Moon Kwan Chung

Complete single-stage management of left colon cancer obstruction with a new device

BackgroundA newly developed device that enables easy intraoperative colonic irrigation and subsequent colonoscopy was introduced recently.MethodsTo evaluate the efficacy of the single-stage procedure with a new device and the significance of on-table colonoscopy, 112 patients with obstructive left colon cancer were recruited.ResultsPrimary anastomosis after tumor resection was performed in 104 cases. The volume of saline used for irrigation averaged 13.5 l over 12.1 min. Subsequent colonoscopic examination added an average of 10.4 min to the operative time. There were three anastomotic leaks, two wound infections, four acute renal failures, and two operative mortalities. On-table colonoscopy resulted in extended resection in 17 cases.ConclusionsThe new device enabled safe, simple, and time-saving, single-stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment and recognition of synchronous bowel pathology.

Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study

Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young-Ho Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung-Jae Myung, Jeong-Sik Byeon, Moon Sung Lee, Il Kwon Jung, Sung-Ae Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: Although advanced adenomatous polyp is an ideal target of colorectal cancer screening, isolated proximal neoplasia without distal pathology would have been missed on a flexible sigmoidoscopy, an effective colorectal cancer screening technique. The aim of the study is to identify predictors of isolated advanced proximal neoplasia of colon. Methods: Data were prospectively collected from the 17,200 patients who presented for colonoscopy in 12 tertiary endoscopic centers. Information gathered included demographic characteristics including body mass index (BMI), endoscopic findings, histology, drug history of aspirin/ NSAID, and known risk factors for colorectal neoplasia. We compared the patients with isolated proximal advanced neoplasia with the patients without colon neoplasia. We defined advanced neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, or adenomas more than 11 mm. Results: Isolated advanced proximal neoplasia was found in 371 (2.2%) patients, and 6234 (36.2%) patients as a control group had no colon neoplasia. While patients older than 65 year had a risk for isolated advanced proximal neoplasia (OR Z 1.38: 95% CI Z 1.07-1.78; p Z 0.015), male gender, obesity (BMI; O27), those who took a daily aspirin or NSAID, and a family history of colorectal cancer were not associated with an increased risk of isolated advanced proximal neoplasia. Conclusion: Because age greater than 65 year increased the risk of finding isolated proximal advanced neoplasia, colonoscopy rather than flexible sigmoidoscopy should be the first consideration as a colorectal screening in the older population.

Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study

Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study Jung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, IL Kwon Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: The current practice of removing adenomatous polyp is based on the belief that this will prevent colorectal cancer. Clinicopathologic charateristics of colon adenomas in the population before the age of 50 is uncertain. Methods: A prospective study was conducted from July 2003 to June 2004. Of the total 17,200 patients performed colonoscopy at 12 tertiary medical centers, the case group was composed of 7,913 patients younger than 50. Colonoscopic polypectomy for adenoma was done in 5,845 patients including 3,051 younger patients. Advanced colorectal adenoma was defined as an adenoma that was 11 mm or more in diameter, a villous adenoma, an adenoma with high grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, the classification was based on the most advanced lesion. We compared their characteristics of adenoma and colonoscopic indications as clinical risk factors for adenoma according to the age. Results: In patients before the age of 50, the most common indication of colonoscopy was asymptomatic screening (32.6%), and another major indications were bowel habit change (23.9%), positive stool occult blood or hematochezia (9.1%), referred cases from primary clinic (3.7%), iron deficiency anemia (2.9%) and surveillance for inflammatory bowel disease (IBD) (1.3%). The proportion of adenoma removed by colonoscopic polypectomy was 38.6% (3,051/7,913) in younger patients and 30.1% (2,794/9,287) in older patients (p ! 0.0001), while the detection rate of advanced adenoma was significantly lower in younger patients than older patients (3.7% vs. 7.2%, p ! 0.0001). The distribution of adenoma was shifted to the right colon (p Z 0.016) with ageing. The risk factors for advanced adenoma as colonoscopic indications in younger population were surveillance for IBD (OR 3.17, 95% CI 1.68-5.60) and referred cases from primary clinic (OR 1.66, 95% CI 1.03-2.58). Conclusion: This study documents colon polyp requiring polypectomy in younger patients has a characteristic of higher proportion of adenoma than in older patients, despite of the lower detection rate of advanced adenoma. Also, in this younger population, the colonoscopic polypectomy should be the first consideration in polyps with IBD patients or referred patients from primary clinic. W1114 Men with Prostate Cancer Are Predisposed to Colon Cancer: Half a Million US Veterans’ Case Control Study Vikas Khurana, Hanmanth R. Bejjanki, Jeffrey A. Goldstein, Gloria Caldito, Charlton Fort, Ruby Kochhar Background: Prostate and colorectal cancers share some common risk factors including age, family history and a diet high in fat. For both cancers the screening for general population starts at age 50. Several studies were done to evaluate the association between them, however the results have been conflicting and inconclusive. Aim: To study the association between prostate and colorectal cancers and to evaluate the effect of prostate cancer diagnosis on the risk for colorectal cancer. Design: VISN 16 data warehouse, which contains clinical and demographic information about all veterans (O1.4 million patients) cared for at the 10 VA Medical Centers in 4 states comprising the South Central VA health Care Network in the mid-south region of the US, was queried from Oct 1998 to June 2004. Patients with prostate cancer were identified using ICD-9 (185) codes and patients with colorectal cancers were identified using ICD-9 (153 & 154) codes. Retrospective case control design was used. Multiple logistic regression analysis was used with calculation of odds ratios and 95% confidence intervals were used universally. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL). Results: We analyzed 443,774 male patients from our database. The mean age of the selected group was 62.5(S.D. G 14.5). There were 26,087 (5.88%) prostate cancer and 5423 (1.22%) colorectal cancer patients in the study group. There was a significant increase in the incidence of colon cancer in patients diagnosed with prostate cancer compared to patients without prostate cancer (Odds Ratio 1.79, 95% CI 1.65 to 1.93 p-value ! 0.0001) after the data was controlled for the above covariates. Discussion: The increased incidence of colon cancer in patients with prostate cancers may be due to several risk factors that are common to both prostate and colon cancers. The data should be evaluated with caution given the limitations of the population, the database and the design of the study. Some factors known to increase the risk of colorectal cancers like family history, diet and inflammatory bowel disease were not incorporated into the study. Conclusion: Our data suggest that prostate cancer is a significant risk factor for colorectal cancer. Patients with prostate cancer may be considered for more aggressive screening for colorectal cancer.

