Sixty-three patients with permanent sigmoid colostomy were surveyed to evaluate their satisfaction and complications with the "irrigation technique" and the "atural evacuation" of the colostomy management (irrigation technique; 32 patients, natural evacuation; 31 patients). All patients had colostomy for at least 12 months without disease recurrence. Each patient was interviewed in addition to standard questionnaire. The irrigation was not associated with any major complication including colonic perforation. The irrigation was used younger age group than the natural evacuation (53+/-10 vs. 62+/-12, P=0.01). The frequency of bowel movement was lower in the irrigation than in the natural evacuation (5.1+/-2.5/wk vs. 10.8+/-9.0/wk, P=0.04). Five patients (16%) of the irrigation experienced spontaneous bowel action but only one patient suffered from it. The time spent for managing irrigation was 59+/-13 minutes. Twenty-three patients (74%) of the natural evacuation suffered from one or moreproblems such as expensive apparatus, leakage, skin irritation or odor. Sixteen patients (52%) of the natural evacuation and 2 patients (6%) of the irrigation were restricted in social activity (P=0.0001). Thirteen patients (42%) of the natural evacuation and 1 patient (3%) of the irrigation were dissatisfied with colostomy management (P=0.002). Thus, the irrigation technique seems to be more effective and satisfactory method for managing colostomy without compromising patient's social activity when it is performed in appropriately selected patients.
Colon ; Colon, Sigmoid ; Colostomy* ; Humans ; Odors ; Surveys and Questionnaires ; Rectal Neoplasms ; Recurrence ; Skin

OBJECTIVES: This study was done to examine the risk factors for the dyspnea of retired coal miners in Korea. METHODS: Eight hundred and sixteen male workers who took the health examination for retired coal miners in the T hospital were recruited, in this study and their health examination records were employed to assess the risk factors for dyspnea. Both univariate and multiple logistic regression analyses were used to estimate the relationship between known risk factors and the presence of dyspnea. RESULTS: Variables in the univariate analysis, which showed a significant relationship with dyspnea were age(>or=60 years) (OR : 2.20, 95% CI : 1.63-3.00), work duration(>or=2 0 years) (OR : 1.67, 95% CI : 1.24-2.25), profusion of small opacity(>or=1/0) (OR : 1.81. 95% CI : 1.30-2.51), large opacity(>or=A) (OR : 2.19, 95% CI : 1.30-3.70), and the ratio of the distance between the start of the first division of the right and left main pulmonary arteries divided by the transverse diameter of the thorax (cor pulmonale index)(>or=0 . 3 6 ) (OR : 2.37, 95% CI : 1.77-3.17). The multivariate analysis using logistic regression analysis showed age(>or=60 years)(OR : 1.69, 95% CI : 1.28-2.21), smoking amount(>or=1 filters/day) (OR : 1.61, 95% CI : 1.06-2.45), no experience of having quit smoking (OR : 1.40 95% CI : 1.06-1.84), and the cor pulmonale index(>or=0.36)(OR : 1.75, 95% CI : 1.34-2.29) were associated with an increased risk for dyspnea. CONCLUSIONS: These results suggests that the cor pulmonale index is the most significant risk factor in predicting dyspnea in retired coal miners. In addition, this study also revealed that workers aged 60 years or more or smokers were more likely to experience dyspnea as compared to those aged 60 years or less and nonsmokers.
Coal* ; Dyspnea* ; Humans ; Korea* ; Logistic Models ; Male ; Multivariate Analysis ; Pulmonary Artery ; Pulmonary Heart Disease ; Risk Factors ; Smoke ; Smoking ; Thorax

