Shu-Wen Jao

Effect of germanium on 1,2-dimethylhydrazine-induced intestinal cancer in rats.

Through recent research, the trace element, germanium, was found to have an anticancer effect. The purpose of this research was to determine the effect of germanium on 1, 2-dimethylhydrazine-induced intestinal cancer in rats. Ninety-six 8-week-old Sprague-Dawley male rats were divided into 4 groups, with 24 rats in each group. All received dimethylhydrazine, 20 mg/kg body weight, subcutaneously, once a week for 20 weeks. Except for one control group, the other three groups were subdivided into six groups and administered three different kinds of germanium (inorganic germanium, organic germanium, and natural organic germanium) one month before and during dimethylhydrazine treatment, and during dimethylhydrazine treatment, respectively. Twenty-four weeks after carcinogen exposure, all surviving animals were sacrificed and examined for intestinal tumors. The number and location of the tumors were recorded and the pathology examined. The incidence of intestinal cancer in the control group (dimethylhydrazine only) was 91 percent; in groups provided with inorganic germanium one month before and during dimethylhydrazine treatment, and during dimethylhydrazine treatment only, it was 91 and 78 percent; in groups provided with organic germanium one month before and during dimethylhydrazine treatment, and during dimethylhydrazine treatment only, it was 64 and 64 percent; in groups provided with natural organic germanium one month before and during dimethylhydrazine treatment and during dimethylhydrazine treatment only, it was 50 and 45 percent. From these results, the authors conclude that natural organic germanium has the best prevention effect for intestinal cancer in this animal model (P<0.01), followed by organic germanium (P<0.05). Inorganic germanium has no effect. However, there is no difference in the cancer prevention effect of germanium provided one month before and during dimethylhydrazine treatment, and during dimethylhydrazine treatment only.

NECROTIZING FASCIITIS DUE TO ACUTE PERFORATED APPENDICITIS: CASE REPORT

Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in treatment increases the likelihood of complications such as perforation, which is associated with an increase in morbidity and mortality rates. We herein present the case of a 76-year-old woman presenting with necrotizing fasciitis of the abdominal wall and right flank regions due to a perforated appendix. Such complication is extremely rare but life-threatening. It may be confused with cellulitis, causing a delay in aggressive treatment. This case represents an unusual complication of a common disease. Also, acute appendicitis or intra-abdominal pathologies should be taken into consideration in determining the cause of necrotizing fasciitis presenting over abdominal, flank, or perineal regions.

Rare rectal mucocele mimic tumor following hemorrhoidectomy in an adult patient

Mucoceles are commonly associated with the appendix and cranial sinuses. Rectal mucoceles are rare. There are case reports of rectal mucoceles following Hartmann’s procedure, and secon dary to high anal sphincter tone following spinal trauma (1,2). Mucoceles have developed in defunctioned colon after pull-through surgery due to stenosis and retraction of the colonic stump (3,4). Scarring of the mucus fistula, or failure to create a mucus fistula are other described contributing factors. We report a case of small rectal mucoceles following hemorrhoidectomy which caused scarring and stricture of the anal canal.

Schwannoma of the rectum: report of a case and review of the literature.

Schwannoma is well-known as a benign tumor originating from the Schwann cells, which produce insulating myelin sheath to cover peripheral nerves. It could occur in any nerve region, typically in the extremities, spinal cord and central nervous system (1). In the literature, only few cases of rectal schwannoma have been reported (2-8). The surgical approaches, including abdominoperineal resection, transanal excision, perianal intersphincteric excision and transanal endoscopic resection were described for rectal schwannoma (2-8). In this report, we report one rare case of rectal schwannoma and review the published literatures. The surgical approaches and diagnosis are discussed.

The Use of Table Fixation Staples to Control Massive Presacral Hemorrhage : A Successful Alternative Treatment. Report of a Case

Management of presacral hemorrhage has always been a challenge for surgeons because such bleeding can rapidly destabilize a patient during pelvic surgery. Conventional hemostatic measures are often effective for arresting this type of hemorrhage, however, sometimes conventional measures make the problem worse. A number of alternative hemostatic techniques have been proposed. This case report describes a successful tamponade of presacral hemorrhage with a titanium table fixation staple and a cancellous bone graft fixed to the sacrum. The bleeding was stopped immediately and the patient recovered uneventfully. We think this is an effective alternative method for controlling massive hemorrhage from a large hole in presacral fascia.

Modified Longo’s stapled hemorrhoidopexy with additional traction sutures for the treatment of residual prolapsed piles

PurposeResidual prolapsed piles is a problem after the stapled hemorrhoidopexy, especially in large third- or fourth-degree hemorrhoids. We have developed a method using additional traction sutures along with modified Longo’s procedure to manage this problem.Materials and methodsFrom January 2005 to October 2005, 30 consecutive patients with symptomatic third- or fourth-degree hemorrhoids who underwent the modified Longo’s stapled hemorrhoidopexy with additional traction sutures in a single institution were collected. The demographics, postoperative pain score, surgical features, outcomes, and early and late complications were recorded. All patients were followed for a mean duration of 8.8 (range, 4–15) months.ResultsThirty patients (17 males) with a mean age of 45 (range, 27–63) years were identified. The mean postoperative pain score on the morning of the first postoperative day was 2.8 (range, 1–4). The mean duration of operation was 30.7 (range, 25–37) min. The mean duration of hospital stay was 2 (range, 1–3) days. The mean days for patients to resume normal work was 6.7 (range, 4–9) days. No other procedure-related complications occurred in all patients. There was no early complication except for fecal urgency found in one patient during the first postoperative days. Regarding the late complications, no residual prolapsed piles, persistent anal pain, incontinence, anal stenosis, or recurrent symptoms were found.ConclusionsOur preliminary experiences indicated that this modified procedures truly contributed to reduce the residual internal hemorrhoids and maintained the benefits of stapled hemorrhoidopexy. Randomized trial and long-term follow-up warrant to determine possible surgical and functional outcome.

