The current status of hormone treatment for prostate cancer patients in Korean real-world practice: a multi-institutional observational study / 亚洲男科学杂志(英文版)

We aimed to evaluate the current nationwide trend, efficacy, safety, and quality of life (QoL) profiles of hormone treatment in real-world practice settings for prostate cancer (PCa) patients in Korea. A total of 292 men with any biopsy-proven PCa (TanyNanyMany) from 12 institutions in Korea were included in this multi-institutional, observational study of prospectively collected data. All luteinizing hormone-releasing hormone (LHRH) agonists were allowed to be investigational drugs. Efficacy was defined as (1) the rate of castration (serum testosterone ≤50 ng dl-1) at 4-week visit and (2) breakthrough (serum testosterone >50 ng dl-1 after castration). Safety assessments included routine examinations for potential adverse events, laboratory tests, blood pressure, body weight, and bone mineral density (BMD, at baseline and at the last follow-up visit). QoL was assessed using the Expanded Prostate Cancer Index Composite-26 (EPIC-26). The most common initial therapeutic regimen was LHRH agonist with anti-androgen (78.0%), and the most commonly used LHRH agonist for combination and monotherapy was leuprolide (64.0% for combination and 58.0% for monotherapy). The castration and breakthrough rates were 78.4% and 6.6%, respectively. The laboratory results related to dyslipidemia worsened after 4 weeks of hormone treatment. In addition, the mean BMD T-score was significantly lower at the last follow-up (mean: -1.950) compared to baseline (mean: -0.195). The mean total EPIC-26 score decreased from 84.8 (standard deviation [s.d.]: 12.2) to 78.3 (s.d.: 8.1), with significant deterioration only in the urinary domain (mean: 23.5 at baseline and 21.9 at the 4-week visit). These findings demonstrate the nationwide trend of current practice settings in hormone treatment for PCa in Korea.

Pseudobacteremic Outbreak of Leclercia adecarboxylata and Pseudomons aeruginosa Related to Contaminated Saline Cotton / 병원감염관리

BACKGROUND: During a 1-month period in 2005 , a series of 4 Leclercia adecarboxylata and 8 Pseudomonas aeruginosa bacteremias were reported from patients admitted to the emergency room. METHODS: An outbreak of L. adecarboxylata and P. aeruginosa bacteremia that occurred from February to March 2005 was investigated. The infection control nurse reviewed medical records and observed the procedures of blood cultures at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from alcohol sponge, tray, sink, water of sink, saline cotton, microscope, computer, and telephone. RESULTS: L. adecarboxylata was isolated from 4 patients and P. aeruginosa from 8 patients during a 1-month period. Observation of the culture procedure revealed that saline cotton was used to prevent betadin skin discoloration. The culture of the saline solution yielded a heavy growth of P. aeruginosa, which was not isolated from any other specimens. CONCLUSIONS: This was a pseudoepidemic caused by contaminated saline cotton. The use of the saline cotton was stopped, and during the follow-up period of 3 months, no additional L. adecarboxylata or P. aeruginosa bacteremia were reported.

Atypical Pathogens as Etiologic Agents in Hospitalized Patients with Community-Acquired Pneumonia in Korea: A Prospective Multi-Center Study

Local epidemiologic data on the etiologies of patients hospitalized with community-acquired pneumonia (CAP) is needed to develop guidelines for clinical practice. This study was conducted prospectively to determine the proportion of atypical bacterial pathogens in adults patients hospitalized with CAP in Korea between October 2001 and December 2002. Microbiological diagnosis was determined by serology for antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneu-mophila. Nucleic acid of M. pneumoniae and C. pneumoniae in respiratory samples and Legionella antigen in urine samples were detected. The study population consisted of 126 patients (71 males, 55 females), averaging 54.6 yr (SD+/-17.8), whose paired sera were available. An etiologic diagnosis for atypical pathogens was made in 18 patients (14.3%): C. pneumoniae 9 (7.1%), M. pneumoniae 8 (6.3%), and L. pneumophila 3 patients (2.4%). Streptococcus preumoniae and other typical pathogens were isolated from 36 patients (28.6%). Of 126 patients, 16 (12.7%) were admitted to intensive care unit and atypical pathogens were identified in 5 patients (31.3%). Initial clinical features of patients with pneumonia due to atypical, typical or undetermined pathogens were indistinguishable. We conclude that atypical pathogens should be seriously considered in hospitalized patients with CAP, when initiating empiric treatment in Korea.

