Annals of Coloproctology

Volume 15(3); August 1999

Original Articles

Changes of Antioxidant Capacity in Colorectal Cancer Patients.: Kwon, Deuk Young , Lee, Han Il , Park, Ki Hyuk , Joo, Dae Hyun , Park, Sung Whan , Yoo, Yong Oon , Park, Ki Ho , Jeon, Chang Ho , Cheon, Jong Yul , Cheon, Jin; J Korean Soc Coloproctol. 1999;15(3):151-158.

978 View
3 Download

Abstract PDF: PURPOSE
Free radicals are defined as any species capable of independent existence that contains one or more unpaired electrons and they have the effects on carcinogenesis and tumor progression by causing mutations on genetic structure or suppressing repair of mutated DNA. This study was aimed to identify changes of antioxidant capacity in carcinogenesis and tumor progression of colorectal cancer (CRC).
METHODS
We studied the level of serum antioxidant capacity using ABTS technique for 34 CRC patients who were operated between July 1997 and January 1998 at department of surgery, Taegu Catholic Medical Center and compared with 38 persons who had normal value of liver function during the same period.
RESULTS
CRC patients showed decreased serum antioxidant capacity level compared to that of control group (CRC male 1.23 0.15 mmol/L, CRC female 1.11 0.13 mmol/L, control male 1.40 0.15, control female 1.35 0.11 mmol/L). Changes of antioxidant capacity levels were not correlated with stages, even though the marginal difference between T-stages (T1/2 1.23 0.10 mmol/L, T3/4 1.16 0.15 mmol/L).
CONCLUSIONS
Free radicals may be the causative agent of colorectal carcinogenesis and can be associated with early phase of carcinogenesis rather than tumor progression.

Diagnosis and Treatment of Depressed Colorectal Neoplastic Lesion.: Kim, Hyun Shig , Park, Weon Kap , Hwang, Do Yean , Kim, Kuhn Uk , Lee, Kwang Real , Yoo, Jung Jun , Lim, Seok Won , Lee, Jong Kyun; J Korean Soc Coloproctol. 1999;15(3):159-167.

1,040 View
17 Download

Abstract PDF: PURPOSE
Depressed colorectal cancer is a newly recognized colorectal cancer. It has the characteristics of rapid growth and early invasion of the submucosa. Accordingly, recognition of that lesion is important. However, it is still rarely detected in Korea. This study was designed to evaluate the characteristics of depressed colorectal neoplastic lesions.
METHODS
We experienced 22 cases of depressed neoplastic lesions from January 1997 to December 1998. All of them were detected by performing colonoscopy. Among them, 6 were early colorectal cancers. The twenty-two cases accounted for 1.3% of all neoplastic lesions but advanced colorectal cancers encountered during the same period, and the six accounted for 6.6% of all early colorectal cancers during that period. We reviewed and analyzed those 22 lesions with respect to their clinicopathologic characteristics, especially size and histology.
RESULTS
The most common age group was the 6th decade. The male-to-female ratio was 2.7 to 1. The predilection of sites were the descending colon, the transverse colon, and the sigmoid colon in that order. The most common size was 3~4 mm, 9 lesions (40.9%) and the next was 5~6 mm, 7 lesions (31.8%). Twenty lesions (90.9%) were 8 mm or smaller in size. The overall malignancy rate was 27.3% (6/22), comprising 9.1% (2/22) for mucosal cancers, and 18.2% (4/22) for submucosal ones. The two lesions which were larger than 10 mm were submucosal cancers. Endoscopic mucosal resection (EMR) was the most common type of treatment, accounting for 59.1%. Two submucosal cancers and one mucosal cancer were operated on without any endoscopic treatment. That one mucosal cancer had initially been suspected of being a submucosal one upon endoscopic examination. There were neither complications nor recurrences during the average 10-month follow-up.
CONCLUSIONS
The target for detecting and treating depressed colorectal cancer should be lesions below 10 mm in size, and the treatment of choice should be EMR.

Endoscopic Diagnosis and Treatment of Early Colorectal Cancer.: Kim, Hyun Shig , Lim, Seok Won , Yoo, Jung Joon; J Korean Soc Coloproctol. 1999;15(3):168-178.

