Annals of Coloproctology

Volume 13(3); September 1997

Original Articles

Molecular Mechanism of Fas-mediated Apoptosis in Colon Cancer Cell Line.: Kim, Won Ho , Ha, Sung Ho , Kang, Jin Kyung , Park, In Suh; J Korean Soc Coloproctol. 1997;13(3):301-316.

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Abstract PDF: BACKGROUND
/AIMS: Physiologic cell death occurs primarily through an evolutionary conserved form of cellular suicide termed apoptosis. Recent evidence suggests that alterations in regulation of apoptosis contribute to the pathogenesis of a number of human diseases, including cancer, viral infections, autoimmune diseases, degenerative diseases and inflammatory diseases. Fas antigen(APO-1, CD95) is a cell surface receptor protein that is broadly expressed in normal and neoplastic cells and can mediate apoptosis in susceptible cells. Fas is involved in immune-related apoptosis including T-cell selection in thymus, down regulation of immune response and cytotoxic T-cell mediated cytotoxicity. In contrast to immune system, little is known about the function of Fas antigen expressed on epithelial cells. Recently, however, it has been shown that Fas is also important for the pathogenesis of liver disease and inflammatory skin disease. We have recently reported that although colon cancer cells HT-29 express Fas antigen on their surface, Fas ligation using IgM anti-Fas monoclonal antibody(CH-11) is not sufficient to induce apoptosis. In addition, cellular activation by IFN-gamma not only enhances Fas expression but also sensitizes HT-29 to apoptosis induced by Fas ligation as well as treatment with cycloheximide and actinomycin D. However, molecular mechanisms of Fas-mediated apoptosis are yet far from complete understanding. We, therefore, studied the functional role of Fas and apoptosis-related gene expression in apoptosis of colon cancer cell line HT-29 and signal transduction pathways including protein kinase C as well as protein phosphatase I and 2A. METHODS: Fas, Fas ligand and apoptosis related gene mRNA expression was measured by RT-PCR. Cytotoxicity and cell survival were assessed by LDH assay and MTT assay, respectively. Apoptosis was detected by confocal microscopic observation of chromatin condensation after DAPI stain and confirmed by demonstration of DNA fragmentation in agarose gel electrophoresis as well as TUNEL assay. DNA content was deteunined by flow cytometry after staining with propidium iodide and sub-G1 peak was considered as apoptotic cells. Results: Fas ligation by IgM anti-Fas monoclonal antibody(CH-11) tailed to induce poptosis in control HT-29. However, Fas ligation in IFN- gamma pretreated HT-29 induced apoptosis dose-dependently. HT-29 expressed very low level of bcl-2 mRNA, which was not changed by IFN-gamma pretreatment. IFN-gamma pretreatment did not alter the mRNA expression levels of bax, c-myc, p53, and caspases such as ICE, hich and cpp32. Protein kinase C inhibitor such as staurosporine and H7 did not inhibit Fas-mediated apoptosis of IFN-gamma pretreated HT-29. Fas-mediated apoptosis of IFN-gamma pretreated HT-29 was not suppressed as well by protein phosphatase 1 and 2A inhibitor calyculin A. Conclusions: Colon cancer cell line HT-29 expresses Fas antigen on the surface which is not sufficient to induce apoptosis. IFN-gamma pretreatment sensitizes HT-29 to Fas-mediated apoptosis, but dose not alter the expression of apoptosis-related genes including bcl-2, bax, p53 and caspases. Fas-mediated apoptotic signal in IFN-gamma pretreated HT-29 maybe independent with protein kinase C as well as with protein phosphatase 1 and 2A.

The Expression of DCC Protein in Colorectal Carcinomas.: Kim, Jong Woo , Ahn, Dae Ho , Chung, Jae Sam , Lee, Kyung Po; J Korean Soc Coloproctol. 1997;13(3):317-324.

