Annals of Coloproctology

Volume 14(3); September 1998

Original Articles

Clinical Aspect of Suspected HNPCC in Korea.: Lee, Eun Jeong , Park, Young Jin , Park, Kyu Joo , Park, Jae Gahb; J Korean Soc Coloproctol. 1998;14(3):331-340.

947 View
9 Download

Abstract PDF: PURPOSE
The criteria for Suspected hereditary nonpolyposis colorectal cancer(Suspected HNPCC) has been devised by the Korean Hereditary Tumor Registry for families who do not fulfill Amsterdam criteria, but hereditary background is strongly suggested. This study was performed to define the clinical characteristics of 'Suspected HNPCC'.
METHODS
The 'Suspected HNPCC' criteria include the followings: a) vertical transmission of colorectal cancer or at least two siblings affected with colorectal cancer in a family and b) development of multiple colorectal tumors (including adenoma) or at least one colorectal cancer case diagnosed before the age of 50 years or development of extracolonic cancers (endometrium, urinary tract, small intestine, stomach, hepatobiliary system, ovary) in family members. We analysed the clinical characteristics of 93 patients from 39 Suspected HNPCC families and compared these characteristics with 176 HNPCC familes and with 1,204 non-hereditary colorectal cancer patients.
RESULTS
The mean age of Suspected HNPCC patients at the time of diagnosis (49.0 years) was significantly lower than that of non-hereditary colorectal cancer patients (56.1 years), but higher than that of the HNPCC patients (44.5 years). Tumors were more frequently located in the right colon (34%) in Suspected HNPCC compared to non-hereditary colorectal cancer (23%). Dukes' A and B cancers were more frequent in the Suspected HNPCC as compared to non-hereditary colorectal cancer (55% vs. 48%, p<0.05), but tumor differentiation was not statistically different between the two groups. Among the Suspected HNPCC, 24.0% of the patients had synchronous adenomatous polyps and 20.0% had synchronous colorectal cancers and 15.6% had metachronous polyps or cancers. These findings were similar to HNPCC, but significantly higher than non-hereditary colorectal cancers (p<0.05). In Suspected HNPCC families, 42 patients had extracolonic malignancies with the stomach cancer being the most common (n=22).
CONCLUSION
These data indicate that the clinical characteristics of Suspected HNPCC are similar to those of HNPCC and may suggest that the management principles of the HNPCC should also be applied to the Suspected HNPCC.

Selective Approach to Sphincter-Saving Procedure after Chemoradiation in Low Rectal Cancer.: Lim, Dae Jin , Ahn, Soo Min , Sohn, Seung Kook , Kim, Nam Kyu; J Korean Soc Coloproctol. 1998;14(3):341-348.

944 View
9 Download

Abstract PDF: PURPOSE
The conventional surgical treatment for patients with potentially curable low rectal cancer is abdominoperineal resection. Recently there has been increasing interest in the use of preoperative radiation therapy and sphincter-saving procedure as primary therapy for selected low rectal cancers. We report our institutional experience with this approach.
METHODS
From 1995 to 1997, Twelve patients with resectable distal rectal cancer were offered sphincter-saving procedure, excluding the patients whose pretreatment tumor presentation demonstrated fixation to anal sphincter or puborectalis muscle. The distance from the anal verge to the distal tumor margin at initial diagnosis ranged from 1 to 5 cm. Patients received a median 50.4 Gy and chemotherapy Surgery was carried out 4 to 8 weeks after radiation.
RESULTS
No patient had toxic reaction that required interruption of chemoradiation. Four patients (33%) had complete pathologic response, but one patient with complete clinical response had residual cancer. Seven patients underwent hand-sewn coloanal anastomosis and five patients transanal excision en bloc. All patients were able to successfully undergo a sphincter-saving procedure. With a mean follow-up of 23 months (range, 6~32), the authors noted no recurrence or complication. Sphincter function was good in 92%. Daily bowel movements was two (range, 1~10).
CONCLUSION
Preoperative chemoradiation appears promising in terms of better patient compliance, lesser toxicity, and downstaging tumor, making the sphincter-saving procedure feasible in carefully selected cases. Surgical resection remains essential to confirm and to achieve complete clinical remission. The results of preoperative chemoradiation and sphinctersaving procedure are encouraging, but more experience is needed to determine whether this approach ultimately has similar local control and survival rate compared to standard surgery.