1,141 View
10 Download

Abstract PDF: PURPOSE
Detecting and treating early colorectal cancers are most important for preventing advanced colorectal cancers which are difficult to manage. However, there is still a lack of data and guidelines in Korea about early colorectal cancers, especially when endoscopy is concerned. This study was undertaken in an effort to gather information in this area.
METHODS
We experienced 107 early colorectal cancers from 1995 to 1998. We analyzed them with special reference to endoscopic characteristics and treatment. Ninty-six cases were followed for an average of 17 months.
RESULTS
Ninty-four (87.9%) of the early colorectal cancers were detected during the last two years of the study. The male-to-female ratio was 2.1 to 1. The most common age group was the 7th decade. The rectum and the sigmoid colon were involved in 85% of the early cancers. Lesions smaller than 20 mm accounted for 54.2% of the early cancers and ones smaller than 10 mm 15%. There were no malignancies in flat-elevated lesions smaller than 10 mm; to the contrary, there was a 66.7% malignancy rate in depressed lesions. Malignancy developed in LSTs (Laterally spreading tumors) larger than 20 mm. Regarding configuration, protruded-type tumors accounted for 80.4% of the lesions, depressed-type tumors 5.6%, and LSTs 4.7%. The most common endoscopic characteristic of early colorectal cancer was redness. White spots, hardness, easy bleeding upon touch, and nodules were recognized in more than 20% of the tumors; depression and erosion were noticed in more than 10%. An expanded figure, convergence of mucosal folds, a whitish patch, and ulceration were useful in some cases. The submucosal cancer rate was 30.2% in protruded-type lesions and 66.7% in depressed-type ones. The overall adenoma-association rate was 93%. All lesions without an adenomatous component were submucosal cancers. The overall endoscopic resection rate was 87.9%. Among them, those who needed additional surgical resection accounted for 13.8% (13/94). Three recurrences were recognized. Those three were all early rectal cancers associated with villous tumors and were larger than 20 mm. All recurrences were treated endoscopically. There was one case of bleeding within 1 day after endoscopic resection. That was associated with a 20-mm, pedunculated lesion in the ascending colon and was treated using a detachable snare.
CONCLUSIONS
It is important to recognize the endoscopic characteristics of early colorectal cancers, especially those of depressed lesions and LSTs. Those characteristics are also useful in selecting appropriate candidates for endoscopic resection.

Randomized Controlled Trial

The Effects of Early Ambulation on Urinary Retention and.: Kim, Seon Hahn , Lee, Il Ok , Kim, Dong Hee; J Korean Soc Coloproctol. 1999;15(3):179-185.

2,130 View
65 Download

Abstract PDF: INTRODUCTION: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation. PURPOSE: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH.
METHODS
In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted.
RESULTS
Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group (22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group).
CONCLUSIONS
Early ambulation has important implication on reducing the incidence of urinary retention after anal surgery under spinal anesthesia, without causing PDPH.

Original Articles

Clinical Review of Melanosis Coli.: Park, Weon Kap , Cho, Kyung A , Hwang, Do Yean; J Korean Soc Coloproctol. 1999;15(3):187-193.

1,188 View
33 Download

Abstract PDF: PURPOSE
Melanosis coli, which is a relatively common disease encountered during colonoscopy, is a brownish or blackish pigmentation of the colon and is associated with the ingestion of anthraquinone compounds. Its histopathological pathogenesis is recognized as colonic epithelial apoptosis. This study was designed to identify the relation between melanosis coli and the colonic transit time, as well as the relation between melanosis coli and other clinical characteristics.
METHODS
We reviewed the clinical records of 80 patients with melanosis coli who had been diagnosed by colonoscopy between Jan. 1997 and Sep. 1998. The colonic transit time was checked in 26 cases of patients with melanosis coli and in 28 cases of patients with constipation without melanosis coli by using the multiple marker bolus technique.
RESULTS
1) The frequency of melanosis coli in patients undergoing a total colonoscopy was 1.25% (80/6422). 2) The age distribution was 20 to 76 years old (mean: 49). The grade of melanosis coli seemed to be related with age. 3) The four causative agents related with melanosis coli were anthraquinone compounds (69.2%), tea (12.3%), herbs (12.3%) and health foods in that order. 4) The duration of medication was from 2 months to 20 years (mean: 48 months). The grade of melanosis coli seemed to be related with the duration of medication. 5) The colonic transit time was normal in 11 cases (42.3%) and delayed in 15 cases (57.5%) of melanosis coli and normal in 10 cases (35.7%) and delayed in 18 cases (64.3%) of patients with constipation without melanosicoli. 6) Colon polyps were detected in 12 cases (15%). However, no relation between the incidence of colon polyps and either the grade of melanosis coli or the duration of medication was noted.
CONCLUSIONS
Melanosis coli is a marker of ingestion of some drugs, such as anthraquinone compounds, and/or some kinds of acidic polysaccharides. Melanosis coli is not an indicator of colonic motility disorder or a danger signal for colon polyps or cancer.

