Annals of Coloproctology

Volume 17(1); February 2001

Original Articles

The Expression of Gastrin and Gastrin/ CCK-B Receptor mRNA in Cancer and Normal Tissue of Large Intestine.: Oh, Jae Hwan , Hwang, You Jin , Chung, Moon Gi , Kang, Dong Hoon; J Korean Soc Coloproctol. 2001;17(1):1-6.

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Abstract PDF: PURPOSE
Gastrin, a peptide hormone produced by the G cells of the gastric antrum, plays a major role in regulating acid secretion in the stomach, and acts as a trophic factor in the gastrointestinal tract. The relationship between gastrin and the development of colorectal cancer remains controversial. To study its possible role in development or proliferation of colorectal cancer, we evaluated the expression of gastrin and gastrin/CCK-B receptor mRNA in cancer and normal tissue from colorectal cancer patients. We also reviewed clinical records to evaluate the correlations between gastrin receptor expression and clinical characteristics of colorectal cancer.
METHODS
Reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate mRNA expression for gastrin and gastrin/CCK-B receptor in 26 surgical specimens of colorectal cancer.
RESULTS
The mRNA expression of gastrin was detected in 24 out of 26 cancer specimens and 9 out of 26 normal colon specimens (p<0.05). The mRNA expression of gastrin/ CCK-B receptor was detected in 18 out of 26 cancer specimens and 17 out of 26 normal colon specimens (p>0.05). There was no significant correlation between gastrin receptor expression and clinical characteristics of colorectal cancer.
CONCLUSIONS
The gastrin gene products might be more important than gastrin/CCK-B receptor in development or proliferation of colorectal cancer, which supports the hypothesis that gastrin gene products play a role in proliferation of colorectal cancer as an autocrine factor.

Factors Influencing Fecal Incontinence in Complete Rectal Prolapse: A Prospective Analysis.: Yoon, Seo Gue , Lee, Kwang Real , Kim, Khun Uk , Song, Seok Kyu , Kim, Chil Seok , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(1):7-14.

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Abstract PDF: PURPOSE
This study was undertaken to identify factors influencing fecal incontinence in rectal prolapse.
METHODS
The clinical and anorectal physiologic data (anal manometry, rectal sensitivity test, pudendal nerve terminal motor latency (PNTML)) of 42 complete rectal prolapse patients were collected in a prospective database and were analyzed according to Wexner's incontinence score (0-20).
RESULTS
The mean Wexner's incontinence score was 10.6. Females (n=24) were more prone to be incontinent than males (n=18)(incontinence score 14.8 vs 5.1, p<0.001). A linear regression analysis showed that increased age (r= 0.497, p=0.001), decreased maximum resting pressure (MRP) (r= 0.686, p<0.001), decreased maximum squeezing pressure (MSP)(r= 0.789, p<0.001), decreased maximal rectal tolerable volume (MTV) (r= 0.386, p=0.012) influenced the incontinence score. An absent rectoanal inhibitory reflex (RAIR) was not related to incontinence, but was related to significantly low resting anal pressure. Delayed PNTML did not influence incontinence or the MSP. In a multiple regression analysis, decreased MRP (beta= 0.383; p=0.002), decreased MSP (beta= 0.345; p =0.007) and female gender (beta=0.343; p=0.006) influenced incontinence significantly.
CONCLUSIONS
Major factors influencing fecal incontinence in complete rectal prolapse were decreased MRP and MSP. Female patients were more prone to fecal incontinence than males. RAIR and MTV were not significant factors. PNTML did not show any relation to incontinence score or the anal pressure.

Surgical Management of Cecal Diverticulitis Detected during Appendectomy.: Park, Chul Woon , Kim, Bong Goo , Kim, Ki Sang , Byun, Young Hoon , Cho, Kwang Ho , Byun, Sang Hyun , Kim, Byung Ju; J Korean Soc Coloproctol. 2001;17(1):15-19.

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Abstract PDF: PURPOSE
Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease.
METHODS
Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998.
RESULTS
There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage.
CONCLUSION
We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.

Clinical Aspects and Surgical Methods in Perianal Hidradenitis Suppurativa.: Hwang, Do Yeon , Park, Weon Kap , Lee, Jong Ho , Yoon, Jong Sup , Cho, Kyung A , Kim, Hyun Shig , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(1):20-25.