No abstract available.
Adenocarcinoma* ; Adenoma* ; DNA*

Cell-matrix interactions have major effects upon phenotypic features such as gene regulation, cytoskeletal structure, differentiation, and aspects of cell growth control. Upon detachment from the matrix epithelial cells enter into programmed cell death and this cell detachment-induced apoptosis has been referred to as "anoikis". This study was undertaken to determine whether apoptosis is induced by inhibition of contact with extracellular matrix in mouse inner medullary collecting duct cells (mIMCD-3), what are signaling mechanisms of the process and whether EGF protects detachment-induced apoptosis. Upon detachment from the extracellular matrix, MDCK and mIMCD-3, which were derived from inner medulla of SV40 transgenic mouse, entered into programmed cell death as a time-dependent manner. Apoptotic cell death induced by cell detachment increased in serum-free medium, which was partly protected by the addition of epidermal growth factor (EGF). Ly294002 and wortmannin, inhibitors of phosphatidylinositol 3-kinase (PI 3-kinase), negated the EGF effect, whereas PD98059, a MEK inhibitor, did not. The addition of SB203580, an inhibitor of p38 kinase, did not protect apoptosis in suspended mIMCD-3 cells. These results indicate that apoptosis is induced by inhibition of contact with extracellular matrix in mouse inner medullary collecting duct cells and that PI 3-kinase, not MAPK, is a key mediator of the EGF-induced survival of renal epithelial cells in the absence of attachment.
Animals ; Apoptosis ; Cell Death* ; Epidermal Growth Factor ; Epithelial Cells* ; Extracellular Matrix* ; Mice* ; Mice, Transgenic ; Phosphatidylinositol 3-Kinase ; Phosphatidylinositol 3-Kinases ; Phosphotransferases

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The injection of rocuronium causes pain and withdrawal responses.This study was designed to determine an optimal dose of alfentanil to prevent the withdrawal responses associated with injection of rocuronium in children. METHODS: One hundred and ten ASA physical status I and II pediatric patients were randomly allocated into four groups; Group C (control; normal saline 3 ml, n = 28), Group A5 (alfentanil 5microgram/kg, n = 28), Group A10 (alfentanil 10microgram/kg, n = 27) and Group A15 (alfentanil 15microgram/kg, n = 27). After the induction of anesthesia with 5 mg/kg of thiopental sodium, the test drug was injected over 20 seconds, respectively. After one minute, rocuronium 0.6 mg/kg was injected over 5 seconds. The patient's response after injection was graded using a four-point scale. Additionally, the mean arterial pressure and heart rate were recorded upon arrival in the operating room, as well as 1 min before and 1 min after tracheal intubation. RESULTS: The incidence of withdrawal responses was 96%, 61%, 19% and 19% in groups C, A5, A10 and A15, respectively. The incidence and severity of withdrawal responses in group A10 and A15 were lower than group C and A5. CONCLUSIONS: After thiopental injection, alfentanil 10microgram/kg prevent the withdrawal responses on injecting rocuronium in pediatric patients.
Alfentanil ; Androstanols ; Anesthesia ; Arterial Pressure ; Benzeneacetamides ; Child ; Heart Rate ; Humans ; Incidence ; Intubation ; Operating Rooms ; Piperidones ; Thiopental

BACKGROUND/AIMS: Guidelines for current postoperative colonoscopic surveillance are not specified in colorectal cancer (CRC) patients with synchronous adenoma (SA). We performed this retrospective study to determine the postoperative colonoscopic surveillance interval for the CRC patients with SA. METHODS: One hundred and twenty-four CRC patients with SA (SA-group) and the same number of patients without SA (NSA-group) were selected from our database. Two groups were matched by the stage of CRC. Median colonoscopic surveillance period was 55 (12-99) months. The colonoscopic surveillance frequency and interval were similar between the two groups. RESULTS: Mean age was higher and male was more frequent in SA-group than NSA-group (p= 0.0001). The incidence of missed adenoma, advanced missed adenoma and metachronous adenoma (MA) were higher in SA-group (30.8% vs. 5.8% at 1st yr., p=0.0001; 4.4% vs. 0%, p=0.0001; 31.1% vs. 9.1% at 2nd yr., p=0.016) during the first consecutive two years of surveillance. The MA- and advanced-MA-free survival rate were lower in SA-group (24.6% vs. 6.6%, p=0.0001; 4.1% vs. 0%, p=0.02) during three years after surgery. Dysplasia of the SA (p=0.04; OR, 110.3; 95% CI, 1.13-10742.6) and presence of missed adenoma (p=0.036; OR, 43.6; 95% CI, 1.28-1490.1) were risk factors for the advanced MA on a multivariate analysis in SA-group. CONCLUSIONS: Postoperative colonoscopic surveillance at first year after surgery is warranted in CRC patients with SA.
Adenoma/diagnosis/*surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma/diagnosis/*surgery ; Colonic Neoplasms/diagnosis/*surgery ; *Colonoscopy ; Colorectal Neoplasms/diagnosis/*surgery ; Disease-Free Survival ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*surgery

