The Significance of Preoperative Stoma Site Marking

PURPOSE: The complication after colostomy formation may place undue hardship and emotional trauma on the ostomates. The purpose of this study was to find the effect of preoperative stoma site marking on postoperative stoma related complication. METHODS: We recruited 127 colostomy patients who underwent sigmoid or descending end colostomy, by elective operation. Transverse colostomy, loop colostomy, and emergency operation were excluded in this study. We divided the patients into two groups according to pre-operative stoma site marking by an enterostomal therapist. Postoperative stoma related complications were compared and analysed prospectively using chi-square test and paired t-test. Significance was assigned to a P value of < 0.05. RESULTS: Among 127 patients, 49 were marked preoperatively (marking group) while 78 were not marked (non- marking group). Overall stoma related complications were developed in 32 (25%) cases. Major complications including prolapse, parastomal hernia, stenosis were developed in 10 (8%) cases and minor complications including peristomal dermatitis and wound infection were developed in 22 (17%) cases. Stoma related complications were developed in 7 (14%) cases in the marking group and 25 (32%) cases in the non-marking group (P<0.05). Major complications were developed in 2 (4%) cases in the marking group and 8 (10%) cases in the non-marking group. Minor complications were developed in 5 (10%) cases in the marking group and 17 (22%) cases in the non-marking group. However, the difference in major and minor complications between the groups was not statistically significant. Of minor complications in the non-marking group, 9 (53%) cases due solely to postoperative frequent stool leakage caused by inappropriate location of the stoma. However, in the marking group, postoperative stool leakage was not observed. CONCLUSIONS: Preoperative stoma site marking by an enterostomal therapist may reduce postoperative stoma related complication. All elective procedure that result in stoma formation should be assessed and marked preoperatively.

Assay of Proliferative Activity, Clonality and Immortality of

Among the precancerous lesions, dysplasia of the uterine cervix and adenoma of the colon have been widely studied in terms of genetic alterations. However, little has been performed regarding phenotypic alterations of the precancerous lesions. We investigated the relationship among cellular proliferation, clonality, immortality and histopathologic grading of the squamous epithelial lesions of the uterine cervix. Proliferation index (PI) was calculated based on the ratio of the epithelial cells positive for proliferating cell nuclear antigen to the total epithelial cells. Clonality was assayed by X-linked HUMARA polymorphism. For immortality assay, PCR-based TRAP (telomeric repeat amplification protocol) was done and telomerase processivity was calculated by comparison with the positive control. PI increased gradually as the lesions advanced from dysplasia to invasive carcinoma. Among informative case, all of the carcinoma in situ showed monoclonal pattern (7 of 7). Among invasive squamous cell carcinoma, 6 cases showed monoclonal pattern and 2 cases polyclonal pattern. TRAP reaction was positive in 92.6% (25 of 27) of dysplasia (high grade: 14 of 15; low grade: 11 of 12), 95.0% (19 of 20) of carcinoma in situ, 100% (9 of 9) of microinvasive carcinoma, and 92.9% (13 of 14) of invasive carcinoma. It was also positive in 12 of 12 samples of chronic cervicitis or squamous metaplasia near the lesions of dysplasia. There was no difference in TRAP positivity among the dysplasia, carcinoma in situ and invasive carcinoma, whereas telomerase processivity showed significant correlation. These results suggest that proliferative activity and telomerase processivity may be progressive events in oncogenesis, although telomerase activation may be an early event.

Report of Two Cases of Hypomelanosis of Vitiligo Type Probably due to Benoquin / 대한피부과학회지

Two cases of vitiligo-type hypomelanosis followed by the local application of Benoquin ointment for the treatment for the treatment of melasma are reported. These two cases of hypomelanosis are unwanted and unintended side effects probably caused by the application of monobenzyl ethers of hydrcquinone (monobenzone). Monobenzone blocks the enzyme tyrosinase and thereby prevents the conversion of tyrosine to dihydroxyphenylanine, a precursor of melanin, and since this does not destroy melanocyte or facilitate the loss of melanin. The skin contact with the material will not occur, repigmentation will slow but eventuaIly complete.