A major outcome of importance for rectal cancer is local control. Parallel to improvements in surgical technique, adjuvant therapy regimens have been tested in clinical trials in an effort to reduce the local recurrence rate. Nowadays, the local recurrence rate has been reduced because of both good surgical techniques and the addition of radiotherapy. Based on recent reports in the literature, preoperative chemoradiotherapy is now considered the standard of care for patients with stages II and III rectal cancer. Also, short-course radiotherapy appears to provide effective local control and the same overall survival as more long-course chemoradiotherapy schedules and, therefore, may be an appropriate choice in some situations. Capecitabine is an acceptable alternative to infusion fluorouracil in those patients who are able to manage the responsibilities inherent in self-administered, oral chemotherapy. However, concurrent administration of oxaliplatin and radiotherapy is not recommended at this time. Radiation therapy has long been considered an important adjunct in the treatment of rectal cancer. Although no prospective data exist for several issues, we hope that in the near future, patients with rectal cancer can be treated by using the best combination of surgery, radiation therapy, and chemotherapy in near future.
Appointments and Schedules ; Chemoradiotherapy ; Drug Therapy ; Fluorouracil ; Hope ; Humans ; Radiotherapy ; Rectal Neoplasms* ; Recurrence ; Standard of Care ; Capecitabine

STUDY DESIGN: Retrospective study OBJECTIVES: This study examined the effect of a TLSO brace treatment for the correction of axial rotational deformities in idiopathic scoliosis. SUMMARY OF THE LITERATURE REVIEW: A TLSO brace treatment is effective in correcting 2-dimensional deformities of idiopathic scoliosis but is questionable in axial rotational deformities. MATERIALS AND METHODS: Fifty three cases treated by bracing in March, 1999~February, 2005 at our department were reviewed. The posteroanterior and lateral radiographs were checked in the standing position throughout the study. The change in axial rotational deformity were analyzed using Nash & Moe method and Perdriolle's method. RESULTS: The rotational deformity had improved in 2 curves, was aggravated in 8 curves, and showed no change in 43 curves with the TLSO brace. CONCLUSIONS: The TLSO brace treatment in axial rotational deformity of idiopathic scoliosis is not effective in correcting the rotational deformity but is effective in preventing the progress of a rotational deformity.
Braces ; Congenital Abnormalities ; Orthotic Devices ; Retrospective Studies ; Scoliosis

OBJECTIVES: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress in anxiety disorder patients. METHODS: HRV was measured at resting, upright, and psychological stress states in 60 anxiety disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity. Differences between HRV indices were evaluated using paired t-tests. Gender difference analysis was accomplished with ANCOVA. RESULTS: SDNN (Standard deviation of normal RR intervals) and low frequency/high frequency (LF/HF) were significantly increased, while NN50, pNN50, and normalized HF (nHF) were significantly decreased in the upright position compared to resting state (p < 0.01). SDNN, root mean square of the differences of successive normal to normal intervals, and LF/HF were significantly increased, while nHF was significantly decreased in the psychological stress state compared to resting state (p < 0.01). SDNN, NN50, pNN50 were significantly lower in upright position compared to psychological stress and nVLF, nLF, nHF, and LF/HF showed no significant differences between them. CONCLUSION: The LF/HF ratio was significantly increased after both physical and psychological stress in anxiety disorder, but did not show a significant difference between these two stresses. Significant differences of SDNN, NN50, and pNN50 without any differences of nVLF, nLF, nHF, and LF/HF between two stresses might suggest that frequency domain analysis is more specific than time domain analysis.
Anxiety ; Anxiety Disorders* ; Autonomic Nervous System ; Depression ; Equipment and Supplies ; Heart Rate* ; Humans ; Stress, Psychological*

Uterine prolapse with pregnancy is rare condition. The overall incidence is 1/10000- 15000 deliveries. The complications from uterine prolapse range from minor cervical ulceration and infection to fetal death or uterine rupture. The fetal mortality was as high as 22% mainly due to prematurity, respiratory infection. The management of this condition is focused on preventing late occurrence of prolapse during pregnancy and continued reduction. We present a case of uterine prolapse in pregnancy with a brief review of the literature.
Fetal Death ; Fetal Mortality ; Incidence ; Pregnancy* ; Prolapse ; Ulcer ; Uterine Prolapse* ; Uterine Rupture

Purpose: Nrf2 regulates antioxidant protein expression and protects against drug toxicity and oxidative stress, whereas Keap1 controls Nrf2 activity. The Keap1-Nrf2 pathway affects the prognosis of various cancers, however, its effect on cholangiocarcinoma chemoresistance and prognosis remains unclear. This study aimed to determine whether the Keap1-Nrf2 pathway affects chemoresistance and prognosis of distal cholangiocarcinoma. Methods: We investigated the correlation between Nrf2 and Keap1 expression and clinical characteristics and prognosis in 91 patients with distal cholangiocarcinoma who underwent curative surgery. Immunohistochemical staining was performed on paraffin blocks using primary antibodies against Nrf2 and Keap1. The relationship between Keap1 and Nrf2 protein expression levels, and clinical characteristics and prognosis was examined. Results: Nrf2 expression was not associated with overall survival in patients who did not receive adjuvant chemotherapy (P=0.994). Among patients receiving adjuvant chemotherapy, the Nrf2 low expression group had a significantly longer median overall survival than the Nrf2 high expression group in Kaplan-Meier survival analysis (P=0.019). In multivariate analysis, high expression of Nrf2 was confirmed as an independent poor prognostic factor in the group receiving adjuvant chemotherapy (P=0.041). Conclusion This study suggests that Nrf2 overexpression reduces the efficacy of adjuvant chemotherapy in distal cholangiocarcinoma.

