PURPOSE: Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique. METHODS: We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation. RESULTS: One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001). CONCLUSION: The trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient's recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.
Colostomy* ; Flatulence ; Humans ; Laparotomy ; Methods ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Surgeons

BACKGROUND/AIMS: Antispasmodics such as octylonium are widely used to manage irritable bowel syndrome (IBS) symptoms. However, the efficacy and safety of another antispasmodic, tiropramide, remain uncertain. We aimed to evaluate the efficacy and safety of tiropramide compared with octylonium in patients with IBS. METHODS: In this multicenter, randomized, non-inferiority trial, 287 patients with IBS (143 receiving tiropramide and 144 octylonium) were randomly allocated to either tiropramide 100 mg or octylonium 20 mg t.i.d (means 3 times a day) for 4 weeks. Primary endpoint was the mean change of abdominal pain from baseline assessed by visual analogue scales (VAS) score after 4 weeks of treatment. Secondary endpoints were the changes in abdominal pain from baseline at week 2 and in abdominal discomfort at weeks 2 and 4, using VAS scores, patient-reported symptom improvement including stool frequency and consistency, using symptom diaries, IBS-quality of life (IBS-QoL), and depression and anxiety, at week 4. RESULTS: The VAS scores of abdominal pain at week 4, were significantly decreased in both tiropramide and octylonium groups, but the change from baseline did not differ between the 2 groups (difference,-0.26 mm; 95% CI,-4.33-3.82; P = 0.901). Abdominal pain and discomfort assessed using VAS scores, diaries, and IBS-QoL were also improved by both treatments, and the changes from baseline did not differ. The incidence of adverse events was similar in the 2 groups, and no severe adverse events involving either drug were observed. CONCLUSIONS: Tiropramide is as effective as octylonium in managing abdominal pain in IBS, with a similar safety profile.
Abdominal Pain ; Anxiety ; Depression ; Humans ; Incidence ; Irritable Bowel Syndrome* ; Parasympatholytics ; Weights and Measures

BACKGROUND: Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models. METHODS: Male Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles. RESULTS: After 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04). CONCLUSION: The present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.
Animals ; Body Weight ; Enzyme-Linked Immunosorbent Assay ; Glucose Intolerance* ; Glucose Tolerance Test ; Homeostasis ; Insulin Resistance ; Interleukin-15* ; Male ; Muscle, Skeletal ; Muscles ; Rats ; Rats, Zucker*

BACKGROUND: Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models. METHODS: Male Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles. RESULTS: After 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04). CONCLUSION: The present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.
Animals ; Body Weight ; Enzyme-Linked Immunosorbent Assay ; Glucose Intolerance* ; Glucose Tolerance Test ; Homeostasis ; Insulin Resistance ; Interleukin-15* ; Male ; Muscle, Skeletal ; Muscles ; Rats ; Rats, Zucker*

The aim of this investigation was to determine if resistance exercise improved musculoskeletal embryonic nuclear protein 1 (Mustn1) mRNA expression in skeletal muscle of rat. Thirty-two male Sprague-Dawley rats were separated into sedentary (control group, CON; n=16) and exercise-trained groups (resistance exercise group, REG; n=16). CON and REG subsequently were separated into 4 weeks group (4 weeks CON, 4 weeks REG) and 8 weeks group (8 weeks CON, 8 weeks REG). The rats in the resistance exercise group were trained to climb a 1-m vertical (85 degree incline) ladder with weights secured to their tail, and they climbed the ladder 10 times 3 days per week for 8 weeks progressively. After weeks of exercise, skeletal muscle was taken from the flexor halucis longus. After separating the total ribonucleic acid (RNA) of each group, quantitative polymerase chain reaction was used to analyze RNA quantitatively. After 4 weeks of resistance exercise, Mustn1 mRNA expression increased significantly in REG compared to CON (p<0.001). Additionally, there was a significant increase of Mustn1 mRNA expression in 8 weeks REG compared to 8 weeks CON (p<0.01). Interestingly, there was a significant difference in Mustn1 mRNA between 4 weeks REG and 8 weeks REG (p<0.01). In the REG, Mustn1 mRNA increased by 3.7-fold and 2.1-fold relative to CON, respectively. In conclusion, the resistance training increased Mustn1 mRNA expression in skeletal muscle of rat. This shows that the Mustn1 mRNA expression gives positive effect on myogenesis and muscle regeneration in skeletal muscle of rat results from resistance ladder exercise.
Animals ; Humans ; Male ; Muscle Development ; Muscle, Skeletal ; Muscles ; Nuclear Proteins ; Polymerase Chain Reaction ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Resistance Training ; RNA ; RNA, Messenger ; Tail ; Weights and Measures

BACKGROUND: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in advanced metastatic cancer. METHODS: This study included 130 patients with ECOG PS (Eastern Cooperative Oncology Group performance status) 1~3 in advanced metastatic cancer following the palliative chemotherapy. ECOG PS, body mass index, alpha 1-acid glycoprotein, C-reactive protein, albumin, prealbumin, transferrin, protein, lactate dehydrogenase, PINI ratio, and survival time were evaluated. RESULTS: In 130 patients, the median age was 57 years. The ECOG PS was 1 68 patients, 2 43, 3 19. The mean value of PINI was PS 1 16.0+/-47.8, PS 2 55.6+/-106.9, PS 3 106.3+/-141.6. The mean survival was PS 1 144.0+/-71.8, PS 2 68.9+/-41.2, PS 3 32.0+/-6.9 days. In the PS 3 group, the mean values of alpha 1-acid glycoprotein, C-reactive protein, and lactate dehydrogenase were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of albumin, prealbumin, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r=-0.602, p<0.001,), PINI (r=-0.318, p<0.001,), alpha 1-acid glycoprotein (r=-0.265, p=0.002), C-reactive protein (r=-0.345, p<0.001), albumin (r=0.324, p<0.001), prealbumin (r=0.260, p=0.003) and transferrin (r=0.277, p=0.001). CONCLUSIONS: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis in advanced metastatic cancer following palliative chemotherapy, but the ECOG PS is most strong correlation with the survival time.
Body Mass Index ; C-Reactive Protein ; Critical Illness ; Drug Therapy ; Humans ; L-Lactate Dehydrogenase ; Nutrition Assessment ; Nutritional Status* ; Orosomucoid ; Prealbumin ; Prognosis* ; Transferrin ; Weight Loss

Korea Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.
Anal Canal ; Biopsy* ; Climate ; Diagnosis ; Edema ; Exanthema ; Humans ; Immunoglobulin G ; Intestine, Small ; Intestines ; Korea ; Larva ; Palpation ; Parasites ; Parasitic Diseases ; Pruritus ; Serologic Tests ; Soil ; Stomach ; Strongyloides stercoralis ; Strongyloidiasis* ; Urticaria

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