In the last few years, the knowledge of molecular oncology has led to the development of many new biological agents whose targets are extracellular or intracellular molecules involved in the main signaling pathways that play major roles in cancer development and progression. Now new agents against epidermal growth factor receptor (EGFR), farnesyl transferase (FT), vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP), cyclooxygenase (COX)-2 are developed. These agents represent a new approach to the colorectal cancer, as for many other types of tumors. Preliminary data show that the targeted therapy may enhance activity of chemotherapeutic agents. Despite the encouraging preclinical results, the majority of these compounds have not yet produced convincing clinical results. However, these new agents raise a new challenge in the treatment of colorectal cancers in the new millennium.
Biological Factors ; Colorectal Neoplasms* ; Molecular Targeted Therapy* ; Prostaglandin-Endoperoxide Synthases ; Receptor, Epidermal Growth Factor ; Signal Transduction ; Transferases ; Vascular Endothelial Growth Factor A

OBJECTIVES: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
Drug Utilization Review* ; Humans ; Information Systems ; Medicare Assignment ; Outpatients ; Patient Safety ; Prescriptions ; Tertiary Care Centers

PURPOSE: The circular stapled hemorrhoidectomy established by A. Longo involves reducing the mucous membrane prolapse and blocking the end branches of the upper hemorrhoidal artery through transverse incision of a suitable section of the mucosa between the rectum and the anal canal. This study was undertaken to determine the efficacy and the safety of a circular stapled hemorrhoidectomy by comparing it with a conventional Milligan-Morgan hemorrhoidectomy. METHODS: One hundred thirty (130) patients with prolapsed hemorrhoids underwent surgical treatment with either a conventional (n=66)(conventional group) or a circular stapled (n=64) (stapled group) hemorrhoidectomy. The operation time was recorded, and the resected specimen was examined. The patients assessed their postoperative pain. Time to first bowel movement, hospital stay, and postoperative complications were analyzed. All patients received follow-up examinations at the out-patient clinic, and the time to return to work and the degree of their satisfaction were checked. RESULTS: The stapled group had a shorter average operation time (19.2 min. vs 26.1 min., P=0.016). The postoperative pain score in the stapled group was significantly lower than it was in the conventional group (P<0.05). Time to first bowel movement and hospital stay were not significantly different between the groups. Return to work was significantly faster in the stapled group (6.5 days vs 15.8 days, P<0.05). The degrees of satisfaction for the two groups were similar, and postoperative complications in the two groups were both similar and acceptable (6.1% vs 11.0%, P>0.05). CONCLUSIONS: A circular stapled hemorrhoidectomy offers a significantly less painful alternative to the conventional technique and is associated with an earlier return to normal activity. However, the long-term outcome needs to be evaluated further.
Anal Canal ; Arteries ; Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Mucous Membrane ; Outpatients ; Pain, Postoperative ; Postoperative Complications ; Prolapse ; Rectum ; Return to Work

PURPOSE: This study was undertaken to determine whether a mechanical bowel preparation with 90 ml of sodium phosphate (NaP) solution (Group II) increased the acceptability of bowel preparation and reduced discomfort compared with 2 liters of polyethylene glycol (PEG) combined with a bisacodyl 20 mg (Group I). METHODS: We conducted a prospective, randomized, single-blinded study. Forty-four patients undergoing elective colorectal surgery in the National Health Insurance Corporation Ilsan Hospital from March 2002 to November 2002 were included in this study. We assessed the patients' tolerance and cleansing ability, as well as the surgeon's satisfaction, by using a structured questionnaire. Postoperative complications were also evaluated. RESULTS: Patient tolerance to NaP was higher than it was to PEG (P=0.034). The cleansing ability and the surgeon's satisfaction were not different between the two groups (P=0.217, P=0.349). There is no significant postoperative complication except for 1 case of wound infection in both group. CONCLUSIONS: Both oral solutions proved to be equally effective and safe. However, patient tolerance to the small volume of NaP demonstrated a clear advantage over the traditional PEG solution.
Bisacodyl ; Colorectal Surgery* ; Humans ; National Health Programs ; Polyethylene Glycols* ; Polyethylene* ; Postoperative Complications ; Preoperative Care ; Prospective Studies* ; Surveys and Questionnaires ; Sodium* ; Therapeutic Irrigation* ; Wound Infection

Purpose: Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups. Conclusions: In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.

