Hyun Shig Kim

Familial occurrence of inflammatory bowel disease in Korea

Background Little information is available about the familial aggregation of inflammatory bowel disease (IBD) in Asian populations. We therefore determined the risk of familial aggregation of IBD among first‐degree relatives of patients with ulcerative colitis (UC) or Crohns disease (CD) in an ethnically distinct Korean population. Methods Familial aggregation of IBD was evaluated in terms of family history, prevalence, lifetime risk, and population relative risk in first‐degree relatives of 1440 unrelated patients with UC (n = 1043) or CD (n = 397). Results A positive first‐degree family history of IBD was observed in 27 probands (1.88%): 21 of 1043 (2.01%) with UC and 6 of 397 (1.51%) with CD. The crude prevalence of IBD in first‐degree relatives of probands with IBD was 0.31%. The lifetime risk of IBD was 0.54% in all first‐degree relatives of IBD probands, 0.52% in UC probands, and 0.67% in CD probands, with overall lifetime relative risks of 0.12% in parents, 0.79% in siblings, and 1.43% in offspring. The age‐ and sex‐adjusted population relative risk of IBD was 13.8 in first‐degree relatives of probands with IBD. Conclusions Although a positive family history, prevalence, and lifetime risk of IBD among first‐degree relatives of Korean IBD patients are much lower than among relatives of Western patients, the population relative risk in first‐degree relatives is about equal in Koreans and Westerners. This finding indicates that a positive family history is an important risk factor for IBD in Koreans and in Westerners.

Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemorrhoidectomy: results of a randomized, prospective, double-blind, placebo-controlled trial.

PURPOSE Glyceryl trinitrate ointment acts as a dilator of the internal anal sphincter. It has been used as a treatment modality that replaces the lateral sphincterotomy in chronic anal fissures. When glyceryl trinitrate ointment is applied to the wound from a hemorrhoidectomy, it is thought that it will shorten the healing time and decrease postoperative pain. Our study focused on the efficacy of using 0.2 percent glyceryl trinitrate ointment to shorten the healing time after a hemorrhoidectomy. METHODS A randomized, prospective, double-blind, and placebo-controlled study was designed. The power test indicated that 55 patients should be in each group to give a 90 percent chance of finding a 30 percent difference in healing time. The selection criteria for inclusion in this study were patients with third-degree or fourth-degree hemorrhoids and patients undergoing hemorrhoidectomies for three or more piles. From November 2000 to July 2001, the first 110 patients to meet our criteria were selected, 55 in the nitroglycerin group and 55 in the placebo group. The same physician performed all of the hemorrhoidectomies, and intravenous patient-controlled analgesia was not used. Cases involving other procedures for fissures or fistulas were excluded. The patients randomly received glyceryl trinitrate and placebo ointments from the pharmacologist. The pain score was checked using a visual analog scale (minimum = 0, maximum = 10) during the hospital stay, and complete wound healing was checked at three weeks after the operation. Demands for analgesics and the frequency of postoperative complications were recorded. RESULTS When the trial was completed, 49 patients remained in the nitroglycerin group and 53 patients in the placebo group. No significant differences in the gender and the age distributions, the number of excised piles, the time for the procedures, the length of hospital stay, and the consumed amounts of analgesics existed between the two groups. The pain score in the nitroglycerin group showed a significant difference with the repeated measures analysis (P < 0.001). The wound healing rates at three weeks postoperative were 74.5 percent in the nitroglycerin group and 42 percent in the placebo group (P = 0.002). There was no significant increase in complications in the nitroglycerin group. CONCLUSION More rapid healing of hemorrhoidectomy wounds without any specific complications was effected by 0.2 percent glyceryl trinitrate ointment.

Effect of 0.2 Percent Glyceryl Trinitrate Ointment on Wound Healing After a Hemorrhoidectomy

