Annals of Coloproctology

Volume 17(3); June 2001

Original Articles

Change of alpha-SM Actin Expression Induced by the Antibody for TGF-beta in Fibroblast NIH3T3 Culture: The basic research for the inhibition of wound contracture.: Lee, Bong Hwa , Kang, Hyung Kil , Kim, Jeong Jin , Kim, Dong Kun , Yoon, Dae Won; J Korean Soc Coloproctol. 2001;17(3):113-118.

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Abstract PDF: PURPOSE
The purpose of this experiment is to measure the expression of TGF-beta and alpha-SM actin (smooth muscle actin) from fibroblast culture by the duration of culture days and to analyze the inhibition of alpha-SM actin expression in fibroblast by the antibodies for TGF-beta.
METHODS
The levels of alpha-SM actin from the paired NIH3T3 cell cultures with TGF-beta 1 containing medium (10 ng/ml) and with the antibody (for TGF-beta) medium (1 or 2 ug/ml) were determined by SDS PAGE for cell lysate protein, Western blot with ECL autoradiography and immuno - slot blot.
RESULTS
In NIH3T3 culture, the expression of alpha-SM actin increased at culture days 4, 5, 6. TGF-beta was expressed from 2nd day of culture and increased by day 7. The addition of TGF beta (10 ng/ml) did not increased the expression of alpha-SM actin. But alpha-SM actin expression decreased in the presence of anti-TGF beta antibody. The decrease of expression was proportional to the concentration of antibody and duration of exposure to the antibody.
CONCLUSIONS
Endogenous TGF-beta produced by fibroblast cultures is sufficient to express the alpha-SM actin from the myofiboblast. There was no additive expression of alpha-SM actin with exogenous TGF-beta 1. The antibody for TGF- beta inhibits the production of the alpha-SM actin during wound healing and may prevent the wound contracture.

Surgical Treatment of the Patient with Non- specific Colon Ulcer.: Jeong, Seong Hun , Kim, Cheong Yong , Byun, Joo Nam; J Korean Soc Coloproctol. 2001;17(3):119-124.

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Abstract PDF: PURPOSE
Non-specific ulceration of colon is a rare disease of unknown etiology. To establish correctly the diagnosis of nonspecific colon ulcer preoperatively is difficult, but with more wide spread use of colonoscopy and complementary diagnostic aids, this lesion may be accurately diagnosed more often. The presentating symptoms were mainly lower abdominal pain, which mimic such conditions as acute appendicitis, diverticulitis, intestinal obstruction, and colon cancer. If its serious complications (perforation, abscess formation, or uncontrolled bleeding) were developed, resection of ulcerated segment or more extensive colectomy was recommended. The purpose of this study was to establish correctly the diagnosis of nonspecific colon ulcer preoperatively and to identify definitive treatment of complicated colon ulcer.
METHODS
6 cases, surgically treated as non-specific colon ulcer at Chosun University hospital from January 1995 to December 1999 were studied retrospectively.
RESULTS
The ages of the patient ranged from 35 to 70 years; the ratio of male to female is 2: 1. The main clinical symptoms were abdominal pain (6 cases), nausea and vomiting (4 cases), hematochezia (3 cases), constipation (2 cases) and palpable mass (1 case). The preoperative diagnosis was generalized peritonitis (2 cases), colon cancer (2 cases), acute appendicitis (1 case), mechanical obstruction (1 case). 3 cases had past medication history, one was anti-hypertensive drug and the two were nonsteroidal anti-inflammatory drug. The preoperative diagnostic study were simple abdomen (6 cases), abdominal CT (6 cases), colon study (3 cases), abdominal sonograph (4 cases) and selective angiogram (1 cases), The location of ulcer were cecum (2 cases), sigmoid colon (2 cases), transversecolon (1 case) and descending colon (1 case). The methods of operation were hemicolectomy (3 cases), segmental resection (1 case) and anterior resection (2 case). There was one death, but 5 cases were completely recovered.
CONCLUSIONS
Non-specific ulcer of the colon is not detected until complicated by bleeding, perforation, or obstruction. The patient who has chronic abdominal pain and rectal bleeding can be diagnosed preoperatevely by colonoscopy and colon study. The recommended therapy of complicated cases is resection of the ulcerated segment or more extensive colectomy. Non-specific colonic ulcer should be suspected as one of colonic disease in the patients with complications.

Association between Helicobacter pylori and Colorectal Neoplasm.: Ahn, Joong Wook , Rhyou, Jai Hyun , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 2001;17(3):125-129.

