Bacteriologic Study and Antibiotics Sensitivity of Acute Appendicitis Treated with Laparoscopic Appendectomy

PURPOSE: This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivity in acute appendicitis. METHODS: The microbiologic culture and antibiotics sensitivity tests were done on 165 patients who underwent laparoscopic appendectomy under the diagnosis of acute appendicitis. The postoperative complications were also checked. The microbiologic and clinical results were compared between perforated and non-perforated groups. RESULTS: The most common organism cultured from the periappendiceal fluid was Escherichia coli (51.2%), followed by Enterobacter (16.2%) and Pseudomonas (8.9%). In the antibiotics sensitivity test, ciprofloxacin and levofloxacin were highly susceptible. Ceftriaxone and cefotaxime were also highly susceptible. Piperacillin/tazobactam, imipenem and meropenem were very highly susceptible. The complication rate of perforated appendicitis group (17.9%) was higher than that of the non-perforated appendicitis group (7.1%) (P<0.001). A surgical drain was used more frequently in perforated group (23% vs 84.6%, P<0.001). The mean in-patient days were longer in the perforated group (5.7 vs 7.2 days, P<0.001). In the patients with infectious wound complication, antibiotic resistance was more prominent in the non-perforated group than in the perforated group. CONCLUSION: In the perforated appendicitis group, more precise and careful procedure was required. In the non-perforated appendicitis group, more prudent use of the available antibiotics to conserve valuable therapeutic resources and improved infection control to limit the spread of resistant organisms was required.

The Significance of the Lymphatic Micro Vessel Density and Vascular Endothelial Growth Factor- C Expression for Colorectal Cancer

PURPOSE: Studying the prognostic factors of distant metastasis is quite important for predicting these patients' prognosis and also for providing standards for post-operative adjuvant chemotherapy. Microbiological studies currently enable researchers to look for new predictors of distant metastasis in patients with colon cancers. In this study, the VEGF-C expression and stain rate of D2-40 were investigated as prognostic factors. METHODS: 79 Specimens were collected from the patients who underwent colorectal operation and they were pathologicaly diagnosed with cancer at Chung-Ang University hospital from March, 2003 to Sept. 2005. The specimens were immunohistochemically stained to detect the VEGF-c expression and the D2- 40 stain rate. RESULTS: The VEGF-C expression was related to lymph node metastasis, tumor embolism and the frequency of the T- stage, but it was not related to progression of cancer. The D2-40 stained lymphatic density was significantly increased in the cases with lymph node metastasis and in the tumor embolism cases; furthermore, the density became higher in relation to the increased T-stage and progression of cancer. CONCLUSION: The VEGF-C expression and lymphatic vessel density appear to be prognostic factors for colon cancer.

Immunohistochemical Expression of p53 Protein and CREB-binding Protein in Polyps and Adenocarcinomas of Colon

Purpose: Alterations in the structure of the p53 protein are one of the most common changes associated with human cancers. The CREB-binding protein(CBP) is a transcriptional co-activators of various sequence-specific DNA-binding transcription factors and is involved in a wide variety of cellular activities, such as DNA repair, cell growth, differentiation, and apoptosis. This article examined the expression levels of the p53 protein and CBP as well as their diagnostic value in a biopsy sample. METHODS: Immunohistochemical analysis were performed in 60 hyperplastic polyps, 180 adenomatous polyps, and 120 adenocarcinomas which had sampled from colono-fibroscopic exam from January 2000 to August 2003. RESULTS: 1. p53 protein expression was observed in 15% (9/60) of hyperplastic polyps, in 68.9% (124/180) of adenomatous polyps, and in 80% (96/120) of adenocarcinomas (P<0.01). 2. p53 protein expression according to the cellular atypia in the adenomatous polyp was observed in 45% (27/ 60) of mild dysplasia, 78.3% (47/60) of moderate dysplasia, and 83.4% (50/60) of severe dysplasia. There was an increasing tendency in high grade dysplasia, which is statistically significant (P<0.05). 3. p53 protein expression according to the level of differentiation was observed in 90% (54/60) of well differentiated adenocarcinomas, 78% (39/50) of moderately differentiated adenocarcinomas, and 30% (3/ 10) of poorly differentiated adenocarcinomas (P<0.01). 4. CBP expression was observed in 30% (18/60) of hyperplastic polyps, 70.6% (127/180), of adenomatous polyps, and 85% (102/120) of adenocarcinomas (P<0.01). 5. CBP expression according to cellular atypia in adenomatous polyp was observed in 48.3% (29/60) of mild dysplasia, 76.6% (46/60) of moderate dysplasia, and 86.7% (52/60) of severe dysplasia (P<0.05). 6. CBP expression according to cellular differentiation was observed in 90% (36/60) of well differentiated adenocarcinomas, 86% (43/50) of moderately differentiated adenocarcinomas, and 50% (5/10) of poorly differentiated adenocarcinomas (P<0.05). Conclusion: The p53 protein and CBP expression can indicate the malignant potentiality of the colon cell indirectly.