No abstract available.
DNA*

PURPOSE: Angiogenesis, playing a critical role in tumor growth, development, and metastatic process, is alleged to be related to the prognostic factors and patient's survival of the colo-rectal cancer. The p53 gene, present in short arm of chromosome 17, is involved in multistep colo-rectal carcinogenesis. The correlation of p53 gene and angiogenesis has been recently reported. So, we designed to assess (1) the rate of p53 overexpression, (2) the prognostic significance of microvessel count, and (3) the relationship of p53 overexpression and angiogenesis in early colo-rectal cancer(ECC) patients. MATERIAL AND METHODS: The study material included 68 ECC from 65 patients, 40 mucosal (m-ECC) and 28 submucosal ECCs (sm-ECC). Immunostainings against p53 and factor VIII-related antigen were done and the results were analyzed with respect to tumor depth, site, and differentiation. And also the correlation between p53 overexpression and microvessel counts(MVC) was performed. RESULT: The rate of p53 overexpression was higher in sm-ECC than in m-ECC (p < 0.05). The rate of p53 overexpression was highest in sigmoid colon and statistically significantly different compared with other sites. The differentiation of the tumor was closely correlated with p53 overexpression and the poorer the differentiation, the more overexpression of p53 (p<0.05). There was no significant difference between MVCs of m-ECC and sm-ECC (27.2+/-5.5 and 29.8 +/-6.0,respectively). However, MVC were higher in sigmoid colon than in any other sites (p<0.05). MVC did not show significant correlation with tumor differentiation or p53 overexpression. CONCLUSION: These data indicate that p53 overexpression is correlated with tumor depth and differentiation but not MVC. The significance of higher MVC and p53 overexpression in sigmoid colon are reserved for further studies.
Arm ; Carcinogenesis ; Chromosomes, Human, Pair 17 ; Colon, Sigmoid ; Colorectal Neoplasms* ; Genes, p53 ; Humans ; Microvessels* ; von Willebrand Factor

PURPOSE: The last decade has focused on healing as the major outcome of burn management with little attention paid to other important patient-centered outcomes, such as pain. Traditional standard dressings using silver sulfadiazine cream and vaseline gauze may result in significant pain at dressing change, wound dryness, increase necessity for dressing change, and also traumatizing the skin and wound bed. In this paper we introduce Mepitel(R), a new silicone dressing material showing satisfactory result than previous traditional standard dressings in burn dressing. METHODS: We conducted a prospective, observational study of 15 adult patients with second degree burn. At the arrive, we initially applied Mepitel(R) after bullae aspiration and changed the cover dressing depending on the degree of exudate from burn while still applying Mepitel(R) for 3 days. After dressing change, pain intensity was measured on an 11-point numeric rating scale. RESULTS: Mean time to wound reepithelization was 10.2 days and mean pain scores on a 11-point scale associated with dressing changes was 5.2 while requiring 0.5 intravenous narcotic administrations per dressing change. CONCLUSION: Mepitel(R) is a new grid like silicone coated nylon dressing containing no additional biologic compounds. The advantages of the Mepitel(R) are easy of use, non-adhesion to the wound, very good tolerance, keep moisture of wound and absence of pain during dressing change. This product has been used in our clinics and this paper serves as a report on our experiences with it.
Adult ; Bandages ; Blister ; Burns ; Exudates and Transudates ; Humans ; Nylons ; Petrolatum ; Prospective Studies ; Silicones ; Silver Sulfadiazine ; Skin