Epidemiology of Hemorrhagic Fever with Renal Syndrome in Endemic Area of the Republic of Korea, 1995-1998

We conducted an epidemiologic study to understand temporal and spatial patterns of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Korea (ROK). We estimated the incidence among civilians in endemic areas through the active surveillance system during the major epidemic periods, from September to December, between 1996 and 1998. We also estimated the prevalence among Korean military personnel from 1995 to 1998. In addition, we assessed seroprevalence, subclinical infection rate, and vaccination rates in both civilians and military personnel. The incidence in civilians ranged from 2.1 to 6.6 per 100, 000 person-months. The annual prevalence in the military personnel was 40-64 per 100, 000 military populations, and remained generally constant throughout the study period with seasonal variation. This is the prospective epidemiologic data set on HFRS in the ROK since the inactivated Hantaan virus vaccine was licensed for use in the late 1990s. These results will be invaluable in establishing a national immunization program against HFRS.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003 / 감염과화학요법

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

Community-acquired Pneumonia in Elderly: Comparison of Clinical Manifestations and Causative Organisms before and after the Separation of Prescription and Drug-Selling / 감염과화학요법

INTRODUCTION: Community-acquired pneumonia is a common infectious disease in the elderly patients with high mortality. We studied to see if there were any differences in clinical manifestations and etiologies, and antibiotic-resistance in etiologic pathogens before and after the Separation of Prescription and Drug-selling. METHODS: We reviewed medical records of the elderly patients (> or =65 years-old of age) with CAP who visited Korea University Guro hospital. 119 patients (from Jan. 1994 to Dec. 1997) before the separation and 107 patients (from Dec. 2000 to Aug. 2003) after the separation were reviewed. Clinical manifestations, etiologies, and antibiotic resistance of pathogens were compared. RESULTS: The percentage of patients who has taken some antibiotics before coming to our hospital decreased after the Separation of Prescription and Drug-Selling. There were no differences in symptoms except for altered mental status which were more common before the separation. The average duration of hospital stay, complications and mortality showed no significant differences. S. pneumoniae, S. aureus, and K. pneumoniae were the main pathogens in both groups. Antibiotic susceptibility test results of S. pneumoniae, K. pneumoniae, P. aeruginosa were compared. Resistant pathogens were somewhat decreased after the Separation but there was no statistical significance. CONCLUSION: After the separation of Prescription and Drug-Selling, antibiotic use among elderly CAP patients before coming to the hospital decreased. Causative organisms were not changed. Antibiotic resistance improved a little but there was no statistical significance.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003 / 감염과화학요법

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

Community-acquired Pneumonia in Elderly: Comparison of Clinical Manifestations and Causative Organisms before and after the Separation of Prescription and Drug-Selling / 감염과화학요법

INTRODUCTION: Community-acquired pneumonia is a common infectious disease in the elderly patients with high mortality. We studied to see if there were any differences in clinical manifestations and etiologies, and antibiotic-resistance in etiologic pathogens before and after the Separation of Prescription and Drug-selling. METHODS: We reviewed medical records of the elderly patients (> or =65 years-old of age) with CAP who visited Korea University Guro hospital. 119 patients (from Jan. 1994 to Dec. 1997) before the separation and 107 patients (from Dec. 2000 to Aug. 2003) after the separation were reviewed. Clinical manifestations, etiologies, and antibiotic resistance of pathogens were compared. RESULTS: The percentage of patients who has taken some antibiotics before coming to our hospital decreased after the Separation of Prescription and Drug-Selling. There were no differences in symptoms except for altered mental status which were more common before the separation. The average duration of hospital stay, complications and mortality showed no significant differences. S. pneumoniae, S. aureus, and K. pneumoniae were the main pathogens in both groups. Antibiotic susceptibility test results of S. pneumoniae, K. pneumoniae, P. aeruginosa were compared. Resistant pathogens were somewhat decreased after the Separation but there was no statistical significance. CONCLUSION: After the separation of Prescription and Drug-Selling, antibiotic use among elderly CAP patients before coming to the hospital decreased. Causative organisms were not changed. Antibiotic resistance improved a little but there was no statistical significance.

