Annals of Coloproctology

Volume 20(4); August 2004

Original Articles

Sulindac-induced Apoptosis without Oligonucleosomal DNA Fragmentation in HT-29 Cells: Its Special References to Mitochondrial Pathway.: Park, Ki Jae , Kwon, Yuk , Kim, Sung Heun , Kim, Min Chan , Choi, Hong Jo , Kim, Young Hoon , Cho, Se Heon , Jung, Ghap Joong , Kim, Sung Hyun , Kwon, Hyuk Chan; J Korean Soc Coloproctol. 2004;20(4):191-198.

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Abstract PDF: PURPOSE
This study was undertaken to reveal the molecular mechanism underlying sulindac-induced apoptosis in the human colon cancer cell line HT-29 (mutant p53).
METHODS
Apoptosis was determined by using Hoechst 33342 staining, and translocation of proteins was established by using immunofluorescence, immunoelectron microscopy, and Western blotting after ultra- fractionation.
RESULTS
This type of apoptosis was associated with decreased mitochondrial membrane potential, a translocation of the apoptosis-inducing factor (AIF) to the nucleus, and morphological evidence of nuclear condensation. However, DNA electrophoresis did not elucidate the ladder pattern of DNA fragments. Instead, a pulse-field gel electrophoresis showed that sulindac led to disintegration of nuclear DNA into-high- molecular-weight DNA fragments of about 100~300 kbp.
CONCLUSIONS
Our findings indicate that sulindac induces large-scale DNA fragmentation, suggesting a predominantly AIF-mediated cell-death process, through translocation of the AIF to the nucleus in HT-29 cells.

Intussusception in Adults.: Yun, Sang On , Namgung, Hwan , Lee, Chang Hwan , Park, Dong Guk; J Korean Soc Coloproctol. 2004;20(4):199-204.

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Abstract PDF: PURPOSE
Intussusception in adults is uncommon and constitutes approximately 5% of all intussusceptions. An organic lesion is found to be the lead point in 75 to 90% of the cases, so surgical intervention is necessary in most cases. This study was designed to review our experience with adult intussusception and to determine an appropriate method for diagnosis and management.
METHODS
Thirteen (13) patients over 15 years of age were diagnosed as having on intussusception at our center between 1994 and 2003. We reviewed the medical records of these patients retrospectively.
RESULTS
The preoperative diagnosis had been made correctly in 85% of patients (11 cases) by combined use of abdominal ultrasonography and a CT scan. The types of intussusceptions wene jejuno-jejunal in two cases, ileo-ileal in four, ileo-colic in three, and colo-colic in four. Causative organic lesion was found in all patients; seven cases (54%) were due to benign tumors, and six (46%) were due to malignant tumors. Surgical intervention was carried out in all cases; 11 patients underwent a surgical resection without manual reduction, and 2 patients underwent a surgical resection after manual reduction.
CONCLUSIONS
Both abdominal ultrasonography and CT scan are effective and useful diagnostic tools in the diagnosis of adult intussusception. Since tumors, benign or malignant, are the most frequent cause of adult intussusception, surgical intervention is mandatory.

c-Met Expression in Colorectal Carcinoma and Adenomas: Correlation with Clinicopathologic Parameters.: Kim, Jin , Kim, Jung Yun , Lee, Won Jin , Cho, Seong Jin , Min, Byoung Wook , Um, Jun Won , Cho, Min Young , Suh, Sung Ock , Moon, Hong Young , Hwang, Cheung Wung; J Korean Soc Coloproctol. 2004;20(4):205-210.

