploidy, recurrence and histology. Metachronous adenomas were detected in 79 patients(35.6%) and both metachronous and syachronous adenomas were observed in 29 cases(13.1%). High risk variables for adenomas were male, old age and presence of synchronous adenoma. There were 2 patients with maligant change of adenomas. Yearly follow-up by complete colonoscopy over 3 years or more is recommended and follow-up interval should be shortened in the high risk groups.