No abstract available.
Dysentery, Amebic ; Enterocolitis, Pseudomembranous ; Sigmoidoscopy

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.
Hospitals, Veterans ; Humans ; Korea ; Sigmoidoscopes ; Sigmoidoscopy*

Although malignant melanoma usually occurs after the diagnosis of vitiligo-like depigmentation, the latter is rarely followed by the former. We herein report on such a case in which recognition of the vitiligo-like depigmentation preceded diagnosing the metastatic melanoma by several months. A 56-year-old woman had first developed vitiligo-like depigmentation on the forehead, eyelids, neck and back 18 months previously and thereafter she detected a hard mass in the left axilla 2 months previously. Based on the histologic findings, the axillary mass was diagnosed as metastatic melanoma. To evaluate the primary tumor focus, thorough examinations that included PET-CT, bone scan and sigmoidoscopy were performed, but we couldn`t find any the original primary tumor. Our case suggests that the vitiligo-like depigmentation could be a sign that heralds metastatic melanoma.
Axilla ; Eyelids ; Female ; Forehead ; Humans ; Melanoma ; Middle Aged ; Neck ; Sigmoidoscopy

A series of 510 patients with carcinoma of the uterine cervix given the curative radiation therapy from March 1979 through December 1986 was evaluated to determine the value of intravenous pyelography(IVP), cystoscopy, sigmoidoscopy, and abdomino-pelvic CT as staging work-up prior to treatment. On IVP and cystoscopy, 10.7%(49/456) and 5/3%(24/452) showed abnormality, respectively, but only 0.7% (3/413) did on signoidoscopy. As a result of these work-ups prerequisite to FIGO staging, twenty six (5.1%) out of 510 patients were upstaged from the stage determned by the findings of physical examination alone. The proportions of upataging in each stage were as follows none in stage IB(35), IIA (89) and IIIA(8), 7.9%(20/252) in stage IIB(14 patients to FIGO Stage IIIB, 6 patients to FIGO stage IVA), and 4.8% (6/126) in stage IIIB (all to FIGO stage IVA). Positive findings of staging work-ups were found only in patients with advanced stages of stage IIB or over determined by physical examination alone but not in those with earlier stages. CT was performed in 337 patients. CT detected pelvic lymph node (LN) enlargement in 25.2% (85/337) and paraaortic LN enlargement in 7.4% (25/337). Pelvic LN positivity was well correlated with increasing stage but paraaortic LN positivity was not. In the evaluation of parametrial involvement, CT findings were in accordance with those of physical examination only in 65.6%(442/674). When compared with endoscopic studeies, CT had much lower positive predicitive value than negative predicitive value in the evaluation of adjacent organ invasion. The staging work-ups should be individualized by the disease extent of each patient, and then the efficiency of work-ups may be increased without compromising the appropriate FIGO staging and treatment.
Cervix Uteri* ; Cystoscopy ; Female ; Humans ; Lymph Nodes ; Physical Examination ; Sigmoidoscopy ; Uterine Cervical Neoplasms

BACKGROUND AND AIMS: There has been a lot of controversy regarding the significance of hyperplastic or diminutive polyps found during sigmoidoscopy, as markers for synchronous adenomatous polyps. Therefore, prospective colonoscopy was performed in subjects with distal polyps found using sigmoidoscopy to determine the association between synchronous polyps with distal polyps. METHODS: A sigmoidoscopy was performed in 2,895 subjects out of 10,705 who visited Samsung Medical Center for a routine check up from Aug. 1994 to Nov. 1995. Distal polyps were found in 590 of 2,895 and colonoscopy was performed in 280 of 590. RESULTS: Of 280 subjects, 73 (26.1%) subjects had synchronous polyps and 55 subjects (19.6%) had synchronous adenomatous polyps. 134 polyps were found during colonoscopy; adenomatous polyps were most common (70.1%): Hyperplastic polyps (18.7%) and inflammatory polyps (11.2%) were also found. A greater percentage of subjects with distal adenomatous polyps had synchronous adenomatous polyps compared with those with distal hyperplastic polyps (25.1% vs. 6.3%, p<0.05). A greater percentage of subjects with distal large polyps (>0.5 cm) had synchronous adenomatous polyps compared with those with distal diminutive polyps (<=0.5 cm) (50.0% vs. 16.1%, p<0.05). CONCLUSIONS: Adenomatous polyps found during sigmoidoscopy justify colonoscopy for synchronous polyps. However, diminutive hyperplastic polyps are not significant indicators of risk for synchronous adenomatous polyps.
Adenoma* ; Adenomatous Polyps ; Colon* ; Colonic Polyps* ; Colonoscopy ; Polyps ; Prospective Studies ; Sigmoidoscopy