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Abstract PDF: PURPOSE
Hepatocyte growth factor (HGF) stimulates proliferation, migration, and morphogenesis of epithelial cells by specifically binding to its receptor c-met. Abnomalities of the c-met oncogene have been studied in cancers of many organs including thyroid, lung, pancreas, and stomach. However, little is known about the clinical significance of c-met oncogene abnormalities in colorectal carcinomas. In this study, we investigated over- expression of the c-met protein in colorectal adenomas and adenocarcinomas, and analyzed the clinicopathologic significance of this over-expression.
METHODS
Expression of the c-met protein localized in colorectal adenoma and adenocarcinoma tissues was analyzed by using immunohistochemistry. The results were compared with clinicopathologic parameters to find clinical correlation.
RESULTS
c-met protein was detected in 42.5% (17/40) of colorectal cancers and in 10.0% (4/40) of colorectal adenomas (P= 0.001). In colorectal cancer, the proportion of expression of c-met protein was 0% (0/40) in stage I, 47.6% (10/40) in stage II, 53.8% (7/40) in stage III and, 0% (0/40) in stage IV. c-met protein expression was 18.8% (3/40) in tumors with invasion into the muscularis propria (MP), and 58.3% (14/40) in tumors with invasion beyond the MP. The depth of tumor invasion was a statistically significant factor (P=0.022) for c-met expression.
CONCLUSIONS
The c-met protein expression was related to the depth of invasion of colorectal cancer and showed a significant difference in its rate of expression between adenoma and adenocarcinomas.

Clinicopathologic Features of Colorectal Cancer with Liver Metastases.: Choi, Sun Keun , Jeon, Yong Sun , Bae, Sun Young , Kwak, Min Keun , Hur, Yoon Seok , Lee, Keon Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ik , Hong, Kee Chun , Shin, Seok Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2004;20(4):211-217.

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Abstract PDF: PURPOSE
The aim of this study was to clarify the clinicopathologic features in colorectal cancer with liver metastases and to evaluate their clinical significance.
METHODS
From August 1996 to April 2002, 545 patients, who underwent radical surgery for primary colorectal cancers, were analyzed retrospectively.
RESULTS
Colorectal cancers with and without synchronous liver metastases at the time of the surgery were 36 and 509 cases, respectively. Of the 509 cases without metastases, 34 cases had metachronous liver metastases by April 2002, but the others did not. Serosal, vascular, perineural, and lymph node invasions, as well as increased preoperative CEA levels, were more frequently observed in those with synchronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, lymph node invasion was statistically significant as an independent variable in those with synchronous metastases (P=0.009). Serosal, vascular, and lymph node invasions, increased preoperative CEA levels, DNA ploidy, and positive lateral resection margins were more frequently observed in those with metachronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, vascular invasion was statistically significant in those with metachronous metastases (P=0.015).
CONCLUSIONS
Lymph node and vascular invasions appear to be significant determinants for synchronous and metachronous liver metastases in colorectal cancers. Therefore, close observation and careful postoperative follow-up is needed for such patients.

Clinicopathological Correlation of hMLH1 and hMSH2 Protein Expressions in Stage III Colon Cancer.: Cho, Young Kyu , Yu, Chang Sik , Namgung, Hwan , Kim, Hee Chul , Kim, Jung Seon , Lee, Je Hwan , Kim, Tae Won , Kim, Jin C; J Korean Soc Coloproctol. 2004;20(4):218-224.

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Abstract PDF: PURPOSE
Functional loss of mismatch repair has been reported to be the reason for resistance to several chemotherapeutic drugs. The expressions of hMLH1 and hMSH2 were examined to assess whether they correlated with the biological behavior and the chemotherapeutic responsiveness in paflents with sporadic colon cancers.
METHODS
Ninety-one patients with stage III primary colon cancer were included from the tumor registry of the Asan Medical Center, Seoul, Korea. All patients underwent a curative operation and postoperative chemotherapy with 5- fluorouracil and leucovorin for 6 cycles between 1993 and 1997. Immunohistochemical staining for hMLH1 and hMSH2 was performed using archival paraffin blocks. A positive expression was determined when unequivocal nuclear staining was identified in more than 10% of the cancer cells. The survival and the clinicopathologic variables regarding hMLH1 and hMSH2 expressions were assessed using the log-rank test and the Cox proportional regression method.
RESULTS
Either hMLH1 or hMSH2 expression was lost in nine cases (9.9%). hMLH1 and hMSH2 expressions were significantly correlated with tumor invasion (P=0.012) and tumor differentiation (P=0.017). The disease-free survival did not differ with respect to hMLH1 and hMSH2 expressions. The number of metastatic lymph nodes and the preoperative serum CEA level were independent predictors of disease-free survival on a multivariate analysis.
CONCLUSIONS
The loss of hMLH1 or hMSH2 expresscon appears to be involved in the differentiation of and the invasion by colon cancer. However, nether hMLH1 nor hMSH2 expression was correlated withthe 5-fluorouracil responsiveness.