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Abstract PDF: Colorectal cancer is one of the malignant tumours of which molecular genetic alterations have been much unveiled among the human cancers. In the multi-stepwise process to the carcinogenesis, it has been recently revealed that the neoplastic growth is originated either from the activiation of oncogene through its mutation, rearragement and amplification, or from the inactivation of the tumour suppression gene through its mutation and deletion. DCC(Deleted in colon cancer) protein is the product of DCC gene, the representative of tumor suppressor genes. The alteration of DCC protein may be related with the aggressiveness of carcinoma and metastasis. As a result, the prognosis of the cancer may be also thought to be affected. Now the prognosis of colorectal cancer mainly depends on pathologic staging, but there are some variations of survival and recurrence among the patients in same stage. Then this study is aimed to reveal the significance of alteration of DCC protein as an independent factor related to prognosis. Twenty three cancer tissues were obtained from the rejected specimens of colorectal carcinomas. We exacted the DCC gene products in the cancer tissues by the methods of immunohistochemical stains and Western blots. We also analyzed the relationships between the alteration of DCC proteins and the status of regional lymph node metastasis or the serum levels of CEA's(carcinoembryonic antigen). As results, we found the abscence or very scanty stains of DCC protein by Western lot in 14 cancer tissues of available 19 cases, but there were all negative responses in immunohistochemical stains. In contrast with above results, there were all positively stains of DCC proteins in corresponding 23 normal colorectal tissues by both the methods. There was no significantly statistical relation between the alteration of DCC proteins and the status of regional lymph node metastasis or the serum level of CEA. In conclusion, we can confirm that the DCC proteins are abscent or very scanty in colorectal cancer tissues and that may be related with the process of carcinogenesis. But the role of DCC protein loss as an independent prognostic factor was not found in this study.

Clinicopathologic Analysis on Mucinous Adenocarcinoma of Colon & Rectum.: Shin, Dong Woo , Kim, Nam Kyu , Min, Jin Sik , Kim, Ho Keun , Yang, Woo Ik; J Korean Soc Coloproctol. 1997;13(3):325-332.

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Abstract PDF: We have performed a retrospective analysis of 59 patients with mucinous colorectal carcinomas who were operated at the department of surgery, College of Medicine, Yonsei University Hospital between 1993 and 1996. Among the total 914 patients who had been treated by surgery due to colon & rectal cancers during the same period, 62 were diagnosed as mucinous adenocarcinomas(MC) of colon & rectum. Of these 62 patients, we have analyzed 59 patients of colorectal MCs'comparing with another 59 patients of non-mucinous adenocarcinomas(NMC) who were randomly selected during the same period. Mean age of MCs' was 54.6(25-84) and that of NMCs'was 58.2(30-76). The sex ratio was 1.1:1 and 1.6:1 respectively. The age distribution showed peak incidences at 50s' for MCs' and at 60s' for NMCs'. The tumor locations were more proximal in MCs'. Preoperative CEA levels were similar but postoperative serum CEA levels were more reduced in NMCs' than in MCs'. There were more frequent perineural and vascular invasions in MCs' The distribution according to Modified Dukes'stages showed more frequences of NMC's in stage A and there were more frequent synchronous metastases in MCs'. 110 patients out of 118 were followed up. The mean fellow-up periods were 17.9 months in MCs' and 17.6 months in NMCs'. During the period of follow-ups, 12 patients were detected for recurrence in MCs', and 8 patients in NMCs'. Although there was no statistical significance, mucinous carcinoma showed more high incidences of local & systemic recurrences. The three-year survival in groups of Dukes' stage C was poorer in mucinous group. Despite short follow-up period and limited number of patients, our results showed more aggressiveness of mucinous carcinoma.

Comparative Analysis of Growth Patterns in Colorectal Cancers that Invaded to.: Lim, Dae Hoon , Yoon, Seo Gue , Choi, Kyong Woo , Chang, Hee Jin; J Korean Soc Coloproctol. 1997;13(3):333-342.

