Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.
Colorectal Neoplasms* ; Hemorrhage ; Humans ; Incidence ; Mass Screening ; Mortality ; Postoperative Complications ; Reoperation

Effect of varying hematocrit ratio on the gastric acid production was studied in the heart-stomach preparation of the frog. When the hematocrit ratio was raised by injecting packed red blood cells obtained from the same species of frog, the acid production was increased significantly as compared to the low hematocrit group in which hematocrit ratio was lowered by injecting frog's normal saline. When a small amount of histamine was added to the medium of 25degree C, the acid production was increased in all cases, but the difference in the acid production between the high and the low hematocrit groups was abolished. However, when the temperature of the medium was lowered to 15degree C, the differences in the acid production between the two groups became significant. When a large amount of acetazolamide was added to the medium at 25degree C, the acid production was decreased significantly in both groups without showing a significant difference between the two groups. The reason(s) responsible for the increased acid production in the high hematocrit group was discussed.

The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.
Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Sigmoid ; Humans ; Mortality ; Wounds and Injuries

PURPOSE: To see the stability and error in the diffusion-weighted magnetic resonance (MR) imaging technique in the experimental models and to observe the signal intensities in the early cerebral lesions of the animal models. MATERIALS AND METHODS: Diffusion coefficients of acetone and distilled water were measured by diffusion-weighted MR image and were compared with actual values. Differentiation of diffusion from perfusion were done at the resin flow phantom. The signal intensities caused by early parenchymal changes were measured in normal, hypovolemic, and embolic, and dead animal models by using diffusion-weighted image and compared with pathoIogic finding and vital staining. RESULTS: Diffusion coefficients of acetone and distilled water were 4.48 x 10-3 and 2.72 x 10-3 which were very close to the actual values. Diffusion-weighted MR image obtained at flow phantom was not affected by flow (perfusion) at the 100-400 of b-factor range. Animal study done at that b-factor range revealed a significant signal difference between the left and right sides only at the embolic model induced by polyvinyl alchol particles (p<0.05). These changes were not detected in microscopic finding but could be identified in vital staining. CONCLUSION: Diffusion-weighted MR image can be used to detect early parenchymal change when the appropriate b-factor range was applied.
Acetone ; Animals ; Diffusion* ; Hypovolemia ; Models, Animal ; Models, Theoretical* ; Perfusion ; Polyvinyls ; Water

BACKGROUND: The aim of this study was to compare the effects of isoflurane and enflurane on respiratory resistance using flow-interruption technique. METHODS: Twenty one cats were divided into 3 groups according to the agents administered; Control(control), Isoflurane(1 MAC of isoflurane) and Enflurane(1 MAC of enflurane) groups. Tracheal pressure was measured at 2 cm beyond the distal end of the tube. After measuring the baseline value, methacholine chloride(25 microgram/kg/min) was infused to induce bronchoconstriction which was continued throughout the experiment. Anesthetics were administered for each group 15 minutes after methacholine infusion (control value) via low pressure inlet of the ventilator. Measurements were made every 15 minutes. Intermittent mandatory ventilation was applied with Servo 900C ventilator. Inspiratory flow rate and tidal volume were fixed throughout the experiment for each subject. Pressure, volume and flow were monitored with Bicore CP100 pulmonary monitor. The data were transferred to a personal computer and analyzed by a processing software. Respiratory system, airway and tissue resistances, and dynamic and static compliances were calculated. RESULTS: Methacholine infusion increased both airway and tissue resistances. Fifteen minutes after administering inhalation anesthetics(M30), airway resistances for isoflurane and enflurane decreased to 50.8+/-4.7% and 62.5+/-4.9% of the control value(p<0.05). And the values of tissue resistances for isoflurane and enflurane decreased to 54.7+/-6.2% and 68.0+/-4.4% of the control value respectively (p<0.05). There were significant differences between the isoflurane and enflurane in the values of airway and tissue resistances at M30(p<0.05). But there were no significant differences between the two agents in the values of airway and tissue resistances at M45. CONCLUSION: For isoflurane and enflurane, both airway and tissue resistances are reduced. Isoflurane is more potent than enflurane in reversing methacholine-induced bronchoconstriction in this animal model.
Airway Resistance ; Anesthetics ; Animals ; Bays ; Bronchoconstriction* ; Cats* ; Enflurane* ; Inhalation ; Isoflurane* ; Methacholine Chloride ; Microcomputers ; Models, Animal ; Respiratory Mechanics* ; Respiratory System ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

