Correlation of endoscopic findings with suspected intestinal endometriosis in the distal sigmoid and rectum as observed on transrectal ultrasonography

Introduction: Colonoscopy enables detailed endoscopic evaluation of the interior of the colon. Changes observed via colonoscopy may be subtle or pronounced and can sometimes mimic those of other diseases, such as deep intestinal endometriosis. The diagnosis of endometriosis in the distal sigmoid and rectum by colonoscopy has been described in previous case reports. Objective: We aimed to correlate the endoscopic changes found in the distal sigmoid and rectum with the presence of endometrial deposits confirmed by transrectal ultrasound (TRUS). Methods: We included 50 female patients referred to the endoscopy department at our institution for colonoscopy, rectosigmoidoscopy, or TRUS, who exhibited one or more symptoms associated with endometriosis. Results: The colonoscopic findings were normal in 36 patients but showed alterations in 14 patients. Among the latter, TRUS revealed involvement of the sigmoid and/or rectal wall in 11 patients. Conclusions: The endoscopic changes in the distal sigmoid or rectum described in this study were strongly associated with endometrial deposits confirmed using TRUS. (AU)

Trauma de recto penetrante: revisión de tema / Penetrating rectal trauma: a comprehensive review

Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aún existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en inglés y español. Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopía. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas. Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.

Introduction. Currently, rectal trauma continues to be a complex clinical and potentially fatal situation. Its early detection and management is the cornerstone to avoid both mortality and morbidity of patients. Today there is still debate about the ideal surgical approach in rectal trauma, and intraoperative management decisions are greatly affected by the experience and preferences of the surgeon. Methods. A literature search was performed in the PubMed, Clinical Key, Google Scholar and SciELO databases using the keywords described. The most relevant articles published in the last 20 years were selected. Articles written in English and Spanish were considered.Discussion. The rectum is the organ less frequently injured in trauma; however, the clinical implications of overlooking this injury can be devastating for the patient. Options for diagnosis include digital rectal examination, computed tomography and rectosigmoidoscopy. Surgical management will depend on the location, degree of the injury and the associated injuries. Conclusion. Knowledge of the anatomy, the mechanism of trauma and the associated injuries will allow the surgeon to make an adequate clinical-surgical approach that leads to optimal clinical outcomes in patients presenting with rectal trauma.

Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion

BACKGROUND/AIMS: Although multiple treatment options exist for the management of sigmoid colon volvulus, no study has examined the factors associated with successful endoscopic detorsion. This study aimed to examine the clinical course of patients with sigmoid colon volvulus and to identify factors related to successful endoscopic detorsion. METHODS: This study included 30 cases (21 patients) of sigmoid volvulus from among 545 cases of intestinal obstruction at a single center. We retrospectively examined the clinical course and the factors associated with the possibility of endoscopic detorsion of sigmoid colon volvulus. RESULTS: The rate of laxative use among the study participants was 76.2%; the rate of comorbid neuropsychiatric disorders was 61.9%; and 57.1% of patients had a history of open abdominal surgery. All patients were initially treated with endoscopic detorsion, and this procedure had a 61.9% success rate. The recurrence rate after detorsion was as high as 46.2%, but detorsion during revision endoscopy was possible in all cases. Statistical analysis revealed that the absence of abdominal tenderness (P=0.027), the use of laxatives (P=0.027), and a history of open abdominal surgery (P=0.032) were factors predictive of successful endoscopic detorsion. CONCLUSIONS: The results of our study are consistent with previous reports with respect to the success rate of endoscopic detorsion, the subsequent recurrence rate, and the proportion of patients requiring surgical treatment. In addition, we identified the absence of abdominal tenderness, the use of laxatives, and history of open abdominal surgery as factors predicting successful endoscopic detorsion of sigmoid colon volvulus.

The diagnostic efficiency of sigmoidoscopy in patients with bleeding per rectum

Background: Rectal bleeding is the most common symptom of large bowel pathology which comprises 14 to 19% in adult population. Sigmoidoscopy is a feasible and safe method for diagnosing colorectal problems than colonoscopy and proctoscope. Aim: The present study was an attempt to evaluate the patients with bleeding per rectum sigmoidoscopically and to select the best possible approach to treat the underlying pathology. Materials and methods: A total 54 patients with bleeding per rectum were considered from outpatient department form April 2013 to April 2015 and all the subjects were undergone for routine blood, urine and stool investigations, and sigmoidoscopic investigation. Results: A total of 26 cases were examined sigmoidoscopically for rectal bleeding in that 73.08% cases were able to confirm as definitive source of bleeding and 26.92% cases have other lesions which could not be detected by sigmoidoscope. Conclusion: Sigmoidoscopy has a very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum. Haemorrhoids followed by ulcerative colitis were the leading cause of bleeding per rectum in this study.

