The Diagnosis of Tailgut Cyst in the Setting of Elevated Serum CEA Levels

Tailgut cysts (TGCs) are rare congenital lesions arising from remnants of the postanal gut, which normally involutes by the 8th wk of embryonic development (the 3-8 mm stage). They are usually found in the retrorectal or presacral space. They often present in middle aged women with perirectal symptoms. CEA producing adenocarcinoma from a TGC is extremely rare, but such cases have recently been reported in the literature. The diagnosis has to differentiate between carcinomas of the colorectum, hamartomas, lymphomas, teratomas, chordomas, abscess formation, dermoid cysts, epidermoid cysts and enteral cysts. An elevated level of CEA may point to malignancy, but other causes must be excluded. Complete surgical resection is the therapy of choice. We report here on a case of a tailgut cyst that occurred in a 72-year-old male suffering from pneumoconiosis, and this patients showed unusual findings such as an unusual location and an elevated serum CEA level.

Laparoscopic vs. Conventional Appendectomy in Pregnancy

PURPOSE: The purpose of this study was to evaluate the clinical course and pregnancy outcome according to operative management of appendictis in the Department of Surgery. METHODS: We reviewed the charts of pregnant patients who went through a convential appendectomy and a laparoscopic appendectomy at the Department of Surgery, Catholic University of Korea St. Mary's Hospital, from May 1995 to June 2006. RESULTS: The incidence of acute appendicitis during pregnancy was the highest at the 2nd trimester and at ages from 25 to 30 years. The laparoscopic appendectomy was shorter than the open appendectomy in hospital stay and decreased leukocytosis faster in the first postoperative day, except in cases of perforated appendicitis, but the operation times were similar. There was a significant difference in gestational age at delivery between perforated appendicitis and suppurative. We found one fetal anomaly, but it was not related to either the appendicitis or the operation method. CONCLUSIONS: In this study, we found that a laparoscopic appendectomy was better than an open appendectomy for recovery and was safe in pregnant appendicitis patients at any gestational age. However, follow up and investigation in a larger population is needed to get more accurate results.

Colon Obstruction due to Colonic Metastasis of a Breast Carcinoma

Breast cancer is a common malignancy in women and metastasizes to the liver, the lung, the brain, and the bone, but metastasis to the colon is rare. We describe a 58-year-old woman with colon metastasis of breast cancer. She was diagnosed with right colon cancer, and during investigation for colon cancer, we found a breast cancer. She received a palliative right hemicolectomy due to obstruction before chemotherapy. The histology of the tissue taken from the right colon was shown to be the same as that of the left breast mass. This is a case of colonic metastasis from breast cancer and we report this case with a review of literature.

The Synergistic Cell Killing Effects by the Transduction of the w-p53 Gene and 5-FU Administration in Colon Cancer Cell Lines

PURPOSE: It is known that the wild-type p53 (w-p53) gene has several functions such as suppression of tumor cell growth, control of the cell cycle, stabilization of the genes and cellular differentiation. Recombinant w-p53 adenovirus was transfected and 5-FU was administered into the LoVo (w-p53 gene positive) and SW-837 (mutant-p53 gene positive) colon cancer cell lines to determine the cell death effects according to the presence or absence of the w-p53 gene. METHODS: The transduction of the p53 gene was done using recombinant adenovirus and liposomes, and the cell death effect was determined by performing MTT assay. RESULTS: The cell death effect by 5-FU was higher in the LoVo cell line than that in the SW-837 cell line. The rate of w-p53 gene transduction was about 90%. The cell death effect by w-p53 gene transduction was shown by the administration of 10 microM of 5-FU. The cell death effect according to the administration of 5-FU after w-p53 gene transduction was 10 fold of that with 5-FU administration in the both cell lines, and there was a more significant effect in the LoVo cell line. CONCLUSION: The cell killing effect by 5-FU administration after w-p53 gene transduction showed a synergistically higher effect than those of w-p53 transduction only or 5-FU administration only in the colon cancer cell lines. Gene therapy using w-p53 gene transduction requires more extensive clinical trials.

