Hazardous Drinking and Its Association With Smoking and Ego-Resiliency in Medical Students / 생물치료정신의학

Objectives@#The aim of this study was to investigate the prevalence of hazardous drinking (HD) and its association with sociodemographic factors, smoking, social anxiety, self-esteem, and ego-resiliency in medical students. @*Methods@#A total of 408 medical students were included in this study. Data were collected by self-administered questionnaire, and HD was assessed by Alcohol Use Disorder Identification Test (AUDIT). The HD and non-HD group were defined using the AUDIT score 10 for male and 6 for female as a cut-off, respectively. Multiple logistic regression analyses were carried out to examine the impact of sociodemographic factors, smoking, social anxiety, self-esteem, and ego-resiliency on HD. @*Results@#A total of 192 participants (47.1%) were identified as having HD. Frequency of smoking and the severity of social anxiety were significantly higher in HD group than non-HD group. Meanwhile, the levels of self-esteem and egoresiliency were significantly lower than HD group than non-HD group. In multiple logistic regression, smoking was associated with a higher risk of HD, whereas ego-resiliency and age were associated with a lower risk of HD. Compared to the high level of subjective socioeconomic status, both middle and low level were associated with a lower risk of HD. @*Conclusions@#HD among medical students was quite common and associated with smoking, ego-resiliency, age, and level of subjective socioeconomic status. Strong efforts to improve smoking cessation and ego-resiliency, as well as education for HD in medical schools, is needed to reduce the harmful effects of alcohol.

Null Association between BRAF V600E Mutation and Tumor Recurrence in Patients with Papillary Thyroid Microcarcinoma in South Korea

Background and Objectives@#The clinical implications of the BRAF V600E mutation in papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm of tumor size, remain controversial. We investigated the association between the BRAFV600E mutation and PTMC recurrence in a retrospective cohort of patients with thyroid cancer. @*Materials and Methods@#This study included 2319 patients with PTMC (median age, 50 years [interquartile range (IQR), 41-57 years]) who underwent thyroid surgery from 2010 to 2019 at a single tertiary medical center. The median follow-up time was 75 months (IQR, 30-98 months). Tumor recurrence was confirmed by histological, cytological, radiographic, and biochemical criteria, combined with persistent and recurrent disease. @*Results@#A total of 60.2% (1395/2319) patients with PTMC had the BRAF V600E mutation. The tumor recurrence rate was 2.1% (19/924) in BRAF mutation-negative patients and 2.9% (41/1395) in BRAF mutation-positive patients, with a hazard ratio (HR) of 1.05 (95% confidence interval [CI], 0.61-1.84) after adjusting for clinicopathological risk factors. Similar results were found in patients with high-risk PTMC (adjusted HR, 1.09; 95% CI, 0.56-2.11) who had lymph node metastasis (LNM), extrathyroidal extension (ETE), or distant metastasis (DM) at diagnosis and in patients with low-risk PTMC (adjusted HR, 1.00; 95% CI, 0.35-2.83) who had no LNM, ETE, or DM. @*Conclusion@#The finding that the BRAF V600E mutation was not associated with tumor recurrence in our cohort of Korean patients with PTMC, especially in patients with low-risk PTMC, suggests that its value in the prediction of disease progression is limited.

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem / 대한고관절학회지

PURPOSE: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. MATERIALS AND METHODS: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. RESULTS: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. CONCLUSION: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

Characteristics and Treatment of Cutaneous Melanoma of the Foot

BACKGROUND: In East Asia, the foot is the most common site of cutaneous melanoma. The purpose of this study was to investigate the differences between cutaneous melanoma of the foot and melanomas of other sites. METHODS: We studied 52 patients who underwent surgical treatment for cutaneous melanoma of the foot from September 2000 to January 2015. Through a retrospective review of their medical records, we collected data relating to their sex, age, histopathological subtype, Clark level, tumor thickness, lymph node involvement, stage, and survival rate, and we compared these parameters to those of 61 patients treated for melanoma of other sites. Moreover, we analyzed the surgical procedures, complications, and mortality rates associated with cutaneous melanoma on various parts of the foot. RESULTS: Melanoma of the foot differed from other melanomas only in the histopathological subtype. Other clinical features, including survival rate, did not differ significantly between the two groups heel was the most common site of melanoma of the foot (22 cases, 42.3%). The method of reconstruction varied depending on the region involved. CONCLUSIONS: A comparison of melanoma of the foot to other melanomas showed that melanoma of the foot was associated with a significantly different distribution of histological subtypes. Consistent with previous findings, we found that the acral lentiginous subtype was the most common among melanomas of the foot. Furthermore, in contrast with previous studies, we did not find a worse prognosis or lower survival rate for melanoma of the foot in comparison with other melanomas.

Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism

BACKGROUND: Thyroid function depends on ethnic and environmental factors. North Korean refugees have the same genetic background as South Koreans, but they have been exposed to different environments. This study examines the prevalence and pattern of thyroid disorders in North Korean women living in South Korea, focusing on subclinical hypothyroidism (SCH). METHODS: The intended sample was a total of 327 North Korean women residing in Seoul. Health questionnaires and medical examinations, including serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine, and thyroid autoantibodies, were conducted. RESULTS: The prevalence of SCH was 9.4%. In logistic regression analysis, smoking, menopause, length of stay in South Korea, body mass index, history of thyroid disease, and metabolic syndrome were not associated with the risk of SCH. Whereas, the positivity of autoantibodies were associated with a high risk for SCH (odds ratio [OR], 4.840; 95% confidence interval [CI], 1.80-13.017; P = 0.002), and age was associated with a low risk for SCH (OR, 0.94; 95% CI, 0.888-0.994; P = 0.031). The serum TSH levels also decreased with increasing age, and in particular, there was significant difference between 30-39 years, and over 60 years (2.33 +/- 1.51 microIU/mL vs. 1.54 +/- 0.73 microIU/mL, P = 0.028). CONCLUSION: In North Korean women, the positivity of autoantibodies was associated with a high risk for SCH. But interestingly, a younger age was associated with a high risk for SCH. Considering that they suffered from severe famine at the period of growth, and this led to malnutrition, their thyroid dysfunction might be associated with the peculiar environment that they experienced.

The Effect of Cellular Phone-Based Telemedicine on Glycemic Control in Type 2 Diabetes Patients Using Insulin Therapy / 당뇨병

BACKGROUND: Cellular phones are extremely prevalent in modern society and they enable appropriate feedback mechanisms through real time monitoring and short message services regarding blood glucose levels. We investigated whether cellular phone-based telemedicine support system could improve blood glucose control in type 2 diabetes patients who were in inadequate glycemic control regardless of insulin therapy. METHODS: A randomized, controlled clinical trial was conducted involving 74 type 2 diabetic patients with suboptimal glycemic control (HbA1c levels > 7%) regardless of insulin therapy. The intervention (cellular phone-based telemedicine) group managed their blood glucose using a cellular phone for 3 months, while the control (self monitoring of blood glucose) group managed their blood glucose with a standard glucometer for the same period. RESULTS: Three months later, HbA1c levels were decreased in both groups. However, the decrease in the control group from 8.37% to 8.20% was only 0.20% (P = 0.152) which was not significant. In contrast, the intervention group had a significant reduction of 0.61% from 8.77% to 8.16% (P or = 8%, the patients in the intervention group showed a significant reduction of 0.81% from 9.16% to 8.34% (P < 0.001). CONCLUSION: HbA1c levels were significantly decreased in the cellular phone-based telemedicine group compared with the control group after 3 months. This study suggests that cellular phone-based telemedicine is helpful for better glucose control in type 2 diabetes patients who previously were unable to control glucose levels adequately with insulin therapy.

