No abstract available.
Abscess* ; Multivariate Analysis* ; Recurrence*

On the contrary to congenital anomalies of intestinal rotation in pediatric patients, those in adults are generally nonsymptomatic and of little consequence. Occasionally, however, an adult may have midgut nonrotation and complain of chronic or recurrent abdominal pain. Intestinal nonrotation can be divided into complete or partial failure of rotation and into abnormalities affecting the proximal segment, the distal segment or both. We report herein a 43-year old female patient with symptomatic partial, cecocolic nonrotation.
Abdominal Pain ; Adult* ; Female ; Humans

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence.
Aged ; Constipation ; Female ; Hemorrhoids ; Humans ; Incidence ; Korea ; Laparoscopy ; Male ; Prolapse ; Rectal Prolapse ; Recurrence ; Sutures

No abstract available.
Recurrence* ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications

PURPOSE: The laparoscopic rectopexy has become increasingly popular with verified stability, surgical route selection should be tailored to individual patient characteristics rather than operative risk. The perineal approach is useful in young male patients who need to preserve fertility. This study aimed to compare the characteristics of men and women who underwent Delorme-Thiersch procedures and analyze the postoperative outcomes of the perineal approach by sex. METHODS: We retrospectively reviewed the medical records of 293 patients who underwent Delorme-Thiersch operations in Seoul Song Do Colorectal Hospital between January 2011 and September 2017. Patient clinical characteristics and postoperative complications were analyzed by sex. We analyzed surgical outcomes with preoperative and 3-month postoperative incontinence questionnaires, constipation levels, and anal manometry. RESULTS: In this study, men with rectal prolapse were younger than women with the same condition. American Society of Anesthesiologists physical status classifications were higher in women and women had more L-spine X-ray and pudendal nerve terminal motor latency test abnormalities. Anorectal manometry pressures were higher in men. Men also had longer operation times and hospital stays and more postoperative complications (8 T ring infections, 6 patients with bleeding, 3 with strictures, 2 with severe pain, and 2 with rectal perforations). The recurrence rate was higher among women. CONCLUSION: Men with rectal prolapse were younger, healthier, and had relatively better anorectal function than women. The Delorme-Thiersch operation in men promoted lower recurrence rates and was advantageous in preserving the fertility of young patients, but the incidence of complications was also higher in men. Adequate counseling and preparation for the possibility of complications are needed.
Classification ; Constipation ; Constriction, Pathologic ; Counseling ; Female ; Fertility ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Male ; Manometry ; Medical Records ; Music ; Postoperative Complications ; Pudendal Nerve ; Rectal Prolapse ; Recurrence ; Retrospective Studies ; Seoul

Despite major diagnostic advances, 10-30% of hepatic metastases of colorectal carcinoma remain undetected. In this study, CEA levels of peripheral (p-CEA), drainage venous blood(d-CEA) and gallbladder bile(b-CEA) in patients with colorectal cancer were determined to examine the significance of their CEA levels in predicting hepatic metastases. From January 1993 through May 1996, p-CEA, d-CEA and b-CEA were obtained in 50 colorectal carcinoma patients without gallbladder pathology. Synchronous hepatic metastases were found in 5 patients(Hm group) and 45 cases had no hepatic metastasis. Among the 27 cases who followed up over 2 years, metachronous hepatic metastases(Hr group) were found in 6 cases and remaining 21 cases had no metastases(Ho group). Elevation of p-CEA, d-CEA, and b-CEA was significantly correlated with lymph node metastases and hepatic metastasis. The b-CEA levels were significantly correlated with p-CEA(r=0.533926, p<0.0001) while d-CEA levels were not(r=0.276437, p=0.0520). Although all the levels of p-CEA, d-CEA, and b-CEA in Hr & Hm group were significantly higher than those in Ho group, d-CEA level was considered as most sensitive index in predicting hepatic metastases(mean 12.7 ng/ml in Ho, 88.6 in Hr, and 137.3 in Hm group. p<0.0001). The possible cut-off level of d-CEA was 40 ng/ml because all of the cases with d-CEA < 40 ng/ml had no hepatic metastasis nor hepatic recurrance, whereas 11 out of 12 patients with d-CEA > 40 ng/ml had hepatic metastases(5 synchronous, 6 metachronous). However it is impossible to establish the possible of b-CEA because of high false positive and negative rate in predicting metachronous hepatic metastases. In conclusion, it is suggested that d-CEA could be highly sensitive indicator for selecting high-risk patients of metachronous hepatic metastases of colorectal cancer.
Bile* ; Colorectal Neoplasms* ; Drainage* ; Gallbladder* ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Pathology

A retrospective review was undertaken of 19 patients with occult papillary carcinoma of thyroid (lesions<1.5 cm in diameter) who were operated on at National Medical Center between 1980 and 1993. The prevalence of occult thyroid cancer was 11.7 %(19/162) of papillary cancer and 3.5 %(19/535) of all cases operated for thyroid disease. All patients were female and the mean age of patients was 45 years. Four out of 19 patients (21%) had cervical lymph node metastasis. The mean age for the group of patients with nodal metastasis was 37 years, which was more than a decade younger than the age for those without nodal metastasis, 47 years. The mean maximum diameter of the tumors was 0.72 cm with the range of 0.2 to 1.4 cm. Histologically all lesions were densely fibrotic, unencapsulated and composed of a predominantly follicular pattern. Operations were conservative. For patients with nodal metastasis, lymphadenectomy generally involved a selective node excision or a modified radical neck dissection. The mean follow-up period was 6.5 years. All patients were alive without evidence of recurrent disease and distant metastasis. Thus, radical surgical or medical extirpation of all thyroid tissue is unnecessary in the treatment of this disease.
Carcinoma, Papillary* ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Prevalence ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms

OBJECTIVE: Bacteroides fragilis is the most frequently isolated anaerobes in tissue of intraabdominal infection, particularly in intraabdominal sepsis or abscess. In acute experimental model with an intraabdominal infection, the response to B. fragilis is characterized by infiltration of neutrophils and monocytes. To understand the pathogenesis of B. fragilis infection, it is important to explore the mechanism for inflammatory signals such as chemokines induced by this bacteria. The goal of this study was to determine whether peritoneal monocytes or fibroblasts surrounding with intraabdominal abscess induced by B. fragilis could express chemokines such as monocyte chemotactic protein-1 (MCP-1) or macrophage inflammatory protein-1a (MIP-1a). METHODS: 1) After C57BL/6 mice were intraperitoneally inoculated with abscess-inducing agents containing B. fragilis, RNA was extracted from the intraperitoneal tissues of the mice using Ottawa sand and the guanidinium thiocyanate-phenol-chloroform method in 3 days later. 2) After C57BL/6 mouse peritoneal monocytes were infected with B. fragilis for 1, 4 and 9 hours, cellular RNA was extracted from the cells. 3) Fibroblasts isolated from intraabdominal abscess nodules induced by B. fragilis infection were growth in tissue culture for 3 to 4 weeks. After the fibroblasts were stimulated with IL-1alpha (0.1-10 ng/ml) or TNFalpha (0.1-10 ng/ml) for 24 hours, total cellular RNA was extracted. MCP-1 or MIP-1alpha mRNA expression was assessed using RTPCR. MCP-1 or MIP-1alpha proteins in cluture supernatants or tissue extracts were also measured by ELISA. RESULTS: 1) MCP-1 or MIP-1alpha mRNA was highly expressed in peritoneal tissue of C57BL/6 mice bearing with intraabdominal abscess induced by B. fragilis. 2) Expression of MCP-1 mRNA increased at 9 hours in mouse peritoneal monocytes infected with B. fragilis. MIP-1alpha mRNA was initially expressed and perisisted in the monocytes infected with B. fragilis for 9 hours. MCP-1 or MIP-1alpha proteins was also parallel to the expression of those chemokines. 3) The fibroblasts isolated from intraabdominal abscess nodules by B. fragilis infection constitutively expressed MCP-1, MIP-1alpha, production in the fibroblasts was significantly upregulated in response to proinflammatory cytokines produced in the monocytes, including IL-1alpha and TNFalpha, but MCP-1 production were not. The normal fibroblasts from uninfected mice didnot show significant production of MCP-1 or MIP-1a in response to IL-1a or TNFalpha. CONCLUSION: These results suggest that peritoneal monocytes and fibroblasts surrounding with abscesses induced by B. fragilis produce MCP-1 or MIP-1a. Furthermore, it could be extrapolated that those effects may play a role in the formation of intraabdominal abscess nodules.
Abscess* ; Animals ; Bacteria ; Bacteroides fragilis* ; Bacteroides* ; Chemokine CCL2* ; Chemokine CCL3 ; Chemokines ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Guanidine ; Intraabdominal Infections ; Macrophages* ; Mice ; Models, Theoretical ; Monocytes* ; Neutrophils ; RNA ; RNA, Messenger ; Sepsis ; Silicon Dioxide ; Tissue Extracts ; Tumor Necrosis Factor-alpha

This study examined the effects of aging on nitric oxide synthase (NOS) and vasoactive intestinal polypeptide (VIP)-positive neurons of the cerebral cortex in young (4 months) and aged (24 months) Wistar rats. Expressional change was assessed by histochemistry, immunohistochemistry and RT-PCR. Nitric oxide (NO) is synthesized by cells containing NOS, and NADPH-diaphorase is a selective histochemical marker for the NOS in the brain. In this study, the coexistence of NADPH-d and VIP was not found in the cerebral cortex of both groups. In the aged group, the number of NADPH-d positive neurons was not significantly changed in cerebral cortex than control groups. However, the number of VIP positive neurons was significantly decreased in cerebral cortex of the aged rats. NADPH-d and VIP positive neurons exhibited morphological characteristics of multipolar or bipolar in most neurons. In the aged group, NADPH-d and VIP positive nerve fibers were more irregular and tortuous compared to the control group. Perikaryal size of NADPH-d positive neurons was not significantly different in both groups. However, significant shrinkage of VIP positive neurons was found in the aged group. The enzyme activity of NADPH-d was increased in the aged group.The basal level of mRNA for NOS and VIP was detected in the cerebral cortex of control group. The expression level of iNOS mRNA was decreased in the aged group. The mRNA for nNOS, eNOS and VIP was not significantly different in both groups. The selective depletion and atrophy VIP positive neurons from the cerebral cortex of aged rats may reflect an increased vulnerability of VIP positive neurons to the aging process compared with NOS positive neurons.
Aging ; Animals ; Atrophy ; Brain ; Cerebral Cortex* ; Immunohistochemistry ; Nerve Fibers ; Neurons ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Rats, Wistar ; RNA, Messenger ; Vasoactive Intestinal Peptide*