Twelve patients with inflammatory bowel disease had been operated at the department of surgery, Chonnam University Hospital during the period from March 1988 to February 1997. In this study, we report on the operative cases regarding age, sex, symptoms, duration of disease, location of disease, preoperative diagnosis, operative indication, frequency of operation, histopathologic findings and follow up. The results were as follows: 1) The male to female ratio in ulcerative colitis was 1 : 1, and the mean age was 54.5 years. In Crohn's disease, male to female ratio was 2.3 : 1 and the mean age was 42.1 years. 2) The mean duration of symptoms in ulcerative colitis was 39 months and in Crohn's disease was 13.9 months. The common symptoms in ulcerative colitis were abdominal pain, bloody diarrhea, indigestion, weight loss and in Crohn's disease abdominal pain, palpable mass, weight loss, indigestion. Extraintestinal symptoms in Crohn's disease were cholelithiasis like symptom, anal fistula, anal fissure. 3) The involvement site in ulcerative colitis was large bowel only, but in Crohn's disease small bowel (50%), large bowel (20%), small and large bowel (30%) were involved. 4) Preoperative diagnosis in ulcerative colitis was accurate, but in Crohn's disease accurate diagnosis was made only in 20% and the other cases were operated under the impression of different diseases or conditions (intestinal tuberculosis (50%), bowel perforation (20%), mechanical ileus (10%)). 5) The indication of surgery in ulcerative colitis was intractability to medical treatment, on the other hand, in Crohn's disease most operative cases were made under the emergentconditions (bowel perforation, bowel obstruction, enterocutaneous fistula, abdominal mass). The frequency of operation in ulcerative colitis were two times in one case, three times in one cases. In Crohn's disease half of cases experienced two or three times of surgery. The method of operation in ulcerative colitis was total proctocolectomy with J-pouch ileoanal anastomosis. In Crohn's disease resection of diseased bowel segment was performed.
Abdominal Pain ; Cholelithiasis ; Colitis, Ulcerative ; Colonic Pouches ; Crohn Disease ; Diagnosis ; Diarrhea ; Dyspepsia ; Female ; Fissure in Ano ; Follow-Up Studies ; Hand ; Humans ; Ileus ; Inflammatory Bowel Diseases* ; Intestinal Fistula ; Jeollanam-do ; Male ; Rectal Fistula ; Tuberculosis ; Weight Loss

Colorectal carcinoma in patients under 40 years and over 70 years of age is unusual but not rare. The prognosis of these two groups, compared with remainder of patients, is thought to be unfavorable. From Jan. 1981 to Dec. 1997, 541 patients with primary colorectal cancer who were treated by surgical resection were analyzed retrospectively. They were divided into three age groups according to the age at admission, i.e. under 40 years, over 70 years and between 40 and 69 years(control group). Among three age groups, sex ratio, tumor characteristics(size, location , depth of invasion, lymph node metastasis, liver metastasis, peritoneal metastasis, histopathologic classification, stage, DNA ploidy pattern), serum CEA level and survival were compared and analyzed. The results were as follows: 1) In the young patient group(52 cases), female predominence, large tumor size, high proportion of mucinous adenocarcinoma in histopathologic classification, more frequent metastasis to regional lymph node, frequent peritoneal metastasis and high incidence in tumor location at transverse colon were noted(p<0.05). 2) In the elderly group(69 cases), deep invasion of tumor(T4) was noted (p<0.05). In addition, among them, concomittent diseases were presented in 25 patients(36%). They were diabetes(8), cardiac arrhythmia(4), old myocardial infarction(2), liver cirrhosis(5), COPD(3), previous cancer(3). 3) The 5-year survival rates of the young patient group and that of elderly patient group were lower than that of the other(p<0.01). 4) There was no significant differences in liver metastasis, tumor stage, DNA ploidy pattern, serum CEA level among three age groups.
Adenocarcinoma, Mucinous ; Aged* ; Classification ; Colon, Transverse ; Colorectal Neoplasms* ; DNA ; Female ; Humans ; Incidence ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Retrospective Studies ; Sex Ratio ; Survival Rate

