Determinant of anal resting pressure gradient in association with continence function.

BACKGROUND/AIMS: Gradient of resting pressure across the anal canal, which is known to have a role in continence mechanism, has 2 components of determination; pressure and length factor of the anal canal. This study evaluates which factor between them plays more significant role for the determination of the gradient in association with continence function. METHODS: Anal manometric measurements of 69 patients with fecal incontinence and 60 controls were retrospectively reviewed. In addition to resting pressure gradient, typical manometric parameters such as maximum resting pressure, basal resting pressure, length of the anal canal, length of high pressure zone and relative position of highest pressure, which were measured with rapid pull-through technique were all contrasted. RESULTS: Demographics of the 2 groups were similar. Maximum resting pressures of patients with incontinence and controls were 59.1 ± 28.3, 74.6 ± 24.0 mmHg (P = 0.001), respectively. Basal resting pressures were 5.7 ± 6.4 and 7.3 ± 3.9 mmHg (P = 0.097), lengths of the anal canal were 35.8 ± 9.1 and 38.1 ± 8.3 mm (P = 0.133), lengths of high pressure zone were 21.2 ± 6.7 and 23.3 ± 6.5 mm (P = 0.091), relative positions of highest pressure were 69.2 ± 10.6 and 70.1% ± 14.9% (P = 0.717) and resting pressure gradients were 2.28 ± 1.08 and 2.74 ± 1.14 mmHg/mm (P = 0.019), respectively. Difference was significant in maximum resting pressure and resting pressure gradient, but not in length factors such as full length of the anal canal, length of high pressure zone and relative position of highest pressure. CONCLUSIONS: Proximal location of high pressure zone in incontinent patients is not definite and resting pressure gradient of the anal canal depends more on pressure factor than length factor in association with continence function.

[Gene expression profiling using oligonucleotide microarray in atrophic gastritis and intestinal metaplasia].

BACKGROUND/AIMS: The atrophic gastritis with intestinal metaplasia of gastric mucosa has been considered to be the major factor of carcinogenesis in the stomach. However, the key molecules are still poorly understood. To elucidate the molecular genetic basis, we report the results of our initial microarray data to analyze the genome pattern in patients with atrophic gastritis and intestinal metaplasia of the stomach. METHODS: We used oligonucleotide microarray technique to evaluate the gene expression profiles in atrophic gastritis with intestinal metaplasia, in comparison with those of normal mucosa. For the identification of differentially expressed genes, Significance Analysis of Microarrays (SAM) package method was used. The results were analyzed using global normalization, intensity dependent normalization, and box plot normalization. RESULTS: Eight genes including FABP, REG, OR6C1, MEP1, SLC6A1, SI, Mucin 1, and RAB23 in mucosa of atrophic gastritis and intestinal metaplasia were up-regulated by more than 10 times as compared with normal gastric mucosa. Only one gene, LOC44119 was down-regulated by more than 10 times of the expression as compared with normal gastric mucosa. In respect to the expression of known genes related to gastric carcinogenesis, 8 genes including FN1, SRMS, TP53, TP53IMP2, TP53I3, FGFR4, TGFB1, and TGFA showed up- and down-regulations more than 2 folds in expression pattern. CONCLUSIONS: We could identify a total genome pattern in patient with atrophic gastritis and intestinal metaplasia using oligonucleotide microarray. We believe that the current results will serve as a fundamental bioinformative basis for clinical applications in diagnosis and treatment of gastric cancer and precancerous lesion in the future.

Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer.

BACKGROUND AND AIMS: Recently there has been growing acceptance of the one-stage resection and primary anastomosis with intraoperative antegrade irrigation. This study evaluated the efficacy of a newly developed device for performing a single-stage procedure in patients with obstructing left-sided colon cancer. PATIENTS AND METHODS: A series of 151 consecutive patients with obstructing left-sided colonic cancer underwent on-table irrigation, resection, and primary anastomosis with the use of a newly developed device; 75 patients on-table colonoscopy. The study spanned a 3 years from September 1999 to August 2002. The observed variables were the volume of irrigated saline, time for irrigation and colonoscopic examination, synchronous pathology, operative mortality and morbidity, time to passage of flatus, restarting day of oral intake, and length of hospital stay. RESULTS: The mean volume of irrigated saline was a mean of 12.5 l (range 1-32) over a mean of 14.2 min (range 1-45). Subsequent colonoscopic examination added a mean of 10.7 min (range 3-15). The incidence of synchronous polyps was 47% (35 of 75 cases) in performing the on-table colonoscopic investigations. On-table colonoscopy induced surgeons to extend resection because of synchronous malignancy attested by frozen biopsy specimen in ten patients and because of mucosal necrosis of the proximal colon in three. There were two anastomotic leakages, six wound infections, and one operative mortality. The time to passage of flatus was an average of 3.6 days (range 1.0-7). The time to oral intake was an average of 4.3 days (range 3-8). The length of hospital stay was 11.7 days (range 6-43). CONCLUSION: These findings suggest that our device is an effective tool to facilitate acceptance of the one-stage procedure in patients with obstructing left-sided colonic cancer. Specifically, our device enables quick and easy on-table colonoscopy.