Impact of Sigmoidoscopy and Colonoscopy on Colorectal Cancer Incidence and Mortality: An Evidence-Based Review of Published Prospective and Retrospective Studies

Screening for colorectal cancer (CRC) using sigmoidoscopy or colonoscopy is now common in many developed countries. This concise, evidence-based review looks at the impact of sigmoidoscopy or colonoscopy screening on CRC incidence, CRC mortality and overall mortality. Data from controlled retrospective and prospective (observational or randomized) studies have generally shown that sigmoidoscopy and colonoscopy, whether for diagnostic, screening or surveillance purposes, are associated with a significant reduction in CRC incidence and CRC mortality. The data on their impact on overall mortality is much more limited, with most studies unable to report a reduction in overall mortality. The results of three meta-analyses have confirmed these conclusions. As expected, sigmoidoscopy has a predominant effect on left-sided CRC, although some studies have shown modest effects on right-sided colon cancer as well. Most studies on colonoscopy have demonstrated that the protective effect applies to both right and left-sided cancer, although the protection seemed better on the left side. Despite the introduction of other screening and diagnostic modalities for the colon, such as computed tomography colonography and colonic capsule endoscopy, lower endoscopy will continue to be an important mode of screening for CRC and evaluating the colon.

Indications for endoscopy according to the revised FIGO staging for cervical cancer after MRI and CT scanning / 부인종양

OBJECTIVE: A recent revision of the FIGO staging system does not recommend the mandatory use of cystoscopy and sigmoidoscopy. The objective of this study was to assess the clinical utility of CT or MRI scans for ruling out bladder or rectal invasion and determine the indication for endoscopy in patients with cervical cancer. METHODS: We retrospectively reviewed 769 patients with cervical cancer, who underwent imaging and endoscopic work-up between January 1997 and December 2010. Using endoscopy as the standard reference for comparison, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the imaging modality for bladder or rectal invasion. RESULTS: The CT scan showed 68.2% and 85.7% for sensitivity and 96.4% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. CT scan provided a low PPV (51.7%, 54.5%) and a high NPV (98.2%, 99.8%). MRI scan showed 88.0% and 75.0% for sensitivity and 93.1% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. MRI scan provided a low PPV (35.6%, 42.9%) and a high NPV (99.4%, 99.7%). The accuracies of CT and MRI scans in identifying bladder invasion were 94.9% and 92.8%, respectively. The accuracies of CT and MRI in identifying rectal invasion were 98.7% and 98.6%, respectively. CONCLUSION: The results of this study demonstrate that additional invasive endoscopy is not necessary for patients who present with no invasion on imaging work-up, and therefore, endoscopy should be considered a tool for confirming cases that are positive for invasion based on imaging work-up.

Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy / 대한소화기학회지

Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.

Pseudomembranous colitis in children: Experience of a university hospital in Korea / 소아과

PURPOSE: Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. METHODS: Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. RESULTS: Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case. CONCLUSION: PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.

A case of amebic colitis mimicking pseudomembranous colitis / 대한내과학회지

No abstract available.

Diagnosis of Clostridium difficile-associated diarrhea / 대한내과학회지

Clostridium difficile-associated diarrhea (CDAD) has been one of common nosocomial infections associated with previous antibiotic use. Early diagnosis and adequate management of CDAD is necessary especially for severe cases, however, diagnosis has not been satisfactory. Cytotoxicity assay or toxigenic culture can be considered as a golden standard for diagnosis of CDAD, however, they are labor intensive and require a long time. Instead, a rapid enzyme immunoassay for toxin A and B has been widely utilized in most clinical laboratories. However, its low sensitivity has also been a limitation. Sigmoidoscopy can be helpful in a rapid diagnosis of CDAD for some cases which show negative results in enzyme immunoassay.

