PURPOSE: Lateral partial internal sphincterotomy is considered as the best surgical procedure of the idiopathic chronic anal fissure. Because the aim of surgery is to relieve sphincter spasm, and occasional minor incontinence following surgery has been reported, alternative chemical means of spasmolysis could be considered. Nitric oxide (NO) is known to be a major inhibitory neurotransmitter of the internal anal sphincter, so we investigated the effect of topical nitroglycerin for chronic anal fissure. METHODS: Twenty nine patients (19 women, mean age 36 years) with chronic anal fissure were treated with 0.2% nitroglycerin ointment. Pain score was quantitated with Visual Analog Scale (VAS) in regular time interval. Manometry was performed in five patients and maximum anal resting pressure (MARP) was measured before and 30 minutes after topical application of nitroglycerin ointment. All patients were re-examined and questioned regarding pain relief and side effects 2 years after cessation of treatment. RESULTS: All had appearances of chronicity and pain. There were 25 posterior and 12 anterior fissures. Pain was significantly abolished within 5 minutes after application of nitroglycerin ointment. Mean pain score (VAS) was 6.03 before, 0.69 30 min after, 0.58 1 week after, and 0.53 3 weeks after application of nitroglycerin ointment (P<0.001). MARP was markedly reduced 30 minutes after application of nitroglycerin from 166.2 15.1 cmH2O to 108.8 20.9 cmH2O (P<0.05). The 57% of patients (13/23) were effective for 2 years and 22% of patients (5/23) had recurred their symptom after cessation of nitroglycerin ointment. Two patients (9%), whose fissures had not healed completely within 3 weeks were requested for surgery and the other 2 patients (9%) had been operate due to the side effect of the ointment. Mild headache (7%) and dizziness (10%) were occured, but well tolerated when the dose was reduced. CONCLUSIONS: Topical application of nitroglycerin ointment seems to be an effective and safe alternative in the treatment of chronic anal fissure.
Anal Canal ; Dizziness ; Female ; Fissure in Ano* ; Headache ; Humans ; Manometry ; Neurotransmitter Agents ; Nitric Oxide ; Nitroglycerin* ; Spasm ; Visual Analog Scale ; Withholding Treatment

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). CONCLUSION: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.
Biopsy ; Breast ; Breast Neoplasms ; Humans ; Learning Curve ; Lymph Nodes* ; Sentinel Lymph Node Biopsy

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). Conclusion: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.
Biopsy ; Breast ; Breast Neoplasms ; Humans ; Learning Curve ; Lymph Nodes* ; Sentinel Lymph Node Biopsy

PURPOSE: This report outlines the incidence and the clinical features of patients with a neuroendocrine (NE) neoplasm of the colon and rectum and describes, in detail, their histologic and immunohistochemical findings. Also, we attempted to determine the impact of several clinical variables, including tumor stage, tumor location, NE pattern, and cellular subtype on survival. METHOD: Of 690 colorectal cancers operated on from April 1990 to November 1998 at Chungnam National University Hospital, 41 cases were originally diagnosed as poorly differentiated adenocarcinoms on the basis of conventional light microscopy. Paraffin blocks from the aforementioned cases were retrieved, and sections were im munostained with antibodies to human chromogranin A, neuron specific enolase, and synaptophysin. RESULTS: Of the 690 cases of colorectal caner, 35 cases (5.1%) of NE neoplasm were identified retrospectively: 28 males and 7 females. About 90% of the tumors were located at the cecum and the rectosigmoid. Pathologic stages were as follows: modified Dukes stage B2, 6; stage C1, 8; stage D1, 12; and stage D2, 9. The most common metastatic site at the time of diagnosis was the liver (8/9). Four NE patterns were identified: pure NE (n=4), and predominantly NE (n=8), equal NE and exocrine (n=4), and predominantly exocrine (n=19). Two cellular subtypes were identified: well-differentiated (n=3) and intermediate (n=32) cells. Survival statistically correlated with stage (p=0.03), but not with age, sex, tumor location, NE pattern, or cellular subtype. CONCLUSION: This study suggests that NE neoplasms of the colon and rectum are more frequent than previously believed. Since a NE neoplasm is believed to be an extremely biologically aggressive tumor, recognition of a NE neoplasm is very important because of its evident clinical and therapeutic implications.
Antibodies ; Cecum ; Chromogranin A ; Chungcheongnam-do ; Colon* ; Colorectal Neoplasms ; Diagnosis ; Female ; Humans ; Immunohistochemistry ; Incidence ; Liver ; Male ; Microscopy ; Paraffin ; Phosphopyruvate Hydratase ; Rectum* ; Retrospective Studies ; Synaptophysin

