PURPOSE: We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. METHODS: Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. RESULTS: The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. CONCLUSION: Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.
Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Metastasectomy* ; Neoplasm Metastasis* ; Survival Rate

BACKGROUND: The addition of remifentanil during the propofol induced anesthesia facilitates the insertion of laryngeal mask airway (LMA) with minimal adverse hemodynamic disturbances. This study predicted the optimal effect-site concentration of remifentanil for LMA insertion with propofol target-controlled infusion (TCI). METHODS: In 25 adults patients, aged 18-60 years, anesthesia was induced with propofol TCI at the effect-site concentration of 4microgram/ml. Two minutes later, the predetermined effect-site concentration of remifentanil was started. The remifentanil concentration was determined using modified Dixon's up-and-down method (0.5 ng/ml as a step size). The first patient was tested at 2.0 ng/ml remifentanil. The insertion of LMA was attempted 3 min after remifentanil TCI began. The response of the patients to the insertion of LMA was classified as either 'movement' or 'no movement'. RESULTS: The remifentanil concentration at which there was a 50% probability of successful LMA insertion (EC50) was 3.18 +/- 0.53 ng/ml. From probit analysis, the EC50 of remifentanil was 3.10 ng/ml (95% confidence limits, 2.55-4.11 ng/ml), and the EC95 was 4.31 ng/ml (95% confidence limits, 3.64-11.11 ng/ml). CONCLUSIONS: The predicted effect-site concentration of remifentanil for facilitating LMA insertion was 3.18 ng/ml in 50% of adults during propofol TCI at an effect-site concentration of 4microgram/ml without premedication.
Adult ; Anesthesia ; Hemodynamics ; Humans ; Laryngeal Masks* ; Premedication ; Propofol*

BACKGROUND: We evaluated volumetric differences of syringe brand compatibilities, and investigated the impact of false brand settings on target-controlled infusion (TCI) and their methods of correction. METHODS: Gravimetric measurement of 10 ml bolus infusions was performed using BD Plastipak (BDP) and Terumo compatible syringes, while setting to 7 different kinds of brand compatibilities (BDP, Sherwood Monoject, BD Perfusion, Braun Perfusor, Braun Omnifix, Fresenius Injectomat, and Terumo). To investigate the performance of TCI using BDP with a false setting to Terumo (BDPTERUMO) and Terumo to BDP (TERUMOBDP), 24 TCI targeting 4.0 microg/ml of effect-site concentration (Ceff) of propofol were performed. Subsequently, another 24 TCI were evaluated for simple corrections of false settings at 30 min. We also investigated 24 TCI using active corrections (fill-up for BDPTERUMO, evacuation for TERUMOBDP) based on the pharmacokinetics of propofol. The Ceff at 30 min of TCI and time to normalize to +/- 5% of target concentration (T+/-5%target) were compared. RESULTS: The Ceff of BDPTERUMO showed negative bias and 17.2% inaccuracy, and the Ceff of TERUMOBDP showed positive bias and 19.5% inaccuracy. The Ceff at 30 min showed no difference between the methods of correction in BDPTERUMO or TERUMOBDP. The T+/-5%target in both the active corrections was significantly shorter than that of each simple corrections (P < 0.001). CONCLUSIONS: False brand setting of syringe proportionally maintained different predicted concentrations as much as the volumetric differences of syringe brand. Based on the results, it is proposed that correction methods based on pharmacokinetics could effectively normalize the differences, without giving up the wrong TCI.
Androsterone ; Bias (Epidemiology) ; Perfusion ; Propofol ; Syringes

Sweet's syndrome is an acute febrile neutrophilic dermatosis that occurs with malignant disease, mainly myeloid hemopathies, in about 20% of cases. When associated with myelodysplasia, clinical and histologic features of Sweet's syndrome can be atypical; however its significance is still debated. We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 63-year-old woman. The clinical presentation strongly suggested Sweet's syndrome but, histopathologic examination showed dense histiocytic infiltration with prominent upper dermal edema and little neutrophil infiltration. In the evaluation for atypical histopathology and laboratory abnormalities, she was diagnosed with myleodysplastic syndrome by peripheral blood smear and bone marrow biopsy. Histiocytoid Sweet's syndrome is a currently accepted concept and probably has a close relation with underlying myeloid hemopathies.
Biopsy ; Bone Marrow ; Edema ; Female ; Humans ; Middle Aged ; Myelodysplastic Syndromes* ; Neutrophil Infiltration ; Sweet Syndrome*