A 42-year-old woman preseated with intermittent rectal bleeding of a week's duration. A large polypoid mass with pigmented, ulcerated, nodular surface was seen in the rectum at 3cm from the anal verge during flexible sigmoidoscopy. A histologic diagnosis of metastatic melanoma wae made on light microscopic examination of biopsies obtained at sigmoidoscopy. The presence of metastatic melanoma at sites other than the rectum was found at the skin, pleura and lung. We report a case of metastatic malignant melanoma of the rectum with the review of the literature.
Adult ; Biopsy ; Diagnosis ; Female ; Hemorrhage ; Humans ; Lung ; Melanoma* ; Pleura ; Rectum* ; Sigmoidoscopy ; Skin ; Ulcer

The etiology of small and fresh rectal bleeding in neonates who are not sick is usually unknown; the only known cause is food protein-induced proctocolitis (FPIPC). It has been recently reported that FPIPC is a rare cause of rectal bleeding in newborns, and most cases have been proved to be due to idiopathic neonatal transient colitis. A recommended strategy for diagnosing suspected FPIPC in neonates is as follows. During the early stage, the etiology of small and fresh rectal bleeding in an otherwise healthy newborn need not be studied through extensive investigations. In patients showing continued bleeding even after 4 days, sigmoidoscopy and rectal mucosal biopsy may be performed. Even if mucosal histological findings indicate a diagnosis of FPIPC, further oral food elimination and challenge tests must be performed sequentially to confirm FPIPC. Food elimination and challenge tests should be included in the diagnostic criteria of FPIPC.
Biopsy ; Colitis ; Diagnosis ; Dietary Proteins ; Food Hypersensitivity ; Hemorrhage ; Humans ; Infant, Newborn* ; Proctocolitis* ; Sigmoidoscopy

Recently the incidence of colonic disease increases in Korea. Because a large proportion of polyps and cancer occur in the rectosigmoid colon, fecal occult blood test and sigmoidoscopy have been used widely in screening test. (continue...)
Colon* ; Colonic Diseases ; Colonic Neoplasms ; Colonoscopy ; Incidence ; Korea ; Mass Screening ; Occult Blood ; Polyps ; Sigmoidoscopy

A stapled hemorrhoidopexy (SH) is widely used for treatment of patients with grades III and IV hemorrhoids. The SH is easy to perform, is associated with less pain and allows early return to normal activities. However, complications, whether severe or not, have been reported. Here, we present the case of a female patient with persistent bleeding after a SH. The bleeding was caused by the formation of granulation tissue at the stapler line, diagnosed with sigmoidoscopy, and successfully treated via transanal excision (TAE) under spinal anesthesia. The biopsy showed inflammatory granulation tissue. After the TAE, her symptom was completely gone.
Anesthesia, Spinal ; Biopsy ; Female ; Granulation Tissue ; Hemorrhage* ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Sigmoidoscopy

Cervix cancer is the most common female cancer in Korea. In spite of their relatively local invasive tendency, still 44% of patient will develop recurrent cancer This result suggests that more aggressive local treatment may increase the cure rate but increased complication risk also cannot be avoidable. Various institutions proposed different treatment regimen, but recommended dose were about 4500 cGy for whole pelvis and 8000 cGy at point A, even though they agreed that those doses may not be satisfactory for control of bulky disease. 96 cases of invasive cervical cancer, treated with postoperative or primary radiation therapy were analyzed to determine the complication rate and prognostic factor in our treatment regimen which is 500~1000 cGy higher than other institution. Mean follow up duration was 21 months. Symptomatic patients including mild but persistent abdominal discomfort was 46%, but only 1 patient (1%) had operative treatment because of incomplete obstruction of small bowel. Most symptoms appeared within 12 months and most common complaints were frequent bowel movement. Barium enema and sigmoidoscopy were performed for persistent symptomatic patients. Only one patient had abnormal finding in barium enema which showed inefficiency of this method for detecting bowel complication. Patient's age, total tumor dose, total TDF, rectal dose were not significant risk factors for complication, but boost dose, previous history of operation had some relationship with complication risk. Even though dose of point A and rectum is 500~1,000 cGy higher than other institution, such a low rate of severe complications may suggest that fear of complications should not be overestimated than cure rate and the possibility of more aggressive treatment for better local control should not be underestimated.
Barium ; Enema ; Female ; Follow-Up Studies ; Humans ; Korea ; Pelvis* ; Rectum ; Risk Factors ; Sigmoidoscopy ; Uterine Cervical Neoplasms