A Comparative Analysis of the Preoperative Chemoradiation Versus Radiation only for Mid and Lower Rectal Cancer.: Kim, Je Ryong , Kim, Jae Sung , Yoon, Wan Hee; J Korean Soc Coloproctol. 1998;14(3):349-358.

1,039 View
9 Download

Abstract PDF: This study was designed to evaluate the worth of preoperative chemoradiation therapy in the management of locally advanced rectal cancer. Between march 1993 and January 1997, 64 patients with adenocarcinoma of the rectum were treated with preoperative irradiation followed by operation by one surgeon at department of surgery, Chungnam national university hospital. Cancers were treated with high-dose radiation (45 to 54 Gy) with (group 2) or without (group 1) chemotherapy Preoperatively 64 Patients were analysed prospectively, of these, 15 cases were preoperative radiotherapy alone arm and 49 cases were preoperative radiotherapy plus chemotherapy arm. The average age of the patients were 56 years (range 38~67) in group 1 and 57 years (range 27~80) in group 2. Male to female ratio was 8 : 7 in group 1 and 30 : 19 in group 2. Most clinical stage of the primary tumor mass were 73 (80% in Group 1,96% in group 2), being palpated slightly fixed (40% in group 1, 43% in group 2) or fixed (13.3% in group 1, 24.5% in group 2). As to distance of tumor from anal verge, most patients ranged from 4 to 8 cm (53% in group 1, 63.3% in Group 2). Chemotherapy consisted of 2 cycles of 5-fluorouracil (500 mg/m2/day for S days) delivered as a continuous infusion or bolus therapy and low-dose leukovorin (20 mg/m2/day for 5 days). After six weeks resting period of radiation, definitive surgical approach was performed. Overall treatment related toxicity rate was similar in both group except erythema on perineal skin, which was more frequent in group 2 than in group 1. Most frequent postoperative complication was intestinal obstruction (7.8%) followed by wound infection (6.3%), but there was no significant difference between two groups. There was one case of postoperative mortality in group 2 patients at 44 days after operation due to pneumonia and sepsis combined with liver cirrhosis. Tumor depth was downstaged in 38.5% of group 1 and 70% of group 2 patients on preoperative CT staging, and nodal downstaging was more effective on the respect of postoperative pathological report. Overall recurrence rate was 38.5% in group 1 and 20.5% in group 2. Of these, failure occured first as a distant metastasis more frequently than as a local recurrence in both group. These data do suggest that the preoperative chemotherapy and radiotherapy used are as safe as preoperative radiotherapy alone. Futhermore, tumor and lymph node downstaging are more effective in combined arm. Preoperative chemotherapy will more promising in prevention of distant metastasis when treated in the period of least metastatic tumor burden. Whether combined arm will have greater or lesser survival awaits the completion of this relevant study.

Effectiveness of Partial Autonomic Nerve Preservation Surgery for Sexual Function in the Male in the Advanced Rectal Cancers.: Bae, Ok Suk , Park, Seong Dae; J Korean Soc Coloproctol. 1998;14(3):359-364.

876 View
3 Download

Abstract PDF: BACKGROUND
During the past eight years, we have been performing partial autonomic nerve preservation surgery (PANP) for the treaolent of advanced rectal cancer in order to reduce the postoperative male sexual dysfunctions.
METHODS
This is a prospective study of 25 rectal cancer patients who underwent PANP from 1990 to 1997. All patient were in Duke C stage and their ages were between 30 and 55. Patients were divided into four types: 1) Partial sacrifice of inferior mesenteric plexus (PSIP). 2) Partial sacrifice of preaortic nerve (PSPN). 3) Complete sacrifice of preaortic nerve with complete pelvic nerve preservation (CSPN). 4) Unilateral sacrifice of pelvic autonomic nerve (USPN).
RESULTS
The percentage of ejaculation and erection difficulties at each surgery was as follows: PSIP 0/5 (0%) for ejaculation vs. 0/5 (0%) for erection, respectively, PSPN 5/7 (71.4%) vs. 2/7 (28.6%), CSPN 6/7 (85.7%) vs. 0/7 (0%) and USPN 6/6 (100%) vs. 5/6 (83.3%). Summary: PANP is possible for the treatment of advanced rectal cancer.