A modified Ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids with skin tags.

PurposeWe describe a modification of the Ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids. This details the operative procedure and compares the results of other radical methods in patients with circumferential hemorrhoidal disease.MethodsA total of 738 patients (mean age, 43 (range, 19–83) years) were treated with our modified Ferguson method under sedative analgesia between 1989 and 2004: 576 patients had Grade III and 162 patients had Grade IV hemorrhoids, and 131 patients also had a partial lateral internal sphincterotomy to correct anal hypertonia.ResultsPostoperative bleeding occurred in 16 patients, 3 of whom required surgical hemostasis. Fecal impaction occurred in 11 patients and wound complications in 6 patients. Thirty-two patients needed bladder catheterization because of acute urinary retention. The median follow-up was 13.2 months in our outpatient department. One patient developed mild gas incontinence, five developed anal stenosis, and three had an anal fissure. Only three patients had recurrent skin tags, which did not affect their quality of life.ConclusionsOur modified Ferguson method represents a good choice for radical treatment of circumferential prolapsed hemorrhoids because it is easy to perform, has few complications, and provides satisfying results.

Postoperatively parastomal infection following emergent stoma creation for colorectal obstruction: the possible risk factors

BackgroundThe aim of the present study was to discuss the possible risk factors related to the parastomal infection after the patients received emergent stoma creation in colorectal obstruction that was caused by adenocarcinoma, diverticulitis, or a variety of other miscellaneous causes.Patients and methodsA total of 360 patients with colorectal obstruction underwent emergent stoma creation, including diversion and Hartmann’s procedure between January 1996 and January 2005. We analyze the patients’ records to document the possible risk factors associated with parastomal infection. Patients’ demographics, indication for ostomy, ostomy type/location, and risk factors were recorded. Logistic regression was used to calculate adjusted odds ratios. A p value of less than 0.05 was considered significant.ResultsTwenty patients (5.6%) with emergent stoma creation had parastomal infection. Descending colostomy had the highest incidence (6.7%) of parastomal infection, followed by transverse colostomy (6.1%) and ileostomy (3.2%). Significant predictors of parastomal infection as presented with odds ratios and 95% confidence intervals include obstruction period, obesity, operative time, serum albumin, and serum C-reactive protein (CRP). Parastomal infection is also highly associated with abdominal surgical wound infection.ConclusionWe concluded that risk factors for parastomal infection include obstruction period, obesity, operative time, serum albumin, and serum CRP. Furthermore, the abdominal surgical wound infection predispose to parastomal infection. Therefore, prolonged and specific antibiotics for results of culture should be used for patients with the above risk factors to prevent parastomal infection.

Adjuvant chemotherapy with tegafur/uracil for more than 1 year improves disease-free survival for low-risk Stage II colon cancer

Background It is uncertain whether adjuvant chemotherapy (CMT) improves survival in patients with low‐risk Stage II colon cancer. We aimed to determine the disease‐free survival (DFS) and 5‐year overall survival (OS) of low‐risk Stage II colon cancer patients treated with adjuvant tegafur/uracil (UFUR). Methods From January 2004 to December 2011, the follow‐up status of 278 low‐risk Stage II colon cancer patients who underwent surgery in a single medical center was retrospectively analyzed. These patients were divided into three groups based on whether they received adjuvant CMT with UFUR, adjuvant CMT with 5‐fluorouracil, or surgery alone. DFS and 5‐year OS curves were calculated using Kaplan–Meier survival analysis and Cox proportional hazards regression. Results In the study population, including 278 low‐risk Stage II colon cancer patients with a mean age of 68.28 ± 13.01 years, 132 (47.5%) received adjuvant CMT with UFUR, 49 (17.6%) received adjuvant CMT with 5‐fluorouracil, and 97 (34.9%) underwent radical surgery alone. At 5 years, the adjusted DFS and OS of low‐risk Stage II colon cancer patients were 85.5% and 81.8%, respectively, in the surgery alone group and 97.9% and 96.2%, respectively, in the surgery plus UFUR > 12 months group (p = 0.004 and p = 0.098, respectively). In multivariate analysis, CMT with UFUR for more than 12 months increased DFS over surgery alone. There was no statistical difference in the 5‐year OS. Conclusion Adjuvant CMT treatment of low‐risk Stage II colon cancer patients with UFUR for more than 12 months following surgery improves DFS over surgery alone.

Two-stage resection for malignant colonic obstructions: The timing of early resection and possible predictive factors

AIM To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction. METHODS Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008. Patients were classified into two groups (n = 19 each): early radical resection (interval ≤ 10 d) and late radical resection (interval > 10 d). Baseline demographics, post-diversion outcome, perioperative data, tumor characteristics, outcome and complications were analyzed. RESULTS The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group (P < 0.001) and more obstruction days in the late group (P = 0.009). The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d, respectively (P < 0.001). After diversion, the presence of bowel sounds, flatus, removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group. The operation time and duration of hospital stay were both significant reduced in the early group. Complication rates did not differ between groups. CONCLUSION The earlier recovery of bowel function seems to be predictive of early radical resection. In contrast, pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.