Microorganisms coexist in the human body and its function is essential to maintain normal physiology and homeostasis. Microbiota refers to the entire population of microorganisms that colonizes a particular location; includes not just bacteria but also other microbes. Gut microbiota is vast and complex. It could be changed dynamically according to the variable factors. Well balanced host-microbial symbiotic state is a harmonious ecosystem in the stable individual. But, dysbiosis is a state of deviation in composition or function from the usual gut microbiota. It has been found that this condition is associated with many gastrointestinal, metabolic, allergic and the other diseases. Dysbiosis plays an important role in the pathophysiology of functional bowel disease, such as irritable bowel syndrome and functional constipation. Probiotics is microorganism which, when administrated in adequate amounts, confer a health benefit on the host. Probiotics have beneficial effects to reduce several symptoms of functional bowel diseases. Currently, complementary and alternative medicine therapies with probiotics is recommended for symptomatic relief from functional bowel disease.
Bacteria ; Colon ; Complementary Therapies ; Constipation ; Dysbiosis ; Ecosystem ; Gastrointestinal Microbiome* ; Homeostasis ; Human Body ; Insurance Benefits ; Irritable Bowel Syndrome ; Microbiota ; Physiology ; Probiotics*

Synchronous neoplams are uncommon condition but the incidence is now being increased. The situation is rare when these tumors comes from different origin. We experienced the case with synchronous sigmoid colon cancer and anal squamous cell carcinoma with rectal mucosal metastasis. The patient was 61 years old male. He complained of intermittent hematochezia since 3~4 months ago. The patient underwent anterior resection for colon cancer and wide excision for anal squamous cell carcinoma. After surgical operation, postoperative adjuvant chemotherapy (5-FU + Leucovorin) and radiotherapy were done. In this case, we could preserve the anal sphincter using combined therapy. We think that this type of management may be useful treatment in patients with colon cancer and anal squamous cell cancer simultaneously.
Adenocarcinoma* ; Anal Canal ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Colon, Sigmoid* ; Colonic Neoplasms ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Metastasis* ; Neoplasms, Squamous Cell ; Radiotherapy ; Sigmoid Neoplasms

PURPOSE: Horseshoe type-ischiorectal fistula is originating initially from infected anal gland that connect with an anal crypt usually situated in the posterior midline of the anal canal. In the modified Hanley's operation, a prove inserted into the primary opening in directed into the posterior anal space. A straight incision from the primary opening toward the tip of the coccyx is made to unroof the posterior anal spcae and the anal portion of the fistulous tract. The secondary external fistula openings are incisied to permit better external drainage. The tracts are curratted but their entire lengths are not unroofed. This study presents the clinical features and the results obtained with modified Hanley's operation in the surgical management of horseshoe fistula. METHODS: This report is based on the clinical analysis of 22 cases of horseshoe type among 329 cases of fistula in ano, which were treated at the Department of General Surgery of Ewha Womans University Hospital from October 1993 to May 1998. RESULTS: The male to female ratio was 3.7:1 and the age was range from 19 years-old to 61 years-old. The symptom were anal discharge and pain. The previous or combined anal disease were anal abscess and hemorrhoids. The internal openings were located at the dentate line in 18 cases and anterior portion in 5 cases. Horseshoe ischorectal fistula included 17 cases of semi-horseshoe fistula and 1 case of horseshoe fistulous sinus. The spinal anesthesia and lithotomy position was used for operations. The cutting seton was applied in the 4 cases for preservation of sphincter function. The average hospital stay was 7.6 days and average wound healing time was 5.4 weeks. The postoperative complication of urinary retensio was found in the 2 cases. Recurrence, fecal incontinence, anal deformity and anal anterior diaplacement was not developed during following periods. CONCLUSIONS: We confirm that the modified Hanley's operation is a effective and conservative surgical procedure that minimizes the disadvantages of complete unroofing method & useful method for preservation of sphincter function.
Abscess ; Anal Canal ; Anesthesia, Spinal ; Coccyx ; Congenital Abnormalities ; Cutaneous Fistula ; Drainage ; Fecal Incontinence ; Female ; Fistula ; Hemorrhoids ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Wound Healing ; Young Adult