Necrotizing Pancreatitis with Gas Gangrene

Acute necrotizing pancreatitis is a disease with high morbidity and mortality despite the progress made in intensive care. Gas gangrene of the pancreas, usually caused by anaerobe infection, is an extremely rare, but severe form of acute necrotizing pancreatitis. Several severity-of-illness classifications for acute pancreatitis are used to identify patients at risk for complications. Pancreatic necrosis is diagnosed radiographically by dynamic intravenous contrast-enhanced computed tomography (CT) of the abdomen. Early CT in patients with suspected necrotizing pancreatitis contributes to early intervention and many advantageously enhance survival. We report here on two cases of necrotizing pancreatitis with gas gangrene in 49-year-old male patient and 86-year-old female patient.

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy

PURPOSE: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality. METHODS: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics. RESULTS: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086). CONCLUSIONS: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.

Analysis of the Diagnostic Maneuver and Timing of Operation in Adult Intussusception

PURPOSE: Intestinal intussusception in adults is a rare entity and its clinical course and etiology differ from pediatric counterpart. About 90% have a primary pathologic lesion, especially malignancy consists of etiology as 30% in small bowel and 66% in large bowel. The purpose of this study is to investigate of accurate diagnosis, treatment, and timing of operation by review of clinical symptom, physical examination, laboratory finding, pathologic finding, and operation finding of adult intussusception patients. METHODS: We studied 20 adult patients who were diagnosed as intussusception between July 1993 and September 2005. Intussusception by operation and rectal prolapse were excluded. Clinicopatholgic findings were analyzed retrospectively through the medical record. RESULTS: There was 15 males and 5 females in all 20 patients, and mean age was 52.3 years with a range of 29 to 78 years. Preoperative diagnosis was suspected in 14 of 20 patients (70%). We performed emergency operation in 8 cases (40%) and elective operation in 12 cases (60%). Two cases of them which preoperative diagnosis were strangulation and peritonitis accompanied with small bowel necrosis and leukocytosis. There were 12 small bowel lesions (60%) and 6 colonic lesions (30%). In two cases, there were no primary lesions. Of the cases with a defined cause, 12 cases were malignant (60%) and 6 cases were benign (30%). CONCLUSION: The most useful diagnostic method is computed tomography to reveal adult intussusception. Two cases of all were strangulated and also had a leukocytosis. In adult intussusception, most common cause is malignancy. If there is no evidence of strangulation such as leukocytosis, we recommend that elective surgery is adequate.

Anal Diseases among Patients with Leukemia

PURPOSE: Anal diseases are a common complication among patients with leukemia, and the perianal abscess may prove to be the most fatal among anal diseases. We report here the prevalence, the treatment methods, and the prognosis for anal diseases among patients with leukemia. METHODS: Among the 310 patients who were diagnosed with and treated for leukemia between October 1999 and September 2000, we investigated the medical records of 53 patients with complications due to anal diseases. RESULTS: Among the 310 patients with leukemia, 53 (17.1%) reported anal diseases. There were 30 patients with hemorrhoids, 15 patients with a perianal abscess, 3 patients with an anal fistula, 3 patients with a fissure and 2 patients with hemorrhoids and fistulas. Anal pain was the most common complaint. Conservative treatment improved the symptoms in 42 patients (79.2%) while surgery was necessary in the remaining 11 patients (20.8%). A hemorrhoidectomy was undertaken in 4 patients, a drainage procedure in 4 paients, and a fistulotomy in 3 patients. Throughout the study period, 6 patients died (11.3%), 3 of them with perianal abscesses. Among the 15 patients with a perianal abscess, 13 showed fever (87%), and 9 patients underwent drainage (4 surgical drainages and 5 natural drainages). E. coli was the most commonly cultured organism. CONCLUSIONS: The incidence of anal diseases in patients with leukemia was high. Nonsurgical methods were sufficient for hemorrhoids and fistulas. For a perianal abscess, drainage should be undertaken when abscess formation is evident. When abscess formation is not evident, medical treatment is the primary modality, and surgery should be considered only when medical treatment fails to improve or worsens the patient's condition, but the prognosis is poor.