Prognostic Significance of the Expression of MRP and p53 in Colorectal Carcinoma.: Chang, Ji Young , Min, Young Don , Kim, Kweon Cheon , Lim, Sung Chul; J Korean Soc Coloproctol. 1998;14(3):365-374.

930 View
17 Download

Abstract PDF: Although MDR was previously thought to be predominantly caused by the expression of the MDR1 gene, it is now increasingly believed to be caused by other mechanism. Recently, over-expression of the multidrug resistance-associated protein (MRP) was suggested a possible mechanism for non-Pgp mediated MDR. Recent studies showed that MRP can confer resistance to a wide spectrum of natural product drug, but the clinical relevance of MRP-mediated MDR in human cancer is poorly understood. p53 is the most widely known tumor suppressor gene. It has been suggested that mutant p53 is related to abnormal proliferation of cell and some what is been related to cellular apoptosis. To determine the clinical significance of MRP and/or p53 expression in colorectal carcinoma, the authors investigated the expression of the MRP and p53 in 81 cases of primary colorectal carcinoma, the relationship between the MRP and/or p53 expression and clinical parameters including 5-yr. survival rate, and the relationship between the expression of MRP and p53. The results were as follows: 1) Of the 81 colorectal carcinomas, 36 (42%) were MRP positive and 28 (34%) were p53 positive. 2) The expression of MRP and/or p53 was not significantly correlated with sex, age, histologic grades, tumor invasion, tumor location, tumor size, lymph node metastasis, TNM stage and survival of patients. In conclusion, these results suggest that expression of MRP and/or p53 is neither related to the known prognostic factors nor a prognostic factor by itself.

Early Colorectal Cancer.: Lee, Jae Bum , Park, Young Jin , Park, Kyu Joo , Kim, Sun Whe , Park, Jae Gahb , Lee, Kuhn Uk , Park, Yong Hyun , Choe, Kuk Jin , Kim, Jin Pok; J Korean Soc Coloproctol. 1998;14(3):375-384.

923 View
7 Download

Abstract PDF: Purpose
: Early colorectal cancer is defined as the depth of tumor invasion limited to mucosa or submucosa regardless of the presence or absence of lymph node metastasis. We performed a retrospective study to determine the chronological changes in frequencies of early colorectal cancer and clinicopathologic differences between early colorectal cancer (ECC) and advanced colorectal cancer (ACC).
Methods
: We reviewed hospital records of the patients with colorectal cancer operated between January 1990 and December 1995. We classified the patients into two groups, ECC and ACC, according to the depth of tumor invasion and compared the clinicopathologic characteristics.
Results
: Fifty eight patients (5.2%) were diagnosed with early colorectal cancer among 1113 colorectal cancer patients operated at the same period. The frequency of ECC has increased from 1.9% in 1970~1989 to 5.2% in 1990~1995. The average age of patients with ECC at the time of surgery was 55.8 compared to 56.5 for patients with ACC group (p>0.05). Most patients (72.4%) with ECC had bleeding symptoms and majority of the ECCs were located in the rectum (72.4%). The mean size of tumors was 2.6 cm in its greatest diameter and was significantly smaller than that of ACC (5.7 cm). Compared to ACC, ECC had better histologic differentiation and fewer lymph node metastases (p<0.05). Thirty six of the ECC patients underwent bowel resection and remaining 22 underwent local excision. After a mean follow up period of 39.1 months (range 2~81months), recurrence was detected in one case. There was no death during the follow up period.
Conclusion
: The frequency of ECC has increased recently. Compared to patients with ACC, patients with ECC had more favorable clinicopathologic characteristics and better outcome. In selected patients, minimal operation can be applied without compromising the clinical outcome.

The Significance of Monitoring Serum Carcinoembryonic Antigen in the Colorectal Cancer after Curative Resection.: Kim, Jin Cheon , Jeong, Choon Sik , Kim, Chang Nam , Park, Sang Kyu , Yu, Chang Sik , Kim, Byung Sik , Park, Kun Choon; J Korean Soc Coloproctol. 1998;14(3):385-392.