Clinical Significance of Defecography in Patients with Constipation.: Kwon, Ho Young , Kim, Kwang Ho , Shim, Kang Sub; J Korean Soc Coloproctol. 1999;15(3):195-202.

1,138 View
3 Download

Abstract PDF: PURPOSE
To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and pathophysiology of constipation. A retrospective study of 56 constipated patients who had no abnormalities in colonoscopy, barium enema and rectal exam were done.
METHODS
Fifty-six patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients underwent colonic transit studies. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum.
RESULTS
Normal defecography finding was observed in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56), 30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at rest, during straining were 92.65 9.08o, 108.09 14.35o, while 99.85 11.85o, 95.90 17.84o, in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36), 3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele, respectively. Normal colonic transit time was observed in twenty six of the 37 patients. Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%) patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26, rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet obstruction.
CONCLUSIONS
Our findings suggest that constipation is often a disorder of defecation rather than a impairment of colonic motility. Defecography should be considered first of all in evaluating the pathophysiology of constipation, especially for whom complaining of difficult bowel.

Randomized Controlled Trial

The Efficacy of a Nd:YAG Laser in a Hemorrhoidectomy.: Lim, Seok Won , Lee, Kwang Real , Hwang, Do Yean; J Korean Soc Coloproctol. 1999;15(3):203-208.

1,165 View
22 Download

Abstract PDF: BACKGROUND
Even though lasers have been used in hemorrhoidectomies, there has been much debate about their effect. PURPOSE: A prospective randomized study was performed comparing the efficacy of a Nd:YAG laser with that of scalpel excision when performing a ligation excision, semi-closed hemorrhoidectomy.
METHODS
Sixty patients, who had more than three piles, with 3rd or 4th grade hemorrhoids, were enrolled into this study. Hemorrhoidectomies were performed under low spinal anesthesia. The ligation excision, semi-closed hemorrhoidectomy technique was used. Data evaluated included age, sex, operative time, postoperative pain scores, postoperative analgesic requirement, wound-healing time, and postoperative complications. Of the sixty patients enrolled into this study, 30 received laser excision and the other 30 scalpel excision.
RESULTS
There were no significant differences between the two groups, except for operative time (laser, 34.6 8.4 min; scalpel, 24.1 4.8 min). Postoperative complications, such as urinary retention, fecal impaction, skin tags, and postoperative fissure, were more common in the laser group.
CONCLUSIONS
A hemorrhoidectomy using a Nd:YAG laser takes longer than a conventional hemorrhoidectomy and neither reduces the postoperative pain nor shortens the wound-healing time. For achieving an effective treatment in hemorrhoids by using lasers, improved laser instruments are required, along with more detailed study of lasers and their effects.

Original Articles

Clinical Characteristics of Diverticular Disease of the Colon.: Kang, Kil Ho , Baek, Moo Jun , Kim, Chang Ho; J Korean Soc Coloproctol. 1999;15(3):209-218.