The Significance of Peritoneal Effusion in Colorectal Cancer

PURPOSE: It has been reported that in colorectal cancer, the positive rate of the cytological examination of ascites is low and that the cytologically positive result of the cancer cell influences its prognosis; nonetheless, not many studies on the correlation of the formation of peritoneal effusion and cancer have been done yet. Thus, this study on the correlation of clinico-pathological findings with peritoneal effusion was initiated. METHODS: The study population, includes a total of 191 patients who underwent an operation for colon cancer and rectal cancer from May 1, 2004, to December 31, 2005. Peritoneal effusion considered to be present in cases with more than 10 cc of body fluid retained in the Douglas pouch, and a cytological test was performed on patients whose retained fluid was more than 50 cc. In all patients, the correlation of the clinico-pathological findings with peritoneal effusion was analyzed, and the volume of effusion and the positive result of peritoneal cytology were compared. RESULTS: Among the 191 patients, patients without peritoneal effusion numbered 133 (69.6%) and patients with peritoneal effusion numbered 58 (30.4%). Between the two groups, the presence of intestinal obstruction due to cancer (P0.05). CONCLUSIONS: For colorectal cancer patients with peritoneal effusion, but without co-morbid medical diseases inducing such peritoneal effusion, by regarding peritoneal effusion itself as meaningful, the range of lymphadenectomies, adjuvant chemotherapy, and other additional therapy should be considered.

Primary Signet-ring-cell Carcinoma of the Right and the Sigmoid Colon in Crohn's Disease

A 31-year-old woman with a 5-year history of Crohn's disease was admitted to our hospital because of recurrent right lower quadrant pain and diarrhea. Abdominal computed tomography showed multiple fistulas between the terminal ileum, the sigmoid colon, and the cecum, and mucosal wall thickenings due to an active inflammatory process and mucosal enhancements. Colonoscopic examinations showed a finger-like projection of a polypoid mass at the ileocecal valve, long-neck, finger-like pseudopolyps at the cecum, and soft, lumen narrowing and multiple pseudopolyps at the sigmoid colon and the intact rectum. There was healing scarring of the anal fistula. These findings were compatible with those of Crohn's disease. Histologic findings were chronic inflammation with erosion and regenerative crypt epithelium. The patient underwent infliximab therapy. She underwent a right colectomy, a Hartman's procedure, and a small bowel segmental resection due to multiple fistulas. The pathologic diagnosis was a signet-ring-cell carcinoma with non-caseating granuloma in the ascending colon, ileum, and sigmoid colon. We report this case of Crohn's disease associated with a colonic signet-ring cell carcinoma.

Internal Hernia in Adult Patients: Transmesenteric Hernia and Internal Hernia through a Defect of the Broad Ligament

An internal hernia is a rare disease that causes bowel obstruction. It is difficult to diagnose because the symptoms and the signs are the same as those for other obstructive diseases of the bowel. Early diagnosis and management are essential, and early surgical management may reduce complications such as ischemia, and strangulation. We experienced two cases of internal hernias. One patient underwent a laparotomy, and had a transmesenteric defect with a herniated and strangulated small bowel segment. The other patient underwent a laparoscopic surgery, and we found that the left broad ligament had a focal defect with a herniated small bowel segment. An internal hernia is an uncommon disease, and its differentiation from other obstructive diseases of the bowel is difficult. However, the clinician should consider that the internal hernia might be the cause of the bowel obstruction, especially in patient with no previous history of intra- abdominal surgery. Early diagnosis can improve the clinical outcome through early surgery.

