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Purpose: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients. Methods: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative bypass surgery. Outcomes for elderly patients (≥75 years) were compared with those of younger patients (＜75 years). Results: In comparison of 257 younger patients (＜75 years, median age 61 years), 38 elderly patients (≥75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2∼3 (97.3% vs.42.0%, p＜0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups. Conclusion: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.

This paper describes the design and fabrication of a flexible three-axial tactile sensor array using advanced polyimide micromachining technologies. The tactile sensor array is comprised of sixteen micro force sensors and it measures 13 mm × 18 mm. Each micro force sensor has a square membrane and four strain gauges, and its force capacity is 0.6 N in the three-axial directions. The optimal positions of the strain gauges are determined by the strain distribution obtained form finite element analysis (FEA). The normal and shear forces are detected by combining responses from four thin-film metal strain gauges embedded in a polyimide membrane. In order to acquire force signals from individual micro force sensors, we fabricated a PCB based on a multiplexer, operational amplifier and microprocessor with CAN network function. The sensor array is tested from the evaluation system with a three-component load cell. The developed sensor array can be applied in robots’ fingertips, as well as to other electronic applications with three-axial force measurement and flexibility keyword requirements.

INTRODUCTIONStercoral perforation of the colon has rarely been reported. Only 3 cases of stercoral perforation of the colon proximal to an end colostomy have been reported. We present two cases of stercoral perforation of the colon in end colostomy patients.PRESENTATION OF CASEA 70-year-old man who had undergone abdomino-perineal excision for anal cancer was referred for left lower quadrant pain and fever. Stercoral perforation was discovered along the distal descending colon, proximal to the end sigmoid colostomy. The patient underwent segmental resection of the colon and revision of the stoma and was discharged on postoperative day 32. A 71-year-old woman who had undergone abdomino-perineal excision for distal rectal cancer with preoperative chemoradiation presented fever with 2 days of low abdominal pain. The patient had sacral bone and lung metastases from rectal cancer and suffered from chronic constipation. Stercoral perforation was found around the sigmoid colon, just proximal to the end sigmoid colostomy. The patient underwent simple repair of the perforated colon through the parastomal incision. On postoperative day 8, leakage occurred at the repair site. Segmental resection of the colon and revision of the stoma were performed. She was discharged 44 days after the initial surgery.DISCUSSIONSegmental resection of the perforated colon, rather than simple repair, appears to improve postoperative outcomes.CONCLUSIONAs the number of cancer survivors increases, appropriate management of constipation is important to prevent stercoral perforation during follow-up.

This study aimed to develop an economically viable enzyme for the optimal production of steviol (S) from stevioside (ST). Of 9 commercially available glycosidases tested, S-producing β-glucosidase (SPGase) was selected and purified 74-fold from Penicillium decumbens naringinase by a three-step column chromatography procedure. The 121-kDa protein was stable at pH 2.3-6.0 and at 40-60 °C. Hydrolysis of ST by SPGase produced rubusoside (R), steviolbioside (SteB), steviol mono-glucoside (SMG), and S, as determined by HPLC, HPLC-MS, and (1)H- and (13)C-nuclear magnetic resonance. SPGase showed higher activity toward steviol mono-glucosyl ester, ST, R, and SMG than other β-linked glucobioses. The optimal conditions for S production (30 mM, 64 % yield) were 47 mM ST and 43 μl of SPGase at pH 4.0 and 55 °C. This is the first report detailing the production of S from ST hydrolysis by a novel β-glucosidase, which may be useful for the pharmaceutical and agricultural areas.

Purpose To evaluate the influence of preoperative mechanical bowel preparation (MBP) based on the occurrence of anastomosis leakage, surgical site infection (SSI), and severity of surgical complication when performing elective colorectal surgery. Materials and Methods MBP and non-MBP patients were matched using propensity score. The outcomes were evaluated according to tumor location such as right- (n=84) and left-sided colon (n=50) and rectum (n=100). In the non-MBP group, patients with right-sided colon cancer did not receive any preparation, and patients with both left-sided colon and rectal cancers were given one rectal enema before surgery. Results In the right-sided colon surgery, there was no anastomosis leakage. SSI occurred in 2 (4.8%) and 4 patients (9.5%) in the non-MBP and MBP groups, respectively. In the left-sided colon cancer surgery, there was one anastomosis leakage (4.0%) in each group. SSI occurred in none in the rectal enema group and in 2 patients (8.0%) in the MBP group. In the rectal cancer surgery, there were 5 anastomosis leakages (10.0%) in the rectal enema group and 2 (4.0%) in the MBP group. SSI occurred in 3 patients (6.0%) in each groups. Severe surgical complications (Grade III, IV, or V) based on Dindo-Clavien classification, occurred in 7 patients (14.0%) in the rectal enema group and 1 patient (2.0%) in the MBP group (p=0.03). Conclusion Right- and left-sided colon cancer surgery can be performed safely without MBP. In rectal cancer surgery, rectal enema only before surgery seems to be dangerous because of the higher rate of severe postoperative complications.