Right Lower Quadrant Pain in Patients with Acute Myeloid Leukemia

PURPOSE: Acute appendicitis and typhlitis are difficult problems in acute myeloid leukemia (AML) patients. Whereas the treatment of typhlitis is primarily conservative, acute appendicitis is managed by surgery. The difficulty lies in distinguishing between the two becauae they both present similar conditions, and before surgery or autopsy, differentiation of these disease is nearly impossible. Careful evaluation is necessary before considering surgical treatment. In order to determinate proper treatment, we have reviewed our experiences with the right lower quadrant (RLQ) abdominal pain in patients with AML. METHODS: From July 1990 to December 2001, at St. Mary's hospital, Seoul, Korea, the records of AML patients that were consulted to the surgical department for RLQ abdominal pain were reviewed. Thirty patients were consulted and 12 out of the 30 patients underwent surgery. RESULTS: The average age of the patients who underwent operation was 33.9, with 9 males and 3 females. Six patients were in complete remission, and the other 6 were in the active state. RLQ pain was the first symptom of AML in four patients. All 12 patients had RLQ pain and 10 had rebound tenderness. In three patients, the white blood cell (WBC) count was less than 1, 000/mm3. Appendectomy was performed in five patients, appendectomy with drainage was performed in five, and laparoscopic appendectomy was performed in two patients. The final diagnosis was periappendicial abscess in four cases, leukemic cell infiltration in three cases, adenocarcinoma in one case, and typhlitis in three patients. Four patients developed wound infection and one patient died due to sepsis 7 days after the operation. For the patients who were treated medically, the average age was 36, with 11 males and 7 females. Seven patients were in the active state, three patients were in CR, four patients were in the refractory state, and two patients were in relapse. Six patients died within one month because of sepsis or pneumonia. CONCLUSION: Surgery is safe and is the sole method that can improve the survival rate in patients with AML and RLQ abdominal pain. Furthermore, complications related to surgery may be reduced through the laparoscopic surgery.

A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient / 감염과화학요법

Invasive aspergillosis of skull base is a rare but potentially lethal disease which complicates fungal sinusitis and requires surgical debridement, and long term antifungal therapy. However, optimal duration of antifungal therapy and standard method to monitor of clinical response are not known. A 55-year-old diabetic female patient presented with headache and otalgia 4 months after surgery for non-invasive aspergilloma of sinus. Brain MRI findings revealed bone destructions at the skull base and mastoid process. Mastoidectomy and tympanoplasty were performed, and the resected specimen showed fungal hyphae invading the tissue. Amphotericin B was given for 9 weeks (a total dose of 3.3 g) with oral itraconazole, followed by itraconazole (400 mg daily) alone for another 12 weeks. Serial gallium scans, taken before treatment and at 8th and 16th weeks following therapy, showed gradual reduction in uptake of the lesions. We emphasize that non-invasive Aspergillus sinusitis may progress to invasive disease, and strong suspicion of invasiveness is mandatory, especially in immunocompromised patients including diabetes mellitus. Also, we suggest that gallium scan is useful for determining the presence and extent of the disease, and monitoring clinical response following therapy.

A Case of Relapsed Subarachnoid Racemose Cysticercosis Successfully Treated with Albendazole / 감염과화학요법

The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.

A Case of Invasive Aspergillosis of Skull Base in a Diabetic Patient / 감염과화학요법

Invasive aspergillosis of skull base is a rare but potentially lethal disease which complicates fungal sinusitis and requires surgical debridement, and long term antifungal therapy. However, optimal duration of antifungal therapy and standard method to monitor of clinical response are not known. A 55-year-old diabetic female patient presented with headache and otalgia 4 months after surgery for non-invasive aspergilloma of sinus. Brain MRI findings revealed bone destructions at the skull base and mastoid process. Mastoidectomy and tympanoplasty were performed, and the resected specimen showed fungal hyphae invading the tissue. Amphotericin B was given for 9 weeks (a total dose of 3.3 g) with oral itraconazole, followed by itraconazole (400 mg daily) alone for another 12 weeks. Serial gallium scans, taken before treatment and at 8th and 16th weeks following therapy, showed gradual reduction in uptake of the lesions. We emphasize that non-invasive Aspergillus sinusitis may progress to invasive disease, and strong suspicion of invasiveness is mandatory, especially in immunocompromised patients including diabetes mellitus. Also, we suggest that gallium scan is useful for determining the presence and extent of the disease, and monitoring clinical response following therapy.