Recently, abnormalites in DNA content have been considered as a new prognostic factor in gastric cancer. However, whether abnormal DNA content can be used as a prognostic tool for gastric cancer is still unknown .For that reason, the relationship between the DNA ploidy pattern and the conventional clincopathologic findings was studied and the corresponding survival rates were compared. A group of 690 newly diagnosed and surgically resected gastric cancer specimens obtained from January 1986 to June 1996 were examined for DNA content by flow cytometry. The results showed that 411 cases (59.6%) had DNA diploidy and 279 cases (40.4%) had aneuploidy; DNA aneuploidy was significantly correlated to well differentiated adenocarcinoma, whereas diploidy was correlated to signet ring cell carcinoma. The DNA diploidy group was differentiated from the aneuploidy group by depth of invasion and nodal involvement. Tumor cells confined to mucosa and no involvement of the lymph node (N0) were significant in the diploidy group of gastric cancer. In addition, stage Ia was predominant in the diploidy group. However the results of surgical resection and the 5-year survival rates of patients in the two groups were not signifcantly different (p>0.05). We, therefore, propose that the DNA ploidy pattern is useful for evaluating tumor growth, including lymph-node involvement, but not for determining the survival and prognosis.
Adenocarcinoma ; Aneuploidy ; Carcinoma, Signet Ring Cell ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Lymph Nodes ; Mucous Membrane ; Ploidies* ; Prognosis ; Stomach Neoplasms* ; Survival Rate

Telomerase, an enzyme associated with cellular immortality, is expressed by most malignant cells and is inactive in most normal somatic cells, with the exception of proliferative stem cells, germ cells and activated lymphocytes. Measuring telomerase activity clinically may provide useful diagnostic and prognostic information of cancer. The purpose of this study was to investigate the change in telomerase activity following chemoradiation in rectal cancer, which almost always produces positive enzymatic activity. A total of 24 tumor tissue samples were used in this study, consisting of 12 paired specimens before and 4 week after chemoradiation. Telomerase activity was determined by PCR-based telomeric repeat amplification protocol (TRAP) assay. The telomerase activity was positive in 10 out of 12 patients (83%) in pre-irradiated and post-irradiated states. The levels of telomerase activity was decreased in 8 out of 10 patients after chemoradiation (80%) and two cases showed no change in enzymatic activity. One case showed no activity in either sample. The other case showed no enzymatic activity in the pre-irradiated sample, but showed weak activity in the post-irradiated sample. These data indicate that telomerase activity in rectal cancer is reduced after neoadjuvant chemoradiation therapy, possibly suggesting a mechanism of downstaging following chemoradiation therapy in cancer.
Adult ; Aged ; Antimetabolites, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Cisplatin/administration & dosage ; Combined Modality Therapy ; Enzyme Activation/radiation effects ; Enzyme Activation/drug effects ; Female ; Fluorouracil/administration & dosage ; Gene Amplification ; Human ; Male ; Middle Age ; Rectal Neoplasms/radiotherapy* ; Rectal Neoplasms/enzymology* ; Rectal Neoplasms/drug therapy ; Telomerase/metabolism*

PURPOSE: Although obstructive jaundice is a rare presentation, it is an omnious prognostic sign in patients with gastrectomy for gastric carcinoma. The major cause of bile duct obstruction has been identified as lymphadenopathy in the hepatoduodenal ligament that has metastasized from predominantly advanced gastric carcinomas. METHODS: Extrahepatic biliary obstruction caused by metastatic gastric carcinoma was retrospectively studied in order to determine demographics, pathological characteristics, time interval from previous gastrectomy, site of recurrence, and the prognosis of the disease. RESULTS: In this study, 983 patients with gastric adenocarcinoma underwent gastrectomy, and obstructive jaundice was revealed in 22 patients (2.2%). The mean age of the patients was 56 years, and the male to female sex ratio was 1.7 : 1. Antrally located, poorly differentiated, and advanced stage (above III) gastric carcinoma were commonly associated with obstructive jaundice. The most common site of the obstruction was the porta hepatis (54%). A percutaneous transhepatic biliary drainage (PTBD) procedure was accomplished in 19 patients and the jaundice was decreased, however the survival was not improved. The mean duration from jaundice to death was 2.8 months. CONCLUSION: These results show that the cause of bile duct obstruction in advanced gastric carcinoma was predominantly metastatic lymphadenopathy in the hepatoduodenal ligament. In order to improve the quality of life in obstructive jaundiced patients, further evaluation and continued follow-up and examination may be necessary.
Adenocarcinoma ; Cholestasis ; Demography ; Drainage ; Female ; Gastrectomy* ; Humans ; Jaundice ; Jaundice, Obstructive* ; Ligaments ; Lymphatic Diseases ; Male ; Prognosis ; Quality of Life ; Recurrence ; Retrospective Studies ; Sex Ratio