PURPOSE: We evaluated the prognostic value of the 5-tiered grade group in Korean patients who underwent radical prostatectomy. MATERIALS AND METHODS: Between 1996 and 2016, a number of 2,883 consecutive patients who underwent radical prostatectomy were included for the analysis. The impacts of biopsy and pathologic grade group on predicting biochemical recurrence (BCR) were assessed using multivariate analysis. Median follow-up duration was 49.0 months. RESULTS: Mean age was 66.5 years and prostate-specific antigen (PSA) was 11.8 ng/mL. Prostate cancer was locally advanced on magnetic resonance imaging in 13.4%. Biopsy grade group was as follows: 1 (46.8%), 2 (19.8%), 3 (14.2%), 4 (14.1%), and 5 (5.1%). Pathology stage was ≤T2 in 63.6%, T3a in 26.0%, and T3b/T4 in 10.4% patients. Pathologic grade was as follows: 1 (31.3%), 2 (37.9%), 3 (20.2%), 4 (4.7%), and 5 (5.1%). In multivariate analysis using biopsy-related variables, biopsy grade group (1, reference; 2, hazard ratio [HR], 1.771; p=0.001; 3, HR, 2.736; p < 0.001; 4, HR, 2.966; p < 0.001; 5, HR, 3.707; p < 0.001) was associated with BCR-free survival, PSA level and % positive core. In multivariate analysis using pathologic outcomes, pathologic grade group (1, reference; 2, HR, 1.882; p < 0.001; 3, HR, 3.352; p < 0.001; 4, HR, 3.890; p < 0.001; 5, HR: 3.118, p < 0.001) was associated with BCR-free survival in addition to pathologic stage and positive surgical margin. CONCLUSIONS: New 5-tiered grading system could be useful for predicting oncological outcomes in Korean patients although its role for distinguishing outcomes between patients with grade groups 3–5 need to be validated before wide application of this grade system in Korea.
Biopsy ; Follow-Up Studies ; Humans ; Korea ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neoplasm Grading ; Pathology ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence

Inflammatory myofibroblastic (IMF) tumor is a rare solid tumor that often affects children. IMF tumors occur primarily in the lung, but the tumor may affect any organ system with protean manifestations. A 22-year-old woman was evaluated for palpable low abdominal mass that had been increasing in size since two months prior. Abdominal computed tomography showed a lobulated, heterogeneous contrast enhancing soft tissue mass, 6.5 x 5.7 cm in size in the ileal mesentery. At surgery, the mass originated from the greater omentum laying in the pelvic cavity and was completely excised without tumor spillage. Histologically, the mass was a spindle cell lesion with severe atypism and some mitosis. Immunohistochemistry for anaplastic lymphoma kinase-1 revealed that the lesion was an IMF tumor. Because of its local invasiveness and its tendency to recur, this tumor can be confused with a soft tissue sarcoma. Increasing physician awareness of this entity should facilitate recognition of its clinical characteristics and laboratory findings.
Child ; Female ; Humans ; Immunohistochemistry ; Lung ; Lymphoma ; Mesentery ; Mitosis ; Myofibroblasts ; Omentum ; Sarcoma ; Young Adult

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.
Classification ; Colon* ; Comorbidity ; Humans ; Inflammation ; Intestinal Perforation ; Ischemia ; Mortality* ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors* ; Sepsis

PURPOSE: The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation. METHODS: From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy. RESULTS: A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly. CONCLUSION: Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.
Colectomy ; Colon* ; Colon, Sigmoid ; Colonoscopy* ; Colostomy ; Diagnosis ; Hemorrhage ; Humans ; Incidence ; Intestinal Perforation ; Male ; Mortality ; Retrospective Studies ; Risk Factors

PURPOSE: Although there are more than a hundred techniques, including the transabdominal and the perineal approaches, for the repair of the rectal prolapsed, none of them is perfect. The best repair should be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The aim of this retrospective review is to evaluate clinical outcomes of the Delorme's procedure for the management of the complete rectal prolapse. METHODS: A total of 19 patients (13 females and 6 males) with complete rectal prolapses were treated by using the Delorme's procedure in St. Vincent's Hospital, The Catholic University of Korea, from February 1997 to February 2007. Postoperative anal incontinence was evaluated using the Cleveland Clinic Incontinence Score. RESULTS: All 19 patients had incontinence to liquid stool, solid stool, and/or flatus preoperatively. Three (15.8%) patients reported recurrence of the rectal prolapse (at 6, 18, 29 months, respectively, after the operation). Information on postoperative incontinence was available for 16 of the 19 patients. Twelve of the 16 patients (75%) reported improved continence (5 [31.3%] were improved and 7 [43.7%] completely recovered from incontinence) while 4 patients had unchanged incontinence symptoms. One (6.3%) patient who did not have constipation preoperatively developed constipation after the operation. CONCLUSION: The Delorme's procedure is associated with a marked improvement in anal continence, relatively low recurrence rates, and low incidence of postoperative constipation. This allows us to conclude that this procedure still has its own role in selected patients.
Constipation ; Fecal Incontinence ; Female ; Flatulence ; Humans ; Incidence ; Korea ; Prolapse ; Rectal Prolapse ; Recurrence ; Retrospective Studies