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Abstract PDF: In this retrospective study, 49 patients who were treated by surgical resection of colorectal cancer, confuted to proper muscle and confirmed histologically from 1979 to 1996 were included. To examine the significance of growth pattern in terms of polypoid growth(PG)(n=26; m,sm 5, pm 21) and non-polypoid growth(NPG)(n=23; m,sm 3, pm 20), we analyzed several clinocopathologic variables by x2 test and unpaired t-test, 5-year survival rate by Kaplan-Meier method and Log-Rank statistics according to growth type comparatively: 1) In the PG tumor, muscle elevation(P<0.0117) and association with adenoma(P<0.0001) were more frequent than in the NPG. 2) The NPG type showed smaller size(P<0.0172) and higher rate of lymph node metastasis(P=0.025) and higher tendency of lymphatic invasion(P=0.07) and poor differentiation(P=0.0693) and deeper invasion(P=0.0972) and worse 5-year survival(P=0.0607). 3) Otherwise there was no difference in inflammation, fibrosis, and angioinvasion. 4) The mean thickness of Outer Longitudinal Muscle(OLM) was thicker in rectum than colon(rectum 1.62 mm, colon 0.74 mm, p<0.0059) and pm cancer was more in rectum than in colon(rectum 10.3%, colon 4.0% , p=0.0057). In the view of results, NPG in early colorectal cancer may suggest the possibility of de novo cancer. NPG type was smaller in the size but more aggressive in lymph node metastasis, lymphatic invasion, invasion depth, tumor differentiation, 5-year survival rate. So it needs more thorough follow up. The higher incidence of pm cancer in rectum than in colon, is probably due to thicker OLM of rectum than that of colon.

The Relationship of Depth of Penetration and Tumor Size to the Number of.: Hong, Dong Hwan , Kim, Heung Dae , Shin, Jun Ho , Han, Won Kon , Pae, Won Kil; J Korean Soc Coloproctol. 1997;13(3):343-352.

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Abstract PDF: We examined the interrelationships of depth of penetration, tumor size, and the number of positive lymph nodes in Dukes'c colorectal cancer. This report contains a retrospective study of 256 cases of colorectal cancer that underwent treatment from Jan. 1985 to Dec. 1994 at the Department of Surgery, Kangbuk Samsung Hospital. The most of the patients were on the 6th decades and male to female ratio was 1.27 : 1. By modified Astler-Coller classification, there were stage Cl 29 cases(11.3%), C2 227 cases(88.7%). Eighty patients with colon cancer(31.4%) and 176 patients with carcinoma of the rectum(68.6%) were available for analysis. Utilizing cumulative frequency distributions of tumor size, depth of invasion and the number of positive lymph nodes, comparisons were carried out among three factors. The results indicate that there was no correlation between the longest diameter of the tumor and other two factors but the number of positive lymph node was closely related to depth of invasion. In conclusion, the number of positive lymph node and depth of invasion are very important prognostic factor. But tumor size as a single factor does not correlated with prognosis in Dukes' C colorectal cancer.

Case Report

A Clinical Analysis of 475 Cases of Colorectal Cancer.: Cha, Jeong Gon , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 1997;13(3):353-362.

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Abstract PDF: Colorectal cancer is the third most common malignant neoplasm worldwide and the fourth most common cancer in Korea. Recently, incidence of colorectal cancer is increasing steadily. Because of advances in diagnostic tools, such as colonofiberoscopy, early detection of colorectal cancers is available. The survival rates of colorectal cancer is increasing due to early detection and advances in adjuvant therapy, such as chemotherapy and radiotherapy. The clinical analysis was made on 475 patients with colorectal cancer who have been admitted and operated at the Department of Surgery, Chonnam University Hospital, from January, 1987 to December, 1996. The results were as follows: 1) The peak age group was in the sixth(29.7%) and seventh decade(29.7%) followed by the fifth decade(17.3%) of life. The male: female ratio was 1.1:1. 2) The annual incidence was increased steadily, but since 1994, plateau in incidence has occurred. 3) The most common site was the rectum(62.7%). 4) Common symptoms and signs were anal bleeding(40.1%) and abdominal pain (28.1%). According to site, anal bleeding was the most common complaint in the rectum and left sided colon and abdominal pain was in other colons and cecum. 5) The most common stage by TNM staging system was stage II (38.7%). 6) Most cases of colorectal cancer were adenocarcinoma(97.7%), well differentiated lobular adenocarcinoma(55.6%) in which was the most common histopathologic type. 7) Preoperative circulating CEA(carcinoembryonic antigen) level was checked in 396 patients(83.4%). CEA was less than 10.0 ng/ml in 295 cases(74.5%) and more than 10.0 ng/ml in 101 cases(25.6%). 8) DNA ploidy was checked in 197 cases(41.5%). There ware aneuploid in 102 cases, diploid in 95 cases. 9) Curative surgery were performed in most cases. The most common surgical procedure was low anterior resection(35.4%). 10) Postoperative complications were developed in 63 patients(13.3%). The most common complication was wound infection in 12 cases(19.0%). 11) The overall 5-year survival rate for patients with colorectal cancer was 55.9%. The difference of 5-year survival rate between diploidy and aneuploidy of DNA content was not significant statically(p=0.97). But, patients of preoperative serum CEA level over 10 ng/ml had a low survival rate compared with those under 10 ng/ml(p=0.0002). And also those of tumor size over 3 cm had a low survival rate compared with those under 3 cm(p=0.002).