BACKGROUND: The nm23 gene was originally identified by screening of cDNA libraries from murine melanoma cell lines of varying metastatic potential. Gene expression of nm23 has been investigated in a number of tumors. Its down-regulation has been shown to be associated with metastasis or disease progression in some of the tumors. METHODS: We evaluated the nm23 mRNA levels in 23 surgically resected primary gastric cancers, in the matched adjacent mucosa, and in lymph nodes or distant metastatic foci by using Northern blot analyses and immunohistochemical staining. RESULTS: The expression of nm23 mRNA was lower in the matched normal adjacent mucosa than in the primary tumor. The expressions of the nm23 gene were higher in normal lymph nodes and in lymph nodes with metastasis than in primary tumors. This result was due to the high expression in normal lymph nodes. The expression of nm23 in distant metastatic foci was lower than it was in primary tumor tissues (p<0.05). The expression of the nm23 protein in a primary tumor with distant metastasis was higher than it was in a primary tumor with lymphnode metastasis only (p<0.05). CONCLUSIONS: It is suggested that down-regulation of the nm23 gene might have a role in distant metastasis in gastric cancer, possibly leading to a poor prognosis.
Blotting, Northern ; Cell Line ; Disease Progression ; Down-Regulation ; Gene Expression ; Gene Library ; Lymph Nodes ; Mass Screening ; Melanoma ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; RNA, Messenger ; Stomach Neoplasms*

From among the 1485 patients with gastric cancer who had gastric resections at the Department of General Surgery, Chonnam National University Hospital, from January 1986 to December 1995, a clinical study was made of 104 patients (7%) who had signet ring cell carcinomas. Patients with this form of cancer tended to be younger and female; the tumors were smaller and involved the stomach body and antrum rather than the cardia, but none of these findings was significantly different from the findings for other types of gastric cancer. Mucosal and submucosal tumor were more prominent in gastric canner, and lymph-node metastases were statistically less likely to be present in signet ring cell carcinoma (p<0.05). The tumor stage of signet ring cell carcinomas tended statistically to be early (I) rather than advanced (III, IV) in comparison with those of other types of gastric cancer. The ploidy pattern of signet ring cell carcinomas was tended to be diploidy (80.7%) rather than aneuploidy (19.3%), and this finding was statistically significant compared with those of other types. Surgery was more curative in cases of signet ring cell carcinoma (92.3%) than in cases of other types of gastric cancer (73.4%), and the 5-year survival rates were 43.7% for patients with signet ring cell cancer and 32.8% for those with other types of gastric cancer (p<0.05). In patients with signet ring cell gastric cancer, the lesion is less extensive; thus, these patients probably can expect a longer survival time and good prognosis.
Aneuploidy ; Carcinoma, Signet Ring Cell* ; Cardia ; Diploidy ; Female ; Humans ; Jeollanam-do ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Stomach Neoplasms ; Stomach* ; Survival Rate