Randomized Trial Comparing a Starion(TM) and a Harmonic Scalpel(TM) Hemorrhoidectomy

PURPOSE: The present study was designed to evaluate the efficacy and the outcome when using the Starion(TM) and the Harmonic Scalpel(TM) vessel sealing systems for a sutureless hemorrhoidectomy. METHODS: This study is a randomized, controlled trial. Patients with Grade 3 and 4 hemorrhoids were categorized into two groups: the Starion(TM) hemorrhoidectomy (30 patients) group and the Harmonic Scalpel(TM) hemorrhoidectomy (30 patients) group. The measures of the primary outcomes were the operating time, the postoperative pain score, and the patient satisfaction score. Secondary outcome criteria included early and delayed complications: postoperative bleeding, anal stenosis, urinary difficulty, and skin tag. RESULTS: The satisfaction scores 4 wk postoperatively were not significantly different between the two groups (P=0.186). However, the operating time was reduced (P=0.019), the pain score was lower (P=0.009), and the satisfaction score 1 wk postoperatively (P=0.001) was lower in the Starion(TM) hemorrhoidectomy group. In addition, there were no differences in early and delayed postoperative complications between the two groups (all P>0.05). CONCLUSION: Both methods were found to be surprisingly equivalent in all major aspects analyzed. A Starion(TM) hemorrhoidectomy with submucosal dissection can provide a safe, fast, bloodless, reduced-pain, and low-priced surgical alternative to hemorrhoidal surgery. More studies are needed to determine whether similar favorable results can be attained in patients with more severe, strangulated hemorrhoids.

Bone Marrow Findings, and TNF-alpha, IL-18 Expression in Bone Marrow of Adult Onset Still's Disease Patients / 대한류마티스학회지

OBJECTIVE: Inflammatory cytokines may play important roles in the pathogenesis of adult onset Still's disease. The enhanced expression of IL-18 was reported in the bone marrow of a Japanese systemic onset juvenile rheumatoid arthritis patient but not in the other organs. To date, there are very few studies relating the bone marrow and AOSD. This study examined the bone marrow findings as well as TNF-alpha and IL-18 expression in the bone marrow of AOSD patients. METHODS: A retrospective study was performed on 15 AOSD patients who had undergone a bone marrow examination at a university hospital. The clinical and laboratory findings, as well as the bone marrow findings, were analyzed. Immunohistochemistry of IL-18 and TNF-alpha in bone marrow was performed. RESULTS: The bone marrow cellularity and myeloid/erythroid cell ratio showed no correlation with the clinical and laboratory findings. TNF-alpha was expressed at 0.8~9.8% and IL-18 was expressed at 0.4~9.8% of bone marrow cells. Cytokine expression was not associated with the clinical patterns of AOSD. The platelet count correlated with the bone marrow TNF-alpha expression but TNF-alpha did not correlate with IL-18 expression. CONCLUSION: TNF-alpha and IL-18 expression in bone marrow were observed in some AOSD patients but there was no correlation with the other clinical and laboratory findings except for the platelet count.

Budd-Chiari Syndrome Caused by Diaphragmatic Hernia of the Liver: A Case Report

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous outflow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases (1-3). We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Budd-Chiari Syndrome Caused by Diaphragmatic Hernia of the Liver: A Case Report

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous outflow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases (1-3). We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Usefulness of Spinal MR Angiography for Detecting Adamkiewicz Artery

PURPOSE: We wanted to evaluate the detection rate of the artery of Adamkiewicz (AKA) by contrast-enhanced MR angiography (CE-MRA) and to compare the detection rate of AKA between the coronal source image plane and the sagittal source image plane. MATERIALS AND METHODS: Between December 2004 and May 2005, 23 patients (9 men and 14 women. age range: 11-86 years, mean age: 43 years) who were examined by contrast-enhanced MRI for the purpose of evaluating spondylopathy were also studied by performing spinal CE-MRA. Spinal CE-MRA was performed with a 1.5-T system and with using 3D Fast field echo with a double dose (0.2 mmol/kg) of Gadolinium. Source images were obtained in either the sagittal plane (n = 11) or the coronal plane (n = 12) at random. The source images were reconstructed with multiplanar reconstruction and maximum intensity projection. Two radiologists, who were kept unaware of the source image plane, independently evaluated the CE-MRA with focusing on the AKA. The detection rate was evaluated and the difference of detection rates according to the source image plane was compared and analyzed. RESULTS: CE-MRA could demonstrate the AKA in 11 (47%) of the 23 patients. The interobserver agreement for detection was fair (κ=0.283). Among the 11 patients in whom the MRA was obtained with using the coronal plane source image, CE-MRA detected the AKA in three of them (27%); among the 12 patients in whom the CE-MRA was obtained with using the sagittal plane source image, CE-MRA detected the AKA in 8 of them (67%, p = 0.059). The AKA in 7 cases (63%) originated from the intercostal or lumbar arteries on the left side at L2 (n = 3), L1 (n = 2), T12 (n = 1) or T9 (n = 1), and on the right side at L1 (n = 1) or T12 (n = 3). CE-MRA with coronal slice orientation visualized the AKA in 8 (67%) of the 11 patients (p = 0.059). CONCLUSION: The detection rate of AKA by CE-MRA was 47%. By obtaining the source image in the coronal plane, the detection rate of AKA was 67%.