A Case of Relapsed Subarachnoid Racemose Cysticercosis Successfully Treated with Albendazole / 감염과화학요법

The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.

Laparoscopic Appendectomy is Feasible for All Forms of Appendicitis

PURPOSE: Acute gangrenous and perforated appendicitis are associated with an increased risk for intraoperative conversion, postoperative complications and have been considered a relative contraindication for laparoscopic appendectomy. The objective of this study was to analyze the feasibility of the laparoscopic approach in all forms of appendicitis. METHODS: A retrospective review of 101 patients who underwent laparoscopic appendectomy for uncomplicated and complicated appendicitis (perforated appendicitis and periappendiceal abscess) between June 2000 and May 2001 was performed. RESULTS: There were 84 patients with uncomplicated appendicitis (group A), 11 patients with perforated appendicitis (group B) and 16 patients with periappendiceal abscess (group C). The mean age of the patients was 42 (12~79) years and there were 47 men and 54 women. The mean operation time was 43, 67 and 105 minutes in groups A, B and C, respectively. Oral intake commenced at 1.4, 2.2 and 2.9 days and the hospital stay was 2.5, 2.9 and 5.2 days in groups A, B and C, respectively. There was no conversion to open surgery in groups A and B; however 4 patients in group C were converted. Complications were noted in 3 patients, one for each group. The overall complication rate was 2.9% and conversion rate, 0.9%. CONCLUSION: Although our experience is limited, the laparoscopic appendectomy seems to be a feasible and safe procedure for all forms of apppendicitis, including periappendiceal abscess.

Clinical Analysis of Laparoscopic Adhesiolysis

PURPOSE: Laparoscopic management of intestinal obstruction is hypothetically attractive, However little is known about this procedure in our country. With new advances in diagnostic and therapeutic tools such as laparoscopic procedures, the management of intestinal obstruction has become feasible. METHODS: In order to analyze the clinical results of laparoscopic adhesiolysis, a retrospective review of a consecutive series of 20 cases of intestinal obstruction unresponsive to medical management was done between 1997 and 2000. RESULTS: The mean surgical time for the laparoscopic procedure was 75 min and two cases were converted to open surgery due to dense adhesion and intestinal strangulation. The characterization of adhesion type included 10 cases with simple fibrotic band, 4 cases with multiple fibrotic band and 5 cases with dense adhesion. Additionally, the most common site for adhesion was the small intestine and colon (12 cases). The mean diet start time was 2.3 days, mean hospital stay was 4.7 days and totally mean analgesic use was 1.6 times. CONCLUSION: Laparoscopic management of adhesive bowel obstruction is feasible and safe in experienced hands. The laparoscopic procedure also is an excellent diagnostic modality in case of obstruction, and the majority of these cases can be simultaneously managed laparoscopically. A laparoscopic approach is recommend as a first choice of treatment for selective cases of intestinal adhesion.

Usefulness of Circumsporozoite Protein Genotype-Specific PCR (Polymerase Chain Reaction)-Hybridization Assay for Diagnosis of Vivax Malaria / 감염

