Many nonsurgical techniques are currently employed for outpatient treatment of hemor rhoids. Sclerotherapy, rubber band ligation, cryotherapy, laser therapy, infrared photocoagula tion and direct current therapy have been utilized in the management of hemorrhoids in the outpatient setting, but bipolar diathermy(BICAP) has not been introduced in korea yet. This study is a clinical analysis of 472 patients of hemorrhoids treated with BICAP bipolar diathermy at outpatient department from July 1996 to June 1997. Among them, 396 patients had been followed up for 3 to 15 months. Male to female ratio was 2.2:1 and mean age of male and female was 42.8 and 39.7 years, respectively. Duration of symptoms in 216 patients(57.6%) was below 5 years. The most frequent degree of internal hemorrhoids was second degree(62.7%), followed by third degree(23.9%), first degree (7.8%) and fourth degree(5.5%). Major presenting symptoms were prolapse combined with bleeding(45.8%), prolapse(21.2%) and bleeding(19.7%). In 62.9% of patients 3 piles were treated. Associated anorectal diseases with hemorrhoids, such as skin tags, thrombi and anal polyps were present in 179 patients. Among them, 126 patients were operated as outpatient operation procedure with BICAP therapy. Previous medical managements of hemorrhoids, such as use of rectal suppositories(32%), injection of sclerosing agents(8.6%) and hemorrhoidectomy(7.8%) were done in 240 patients(51%). Number of treatments was one session(88.7%), two sessions(10%), three sessions(1.1%) and four sessions(0.2%) in order of frequency. Mild to moderate anal discomfort was experienced during BICAP therapy by 215 patients(46%), mild sensation of local heat by 95 patients(20%) and mild bleeding by 10 patients(2%). No postdiathermy discomfort was observed in 337 patients(85.1%). However, postdiathermy bleeding and pain were present in 41 patients (10.4%) and 18 patients(4.5%), respectively. Results of followed up patients for 3 to 15 months were asymptomatic in 270 patients(68.2%), improved in 88 patients (22.2%), and no changed in 38 patients(9.6%). Among 18 patients with fourth degree hemorrhoids, only 2 patients(11%) became asymptomatic, 5 patients(28%) improved and 11 patients(61.9%) were not changed in their symptoms. Six patients experienced recurrent hemorrhoids requiring hemorrhoidectomy. In conclusion, bipolar diathermy(BICAP) for hemorrhoids is safe, easy to apply, painless, needs no anesthesia and bowel preparation with short time and repeated treatments and can be applied to first, second, third and some patients of fourth degree hemorrhoids. The effect of treatment was satisfactory in about 90%. Side effects were minimal compared to other nonoperative treatments. Therefore, the auther believes that bipolar diathermy(BICAP) is a desirable nonoperative treatment for internal hemorrhoids.
Anesthesia ; Cryotherapy ; Diathermy* ; Female ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids* ; Hot Temperature ; Humans ; Korea ; Laser Therapy ; Ligation ; Male ; Outpatients ; Polyps ; Prolapse ; Rubber ; Sclerotherapy ; Sensation ; Skin

One of the most interesting subjects in the field of dermatology has become the clarifying of the action mechanism of various drugs in promoting skin permeability in regard to their usefulness or harmfulness to various skin diseases. Although dimethyl sulfoxide (DMSO) detergents and propylene glycol were well known as having a promoting effect on the skin permeability, but the exact action mechanism of them was still unknown because of difficulty in methodology. So an attempt to clarify the action mechanism and find out the differences in the mode of action between them have been made by using frog skin, which has been used in research for the 'membrane transport', during past but having complex structures i.e. soley as 'skin' in this study was done. Abdominal skin was removed from frogs, Rana nigromaculata, captured on the area of Kyung Ki Do. In a series of experimental procedures about effect of experimental agents, short circuit current (SCC) as an estimate of net flux of sodium transport and potential difference (PD) was measured by the method of Ussing and Zerahn(1951). And changes of SCC and PD was observed during treatment with bathing mediums which contained agents and maintained iso-osmorality by varying amount of sodium chloride. These were compared including the effect of concentration of each experimental agent. The experimental agents used were DMSO and various detergent, i.e., sodium lauryl sulphate(SLS): anionic detergent, benzalkonium chloride (BAC): cationic detergents, and 'Tween-80: nonionic detergents. Results obtained are summarized on the followings. 1. The promoting effect of the sodium lauryl sulphate on the active sodium transport was reached to maximum within 10 to 20 min and was present until 40 min. after bathing with it, and thereafter, sodium transport was inhibited irreversibly at the both sides of the frog skin. And the maximal promoting effect of the SLS induced by increasing concentration had relationship in such a way on the saturation curve. 2. The active sodium transport was always increased on the inside of the frog skin after bathing with benzalkonium chloride (BAC) and in spite of changing of bathing medium with Ringer's solution, the active sodium transport was steadiIy increased even beyond the effect of BAC except temporally decreasing just after the bathing with Riger's solution. But the frog skin died within 20 min. at the outside after bathing with BAC. 3. Tween-80 brought about reversible reaction increasing the active sodium transport across the frog skin at the inside after bathing. And it seemed to be parallel to the degree of tle coneentration of it. 4. The effect of dimethyl sulfoxide (DMSO) on the active sodium transport across the frog skin was altered seasonaly, i.e., promoting sodium transport during the summer months hut inhibiting it during the winter months. So it was suggested that the action of DMSO on the sodium transport depends on the metabolic rates of the frog skin and the action differed from that of ADH hormone which promotes the sodium transports only in winter months. Also the effect of the DMSO differed from various detergents in view of seasonal variation and reversibility of the action of it. From the above resu]ts, this experimental method should be used more preferably using isolated frog skin in the research for clarifying the action mechanisms of the various other drugs in skin permeability.
Baths ; Benzalkonium Compounds ; Dermatology ; Detergents ; Dimethyl Sulfoxide ; Permeability* ; Propylene Glycol ; Ranidae ; Seasons ; Skin Diseases ; Skin* ; Sodium ; Sodium Chloride

