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Seoul, South Korea

Chun J.,Tuckson Colorectal Surgery | Lee D.,Daehang Hospital | Stewart D.,Penn State Milton rshey Medical Center | Talcott M.,University of Washington | Fleshman J.,University of Washington
Surgical Innovation | Year: 2011

Purpose. The aim of this study was to compare characteristics of rectal compression and stapled anastomoses at multiple time points. Methods. A total of 50 domestic pigs underwent a rectal anastomosis with a compression device or a circular stapler. They were sacrificed at zero-time, 2 days, 1 week, 1 month, and 3 months. Burst and maximal tolerated pressure and sites of failure, internal diameters, and radiographic leak rates were assessed. Desmosine (elastin) levels were determined. Results. There were no clinical or radiographic leaks. Overall, 10 out of 27 (37%) compression anastomoses burst at higher pressures than the 14 out of 24 (58%) stapled anastomoses. Mean circumference and anastomotic index were greater for the EndoCAR at 1 week and 3 months. Desmosine levels were similar. Conclusions. In the porcine model, compression rectal anastomoses with the EndoCAR had improved bursting pressures and internal circumference compared with circular stapled anastomoses. © 2011 SAGE Publications. Source


Hong K.D.,Korea University | Lee D.,Daehang Hospital | Lee Y.,Korea University | Lee S.I.,Korea University | Moon H.Y.,Korea University
American Surgeon | Year: 2013

The homeodomain transcription factor CDX2 directs development and maintenance of normal intestinal epithelium. However, the role of CDX2 in colorectal carcinogenesis is poorly understood. Hence, we investigated the CDX2 expression in patients with colorectal cancer and its relationship to tumor cell proliferation and differentiation and evaluated the role of this molecule as a biologic marker for the prediction of poor patient survival. We retrospectively reviewed 207 patients with colorectal cancer, with an available paraffin block, who underwent surgical resection between January 2002 and December 2004 at Korea University Guro Hospital. CDX2 expression was compared between tumor tissue and the adjacent normal mucosa using immunohistochemistry and Western blot analysis. Immunohistochemical staining for CDX2, Ki-67, and CK20 was performed in each tumor tissue. Immunohistochemistry revealed that CDX2 protein is overexpressed by colorectal cancer compared with adjacent normal mucosa (P < 0.001). In the Western blot analysis, tumor tissue showed a trend toward overexpression of CDX2 protein compared with normal mucosa (P = 0.09). CDX2 expression showed a significant direct correlation with the expression of Ki-67 and CK20 in tumor tissue (P = 0.028 and P = 0.042, respectively). Survival analysis showed that reduced CDX2 expression was statistically and significantly related to poor overall survival. Reduced CDX2 expression is associated with poor overall survival in patients with colorectal cancer and may be clinically useful as a marker for poor prognosis. Source


Snare polypectomy of a giant pedunculated colorectal polyp is sometimes technically demanding, and, therefore, piecemeal resection is inevitable, despite the relative risk of invasive cancer and postpolypectomy bleeding. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection in comparison with conventional snare polypectomy for giant pedunculated polyps We retrospectively reviewed the clinical outcomes and complications of endoscopic polypectomy for giant pedunculated polyps from October 2006 to November 2011. All the patients who underwent endoscopic submucosal dissection (n = 23) or snare polypectomy (n = 20) for pedunculated polyps ≥ 3 cm were enrolled consecutively. In the case of a giant pedunculated polyp with 1) poor visualization of the stalk, 2) technical difficulties in snare positioning for en bloc resection, or 3) need for trimming of the head, we did not attempt piecemeal snare polypectomy, and we performed endoscopic submucosal dissection instead. (These were arbitrarily defined as "difficult" giant pedunculated polyps.) Data on the patient's demography, endoscopic and histopathologic findings, clinical outcomes, and complications were analyzed. Among the 43 giant pedunculated polyps, 23 polyps were defined as "difficult" polyps and were removed with endoscopic submucosal dissection. Subpedunculated (stalk <1 cm) type was more common in the "difficult" polyp group (p = 0.01). The overall incidence of cancer was 18.6% (8/43). En bloc resection rates were 100% (23/23) in the endoscopic submucosal dissection group and 90% (18/20) in the snare polypectomy group. The procedure times of snare polypectomy and endoscopic submucosal dissection group did not differ significantly (41.7 ± 13.7 minutes vs 44.9 ± 35.6 minutes, p = 0.70). Postpolypectomy bleeding was noted in 1 case (4.3%) in the endoscopic submucosal dissection group and in 3 cases (15%) in the snare polypectomy group. Endoscopic submucosal dissection, as well as the snare polypectomy for giant pedunculated polyps, appeared to be effective without major complications and can be an alternative option to achieve en bloc resection, particularly for difficult cases, such as giant subpedunculated polyps. Source


