Since Whitehead had described a circular hemorrhoidectomy in 1882, many surgeons adopted it for decades for patients with protruding anal deformity. After a few decades of performing Whitehead operation, devastating complications such as anal stricture, fecal incontinence, and wet anus with mucosal eversion had been reported on the literatures and then it was buried as an abandoned procedure by surgeons for a long period. Recently, a few prominent anal surgeons reported that they could avoid such devastating complications by introducing diverse modifications of the original Whitehead's operation. The authors analyzed 22 patients who had undergone original Whitehead circular hemorrhoidectomy with the technique of preserving most of the perianal skin and W-shaped circular incision during the period from 1991 to 1996, with special regard to the com plications such as anal stricture and anal mucosal eversion which have been debated on so far and reviewed the articles about these issues. In immediate postoperative period, suture failure and resultant non-surgery requiring, mild anal stricture were documented in 3 of the 22 cases(13.6%). On long-term follow-up with the mean period of 44 months (18~79 months) in 14 cases, except those 8 cases that were lost, with phone-call questionaire, 13 patients(93%) had quite normal anal functions. The authors would like to suggest that the original Whitehead's circular hemorrhoidec tomy is a valuable surgical technique to manage the protruding anal deformity if surgeons can avoid well known complications such as anal stricture and anal mucosal eversion by choosing a correct location of initial W-shaped incision to preserve as much perianal skin as possible.
Anal Canal ; Congenital Abnormalities ; Constriction, Pathologic ; Fecal Incontinence ; Follow-Up Studies ; Hemorrhoidectomy* ; Humans ; Postoperative Period ; Skin* ; Sutures

The changes in the size of human oviduct and ovary after immersion in formalin (4%, 10%) were investigated. The results were as follows : 1. After fixation, the length of oviduct was significantly reduced to 93%, but the cross sectional area of oviduct was significantly increased. The length of oviduct showed no significant difference between 4% and 10% formalin. The length of ovarian ligament was also significantly reduced to 84% after fixation. 2. After fixation, the volume of oviduct was increased significantly and showed a difference between the two fixatives. The volume of oviduct in 4% formalin has increased to 107%, as compared to 103% increase in 10% formalin. 3. After fixation, the volume of ovary was increased significantly and showed a difference between the two fixatives. The volume of ovary in 4% formalin has increased to 109%, as compared to 103% increase in 10% formalin.
Animals ; Female ; Fixatives ; Formaldehyde* ; Humans* ; Immersion* ; Ligaments ; Ovary* ; Oviducts*

PURPOSE: To evaluate the MR findings of embolized cerebral arteriovenous malformations according to various embolic materials. MATERIALS AND METHODS: We performed the endovascular embolization using four different kinds of embolic materials in 33 patients. Embolization related changes in the nidus and surrounding brain parenchyme were analyzed and the results were compared with pre- and postembolization MRI, CT and anglographic findings in all patients. RESULTS: Embolized vessels with N-buthyl-2-cyanoacrylate(NBCA) mixture showed some artifact in CT due to metallic character of tantalum powder or fatty nature of lipiodol. But in MRI, it was represented by fatty signals without artifact. In cases of using polyvinyl alcohol and ethylene vinyl alcohol copolymer(EVAL), there were no specific signal by the embolic material except for the disappearance of flow related signals in feeding arteries and shrinkage of venous ectasis. CONCLUSION: MRI is a valuable imaging modality for analysing the morphology and hemodynamics of cerebral AVMs, especially after embolization of pathologic vessels. Recognition of the signal of embolic agents and thus the thrombosed portion could lead to more precise analysis before surgery or radiosurgery.
Arteries ; Artifacts ; Brain ; Ethiodized Oil ; Hemodynamics ; Humans ; Intracranial Arteriovenous Malformations ; Magnetic Resonance Imaging* ; Polyvinyl Alcohol ; Radiosurgery ; Tantalum

Interventional procedures around the cervical spine have been classically performed under the guidance of fluoroscopy with radiation hazards to patients and doctors. Even though under fluoroscopic guidance, vascular and nerve structures cannot be shown and there are actual risks for the patient. Nowadays, we can use high resolution image ultrasound around cervical spine procedures. Real time imaging is possible. Cervical root block, medial branch block and many other interventions can be performed under ultrasound guidance. In out-patient clinics, ultrasound is very helpful in management of cervical problems in differentiating the origin of pain and treatment for the pain. Ultrasound is radiation free, easy to use and the imaging can be performed continuously while the injectant is visualized in real-time, increasing the precision of injection. Importantly, ultrasound enables visualization of major nerves and vessels and thus leads to improved safety of cervical interventions by decreasing the incidence of injury or injection into nearby vasculature. We therefore performed a review to investigate the feasibility of performing cervical interventions under real-time ultrasound guidance.
Fluoroscopy ; Humans ; Incidence ; Outpatients ; Spine* ; Ultrasonography

No abstract available.
Angioplasty* ; Carotid Artery, Internal* ; Carotid Stenosis*