PURPOSE: The detection of hydronephrosis(HN) with antenatal ultrasonography was first reported in the 1970s. Prenatal HN is diagnosed with an incidence of 1:100 to 1:500 on antenatal screening. Recently, the purpose of antenatal screening has changed from simple detection to selection for specific diagnosis-based management. this study is to evaluate the usefulness of antenatal sonography for HN and to investigate the differential causes of HN and their clinical outcomes. PATIENTS AND METHODS: 11,783 live neonates with prenatal ultrasonographic examination at Ajou University School of Medicine, from Sep. 1994 to Aug. 2001 were analyzed. RESULTS AND CONCLUSION: Hydronephrosis (>10 mm) was detected in 119 (1.0%) cases antenatally and among these, 91 were proved to have HN postnatally. Males were three times more affected than females. Additional imaging studies revealed that ureteropelvic junction obstruction was the most common postnatal diagnosis (47%), followed by multicystic dysplastic kidney, vesicoureteral junction obstruction and vesicoureteral reflux. During 20 months' follow-up (3 to 72 months), 58(48%) renal units showed spontaneous resolution and surgical interventions were necessary in 10 (7.4%) of postnatally confirmed hydronephrotic renal units.
Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Incidence ; Infant, Newborn ; Male ; Multicystic Dysplastic Kidney ; Prenatal Diagnosis ; Ultrasonography ; Vesico-Ureteral Reflux

This report is a retrospective clinical analysis fo 84 cases more than 65 years of colorectal carcinoma treated surgically by the Department of General Surgery, College of Medicine, Soon Chun Hyang University from January 1991 to December 1995. The average age was 71.3 years; 49 patients were male and 35 were female. Tumor location was as follows; rectum 39(46.4%), sigmoid 22(26.2), ascending colon 12(14.3%), descending colon 8(9.5%), transverse colon 3(3.6%). The most frequent symptom in colorectal cancer was abdominal pain. The patients whose clinical symptom had been for less than 1 month before the hospitalization was about 31.0%. The rate of curative resection was 88.1%, Emergency operation was performed about 19.0%(16 cases). By Astler Coller classification, there were stage A 2 cases(2.5%), Bl 13 cases(16.5%), B2 28 cases(35.4%), Cl 2 cases(2.5%), C2 24 cases(30.4%), D 10 cases(12.7%). The average size of mass was 4.41 on. The most common pathologic type was moderately differentiated adenocarcinoma. Postoperative mortality rate was 4.7%(4 cases). The 5 year cumulative survival rate was 42.9%. In conclusion, the postoperative mortality and survival rates obtained in this study encourage us not to consider age as a limiting factor for curative surgical treatment. Early detection of colorectal cancer, adequate management of preoperative underlying disease and aggresive curative resection are improving outcome in the surgery of old aged patients with colorectal cancer.
Abdominal Pain ; Adenocarcinoma ; Aged* ; Classification ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colorectal Neoplasms* ; Emergencies ; Female ; Hospitalization ; Humans ; Male ; Mortality ; Rectum ; Retrospective Studies ; Survival Rate