Expression of HER-2/neu in Gastric Adenocarcinoma

PURPOSE: The HER-2 oncogene plays a role in cellular oncogenic transformation, and is related to the aggressive tumor behaviour. Several studies have addressed the prognostic and predictive roles of the HER-2 status in gastric cancer; however, the HER-2 gene has not been used as a therapeutic target, as the opinions relating to its prognostic role are controversial. METHODS: Between January 1994 and December 1997 (1995 group), 192 patients who underwent a curative resection for a gastric adenocarcinoma at St. Mary's Hospital, College of Medicine, The Catholic University of Korea, were retrospectively reviewed from their paraffin embedded tissues and medical records. One hundred and twenty-seven patients, with the same characteristics and operated on between January and December 2002 (2000 group) were compared. The expression of HER-2 was analyzed by means of immunohistochemistry, with regard to the clinicopathological features and survival rate. RESULTS: The average ages of patients in the 1995 and 2000 groups were 56.3 and 59.1 years, respectively. In the 1995 group, 40.1, 26.5, 24.0 and 9.4%, had stage I, II, III and IV diseases, Whereas, in the 2000 group, these figures were 57.5, 18.1, 19.7, and 4.7%, respectively. The expression of HER-2 was positive in 12/192 patients (6.3%) in the 1995 group, and in 7/127 (5.5%) in the 2000 group. There was no relation between the overexpression of HER-2 and the pathological findings. However, the 5-year survival rates of patients with negative and positive HER-2 expression were 91.7 and 75.0%, in stage I and II gastric cancers, respectively. There was a significant difference in the survival rates between the two groups (P=0.010). CONCLUSION: HER-2 overexpression is an early event in gastric cancers, appearing at all stages of the disease, and is related to the poor prognosis of stage I, and II diseases. This fact is thought to be the basis of monoclonal antibody treatment and chemotherapy following a surgical operation for early gastric cancer.

Irinotecan, Continuous 5-Fluorouracil, and Low dose of Leucovorin (modified FOLFIRI) as First Line of Therapy in Recurrent or Metastatic Colorectal Cancer

BACKGROUND: Irinotecan, in combination with 5-fluorouracil (5-FU) and a high dose of leucovorin (LV), known as FOLFIRI regimen, has shown activity in recurrent or metastatic colorectal cancer. Therefore, we evaluated the efficacy and safety of irinotecan, 5-FU and a low dose of LV (modified FOLFIRI) as a first line of therapy for patients with relapsed or metastatic colorectal cancer. METHODS: Between January 2002 and October 2004, 44 patients with histologically confirmed recurrent or metastatic colorectal cancer were enrolled. The chemotherapy regimen schedule consisted of 180 mg/m2 of irinotecan being administered intravenously (i.v) on Day 1, 400 mg/m2 of 5-FU via i.v bolus with 600 mg/m2 of continuous infusion for 22 hrs on both Day 1 and 2, and 20 mg/m2 of leucovorin on both Day 1 and 2, repeated every two weeks. RESULTS: The overall response rate was 47.8%. Of the 40 evaluated patients, one had CR (2.3%) and 20 had PR (46.5%). Toxicities were mild and easily manageable. Three patients experienced 23 episodes of Grade 3/4 leukopenia., Only one patient developed Grade 3/4 diarrhea. None experienced Grade 3/4 thrombocytopenia. CONCLUSION: Modified FOLFIRI with a low dose of LV is an effective and tolerable regimen for patients with recurrent or metastatic colorectal cancer.

Clinicopathological Analysis of Antibiotic Treatment after Appendectomy: A Randomized Prospective Trial

PURPOSE: The optimal antibiotic regimen for appendicitis still remains poorly defined. The aim of this study was to define the optimal duration and route of antibiotics after an appendectomy, with regard to the clinicopathololgical aspects. METHODS: This study was performed on 73 consecutive patients who underwent an appendectomy. Groups A and B, which were composed of cases of simple appendicitis (phlegmonous and suppurative type) and complicated appendicitis (gangrenous and perforated type), respectively. Group A was randomized after the appendectomy into either A1 (n=17), a 1-day course of a combination of IV first generation cephalosporin and tobramycin; or to A2 (n=26), a 3-day course of the same regimen. Group B was randomized into either B1 (n=16), a 3-day course of a combination of IV cephalosporin, tobramycin, and metronidazole, followed by conversion to a 4-day course of a combination of PO third generation cephalosporin and metronidazole; or B2 (n=7), a 7-day course of a combination of IV cephalosporin and metronidazole, along with a 5-day course of tobramycin. The total leukocyte count (WBC), neutrophil count, and C-reactive protein (CRP) were analyzed preoperatively and on POD #3 and #7. An intraoperative culture of the surface of the appendix was also performed. RESULTS: The most common cultured organism was Escherichia coli (n=30). Ampicillin and first generation cephalosporin were 73% and 49% resistant to Gram-negative organisms, respectively. Third generation cephalosporin and imipenem were 100% sensitive. The subjects in group A were all under normal limits in the postoperative laboratory analyses, and had no complication. Groups B1 and B2 showed no significant differences in their WBC (P=0.301), neutrophil count (P=0.730), and complications (P=0.907), with the exception of CRP (P=0.040). CONCLUSION: After the appendectomy, simple appendicitis was treated with antibiotics for 24 hrs, with no complications. For complicated appendicitis, a 3-day IV course, followed by a conversion to 4-day PO antibiotics, was found to be safe. Surveillance of the WBC and neutrophil counts, CRP values, and body temperature permitted safe utilization of this regimen.

