Purpose: The adenosine-triphosphate-based chemotherapy response assay (ATP-CRA) is a well-documented and validated technology for individualizing chemotherapy in cancer patients. We evaluate the feasibility of ATP-CRA in colorectal cancer patients. This study will illustrate the assay's success rate, the mean coefficient of variation, and the turnaround time as a validation tool for a chemosensitivity test. Methods: A total of 118 patients, treated by surgery between June 2004 and September 2005 were evaluated for chemosensitivity to seven anticancer agents (5-fluorouracil (5-FU), oxaliplatin, irinotecan, epirubicin, etoposide, gemcitabine, and paclitaxel) by using an ATP-CRA. To allow a comparison between samples, we calculated the chemosensitivity index (CI) based on the percentage cell death rate (CDR, %) at each test drug concentration. Results: The assay success rate was 85.5% (118/138), and the mean coefficient of variation, indicating intra-assay error level, was 9.2%. CDR measured at a therapeutic peak plasma concentration ranged from 0% to 93.6% with a median of 31.0% for 5-FU, 28.5% for oxaliplatin, 34.0% for irinotecan, 25.0% for epirubicin, 21.0% for etoposide, 22.0% for gemcitabine, and 25.2% for paclitaxel. According to the CI, the most sensitive drug varied from patient to patients 10.9% for 5-FU, 10.9% for oxaliplatin, 24.7% for irinotecan, 11.8% for epirubicin, 22.4% for etoposide, 1.1% for gemcitabine, and 23.3% for paclitaxel. Conclusions: Our data suggest that the ATP- CRA is a feasible in-vitro chemosensitivity test in colorectal cancer and that patients show heterogeneous chemosensitivity. A study evaluating the predictive value of ATP-CRA directed therapy is needed to determine the clinical usefulness of the test.
Mortality ; Predictive Value of Tests

PURPOSE: The aim of this study was to assess the clinicopathological characteristics and prognosis of colorectal mucinous carcinomas. METHODS: 1, 809 patients who underwent curative resection, between January 1989 and December 1999, for colorectal carcinomas, were enrolled in this study. Of these, 128 patients had more than 50% mucin secreting acini that could be classified as the mucinous type. These mucinous carcinoma patients were compared with 1, 681 non-mucinous carcinoma patients, in order to evaluate differences in their clinicopathological characteristics, recurrence pattern and prognosis. RESULTS: The incidence of mucinous carcinomas was 7.1%. The mean age of the mucinous carcinoma patients was younger than the non-mucinous carcinoma patients (P=0.001). The mucinous carcinomas occurred in the right colon more frequently than non-mucinous carcinoma, and the size of the tumor was larger (P<0.001). There were no significant differences in the loco-regional and systemic recurrence rates, but the systemic recurrence pattern of the mucinous carcinomas was different from those of the non-mucinous carcinomas. With a mucinous carcinoma, the most common site for systemic recurrence was the peritoneal metastasis, whereas in a non-mucinous carcinoma, was the liver. There was no significant difference in the 5-year survival rate between the two groups. CONCLUSION: In a mucinous carcinoma, the most common pattern of treatment failure was a peritoneal recurrence. The hepatic recurrence rate of the mucinous carcinomas was less than that of the non-mucinous carcinoma. Therefore, more aggressive diagnostic and therapeutic approaches, under the consideration of peritoneal recurrence in mucinous carcinomas, will be required.
Adenocarcinoma, Mucinous* ; Colon ; Colorectal Neoplasms ; Humans ; Incidence ; Liver ; Mucins* ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate ; Treatment Failure

The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy.
Appendectomy ; Appendicitis* ; Appendix ; Burkitt Lymphoma* ; Drug Therapy* ; Female ; Humans ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Young Adult