BACKGROUND: In Korea, the incidence rate of colorectal cancer is increasing, even in patients under 40 years of age. In most young adult patients with colorectal cancer, the tumors are already in advanced stages at initiation of treatment, and they are more aggressive, so the prognosis is considered unfavorable. In addition, alteration of the p53 gene may be associated with poor prognosis for colorectal cancer. METHODS: We evaluated the p53 expression in a young adult group and an adult group with colorectal cancer who had been operated at the Department of Surgery, Doungdaemoon Hospital, Medical Center of Ewha Womans University, from 1991 to 1996. We retrospectively reviewed the medical records of a randomized sampling of patients, 17 in the young adult group under 40 years of age and 20 in the adult group over 41 years of age. Pathologic slides were prepared for immunohistochemical staining of the p53 protein. The staining results were divided into positive and negative. The chi-square test, Fisher's exact test, and student t-test were perforemd with SAS program. RESULTS: There was no difference in the sex ratio, the tumor stage, the preoperative CEA level, the size of the tumor, the location of the tumor and the histologic differentiation between the two groups (p>0.05). In the young adult group, p53 was expressed in 41% of the cases (7/17), and in the adult group, p53 was expressed in 10% of the cases (2/20); thus p53 was expressed more frequently in the young adult group (p<0.05). CONCLUSION: The p53 expression tended to be associated with age and with more aggressive colorectal cancer, p53 expression may be a useful factor in determining a poor prognosis for patients with colorectal cancer.
Adult ; Colorectal Neoplasms* ; Female ; Genes, p53 ; Humans ; Incidence ; Korea ; Medical Records ; Prognosis ; Retrospective Studies ; Sex Ratio ; Young Adult

A case of a papillary thyroid carcinoma presenting as a cystic lateral neck mass is reported. A 73-year-old woman presented with a painless swelling of the right side of the neck which had been noticed for 60 years. The soft tissue mass was clinically and sonographically thought to be branchial cleft cyst. However, excisional biopsy showed it to be a cystic lymph-node metastasis from a papillary thyroid carcinoma. Two weeks later, a total thyroidectomy was performed, but no malignant lesion was found in the thyroid. This case of a metastatic papillary thyroid carcinoma to the lateral neck node mimiced a branchial cleft cyst. In old age, a lateral neck cyst being a cystic metastasis, as well as a benign cyst, should be considered so a careful preoperative evaluation is neccessary.
Aged ; Biopsy ; Branchioma ; Female ; Humans ; Neck* ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

A case of a papillary thyroid carcinoma presenting as a cystic lateral neck mass is reported. A 73-year-old woman presented with a painless swelling of the right side of the neck which had been noticed for 60 years. The soft tissue mass was clinically and sonographically thought to be branchial cleft cyst. However, excisional biopsy showed it to be a cystic lymph-node metastasis from a papillary thyroid carcinoma. Two weeks later, a total thyroidectomy was performed, but no malignant lesion was found in the thyroid. This case of a metastatic papillary thyroid carcinoma to the lateral neck node mimiced a branchial cleft cyst. In old age, a lateral neck cyst being a cystic metastasis, as well as a benign cyst, should be considered so a careful preoperative evaluation is neccessary.
Aged ; Biopsy ; Branchioma ; Female ; Humans ; Neck* ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Interest is mounting in developing prevention strategies for patients at high risk of developing colorectal cancer. Recent epidemiological investigations indicate an inverse relationship between the intake of NSAIDs and colorectal cancer risk. Cyclooxygenase (COX) enzyme may be involved in the initiation and/or the promotion of carcinogenesis. A major action of NSAIDs is the inhibition of COX. We have studied the clinical significance of COX-2 expression in colorectal adenoma and carcinoma. METHODS: We studied 19 patients with colorectal adenomas (15 males and 4 females: ages 30~73 years) and 20 patients with colorectal carcinoma (12 males and 8 females: ages 35~80 years). COX-2 status were determined by immunohistochemical methods using the mouse monocolnal antibody for COX-2 (Transduction Lab, USA) on paraffin sections. RESULTS: Immunoreactive COX-2 were expressed in 9 patients (47%) of colorectal adenoma and 9 patients (45%) of colorectal carcinoma. 57% of villous adenoma and 42% of tubular adenoma were positive for COX-2 in colorectal adenoma (p=0.650). COX-2 were expressed in 12.5% of stage B and 73% of stage C of colorectal cancer (p=0.006). COX-2 expression did not relate with the size of adenoma and carcinoma. CONCLUSIONS: The data suggest that COX-2 may be more expressed in villous adenoma and advanced carcinoma. Therefore, enhanced expression of COX-2 may play a role in the carcinogenesis of colorectal cancer.
Adenoma* ; Adenoma, Villous ; Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Carcinogenesis ; Chemoprevention ; Colorectal Neoplasms ; Cyclooxygenase 2* ; Female ; Humans ; Male ; Mice ; Paraffin ; Prostaglandin-Endoperoxide Synthases

