Expression of Survivin in Human Colorectal Cancer Tissues

Survivin, the recently discovered apoptosis inhibitor of inhibitor of apoptosis (IAP) family is located in chromosome 17q25. It is found only in fetal tissue and transformed tissue but is never found in normal adult tissue. Several authors reported survivin expression in various cancer tissues, which suggested the role of survivin in cancer development. This study intended to find the degree of survivin expression making use of RT-PCR technology and to compare the expression pattern of survivin, caspase 3, and PARP. METHODS: The cell lines known to have survivin expression such as HL60, Daudi, THP1, and colon cancer cell lines such as COLO 201, WiDr and breast cancer cell line ZR-75-1 were used for the positive control. For the negative control, normal colon tissues were included. The total RNAs from the frozen tissue of 6 normal colon, 36 specimens of colorectal cancer, and cell lines were used in RT-PCR. The 20 paraffin embedded tissues were used in immunohistochemical study in order to find out the degree of protein expression of caspase 3 and PARP. Western blotting was conducted on same tissues for caspase 3 as usual manners. RESULTS: The survivin expression by RT-PCR techniques was found in the 22 cases (61.1%). As a result of the immunohistochemical staining, 13 cases (65%) in caspase 3, 17 cases (85%) in PARP showed reduced staining. In western blotting, 32 kDa inactive form of caspase 3 was expressed in 16 cases (80%), but the band of active split form was not found. No significant relationship was found between survivin expression and clinicopathologic data of colorectal carcinomas, and expression of caspase 3 and PARP. CONCLUSIONS: These result suggest that apoptosis mechanism is depressed in colorectal cancer tissues and survivin plays a role in the inhibition of apoptosis of colorectal cancer. More profound study could confirm the apoptosis mechanism in tumorigenesis.

Comparative Study of Anatomic and Physiologic Measurement of the Anal Sphincter in Adult Women

PURPOSE: This study has carried out to clarify the relationship between changes in the anal sphincter muscle thickness and pressure. Also, this study shows the effect of vaginal delivery and benign anal disease on the function and structure of the anal sphincter. METHODS: Women (n=42; mean age: 33.2 +/- 9.6 years old) without defecation problems or history of anal surgery, who came to Ewha Womans University Hospital between July 1999 and October 1999, were chosen. We measured the resting and the squeezing pressure with anal manometry and the thickness of the internal anal sphincter (IAS) and external anal sphincter (EAS) by endoanal sonography. RESULTS: The mean squeezing and resting pressures were 98.3 +/- 38.2 and 53.9 +/-17.4 cmH2O, and the mean EAS and IAS thicknesses were 4.9+/-0.9 and 1.9+/-0.3 mm, respectively. The thickness of the EAS and squeezing pressure did not correlate. Neither did the IAS thickness and the resting pressure. In cases with a history of vaginal delivery (n=15), the squeezing and the resting pressures were 94.0+/-43.0 and 57.1+/-22.2 cmH2O, and the thicknesses of the EAS and the IAS, 4.6+/-0.9 and 2.0+/-0.4 mm, respectively. The number of deliveries had no correlation with the thickness or the pressure of the anal sphincter. In patients with benign anal lesions (n=11), the squeezing and the resting pressure was 113.0+/-42.9 and 57.0+/-14.0 cmH2O, and the thicknesses of the EAS and the IAS were 5.0+/-1.3 and 2.1+/-0.4 mm, respectively. CONCLUSION: Our data suggest that the function and the structure of the anal sphincter are independent. In adult women, the thickness of the anal sphincter, the history of vaginal delivery, and the existence of benign anal lesions had no effect on anal sphincter function.

Chemoembolization in the Treatment of Multiple or Unresectable Hepatic Metastases from Colorectal Cancer

BACKGROUND: Hepatic artery chemoembolization represents an alternative treatment for patients of metastasis or primary hepatic malignant lesions. The aims of this study was confirm the usefulness, the complications and the survival benefits of chemoembolization for patients with colorectal carcinoma metastasis to the liver. METHODS: During 3 years, 23 patients with multiple or bulky unresectable liver metastasis from colorectal cancer were treated with chemoembolization using adriamycin, cisplatin or mitomycin with lipiodol . Repeated treatments were perform at 6- to 8-week intervals. RESULTS: Hepatic metastases were detected at the initial diagnosis of colorectal cancer in 15 patients. The metastatic lesions included 7 cases of a single bulky lesion and 16 cases of multiple lesions. A decrease of at least 25% of the baseline CEA level occurred transiently in 43% of the cases. The median survival for all 23 patients was 10 months after initiation of chemoembolization, and the 1-year survival rate was 36%. Complications were liver abscesses with cholecystitis, thrombocytopenia, and ascites. CONCLUSION: Chemoembolization is feasible treatment modality for patients with multiple or un resectable hepatic metastases from colorectal cancer.