Restorative proctocolectomy (total proctocolectomy and ileal J pouch anal anastomosis) has been accepted as the operation of choice in the setting of chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess operative safety and functional outcome after restorative proctocolectomy. A total of sixteen patients underwent surgery between January 1996 and December 1999. Hand sewn anastomosis with diverting ileostomy was performed in 9 patients and double stapled anastomosis in 7 patients. The underlying disease was ulcerative colitis in 9 cases and familial adenomatous polyposis in 7. Postoperative complications developed in 8 cases (50%), and intestinal obstruction was found in 4 cases (2 cases were operated upon). Anastomosis related complications were stenosis (n=2), leak (n=1) and perianal abscess (n=1). All patients were followed up at the outpatient clinic using questionnaires, with a mean follow up period of 19.9 months. The frequency of bowel movement was 8.2 per day in hand sewn anastomosis (HS), and 12 per day in double stapled anastomosis (DS) 3 months after surgery (period 1). This frequency decreased to 5.5 per day in HS, and 4.6 per day in DS after one year (period 2). Day and night continence was shown in 12/15, and 5/15, respectively in period 1, but improved to 10/11, and 10/11, respectively in period 2. Night time incontinence was noted in 10 of 15 patients in period 1 (seepage 3/15, soiling 7/15). The need to take anti-diarrheal medication, and to use a pad was noted in 2/15, and 10/15, respectively in period 1, but no patient took antidiarrheal medication or wore a protective pad in period 2. Postoperative urinary function was satisfactory in 13/14 patients. Postoperative sexual function was analyzed in a total of 8 patients, who showed good erection (5/5), ejaculation (5/5) and satisfactory sexual life (5/5). In females, 3 patients showed a satisfactory sexual life. In conclusion, restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis can be performed safely with excellent functional outcomes, including bowel movement, urinary and sexual functions one year after surgery.
Adenomatous Polyposis Coli/surgery ; Adult ; Colitis, Ulcerative/surgery ; Defecation ; Ejaculation ; Female ; Human ; Male ; Patient Satisfaction ; Penile Erection ; Proctocolectomy, Restorative*/adverse effects ; Safety ; Sex Behavior ; Treatment Outcome

No abstract available.
Adolescent ; Adult ; Age Factors ; Aged ; Cholelithiasis/epidemiology* ; Comparative Study ; Female ; Human ; Korea ; Male ; Middle Age

We performed one-stage microsurgical phalloplasty on a 17-year-old male-pseudohermaphroditism patient after bilateral orchiopexy and urethroplasty, using the free radial forearm osteocutaneous sensory flap. The main advantages of this technique are not only the one-stage reconstruction and the satisfactory cosmetic and functional solution, but also the possibility of obtaining normal erogenous and tactile sensibility. One week after the operation, the urethrocutaneous fistula was developed between the native proximal urethra and the constructed neourethra, but seven weeks after the development, it spontaneously healed well. The results of our S-month follow-up are satisfactory in the following respects : 1) satisfactory cosmetic appearance 2) voluntary control of transurethral urination while standing 3) tactile and thermal sensibility. Further follow-up study is necessary for the confirmation of erogenous sensibility, successful sexual life and late complication.
Adolescent ; Fistula ; Follow-Up Studies ; Forearm* ; Humans ; Orchiopexy ; Urethra ; Urination

PURPOSE: The restorative proctocolectomy has been accepted as the operation of choice for chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the operative safety and the functional outcome after a total proctocolectomy and ileal-pouch anal anastomosis. METHODS: The medical records of 16 patients who had undergone a total proctocolectomy and ileal-pouch anal anastomosis for ulcerative colitis (n=9) and familial adenomatous polyposis (n=7) from January 1996 to December 1999 were reviewed. The mean length of follow-up was 19.9 months, and we evaluated functional outcome using a prepared questionnaire. RESULTS: A hand-sewn anastomosis with diverting ileostomy was performed in 9 patients, and a double stapled anastomosis was done in 7 patients. Postoperative complications occurred in 8 cases (50%): intestinal obstructions in 4 patients and anastomosis related complications in 4 patients, i.e. stenosis (n=2), leak (n=1) and perianal abscess (n=1). The defecation frequency and the, day and night continence were improved in the first period (one year after surgery) compared to the second period (3 months after surgery). The need for anti-diarrheal medication, and for the use of a pad was also decreased in the second period compared to the first period. Postoperative urinary function was satisfactory in 13 of 14 patients. Postoperative sexual function was assessed in 8 patients (5 males, 3 females) and showed in good erection (5/5), ejaculation (5/5), and satisfactory sexual life (8/8). CONCLUSION: Satisfactory functional outcomes regarding the frequency of bowel movement and fecal incontinence and operative safety can be achieved after a restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis.
Abscess ; Adenomatous Polyposis Coli ; Colitis, Ulcerative ; Constriction, Pathologic ; Defecation ; Ejaculation ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Intestinal Obstruction ; Male ; Medical Records ; Postoperative Complications ; Proctocolectomy, Restorative* ; Surveys and Questionnaires