PURPOSE: Clinical usefulness of sentinel lymph node (SLN) mapping in colorectal cancer remains controversial. The aim of this study is to evaluate the accuracy of the SLN mapping technique using serial sectioning, and to compare the results between ex vivo and in vivo techniques. METHODS: From February 2011 to October 2012, 34 colon cancer patients underwent SLN mapping during surgical resection. Eleven patients were analyzed with the in vivo method, and 23 patients with the ex vivo method. Patient characteristics and results of SLN mapping were evaluated. RESULTS: The SLN mapping was performed in 34 patients. Mean age was 67.3 years (range, 44-81 years). Primary tumors were located in the following sites: 13 in the right colon (38.2%) and 21 in the left colon (61.8%). SLN mapping was performed successfully in 88.2% of the patients. There was no significant difference in the identification rate between the two methods (90.9% vs. 87.0%, P = 1.000). Both the mapping methods showed a low sensitivity and high rate of skip metastasis. CONCLUSION: This study showed that SLN evaluation using serial sectioning could not predict the nodal status with clinically acceptable accuracy despite the high detection rate.
Colon ; Colonic Neoplasms* ; Colorectal Neoplasms ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Sentinel Lymph Node Biopsy

No abstract available.
Adult ; Axilla* ; Hair ; Humans

Primary cutaneous marginal zone B-cell lymphoma, known as the cutaneous counterpart of mucosa-associated lymphatic tissue lymphoma (MALT lymphoma), is the most frequent of the primary cutaneous B-cell lymphoma. It is one of the low-grade lymphomas of B-cell type, which has an excellent prognosis with indolent behavior, despite frequent cutaneous recurrences. Histologically, cutaneous marginal zone B-cell lymphoma is composed of polymorphous infiltrate that includes centrocyte-like, centroblast-like, monocytoid, and lymphoplasmacytoid lymphocytes. We present two cases of primary cutaneous marginal zone B-cell lymphoma. A 48-year-old woman visited the dermatologic clinic with 1.5x1.5 cm sized, skin colored, palpable nodule on the left temporal area and a 26-year-old man visited the dermatologic clinic with 1x1 cm sized erythematous nodule on the nose. Both of them showed compatible histologic findings of marginal zone B-cell lymphoma and had no past medical history and no evidence of metastasis on PET-CT and bone marrow biopsy. The woman was treated with radiation treatment after excision and the man was treated with radiation treatment alone. Follow-up indicates that 1 year after treatment there is no evidence of recurrence.
Adult ; B-Lymphocytes ; Biopsy ; Bone Marrow ; Female ; Follow-Up Studies ; Humans ; Lymphocytes ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin ; Middle Aged ; Neoplasm Metastasis ; Nose ; Prognosis ; Recurrence ; Skin

PURPOSE: This study reviews the feasibility of a total colectomy with ileo-rectal anastomosis (TCIRA) and the functional outcome following the operation. METHODS: The cases of a total of 50 patients (31 men and 19 women) with a median age of 61 who underwent a TCIRA were reviewed retrospectively. The median follow-up time was 28 months (4~72). The clinical records were reviewed to analyze the postoperative complications and bowel function. The clinical outcomes were examined directly from patients' scoring. RESULTS: The indications of TCIRA were metachronous or synchronous colorectal cancer (34 percent), multiple polypoid lesions (22 percent), malignant colon obstruction (24 percent), ischemic colitis (2 percent), Crohn's disease (6 percent), and tuberculosis colitis (2 percent). The overall mortality and morbidity rates were 0 and 31 percent, respectively. The morbidity included postoperative bleeding, obstruction, intra-abdominal abscess formation, pneumonia, and wound complications. We used the CCIS index to evaluate postoperative functional bowel habit change. The CCIS index evaluation revealed perfect continence in 57 percent of the patients with short-term follow up (<6 months) and in 83 percent of the patients who had undergone a TCIRA more than 2 years ago. CONCLUSIONS: Most patients were satisfied with their bowel function on long-term follow up, and we think the TCIRA is a safe operation, and the clinical outcomes are relatively satisfactory.
Abdominal Abscess ; Colectomy* ; Colitis ; Colitis, Ischemic ; Colon ; Colorectal Neoplasms ; Crohn Disease ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Mortality* ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Tuberculosis ; Wounds and Injuries

PURPOSE: The use of barium enemas to confirm the anastomotic integrity prior to ileostomy closure is still controversial. The purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis. METHODS: One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for rectal cancer. All patients were evaluated by physical examination, proctoscopy, and barium enema prior to ileostomy closure. RESULTS: The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clinically relevant strictures at the colorectal anastomosis on routine barium enema. One patient (0.7%) showed anastomotic leak on their barium enema. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative complication occurred in three patients (2.1%). None of them showed abnormal barium enema finding, which suggested that routine contrast enema examination did not predict postoperative complication. CONCLUSION: Routine barium enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative colorectal anastomotic complication.
Anastomotic Leak ; Barium ; Constriction, Pathologic ; Enema ; Humans ; Ileostomy ; Physical Examination ; Postoperative Complications ; Proctoscopy ; Rectal Neoplasms