BACKGROUND: Molecularornucleicacid-based method has been developed for diagnosis as well as epidemiological studies of malaria infection recent years. We developed and evaluated a polymerase chain reaction (PCR)-hybridization assay for its usefulness in diagnosis and genotyping of vivax malaria resurged in South Korea. METHODS: Blood samples were collected from 30 patients diagnosed as vivax malaria and 48 patients with other diseases. The circumsporozoite protein (CSP) gene fragment of Plasmodium vivax was amplified by PCR and hybridized with genotype (VK210 or VK247)-specific oligonucleotide probes. The performance of the assay was evaluated and compared with that by a commercially available immunochromatographic test (ICT; AMRAD, Australia). RESULTS: Twenty-five out of thirty P. vivax-positive blood samples were positive for the PCR-hybridization assay. All products amplified were hybridized only with the VK210-specific probe and showed size polymorphism with approximately 900~ and 865 bp, suggesting of genetic variations of CSP gene. Based on the results of Giemsa-stained blood smear, comparative analysis of test performance demonstrated that sensitivities of the PCR-hybridization assay and ICT were 83.3% and 73.3%, respectively and no false positive results were found. The ktest ratio of two tests yielded results of 0.91 with excellent correlation. CONCLUSOIN: The study suggested that vivax malaria resurged in South Korea has the VK210 genotype of CSP with presence of genetic variants, and that the PCR-hybridization assay is useful for diagnosis as well as genotyping of vivax malaria.

Clinical Study of Mucinous Colorectal Carcinoma

PURPOSE: The clinical influences of mucinous colorectal carcinomas are still controversial. Some previous reports have suggested that mucinous carcinomas of colorectum affect more young patients, involve the more proximal colon, are more advanced at diagnosis, show increased incidence of local and distant metastasis, and have a worse prognosis than adenocarcinoma. We evaluated the clinicopathological aspect of mucinous colorectal carcinoma. METHODS: A retrospective review of colorectal cancer patients treated between January 1990 and December 1998 was undertaken. Eight-hundred-fifty patients were operated for colorectal cancer during the period, among them seven- hundred-eighty-two patient records were available for this study. Sixty-two patients (7%) could be classified as mucinous carcinoma as defined by more than 50% of mucin- secreting pattern on histological examination. The age and sex distribution, primary location of tumor, modified Dukes' classification at diagnosis, recurrence rates and 5-year survival of mucinous carcinoma patients were compared with those of adenocarcinoma patients. Survival was calculated according to Kaplan-Meyer, and the differences were compared using the log-rank test. RESULTS: The sex ratio of mucinous carcinoma was 2.05: 1, whereas 1.32: 1 in adenocarcinoma. The age distribution of mucinous carcinoma showed orderly 60s (30.7%), 50s (17.7%), 40s (17.7%) similar to adenocarcinoma. The sites of the mucinous carcinoma were 22 (35.5%) in the rectum, 21 (33.9%) in the right colon, 6 (9.7%) in the transverse colon, whereas for adenocarcinoma 250 (37.0%) in the rectum, 137 (20.3%) in the sigmoid colon, 114 (16.9%) in the ascending colon. The stage of primary tumor at diagnosis was as follows: In mucinous carcinoma, 5 stage B1 (8.1%), 13 B2 (21.0%), 33 C2 (53.2%), 11 D (17.7%). In adenocarcinoma, 20 stage A (3.0%), 61 B1 (9.0%), 210 B2 (31.1%), 15 C1 (2.2%), 250 C2 (37.0%), 120 D (17.7%). Three-year and five-year disease free survival rates were similar, but slightly higher in patients with adenocarcinomas. Mean survival time was also similar, 45.5+/-38.1 months in the mucinous carcinoma group and 45.6+/-33.4 months in the adenocarcinoma. Five-year survival was 65.6% and 68.1% in patients with mucinous carcinomas and adenocarcinomas, respectively; but the difference was not statistically significant. The recurrence rates were 41.9% and 22.3% in patients with mucinous carcinoma and adenocarcinoma, respectively with statistical significance (P<0.005). Local recurrence was more frequent in the mucinous carcinoma than in the adenocarcinoma significantly. CONCLUSIONS: Our study suggested that mucinous colorectal carcinoma showed decreased survival, although having no statistical significance and increased recurrence rates with statistical significance compared with those of adenocarcinoma. So, we recommend aggresive surgical treatment and careful follow-up in mucinous colorectal carcinoma.