PURPOSE: To evaluate the functional results, activity status after surgical treatment in combined PCL and PL instability of the knee. MATERIALS AND METHODS: Fifteen patients with combined PCL and PL injury were diagnosed and treated. PCL injury was treated by using tibial inlay method with arthroscopy and PL injury was treated by using repair (acute 4 cases) and reconstruction (chronic 11 cases, Warren method) and followed more than 2 years with average follow-up period of 27.3 months (24-38). Mean age was 39 years (17-67) at operation. Radiologic evaluation was done by simple X-ray, stress view and MRI. Functional evaluation of Lysholm score and Tegner activity score was used. RESULTS: Average Lysholm and Tegner activity score was 43 and 1.5 preoperatively and was improved to 85 and 4.0 postoperatively. Varus laxity was improved from 9.3 mm to 4.0 mm and posterior translation was improved from 18.4 mm to 5.6 mm in stress view. The PCL and PL instability of the knee were improved in all cases. Postoperative improvement of functional and activity score were determined by absence of combined injury not by age or delayed time for operation. Complications were limitation of motion (3 cases), lateral instability (4 cases), osteoarthritic change (4 cases) and quadriceps atrophy (15 cases, severe 4 cases). CONCLUSION: PCL reconstruction using tibial inlay method and PL reconstruction using warren method (chronic cases) and repair (acute cases) improved function, activity and stability in PCL and posterolateral instability.
Arthroscopy ; Atrophy ; Follow-Up Studies ; Humans ; Inlays ; Knee* ; Magnetic Resonance Imaging

Propofol is widely used for sedation during endoscopy. Hemodynamic compromise and respiratory depression might occur under propofol sedation, whereas anaphylaxis is rare. We recently experienced this rare side effect. A 71-year-old woman suffering from substernal chest discomfort underwent endoscopic examination under propofol sedation. She denied any history of allergic reaction to drugs or foods such as beans and eggs. After completion of the endoscopic examination, she developed a whole-body rash with pruritus and edema of her face, including the eyelids and lips. Hypotension was seen on physical examination, and her oxygen saturation was decreased on pulse oximetry. She recovered completely after treatment with epinephrine, an antihistamine, and steroids, with supportive care. Anaphylaxis to propofol is a rare side effect, and prompt treatment is mandatory when it develops.
Aged ; Anaphylaxis ; Conscious Sedation ; Edema ; Eggs ; Endoscopy ; Epinephrine ; Exanthema ; Eyelids ; Fabaceae ; Female ; Hemodynamics ; Humans ; Hypersensitivity ; Hypotension ; Lip ; Ovum ; Oximetry ; Oxygen ; Physical Examination ; Propofol ; Pruritus ; Respiratory Insufficiency ; Steroids ; Stress, Psychological ; Thorax

Villous adenomas of the stomach are rare, although they more frequently occur in the colon and rectum. Clinical symptoms are similar to gastric polyps, but acute or chronic bleeding with anemia occurs frequently. The size of tumors varies between 4 and 6 cm, and the malignant potential is greater when the tumor is larger. Complete resection with surgery or endoscopic resection is the treatment of choice. Endoscopic findings revealed a dome-like or pedunculated appearance. Microscopically, the tumor was composed of long fronds and papillations covered by columnar epithelia with a reduced number of goblet cells. We report a case of polyps with chronic intermittent and acute bleeding for 6 months, which was alleviated by endoscopic mucosal resection and was confirmed as a villous adenoma.
Adenoma ; Adenoma, Villous ; Anemia ; Colon ; Gastrointestinal Hemorrhage ; Goblet Cells ; Hemorrhage ; Polyps ; Rectum ; Stomach