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Abstract PDF: PURPOSE
Helicobacter pylori infection has been reported as a major factor of chronic gastritis, peptic ulcer, gastric lymphoma, and stomach cancer. In some uncontrolled studies, a high seroprevalence of H. pylori infection unexpectedly has been found in patients with colorectal cancer. The purpose of this study was to investigate the prevalence of H. pylori infection in patients with colorectal neoplasm.
METHODS
93 colonic tissue samples were collected during the colonoscopic biopsy. The specimens included polyp, cancer, and normal colonic mucosa. The CLO testTM kit (Delta West Ltd., Bentley, Western Australia) was used for detection of H. pylori. The SAS program (USA) was used for the Fisher's exact test.
RESULTS
H. pylori infection was detected 11 (11.8%) of total 93 specimens, 7 (25.7%) of 27 in cancers and 3 (6.9%) of 43 in polyps. Significantly higher H. pylori infection was detected in the colorectal cancers than non-cancer lesions (p=0.012) and polyps (p=0.038).
CONCLUSIONS
These results suggest a statistically significant association between H. pylori and colorectal neoplasm. The mechanism underlying this association needs to be investigated.

Diagnosis and Treatment Modalities in Pseudomyxoma Peritonei.: Lee, Yeong Jin , Kim, Hee Cheol , Lee, Dong Hee , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(3):130-134.

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Abstract PDF: Pseudomyxoma peritonei is an unusual condition in which gelatinous fluid collection is associated with mucinous implants on the peritoneal surfaces and omentum. PURPOSE: The aim of this study was to evaluate the clinical characteristics of pseudomyxoma peritonei and elucidate the optimal treatment modality.
METHODS
Nine patients (male: female=2: 7) who had been operated on due to pseudomyxoma peritonei were analyzed retrospectively, in terms of clinical characteristics.
RESULTS
The common symptoms and signs were abdominal pain, mass and distension. Elevated serum carcinoembryonic antigen (CEA) level was found in six cases. CT and ultrasonography were most valid diagnostic tools for pseudomyxoma peritonei. Six cases underwent debulking operation as initial treatment and two of them underwent intraoperative chemotherapy with 5-fluorouracil and other three cases did open biopsy. The origin of the primary tumor were appendix in three cases, ovary and appendix in three cases, ovary and colon in one case, ovary in one case, while the tumor origin could not be identified in one case. The three cases with cystadenoma remain free of disease after debulking operation. 2-Year survival rate of nine cases was 75%.
CONCLUSIONS
This study suggested that (1) the preoperative diagnosis could be made with careful physical examination in conjunction with sonography or computerized tomography; (2) the prognosis may be better in patient with benign origin and aggressive surgical management; (3) serum CEA level may be valuable for detection of this disease.

Increase of Plasma TGF-beta1 Level in Colorectal Cancer Patients.: Lim, Chang Ki , Choi, In Young , Shin, Hoon , Ryu, Min Hee , Sohn, Seung Kook , Jin, Seung Won; J Korean Soc Coloproctol. 2001;17(3):135-140.

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Abstract PDF: PURPOSE
Many kinds of malignant tissues, including colorectal cancer were reported to overexpress transforming growth factor-beta1 (TGF-beta1) gene. However, little work has been done on the circulating TGF-beta1 and the association of TGF-beta1 with progression in patients with malignant tumors. In this study, we measured the plasma level of TGF-beta1 in colorectal cancer patients.
METHODS
Enzyme-linked immunosorbent assay (ELISA) was used to measure plasma TGF-beta1 level in 52 colorectal cancer patients and 290 normal controls. And carcinoembryonic antigen (CEA) as a tumor marker was compared with TGF-beta1 in the aspects of sensitivity and specificity.
RESULTS
The mean plasma TGF-beta1 levels were 1.219 +/- 0.834 (0.272~5.772) ng/mL in normal control and 8.207 +/- 2.428 (1.392~39.241) ng/mL in colorectal cancer. In comparison with CEA, TGF-beta1 is more potent in cancer diagnostic sensitivity.
CONCLUSIONS
The results of this study suggest that the plasma TGF-beta1 level can be a useful tumor marker in colorectal cancer patients.

Occurrence and Prognostic Implications of Lymph Node Micrometastases in Patients with Dukes' B Colorectal Carcinoma.: Choi, Yun Young , Choi, Hong Jo , Jung, Ghap Joong , Kim, Sang Soon , Hong, Sook Hee; J Korean Soc Coloproctol. 2001;17(3):141-147.