BACKGROUND: It is a well known phenomenon that alveolar and peritoneal macrophages exposed to bacterial lipopolysaccharide (LPS) induce a large output of nitric oxide (NO) and an inducible nitric oxide synthase (iNOS) m-RNA expression. The author elucidate the effects on NO production and iNOS m-RNA expression of various anesthetics, inhalational (halothane, enflurane, sevoflurane) and intravenous (ketamine, propofol), on endotoxemic rats. METHODS: To examine the production of NO in peritoneal macrophages, NO concentrations were measured from the rats following 2 hours exposure to LPS and 2 hours administration of various anesthetics, respectively. Culture supernatants were collected 24 hours after exposure to LPS and anesthetics and assayed by ELISA (Enzyme Linked Immunosorbent Assay) for production of NO. iNOS m-RNA expression was measured using PCR (Polymerase Chain Reaction) techniques and autoradiography. RESULTS: In the control group, the NO concentration was measured at 120 minutes after infusion of LPS to rats, and showed 12+/-4 micrometer. After insufullation of anesthetics to experimental animals, NO concentration increased in the halothane, enflurane, sevoflurane, propofol, and ketamine groups, 132+/-27 (P< 0.05), 49+/-19 (P< 0.05), 23+/-14 (P< 0.05), 37+/-11 (P< 0.05), and 17+/-2 micrometer respectively. The size and brightness of the iNOS m-RNA bands were large in halothane, enflurane, sevoflurane, propofol and ketamine, in order. CONCLUSIONS: Intravenous anesthetics showed more stability than inhalation anesthetics with regand to production of NO and iNOS m-RNA expression in sepsis on rats. The mechanism is not clear, but it is related to the strong stimulating effect to the airway tract in from inhalational anesthetics.
Anesthetics* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Animals ; Autoradiography ; Enflurane ; Enzyme-Linked Immunosorbent Assay ; Halothane ; Ketamine ; Macrophages, Peritoneal* ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Polymerase Chain Reaction ; Propofol ; Rats* ; Sepsis

PURPOSE: We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). MATERIALS AND METHODS: We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or l (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assess-ment in stress-redistribution and stress-reinjection images. RESULTS: On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fifty two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reversible on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress-reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. CONCLUSION: The 24 hour reinjection imaging is useful in the assessment of rnyocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other.
Complement System Proteins ; Dipyridamole ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon

A rare case in the pattern of the origin of the celiac artery was observed in the cadaver of a 64 year old Korean male and the results are summarized as follows. The superior mesenteric artery originated from the abdominal aorta at the level of the intervertebral dusk between first and second lumbar vertebra. At a point 4cm from the origin of the superior mesenteric arterr, a common trunk appeared and ran 1cm and then divided into the common hepatic artery and the splenic artery. The common hepatic artery divided into the right gastric artery and the proper hepatic artery at a point 4.5cm after the bifurcation. A common trunk formed by the left inferior phrenic artery and the lefts gastric artery arose from the abdominal aorta about 0.8cm about the origin of the celiacomesenteric trunk.
Aorta, Abdominal ; Arteries ; Cadaver ; Celiac Artery* ; Hepatic Artery ; Humans ; Male ; Mesenteric Artery, Superior ; Spine ; Splenic Artery

The laparoscopic cholecystectomy, performed for the first time in France in 1987, has been accepted as in many countries the method of choice when performing a cholecystectomy. The trend toward minimally invasive surgery has prompted general surgeons to try it instead of open cholecystectomy. We performed 1000 laparoscopic cholecystectomies at the Department of General Surgery of Eulji Medical College Hospital from January 1992 to April 1997. The outcome data have been analyzed retrospectively. Moreover, we have compared the case histories of 13 patients who received cholecystostomy with those of 43 patient who did not. We also present preliminary results for an interval laparoscopic cholecystectomy which was a preceded by percutaneous cholecystostomy. The results are as follows: 1) The mean age was 54.3 years ranging from 17 to 86; there were 402 males and 598 females. 2) Of the 1000 patients, 123 patients (12.3%) had a history of abdominal surgery. 3) More than half of the patients(560 patients, 56.0%) underwent operations within 6 months of the onset of symptoms. 4) A preoperative endoscopic retrograde cholecystoscopy was performed on 220 patients (22.0%), and of these, 93 patients received endoscopic sphincterotomies because of bile duct stones. 5) The majority of patients(744 patients, 74.4%) had laparoscopic cholecystectomies which lasted 40 minutes or less. 6) More than half (54%) of the removed gallbladders showed grade II inflammation. 7) Drains were used in 142 patients (14.2%). 8) Postoperative complications were encountered in 48 patients (4.8%). 9) Postoperative oral intake was resumed within 24 hours in most patients. 10) Most patients(854 patients, 85.4%) were discharged within 3 days of the operation. 11) The pathologic diagnosis was chronic nonspecific inflammation in most cases (823 cases, 82.3%). 12) The most common microorganism in the bile was E. coli. 13) Patients who received a cholecystostomy had many benefits: a shorter operation time, a low rate of open cholecystectomy, early oral intake. 14) For the 1160 patients who underwent a cholecystectomy during the same period, the rate of open cholecystectomy was 13.8%.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystostomy* ; Diagnosis ; Female ; France ; Gallbladder ; Humans ; Inflammation ; Male ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Surgical Procedures, Minimally Invasive

The variations of the sigmoid sinus were studied in 50 Korean adults (average age 67). The classification of the shape and a measurement of the diameters of the sinus were done and the morpological. 1. The shape was classified into 4 types, and the round type was the most common in both sides. S shaped type was below 10% in both sides. 2. The breadth was regular in 54% of the right and in 70% of the left sinuses. According to the breadth change, the shape was classified into 4 shapes. 3. The average diameter was 8.6mm on the right side and 7.2mm on the left side. 4. Symmetry was present in 16% of all. 5. The right transverse sinus was absent in 1 case (2%) and the superior petrosal sinus did not open into the sigmoid sinus in 2 cases (4%). 6. Petrosqamous sinus was observed in 16%.
Adult* ; Classification ; Colon, Sigmoid* ; Humans