Case Reports

Appendico-Sigmoid Fistula Due to Appendicitis.: Kim, Seon Woo , Ahn, Byung Kwon , Park, Hyung Seok , Lee, Seung Hyun , Baek, Sung Uhn; J Korean Soc Coloproctol. 2004;20(4):225-227.

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Abstract PDF: An appendico-sigmoid fistula is a rare entity that has seldom been reported in the literature. In review articles, there are only several reports of appendiceal fistulas, including two into the ileum, two into the ascending colon, two into the sigmoid colon, and one into the Meckel's diverticulum. Presumably, these cases were caused primarily by antecedent appendicitis and diverticulitis. We experienced a case of an appendico-sigmoid fistula due to appendicitis. A 42-year-old man was admitted with complaints of low abdominal pain, distension, and a chilling sense for 1 month. On physical examination, the patient had right low-quadrant abdominal tenderness and rebound tenderness. However, the patient had no fever, and the WBC count was 8,900/mm3. On colonoscopy and barium study, the patient was diagnosed as having an appendico-sigmoid fistula due to appendicitis. An appendectomy and segmental resection of the sigmoid colon was done.

Appendicocolic Fistula.: Kim, Min Hoe , Lim, Deok Ho , Kim, Bong Soo , Ku, Jin Hoe , Kang, Haeng Ji , Hwang, Yong Hee , Choi, Kun Phil; J Korean Soc Coloproctol. 2004;20(4):228-230.

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Abstract PDF: An appendicocolic fistula is a rare disease. It seems likely that the appendix becomes adherent to the viscus either before or after its perforation due to appendicitis, so surgeons may become confused when an emergency appendectomy in done. We report one case of an appendicocolic fistula to draw attention to the importance of this fistula and to describe the clinical, the diagnostic, and the therapeutic aspects of the disease.

Peutz-Jeghers Syndrome with Intussusception and Anemia.: Hwang, Jeong Kye , Kang, Won Kyung , Lee, Sang Chul , Lee, Yoon Suk , Park, Seung Man , Rha, Sung Eun , Oh, Seong Taek; J Korean Soc Coloproctol. 2004;20(4):231-235.

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Abstract PDF: Peutz-Jeghers syndrome is a disease entity consisting of gastrointestinal hamartoma, mucocutaneous pigmentation, and autosomal dominant inheritance. From a surgical standpoint, the syndrome is of significance because the hamartoma may lead to intussusception, gastrointestinal bleeding, abdominal pain, and a fifteen-times-increased risk of malignancy in the GI tract, pancreas, breast, ovarles, and testes. Recent reports indicate the STK11 (LKB1) gene, located on region 13.3 of the short arm of chromosome 19, as being the locus of autosomal dominant indentify. The case of a 21-year-old female who required a partial jejunal resection due to intussusception and bleeding from a jejunal hamartoma twice in five years is presented.

Original Article

Crohn's Disease Limited to the Appendix -A Case Report-.: Kim, Do Hyong , Kang, Won Kyung , Park, Seung Man , Lee, Sang Chul , Lee, Yoon Suk , Oh, Seong Taek , Kim, Seung Nam; J Korean Soc Coloproctol. 2004;20(4):236-239.

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Abstract PDF: Crohn's disease is a chronic and insidious condition characterized by an inflammatory process that may extend across all layers of the entire gastrointestinal tract. The common sites involved by Crohn's disease are the terminal ileum and ascending colon. Crohn's disease limited to the appendix is uncommon. Since its first report in 1953 by Meyerding and Bertram, 156 cases of appendiceal Crohn's disease have been documented in the world literature. We experienced a case of Crohn's disease limited to the appendix in a-35year-old female who were performed an ileocecectomy.

Clinical Trial

Circular Stapled Hemorrhoidectomies in the Treatment of Hemorrhoids.: Kim, Jin Sub; J Korean Soc Coloproctol. 2004;20(4):240-248.

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Abstract PDF: The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.

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