Usefulness of Spinal MR Angiography for Detecting Adamkiewicz Artery

PURPOSE: We wanted to evaluate the detection rate of the artery of Adamkiewicz (AKA) by contrast-enhanced MR angiography (CE-MRA) and to compare the detection rate of AKA between the coronal source image plane and the sagittal source image plane. MATERIALS AND METHODS: Between December 2004 and May 2005, 23 patients (9 men and 14 women. age range: 11-86 years, mean age: 43 years) who were examined by contrast-enhanced MRI for the purpose of evaluating spondylopathy were also studied by performing spinal CE-MRA. Spinal CE-MRA was performed with a 1.5-T system and with using 3D Fast field echo with a double dose (0.2 mmol/kg) of Gadolinium. Source images were obtained in either the sagittal plane (n = 11) or the coronal plane (n = 12) at random. The source images were reconstructed with multiplanar reconstruction and maximum intensity projection. Two radiologists, who were kept unaware of the source image plane, independently evaluated the CE-MRA with focusing on the AKA. The detection rate was evaluated and the difference of detection rates according to the source image plane was compared and analyzed. RESULTS: CE-MRA could demonstrate the AKA in 11 (47%) of the 23 patients. The interobserver agreement for detection was fair (κ=0.283). Among the 11 patients in whom the MRA was obtained with using the coronal plane source image, CE-MRA detected the AKA in three of them (27%); among the 12 patients in whom the CE-MRA was obtained with using the sagittal plane source image, CE-MRA detected the AKA in 8 of them (67%, p = 0.059). The AKA in 7 cases (63%) originated from the intercostal or lumbar arteries on the left side at L2 (n = 3), L1 (n = 2), T12 (n = 1) or T9 (n = 1), and on the right side at L1 (n = 1) or T12 (n = 3). CE-MRA with coronal slice orientation visualized the AKA in 8 (67%) of the 11 patients (p = 0.059). CONCLUSION: The detection rate of AKA by CE-MRA was 47%. By obtaining the source image in the coronal plane, the detection rate of AKA was 67%.

Usefulness of Fluoroscopy-Guided Intra-articular Injection of the Knee

PURPOSE: To determine the accuracy of the intra-articular location of hyaluroinc acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. MATERIALS AND METHODS: A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). RESULTS: Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injections (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (p value = 0.14). CONCLUSION: Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

Morphometry of the Cut Surface of the Proximal Tibia for Total Knee Arthroplasty in Korea / 대한정형외과연구학회지

PURPOSE: To provide the morphometric data about the Korean proximal tibia to design a total knee prosthesis for Korean population. MATERIALS AND METHODS: We measured morphologic data from the proximal part of the tibia from 60 knees of 30 male and 30 female cadavers. The 3D images were reconstructed from the data obtained by computed tomography scanning from femoral head to ankle joint. These image were processed as a ideal tibial resection surface which was made during a total knee arthroplasty operation. Then, antero-posterior lengths, medio-lateral lengths and aspect ratios of the cut surface were measured. Measurements were analyzed and compared with those of five popular total knee prosthesis models. RESULTS: The average medio-lateral length, lateral antero-posterior length, aspect ratio of male was 79.4 +/- 3.8 mm, 39.6 +/- 5.0 mm, 49.8 +/- 5.1% respectively. And that of female was 70.4 +/- 3.7 mm, 34.3 +/- 3.6 mm, 48.8 +/- 4.7% respectively. Component size of medio-lateral length of 65~85 mm and lateral antero-posterior length of 30~45 mm, would be required for the Korean population. Aspect ratios were correlated to antero-posterior lengths positively (p < 0.05). CONCLUSION: No prostheses had fulfilled all the requirements for Korean knees in this study. These data could be used for design the optimal components for Korean.

