BACKGROUND: During the past eight years, we have been performing partial autonomic nerve preservation surgery (PANP) for the treaolent of advanced rectal cancer in order to reduce the postoperative male sexual dysfunctions. METHODS: This is a prospective study of 25 rectal cancer patients who underwent PANP from 1990 to 1997. All patient were in Duke C stage and their ages were between 30 and 55. Patients were divided into four types: 1) Partial sacrifice of inferior mesenteric plexus (PSIP). 2) Partial sacrifice of preaortic nerve (PSPN). 3) Complete sacrifice of preaortic nerve with complete pelvic nerve preservation (CSPN). 4) Unilateral sacrifice of pelvic autonomic nerve (USPN). RESULTS: The percentage of ejaculation and erection difficulties at each surgery was as follows: PSIP 0/5 (0%) for ejaculation vs. 0/5 (0%) for erection, respectively, PSPN 5/7 (71.4%) vs. 2/7 (28.6%), CSPN 6/7 (85.7%) vs. 0/7 (0%) and USPN 6/6 (100%) vs. 5/6 (83.3%). Summary: PANP is possible for the treatment of advanced rectal cancer.
Autonomic Pathways* ; Ejaculation ; Humans ; Male* ; Prospective Studies ; Rectal Neoplasms*

No abstract available.

We studied the expressions of E-cadherin, MMP-7 and CD44V in colorectal cancer and their corresponding normal mucosa using RT-PCR. From the 26 patients whom a com parative study of clinical and histopathological data is available, MMP-7 and CD44V were significantly enhanced in cancer and their metastatic tissues, compared with their normal mucosa. E-cadherin did not reveal any difference between cancer and normal mucosa. The relashionship between these genes and colorectal cancer development can not be confirmed by this study, however CD44v and MMP-7 may be associated with metastasis of colorectal cancer.
Cadherins ; Cell Line* ; Colorectal Neoplasms* ; Humans ; Mucous Membrane ; Neoplasm Metastasis*

No abstract available.
Oncogenes* ; Rectal Neoplasms*

PURPOSE: This study was undertaken to obtain better clinical insights and therapeutic approaches to the diverticular diseases of the colon by identifying the clinical characteristics of the right and left colonic diverticular diseases. METHODS: A retrospective analysis was made of 68 colonic diverticular patients treated between August of 1986 and July of 1997. Right colonic diverticular disease was present in 55 patients, left side disease in eight patients, and bilateral disease in five patients. According to the location of the colonic diverticular disease, various clinical parameters such as the nature of the diverticula, age and sex, diagnostic accuracy, and methods of treatment were assessed. RESULTS: The average age of 68 patients in this study was 50.94 years. Fifty two patients were male and sixteen were female. The disease was far more common in the right colon (80.9%) than the left colon (11.7%) and the right colonic diverticular disease was the most common source of confusion in diagnosis from acute appendicitis. Conservative management was tried in 30 of 35 patients above age 50 and obtained a good result without any complication. CONCLUSIONS: There has been a tendency toward increased incidence of annual colonic diverticular diseases in this study. The right colonic diverticular disease was far more common than the left side disease and the disease was more common in the male. In patients above age 50, initial conservative management is a reasonable approach, although early surgical exploration might be better in younger patients. Acute appendicitis should be ruled out before any treatment decision was made.
Appendicitis ; Colon ; Diagnosis ; Diverticulum ; Female ; Humans ; Incidence ; Male ; Retrospective Studies*

PURPOSE: The ligation and excision method of hemorrhoids is a simple and rapid procedure, but it has a drawback of possible damage to the anal cushion. To solve this problem, we tried to preserve the anal cushion with superficial ligation and excision method of anorectal mucosa including removal of the hemorrhoidal tissues from the anal cushion after submucosal dissection. However, it was difficult to remove hemorrhoidal vessels with this procedure and it was time consuming. To minimize these problems, we originally tried a new cushion preserving procedure in 15 patients during 1 year. METHODS: R> After mobilization of the anorectal mucosa, hemorrhoidal tissues and anal cushion from the anal sphincter muscles, the anorectal mucosa was first dissected from the anal cushion, then the hemorrhoidal vessels were removed and the remaining anal cushion was reattached to the anal sphincter muscles. RESULTS: The results of this surgery have been satisfactory with only one postoperative bleeding and two anal skin tags. CONCLUSIONS: This method is simple and convenient for preservation of anal cushion with minimal complications when compared with the conventional method of anal cushion preservation.
Anal Canal ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ligation ; Mucous Membrane ; Muscles ; Skin