1,030 View
2 Download

Abstract PDF: BACKGROUND
/AIM: Serial measurement of serum carcinoembryonic antigen was assessed to define its significance and to determine the adequacy in detecting recurrence after curative resection for colorectal cancer.
METHODS
Six hundred forty-five patients with colorectal cancer underwent curative resection were included. The median follow-up period was 49 months (range, 24~94 months). Serum CEA was analyzed in accordance with location, histologic differentiation, stage of the tumor, recurrence and survival.
RESULTS
The incidence of elevated preoperative serum CEA (> 6 ng/ml) was correlated with tumor stage (stage I vs. II, P=0.01; stage II vs. III, P=0.0001). Fifty five patients among 87 patients with recurrence (63.2%) had concomitant elevation of serum CEA, whereas 32 of 558 patients (5.7%) without recurrence showed a false-positive result. Measurement of serum CEA was more sensitive in patients with elevated preoperative serum CEA and liver metastases than in patients without elevated preoperative serum CEA and local recurrence (P=0.0397). The leading time of serum CEA between the first elevated serum CEA and the identification of recurrence was 3.5 months (range, 1~12 month). Tumor stage and preoperative serum CEA level were found to be significant prognostic variables by multivariate analysis. The overall 5-year survival rate in the normal preoperative serum CEA and the elevated group were 76% and 64% respectively (P=0.00019).
CONCLUSION
Serum CEA seemed to be closely correlated with survival and to be an useful tool to detect recurrence after curative resection for colorectal cancer. The appropriate measurement of serum CEA might be suggested in stage II and III postoperatively: every three month for two years, every 6 month for succeeding 2 years, and annually thereafter. Monitoring of serum CEA in stage I could be individualized by preoperative serum CEA and clinical course.

Differences in Serum CEA Level between Colon and Rectal Cancer.: Song, Woon Seop , Jun, Ho Jin , Park, Dong Kook , Lee, Chan Young , Kim, Jung Tak , Lee, Doo Sun , Jung, Min , Park, Jong Kwon , Rhu, Jin Woo; J Korean Soc Coloproctol. 1998;14(3):393-398.

2,127 View
16 Download

Abstract PDF: We investigated whether there is differences in serum level of carcinoembryonic antigen (CEA) between patients with colon and rectal cancer. Preoperative serum levels of CEA was determined in 65 patients with colon cancer and in 88 patients with rectal cancer. Cut-off value recommended by manufacturers is 5 ng/ml for CEA. At the recommended cut-off levels for CEA, overall sensitivity of CEA was 43.1 percent for colon and 42.0 percent for rectal cancer. In colon cancer CEA was elevated in 38.4, 46.2, 60 percent of patients with Dukes Stages B, C, and D, respectively. In rectal cancer CEA was elevated in 12.5, 31.6, 44.8, 84.6 percent of patients with Dukes Stages A, B, C, and D, respectively. In Stages B, and C, sensitivity of CEA was higher in colon than in rectal cancer, but the difference was not significant. In Stages D, sensitivity of CEA was higher in rectal cancer than in colon cancer, but the difference was not significant. In overall stages sensitivity of CEA was higher in colon than in rectal cancer, but the difference was not significant. The difference was not significant either in overall or in different stages of colon and rectal cancer.

Predicting Lymph Node Metastasis in Patients with Advanced Rectal Cancer: A Prospective Study for the Characteristics of Lymph Node Metastasis of Mesorectum and Extra-Mesorectum.: Shim, Kang Sup , Kim, Kwang Ho , Yoon, Dae Kun , Kim, Ki Hyun , Kim, Sung Phill , Lee, Kun Young , Choi, Eun Chang , Sung, Sun Hee , Han, Woon Sup , Pa, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):399-412.

1,028 View
27 Download

Abstract PDF: It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (<40), poorly differentiation, larger tumor size (>5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.

Statistical Evaluation of Number of Lymph Node in Dukes C Colorectal Carcinoma.: Kim, Jong Hyun , Jung, Bong Wha; J Korean Soc Coloproctol. 1998;14(3):413-418.