Clinical Significance of Cyclooxygenase-2 Expression in Colorectal Adenoma and Carcinoma

PURPOSE: Interest is mounting in developing prevention strategies for patients at high risk of developing colorectal cancer. Recent epidemiological investigations indicate an inverse relationship between the intake of NSAIDs and colorectal cancer risk. Cyclooxygenase (COX) enzyme may be involved in the initiation and/or the promotion of carcinogenesis. A major action of NSAIDs is the inhibition of COX. We have studied the clinical significance of COX-2 expression in colorectal adenoma and carcinoma. METHODS: We studied 19 patients with colorectal adenomas (15 males and 4 females: ages 30~73 years) and 20 patients with colorectal carcinoma (12 males and 8 females: ages 35~80 years). COX-2 status were determined by immunohistochemical methods using the mouse monocolnal antibody for COX-2 (Transduction Lab, USA) on paraffin sections. RESULTS: Immunoreactive COX-2 were expressed in 9 patients (47%) of colorectal adenoma and 9 patients (45%) of colorectal carcinoma. 57% of villous adenoma and 42% of tubular adenoma were positive for COX-2 in colorectal adenoma (p=0.650). COX-2 were expressed in 12.5% of stage B and 73% of stage C of colorectal cancer (p=0.006). COX-2 expression did not relate with the size of adenoma and carcinoma. CONCLUSIONS: The data suggest that COX-2 may be more expressed in villous adenoma and advanced carcinoma. Therefore, enhanced expression of COX-2 may play a role in the carcinogenesis of colorectal cancer.

Management of Complicated Diverticular Disease of the Colon

BACKGROUND: Colon diverticular disease is known to be prevalent in the western population and rare in the oriental population. Nowadays, the incidence in Korea is steadily increasing, so appropriate management has become clinically important. We must decide whether the patient needs surgical management and bowel preparation, or not. We must decide when and how to do it. METHODS: We retrospectively reviewed the medical records of 53 patients who were admitted with colon diverticular disease to Ewha Womans University Hospital from September 1993 to January 1999. RESULTS: They were 35 men and 18 women. The mean age was 47 years. The patients were divide into two groups: the conservatively managed group (Group C, n=28) and the operatively managed group (Group O, n=25). The lesions were located in the right colon in 23 cases of Group C (82%) and 17 cases of Group O (62%). The barium enema was the most commonly used diagnostic tool (Group C: 78.8%; Group O: 56%). However, an abdomino-pelvic CT was a more effective diagnostic tool in emergency cases (66.7%). Recurrence (n=12) was the most common indication for an operation. Bowels were not prepared in some elective (n=5) and all emergency cases (n=6). One-stage operations were performed in 19 cases of elective operations and in three cases of emergency operations. Two-stage operations were performed in the other three cases of emergency operations. Postoperative complications were noted in six cases of elective operation, four with bowel preparation (28.5%) and two without preparation (40.0%) and in five cases of emergency operations (83%). Also we had one mortality. CONCLUSIONS: The barium enema was the most accurate and commonly used diagnostic tool. However, in emergency cases, an abdomino-pelvic CT was effective for deciding on the treatment. It seems better to do an elective operation with bowel preparation than to do an emergency operation without bowel preparation for colon diverticulitis, provided the patient's condition permits.

Comparing Bowel Cleansing Methods

BACKGROUND: Over the past several years, orthograde, peroral, and polyethylene glycol-electrolyte lavage (PEG-EL) has become the popular bowel cleansing agent before colonoscopic and surgical procedures on the colon and the rectum. Despite its proven efficacy, PEG-EL is difficult for some patients to tolerate. This has led to trials of a smaller-volume preparation (90 ml) using a sodium-phosphatebased laxative (NaP). There are reports of significant hyperphosphatemia following oral NaP and case reports of hypocalcemic tetany after NaP enemas. The purpose of this investigation was to assess 1) the changes in biochemical parameters and body weight, 2) the amount of residual stool, and 3) the side effects and patients satisfaction. METHODS: Sixty consecutive outpatients were prospectively randomized to undergo colonic cleansing with conventional PEG-LE or NaP. We analyzed the serum levels of sodium, potassium, magnesium, calcium, phosphate, BUN, albumin, and hematocrit at pre- and post-preparation. RESULTS: Serum sodium and phosphate levels increased significantly after NaP preparation. The changes of other elements were similar in both groups. The overall quality of colon cleansing and the frequency of satisfactory preparation were high in patients administered NaP. CONCLUSIONS: Preparation with NaP is a well-tolerated, efficacious alternative to conventional PEG-EL.