Purpose: We evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) and introduced innovative surgical techniques to maintain the instrument positions during the procedures. Materials and Methods: A cohort of 100 patients underwent extraperitoneal SP-RARP at our institution from December 2021 to April 2023. The procedures were performed by an experienced urology surgeon utilizing two surgical techniques for dissecting the posterior aspect of the prostate—“changing instrument roles” and “using camera inversion”—to prevent positional shifts between the camera and instruments. Results: The mean operation time for SP-RARP was 93.58 minutes, and the mean console time was 65.16 minutes. The mean estimated blood loss during the procedures was 109.30 mL. No cases necessitated conversion to multi-port robot, laparoscopy, or open surgery, and there were no major complications during the hospital stay or in the short-term follow-up. Early outcomes of post-radical prostatectomy indicated a biochemical recurrence rate of 4.0% over a mean follow-up duration of 6.40 months, with continence and potency recovery rates of 92.3% and 55.8%, respectively. Analysis of the learning curve showed no significant differences in operation time, console time, and positive surgical margin rates between the initial and latter 50 cases. Conclusions Extraperitoneal SP-RARP is a feasible and safe option for the treatment of localized prostate cancer in skilled hands.Continued accrual of cases is essential for future comparisons of SP-RARP with multiport approaches.

Purpose: We evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) and introduced innovative surgical techniques to maintain the instrument positions during the procedures. Materials and Methods: A cohort of 100 patients underwent extraperitoneal SP-RARP at our institution from December 2021 to April 2023. The procedures were performed by an experienced urology surgeon utilizing two surgical techniques for dissecting the posterior aspect of the prostate—“changing instrument roles” and “using camera inversion”—to prevent positional shifts between the camera and instruments. Results: The mean operation time for SP-RARP was 93.58 minutes, and the mean console time was 65.16 minutes. The mean estimated blood loss during the procedures was 109.30 mL. No cases necessitated conversion to multi-port robot, laparoscopy, or open surgery, and there were no major complications during the hospital stay or in the short-term follow-up. Early outcomes of post-radical prostatectomy indicated a biochemical recurrence rate of 4.0% over a mean follow-up duration of 6.40 months, with continence and potency recovery rates of 92.3% and 55.8%, respectively. Analysis of the learning curve showed no significant differences in operation time, console time, and positive surgical margin rates between the initial and latter 50 cases. Conclusions Extraperitoneal SP-RARP is a feasible and safe option for the treatment of localized prostate cancer in skilled hands.Continued accrual of cases is essential for future comparisons of SP-RARP with multiport approaches.

Purpose: We evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) and introduced innovative surgical techniques to maintain the instrument positions during the procedures. Materials and Methods: A cohort of 100 patients underwent extraperitoneal SP-RARP at our institution from December 2021 to April 2023. The procedures were performed by an experienced urology surgeon utilizing two surgical techniques for dissecting the posterior aspect of the prostate—“changing instrument roles” and “using camera inversion”—to prevent positional shifts between the camera and instruments. Results: The mean operation time for SP-RARP was 93.58 minutes, and the mean console time was 65.16 minutes. The mean estimated blood loss during the procedures was 109.30 mL. No cases necessitated conversion to multi-port robot, laparoscopy, or open surgery, and there were no major complications during the hospital stay or in the short-term follow-up. Early outcomes of post-radical prostatectomy indicated a biochemical recurrence rate of 4.0% over a mean follow-up duration of 6.40 months, with continence and potency recovery rates of 92.3% and 55.8%, respectively. Analysis of the learning curve showed no significant differences in operation time, console time, and positive surgical margin rates between the initial and latter 50 cases. Conclusions Extraperitoneal SP-RARP is a feasible and safe option for the treatment of localized prostate cancer in skilled hands.Continued accrual of cases is essential for future comparisons of SP-RARP with multiport approaches.

Purpose: We evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) and introduced innovative surgical techniques to maintain the instrument positions during the procedures. Materials and Methods: A cohort of 100 patients underwent extraperitoneal SP-RARP at our institution from December 2021 to April 2023. The procedures were performed by an experienced urology surgeon utilizing two surgical techniques for dissecting the posterior aspect of the prostate—“changing instrument roles” and “using camera inversion”—to prevent positional shifts between the camera and instruments. Results: The mean operation time for SP-RARP was 93.58 minutes, and the mean console time was 65.16 minutes. The mean estimated blood loss during the procedures was 109.30 mL. No cases necessitated conversion to multi-port robot, laparoscopy, or open surgery, and there were no major complications during the hospital stay or in the short-term follow-up. Early outcomes of post-radical prostatectomy indicated a biochemical recurrence rate of 4.0% over a mean follow-up duration of 6.40 months, with continence and potency recovery rates of 92.3% and 55.8%, respectively. Analysis of the learning curve showed no significant differences in operation time, console time, and positive surgical margin rates between the initial and latter 50 cases. Conclusions Extraperitoneal SP-RARP is a feasible and safe option for the treatment of localized prostate cancer in skilled hands.Continued accrual of cases is essential for future comparisons of SP-RARP with multiport approaches.

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.
Academies and Institutes ; Classification ; Continental Population Groups ; Geography ; Humans ; Immunoblastic Lymphadenopathy ; Korea* ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Pathology ; Retrospective Studies

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.
Academies and Institutes ; Diagnosis ; Humans ; Hutchinson's Melanotic Freckle ; Korea* ; Melanoma* ; Nevus, Pigmented ; Pathology ; Retrospective Studies