Morphometry of the Cut Surface of the Proximal Tibia for Total Knee Arthroplasty in Korea / 대한정형외과연구학회지

PURPOSE: To provide the morphometric data about the Korean proximal tibia to design a total knee prosthesis for Korean population. MATERIALS AND METHODS: We measured morphologic data from the proximal part of the tibia from 60 knees of 30 male and 30 female cadavers. The 3D images were reconstructed from the data obtained by computed tomography scanning from femoral head to ankle joint. These image were processed as a ideal tibial resection surface which was made during a total knee arthroplasty operation. Then, antero-posterior lengths, medio-lateral lengths and aspect ratios of the cut surface were measured. Measurements were analyzed and compared with those of five popular total knee prosthesis models. RESULTS: The average medio-lateral length, lateral antero-posterior length, aspect ratio of male was 79.4 +/- 3.8 mm, 39.6 +/- 5.0 mm, 49.8 +/- 5.1% respectively. And that of female was 70.4 +/- 3.7 mm, 34.3 +/- 3.6 mm, 48.8 +/- 4.7% respectively. Component size of medio-lateral length of 65~85 mm and lateral antero-posterior length of 30~45 mm, would be required for the Korean population. Aspect ratios were correlated to antero-posterior lengths positively (p < 0.05). CONCLUSION: No prostheses had fulfilled all the requirements for Korean knees in this study. These data could be used for design the optimal components for Korean.

The Effect of Percutaneous Bilateral Metalic Stent for Hilar Cholangiocarcinoma / 영남의대학술지

BACKGROUND: The purpose of this study was to determine the effectiveness of a percutaneously placed self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. MATERIALS AND METHODS: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral self- expanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. RESULTS: There were 4 cases of Bismuth type II, 21 cases of Bismuth type IIIa, 8 cases of Bismuth type IIIb and 15 cases of Bismuth type IV. Stent placement was technically successful in all patients. All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage rate of 91.1%. There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and Median Survival Time Were 303 Days (Range, 60~815) And 338 Days (Range, 60~1175), Respectively. CONCLUSION: Placement of a percutaneous metallic stent is an effective and safe method for palliation of patients with hilar cholangiocarcinoma.

The Effect after Intra-dermal Methylene Blue, Hydrocortisone, Lidocaine Injection Therapy for Intractable, Idiopathic Pruritus Ani

PURPOSE: Idiopathic pruritus ani is a common and embarrassing proctological condition which can be very difficult to treat. In this study, we documented our results with methylene blue intra-dermal injection in patients with intractable idiopathic pruritus ani. METHODS: 5-ml 1% methylene blue, 100-mg hydrocortisone, and 15-ml 1% lidocaine were injected into the perianal skin of 21 patients with idiopathic pruritus ani which had proved refractory to standard care. Clinical follow-up was undertaken. RESULTS: After one injection of the above solution, 15 (71.4%) of the patients were rendered symptom free. Repeat injection in the initial non- responders ultimately rendered another four. 19 (total: 90.5 %) of the patrents symptom free. Morbidity was 0%. CONCLUSION: This study has shown that intra-dermal methylene blue injection is a safe, simple, and efficient method of treating intractable, idiopathic pruritus ani.

Thymidylate Synthase Gene Polymorphism as a Prognostic Factor for the Colorectal Cancer