PURPOSE: The CD44 has been known a lymph node homing receptor on circulating lymphocytes. CD44 spliced variants have been found to be overexpressed in human cancers and metastatic cancers. The variant CD44v 6-7 in particular has been suggested to have a potential role in tumor metastasis. It has been reported that histopathological examination could occaisionally miss lymph node micrometastasis. PURPOSE: The aim of this study was to investigate the role of CD44v in metastasis of rectal carcinoma to the pelvic lateral lymph nodes around the obturator nerve, obturator vessel and superior vesical artery. METHODS: Thirty pelvic lateral lymph nodes reported normal histopathologically from 22 patients with rectal carcinomas, 22 rectal carcinomas and their corresponding colonic mucosas. We have used RT-PCR for the detection of CD44 gene products (CD44v and CD44 v6-7) in samples. RESULTS: The expression rates of CD44v were 2/22 (9%) for normal colonic mucosa, 20/22 (90%) for cancer tissues, and 4/30 (13.3%) for pelvic lateral lymph nodes. The rates of CD44v6-7 were also 2/22 (9%) for normal colonic mucosa 20/22 (90%) for cancer tissues, but 7/30 (23.3%) for pelvic lateral lymph nodes. CONCLUSIONS: The analysis of CD44v might be useful for determination of pelvic lateral lymph nodes metastasis, but it should not be used as a metastatic marker in general for rectal cancer patients.
Arteries ; Colon ; Humans ; Lymph Nodes ; Lymphocytes ; Mucous Membrane ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Obturator Nerve ; Receptors, Lymphocyte Homing ; Rectal Neoplasms*

No abstract available.
Carcinogens* ; Colon* ; Colonic Neoplasms* ; Humans*

No abstract available.
Rectum*

PURPOSE: To assess relative diagnostic value of Ga-67 planar, Ga-67 SPECT, and CT images for detection of head and neck tumors and cervical lymph node metastasis. MATERIALS AND METHODS: Thirty eight patients of pathologically proven head and neck tumors including squamous cell carcinomas(n=32), malignant lymphomas(n=3), undifferentiated carcinomas(n=2), adenocarcinomas(n=l) were enrolled in this study. Ga-67 planar and SPECT images were obtained with intravenous injection of 5mCi of Ga-67 citrate. On the basis of 30 and 20 mm in the greatest diameter of cervical lymph nodes, we compared lesion detectability of Ga-67 planar, SPECT, and CT. RESULTS: Thirty eight cases of head and neck tumors were detected in 29 cases(76.3%) with Ga-67 planar image, 37 cases(97.3%) with Ga-67 SPECT, and 32 cases(84.2%) with CT. 25 of 32 squamous cell carcinomas were positive with Ga-67 planar image and all of 32 cases with Ga-67 SPECT. Both of two undifferentiated carcinomas were positive with Ga-67 planar and SPECT images. Two of three malignant lymphomas were positive with Ga-67 planar image and all of three with Ga-67 SPECT. Eight of nine tumors were negative with Ga-67 planar image and those were less than 30ram. One case of adenocarcinoma was negative with Ga-67 planar and SPECT images. Seven of nine lymph nodes greater than 30mm were positive with Ga-67 planar image and all of nine with Ga-67 SPECT. On the basis of 20mm in greatest diameter, 16 of 21 lymph nodes greater than 20 mm were positive with Ga-67 planar and SPECT images. CONCLUSION: CT providing better resolution than Ga-67 scan permitted analysis of size and location of metastatic cervical nodes, however primary tumors of oral cavity, vocal cord, and nasopharynx were often not detected on CT when metallic and motion artifacts were present, where Ga-67 SPECT was useful. Ga-67 SPECT enabled better anatomical localization than Ga-67 planar image and was useful in detection of lymph nodes greater than 30 mm.
Adenocarcinoma ; Artifacts ; Carcinoma ; Carcinoma, Squamous Cell ; Citric Acid ; Head* ; Humans ; Injections, Intravenous ; Lymph Nodes ; Lymphoma ; Mouth ; Nasopharynx ; Neck* ; Neoplasm Metastasis* ; Tomography, Emission-Computed, Single-Photon ; Vocal Cords