The role of flexible sigmoidoscopy in the diagnosis of Clostridium difficile-associated diarrhea / 대한내과학회지

BACKGROUND/AIMS: Clostridium difficile is an important cause of diarrhea in hospitalized patients. C. difficile-associated diarrhea (CDAD) is usually diagnosed following a stool test for C. difficile cytotoxin or stool culture for the presence of toxigenic C. difficile. However, the reported sensitivities of these tests are variable. Sigmoidoscopy may be an effective diagnostic method in patients with a false-negative stool test for cytotoxin. This study examined the role of flexible sigmoidoscopy in the diagnosis of CDAD. METHODS: Among the patients who had diarrhea and were examined with sigmoidoscopy in Eulji University Hospital between January 2005 and July 2008, 102 patients suspected of having antibiotic-associated diarrhea (AAD) based on their clinical symptoms were enrolled. Of the 102 patients, 74 were diagnosed with CDAD based on C. difficile cytotoxin or sigmoidoscopic findings of pseudomembranous colitis. The medical records of these 74 patients were reviewed retrospectively. RESULTS: Of the 74 patients, sigmoidoscopic findings revealed a pseudomembrane in 63 patients (85.1%) and colitis in nine (12.2%), while two patients (2.7%) appeared normal. Of the 63 patients with pseudomembranous colitis at sigmoidoscopy, the stool C. difficile cytotoxin assay was negative in 27 (42.9%). CONCLUSIONS: Flexible sigmoidoscopy was highly sensitive in pseudomembranous colitis and is useful in diagnosing patients with a delayed or negative stool test for C. difficile cytotoxin. Therefore, we recommend flexible sigmoidoscopy in patients suspected of having C. difficile-associated diarrhea for the diagnosis of CDAD.

Neoplasias colorretais: aspectos epidemiológicos, endoscópicos e anatomopatológicos - estudo de série de casos / Colorectal neoplasms: epidemiology, endoscopy and histopathology aspects - a study of series of cases

O carcinoma colorretal (CCR), segunda neoplasia mais frequente na população mundial, apresenta alta incidência.Há diferença significativa nos resultados do tratamento precoce, justificando esforços para rastreamento,prevenção e detecção precoce. Em estudo descritivo de série de casos, no período de janeiro de 2002 a dezembrode 2006, aspectos epidemiológicos, endoscópicos e anatomopatológicos das lesões polipóides e neoplasiascolorretais são descritos. O papel da colonoscopia na prevenção e detecção precoce do CCR é avaliado. Foram realizadas 1962 colonoscopias em 1491 indivíduos, dos quais 408 foram considerados para fins de análise,sendo 70% assintomáticos. A prevalência de neoplasias colorretais foi de 50% em homens e de 42,4% em mulheres e foi detectada em 48% dos indivíduos com 50 anos ou mais. Nas 408 pessoas foram realizadas 679colonoscopias; 959 lesões polipóides foram extirpadas, das quais 463 (48,3%) eram neoplásicas, incluindo 13 adenocarcinomas. Displasia foi detectada em 36% das lesões menores que 5 mm. No cólon proximal, 21% daslesões eram neoplásicas e 2% neoplasias avançadas, incluindo seis casos de adenocarcinoma sem evidência delesão em cólon distal. Dentre os 232 indivíduos que apresentavam lesões neoplásicas (benignas e/ou malignas avançadas), 130 (56%) eram apenas no cólon proximal. Em rastreamento apenas com a retossigmoidoscopia, aausência de diagnóstico de lesões neoplásicas benignas seria de 62,3% nas mulheres (76 casos) e de 48,3% nos homens (29 casos). Em relação ao adenocarcinoma, a falta de diagnóstico seria de 50% para ambos os sexos.Por possibilitar a identificação e a remoção das lesões neoplásicas, a colonoscopia configura-se como método que permite interferir diretamente na história natural desta forma de câncer.

Colorectal carcinoma (CRC), the second most frequent malignancy worldwilde, , has high incidence andvariable response to treatment, which justifies efforts targeting prevention, screening, and early detection.This is a descriptive case series, from January 2002 to December 2006, in which the epidemiologic, endoscopicand histopathological features of colorectal polypoid and neoplastic lesions are described. The role ofcolonoscopy in the prevention and early detection of CRC is assessed. 1,962 colonoscopies were performed in1,491 individuals. In this analysis, 408 subjects (70% asymptomatic) were enrolled; 50% of the men, 42.4%of the women, and 48% of all those aged 50 years or above had colorectal neoplastic disorders. The 408individuals underwent 679 colonoscopies, and 959 polypoid lesions were removed. There were 463 (48.3%)neoplastic lesions, including 13 adenocarcinomas. Dysplasia was detected in 36% of lesions smaller than5 mm. In the proximal colon, 21% of the lesions were neoplastic, and 2% advanced neoplastic, includingsix cases of adenocarcinoma without evidence of involvement of the distal colon. Of the 232 individualswith neoplastic lesions (benign and/or advanced), 130 (56%) had lesions in the proximal colon only. On rectosigmodidoscopy screening, benign neoplastic lesions would be missed in 76(62.3%) women and 29(48.3%)men. As for adenocarcinoma, 50% of the lesions would be missed in both genders. Because of the possibility to identify and remove neoplastic lesions, colonoscopy is a method which should be employed in order directlyinterfere with the natural history of this cancer.