Retroperitoneal Hematoma Caused by Ruptured Pancreaticoduodenal Artery Aneurysm

A ruptured aneurysm of the pancreaticoduodenal arteries is an emergency condition, with a high mortality rate. Therefore, early diagnosis and adequate management are needed. Recently, treatment with a transcatheter arterial embolization has decreased the mortality rate. A 68-year-old man presented with persistent abdominal pain and dyspnea. Contrast abdominal computed tomography revealed a large retroperitoneal hematoma, with an actively bleeding focus. An urgent celiac and superior pancreaticoduodenal arteriogram showed a contrast extravasation, about 15 X 8 mm in size, with a saccular aneurysm of the distal anterior superior pancreaticoduodenal artery; therefore transcatheter arterial embolization was performed. The patient's condition improved without complication after the embolization.

Thrombophlebitis of the Inferior Mesenteric Vein

Isolated thrombophlebitis of the inferior mesenteric vein (IMV) is a rare condition, but delayed diagnosis causes severe problems and serious long-term complications. Therefore, the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here, a case of a 64-year-old man with isolated IMV thrombosis on computed tomography (CT) and CT angiography due to inflammation of an abdominal organ and spell our disseminate intravascular coagulation (DIC) is reported. The patient's condition improved without complication after treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT angiograph and no sign of recurrent disease.

The Transfection of Cytosine Deaminase Gene and the Cell Killing Effects of Administration of 5-Fluorocytosine in Colon Cancer Cell Lines

PURPOSE: Among cancer gene therapies, the aims to eliminate malignant cells using genes as drugs as substitutes for conventional therapy, the use of bacterial cytosine deaminase (CD) which can convert the nontoxic 5-fluorocytosine (5-FC) to toxic 5-fluorouracil (5-FU), has been reported to provide a useful system for the selective killing of gene- modified mammalian tumor cells. Recently the transfection and expression of the CD gene, and the toxicity of 5-FC in eukaryotic cells, have been reported in colon, prostate and breast cancers, as well as in glioblastomas. To evaluate the growth inhibition effects in WiDr and LoVo colorectal cancer cells, after CD gene transfection and 5-FC administration, for the selective killing of cancer cells. METHODS: WiDr and LoVo colon cancer cell lines were cultured and the absorbencies for the percentage survival, on days 2, 4, 6, 8, and 10 of the culture, estimated by the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetra-zolium bromide (MTT) test. The experimental subjects were divided as follows; Group 1: administration of 5-FC only, Group 2: administration of 5-FU only, Group 3: administration of 5-FC after CD gene transfection using pCMV/CD-1 plasmid vector. Each experiment, on days 2, 4, 6, 8 and 10 of the culture after the administration of 5-FC or 5-FU concentration of 10, 100 and 1000 uM, was triplicated and calculated the mean with standard deviation. The bacterial CD gene was transfected into each cell lines, using the lipofectin method, and the transfection and expression of the CD protein identified with beta-galactosidase immunohistochemical staining and western blotting. The growth inhibition effects in group 3 were compared with those in group 1 and 2, and the bystander effects and cell recoveries, after finishing the 5-FC treatment, evaluated until day 20 of the culture. RESULTS: The calculated survival percentages by from the MTT tests in the WiDr and LoVo cells revealed 110~150% enhancing effects after the administration of 5-FC concentration of 10, 100 and 1000micro M (group 1), and 30~90% after the administration of 5-FU at the same concentrations (group 2), which were shown to be statistically significantly (P<0.001). After transfection of pCMV/CD-1 plasmid vector into the WiDr and LoVo cells using the lipofectin method, the transfection rate of the WiDr and LoVo cells were 4.2 +/- 0.6% and 13.8 +/- 0.8%, respectively. Also the CD protein, with the polyclonal anti-CD antibody, by western blot, revealed weak expression on day 2, followed by strong expression on day 4, which progressively decreased by days 6 and 8 in the WiDr cells. Conversely, the LoVo cells showed weak expression on day 2, which progressively increased by days 4 and 6, was followed by the strongest expression on day 8 in LoVo cells. About 60~85% significant growth inhibition effects (P<0.001) were revealed in group 3, with proportionally different effects, corresponding to the CD gene transfection rate, concentration of 5-FC and duration of the culture. The 60~85% growth inhibition effects were complex of the response to the transfection rate and the bystander effects of CD expressed cells to the CD non-expressed cells. CONCLUSION: From our results, the administration of 5-FC after CD gene transfection revealed statistically significant growth inhibition effects of 60~85%, which were complex of the effects of CD expressed cells and the bystander effects to the CD non-expressed cells, and proportionally corresponding to the transfection rate, the duration of the CD protein expression and the concentration of 5-FC.