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Abstract PDF: PURPOSE
Whereas lymph node metastases in colorectal carcinoma are important prognostic factor, the prognostic relevance of occult tumor cells in lymph nodes has not been elucidated yet. Aims of this study were to assess the incidence of micrometastases of lymph nodes in patients with Dukes' B colorectal carcinoma and to investigate the correlation between nodal micrometastases and malignant potential to determine whether micrometastases of lymph nodes have prognostic significance, using an anti-cytokeratin immunohistochemical technique.
METHODS
To evaluate the incidence of lymph node micrometastases in patients with Dukes' B colorectal carcinoma, 1160 lymph nodes taken from 65 patients (17.9 per case) were assessed by immunohistochemical technique using a monoclonal anti-human cytokeratin (MNF 116). Clinicopathologic parameters and survival rate were compared between patients with and without micrometastases.
RESULTS
The incidence of nodal involvement by tumor cells in 65 patients with Dukes' B colorectal carcinoma (41 colon, 22 rectum, 2 synchronous cancer) was 30.8% (20 cases) and nodal positivity 3.2% (33/1423 nodes) by the immunostaining. No correlations were observed between the incidence of cytokeratin positivity and various clinicopathologic parameters, including preoperative CEA level, tumor site and size, histologic differentiation, pT stage, vascular invasion and lymphatic invasion and rate of recurrence. There was no difference in five-year survival estimated by Kaplan-Meier lifetable method between the micrometastases negative and positive groups (94.8% and 94.1%, respectively).
CONCLUSIONS
The presence of nodal micrometastases detected by anti-cytokeratin immunohistochemistry is an interesting phenomenon but clinically seems to be of little prognostic value in patients with Dukes' B colorectal carcinoma. Thus, this immunostaining technique does not offer a significant benefit over conventional pathologic staging using hematoxylin-eosin staining.

Surgical Treatment for Obstructing Carcinomas of the Left Colon and Rectum.: Kim, Jung Soo , Park, Sang Su , Yoon, Jin , Kim, Il Myung , Yang, Dae Hyun , You, Byung Ook , Cho, Ik Hang; J Korean Soc Coloproctol. 2001;17(3):148-152.

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Abstract PDF: PURPOSE
There have been many different kinds of operations for obstructing left colon (distal to splenic flexure) cancer and rectal cancer because immediate resection and anastomosis was known to cause many complications. We performed this study to analyse operative cases and evaluate which procedure had the better result.
METHODS
Thirty-six cases of left colon cancer and rectal cancer with complete obstruction were analysed from April 1990 to January 2001 and those cases were divided into two groups, the group of staged procedure and the group of primary resection. 28 cases were curative operations and 8 cases were palliative operations.
RESULTS
The group of staged procedures had 17 cases of curative operations with 1st. stage-colostomy and 2nd. stage-cancer resection. And the group of primary resection had 11 cases of curative operations, 6 cases of Hartmann's procedures, 2 cases with intraoperative colonic lavage and resection and 3 cases with cancer resection, anastomosis and proximal colostomy. There were no differences in the distribution of age and cancer stage between two groups. In both groups, the sigmoid colon was the most prevalent obstruction site. The staged procedure group had higher operative mortality (25%) than the primary resection group (8%). And 5-year survival rate of the primary resection group was higher than that of the staged procedure group (45%: 33%), but there was no statistical significance.
CONCLUSIONS
We think that the primary resection is the better surgical procedure because of shorter hospital stay and fewer operations in the treatment of obstructing left colon and rectal cancer.

Clinical Significance of Expression of DCC Protein in Colorectal Carcinoma.: Kim, Jong Han , Min, Byung Wook , Moon, Hong Young; J Korean Soc Coloproctol. 2001;17(3):153-158.

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Abstract PDF: PURPOSE
The objective of this study was to discover the clinical importance of the DCC protein as a genetic factor that takes part in the metastatic process of colorectal cancer.
METHODS
We performed clinical study among 113 patients who were diagnosed with colorectal cancer and consequently operated, on Korea University Guro Hospital from Jan. 1994 to Dec. 1995. At the immunohistochemical staining, 106 patients, were analyzed according to their recurrence and survival.
RESULTS
From 106 patients 23 (21.7%) showed recurrences and distant metastases during follow up period. There was no difference in local recurrence and distant metastasis between the positive and negative groups. The stages did not contribute to making difference between positive and negative groups, except Dukes' C2, where the recurrence rate in the DCC protein negative group was higher than positive group, and it was of clinical significance. The relationship between survival rate and DCC protein expression was not clinically significant.
CONCLUSIONS
The expression of DCC protein is relevant to the recurrence, distant metastasis, and prognosis of colorectal cancer in many reports. However, in our study, there was no correlation between the expression of DCC protein and recurrence and survival rate, except Dukes' C2 stage. More cases are needed to confirm our result.

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