PURPOSE: Thymidylate synthase (TS) expression in colorectal cancer is regarded as both a prognostic marker and a predictor of response to fluoropyrimidine-based therapies targeting TS. However, results from immunohistochemical staining of TS show wide discrepancies. The human TS gene promoter is polymorphic, having either double or triple tandem repeats of a 28-bp sequence. Here, we determined the significance of this polymorphism in predicting the clinical outcomes for patients with operable colorectal cancer treated by a curative resection. METHODS: The cases of 121 patients with stage II or III colorectal cancer, who underwent a curative resection, were reviewed. After DNA extraction from paraffin- embedded tissues, the promoter region of the TS gene was amplified by polymerase chain reaction. RESULTS: Sixty-eight subjects were homozygotes for the triple repeat variant (group A, L/L, 250-bp), and 53 subjects (group B) were either homozygotes for the double repeat variant (S/S, 220-bp) or heterozygotes (S/L, 220 and 250- bp). The difference between stage II and stage III patients was significant with regard to the 5-year actuarial survival (87% vs 63%, P=0.0320). Examining the survival according to the TS polymorphism, we found a significant difference between group A and B (80% vs 53%, P=0.0481). In patients with stage II disease, the difference in survival rates between group A and B did not reach statistical significance (43% vs 86%, P=0.1678). However, the difference was significant between group A and B for stage III disease (77% vs 41%, P=0.0414). CONCLUSIONS: We found the TS polymorphism to be a significant and independent prognostic factor for operable colorectal cancer. We think assay of the TS polymorphism can overcome the technical pitfalls of immunohistochemical staining and give more solid prognostic information in the treatment of colorectal cancer.

Comparison of Rectoanal Physiologic Changes and Treatment Results between Transanal Repair and Transanal Repair with Posterior Colporrhaphy in Patients with Rectocele

PURPOSE: Rectoceles are often associated with anorectal symptoms. Various surgical techniques have been described to repair rectoceles, but the surgical results vary. The aim of this study was to compare transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR+PC). METHODS: The records of 58 patients operated on during a 56-month period were reviewed. Of those 26 patients had a TAR, and 32 patients had a TAR+PC. Interviews and anorectal physiologic studies were performed preoperatively and postoperatively. RESULTS: The recurrence rate after a TAR+PC was lower than the recurrence rate after a TAR (TAR 19.2% vs. TAR+PC 3.1%). The rectal sensation (sensory threshold: TAR 64.8+/-18.9 ml vs. TAR+PC 56.1+/-23.67 ml; earliest defecation urge: TAR 116.4+/-29.5 ml vs. TAR+PC 104.8+/-31.2 ml) was more improved after a TAR+PC. CONCLUSIONS: A TAR+PC for treatment of a rectocele is safe and effectively corrects obstructed defecation. The improvement probably relates, at least in part, to rectal sensational factors other than the dimensions of the rectocele.

Radiologic Differentiation Between Homogeneously Solid Renal Cell Carcinoma and Muscle-Predominant Renal Angiomyolipoma

PURPOSE: To compare the differential radiologic findings of renal cell carcinoma presenting as a homogeneous solid mass (HS-RCC) and muscle-predominant angiomyolipoma (MP-AML). MATERIALS AND METHODS: Nine of 76 surgically and pathologically proven RCCs presenting at CT or magnetic resonance (MR) imaging as a homogeneous solid mass, and four cases of MP-AML were included in this study. Echogenicity at sonography, attenuation at non-enhanced CT (NECT), the contour of the mass, signal intensities at T1- and T2-weighted MR imaging, the existence of a capsule, and the pattern and degree of enhancement at CT and MR imaging were retrospectively analyzed. RESULTS: Two of five HS-RCCs were isoechoic and three were hyperechoic. Two of three MP-AMLs, however, were isoechoic, and one was mixed echoic. All nine HS-RCCs were round or oval in shape, but three MPAMLs were lobulated and one was round. At NECT, seven of eight HS-RCCs were isodense and one was hypodense compared to surrounding normal renal parenchyme, but three MP-AMLs were hyperdense masses and one was isodense. At enhanced CT, HS-RCCs showed various degrees of homogeneous enhancement, but all MP-AMLs showed moderate homogeneous enhancement. All three MP-AMLs demonstrated heterogeneous hypointensity at T2-weighted MRI and homogeneous hypointensity at T1-weighted MRI. HS-RCCs showed various signal intensities at both T1- and T2-weighted MRI, and in five cases, heterogeneous high signal intensity at T2-weighted MRI. Capsules were observed in seven of nine HS-RCCs but not in any of the three MP-AMLs. At enhanced T1-weighted MRI, MP-AMLs showed mild to moderate enhancement, but HSRCCs showed mild, moderate, and strong enhancement in two, two, and five cases, respectively. CONCLUSION: Echogenicity, density at NECT, signal intensity at MR T2-WI, the contour of the mass, and the existence of a capsule are features which are useful in the differential diagnosis of HS-RCC and MP-AML.