Dietary Intake of Calcium and Distal Colorectal Adenomatous Polyps in Korean Adults / 가정의학회지

BACKGROUND: Colorectal cancer is fourth in prevalence of carcinoma and fourth most cause of death from malignant neoplasm, which has been increasing in Korea. In this study, we tried to investigate the association of dietary intake of calcium and distal colorectal adenomatous polyps known as precursors of colorectal cancer. METHODS: A total of 2,456 subjects who visited a health promotion center in one university hospital in Seoul, Korea, from June 2003 to June 2006 underwent sigmoidoscopy and completed a 24-hour dietary recall. RESULTS: Among the selected 2,408 subjects, the prevalence of distal colorectal adenoma found in sigmoidoscopy was 12.54%. After adjusting for age and total serum cholesterol by multiple logistic regression, the odds ratio of the male subjects who had the highest quintile of dietary intake of calcium was 0.512 (95% CI: 0.305-0.859; P = 0.011) compared with the lowest. CONCLUSION: In male subjects with the highest quintile of dietary calcium density was associated with a low risk of distal colorectal adenomatous polyps.

A study on the clinical courses, sigmoidoscopic and histologic findings of allergic proctocolitis / 소아과

PURPOSE: Allergic proctocolitis is a major cause of bloody stool in early infancy. This study was aimed at ascertaining the clinical courses, sigmoidoscopic and histologic findings of allergic proctocolitis. We also analyzed the relationship between peripheral eosinophilia, the age at symptom onset, and sigmoidoscopic and histologic findings. METHODS: We reviewed 25 infants retrospectively who had sigmoidoscopy and biopsy performed with a clinical diagnosis of allergic proctocolitis from April 2003 to April 2007. RESULTS: The mean age at symptom onset was 15.2+/-13.2 weeks. Fourteen infants (56.0%) were breast fed, one (4.0%) was formula fed, six (24.0%) were on combined formula, and four (16.0%) were on a weaning diet. Peripheral eosinophilia (> or =250/mm3) was seen in eighteen infants (75.0%), but total serum IgE was increased only in six (24.0%). Sigmoidoscopic findings were variable from normal (8.0%), erythema or edema (20.0%), lymphoid hyperplasia (8.0%), erosion (12.0%), hemorrhage and ulcer (4.0%) to lymphoid hyperplasia with erosion, hemorrhage, or ulcer (48.0%). Histologic findings showed focal infiltration of eosinophils in lamina propria (96.0%) and crypt epithelium (96.0%). In twenty four infants (96.0%), the number of eosinophils in mucosa was increased by a more than 60/10 high power field. There was a negative correlation between peripheral eosinophilia and the age at symptom onset. Among the twelve breast fed infants, bloody stool disappeared in ten (83.0%) with a maternal elimination diet of major food groups, but two improved spontaneously. CONCLUSION: Allergic proctocolitis should be considered as one of the major causes of bloody stool in healthy appearing infants. To confirm the diagnosis it is necessary to perform sigmoidoscopy and biopsy but histologic findings are more informative than sigmoidoscopic findings. Peripheral eosinophilia was prominent in the infants with an early onset of symptoms. Most infants experienced benign courses and recovered with the elimination of causative foods but did not need exclusive food restrictions.

Câncer Colorretal Rastreamento, prevenção e controle / Colorretal cancer-screening, prevention and control

O câncer colorretal (CCR) é a segunda neoplasia mais freqüente na população mundial. A alta incidência desse tipo de câncer e a diferença nos resultados do tratamento desta neoplasia, de acordo com o estádio da doença, justificam os esforços para o rastreamento, prevenção e detecção precoce. O objetivo desse estudo foi realizar uma revisão atualizada sobre a incidência de CCR e as estratégias de rastreamento de pólipos e CCR. Concluímos que no Brasil, apesar da importância da prevenção e do diagnóstico precoce do CCR, bem como da existência de estatísticas irrefutáveis do benefício dos exames de rastreamento, existem diversos determinantes nacionais que dificultam a realização de uma efetiva política preventiva em saúde pública para o CCR. Como conseqüência, no Brasil existe atraso do diagnóstico e do tratamento das lesões, que em geral são diagnosticadas em estádios avançados, complexos, demandando internações prolongadas e associados a altos índices de mortalidade.