897 View
5 Download

Abstract PDF: PURPOSE
Colorectal surgery, there are many important prognostic factors---depth of invasion, lymph node metastasis and distant metastasis. In there, the involvement of the lymph nodes by metastatic colorectal carcinoma may depends on several factors such as the sex, the age of the patient, tumor site and size, the symptomatic duration of the disease, tumor cell differentiation, and operating methods. In that point of view, we want to know how many lymph nodes are dissected for enough to determine statistically considerated Dukes C stage.
METHODS
We had studied 128 operation cases of colorectal adenocarcinoma from our hospital admission during the period of May, 1988 to October, 1997 to determine to provide an accurate assessment of the presence of nodal metastases. Patients status, tumor site and size, symptomatic duration of disease, tumor cell differentiation, and operating methods of 128 cases were analyzed. We calculated the probability to find at least one positive node in Dukes C, by binomial distribution from SPSS (version 7.5).
RESULTS
Eighty-three specimens (65%) were classified as Dukes B. Forty-five specimen (35%) had lymph node metastases (Dukes C) with a mean of 4.1+/-4.1 positive lymph nodes per specimen. The mean total number of lymph nodes identified per specimen was 11.6+/-7.4 (range 1~41), Dukes B was 10.9+/-7.1 (range 1~29) and Dukes C was 12.8+/-7.9 (range 3~41). Applying Students t-test to compare two independent average means, the result was the absence of significant differences in the number of nodes for the specimens defined as Dukes B and Dukes C, sex, age, symptom duration, and operationmethods whereas significant differences did exist for the specimen depending on the tumor differentiation, tumor size, and location. Poorly differentiation cancer was more prominent meaning than well or moderately differentiation in Dukes B (p<0.05). In stage Dukes C, if tumor size was below 2cm it was differences in other sizes (p<0.05). In tumor location, if tumor sited ascending colon was more prominent than sigmoid and rectum (p<0.05). According to our result, minimum 6 lymph nodes per specimen were optimal Dukes C staging assessment.
CONCLUSION
The minimum 6 lymph nodes provided an accurate assessment of the presence of nodal metastases (95 percent confidence interval) in Dukes C stage.

Rectal Carcinoid.: Park, Yong Lai , Kang, Young Won , Shin, Dong Ha , Shin, Jun Ho , Kim, Heung Dae , Kim, Yong Shin , Han, Won Kon , Pae, Won Gil , Kim, Kwang Yeon; J Korean Soc Coloproctol. 1998;14(3):419-424.

940 View
11 Download

Abstract PDF: PURPOSE
This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum.
METHODS
A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes.
RESULTS
There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later.
CONCLUSION
We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.

Change of Natural Killer Cell in Patients with Colorectal Carcinoma.: Kim, Kwang Ho , Shim, Kang Sup , Kang, Eun Suk , Hong, Ki Sook , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):425-430.

971 View
8 Download

Abstract PDF: Natural cytotoxicity mediated by natural killer (NK) cells is believed to play an important role in host anticancer defense mechanisms. The aim of this study is to compare the number of NK cells in patients with colorectal cancer and hemorrhoids, and before and after surgery in patients with colorectal cancer. Twenty colorectal cancer patients and twenty hemorrhoid ones were studied. Venous blood samples were obtained preoperatively, and on the 7th, and 14th postoperative days. Mononuclear cells were isolated over Ficoll-Hypaque gradients, and T cells, B cells, and NK cells were measured with CD3 FITC (T cell), CD 19 PE (B cell), and CD56 FITC (NK cell) antibody, The number of T cell (/mm3) was 1224, 1280, and 1125 at preoperative, 7th, and 14th postoperative day in hemorrhoid patients and 1195, 901, and 1060 in colorectal cancer patients respectively. The number of B cell (/mm3) was 243, 160, and 250 in hemorrhoid patients and 147, 78, and 113 in colorectal cancer patients. The number NK cell (/mm3) was 148, 156, and 143 in hemorrhoid patients and 129, 85, and 128 in colorectal cancer patients. There was no difference among Dukes stages in the number of NK cells. In conclusion, the number of NK cells was not changed in colorectal cancer patients compared with hemorrhoid ones. Major operation changed the number of NK cells in colorectal cancer patients.

Passive Bowel Movement with a New Colostomy Device: An Acute Experiment in Dog.: Lee, Gy Yeong , Kim, Jae Hwang , Lim, Myeung Kook , Chim, Myn Chul; J Korean Soc Coloproctol. 1998;14(3):431-438.

