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No abstract available.
Diagnosis* ; Heart Failure* ; Heart Septal Defects, Ventricular ; Heart*

Crypt glandular infection theory is accepted as an explanation of anal fistula's major cause. However, the pathogenesis of an anal fistula in Crohn's disease is different from that of a conventional anal fistula because a Crohn's anal fistula is caused by ulceration which, in turn, is caused by transmural inflammation of the rectal wall due to Crohn's disease. The difficulty with operating on anal fistulas in Crohn's disease lies in the fact that healing of the wound is inhibited because of continuous inflammation of the anorectal tissue due to Crohn's disease. Hence, there is a high possibility of incontinence due to sphincter muscle injury. Especially, because almost all Crohn's disease patients have frequent defecation and diarrhea, the patients will suffer more if incontinence occurs. Nowadays, even with increased understanding of the etiology of Crohn's disease, new medications, and aggressive surgical approaches, the result of treatment is still not satisfactory. Recently, since Korean eating habits have changed to include more western-style food in the diet, inflammatory bowel disease, such as Crohn's disease, is expected to increase. Consequently, the number of cases of anal fistulas in Crohn's disease is also expected to increase. The authors reviewed 20 confirmed cases of anal fistulas in Crohn's disease, which were treated from January 1993 to December 1995 at Song-Do Colorectal Hospital. The results are as follows: 1) Anal fistulas in Crohn's disease were present in 20(0.6%) of the 3378 cases of anal fistulas treated during the time period considered. 2) The male to female ratio for these 20 cases was 2: 1, and the most Prevalent age group was the 3rd decade, followed by the 2nd decade, the 4th decade, and the 5th decade in that order. 3) Three cases of anal fistulas whose origins could be explained by crypt glandular infection theory and which did not involve the rectum healed, although the healing was delayed. 4) Seventeen cases of anal fistulas whose origins could not be explained by crypt glandular infection theory and which involved the rectum did not heal after the operation. he results of the study show that anal fistulas whose origins can be explanined by crypt glandular infection theory and which do not involve the rectum can be cured by conventional fistula surgery. However, perirectal fistulas whose origins can not be explained by crypt glandular infection theory and which involve the rectum do not heal. Because there is the possibility of incontinence after a conventional operation, it is suggested that, in the cases of perirectal fistulas in Crohn's disease, better results, although not completely satisfactory, can be obtained by long-term seton drainage and diversion colostomy.
Colostomy ; Crohn Disease* ; Defecation ; Diarrhea ; Diet ; Drainage ; Eating ; Female ; Fistula ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Male ; Rectal Fistula* ; Rectum ; Ulcer ; Wounds and Injuries

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Recently, inireaing numbers of chemotherapeutic agens are being used to treat cancer patients. Mucocutaeous complications are commonly sen in association with the administration of these medicaticins. OBJECTIVE: We conducted a study in cancer chemotherapy patient so determine the suspected chemotherapeutic agents ancl frequency of various mucocutaneous side effects in these patients. METHODS: The study involved 140 patients admitted from Decerrae 1993 to September 1994 for cancer chemot herapy at Korea University Guro Hospital. RESULTS: The mucocutaneous side effects during chemotherapy were alopecia(55%), hyperpig mentation(32.9%), stomatitis(20%), phlebitis(12.9%), flushing(8.6%) descending order. Visual grade II, IV alopecia patients were most common, but as the chemot retpy cycle increased so, the severer the alopecia. Although the onset of the alopecia were variake many patients experienced alopcia within 17 to 24 days after the start of chemotherapy. Serpeitie supravenous fluorouracil hyperpigmentation were commor,(17.9%), Diffuse and longitudinal or horizontal band like nail pigmentation were observed, and, pigmented macules were also observei, epecially on the palms and digits. Stomatitis usually developed within 10 days after the start of chemotherapy and it persist ed for about 7 days and the most of the lesions were resolved spor Laeously. Other clinical manifestations accompanied with chmotherapy were tinea infection(16.4%), acne(7.1%), oral thrush (7%), white nail band(4.3%), pruritus(2.9%) in descending order. CONCLUSION: So, physiciars need to be aware of the widely divergnal cutaneous reactions which may occur with the use of antiancer medications.
Alopecia ; Candidiasis, Oral ; Drug Therapy* ; Fluorouracil ; Humans ; Hyperpigmentation ; Korea ; Pigmentation ; Stomatitis ; Tinea

No abstract available.
Osteotomy*

No abstract available.
Humans ; Humerus* ; Neck* ; Shoulder Dislocation* ; Shoulder* ; Tears*

No abstract available.
Dislocations* ; Head* ; Hip* ; Necrosis*

The fibroepithelial polyp of the ureter is a rare, benign tumor. Its pathogenesis is unclear, but most investigators agree that it arises from elements of mesodermal origin within the ureteral wall. Symptoms include hematuria and intermittent flank pain secondary to partial ureteral obstruction. Correct radiologic assessment is crucial to direct surgical management. We report a case of a fibroepithelial polyp of the ureter in a child in whom correct preoperative diagnosis was made by correlating the results of excretory urography, sonography, CT and urine cytology.
Child* ; Diagnosis ; Flank Pain ; Hematuria ; Humans ; Mesoderm ; Polyps* ; Research Personnel ; Ureter* ; Ureteral Obstruction ; Urography

BACKGROUND: For anesthesia in cesarean section N2O and low concentrations of inhalation anesthetics are regarded as the anesthetic agent of choice. But a low level of anesthesia frequently leads to increased maternal hemodynamic responses and awareness. The effects of a 3 microgram/kg fentanyl bolus injection after umbilical cord clamping was evaluated in 20 full-term parturients, scheduled for elective cesarean section, versus to 20 parturients without fentanyl. METHODS: The forty parturients (ASA physical status 1, 2) scheduled for cesarean section were randomized to either a N2O-enflurane (E group) or a N2O-enflurane-fentanyl (F group). Thiopental sodium (4 mg/kg) and succinylcholine (1.5 mg/kg) were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 50% N2O and 1% enflurane in oxygen until delivery. After delivery, the intravenous injection of 0.5 mg/kg of atracurium was administered, controlled ventilation was applied to maintain PetCO2 at 30 to 35 mmHg with N2O (3 L/min) and O2 (1.5 L/min). Immediately after clamping the umbilical cord, 3 microgram/kg of fentanyl (F group only) was administered. Heart rate, blood pressure, awareness, recovery time, postoperative complication and recall were evaluated. RESULTS: Heart rate values at 10 and 20 min after umbilical cord clamping and 5 min after extubation, and mean arterial pressure at 5, 10 and 20 min after umbilical cord clamping in group F were found to be significantly lower than in group E. CONCLUSIONS: We conclude that N2O-enflurane-fentanyl at 3 microgram/kg is clinically satisfactory in anesthesia for cesarean section, having no adverse effects on the mother.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Arterial Pressure ; Atracurium ; Blood Pressure ; Cesarean Section* ; Constriction* ; Enflurane ; Female ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation, Intratracheal ; Mothers ; Oxygen ; Postoperative Complications ; Pregnancy ; Succinylcholine ; Thiopental ; Umbilical Cord* ; Ventilation