The methods of hysterectomy for intrapelvic benign disease include total, subtotal, la-paroscopic-assisted transvaginal, and SACSIH operation. There have been 298 cases of SACSIH operation for benign uterine or pelvic diseases at the Chonbuk National University Hospital from November 16, 1992 to March 31, 1997. Patients were 41.8 years old on the average ranging from 29 to 50. Their indications cover uterine myoma(211), adenomyosis(37), uterine myoma with pelvic adhesion(16), uterine my- oma with endometriosis(11), and others(23), the uterine myoma being the most common. Both CIN and CIS is excluded after the full evaluation of the cervical disease through Pap. smear, cervicography, ECC biopsy, and HPV typing etc, and the consent of patient is secu- red. The modified SACSIH operation, when compared with other simple hysterectomy oper- ation, has the following advantages;1) minimal surgery, 2) easy adaptation, 3) avoidance of stump cancer, 4) rapid recovery and 5) less postoperative care as far as psychosomatic posthysterectomy problems are concerned. One of the new equipment for new modified technique is the Electro-Surgical Unit system with Electrode for endocervical canal resection. This is developed at this hospital as a part of the G-7 project supported by the Ministry of Health and Welfare. It is made of electrode and rod from electrosurgical unit system and operated by high frequency of current. Thus, we introduce, herein, the modified SACSIH operation and propose the postopera- tional scoring system to estimate postoperative sequelae and to help carry on personal well- being in terms of sexuality and normal life.
Biopsy ; Electrodes* ; Humans ; Hysterectomy* ; Jeollabuk-do ; Leiomyoma ; Postoperative Care ; Sexuality

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.
Abdominal Pain/etiology ; Adult ; Constipation/etiology ; Diarrhea/etiology ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Irritable Bowel Syndrome/complications/*drug therapy ; Male ; Middle Aged ; Parasympatholytics/*therapeutic use ; Phenothiazines/*therapeutic use ; Severity of Illness Index ; Treatment Outcome ; Trimebutine/*therapeutic use

Background/Aims: Limited data are available regarding psychosocial distress at the time of diagnosis of ulcerative colitis (UC). We investigated the psychosocial burden and factors related to poor health-related quality of life (HRQL) among patients newly diagnosed with moderate-to-severe UC who were affiliated with the nationwide prospective cohort study. Methods: Within the first 4 weeks of UC diagnosis, all patients were assessed using the Hospital Anxiety and Depression Scale (HADS), Work Productivity and Activity Impairment questionnaire, Inflammatory Bowel Disease Questionnaire (IBDQ), and 12-Item Short Form (SF-12) health survey. A multiple linear regression model was used to identify factors associated with HRQL. Results: Between August 2014 and February 2017, 355 patients completed questionnaires. Significant mood disorders requiring psychological interventions, defined by a HADS score ≥11, were identified in 16.7% (anxiety) and 20.6% (depression) of patients. Patients with severe disease were more likely to have presenteeism, loss of work productivity, and activity loss than those with moderate disease (all p<0.05). Significant mood disorders had the strongest negative relationship with total IBDQ score, which indicates disease-specific HRQL (β coefficient: –22.1 for depression and –40.0 for anxiety, p<0.001). The scores of all SF-12 dimensions, which indicate general HRQL, were remarkably decreased in the study population compared indirectly with previously reported scores in the general population. The Mayo score, C-reactive protein level, and white blood cell count showed significant negative associations with the IBDQ score (p<0.05). Conclusions Psychosocial screening and timely interventions should be incorporated into the initial care of patients newly diagnosed with UC.