Significance of p53 Expression in Colorectal Cancer in Young Patients

BACKGROUND: In Korea, the incidence rate of colorectal cancer is increasing, even in patients under 40 years of age. In most young adult patients with colorectal cancer, the tumors are already in advanced stages at initiation of treatment, and they are more aggressive, so the prognosis is considered unfavorable. In addition, alteration of the p53 gene may be associated with poor prognosis for colorectal cancer. METHODS: We evaluated the p53 expression in a young adult group and an adult group with colorectal cancer who had been operated at the Department of Surgery, Doungdaemoon Hospital, Medical Center of Ewha Womans University, from 1991 to 1996. We retrospectively reviewed the medical records of a randomized sampling of patients, 17 in the young adult group under 40 years of age and 20 in the adult group over 41 years of age. Pathologic slides were prepared for immunohistochemical staining of the p53 protein. The staining results were divided into positive and negative. The chi-square test, Fisher's exact test, and student t-test were perforemd with SAS program. RESULTS: There was no difference in the sex ratio, the tumor stage, the preoperative CEA level, the size of the tumor, the location of the tumor and the histologic differentiation between the two groups (p>0.05). In the young adult group, p53 was expressed in 41% of the cases (7/17), and in the adult group, p53 was expressed in 10% of the cases (2/20); thus p53 was expressed more frequently in the young adult group (p<0.05). CONCLUSION: The p53 expression tended to be associated with age and with more aggressive colorectal cancer, p53 expression may be a useful factor in determining a poor prognosis for patients with colorectal cancer.

Transforming Growth Factor-beta1 in Sera of Patients with Colorectal Cancer

BACKGROUNDS: Transforming growth factor-beta1 (TGF-beta1) is a multifunctional polypeptide, promoting angiogenesis and accumulation of an extracellular matrix while inhibiting growth of epithelial cells and immune cells. Increased production of TGF-beta1 may be significant in the progression of cancer because it may result in an increased blood supply to the tumor mass and inhibition of immunologic mechanisms involved in tumor identification and cytolysis. However, little is known about the association of TGF-beta1 with progression of malignant disease in vivo. METHODS: Serum TGF-beta1 levels were measured in 100 patients with colorectal cancer and in 31 normal healthy volunteers used as control subjects. We used an enzyme-linked immunosorbent assay (ELISA) for the detection of serum TGF-beta1. RESULTS: The serum TGF-beta1 levels in the patients with colorectal cancer (40 9 ng/ml, n=100) were significantly higher than those in the control subjects (33 4 ng/ml, n=31)(p<0.001). The serum TGF-beta1 levels were 31 4 ng/ml in Dukes A (n=11), 38 9 ng/ml in Dukes B (n=31), 40 8 ng/ml in Dukes C (n=39), 48 8 ng/ml in Dukes D (n=19). These values, except for the Dukes B and Dukes C patients, were significantly different (p<0.01). The serum TGF-beta1 levels in patients with colorectal cancer increased with increasing tumor size (p<0.01). Simultaneous measurements of CEA and TGF-beta1 significantly increased the percentage of positive serum (72%) as compared with a single measurement. Elevations of the percentages of positive serum were revealed in Dukes A (27%), B (74%), C (72%) and D (94%). CONCLUSIONS: These results suggest that serum TGF-beta1 levels in patients with colorectal cancer may be associated with disease progression and may be of value in the management of patients with colorectal cancer.