We report a case of an incarcerated internal hernia which was diagnosed preoperatively by using an abdominal CT scan. An-84-year-old female patient suddenly developed cramping upper abdominal pain after a meal, followed by nausea and vomiting associated with slight abdominal distension. This patient's initial abdominal plain X-ray was interpreted as indicating abdominal free gas. A dilated small bowel loop was revealed based on a late abdominal CT scan, and an internal hernia was suspected. On operation, herniation through defects in the gastrocolic omentum and gastrohepatic ligament was found and was successfully reduced. A jejunal loop internal herniation of this nature is extremely rare, and closed-loop obstructions result to incarceration or strangulation. When abnormal gas is detected at the right upper or the epigastric area in a simple abdominal X-ray. An unusual internal hernia must be a concern, and an abdominal CT scan can be useful for preoperative diagnosis.
Abdominal Pain ; Diagnosis ; Female ; Hernia* ; Humans ; Intestinal Obstruction* ; Ligaments ; Meals ; Muscle Cramp ; Nausea ; Omentum ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: The number of patients with HIV disease has been increasing rapidly, with anorectal discomfort being the most common complaint of these patients. However, there are no data on HIV disease relating to the benign anorectal area in Koreans. METHODS: A retrospective chart review was performed on patients diagnosed with benign anal diseases, combined with HIV disease, between 1996 and 2001. Their clinical aspects were compared with HIV patients registered with the National Institute of Health in Korea between 1985 and 2001. RESULTS: A total of 1,613 patients were registered, with the National Institute of Health in Korea, as having HIV disease. The ratio of sex was 7.2:1, with a male predominance. The disease was most common in the 3rd & 4th decades, with 64.2%, of the patients in this age range. As for the routes of transmission, sexual contact was the most common (96.9%), followed by blood transfusion (including blood products) (2.8%), vertical transmission (0.1%) and drug injection (0.1%). With regard to the sexual contact routes, homosexuality accounted for 28.0%. Of the cases of HIV disease presenting with a benign anal disease, 32 patients, with a sex ratio of 31:1, with an overwhelming male predominance, were selected. Twenty-six cases had been newly diagnosed at our hospital. As for the routes of the transmission, the disease had been transmitted by sexual contact in all cases. In 43.8% of these cases, the disease had been transmitted by homosexual contact, which showed a marked difference to that of the National database (P<0.05). For those associated with an anal diseases, there were 10 cases of anal fistula, 9 of perianal abscess, 7 of condyloma acuminata, 7 of anal fissure, 5 of hemorrhoids and 2 of ulceration on the lower rectum, noted. CONCLUSIONS: Nowadays, the numbers of anorectal-disease patients with HIV are increasing in Korea. Since HIV is common in the area of benign proctology, all proctologists must consider the possibility of HIV when managing patients.
Abscess ; Blood Transfusion ; Colorectal Surgery ; Fissure in Ano ; Hemorrhoids ; HIV Infections ; HIV* ; Homosexuality ; Humans ; Korea ; Male ; Rectal Fistula ; Rectum ; Retrospective Studies ; Sex Ratio ; Ulcer

PURPOSE: This study has carried out to clarify the relationship between changes in the anal sphincter muscle thickness and pressure. Also, this study shows the effect of vaginal delivery and benign anal disease on the function and structure of the anal sphincter. METHODS: Women (n=42; mean age: 33.2 +/- 9.6 years old) without defecation problems or history of anal surgery, who came to Ewha Womans University Hospital between July 1999 and October 1999, were chosen. We measured the resting and the squeezing pressure with anal manometry and the thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS) by endoanal sonography. RESULTS: The mean squeezing and resting pressures were 98.3 +/- 38.2 and 53.9 +/-17.4 cmH2O, and the mean EAS and IAS thicknesses were 4.9+/-0.9 and 1.9+/-0.3 mm, respectively. The thickness of the EAS and squeezing pressure did not correlate. Neither did the IAS thickness and the resting pressure. In cases with a history of vaginal delivery (n=15), the squeezing and the resting pressures were 94.0+/-43.0 and 57.1+/-22.2 cmH2O, and the thicknesses of the EAS and the IAS, 4.6+/-0.9 and 2.0+/-0.4 mm, respectively. The number of deliveries had no correlation with the thickness or the pressure of the anal sphincter. In patients with benign anal lesions (n=11), the squeezing and the resting pressure was 113.0+/-42.9 and 57.0+/-14.0 cmH2O, and the thicknesses of the EAS and the IAS were 5.0+/-1.3 and 2.1+/-0.4 mm, respectively. CONCLUSION: Our data suggest that the function and the structure of the anal sphincter are independent. In adult women, the thickness of the anal sphincter, the history of vaginal delivery, and the existence of benign anal lesions had no effect on anal sphincter function.
Adult* ; Anal Canal* ; Defecation ; Female ; Humans ; Manometry