BACKGROUND/AIMS: Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) and peroxisome proliferator-activated receptor gamma (PPARgamma) ligands can modulate cellular differentiation, proliferation, and apoptosis through various pathways. It has been shown that HMG-CoA reductase inhibitors and PPARgamma agonists separately inhibit pancreatic stellate cell (PaSC) activation. We studied the effects of a combination of both types of drugs on activated PaSCs via platelet-derived growth factor (PDGF), which has not previously been reported. The present study was performed to elucidate the underlying mechanisms of these effects by focusing on the impact of the signaling associated with cell-cycle progression. METHODS: Primary cultures of rat PaSCs were exposed to simvastatin and troglitazone. Proliferation was quantified using the BrdU method, and cell-cycle analysis was performed using a fluorescent activated cell sorter. The protein expression levels of smooth muscle actin (SMA), extracellular signal-regulated kinase (ERK), and a cell cycle machinery protein (p27Kip1) were investigated using Western blot analysis. RESULTS: Simvastatin reversed the effects of PDGF on cell proliferation in a dose-dependent manner. The combination of a low concentration of simvastatin (1 mM) and troglitazone (10 mM) synergistically reversed the effects of PDGF on cell proliferation but had no effect on cell viability. The expression of a-SMA was markedly attenuated by combining the two drugs, which blocked the cell cycle beyond the G0/G1 phase by reducing the levels of phosphorylated ERK and reversed the expression of p27Kip1 interrupted by PDGF. CONCLUSIONS: Simvastatin and troglitazone synergistically inhibited cell proliferation in activated PaSCs by blocking the cell cycle beyond the G0/G1 phase. This inhibition was due to the synergistic modulation of the ERK pathway and the cell cycle machinery protein p27Kip1.
Actins ; Acyl Coenzyme A ; Animals ; Apoptosis ; Blotting, Western ; Bromodeoxyuridine ; Cell Cycle ; Cell Proliferation ; Cell Survival ; Chromans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Ligands ; MAP Kinase Signaling System ; Muscle, Smooth ; Oxidoreductases ; Pancreatic Stellate Cells ; Phosphotransferases ; Platelet-Derived Growth Factor ; PPAR gamma ; Rats ; Simvastatin ; Thiazolidinediones

Follicular lymphoma (FL) is one of the most common non-Hodgkin's lymphomas in the United States, but it is relatively rare in Asia. FL typically arises in lymph nodes together with spleen, liver, and bone marrow involvement. So, primary extra-nodal FL without peripheral nodal involvement is rare. Histologically, it shows nodular aggregates of lymphoma cells and positivity for CD 10, CD 20 and bcl-2. Not only the stage, but also the grade is associated with the survival rate. Grade 3 FL presents a worse prognosis than does grade 1 and 2 FL and this should be treated with an anthracycline based CHOP regimen. We report here on a case of primary follicular lymphoma arising in the rectum; this was observed in a 58-year-old woman who complained of anorexia, dyspepsia and diarrhea.
Anorexia ; Asia ; Bone Marrow ; Diarrhea ; Dyspepsia ; Female ; Humans ; Liver ; Lymph Nodes ; Lymphoma ; Lymphoma, Follicular* ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prognosis ; Rectum* ; Spleen ; Survival Rate ; United States

BACKGROUND/AIMS: Gastrointestinal peristalsis may hinder inspection of the gastrointestinal track or its treatment during endoscopy. Antispasmodic agents such as hyoscine-N-butylbromide are commonly administered before endoscopy for alleviating peristalsis, although it causes unwanted complications. Peppermint oil (PMO) has a spasmolytic effect on viscera and it has been used as an adjunctive remedy for some disorders. We evaluated the antispasmodic effect of PMO solution during gastroscopy, and we determined if there are any adverse effects. METHODS: 1.6% PMO solution was sprayed on the antrum of the examinees (n=40) during gastroscopy. Observation was performed 5 cm ahead of the pyloric ring to count the peristaltic waves for 3 minutes before and after spraying PMO. The intensity of peristalsis was graded from 0 (none) to 4 (severe), and the pulse rate of all the examinees was recorded every minute. RESULTS: The number of peristaltic contractions decreased after PMO spraying from 7.02+/-2.25 to 3.17+/-2.57 times/3 minutes (p<0.01). The peristaltic intensity also decreased from 3.15+/-1.18 to 1.34+/- \0.95 (p<0.01) with a difference of 1.80+/-1.29. On observing the examinees' pulse rates, using PMO did not induce tachycardia. No adverse effect during and after the investigation with PMO solution was reported. CONCLUSIONS: PMO showed a significant antispasmodic effect, and it reduced the number of peristaltic contractions and the intensity of gastric peristalsis. It also did not have any significant side effects. PMO solution may be used as an effective antispasmodic agent during gastroscopy.
Contracts ; Endoscopy ; Gastroscopy ; Heart Rate ; Mentha piperita ; Parasympatholytics ; Peristalsis ; Plant Oils ; Tachycardia ; Track and Field ; Viscera

