[Clinicopathologic features of colorectal cancer combined with synchronous and metachronous gastric cancer].

BACKGROUND/AIMS: The purpose of this study was to investigate the clinicopathologic features of double primary cancers of the stomach and colorectum, compared to colorectal cancer alone. METHODS: A retrospective analysis was made of 5,288 patients who underwent colorectal cancer surgery between January 2000 and December 2009 at Severance Hospital of Yonsei University. The clinicopathologic features were analyzed between 63 patients of double primary cancers and case-matched 126 patients of colorectal cancer alone. We classified double primary cancers into subgroups as premetachronous, synchronous and postmetachronous gastric cancer to identify differences between the three subgroups also. RESULTS: Double primary cancers group showed 4.3 year-older age, lower BMI, and higher percentage of peritoneal metastasis, compared to colorectal cancer alone group. Overall and colorectal cancer specific survival did not have any significant difference between two groups. In histologic type of gastric cancer, a high percentage of undifferentiated adenocarcinoma (55.6%) and signet ring cell carcinoma (30.2%) were noted. CONCLUSIONS: Double primary cancers of the stomach and colorectum had older-age onset, lower BMI and higher metastasis to peritoneum than colorectal cancer alone. Combined gastric cancer consisted of high percentage of undifferentiated and signet ring cell carcinomas.

Clinical outcomes and factors related to resectability and curability of EMR for early colorectal cancer.

BACKGROUND: EMR has emerged as an alternative therapeutic option for selected cases of early colorectal cancer (ECC). However, the factors associated with resectability and curability of EMR for ECC remain unknown. OBJECTIVE: To investigate clinical outcomes and factors related to resectability and curability in ECC cases treated with EMR. DESIGN: Retrospective study. SETTING: Tertiary-care academic medical center. PATIENTS: This study involved all patients in whom EMR was performed for ECC at Severance Hospital between March 1997 and August 2007. A total of 236 cases of ECC occurring in 231 patients (66.2% men) were enrolled. INTERVENTION: EMR. Curative surgical resection and lymph node dissection were used in cases that were incompletely cured by EMR. MAIN OUTCOME MEASUREMENTS: Resectability, curability, and recurrence. RESULTS: Complete cure was achieved for 162 lesions (68.6%). Of the remaining 74 cases (31.4%), 69 (29.2%) were incompletely cured, and the other 5 (2.1%) had an undetermined resection status and ultimately required supplementary surgical resection for curative treatment. Location on the right side of the colon, piecemeal resection, and submucosal carcinoma were independently associated with incomplete resection, whereas depressed tumor type was independently related to incomplete cure. Among the ECC cases completely cured by EMR and followed for more than a year (n = 118), local recurrence was observed in one case (0.8%) during the median follow-up period of 39.4 months (range 12.4-123.1 months). LIMITATIONS: Single-center, retrospective study. CONCLUSION: Our data show that EMR is feasible and could be an effective option for treatment of ECC if the technique is applied with the appropriate indications.

Predictive capability of anorectal physiologic tests for unfavorable outcomes following biofeedback therapy in dyssynergic defecation.

The purpose of this study is to evaluate the predictive capability of anorectal physiologic tests for unfavorable outcomes prior to the initiation of biofeedback therapy in patients with dyssynergic defecation. We analyzed a total of 80 consecutive patients who received biofeedback therapy for chronic idiopathic functional constipation with dyssynergic defecation. After classifying the patients into two groups (responders and non-responders), univariate and multivariate analyses were performed to determine the predictors associated with the responsiveness to biofeedback therapy. Of the 80 patients, 63 (78.7%) responded to biofeedback therapy and 17 (21.3%) did not. On univariate analysis, the inability to evacuate an intrarectal balloon (P=0.028), higher rectal volume for first, urgent, and maximal sensation (P=0.023, P=0.008, P=0.007, respectively), and increased anorectal angle during squeeze (P=0.020) were associated with poor outcomes. On multivariate analysis, the inability to evacuate an intrarectal balloon (P=0.018) and increased anorectal angle during squeeze (P=0.029) were both found to be independently associated with a lack of response to biofeedback therapy. Our data show that the two anorectal physiologic test factors are associated with poor response to biofeedback therapy for patients with dyssynergic defecation. These findings may assist physicians in predicting the responsiveness to therapy for this patient population.

Prediction of free bowel perforation in patients with intestinal Behçet's disease using clinical and colonoscopic findings.

