Hemorrhoids have afflicted man since the dawn of history. They are among the first conditions described as contributing to the discomfort of humans. When we consider over 90 percent of accurately diagnosed, symptomatic hemorrhoids can be treated without an operation, we have to get detailed information on the several techniques of nonsurgical treatment of hemorrhoids. Modern as well as traditional, drugs are being increasingly used in all grades of symptomatic hemorrhoids. Although drugs can reduce edema, relieve pain, and help in thrombosis, they cannot definitively cure hemorrhoids. Several modes of therapy, not involving surgical excision, have been advocated for the treatment of hemorrhoid patients. These include injection sclerotherapy, cryotherapy, rubber band ligation, infrared photocoagulation, and diathermy. The mechanisms are principally the same, irrespective of which is chosen, as all function ablatively by thrombosis, sclerosis, or necrosis of a part of the internal portion of the hemorrhoidal complex and thereby decrease the volume of the cushions, possibly fixating them in the distal rectum. Usually, rubber band ligation is considered the first treatment for first- to third- degree hemorrhoids, and a hemorrhoidectomy should be reserved for those failing to respond to a ligature procedure. Recently, new treatment modalities for hemorrhoids, such as radiofrequency or hemorrhoidal artery ligation, have been developed to treat symptomatic hemorrhoids. We can choose suitable procedures according to the degree of the hemorrhoids.
Arteries ; Cryotherapy ; Diathermy ; Edema ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Ligation ; Light Coagulation ; Necrosis ; Rectum ; Rubber ; Sclerosis ; Sclerotherapy ; Thrombosis

PURPOSE: Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to review and analyze our cases for more information and in order to achieve more adequate and prudential application. METHODS: We performed 2609 colonoscopic polypectomies from January 1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or the EPMR technique. We analyzed those 77 lesions with special reference to size, configuration, and histologic diagnosis. RESULTS: The most common age group was the 5th decade. The male-to-female ratio was 1.75:1. The most common sites of the lesions were the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile (31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size, and the only submucosal cancer was below 5 mm in size and was a depressed lesion. Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for 9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no complications such as bleeding, perforation, or recurrence. CONCLUSIONS: EMR and EPMR are useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic lesions. Lesions up to 15~20 mm in size are good candidates for EMR and those up to 40 mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent recurrence or complications such as bleeding or perforation.
Adenocarcinoma ; Adenoma ; Carcinoid Tumor ; Colon, Sigmoid ; Colorectal Neoplasms ; Diagnosis ; Hemorrhage ; Humans ; Inflammation ; Rectum ; Recurrence

Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25~56) years. The mean follow-up after operation was 33 (range, 8~62) months. The etiology of the fistula in the majority of patients was obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should be performed.
Colostomy ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Manometry ; Postoperative Complications ; Radiotherapy ; Rectovaginal Fistula* ; Recurrence ; Rubber ; Ultrasonography ; Wound Infection

No Abstract Available.
Allografts* ; Posterior Cruciate Ligament*

PURPOSE: The number of patients with HIV disease has been increasing rapidly, with anorectal discomfort being the most common complaint of these patients. However, there are no data on HIV disease relating to the benign anorectal area in Koreans. METHODS: A retrospective chart review was performed on patients diagnosed with benign anal diseases, combined with HIV disease, between 1996 and 2001. Their clinical aspects were compared with HIV patients registered with the National Institute of Health in Korea between 1985 and 2001. RESULTS: A total of 1,613 patients were registered, with the National Institute of Health in Korea, as having HIV disease. The ratio of sex was 7.2:1, with a male predominance. The disease was most common in the 3rd & 4th decades, with 64.2%, of the patients in this age range. As for the routes of transmission, sexual contact was the most common (96.9%), followed by blood transfusion (including blood products) (2.8%), vertical transmission (0.1%) and drug injection (0.1%). With regard to the sexual contact routes, homosexuality accounted for 28.0%. Of the cases of HIV disease presenting with a benign anal disease, 32 patients, with a sex ratio of 31:1, with an overwhelming male predominance, were selected. Twenty-six cases had been newly diagnosed at our hospital. As for the routes of the transmission, the disease had been transmitted by sexual contact in all cases. In 43.8% of these cases, the disease had been transmitted by homosexual contact, which showed a marked difference to that of the National database (P<0.05). For those associated with an anal diseases, there were 10 cases of anal fistula, 9 of perianal abscess, 7 of condyloma acuminata, 7 of anal fissure, 5 of hemorrhoids and 2 of ulceration on the lower rectum, noted. CONCLUSIONS: Nowadays, the numbers of anorectal-disease patients with HIV are increasing in Korea. Since HIV is common in the area of benign proctology, all proctologists must consider the possibility of HIV when managing patients.
Abscess ; Blood Transfusion ; Colorectal Surgery ; Fissure in Ano ; Hemorrhoids ; HIV Infections ; HIV* ; Homosexuality ; Humans ; Korea ; Male ; Rectal Fistula ; Rectum ; Retrospective Studies ; Sex Ratio ; Ulcer