Liver metastasis is reported about 5 to 7 percent of the time with primary gastric cancer. Advances in diagnostic tools, such as abdominal ultrasonography and abdominal CT, have made detection of liver metastases from primary gastric cancer easy. Many studies have reported on the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, few reports exist on the treatment of metastatic liver tumors from primary gastric malignancy. We experienced 70 cases of gastric cancer with liver metastases among 1391 cases of gastric cancer during a 11-year period from 1986 to 1996, and we examined the relationship between the types of treatment and the mean survival time for those no cases. To that end, those patients were divided into 4 groups. Group A was comprised of 13 patients who underwent a gastrectomy with hepatic resection. Group B was comprised of 41 patients who underwent a gastrectomy with systemic chemotherapy. Group C was comprised of 3 patients who underwent a gastrectomy with chemoimmunotherapy via hepatic artery catheter. Group D was comprised of 13 patients who underwent a gastrojejunostomy only. The thirty-month survival rate of Group A was 23% and that of Group B was 13%. This difference between Groups A and B was statistically significant (p<0.05). In Group C, one patient died within 7 months, one patient died after 13 months of survival, and one patient was still living 3 months postoperatively. In Group D, no patient survived past 12 months. These results suggest that combined resection of the stomach and a part of the liver in gastric cancer patients with liver metastasis leads to longer survival time compared with other treatment methods, such as systemic chemotherapy and chemoimmunotherapy via hepatic artery cannulation.
Catheterization ; Catheters ; Colorectal Neoplasms ; Drug Therapy ; Gastrectomy ; Gastric Bypass ; Hepatic Artery ; Humans ; Liver* ; Neoplasm Metastasis* ; Stomach ; Stomach Neoplasms* ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography

Telomere Length Changes in Colorectal Cancers and Polyps Telomere shortening and telomerase activation occur frequently in cases of colorectal carcinoma. In this study, we correlated the clinicopathological parameters with the telomere length in colorectal carcinomas, colonic polyps, and normal colonic tissues. We also investigated whether the telomere length changes reflect the biologic behavior of tumors and different modes of tumor development. Telomere length was determined by terminal restriction fragment Southern blot analysis in 20 invasive colorectal carcinomas and normal mucosa from the same patients. We also examined 20 colonic polyps and associated normal mucosa. Telomere shortening was detected in 16/20 (80%), and telomere elongation in 2/20 (10%) cases of colorectal carcinoma, and no changes in 2 subjects. In the colonic polyp patients, shortening was detected in 4/20 (20%), elongation in 6/20 (30%), and no change in 10/20 (50%). The frequency of telomere shortening was significantly different between colorectal carcinoma and polyp groups. Decreased telomere length was noted in 92.9% (13/14) of Dukes' C and 50% (3/6) of Dukes' B. The difference between these two sub-groups was statistically significant. This study suggests that the telomere length in colorectal carcinomas is decreased upon the development of malignancy. A significant difference in telomere length between polyps and invasive colorectal carcinomas may reflect a different biologic behavior of colorectal carcinomas.
Adult ; Aged ; Blotting, Southern ; Carcinoma/*pathology ; Colonic Polyps/*pathology ; Colorectal Neoplasms/*pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Telomere/genetics/*pathology

PURPOSE: APC (adenomatous polyposis coli) gene is one of the tumor-suppressor genes that acts in the early stages of cancer. Among general colon cancer patients, normal APC gene expression is deficient in 80%. It seems that APC is the most important gene in the development of colon cancer. This study was performed to analyze the mutation spectra of APC gene in sporadic colon cancer tissue from Korean patients with colon cancer. METHODS: A total of 38 patients with sporadic colon cancer were enrolled. Colon cancer tissues were analyzed for the determination of APC gene mutation spectra by multiplex ligation-dependent probe amplification (MLPA) method using SALSA MLPA P403 APC kit (MRC-Holland, Amsterdam, NL). RESULTS: APC gene mutations showing deletion/duplication in one or more exons were detected in 23 (60.5%) patients. Duplication in 13 patients (56.5%), duplication and deletion in 7 patients (30.4%), and deletion in 3 patients (13.1%) was detected. The incidence of APC gene mutation found in this study was highest in exon 3. From this study, no significant differences were observed with respect to clinicopathologic findings and the presence or absence of APC mutations. CONCLUSION: The frequency of APC gene mutation was about 61% in Korean patients with colon cancer, it showed concordance with the previous reports on the frequency of APC gene mutation from Caucasian patients with sporadic colon cancer. However, in contrast to these reports, the frequency of duplication disclosed much higher than those of western countries.
Colon ; Colonic Neoplasms ; Exons ; Genes, APC ; Humans ; Incidence ; Multiplex Polymerase Chain Reaction