Original Articles

Hereditary Nonpolyposis Colorectal Cancer.: Gung, Hwan Nam , Lee, Seok Hwan , Hong, Sung Hwan , Yoon, Choong , Lee, Kee Hyung; J Korean Soc Coloproctol. 1997;13(3):363-374.

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Abstract PDF: Hereditary nonpolyposis colorectal cancer(HNPCC) is an autosomal dominantly inherited disease associated with a marked increase in cancer susceptibility, especially cancer of the colorectum. The frequency of HNPCC in the general population is yet to be determined, but HNPCC may account for as much as 2% to 5% of colorectal cancer, Colorectal cancer in HNPCC differs from sporadic colorectal cancer by an early age of cancer onset, proximal predominance of colorectal cancer, an excess of synchronous and metachronous colorectal cancer, and excess extra-colonic cancers. We have found 5 HNPCC families since 1992 when we reported first HNPCC family (KHU-Hl) In order to register the patients of HNPCC and to review the clinicopathologic feature and appropriate management, we have analysed 5 HNPCC families. Five HNPCC families included 16 colorectal cancer patients(14 males and 2 females). The average age of first diagnosis was 39. Among 16 patients, 8 patient were operated at the KyungHee University hospital and their operative and pathologic records were available. Two synchronous and seven metachronous cancers were founded, so that eight patients had 15 colorectal cancer lesions. Ten cancers were located proximal to splenic flexure and five were distal. Partial resection of colon was performed in seven cases except one when the first diagnosis was made and recurrence was founded in 5 patients. Recurrence was treated by total colectomy in 3 cases and subtotal colectomy in two. In conclusion, we re-confirmed that HNPCC patient should be treated by no less than a subtotal colectomy because of high multiplicity and high recurrence rate of partial resection.

Primary Resection and Anastomosis of Obstructing Carcinoma of the Left Colon.: Hong, Ki Hoon , Song, In Sang , Yoon, Wan Hee; J Korean Soc Coloproctol. 1997;13(3):375-382.

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Abstract PDF: Differential surgical procedures have been described on the treatment of patients with obstructing carcinoma of the left colon and rectum, and these vary from classical three stage approach to primary resection and anastomosis using intraoperative colonic irrigation or subtotal colectomy. Staged colonic prcedures are associated with significant morbidity and mortality eventhough its initial easy performance, and many patients, unfit for further surgery, are left with a permanent colostomy. We have already reported the initial results of intraoperative antegrade colonic irrigation for one-stage operation in obstructing left colorectal cancers. In this investigation, we evaluated the results of prospective trials of primary resection and anastomosis using intraoperative colon irrigation and subtotal colectomy in obstructing left colon and rectal carcinomas. During recent five years, 19 cases of obstructing left colon and rectal carcinomas which could not received regular colon preparation due to marked abdominal distension were enrolled to this study. There were 12 men and 7 women, and mean age was 61. 14 of the 19 patients which tumors located below mid-descending colon were subjected to primary resection and anastomosis using intraoperative antegrade colonic irrigation, 4 patients which tumors located above the mid-descending colon were treated with subtotal colectomy, and remaining one patient which tumor located upper rectum was performed subtotal coloectomy because of underlying colonic ischemia. There was no mortality and significant postoperative complications such as anastomotic lealrage, pelvic abscess or intraabdominal sepsis which seemed to be related with anastomotic dehiscence. Therefore, primary resection and anastomosis using intraoperative colonic irrigation or subtotal colectomy depending on tumor locations in cases of obstructing left colon and rectal carcinomas might be useful methods to obtain safe one-stage restorative colorectal resections.