Purpose: This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention. Methods: One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention). Results: Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374). Conclusion Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

During the course of evaluation and management of neck masses, consideration for Immunoglobulin G4-related disease (IgG4-RD) should be given. IgG4-RD is relatively a new growing entity of immune-mediated origin, characterized by a mass-forming lesion, the infiltration of IgG4-positive plasma cells and occasionally elevated serum IgG4. The most common manifestations are parotid and lacrimal swelling, lymphadenopathy and autoimmune pancreatitis. A previously healthy 72-year-old man was referred to our clinic with a 2-month history of left cervical lymph node enlargement without systemic manifestations . A cervical lymph node biopsy was planned because of elevated serum IgG4 levels. Pathological findings showed prominent infiltration of IgG4-postive plasma cells in the lymph node. After steroid therapy, a computed tomography scan revealed a decrease in the cervical lymph node size. This case illustrates the importance of including IgG4-RD in the differential diagnosis of a cervical lymph node enlargement.
Aged ; Biopsy ; Diagnosis, Differential ; Humans ; Immunoglobulin G ; Immunoglobulins ; Lymph Nodes* ; Lymphatic Diseases* ; Neck ; Pancreatitis ; Plasma Cells

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

PURPOSE: Superficial temporal artery(STA) aneurysms are very rare and mostly occur as pseudoaneurysms secondary to trauma. Clinical diagnosis of STA pseudoaneurysm is based on a history of trauma or surgery to frontotemporal region, which presents with pulsatile mass. To confirm diagnosis, many imaging strategies can be used such as digital subtraction angiography, sonography, CT and MRI. But, these imaging modalities are invasive or inaccurate or expensive. Thus, we used 3D CT angiography to confirm STA aneurysm and to get accurate information. METHODS: We have experienced two cases of pulsatile mass on the temporal area, suspected as STA pseudoaneurysms. On the basis of clinical information, we performed 3D CT angiography to get more accurate information about this pulsatile mass and to confirm diagnosis. On the basis of information from 3D CT angiography, we performed operation. RESULTS: The lesions were diagnosed as pseudoaneurysm of superficial temporal artery by 3D CT angiography, and surgically resected safely without any complication on the basis of information from 3D CT angiography. 3D CT angiography was excellent diagnostic method for detecting STA pseudoaneurysms, and effectively showed many information about pseudoanerysms such as relationship between the aneurysms and surrounding structures, and its size. CONCLUSION: We could effectively diagnose and treat on the basis of information from 3D CT angiography. We present our cases with a brief review of the literature related to STA traumatic pseudoaneurysms.
Aneurysm ; Aneurysm, False* ; Angiography* ; Angiography, Digital Subtraction ; Diagnosis ; Magnetic Resonance Imaging ; Temporal Arteries*

A 3-year-old girl had multiple anomalies compatible with Treacher Collins Syndrome (TCS). From the neonatal period, sucking was poor, making tube feeding necessary. Excessive saliva was retained in the oral cavity. Nasal leakage caused by the cleft palate was observed when she spoke. The initial videofluoroscopic swallow study (VFSS) showed a poor posterior bolus transit and nasopharyngeal regurgitation. A delayed swallow reflex and bolus stasis at the vallecular and pyriform sinuses were recognized. Based on the VFSS findings, the patient underwent palatoplasty at 20 months of age. At approximately 23 months of age, a follow-up VFSS was performed; poor posterior bolus transit, nasopharyngeal regurgitation, and delayed swallow reflex were not observed. Finally, the patient was able to eat ground or chopped foods and solid foods orally. We deem VFSS to be helpful in deciding the appropriate management of dysphagia in TCS.
Child, Preschool ; Cleft Palate* ; Deglutition Disorders ; Enteral Nutrition ; Female ; Fluoroscopy ; Follow-Up Studies ; Humans ; Mandibulofacial Dysostosis* ; Mouth ; Pyriform Sinus ; Reflex ; Saliva