BACKGROUND/AIMS: C-reactive protein (CRP) is a general marker of inflammation and increased CRP level is reported in several cancers. It has been reported that CRP is an independent factor predicting survival in colorectal cancer patients, although this claim is still under debate. The aim of this study was to investigate the association between CRP and the characteristics of colorectal cancer patients. METHODS: One hundred eighty-four patients diagnosed with colorectal cancer between January 2007 and January 2009 were included. The patients with active infectious diseases, other tumors, cardiovascular disease, or inflammatory bowel disease were excluded. The CRP levels of colorectal cancer patients were compared with the control group comprised of 175 healthy adults with a normal colonoscopy. RESULTS: The median CRP in the colorectal cancer patients (3.36 mg/L) was higher than the control group (0.48 mg/L). There was a significant correlation between CRP and the stage of colorectal cancer (p<0.001). CRP was increased significantly in Dukes' stage D. CRP had a significant correlations with the CEA and CA 19-9 levels, the ESR, and the white blood cell count, and an inverse correlation with albumin. The CRP level in colon cancer patients was higher than rectal cancer patients (p=0.032). There were no significant difference in the CRP according to metastatic sites, such as the liver and peritoneum. CONCLUSIONS: Serum CRP levels were higher in patients with colorectal cancer and high CRP level is a predictor of advanced disease.
Adult ; C-Reactive Protein ; Cardiovascular Diseases ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Communicable Diseases ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Leukocyte Count ; Liver ; Peritoneum ; Rectal Neoplasms

BACKGROUND/AIMS: C-reactive protein (CRP) is a general marker of inflammation and increased CRP level is reported in several cancers. It has been reported that CRP is an independent factor predicting survival in colorectal cancer patients, although this claim is still under debate. The aim of this study was to investigate the association between CRP and the characteristics of colorectal cancer patients. METHODS: One hundred eighty-four patients diagnosed with colorectal cancer between January 2007 and January 2009 were included. The patients with active infectious diseases, other tumors, cardiovascular disease, or inflammatory bowel disease were excluded. The CRP levels of colorectal cancer patients were compared with the control group comprised of 175 healthy adults with a normal colonoscopy. RESULTS: The median CRP in the colorectal cancer patients (3.36 mg/L) was higher than the control group (0.48 mg/L). There was a significant correlation between CRP and the stage of colorectal cancer (p<0.001). CRP was increased significantly in Dukes' stage D. CRP had a significant correlations with the CEA and CA 19-9 levels, the ESR, and the white blood cell count, and an inverse correlation with albumin. The CRP level in colon cancer patients was higher than rectal cancer patients (p=0.032). There were no significant difference in the CRP according to metastatic sites, such as the liver and peritoneum. CONCLUSIONS: Serum CRP levels were higher in patients with colorectal cancer and high CRP level is a predictor of advanced disease.
Adult ; C-Reactive Protein ; Cardiovascular Diseases ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Communicable Diseases ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Leukocyte Count ; Liver ; Peritoneum ; Rectal Neoplasms

Background: s/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.