The Role of Intraoperative Colonoscopy in Patients with Left Side Colon Cancer Obstruction

Background/Aims: The aim of this study was to evaluate the role of an intraoperative colonoscopy for a single stage operation in patients with a left-side colon cancer obstruction. Met hods: From September 1999 to August 2002, 62 patients (mean age=6114 year old, M : F=30 : 32) underwent an intraoperative colonoscopy during a single stage operation for a left side colon cancer. Intraoperative colonic irrigation method and colonoscopy with NICI (new intraoperative colonic irrigator, MITech Co., Ltd, Seoul, Korea) were used. Results: The locations of the left-side colon cancers were the rectum in 33 (53.2%), sigmoid colon in 20(32.3%), and descending colon in 9 (14.5%). Synchronous polyps were found in 31 patients (50%). Six patients (9.7%) had a synchronous colon cancer and 2 (3.2%) had a high grade dysplasia. Of these 62 patients, 11 (17.7%) required more extensive surgery than dictated by the primary tumor. Altered operative methods were a total colectomy in 2patients, an extended resection in 8 patients, and a wedge resection in 1 patient. Conclusions: An intraoperative colonoscopy in patients with a left-side colon cancer is a useful adjunct in diagnosing a synchronous lesions, which should allow a more appropriate surgical procedure.

A Case of Acute Intermittent Porphyria: A case report

We report a case of acute intermittent porphyria presenting with variable symptoms and signs such as hypertention, polyneuropathy, syndrome of inappropriate secretion of antidiuretic hormone and cerebral infarction. A 47 year-old female patient entered hospital with abdominal pain followed by generalized seizure. She was diagnosed to have acute intermittent porphyria in consequence of Watson-Schwartz test and -ALA in 24 hours urine, but died of respiratory failure.

An Outbreak of Tsutsugamushi Disease in Vicinity of Taegu City and Kyungpook Province in 1988

Since the first cases of tsutsugamushi disease reported in Korea in 1986. many cases has been reported and its occurrence has been increasing. Only 2 cases has been reported in Taegu city and Kyungpook area. We experienced an outbreak of 26 cases of tsutsugamushi disease in this area and their clinical manifestations are ; 1. The outbreak occurred in September to November in 1988 and its peak occurrence was in October. 2. Mean age was 52 years old (18 to 69 years old) and peak incidence was in the 6th decade. 3. Major symptoms and abnormal signs are fever/chills(88%), myalgia(65%), headache(54%), nausea and vomiting(31%), and abdominal pain(27%). The eschar was detected on lower part of body in most of cases. and more frequently in male(M : F 100 vs 58%). 4. Patients were treated with tetracyclines(TC) and/or chlorampenicol(CM) and mean duration of defervescence from initiation of antibiotic therapy was 2.1 days with TC and 2.5 days with CM. 5. Complications are 2 cases of meningitis and 1 cases of shock. and all cases were recovered without any sequlae. As above, tsutsugamushi disease occurs in Taegu city and Kyung Pook area as other part of Korea and clinical manifestations are similar to other reports.

Eaton-Lambert Syndrome with Small Cell Lung Cancer: A case report

Eaton Lambert Syndrome(ELS)is a disorder of neuromuscular transmission. The defect of neuromuscular transmission is due to decrease in the release of acetylcholine guanta from nerve terminal. This syndrome is frequently associated with bronchogenic carcinoma. The diagnosis is established by electromyography, which characteristically shows 1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, 2) significant decremental response at low rates of stimulation 3) marked incremental response at high rates of stimulation. Our patient is 52year old man with dyspnea, coughing and muscle weakness of proximal lower limbs. He has small cell lung cancer and associated with ELS, Superior venacava syndrome and has metastatic lesion on right supraclavicular lymphnode confirmed by pathology. Metastatic mass and SVC syndrome are marked improved following chemotherapy and radiotherapy, however follow up EMG finding does not improved. We are here reporting one case which considered compatible for ELS, with a few elementary reviewed literatures.