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 treatment of open tibia fracture is challenging to Orthopedic Surgeon with its high infection rate and other complications. We had wound culture of open tibia fracture at emergency room in all cases, and treated using various External Fixators. The author analized the 134 cases of the open tibia fractures from March 1979 to February 1987. The average follow-up was one year. The results were as follws : 1. Type I open fracture was 23 cases, Type II 58 cases, Type IIIA 33, Type IIIB and Type IIIC was 10 cases each. The most frequent type of fracture was Type II, 58 cases by Gustilo classification. 2. The union time of Type I fracture was 6.5 months in average, and that of Type II and Type III was 9.5 months, 11.2 months. 3. Of those 52 cases whose initial culture was positive, 12 cases developed infection. The low infection rate would probably be due to combined administration of cephalosporin and firm application of external fixator to severe open tibia fractures.
Classification ; Clinical Study ; Emergency Service, Hospital ; External Fixators ; Follow-Up Studies ; Fractures, Open ; Orthopedics ; Tibia ; Wounds and Injuries

OBJECTIVE: To verify the effect of Matrigel, a ECM complex from Engelbreth-Holm-Swarm(EHS) mouse sarcoma on the preimplantation development and apoptosis of mouse fertilized eggs. METHOD: Late Pronucleus stage eggs were cultured through the blastocyst stage in the presence of Matrigel (0.5%, v/v). Characteristics of apoptosis and cell number assessed by Hoecst staining and TUNEL labeling at the blastocyst stage, respectively. RESULTS: Morphological development, number of cells per embryo was significantly increased but rate and number of TUNEL positive nuclei of the embryo were decreased in the presence of Matrigel. CONCLUSION: This result suggested that at low concentration of Matrigel improves both viability and morphological development in the preimplantation mouse embryos.
Animals ; Apoptosis* ; Blastocyst ; Cell Count ; Eggs ; Embryonic Structures* ; In Situ Nick-End Labeling ; Mice* ; Ovum ; Sarcoma ; Zygote

Posterior cerebral artery (PCA) aneurysm is a rare disease, and has some distinctive features compared with aneurysms located elsewhere. This study is to investigate results of the management and characteristics of posterior cerebral artery aneurysm. Between 1996 and 2005, we treated 8 patients (4 male, 4 female) via endovascular or surgical approach. Six patients underwent endovascular treatment and two were treated with open surgery. The Glasgow Outcome Scale (GOS) was used for estimating the results. Five patients had ruptured PCA aneurysms and three had unruptured aneurysms. The locations were one case of P1 branch, two cases of P1-P2 junction, four cases of P2-P3 junction and one case of distal P4 branch. Among 8 patients, five had good recovery, two had a moderate disability and another one was expired due to rebleeding. Optimal treatment of PCA aneurysms is able to perform via surgical or endovascular approach. Endovascular treatment is effective and an alternative method for PCA aneurysm because of the difficulty and several complications of surgical approach.
Aneurysm ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Male ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Rare Diseases

PURPOSE: To investigate the risk factors related to the location of visual field defects in normal tension glaucoma. METHODS: Eighty-one eyes diagnosed as normal tension glaucoma in patients with early glaucomatous visual field defects were divided into central visual field defects and peripheral visual field defects. The difference between the 2 groups based on the intra-individual comparison were assessed with several ocular risk factors such as sex, age, hypertension, diabetes mellitus, smoking, laterality, intraocular pressure, central corneal thickness, cup-disc ratio, peripapillary atrophy, mean deviation, pattern standard deviation, best corrected visual acuity, and refractive errors. RESULTS: The incidence of hypertension in the central visual field defects group (60.6%) was higher than in the peripheral visual field defects group (22.9%, p = 0.001). The central corneal thickness in the central group (533.1 +/- 18.2 microm) was thinner than in the peripheral group (545.0 +/- 30.0 microm, p = 0.003). Hypertension was the only risk factors for central visual field defects (p = 0.001). In both the central group and peripheral group, upper visual field defects were more common than lower defects. CONCLUSIONS: Hypertension in patients with normal tension glaucoma was a factor involved in central visual field defects. Additionally, numerous visual field defects were mainly found the superior portion.
Atrophy ; Diabetes Mellitus ; Eye ; Humans ; Hypertension ; Incidence ; Intraocular Pressure ; Low Tension Glaucoma ; Risk Factors ; Smoke ; Smoking ; Visual Acuity ; Visual Fields

PURPOSE: The purpose of this study was to examine the significance of increased bone density according to whether bone grafts were applied using demographic data with Cone Beam Computed Tomography (CBCT) and to compare the bone densities between before and after implant prosthesis using the Hounsfield index. MATERIALS AND METHODS: Thirty-six randomly selected computed tomography (CT) scans were used for the analysis. The same sites were evaluated digitally using the Hounsfield scale with V-Implant 2.0(TM), and the results were compared with maxillary posterior bone graft. Statistical data analysis was carried out to determine the correlation between the recorded Hounsfield unit (HU) of the bone graft and implant prosthesis using a Mann-Whitney U test and Wilcoxon Matched-pairs test. RESULTS: The bone grafted maxillary posterior teeth showed an increase in the mean values from-157 HU to 387 HU, whereas non-grafted maxillary posterior teeth showed an increase from 62 HU to 342 HU. After implantation, the grafted and non-grafted groups showed significantly higher bone density than before implantation. However, the grafted group showed significantly more changes than the non-grafted group. CONCLUSION: Bone density measurements using CBCT might provide an objective assessment of the bone quality as well as the correlation between bone density (Hounsfield scale) and bone grafts in the maxillary molar area.
Bone Density ; Cone-Beam Computed Tomography ; Data Interpretation, Statistical ; Dental Implants ; Molar ; Prostheses and Implants ; Tooth ; Transplants

No abstract available.
Knee Joint* ; Knee*

Roux-en-Y reconstruction is an occasional occurrence of Roux-Y stasis syndrome, characterized by chronic abdominal pain, persistent nausea, and intermittent vomiting. Construction of the Roux limb requires transection of the jejunum, which disturbs normal propagation of pacesetter potential and evokes development of ectopic pacemakers in the Roux limb. Ectopic pacemakers in the Roux limb generate pacesetter potentials, which with their associated orally propagating contractions, result in slower transit through the Roux limb.To prevent the Roux stasis syndrome, a new operation has been designed that is similar to the standard Roux-en-Y gastrojejunostomy construction but theoretically without inherent motor pathophysiology. The authors designed a new unbalanced " Uncut Roux-en-Y" procedure to avoid postoperative blind loop syndrome and performed the procedures with staple occlusion of the afferent loop in 11 patients who required gastric resection and reconstruction, during a period of 6 months from April 1995 to September 1995. Results were summarized as follows. 1) 9 of the 11 patients( 81%) had excellent results with stable or increased weight and no stasis syndrome. 2) 2 patients(19%) had poor results with alkaline reflux gastritis or esophagitis. Both had documented staple line dehiscence. One of them was operated on and converted to a standard Roux operation, but died. The other one continued to loose weight but maintained a normal dietary pattern. 3) Unbalanced Roux technique worked well without harmful complications. 4) Reinforcing serosal sutures on the staple line could prevent a possible jejunal leakage in the case of staple line dehiscence and might prevent dehiscence of staple lines.
Abdominal Pain ; Blind Loop Syndrome ; Esophagitis ; Extremities ; Gastric Bypass* ; Gastritis ; Humans ; Jejunum ; Nausea ; Sutures ; Vomiting