BACKGROUND: A lipo-prostaglandin E1 agonist is effective for the treatment of neurological symptoms of spinal stenosis when administered by an oral or intravenous route. we would like to reveal the therapeutic effect of an epidural injection of lipo-prostaglandin E1 on hyperalgesia in foraminal stenosis. METHODS: A total of 40 male Sprague-Dawley rats were included. A small stainless steel rod was inserted into the L5/L6 intervertebral foramen to produce intervertebral foraminal stenosis and chronic compression of the dorsal root ganglia (DRG). The rats were divided into three groups: epidural PGE1 (EP) (n = 15), saline (n = 15), and control (n = 10). In the EP group, 0.15 microg.kg-1 of a lipo-PGE1 agonist was injected daily via an epidural catheter for 10 days from postoperative day 3. In the saline group, saline was injected. Behavioral tests for mechanical hyperalgesia were performed for 3 weeks. Then, the target DRG was analyzed for the degree of chromatolysis, chronic inflammation, and fibrosis in light microscopic images. RESULTS: From the fifth day after lipo-PGE1 agonist injection, the EP group showed significant recovery from mechanical hyperalgesia, which was maintained for 3 weeks (P < 0.05). Microscopic analysis showed much less chromatolysis in the EP group than in the saline or control groups. CONCLUSIONS: An epidurally administered lipo-PGE1 agonist relieved neuropathic pain, such as mechanical hyperalgesia, in a rat foraminal stenosis model, with decreasing chromatolysis in target DRG. We suggest that epidurally administered lipo-PGE1 may be a useful therapeutic candidate for patients with spinal stenosis.
Alprostadil ; Animals ; Catheters ; Constriction, Pathologic ; Diagnosis-Related Groups ; Fibrosis ; Ganglia, Spinal ; Humans ; Hyperalgesia ; Inflammation ; Injections, Epidural ; Male ; Neuralgia ; Rats* ; Rats, Sprague-Dawley ; Spinal Stenosis* ; Stainless Steel

Although many improvements have been made in surgical technique, as well as preoperative and postoperative care, the pancreaticoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. This study concerns a total of 43 patients that underwent a pancreaticojejunostomy using a polyethylene stent by the Dunking method in a pancreaticoduodenectomy at Soon Chun Hyang University Hospital from January 1990 to December 1996. The results obtained are as follows:1) In our study, there were 13 patients with pancreatic head cancer, 11 patients with ampulla of Vater cancer, 5 patients with distal common bile duct cancer, 4 patients with duodenal cancer, 3 patients with chronic pancreatitis, 3 patients with trauma, 3 patients with a choledochal cyst, 1 patient with stomach cancer. 2) There were 23 men (53.5%) and 20 women (46.5%). 3) Postoperative complications developed in 25 patients (58.1%). Of the complications, bleeding was the most commonly observed, after which, in order of frequency, wound infection, leakage at the anastomotic site, intestinal obstruction, and intraabdominal abscess were also observed. 4) The overall operative mortality was 13.9% (excluding emergency cases, mortality was 7.5 %). Four patients died of intraabdominal or gastrointestinal bleeding, one patient died of pancreatic leakage, and one of hepatic failure. 5) Transfusion during the operation (above 5 pints) was significantly correlated with operative morbidity. Preoperative percutaneous transhepatic biliary drainage (PTBD) with serum bilirubin greater than 10 mg/dl significantly decreased the operative morbidity. 6) A prothrombin time more than 13.9 second, serum albumin less than 3.0 g/dl, and an emergency operation were significantly correlated with operative mortality.
Abscess ; Ampulla of Vater ; Bilirubin ; Choledochal Cyst ; Common Bile Duct ; Drainage ; Duodenal Neoplasms ; Emergencies ; Female ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Liver Failure ; Male ; Mortality* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Polyethylene ; Postoperative Care ; Postoperative Complications ; Prothrombin Time ; Serum Albumin ; Stents* ; Stomach Neoplasms ; Wound Infection

An annular pancreas is a rare congenital variant of the pancreatic anatomy, which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis, and is often hard to diagnose before operation. The case of an annular pancreas with intermittent abdominal pain in a 38-year-old alcoholic man is described. A duodenal obstruction with consecutive ulcers was the clinical manifestation in this patient. The annular pancreas was diagnosed by using hypertonic duodenography followed by pancreatic angiography. The duodenoscopy revealed stenosis of the pancreas. A duodeno-duodenostomy relieved the symptoms. The patient had an uneventful recovery following a operation.
Abdominal Pain ; Adult* ; Alcoholics ; Angiography ; Constriction, Pathologic ; Duodenal Obstruction ; Duodenoscopy ; Gastric Outlet Obstruction ; Humans ; Pancreas* ; Pancreatitis ; Ulcer