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Abstract PDF: PURPOSE
Hidradenitis suppurativa is a chronic suppurative and cicatricial inflammatory disease involving apocrine gland- bearing areas including the axilla, groin, and anogenital regions. Recurrence after surgery is not rare, and there is much debate about operative methods. This study analyzed the clinical characteristics and the relationship between different surgical methods and recurrences of perianal hidradenitis suppurativa.
METHODS
A retrospective study of 20 patients with perianal hidradenitis suppurativa was done. The clinical characteristics were examined. The patients were divided into several groups (acute, chronic regional, chronic extensive) according to lesion status; then, different operative methods and recurrence rates were compared.
RESULTS
All of the patients were male smokers. The mean age of onset was 28.4 years. The mean duration of disease was 10 years. The total number of operations, including incision and drainage, was 29 cases. Only 4 patients were overweight or obese. The most common symptom was pus discharge (52%). The recurrence rate after final surgery was 30.0%. After incision and drainage in the acute group, 7 of 8 cases (87.5%) recurred. In the chronic regional group, 5 of 9 cases (55.6%) experienced recurrence after excision and primary repair. After excision and healing by secondary intention, 1 of 7 cases (14.3%) had recurrence. In the case of one unroofing and marsupialization, there was no recurrence. In the chronic extensive group, 1 recurrence was noted in 4 unroofings and marsupializations.
CONCLUSIONS
In the case of abscess, proper incision and drainage is needed, but further definitive surgery must be done. In the case of chronic disease, if the lesions are regional, excision and healing by secondary intention is more ideal for decreasing the recurrence rate. If the lesions are extensive, unroofing and marsupialization is recom-mended.

Biofeedback Therapy in Patients with Nonrelaxing Puborectalis Syndrome: Are there differences of therapeutic effect according to methods of diagnosis?.: Jeong, Jae Heon , Choi, Jeong Seok , Seo, Yong Jun , Kim, Jun Hyun; J Korean Soc Coloproctol. 2001;17(1):26-32.

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Abstract PDF: PURPOSE
To evaluate therapeutic effect of biofeedback therapy according to methods of diagnosis in patients with norelaxing puborectalis syndrome.
METHODS
From September, 1, 1998 to February, 30, 1999, the patients who were diagnosed with norelaxing puborectalis syndrome on anal electromyography (EMG) and/or cinedefecography (CD) underwent biofeedback therapy. The patients were divided into 3 groups according to the diagnostic method; CD group - only diagnosed on cinedefecography, EMG group - only diagnosed on anal electromyography, CD EMG group - diagnosed on both tests.
RESULTS
Nineteen patients were diagnosed nonrelaxing puborectalis syndrome on CD and/or EMG. There were 14 females and 5 males with a mean age of 40.8+/-18.4 years. The patients were classified into CD group; five patients (26.3%); EMG group, eight patients (42.1%); CD EMG group, six patients (31.6%). The patients had 5.4 3.7 sessions of outpatient EMG-based biofeedback sessions. Subjective symptoms after biofeedback therapy improved in 4 (80.0%), 6 (75%), 5 (83%) patients in CD, EMG, CD EMG groups, respectively. There was a statistically significant increase in spontaneous bowel movements, and a reduction in assisted bowel movements after biofeedback therapy in patients in all three groups (p<0.05). However, no significant difference was found among the three groups.
CONCLUSION
This study demonstrated that biofeedback therapy had a high therapeutic effect regardless to the diagnostic method. Therefore, biofeedbck therapy can be performed if one test results in the diagnosis of norelaxing puborectalis syndrome in patients with constipation.

Toxicity Evaluation of Oral Adjuvant Chemotherapeutic Drugs UFT Versus UFT-E in the Colorectal Cancer.: Hong, Hyoun Kee , Cho, Yeong Kyu , Kim, Hee Cheol , Yu, Chang Sik , Kim, Tae Won , Lee, Je Hwan , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(1):33-37.

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Abstract PDF: PURPOSE
Oral UFT is known to be a safe and effective antineoplastic regimen for adjuvant chemotherapy of colorectal cancer. As it sometimes produces upper gastrointestinal symptoms such as anorexia, nausea, vomiting and abdominal pain, medication should be stopped transiently or dosage reduced. UFT-E, an enteric coated granule of UFT was introduced to reduce UGI toxicity. We analyzed the toxicity of UFT and UFT-E prospectively for the purpose of comparison between the two types.
METHODS
The toxicity of UFT and UFT-E were evaluated in 83 patients (UFT; 45, UFT-E; 38) with colorectal cancer who underwent curative surgery according to the WHO toxicity criteria. All patients were selected consecutively with patients' approval and by the "Institutional Review Board, Asan Medical Center".
RESULTS
The toxicity incidence in UFT-E group was slightly less than that in UFT group without statistical significance. The severity of toxicity seemed to be mild within grade 1 or 2 and most of them toxicity self-limiting. The regimen was completely interrupted in 9 patients (20%) in the UFT group, 3 patients (7.9%) in the UFT-E group due to severe UGI symptoms, prolonged leukopenia, derrangement of liver function and skin rash.
CONCLUSIONS
Toxicity rate of UFT-E was not higher than that of UFT. But we cannot prove superiority of UFT-E on UGI toxicity. Oral UFT-E can be administered safely on an outpatient basis without lethal toxicity requiring hospitalization.