AbstractPURPOSE: Glyceryl trinitrate ointment acts as a dilator of the internal anal sphincter. It has been used as a treatment modality that replaces the lateral sphincterotomy in chronic anal fissures. When glyceryl trinitrate ointment is applied to the wound from a hemorrhoidectomy, it is thought that it will shorten the healing time and decrease postoperative pain. Our study focused on the efficacy of using 0.2 percent glyceryl trinitrate ointment to shorten the healing time after a hemorrhoidectomy. METHODS: A randomized, prospective, double-blind, and placebo-controlled study was designed. The power test indicated that 55 patients should be in each group to give a 90 percent chance of finding a 30 percent difference in healing time. The selection criteria for inclusion in this study were patients with third-degree or fourth-degree hemorrhoids and patients undergoing hemorrhoidectomies for three or more piles. From November 2000 to July 2001, the first 110 patients to meet our criteria were selected, 55 in the nitroglycerin group and 55 in the placebo group. The same physician performed all of the hemorrhoidectomies, and intravenous patient-controlled analgesia was not used. Cases involving other procedures for fissures or fistulas were excluded. The patients randomly received glyceryl trinitrate and placebo ointments from the pharmacologist. The pain score was checked using a visual analog scale (minimum = 0, maximum = 10) during the hospital stay, and complete wound healing was checked at three weeks after the operation. Demands for analgesics and the frequency of postoperative complications were recorded. RESULTS: When the trial was completed, 49 patients remained in the nitroglycerin group and 53 patients in the placebo group. No significant differences in the gender and the age distributions, the number of excised piles, the time for the procedures, the length of hospital stay, and the consumed amounts of analgesics existed between the two groups. The pain score in the nitroglycerin group showed a significant difference with the repeated measures analysis (P < 0.001). The wound healing rates at three weeks postoperative were 74.5 percent in the nitroglycerin group and 42 percent in the placebo group (P = 0.002). There was no significant increase in complications in the nitroglycerin group. CONCLUSION: More rapid healing of hemorrhoidectomy wounds without any specific complications was effected by 0.2 percent glyceryl trinitrate ointment.

Depressed-type submucosal colon cancer: report of a case.

AbstractPURPOSE: The article presents one of very few Korean reports on the detection of depressed early colorectal cancers, which have been cited by some Japanese doctors as another pathway for the development of colon cancers. Depressed-type early colorectal cancers have mainly been reported in Japan, and recently a few have also been reported in Western countries. Depressed early colorectal cancers are still rarely detected in Korea, where most colorectal surgeons, endoscopists, and radiologists refer to Western guidelines. METHODS: Recently, the authors experienced a typical 12-mm depressed-type early colon cancer in the ascending colon of a 55-year-old Korean male patient. It was detected by a colonoscopic examination. RESULTS: The lesion was flexible on insufflation and deflation with air and was considered an early colon cancer. Because of the large size, a surgical resection was performed. The final pathologic result was a minimally invasive submucosal cancer without lymph node metastasis. CONCLUSION: This Korean case is one of very few reported abroad, so we think that it might make an important contribution to research on depressed-type early colorectal cancer.

Frustration still exists.

See Article on Page 222-227 The history of colonoscopy could be the history of bowel preparation. In fact, the evolution of bowel preparation is much longer than the history of colonoscopy. Bowel preparation was also inevitable in the era of radiological colon study. Along with the progress in colonoscopy, various studies of bowel preparation have been done. The main emphases of those bowel-cleansing studies were drugs or regimens and administration methods. A single agent or combined regimens have been tried in various ways. In fact, the agents are not as diverse as the colonoscopic procedures. An unavoidable limitation of drugs or agents is that must they do no harm to the human body and be sufficiently effective [1]. This article addresses the single and the combined use of a polyethylene glycol solution and a sodium picosulfate with magnesium citrate solution. The authors reported good results for the sodium picosulfate/magnesium citrate solution, even for its single use [2]. Sodium picosulfate with magnesium citrate is not a novel agent and has already been reported to be an efficient precolonoscopy bowel-preparation agent [3]. However, the study is still worthwhile because the importance of bowel preparation cannot be underestimated in any practical colonoscopies. In other words, bowel cleansing is the basic procedure for successful colonoscopic diagnosis and treatment. Many patients used to say that the colonoscopy itself was bearable, but the process of bowel preparation was a real pain. That was reality! Bowel cleansing is time consuming, uncomfortable and stressful. As a matter of fact, despite the existence of various bowel-cleansing methods, we still experience frustrating situations for patients and even for doctors. Accordingly studies should be continued. Although the efficacies of the drugs and of the administration methods are the key points, practical points, such as the planned timetable and schedules, could be obstacles to bowel cleansing. In short, frustration still exists in bowel preparation. A tailored approach could be helpful. Patience and sincerity are needed for colonoscopists, assisting staff members and patients themselves. The basic principle is important and still remains as an issue.