968 View
9 Download

Abstract PDF: In some clinical situations such as cerebrovascular accident, pelvic bone fracture or any bed ridden states patients do not have self control of their bowel movement. Nursing care around the perianal area is not an easy job. There is no devices which substitude the work because of the chracteristics of the anatomy of the anorectum and the fecal matter made of solid and gel state component. AIM: to evaluate the possibility of passive evacuation of the fecal matter from the rectum with a newly developed silicon device. MATERIAL AND METHODS: A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured external balloon surrounding the internal balloon, a connecting tube disposed under the both internal and external balloons and supply tube containing a pair of air passages and an enema fluid passages. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 20~25 kg of body weight was used for the acute experiment. Three types (1.5, 2.0, 2.5 cm in luminal diameter of the solid portion) of NCD were applied in 3 consecutive every other days. For softening of the stool, normally harder than that of human, Psyllium dextrose 30 gm was added to the daily food. Average 750 cc of tepid water was administered through the device for bowel irrigation. Anesthesia was not used in each procedures. The amount evacuated fecal matter and remained solid stool in rectum were checked. To evaluate the rectal mucosal injury anoscopic examinations were performed.
RESULTS
Stool evacuation was closely correlated with the intemal diameter of the device and stool component. The device with 2.5 cm in luminal diameter passed fecal matter well enough in 5 of 6 dogs however, smaller devices did not. Accidental prolapse of NCD were noted in 4 of 6 cases with 2.5 cm sized and all of 1.5 and 2.0 sized devices eventually until last push.
CONCLUSION
The NCD with 2.5 cm of internal diameter could be used in selected clinical situations.

Clinical Trial

Application of a New Colostomy Device in Incontinent Dog Model.: Lim, Myeung Kook , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 1998;14(3):439-446.

956 View
3 Download

Abstract PDF: BACKGROUND
Recently developed electrically stimulated gracilis neosphicter or artificial sphincter is quite a promising trial in fecal incontinence However, surgical technique is not simple, the devices are expensive and only specialists can perform the procedures successfully. The aim of this study is to evaluate the efficacy of a newly developed simple silicon device in incontinent dog model.
METHODS
A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured extemal balloon surrounding the internal balloon, a connecting tube disposed under the both infernal and external balloons and supply tube containing a pair of air passages and an enema fluid passage. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 22~26 kg of body weight were prepared. Anal incontinence was made by bilateral severing of the internal and external sphincters and puborectalis muscle under the general anesthesia. Marlex mesh ring was applied to the anal canal as Thiersch wire for the prevention of NCD expulsion in straining. After then, NCD with 2.5 cm of luminal diameter was inserted to the rectum proximal to the Malex mesh ring. Daily irrigation and evacuation was done with 800~1000 cc of tepid water in each dogs. Daily food contained 30 gm of Psyllium dextrose.
RESULTS
Initially 6 dogs were observed for 7 days. Daily irrigation made evacuation of fecal matter well in each dogs. There was no prolapse of device through the anal orifice. Anoscopic examination after 7 days showed no rectal and anal mucosal injury. Two dogs were kept for 40 days as same manner. Sometimes spontaneous bowel movement without water irrigation was noted when the stool were loose. Weelky anoscopic examination revealed no evidence of mucosal injuries for 40 days also. There was no septic or other complication.
CONCLUSION
NCD evacuated fecal matter well enough to empty the rectum in all incontinence dog model. Adequate sized NCD could be used for clinical trials in selected incontinence patients.

Original Article

A Survey on Ostomates With the special reference to physical, psychosocial and sexual problems.: So, Hyun Seog , Lee, Seok Hwan , Ko, Young Gwan , Oh, Soo Myung , Yoon, Choong , Joo, Hoong Zae , Lee, Kee Hyung; J Korean Soc Coloproctol. 1998;14(3):447-454.

920 View
4 Download

Abstract PDF: The survey was undertaken among the 105 ostomates who attended the 2nd Workshop for Stoma Rehabilitation on Aug. 30th, 1997 by the Department of Surgery, Kyung-Hee University Hospital to assess the physical, psychosocial and sexual problems with a stoma. The 97% of ostomates had permanent colostomies following abdominoperineal resection. The 67% of ostomates had one or more physical problems caused by stoma. Frequent bowel movement (94.3%), impairment of irrigation (64.6%), unpleasant odor (27.3%), and urinary frequency (21.3%) were common problems encountered by ostomates. Concerning the psychosocial problems, 3.8% of them suffered from profound restriction of social activities and 1.9% of them had psychologic problems such as depression. 42 of 58 ostomates (72.4%) who were employed before operation returned to their work. Among 71 men, 44 (62%) were impaired by sexual function. Most ostomates suffered physical, social, psychologic and sexual problems in their daily life and needed helps of experts such colorectal surgeons, enterostomal therapists, and ostomy association. Attention is needed more to improve the quality of life for the ostomates.

First
Prev
Page of 3
Next
Last

Previous issues