hMLH1/hMSH2 Protein Expression in Sporadic Colorectal Carcinoma and Its Clinicopathological Significance.: Kang, Jae Hee , Lee, Kil Yeon , Lee, Kee Hyung , Yoon, Choong , Oh, Soo Myung , Lee, Joo Hee; J Korean Soc Coloproctol. 2001;17(1):38-46.

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Abstract PDF: PURPOSE
DNA replication errors (RERs) in repeated nucleotide sequences (microsatellite instability) is caused by defective mismatch repair (MMR) genes. Ninety percent of colorectal carcinomas in hereditary nonpolyposis colorectal cancer (HNPCC) patients and 10-15% of sporadic colorectal cancers show microsatellite instability. In the majority of colorectal cancers with microsatellite instability, the defective MMR gene is hMLH1 or hMSH2. The author examined immunohistochemical expression of hMLH1 and hMSH2 in 75 cases of colorectal carcinomas excluding HNPCC, based on Amsterdam criteria for investigating clinicopathological characteristics and prognosis in hMLH1/hMSH2 negative cases.
METHODS
Formalin fixed, paraffin blocks obtained from tumors of 75 cases of colorectal cancers were stained with two monoclonal antibodies (hMLH1 and hMSH2). The correlation between hMLH1/hMSH2 negativity, and clinicopathological feature and prognosis were statistically analysed.
RESULTS
Twelve cases (16.0%) showed hMLH1/hMSH2 negativity. Negative expression of hMLH1/hMSH2 was associated with early onset (under age 50), proximal location, multiplicity, mucinous histologic type and poor differentiation. There was a significant survival advantage in patients with hMLH1/hMSH2 negative colorectal carcinoma.
CONCLUSIONS
This study shows that hMLH1/hMSH2 negative colorectal carcinomas have the same clinicopathological characteristics of colorectal carcinomas with microsatellite instability. The immunohistochemical test for hMLH1/hMSH2 protein can be a simple screening method routinely applicable. The result of this test is available for establishing guidelines for management, and an independent prognostic factor for sporadic colorectal cancers.

Clinical Significance of PCNA and nm23 Expression in Invasive Colorectal Carcinoma.: Kang, Gu , Park, Chul Jae; J Korean Soc Coloproctol. 2001;17(1):47-52.

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Abstract PDF: PURPOSE
It is known that PCNA (proliferating cell nuclear antigen) is associated with cell proliferating activity and nm23 with so called 'anti-metastatic' activity. We tried to elucidate the relationships of PCNA labeling index and nm23 expression in carcinoma cells with survival rates of patients with invasive colorectal carcinoma.
METHODS
Immunohistochemical study was performed using monoclonal antibodies for PCNA and nm23 gene products on 45 cases of paraffin-embedded tissue made of invasive colorectal cancer.
RESULTS
Five-year survival rate was lower in the group with high PCNA labeling index than that with low one, but PCNA labeling index was not associated with the tumor stages. Expression of nm23 was not associated with survival rate, tumor stage, site, and PCNA labeling index.
CONCLUSIONS
Although PCNA labeling index was not associated with tumor stages, this study suggests that PCNA labeling index will be a good prognostic factors in invasive colorectal carcinoma.

Case Report

Malignant Duodenocolic Fistulas: Report of 2 cases.: Koo, Ji Hoe , Lee, Ki Seog , Cho, Young Up , Woo, Ze Hong , Shin, Yong Woon , Kwon, Kye Sook , Kim, Kyung Rae; J Korean Soc Coloproctol. 2001;17(1):53-57.

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Abstract PDF: Malignant duodenocolic fistula is a rare complication of advanced right colon cancer. The surgeon becomes involved not only with the cancer lesion, but also with the physiologic complications, such as electrolyte imbalance and malnutrition. We experienced 2 cases of duodenocolic fistulas arising from right side colon cancers. One of the patients was surgically treated by right hemicolectomy and pancreatico-duodenectomy and another case was lost to follow-up. We report these cases with a brief review of the literature.

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