An Angiography Study of the Colon Artery from the Superior Mesenteric Artery

Incorporation of laparoscopic techniques into the gastrointestinal surgeon's armamentarium has led to a renewal of interest in the anatomy of mesenteric arteries because hemorrhagic complications can be a major cause of conversion and/or morbidity during laparoscopic intestinal surgery. BACKGROUND: Since a colonic resection with laparoscopic techniques has become a common procedure, the limited exposure currently provided in laparoscopic intestinal resection demands a precise knowledge of mesenteric vascular anatomy to avoid such complications and to expedite the procedure. Historically, It was thought that the arterial supply to the right colon consisted of three arterial branches (middle colic artery, right colic artery, ileocolic artery) arising independently from the superior mesenteric artery (SMA). However, on recent reports and clinical observations, two colonic arteries only arising independently from the SMA are more common than three colonic arteries. METHODS: We reviewed 40 cases of angiography which focused on the SMA and it's branches. RESULTS: We found the ileocolic artery in 39 of 40 cases, the middle colic artery in 39 of 40, and the right colic artery in 19 of 40. Based on the existence of the right colic artery in our review, about half (47.5%) of the cases had a right colic artery directly arising from this SMA. CONCLUSION: This knowledge may help lower the risk of vascular complications during laparoscopic intestinal surgery.

Local Excision of Rectal Carcinoma

PURPOSE: Curative local excision of the rectal cancer had been advocated by many surgeons over the standard abdominoperineal resection (APR) for lower rectal cancer due to its low complication rate and improved quality of life. The aim of this study was to evaluate the result of the local excision for rectal cancer. METHOD: We prospectively analyzed 31 rectal cancer patients (including 2 patients of carcinoid tumor) who were suitable indication for local excision between Oct. 1993 and Dec. 1998 at Mokdong Hospital. RESULTS: The age of the patients ranged from 39 to 81 years (>60 years: 77.8%) while sex ratio was 1:5 (M:F). Of 31 patients, 29 patients were located below 4 cm from anal verge. Other two were in between 7 cm and 10 cm from the anal verge. The tumor size ranged from 0.7 cm to 5 cm, most commonly within 3 cm. Invasion depth by tumor were as follows: 12 patients in mucosa; 7 patients in submucosa; 4 patients in inner muscle layer; 6 patients in outer muscle layer; and 2 patients in whole layer. Ten patients had well-differentiated tumors and 17 patients had moderately differentiated tumors, while one patient had mucinous histologic type. Seventy percent of patients with muscular layer invasion received adjuvant radiation therapy. Six patients received oral chemotherapeutic agent and 4 received immunopotentiator. During the follow-up period (mean: 18.4 months, range: 1~54 months), no local recurrence was found in the patients who were operated under curative intent. CONCLUSION: We concluded that this method can be favorabe choice for the treatment of early rectal cancer without lymph node involvement if strict indication of the local excision for rectal cancer could be applied.

Modified Hanley's Operation in the Treatment

PURPOSE: Horseshoe type-ischiorectal fistula is originating initially from infected anal gland that connect with an anal crypt usually situated in the posterior midline of the anal canal. In the modified Hanley's operation, a prove inserted into the primary opening in directed into the posterior anal space. A straight incision from the primary opening toward the tip of the coccyx is made to unroof the posterior anal spcae and the anal portion of the fistulous tract. The secondary external fistula openings are incisied to permit better external drainage. The tracts are curratted but their entire lengths are not unroofed. This study presents the clinical features and the results obtained with modified Hanley's operation in the surgical management of horseshoe fistula. METHODS: This report is based on the clinical analysis of 22 cases of horseshoe type among 329 cases of fistula in ano, which were treated at the Department of General Surgery of Ewha Womans University Hospital from October 1993 to May 1998. RESULTS: The male to female ratio was 3.7:1 and the age was range from 19 years-old to 61 years-old. The symptom were anal discharge and pain. The previous or combined anal disease were anal abscess and hemorrhoids. The internal openings were located at the dentate line in 18 cases and anterior portion in 5 cases. Horseshoe ischorectal fistula included 17 cases of semi-horseshoe fistula and 1 case of horseshoe fistulous sinus. The spinal anesthesia and lithotomy position was used for operations. The cutting seton was applied in the 4 cases for preservation of sphincter function. The average hospital stay was 7.6 days and average wound healing time was 5.4 weeks. The postoperative complication of urinary retensio was found in the 2 cases. Recurrence, fecal incontinence, anal deformity and anal anterior diaplacement was not developed during following periods. CONCLUSIONS: We confirm that the modified Hanley's operation is a effective and conservative surgical procedure that minimizes the disadvantages of complete unroofing method & useful method for preservation of sphincter function.