The Transfection of Cytosine Deaminase Gene and the Cell Killing Effects of Administration of 5-Fluorocytosine in Colon Cancer Cell Lines

PURPOSE: Among cancer gene therapies, the aims to eliminate malignant cells using genes as drugs as substitutes for conventional therapy, the use of bacterial cytosine deaminase (CD) which can convert the nontoxic 5-fluorocytosine (5-FC) to toxic 5-fluorouracil (5-FU), has been reported to provide a useful system for the selective killing of gene- modified mammalian tumor cells. Recently the transfection and expression of the CD gene, and the toxicity of 5-FC in eukaryotic cells, have been reported in colon, prostate and breast cancers, as well as in glioblastomas. To evaluate the growth inhibition effects in WiDr and LoVo colorectal cancer cells, after CD gene transfection and 5-FC administration, for the selective killing of cancer cells. METHODS: WiDr and LoVo colon cancer cell lines were cultured and the absorbencies for the percentage survival, on days 2, 4, 6, 8, and 10 of the culture, estimated by the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetra-zolium bromide (MTT) test. The experimental subjects were divided as follows; Group 1: administration of 5-FC only, Group 2: administration of 5-FU only, Group 3: administration of 5-FC after CD gene transfection using pCMV/CD-1 plasmid vector. Each experiment, on days 2, 4, 6, 8 and 10 of the culture after the administration of 5-FC or 5-FU concentration of 10, 100 and 1000 uM, was triplicated and calculated the mean with standard deviation. The bacterial CD gene was transfected into each cell lines, using the lipofectin method, and the transfection and expression of the CD protein identified with beta-galactosidase immunohistochemical staining and western blotting. The growth inhibition effects in group 3 were compared with those in group 1 and 2, and the bystander effects and cell recoveries, after finishing the 5-FC treatment, evaluated until day 20 of the culture. RESULTS: The calculated survival percentages by from the MTT tests in the WiDr and LoVo cells revealed 110~150% enhancing effects after the administration of 5-FC concentration of 10, 100 and 1000micro M (group 1), and 30~90% after the administration of 5-FU at the same concentrations (group 2), which were shown to be statistically significantly (P<0.001). After transfection of pCMV/CD-1 plasmid vector into the WiDr and LoVo cells using the lipofectin method, the transfection rate of the WiDr and LoVo cells were 4.2 +/- 0.6% and 13.8 +/- 0.8%, respectively. Also the CD protein, with the polyclonal anti-CD antibody, by western blot, revealed weak expression on day 2, followed by strong expression on day 4, which progressively decreased by days 6 and 8 in the WiDr cells. Conversely, the LoVo cells showed weak expression on day 2, which progressively increased by days 4 and 6, was followed by the strongest expression on day 8 in LoVo cells. About 60~85% significant growth inhibition effects (P<0.001) were revealed in group 3, with proportionally different effects, corresponding to the CD gene transfection rate, concentration of 5-FC and duration of the culture. The 60~85% growth inhibition effects were complex of the response to the transfection rate and the bystander effects of CD expressed cells to the CD non-expressed cells. CONCLUSION: From our results, the administration of 5-FC after CD gene transfection revealed statistically significant growth inhibition effects of 60~85%, which were complex of the effects of CD expressed cells and the bystander effects to the CD non-expressed cells, and proportionally corresponding to the transfection rate, the duration of the CD protein expression and the concentration of 5-FC.