A Case of Recurrent Perianal Paget's Disease

Extramammary Paget's disease is an uncommon intraepithelial carcinoma of the skin and mucosa usually occurring in the anogenital area. Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. Clinical manifestations of perianal Paget's disease include pruritis (most common), irritation, rash, lump sensation and the lesion shows erythematous, crusted or scaly area which may weep clear fluid. Lichenified, leukokeratotic or leukoplakia-like patches may also develop in some patients. These areas may resemble eczema or contact dermatitis. Many authors recommend surgery as the treatment of choice. Extended surgical excision for non-invasive lesion and excision of rectum or abdominoperineal resection for invasive disease is recommended. The prognosis for non-invasive lesion is excellent, but for invasive lesion is poor.We experienced one case of perianal Paget's disease which recurred after wide excision of vulvar area for Paget's disase, and performed secondary abdominoperineal resection. Now, radiation therapy was done for adjuvant therapeutic modality.

The Effects of Selective Gut Decontamination with Ciprofloxacin in Liver Cirrhosis Patients / 감염

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a frequent complication of liver cirrhosis, with prevalence ranging from 5% to 25% during hospitalization. Enteric aerobic gram-negative bacteria are the most common causative organisms of SBP. Long term fluoroquinolone administration to cirrhotic patients reduces the risk of SBP but induces high level resistance to antibiotics. In this study, we compare the incidence, clinical characteristics of SBP and antibiotics-resistance of organisms isolated from ciprofloxacin-treated cirrhotic patients with those in cirrhotic patients not receiving fluoroquinone prophylaxis. METHODS: Retrospective analysis was done. 55 ciprofloxacin-treated patients and 92 control patients were selected from cirrhotic patients, they were followed up in Korea university Guro hospital from August 1994 to July 1998. Clinical and laboratory data were compared in both group. RESULTS: We found a significantly lower incidence of SBP in ciprofloxacin-treated patients [27% (15/55) vs 44% (41/92); P=0.03]. There were no significant difference in admission duration, treatment duration, cure rates and mortality. Gram-negative bacilli, especially E. coli are most frequent bacteria isolated from ascites on both groups (60.0% vs 53.6%). Ciprofloxacin resistant gram-negative bacilli were isolated more frequently in the treated group [50% (5/10) vs 16% (5/31); P=0.03]. Methicillin resistant gram-positive cocci were isolated more frequently in the treated group, also. The therapeutic response of SBP were good in spite of ciprofloxacin resistance (90%). High serum creatinine concentration was independent risk factor for poor prognosis of SBP. CONCLUSION: Selective gut decontamination with long term ciprofloxacin in severe cirrhotic patients reduces incidence and recurrence of SBP, but has no significant influence on clinical features and prognosis of SBP. The prevalence of ciprofloxacin resistant gram-negative bacilli and methicillin resistant gram-positive bacilli increased in ciprofloxacin treated group. These findings should be taken into account when weighting the advantage and disadvantage of selective gut decontamination with ciprofloxacin.

Clinical Analysis of Fournier's Gangrene

PURPOSE: Fournier's gangrene is a rapidly progressive (and aggressive), necrotizing fasciitis of the genitalia and perineum. Despite the use of broad spectrum antibiotics and surgical debridement, morbidity and mortality remain significant. The purpose of this study is to investigate and evaluate the clinical and laboratory characteristics of this disease. METHODS: We reviewed 17 cases of Fournier's gangrene during 10 years from January, 1990 to December, 1999. We retrospectively analyzed these patients and considered several factors, which were age, sex, combined and etiologic factors, symptom and location of infection, duration of admission, operation and its complication, result of bacterial culture and sensitivity of antibiotics, morbidity and mortality. RESULTS: the mean age was 47.4 years with an age range of 3 to 77. The etiologies included unknown (65.7%), anorectal infection (23.5%) and hemorrhoidectomy (11.8%). The combined diseases (predisposing factors) included diabetes mellitus (52.9%), alcohol abuse, steroids or chemotherapy, liver cirrhosis and malignancy. Aggressive surgical debridement with broad spectrum antibiotics therapy was done on 16 patients, 1 patient refused operation. There were 3 colostomy cases, one orchiectomy, one suprapubic cystostomy case. The most common cultured organism was E.coli, 8 cases (53.3%). The mean hospital stay was 32.9 days. 3 patients (17.6%) were died due to sepsis and multiorgan failure. CONCLUSIONS: Our results showed that the early recognition, aggressive debridement of devitalized tissue, antibiotic therapy, search for primary source are considered as the treatment of choice for Fournier's gangrene.