Significance of Increased Expression of the Tissue Inhibitor of Matrix Metalloproteinase-2 in Human Colorectal Carcinomas

BACKGROUND : Tumor invasion and metastasis are the major causes of morbidity and death for cancer patients. Metastasis is a complex multistep process in which tumor cells must pass through supporting structures. Proteolytic degradation of the structures is an important part of this process, and matrix metalloproteinase (MMP) has been implicated. The activation and the enzymatic activity of MMP is regulated by the tissue inhibitor metalloproteinase (TIMP). Three distinct TIMP molecules have been isolated. Very little is known about the role of TIMP-2 in tumors. The purpose of this study was to examine the expression of TIMP-2 in human colorectal carcinomas. METHODS : The paraffin blocks of 33 colorectal carcinomas were recalled and immunostained with monoclonal antibodies specific for TIMP-2. The rate of stain was estimated, and the relationships between the expression and the stage, the differentiation, and the recurrence were assessed. RESULTS : The expression of TIMP-2 in tumor tissues increased with increasing Dukes's stage (p<0.05) and recurred cases (p<0.05). CONCLUSIONS : Our results suggest that increased expression of TIMP-2 may be useful as a marker of biologic aggressiveness.

Anal Manometric Assessment of Patients with Anal Diseases and Defecation Disorders

A manometric assessment of anal pressure is known to be an objective method in evaluating anorectal physiology and the function of the anal sphincter. We employed anal menometry to study the anal pressure in patients with hemorrhoids, anal fistulas, anal fissures, constipation, and fecal incontinence. This study was performed in the period from April 1994 to May 1996. The total number of patients with defecation disorder or anal disease assessed in this period at our rectal clinic by using anal manometry was 227; A control group was comprised of 10 patients with no known anal diseases or symptoms. The patient group was catergorized as follows:123 cases of hemorrhoids, 24 cases of anal fistulas, 35 cases of anal fissures, 29 cases of constipation, and 16 cases of fecal incontinence. We measured the maximal anal resting pressure (MARP) and the maximal anal squeeze pressure (MASP) in these patients as well as in the control group. We found the MARP to be higher in patients with hemorrhoids, anal fistulas, and anal fissures, compared to the control group, while the MARP was lower in the constipation group; however, these results were not statistically significant. The anal pressures of hemorrhoid patients were studied with respect to symptom, classification, past history, and the duration of symptoms. The results were as follows:The MARP was found to be increased in hemorrhoid patients with prolapse and pain and for thrombosed external hemorrhoids while it was decreased in patients with a previous hemorrhoidectomy. Furthermore, the MARP was increased in anal fissure patients when the duration of the symptom was short. In conclusion, anal manometric assessment of patients with anal diseases or defecation disorders could be valuable in determining the surgical procedure; furthermore, it could be valuable in evaluating postoperative results in fecal incontinence patients.

One Stage Operation of Colon Perforation

Colon has the highest bacterial concentration in the gastrointestinal tract. When the colon is perforated, the operator has to decide whether to perform primary closure, resection with anastomosis, proximal colostomy, and exteriorizatoion. In this retrospective study, from October, 1993, through July 1998, 56 patient with panperitonitis due to colon perforation were operated at Ewha womans University medical center. The rectal perforation was limited the intraperitoneal portion. Our cases were divided into two groups. Group I included 34 patients who treated with one step operations of primaryrepair or resection anastomosis. Group II included 22 patients who treated with two step operations of proximal colostomy or exteriorization. The one step operations were performed in 34 patients, proximal colostomy in 21 patients, and exteriorization in 1 patient. There was 13.7% in the incidence of motality and 33.3% in the incidence of morbidity. The Chi-square test was used to evaluate the significance of differences between two groups. Independent risk factors for adverse outcomes were compared and used to analyse the probability for adverse outcomes with respect to the mode of treatmen. The mode of treatment was not dependent on the risk factors. These results suggest that one could select positively primary closure or resection with anastomosis for the treatment of patients with panperitonitis due to colon perforation.

Change of Natural Killer Cell in Patients with Colorectal Carcinoma

Natural cytotoxicity mediated by natural killer (NK) cells is believed to play an important role in host anticancer defense mechanisms. The aim of this study is to compare the number of NK cells in patients with colorectal cancer and hemorrhoids, and before and after surgery in patients with colorectal cancer. Twenty colorectal cancer patients and twenty hemorrhoid ones were studied. Venous blood samples were obtained preoperatively, and on the 7th, and 14th postoperative days. Mononuclear cells were isolated over Ficoll-Hypaque gradients, and T cells, B cells, and NK cells were measured with CD3 FITC (T cell), CD 19 PE (B cell), and CD56 FITC (NK cell) antibody, The number of T cell (/mm3) was 1224, 1280, and 1125 at preoperative, 7th, and 14th postoperative day in hemorrhoid patients and 1195, 901, and 1060 in colorectal cancer patients respectively. The number of B cell (/mm3) was 243, 160, and 250 in hemorrhoid patients and 147, 78, and 113 in colorectal cancer patients. The number NK cell (/mm3) was 148, 156, and 143 in hemorrhoid patients and 129, 85, and 128 in colorectal cancer patients. There was no difference among Dukes stages in the number of NK cells. In conclusion, the number of NK cells was not changed in colorectal cancer patients compared with hemorrhoid ones. Major operation changed the number of NK cells in colorectal cancer patients.