The Effect of Perioperative Transfusion on The Prognosis of Patients with.: Park, Yong Lai , Han, Won Kon; J Korean Soc Coloproctol. 1997;13(3):383-388.

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Abstract PDF: The effect of perioperative blood transfusion on the survival rate of patients of colorectal cancer was studied. From January 1990 to December 1995, 533 patients with colorectal cancer underwent surgical treatment in the department of surgery, Kangbuk Samsung Medical Center. In these patients, 430 patients with Dukes stages A, B, and C carcinoma were divided into two groups: those who received perioperative blood transfusion and those who did not. Overall survival curves were constructed using Kaplan-Meier method and the differences between curves were tested by using the log-rank test. Comparison of variables between the transfused and nontransfused groups were evaluated with the Student t test and Chi-square test with SPSS program. Two hundred and three patients (47.2%) received transfusions within the perioperative period. The transfused group included patients with tumors of more advanced stage such as Dukes C(60.1% vs. 44.5%, p< 0.05) and more rectal cancer(88.2% vs. 55.5%, p< 0.05). In the other variables such as age distribution, sex difference, histologic grade and perioperative hemoglobin level, there was no significant difference between the transfused and non-transfused group. Although the 5-year overall survival rate was significantly lower in the transfused group than non-transfused(61% vs. 74.2%, p< 0.05), subgroup analysis according to the tumor location and Dukes stage showed no statiscally significant difference in survival in each location and stage between the two groups. It is postulated that the possible adverse influence of blood transfusion on the survival of patients with colorectal cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself.

Analysis of Result of Primary Treatment of Anal Cancer.: Choi, Dong Lak , Yu, Chang Sik , Kim, Jin Cheon , Kim, Jong Hoon; J Korean Soc Coloproctol. 1997;13(3):389-396.

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Abstract PDF: Anal cancer is a relatively rare disease to supply consistent therapeutic modality. We analysed 18 anal cancer patients treated from 1989 to 1996 at the Department of Surgery, Asan Medical Center, to evaluate two categories of the treatment e.g. initial surgery followed by radiochemotherapy and radiochemotherapy Preceding surgery. The aim of this study is to evaluate the advantage and pitfall of both therapeutic options. Among 18 patients presenting with carcinoma of the anus, the dominant histologic type was squamous followed by cloacogenic and verrucous carcinoma, 72%, 17%, 11% respectively According to the staging system of AJCC/UICC, T1 and T2 were 12 patients, NO were 7 patients. According to the treatment options, abdominoperineal resection preceding radiochemotherapy were performed in 8 patients, Whereas surgery after radiochemo-therapy were in 10 patients. Among the 8 patient with prior surgery, two patients developed recurrent disease and one patient was dead. Among the 10 patient with prior radiochemotherapy, two patients developed recurrent disease and two patients were dead. Histological differentiation of squamous cell carcinoma was significantly related with survival. The metachronous lymph nodes metastasis showed poorer prognosis than the synchronous metastasis. Radiochemotherapy shoud be considered as primary therapy of anal cancer that obviated wide excision sacrificing anorectal function.

Evaluation of the Usefulness of Loop Ileostomy during Low Anterior Resection or.: Kim, Ho Young , Kim, Ik Yong , Kim, Sang Hee , Yoon, Kwang Soo; J Korean Soc Coloproctol. 1997;13(3):397-402.