BACKGROUND: Gastrointestinal tract involvement in Behçet's disease (BD) often requires surgical intervention due to serious complications such as intestinal perforation, fistula formation, or massive bleeding. AIM: The aims of this study were to investigate the clinical and surgical features of free bowel perforation and to determine the risk factors associated with this complication in intestinal BD patients. METHODS: We reviewed the medical records of 129 patients with intestinal BD treated from September 1988 to September 2008. Among them, 33 patients had intestinal perforations and all underwent emergent or elective laparotomy. RESULTS: The mean age of the patients with bowel perforation was 34.8 ± 15.6 years (range 12-70 years) with a sex ratio of 2.3:1 (male:female). Twenty-seven (81.8%) patients were diagnosed with intestinal BD preoperatively, whereas six (18.2%) patients were diagnosed by pathological examination after operation. Fourteen (42.4%) patients experienced postoperative recurrence of intestinal BD and 11 (33.3%) underwent reoperation. Multivariate Cox hazard regression analysis identified younger age (≤ 25 years) at diagnosis (HR = 3.25; 95% CI, 1.41-7.48, p = 0.006), history of prior laparotomy (HR = 5.53; 95% CI, 2.25-13.56, p = 0.0001), and volcano-shaped intestinal ulcers (HR = 2.84; 95% CI, 1.14-7.08, p = 0.025) as independent risk factors for free bowel perforation in intestinal BD. CONCLUSIONS: According to the results of our study, patients diagnosed with intestinal BD younger than 25 years, who had a history of prior laparotomy or volcano-shaped intestinal ulcers have an increased risk of free bowel perforation.

Tracheal gas insufflation (TGI) in patients with increased deadspace fraction:the effect and its determining factors / 결핵

BACKGROUND: Tracheal Gas Insufflation (TGI) is one of the newer ancillary measures in mechanical ventilation employed to enhance carbon dioxide elimination.7G1 exerts its effect through reduction of deadspace ventilation, but the factors determining its effect are not well studied yet. METHOD: The subjects were seven mechanically-ventilated patients (58.8+/-10.6 yrs) who showed increased Physiologic deadspace greater than 60%. After 30 min of stabilization with 100% oxygen on pressure control ventilation, continuous flow TGI was administered via the insufflation lumen of Hi-Lo Jet Tracheal Tube (Mallincrodt, USA) for 15 min at 3 L/min and 5 L/min each. RESULTS: PaCO2 was decreased (51.4+/-17.6 at baseline,49.1+/-18.9 at TGI 3 L/min, 45.0+/- 14.9 mmHg at TGI 5 L/min, p=0.050), and pH was increased (7.37+/-0.12, 7.38+/-0.13, 7.39+/-0.12, respectively, p=0.037) while mixed expired CO2 (PECO2) was not changed significantly from baseline (p=0.336) by TGI. Physiologic deadspace(Vdphy) was decreased (73.0+/-7.9% at baseline, 69.8+/-10.0% at TGI 3 L/min, and 67.1+/-10.1% at TGI 5 L/mi% p=0.015). AaDO2(p=0.147), Vt(p=0.2140), Pmean(p=0.7788) and mean arterial pressure(p=0.4169) were not changed. The correlation between % maximal decrease of Vdphy were r=0.790 with the ratio of baseline Vdana/vdphy(p=0.035) and r=-0.754 with baseline Vdalv(p=0.050). CONCLUSION: TGI was effective in reducing PaCO2 and deadspace, and the deadspace-reducing effect was best correlated with baseline anatomic/physiologic deadspace ratio.

The Respiratory and Hemodynamic Effect of Prone Position in Patients with ARDS / 결핵

BACKGROUND: Prone position improves oxygenation in some patients with ARDS. According to some authors, prone position can also improve the deteriorated hemodynamics induced by PEEP. But these respiratory and hemodynamic effects of prone position has not yet been fully established. METHODS: Twentythree consequtive patients with ARDS(M : F = 11:12, 62.1+/-20.8yrs) were the subjects for this study. ABGA, static compliance of the respiratory system, mean arterial pressure and pulse rate were obtained in supine position and at 5mm, 0.5h and 2h of prone position. Positive respiratory response was defined as 20mmHg or more increase in PaO2/FIO2 within 2h of prone position. Early of late respiratory responses were defined if the positive response was observed within of after 3 day of ARDS onset, respectively. Positive hemodynamic response was defined as l0mmHg or more increase in mean arterial pressure at 5mm of prone position. RESULTS: Fifteen patients (65%) showed positive respiratory response. In the respiratory responders, PaO2 was 69.8+/-17.6mmHg in supine position, 83.2+/-22.6mmHg in prone position 0.5h, 96.8+/-22.7mmHg in prone position 2h(p0.05). But patient without early response showed late response only in 25% (1/4), while patient with early response showed late response in 85.7% (6/7)(p=0.072). Five patients(22%) showed positive hemodynamic response, two of them being respiratory nonresponders. There were no differences in the baseline mean arterial pressure or the level of PEEP applied in supine between the hemodynamic responders and the hemodynamic nonresponders. CONCLUSIONS: Prone position either improved oxygenation or increased arterial pressure in significant proportion of patients with ARDS. And the respiratory response to prone position was thought to be determined in the early stage of ARDS.