Kazunari Akagi

Rectal burn caused by hot-water coffee enema.

A 29-year-old woman underwent a coffee enema with hot water to treat constipation. She quickly evacuated it because of lower abdominal pain; however, she developed chills and proctorrhagia a few hours afterward. The following day, she was referred to our hospital complaining of severe anal pain and hematochezia. Proctoscopy showed black necrotic mucosa and severe erosions of the lower rectum (A). The patient refused to be hospitalized and thus was cared for in the outpatient department. She was instructed to maintain a liquid diet and take a betamethasone suppository daily. Hematochezia continued until the second day of observation, after which bowel movements became normal; pain upon defecation continued. Although there was mild stenosis of the lower rectum induced by the circumferential ulcer and edema (B), the patient had a normal bowel movement and was taking a regular diet by the seventh day of observation. On the fifteenth clinical day, endoscopy showed improvement of the rectal erythema and stenosis (C). Anal pain disappeared on the twenty-ninth clinical day. The patient recovered without

Changes in Bowel Function following Transanal and Transvaginal Rectocele Repair

Aim: This study was designed to compare preoperative and postoperative bowel functions in patients with rectocele repair. Methods: Patients who underwent surgery for rectocele between October 1988 and October 2004 were enrolled. Prior to surgery, the patients were asked to complete a questionnaire regarding evacuation difficulty, itching, fecal incontinence, and the need for digitation. Surgery was performed either transanally (group I) or transvaginally (group II). At follow-up after 12 months, the same questionnaire was obtained in the outpatient clinic or by mail to evaluate preoperative and postoperative changes in bowel function. Results: There were 71 patients in group I and 40 patients in group II. The median age was 56 years in group I and 67 years in group II. The evacuation difficulty was significantly improved in both group I (p < 0.001) and group II (p < 0.001). Incontinence to flatus was slightly increased in group I (p = 0.33) and group II (p = 0.6). Incontinence to solid stool was not statistically different in either group. The need for digitation was markedly improved in group I (p < 0.001) and group II (p = 0.0017). Conclusion: Although surgery for rectocele potentially increases the risk of fecal incontinence, it may be indicated if presented with evacuation difficulty necessitating digitation.

Lymphoepithelioma-Like Carcinoma of the Colon

A 70-year-old female underwent follow-up colonoscopy after colonic polypectomy. The colonoscopy revealed the presence of a 7-mm submucosal tumor in the sigmoid colon. The tumor surface was smooth and covered with normal mucosa. It was diagnosed as a submucosal tumor, and polypectomy was performed. Histopathological examination of the resected specimen revealed moderately to poorly differentiated adenocarcinoma measuring 2 × 5 × 3 mm with marked peritumoral lymphocytic infiltration and lymphoid follicle formation. It was diagnosed as carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma), SM (1,800 μm), ly2, v0, budding; grade 1. We confirmed the indication for noncurative additional surgical resection and performed laparoscopic sigmoid colectomy. No metastases were observed in the dissected lymph nodes.

Consensus Statement on Mandatory Registration of Clinical Trials

ventions and research hypotheses, and basic methodology [2, 4] . The SJEG member journals will require registration of all prospective clinical trials as of July 1, 2007. Trials that begin after July 1, 2007 must register before enrollment of the first study subject, and trials that began before the deadline must register prior to editorial review. Submitted manuscripts must include the unique registration number in the abstract as evidence of registration. Authors submitting manuscripts reporting on unregistered clinical trials may request consideration of their papers if they can provide sufficient evidence of merit, although we anticipate that all clinical trials will be registered after July 1, 2007. The member journals of the Surgery Journal Editors Group (SJEG), in keeping with their commitment to high ethical standards and integrity in surgical publishing and surgical science, agree to adopt the position of the International Committee of Medical Journal Editors (ICMJE) [1, 2] requiring mandatory registration of all clinical trials, whether publicly-funded or commercially-sponsored, as a condition of consideration for publication. Additionally, the SJEG will require registration of Phase I and Phase II trials. Specifically, the SJEG supports the idea of promoting a publicly accessible clinical trial database as suggested by the World Health Organization (WHO) International Clinical Trials Registry Platform established in August 2005, which specifies 20 key study data reporting requirements [2] . The goal of the WHO initiative and this SJEG requirement, based on the ICMJE statement, is to promote transparency and honesty in reporting prospective clinical trial conduct and results (including negative results), to foster public trust, and to ensure that researchers behave in an ethically responsible manner toward patients and study participants [3] . The SJEG member journals will require all clinical trials that prospectively assign human subjects to medical interventions, comparison groups, or control groups for the purpose of examining the potential health effects of such interventions, to be registered in one of several free, publicly accessible, nonprofit electronically searchable databases such as the one administered by the National Library of Medicine (NLM), which is located at http://www.clinicaltrials.gov. The ICMJE defines medical interventions as those that include, among other things, drugs, surgical procedures, devices, behavioral treatments, and process-of-care changes [2] . The required minimal registration data set includes a unique trial number established by the registry, funding source(s), primary researcher and public contact person, ethics committee approval, trial recruitment information, interPublished online: March 27, 2007