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Abstract PDF: This is a retrospective clinical analysis of the usefulness of loop ileostomy for the prevention of anastomotic leakage in patients with low rectal cancer when the low anterior resection or coloanal anastomosis is performed. We reviewed 54 cases of low rectal cancer from January 1994 to May 1996 at Department of Surgery, Wonju College of Medicine, Yonsei University. In 54 cases of low rectal cancer, 28 cases were ileostomy group and 17 cases were no stoma group. There were no differences in clinical characteristics such as age and sex distribution. Most patients were classified into stage B or C by modified Astler-Coiler classification but 2 cases of stage D that simultaneous liver resection was performed were in no stoma group. Tumor locations from the anal verge were 6.8 and 10.3 cm by mean in ileostomy and no stomp group, respectively(P<0.05). Heights of anastomosis were 3.7 and 6.8 cm by mean from the anal verge in ileostomy and no stoma group, respectively(P<0.05). Double stapling technique was used for anastomosis in most patients but hand-sewn technique was also carried out in 1 case in ileostomy group. The most common postoperative minor complication was wound infection in both groups. Anastomotic leakage rate was higher in no stoma group(4 of 17, 23.5%) than that of ileostomy group (1 of 28, 3.6%) but statistical comparison could not be confirmed(P=0.00). But interestingly, such complications as stoma perforation, stoma prolapse and parastomal hernia were developed in ileostomy group and that all complications should be corrected by ileostomy repair. As forementioned above, we had concluded that ileostomy could protect anastomosis site but above mentioned complications associated with building the stoma should be also prevented by careful surgical technique.

Clinical Review of Early Postoperative Intestinal Obstruction after Colorectal.: Choi, Hyo Seong , Kim, Heung Dae , Park, Yong Rae , Han, Won Kon , Pae, Won Kil; J Korean Soc Coloproctol. 1997;13(3):403-412.

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Abstract PDF: This study was undertaken to identify the causative factors that predispose to early postoperative intestinal obstructions after the radical resection due to colorectal cancer, and to determine their preventive operative techniques. The records of 722 patients that had undergone radical resection due to colorectal cancer at the Department of General Surgery, Kangbuk Samsung Hospital, between January 1, 1986 and December 31, 1995, were reviewed. Among them, operative treatments due to early postoperative intestinal obstructions were performed in 39 patients(5.4%). The most common cause of intestinal obstruction in early postoperative period was bowel adhesion, that was developed in 20 cases(51.3%), and next common cause was internal herniation of bowel into the space between colostomy loop and lateral peritoneal wall(3 cases, 7.7%), incarcerated herniation of small bowel into the reperitonealized pelvic cavity(3 cases, 7.7%), pelvic abscess(1 case, 2.6%), and unknown causes(9 cases, 23.1%) in descending frequency. Use of closed suction drains was responsible to development of the 3rd and 4th causes. As a result, during the radical resection due to colorectal cancer, meticulous manupulation of bowels not to injure the bowel serosa, reperitonealization of pelvic floor at narrow interval with inversion of its dissected edge, complete closure of the space between colostomy loop and lateral wall of peritoneum, and adequate alternative use of closed suction drain and natural drain according to the operative condition, should be considered. In conclusion, surgeons should pay more attention to the operating procedures to lower the incidence of early postoperative intestinal obstruction.

An Antiperistaltic Ileostomy on Total Proctocolectomy in familial Adenomatous.: Oh, Nahm Gun; J Korean Soc Coloproctol. 1997;13(3):413-420.

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Abstract PDF: Permanent ileostomy is usually recommended in the cases of total proctolectomy for cancerous change on the distal rectum from ulcerative colitis or familial adenomatous polyposis, but fecal content through conventional ileostomy is usually liquid or semiliquid. Sometimes, it accompanies dehydration and some nutrient loss as complication. So, the author has devised namely, "antiperistaltic ileostomy" for formed stool evacuation. About 25cm length of the most dismal ileum was cut and this distal segment was reversed with intact mesentery and then antiperistaltic ileostomy was performed. The author has performed antiperistaltic ilestomy in 5 cases of familial adenomatous polyposis, or ulcerative colitis with a cancerous change in the low rectum for the past 5 years at the Department of Surgery in Pusan National University Hospital. The results obtained were as follows. 1) In theantiperistaltic ileostomy, the 24-hour ileostomy discharge was averagely 748 cc, in contrast to 1124 cc from conventional one. 2) In terms of weight, the 24-hour evacuated material from the conventional ileostomy weighed 810 gm on the average, but only 540 gm from the antiperistaltic ileostomy. 3) The 24-hour filtered liquid through a coffee filter of the 24-hour ileostomy discharge weighed averagely 514 gm in the conventional group, which was 63.5% of the prefiltered discharge, and weighed averagely 160 gm in the antiperistaltic group, which was 29.6% of the 24-hour discharge. In conclusion, the antiperistaltic ileostomy is claimed to create the effect of a reservoir by producing intestinal stasis in the segment, forming bacterial proliferation. The antiperistaltic ileostomy as a terminal segment is effective in reducing the daily amount of stool and facilitates stoma care owing to diminished liquid component in the ileostomy discharge.