PURPOSE: The treatment of colorecatal cancer depends primarily upon the stage, and whether or not the regimen of adjuvant therapy can also be decided through this staging. In fact, the clinicopathologic prognostic factors are well known. In addition to these prognostic factors, the importance of molecular biological prognostic factors has also come to light. METHODS: This study was devised to analyze the recurrence pattern and the survival rate and correlate them with the prognostic factors in a group of surgically treated colorectal cancer patients, who were recruited from 1989 to 1998 at the Severance Hospital, Yonsei Uinversity College of Medicine. The survival curves were analyzed according to the Kaplan-Meier method, and the Cox regression hazard model was used to analyze the prognostic factors influencing the survival rates. RESULTS: A total of 1973 patients were recruited, and among them 1848 (93.7%) had undergone a resection with 1643 (89.1%) having a curative resection. The overall follow-up time after surgery was 60.5+/-35.4 months and 1945 (98.6%) patients were confirmed to have either survived or died. The overall recurrence rate was 386/1643 (23.5%). Of these, the local recurrence rate was 86/386 (22.2%), the systemic recurrence rate was 236/386 (61.1%), and both local and systemic recurrence rates were 50/386 (12.9%). The overall 5 year survival rate was 61.5%, and according to the TNM stage, the survival rate was 84.3% for stage 1, 79.2% for stage 2, 61.5% for stage 3, and 31.5% for stage 4. Multivariate analysis indicated that the TNM stage, the number of lymph nodes involved, the gross appearance of the tumor, the positive lateral margin, vascular invasion, the preoperative CEA level (higher than 5ng/ml), and rectal cancer were significant prognostic factors for the 5 year survival rate. CONCLUSION: Patient with ulceroinfiltrative, poorly differentiated, rectal cancer and the positive lateral resection margin, vascular invasion etc. had a poor survival rate after a curative resection for colorectal cancer. In addition to these clinicopathologic prognostic factors, an investigation into the molecular biological prognostic factors is also needed.
Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Proportional Hazards Models ; Rectal Neoplasms ; Recurrence* ; Survival Rate*

PURPOSE: Total mesorectal excision has been advocated as the effective operation for patients with rectal cancer to reduce the local recurrence rate after curative resection. Its rationale is to remove possible tumor foci at the mesorectum distal to the level of the rectal cancer. This study was undertaken to clarify the rationale for total mesorectal excision. METHODS: Total mesorectal excision was performed in 72 patients with rectal cancer who admitted in Severance Hospital between December, 1996 and December, 1997. The obtained mesorectums were classified to M0 (from the proximal margin to the distal margin of the tumor), M1 (from the distal margin to 2 cm below the distal margin), M2 (from 2 cm to 5 cm below the distal margin), and microscopic examination was done. RESULTS: The nodal metastases were detected in 7 cases and tumor deposits in 4 cases. Especially in M2 with Dukes' C2, the rate of nodal metastases was 3.6 percent and the rate of tumor deposits was 7.1 percent. The nodal metastases and tumor deposits in the distal mesorectum have no correlation with gross finding, size, location and differentiation of the tumor. CONCLUSIONS: En bloc excision of all mesorectal tissue down to at least 5 cm below the lower margin of the tumor is required for patients with advanced rectal cancer to remove possible metastatic lymph nodes and tumor deposits in the distal mesorectum.
Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Rectal Neoplasms* ; Recurrence

PURPOSE: Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer. METHODS: Forty-eight patients underwent coloanal anastomosis following ultralow anterior resection between January 1988 and January 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences. RESULTS: Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8 at 1 year and 1.5 at 2 years. CONCLUSIONS: With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.
Anal Canal ; Anastomotic Leak ; Autonomic Pathways ; Colon ; Colonic Pouches ; Constriction, Pathologic ; Fecal Incontinence ; Humans ; Postoperative Complications ; Rectal Neoplasms* ; Rectovaginal Fistula ; Recurrence ; Urinary Retention

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.
Adult ; Age of Onset ; Arthritis, Gouty ; Female ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Joints ; Korea* ; Male ; Obesity ; Renal Insufficiency, Chronic ; Retrospective Studies ; Seoul ; Ultrasonography ; Uric Acid

PURPOSE: The common features of brain metastases from gastric cancer are unknown because brain metastasis is an uncommon pattern of metastasis. The purpose of this study was to investigate the clinical features of and the prognosis for patients with brain metastases after a curative resection for gastric cancer. MATERIALS AND METHODS: Twenty-one (21) cases of patients with brain metastases of gastric cancer, who had been treated at the Department of Surgery, Yonsei University College of Medicine, were assessed retrospectively. RESULTS: The mean age was 55.8+/-9.6 years (range: 34~70 years), and the male-to-female ratio was 2.5:1. The most common neurologic symptom was headache (38.5%), and no patient was free from the neurologic symptoms. The incidence of parenchymal metastasis (PM: 76.2%) was higher than that of leptomeningeal metastasis (LM: 19.0%). Patients with gastric cancer and brain metastasis showed high rates of blood and lymphatic vessel invasion (lymphatic vessel invasion: 85.7%; blood vessel invasion: 80.9%). According to Lauren's classification, the incidence of intestinal types was 14/21 (66.7%), that of diffuse types was 3/21 (14.3%) and that of mixed types was 4/21 (19.0%). The mean interval between the gastrectomy and the diagnosis of brain metastasis was 24.7+/-4.0 months (PM: 26.8 months; LM: 20.3 months). The median period of survival after diagnosis of brain metastasis was 2 months for paren chymal metastasis and 0 months for leptomeningeal metastasis. CONCLUSION: During a follow-up period, patients with neurologic symptoms should be suspected of having brain metastasis. Early diagnosis and treatment is the only hope to prolong survival in such patients.
Blood Vessels ; Brain* ; Classification ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Gastrectomy* ; Headache ; Hope ; Humans ; Incidence ; Lymphatic Vessels ; Neoplasm Metastasis* ; Neurologic Manifestations ; Prognosis ; Retrospective Studies ; Stomach Neoplasms*