경피경간담관내압검사

Perendoscopic biliary manometry may not represent the overall sphincter of Oddi (SO) motility, as the recording time is relatively short and it is possibly influenced by the presence of an endoscope in duodenum and air inflation. Percutaneous transhepatic biliary manometry of SO permits long-term recordings without patient discomfort and risk of complications. We investigated the change of human SO motility and the correlation between SO motility and migrating motor complex (MMC) of the small bowel in a fasting state by long-term simultaneous manometric examination of SO and small bowel. During long-term manometry, MMC-like cyclic activities of SO were observed, which consiered to be MMC of SO. It coordinated well with MMC of the small bowel, except that SO was not quiescent during phase I MMC of the small bowel. In addition, the basal pressure of SO changed in accordance with the phases of SO motility. Percutaneous transhepatic biliary manometry also permits prolonged manometric studies to investigate normal physiologic reflexes such as gastroduodeno-sphincteric, cholecysto-sphincteric and choledocho-sphincteric reflexes, and the influence of cholecystectomy on SO motility in humans

폐색성 좌측 대장암에서 Stent 삽입의 종양학적 안정성

Purpose:There is a controversy about the treatment of left-sided obstructive colorectal cancer. Recently, experience using an expandable metallic stent for relief of the obstruction has been increasing, but its oncological safety has not been confirmed. Therefore, we designed this study to evaluate the oncological safety of a metallic stent for the treatment of left-sided obstructive colorectal cancer. Methods: Forty-six patients with left-sided obstructive colorectal cancer who underwent a curative resection from 1994 to 2004, were retrospectively evaluated. Nineteen emergency operations (1994～2003) and 27 metallic stent insertions (2000～2004) were compared based on clinicopathologic features, postoperative complications, recurrence rates, and survival rates. Results: There were no significant differences in age, location, sex, and recurrence rate between the two groups. The complication rate in the emergency group was higher than it was in the stent group, but this difference was not statistically significant (26.3% vs. 14.8%; P=0.33). The overall and the disease-free survival rates were not significantly different. Conclusions: Because there was no significant differences in survival rate and recurrence rate between the two groups, metallic stent insertion can be used safely in the preoperative treatment of obstructive left-sided colorectal cancer

과민성 장증후군에서 설사형 및 변비형 간의 항문직장내압검사 소견 차이

Background/Aims : The aim of this study was to identify differences in anorectal manometry between diarrhea-predominant cases and constipation-predominant cases in patients with irritable bowel syndrome (IBS). Methods : For 62 patients with IBS (29 patients with diarrhea and 33 patients with constipation) and 23 healthy controls, we measured maximum basal and squeeze pressure of anus, threshold of rectoanal inhibitory reflex, rectal compliance and volumes to elicit first sensation, sense of defecation, urgency and maximum toleration. The rectums of subjects were classified into a normal type, a sensitive type, and an insensitive type according to the threshold of sensation and expansion rate of rectum. Results : The volumes to elicit sense of defecation, urgency and maximum tolerable discomfort of patients with diarrhea were significantly lower than those of patients with constipation. Sixteen (55.2%) in the diarrhea-predominant patients with IBS had sensitive rectum but 4 (12.1%) in th constipation-predominant patients with IBS and sensitive rectum. There were no significant differences in other parameters among the two patients groups and controls. Conclusions : There were significant differences in the threshold of rectal sensation and rectal sensitivity between diarrhea-predominant patients with IBS and constipation-predominant patients with IBS

혈중 렢틴치의 운동이상형 기능성 소화불량증과의 관계

Background/Aims: Leptin is known to be related to both appetite and gastric motility. However, little is known about the clinical implication of leptin in functional dyspepsia (FD). The aim of this study was to investigate the association of the plasma leptin levels with dysmotility-like FD. Methods: 42 patients with dysmotility-like FD and 14 healthy controls were enrolled. The gastric emptying time (GET) was measured using a radiolabeled solid meal, and plasma leptin levels were determined before and 30 min after the test meal with using a commercially available radioimmunoassay kit. Results: The mean preprandial and postprandial leptin levels of the patient group were not significantly different from those of the control group. The leptin levels were not significantly correlated with the GET of the patient group. Those levels did not differ between the delayed gastric emptying and normal emptying subgroups. Conclusions: The plasma leptin levels are not altered in dysmotility-like FD patients and they are poorly correlated with the gastric emptying time, suggesting that leptin does not seem to play a significant role in the pathogenesis of dysmotility-like FD. (Kor J Neurogastroenterol Motil 2006;12:157-160

만성 특발성 변비에서 대장 통과 시간의 유형에 따른 항문직장기능검사 소견의 비교

Background/Aims: The pathophysiology of chronic idiopathic constipation is complex. This study was designed to assess the usefulness of colon transit time as screening test in chronic idiopathic constipation. Methods: Colon transit time was evaluated in patients with chronic idiopathic constipation (n=38) in order to determine the type of colon transit time. The change of anorectal angle, perineal descent, rectocele, rectal intussusception, resting and squeezing anal sphincter pressure, and rectoanal inhibitory reflex were evaluated. Results: The abnormal change of anorectal angle at defecation was noted in 10.5% of patients with normal transit and 28.6% of patients with pelvic outlet obstruction. The descending perineum syndrome was observed in 10.5% of patients with normal transit, 25.0% of patients with colonic inertia, 25.0% of patients with hindgut dysfunction and 14.3% of patients with pelvic outlet obstruction. Rectocele greater than 2 cm was observed in 42.1% of patients with normal transit, 37.5% of patients with colonic inertia, 50.0% of patients with hindgut dysfunction and 57.1% of patients with pelvic outlet obstruction. Rectal intussusception severer than grade 3 was observed in 26.3% of patients with normal transit, 25.0% of patients with colonic inertia and 42.9% of patients with pelvic outlet obstruction. The high resting and squeezing anal sphincter pressure were observed in some with normal transit. Conclusions: These results suggest that defecography and anorectal manometry in addition to colon transit time are also recommended as screening test for chronic idiopathic constipation. (Kor J Gastroenterol 1999;33:348 - 357

급성 출혈성 직장 궤양에 의한 직장 출혈

출혈성 직장 궤양 증후군은 하부 위장관 출혈의 매우 드 문 원인이다. 그러나 심각한 전신 질환을 동반한 노인에게서 복통 없이 갑작스러운 대량의 선홍색 혈변을 보일 때 혈변의 원인으로 급성 출혈성 직장 궤양을 고려해보는 것은 중요하다. 출혈성 직장 궤양을 인식하고 있다면 불필요한검사를 피하고 조기에 정확한 진단을 함으로서 환자의 예후 도 향상시킬 수 있을 것이다. 저자는 하부 위장관 출혈의 원인으로 알려져 있으나 인지되지 않아 아직까지 국내에서 보고되지 않은 것으로 생각되는 급성 출혈성 직장 궤양 증후군 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다.Acute hemorrhagic rectal ulcer syndrome (AHRUS) is characterized by the sudden onset of painless, massive, fresh rectal bleeding in elderly or bedridden patients with serious underlying illnesses. With increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRUS has increased in Japanand Western countries in recent years. However, AHRUS remains a controversial disease entity and has not yet been documented in Korea. Here, we present a case of AHRUS to highlight this uncommon disease entity as a potential etiology of massive rectal bleeding in critically ill patients