Results of Surgical Treatment in Intestinal Behcet's Disease.: Kim, Ki Hong , Park, Kyu Joo , Yang, Han Kwang , Park, Jae Gahb , Kim, Sang Joon; J Korean Soc Coloproctol. 1997;13(3):421-434.

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Abstract PDF: Behcet's disease, originally defined by recurrent oral and genital ulcers and uveitis, is regarded as a multisystemic disorder that may involve various organs. Intestinal involvement in Behcet's disease is characterized by ulcers which tend to perforate or penetrate the intestinal wall. Thus, many patients with this disease require surgical intervention. This study was performed to analyze the results of the surgical treatment in patients with intestinal Behcet's disease. We have performed a retrospective analysis of 30 patients with pathologically defined intestinal Behcet's disease who had undergone operations at the Department of Surgery, Seoul National University Hospital between 1984 and 1996. The ulcers were most frequently located in the ileocecal area(79%) and 46% of the patients had multiple ulcers. The mean age at the time of first operation was 34 years(range: 14-58) and the mean interval from onset of symptoms to operation was 22 months(range: 0.3-96). The most common indications which led to operation were intractable pain (37%), followed by suspicion of malignancy(27%), obstruction(13%), perforation(10%) and bleeding(10%). Surgical treatment consisted of resection of the involved area in all cases except one patient who had undergone primary closure of the perforated ulcer. After mean follow-up period of 55 months(range: 1-120) after the primary operation, recurrence was observed in 17 cases(57%). The cumulative recurrence rate was 25% at 1 year, 37.9% at 3 years, and 61.2% at 5 years. Our results indicate that intestinal Behcet's disease is associated with high incidence of postoperative recurrence.

A Clinical Analysis of the Ulcerative Colitis.: Kim, Chang Seek , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1997;13(3):435-442.

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Abstract PDF: Ulcerative colitis is a diffuse inflammatory disease of the mucosal lining of the colon and the rectum without an apparent cause. It is common in European and North American countries, but rare in Korea. We reviewed 59 cases, who were diagnosed by clinical findings, barium enema, and colonoscopic biopsy from March 1988 to Febrary 1996 at the EWHA University hospital. The most prevalent age group was the third decade(32.20%) and a male to female sex ratio was 1 : 1.68 with 22 males and 37 females. The most prominent clinical symptoms were bloody stool(84.7%), diarrhea(61.0%), and abdominal pain(53.2%). The duration of the symptoms was less than 1 month in 38.98%, between 1 and 5 month in 16.9%, more than 6 months in 43.95%. For the anatomical site of the lesion, 28.8% of the cases were in the rectum alone, and 23.7% of the cases were in the entire colon. The laboratory fading showed Hemoglobin level below 10 g/dL in 13 of the 57 cases studied, and an albumin level below 3.0 g/dL in 10 of the 54 cases, ESR below 20 mm/hr in 2 of the 17 cases studied. The endoscopic examination showed positive findings in all of the 58 cases among the 58 cases studied. The barium enema examination showed positive findings in 26 cases among 31 cases. Of 59 cases that were studied, 58 cases were treated by medical therapy, and showed relative improvement but 1 of 59 cases had no improvement. Among the cases that showed a significant improvement, 31 cases had relapsed. Of the 59 cases, 7 cases were operated and completely cured.

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