Simultaneous Elevation of Epidermal Growth Factor Receptor and Transforming Growth Factor - alpha in the Serum of Colorectal Cancer Patients / 대한암학회지

No abstract available.

Nonoperative Management of Blunt Abdominal Trauma with Hemoperitoneum

Because of the two merits of nonoperative management of blunt abdominal trauma, 1) avoidance of operative morbidity and 2) better treatment of associated injuries, the use of nonoperative management has been extended, but the indications for such treatment have not been sufficiently found. One hundred two(102) cases admitted due to hemoperitoneum, 44 involving surgery and 58 conservative managment, were analyzed for age, sex, cause of injury, injured organ, injury grade, transfusion amount, and shock on admission. The major causes of injury in the nonoperative and the operative groups are as follows : 23 cases of auto-pedestrian accidents and 15 cases of in-car accidents in the nonoperative group and 19 cases of auto-pedestrian accidents in the operative group. In terms of the injured organ, liver trauma was the most frequent, and spleen trauma was next. The difference in the transfusion amount between the two groups was statistically significant; 8.1 units in the nonoperative group and 13 units in the operative group. In conclusion, 1) nonoperative management can be considered as a first choice in children with blunt abdominal trauma and stable vital signs; 2) patients with hemodynamically stable liver injury with AAST OIS grade 4 and isolated splenic injury AAST OIS grade 4 are candidates for nonoperative management; and 3) nonoperative management through emergency care without transfusion can be considered in cases with stable vital signs.

Double Primary Cancer Patient with Sigmoid Colon Adenocarcinoma and Anal Squamous Cell Carcinoma with Rectal Mucosal Metastasis A case report

Synchronous neoplams are uncommon condition but the incidence is now being increased. The situation is rare when these tumors comes from different origin. We experienced the case with synchronous sigmoid colon cancer and anal squamous cell carcinoma with rectal mucosal metastasis. The patient was 61 years old male. He complained of intermittent hematochezia since 3~4 months ago. The patient underwent anterior resection for colon cancer and wide excision for anal squamous cell carcinoma. After surgical operation, postoperative adjuvant chemotherapy (5-FU + Leucovorin) and radiotherapy were done. In this case, we could preserve the anal sphincter using combined therapy. We think that this type of management may be useful treatment in patients with colon cancer and anal squamous cell cancer simultaneously.

Changes in Anal Pressure According to Age and Gender in Hemorrhoids and Anal Fissures

Hemorrhoid and anal fissure are common diseases in Korea. It has been demonstrated that patients with hemorrhoidal disease have increased activity of the internal anal sphincter. The fissure causes increased contraction in the internal anal sphincter, thereby increasing pressure in the anal canal. Many studies have reported differences in the anal canal pressures between males and females. Moreover, some papers have shown that sphincter pressures decrease with age. But the majority of these studies were not specific for the hemorrhoid and anal fissure. Therefore, we studied the effect of age and gender on anal pressure in hemorrhoid and anal fissure. Two hundred ninety six patients with hemorrhoid and sixty eight patients with anal fissure were retrospectively assessed. Anorectal manometry using a radial eight-port catheter was performed during resting and squeezing maneuvers of the anal sphincter. In hemorrhoid reduction in maximal average resting(MARP) and squeezing pressure(MASP) were found from the sixth decade, however in anal fissure reduction in MARP and MASP were found in the third decade. In hemorrhoid significant decrease of MARP and MASP were noted in entire ages of female, however in anal fissure increase of MARP and MASP were noted in fifth and sixth decade of female. In conclusion, in hemorrhoid both resting and squeezing pressure decrease with age in female. In anal fissure both resting and squeezing pressure decrease in third decade and in male with fifth and sixth decade.

Predicting Lymph Node Metastasis in Patients with Advanced Rectal Cancer: A Prospective Study for the Characteristics of Lymph Node Metastasis of Mesorectum and Extra-Mesorectum

It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.