Colorectal cancer is the second most frequent cancer in the world population. The high incidence of this type of cancer and the difference in the results of the treatment of cancer, according to the stage of disease justify the efforts for screening, prevention and early detection. The aim of this study was to conduct an updated review on the incidence of colorectal cancer and strategies of screening for polyps and colorectal cancer. We conclude that in Brazil, despite the importance of prevention and early diagnosis of the colorectal cancer, as well as the existence of irrefutable statistics of the benefit of screening examinations, there are several crucial national stumbling blocks as for an effective public health preventive policy for the colorectal cancer. As a result, in Brazil there is a delay of diagnosis and treatment lesions being generally diagnosed at advanced stages, with consequent longer hospital stay and higer mortality rates.

A Case of Primary Syphilis in the Rectum

A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.

Sensitivity of Two-Time Immunochemical Fecal Occult-Blood Testing with Sigmoidoscopy for the Detection of Advanced Colon Adenoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Because detection and removal of colonic adenoma provided an opportunity to prevent colorectal cancer, advanced adenoma (>10 mm, villous or high grade dysplasia) should be the major target of screening. In this study, we assessed the diagnostic sensitivity of one- or two-time immunochemical fecal occult blood test (i-FOBT), flexible sigmoidoscopy and their combination in patients with advanced adenoma or non-advanced adenoma. MEHTODS: From January to October 2002, we performed colonoscopy with i-FOBT using latex agglutination method in 879 individuals. Among these, we diagnosed 234 polyps in 93 patients with advanced adenoma and 179 polyps in 109 patients with non-advanced adenoma. After the diagnosis of adenoma, second i-FOBT was done before polypectomy. Based on these data, we evaluated the diagnostic sensitivities of i-FOBT, flexible sigmoidoscopy and their combination for patients with advanced adenoma or non-advanced adenoma. RESULTS: The diagnostic sensitivity of one- or two-time i-FOBT, flexible sigmoidoscopy and flexible sigmoidoscopy with two-time i-FOBT in patients with advanced adenoma vs.non-advanced adenoma were 17.2% vs. 18.3%, 28.0% vs. 29.4%, 70.1% vs. 66.1% and 81.7% vs. 78.0%. Although repeated application of i-FOBT enhanced diagnostic sensitivity for colon adenoma, this test or combination with flexible sigmoidoscopy did not differentiate advanced adenoma from non-advanced adenoma. CONCLUSIONS: Although it fails to detect one fifth of colon adenoma, combined two-time i-FOBT testing with flexible sigmoidoscopy is an effective and feasible screening modality for advanced colon adenoma.

A Case of Anorectal Actinomycosis / 대한소화기내시경학회지

Actinomycosis is an indolent, slowly progressive infection caused by actinomyces species that normally colonize the mouth, colon, and vagina, characterized by sulfur granule formation. Actinomycosis can affect multiple organs, with local or systemic manifestations. The abdomen is involved in less than 20% of the cases with the ileocecal area being the site most frequently affected. The anorectal region is less frequently involved. We report a case of anorectal actinomycosis, which was diagnosed by histologic study of sigmoidoscopic biopsy. The patient was a 40-year-old man who took immunosuppressive agents after kidney transplantation. Adequate surgical excision was done, being followed by administration of massive dose of a penicillin.

The Efficacy of Computed Tomography in the Staging of Carcinoma of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The authors have aimed to compare the efficacy of the computed tomography with other study methods, and to investigate if replacement by computed tomography is possible METHODS: From January 1998 to December 2002, 203 cervical cancer patients underwent pre-staging studies including computed tomography. The positive predictive values, negative predictive values, sensitivity, specificity of each method of study were compared. RESULTS: 1. Compared computed tomography with intravenous pyelonephrography. Each values of computed tomography for hydronephrosis or non visualization of kidney were sensitivity 91.7%, specificity 97.8%, positive predictive values 84.6%, negative predictive values 98.9%. 2. Compared computed tomography with cystoscopy. Each values of computed tomography for bladder invasion were sensitivity 90%, specificity 95.8%, positive predictive values 52.9%, negative predictive values 99.4%. 3. Compared computed tomography with sigmoidoscopy. Each values of computed tomography for rectal invasion were sensitivity 80%, specificity 94.4%, positive predictive values 26.6%, negative predictive values 99.4%. CONCLUSION: Rather than routine examination for staging of invasive cervical cancer in all patients, it is more ideal to first take a non invasive technique. then perform on intravenous pyelonephrography, cystoscopy and sigmoidoscopy only in patient showing positive findings of hydronephrosis or non visualization of kidney, bladder or rectal invasion on computed tomography.