1,095 View
5 Download

Abstract PDF: PURPOSE
Diverticular disease of the colon is relatively common in western population and rare in oriental population but in recent years the incidence is steadily increasing in oriental population including Korean, so more concerns and appropriate management are required.
METHODS
We reviewed 111cases who had diverticular disease in the colon from January 1988 to May 1998 in the Soonchunhyang University Chunan Hospital. Of 111 cases, 87 cases were treated conservatively and 24 cases received a surgical treatment.
RESULTS
The annual incidence increased progressively for the last 10 years. The mean age of the patients at the time of diagnosis was 49.6 years and the most common age-group was forth decades (25%). The diverticula were located in the right colon 89%, left colon 7% and both side 4%. Among 24 surgically treated cases, the most common preoperative diagnosis was acute appendicitis (75%) and the correct preoperative diagnosis was made only 3 cases (13%) who had previous appendectomy history, previous diagnosed history or received barium enema due to recurrent pain attack. The surgical procedures of the colonic diverticulosis were right hemicolectomy (6 cases), ileo-ascending colectomy (6 cases), diverticulectomy (2 cases), segmental resection of transverse colon (1 case), left hemicolectomy (1 case), appendectomy (2 cases), appendectomy with drainage (3 cases), appendectomy with drainage and diverticulectomy (3 cases). The postoperative complication was wound infection in all complicated cases. There was no postoperative mortality.
CONCLUSIONS
The outcome of patients in our series is satisfactory despite of diagnostic inaccuracies. Preoperative barium study is recommended in those above the 40 years of age suspected the appendicitis. We recommend surgery for patients after two or three episodes of acute diverticulitis that resolves after medical treatment with antibiotics.

A Retrospective Study Comparing Clinical Characteristics between.: Lim, Jeong Soo , Sohn, Chang Yong , Bae, Ok Suk; J Korean Soc Coloproctol. 1999;15(3):219-226.

969 View
3 Download

Abstract PDF: PURPOSE
This study was undertaken to obtain better clinical insights and therapeutic approaches to the diverticular diseases of the colon by identifying the clinical characteristics of the right and left colonic diverticular diseases.
METHODS
A retrospective analysis was made of 68 colonic diverticular patients treated between August of 1986 and July of 1997. Right colonic diverticular disease was present in 55 patients, left side disease in eight patients, and bilateral disease in five patients. According to the location of the colonic diverticular disease, various clinical parameters such as the nature of the diverticula, age and sex, diagnostic accuracy, and methods of treatment were assessed.
RESULTS
The average age of 68 patients in this study was 50.94 years. Fifty two patients were male and sixteen were female. The disease was far more common in the right colon (80.9%) than the left colon (11.7%) and the right colonic diverticular disease was the most common source of confusion in diagnosis from acute appendicitis. Conservative management was tried in 30 of 35 patients above age 50 and obtained a good result without any complication.
CONCLUSIONS
There has been a tendency toward increased incidence of annual colonic diverticular diseases in this study. The right colonic diverticular disease was far more common than the left side disease and the disease was more common in the male. In patients above age 50, initial conservative management is a reasonable approach, although early surgical exploration might be better in younger patients. Acute appendicitis should be ruled out before any treatment decision was made.

Giant Colonic Diverticulum.: Yu, Ki Won , Baek, Moo Jun , Kim, Sung Yong; J Korean Soc Coloproctol. 1999;15(3):227-232.

942 View
5 Download

Abstract PDF: While diverticulosis of the colon is a relatively common disease, a solitary giant colonic diverticulum is rare. Although there exist some theories about the formation of the giant colonic diverticulum, none is really conclusive. The preoperative diagnosis of giant colonic diverticulum is made radiographically with findings of a large, smoothly marginated, round homogeneous radiolucency in the abdomen that is in close apposition to the colon on barium enema examination. Early surgical treatment is necessary since the complication rate is high. One case of giant colonic diverticulum is presented, the clinical, radiologic and pathologic findings are discussed, and the etiology and differential diagnosis, reviewe.

Intractable Rectal Fistula Accompanying Presacral.: Kim, Jin cheon , Kim, Chang Nam , Lee, Han Il; J Korean Soc Coloproctol. 1999;15(3):233-237.

837 View
4 Download

Abstract PDF: No abstract available.

Case Report

A Case of Jejunal Adenocarcinoma in a 13-Year-Old Girl.: Baek, Moo Jung , Lim, Hoon , Kim, Sung Yong; J Korean Soc Coloproctol. 1999;15(3):237-241.

951 View
3 Download

Abstract PDF: The incidence of carcinoma of the small intestine is very low in children, and it is also known that the prognosis of this tumor in children is very poor. A case of adenocarcinoma in a 13-year-old girl arising in the jejunum is herein reported. The girl underwent a curative resection and is free of recurrence or metastasis 12 months after operation. This particular case is reported here with a review of the literature.

First
Prev
Page of 1
Next
Last

Previous issues