Portal Vein and Superior Mesenteric Vein Thrombosis following Cholecystectomy and Choledochostomy

Acute thrombosis of the portal and superior mesenteric vein (SMV) due to inflammation of abdominal organs is a rare condition, but delayed diagnosis causes severe problems and serious long term complications. Therefore the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here a case of an 84-year-old man with portal vein and SMV thrombosis on Doppler ultrasonography and computed tomography (CT) after cholecystectomy and choledochostomy by the 10th day is reported. The patient's condition improved without complication after the treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT or sign of a recurrent disease.

Clinical Analysis for 30 Cases of Total or Subtotal Abdominal Colectomy and Total Proctocolectomy

PURPOSE: A total or a subtotal abdominal colectomy and a total proctocolectomy are performed occasionally for the surgical treatment of familial adenomatous polyposis, multiple colorectal cancers, ulcerative colitis, acute lower GI bleeding, and malignancy other than colorectal cancer. We studied 30 cases of patients who received either a total or a subtotal abdominal colectomy and a total proctocolectomy in one of the three hospitals affiliated with the Catholic University between January 1990 and December 2001. Our goal was to determine whether the total or subtotal abdominal colectomy and the total proctocolectomy are difficult and complicated procedures by comparing the mortality, the morbidity, the survival rate, and the complications to previously considered and reported results. METHODS: Thirty patients treated with either total or subtotal abdominal colectomy and with a total proctocolectomy from January 1990 to December 2001 were chosen for this study. Their gender, age, underlying diseases, family history, hospital days, symptoms, changes in defecation habits following the procedure, complications, mortality, survival rate, and relationship to malignancy were evaluated. RESULTS: Of the patients who received either total or subtotal abdominal colectomy and a total proctocolectomy, the average age was 44.6 years, the gender ratio was 1:1, and the underlying diseases were familial adenomatous polyposis (FAP) (43%), ulcerative colitis (UC) (20%), multiple colorectal cancers (17%), stomach cancer (7%), and Crohn's disease (3%). Diarrhea and rectal bleeding were the most common clinical symptoms, and abdominal pain and intestinal obstruction were frequently observed. A total proctocolectomy (TPC) with permanent ileostomy was the most frequently performed procedure (47%), and a TPC with ileoanal anastomosis was done in 10% of the cases. A total abdominal colectomy (TAC) with ileorectal anastomosis was applied in 23% of the cases, and subtotal abdominal colectomy (sTAC) with ileosigmoidal anastomosis was done in 20% of the cases. The operative mortality rate was 3% as one patient among thirty died. Postoperative complications developed in 33% of the patients. FAP and UC patients without cancer (45%) survived for over 4 or 5 years, but FAP and UC patients with cancer, especially an adenocarcinoma, survived for only 2.5 years. CONCLUSIONS: A total or subtotal abdominal colectomy (TAC or sTAC) and a total proctocolectomy (TPC) are appropriate procedures with low mortality, low morbidity, and a low complication rate for several kinds of diseases. A TPC with ileorectal anastomosis is the procedure of choice for sparing the rectum in FAP and UC patients without coexisting cancer and without mutation of the APC gene after codon 1250, but a TPC with ileoanal anastomosis is recommended if there is a mutation of the APC gene after codon 1250. A TPC with ileostomy is the preferred method for FAP and UC patients with coexisting cancer.