Chun J.,University of Washington | Parikh P.,University of Washington | Lee D.,Daehang Hospital | Fleshman J.,University of Washington
Surgical Innovation | Year: 2011

Purpose. To assess the safety of anastomosis ring (EndoCAR) following chemoradiation. Methods. A total of 10 pigs received radiation to a bioequivalent dose of 4500 cGy with 4 doses of 5-fluorouracil 400 mg/m2 and leucovorin 20 mg/m2 intravenous bolus. On day 21, each animal underwent 2 rectal anastomoses, 10 cm apart, using a 27-mm EndoCAR device and a 29-mm circular stapler. Burst pressures, desmosine and hydroxyproline levels and radiographic leaks were assessed at 2 weeks. Results. In all, 8 pigs were included in the analysis (1 pig died, 1 specimen damaged at harvest). Leaks occurred in 6 (170-300 mm Hg) stapled and 2 ring anastomoses (150-200 mm Hg; P =.13). Internal circumferences were similar (5.5 vs 5.2 cm; P =.5). Desmosine and hydroxyproline levels were similar between groups. Conclusion. Rectal anastomosis, after chemoradiation to the pig rectum using a ring (EndoCAR), is similar to stapled anastomosis. Further trials are needed in humans to determine any clinical advantage associated with these findings. © SAGE Publications 2011. Source


Lee W.Y.,Sungkyunkwan University | Park K.J.,Seoul National University | Cho Y.B.,Sungkyunkwan University | Yoon S.N.,University of Ulsan | And 9 more authors.
Stem Cells | Year: 2013

Fistula is a representative devastating complication in Crohn's patients due to refractory to conventional therapy and high recurrence. In our phase I clinical trial, adipose tissue-derived stem cells (ASCs) demonstrated their safety and therapeutic potential for healing fistulae associated with Crohn's disease. This study was carried out to evaluate the efficacy and safety of ASCs in patients with Crohn's fistulae. In this phase II study, forty-three patients were treated with ASCs. The amount of ASCs was proportioned to fistula size and fistula tract was filled with ASCs in combination with fibrin glue after intrale-sional injection of ASCs. Patients without complete closure of fistula at 8 weeks received a second injection of ASCs containing 1.5 times more cells than the first injection. Fistula healing at week 8 after final dose injection and its sustainability for 1-year were evaluated. Healing was defined as a complete closure of external opening without any sign of drainage and inflammation. A modified per-protocol analysis showed that complete fistula healing was observed in 27/33 patients (82%) by 8 weeks after ASC injection. Of 27 patients with fistula healing, 26 patients completed additional observation study for 1-year and 23 patients (88%) sustained complete closure. There were no adverse events related to ASC administration. ASC treatment for patients with Crohn's fistulae was well tolerated, with a favorable therapeutic outcome. Furthermore, complete closure was well sustained. These results strongly suggest that autologous ASC could be a novel treatment option for the Crohn's fistula with high-risk of recurrence. ©C AlphaMed Press. Source

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