Mucoepidermoid earcinoma occurred in about 2% among salivary gland tumor and in about 15% among malignant parotid gland tumor. The tumor occurred usually in elderly persons and arose as innocent-appearing swelling in the parotid gland region with gradual painless enlargement without alarming and it's usual size is less than 2 cm, However, a few of the poorly differentiated neoplasms grew rapidly and were painful and accompanied by facial nerve paralysis in about 15%. But it's prognosis is better than other salivary gland origin. We report a case of typical mucoepidermoid carcinoma of parotid gland origin which is occurred in 15 years old girl. The tumor begins pea sized painless nodule since about 2 years ago, and enlarged gradually to apple size and accompanied by facial nerve paralysis and pain sensation recently. But there was no evidence of tumor in parotid gland itself and no metastasis.
Adolescent ; Aged ; Carcinoma, Mucoepidermoid* ; Facial Nerve ; Female ; Humans ; Neoplasm Metastasis ; Paralysis ; Parotid Gland* ; Peas ; Prognosis ; Salivary Glands ; Sensation

Secondary localized amyloidosis of the skin is occasionaly associated with keratoma, epithelioma, seborrheic keratosis, chronic dermatitis, etc. It was generally known that amyloidosis, especially lichen amyloidosis, is frequently seen in atopic disorders. But the exact mechanism and relationship of atopic disorders to the development of the amyloidosis is obscure still nowadays. This 72 years old male patient was suffered from itching sensation on the whole body which is suggested to be atopic dermatitis since about 35 years ago and pruritic lichenoicl papulonodular eruptions developed on the extensor surface of the lower extremity first since about 10 years ago and then occured gradually on the thigh and extensor surface of the arm and forearm in both side. The charateristic lesions seems to be lichen amyloidosis. But we suggest thc case is secondary localized amyloidosis of the skin probably due to atopic dermatitis in according to past history, physical examination and eosinophilia without other definitive diseases, The therapeutic results were not promissing, however itching and lichenoid papules were much disappeared during the treatment with steroid cream for occlusivc dressing therapy and oral use of steroid.
Aged ; Amyloidosis* ; Arm ; Bandages ; Carcinoma ; Dermatitis ; Dermatitis, Atopic* ; Dronabinol ; Eosinophilia ; Forearm ; Humans ; Keratosis ; Keratosis, Seborrheic ; Lichens ; Lower Extremity ; Male ; Physical Examination ; Pruritus ; Sensation ; Skin ; Thigh

Disseminated superficial actinic porokeratosis (DSAP) is one of the recently found skin disorderes, which was differentiated from classicaI porokeratosis (Mibelli) and senile keratosis etc. in view of clinical features and hietogenesis by Marvin E. Chernosky on 1967. The one was 60 years old female patient, who had been suffered from multiple dark-brownish keratotic uniform minute papules on dorsa of the hands, forearms and neck with accompanying itching sensation since about 20 year's old of her age. The another one was 38years old housewffe, wha had been suffered from same lesions of the former on the face, neck, extremities especially sun-light exposed area. In both cases, skin lesions were exacerbated during each summer season and increase in numbers of the skin lesions with more severe itching sensation. Chernosky postulated none of a dark-sklnned race affording natural protection against sun-light had skin lesion of D S A P, we were abIe to find out two cases of typical D S A P ih the Korea.
Continental Population Groups ; Extremities ; Female ; Forearm ; Hand ; Humans ; Keratosis ; Korea ; Middle Aged ; Neck ; Porokeratosis* ; Pruritus ; Seasons ; Sensation ; Skin

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.
Anal Canal ; Chickens ; Digital Rectal Examination ; Edema ; Female ; Hemorrhoids ; Humans ; Male ; Nylons ; Proctoscopy ; Prolapse ; Sigmoidoscopy ; Spasm ; Surgical Instruments

PURPOSE: Post-hemorrhoidectomy secondary hemorrhage is a rare but serious complication after a hemorrhoidectomy. This study analyzed the factors associated with secondary hemorrhage following a surgical hemorrhoidectomy. METHODS: A total of 1,751 patients received a semiclosed hemorrhoidectomy for symptomatic hemorrhoidal disease from May 2001 to January 2004. A retrospective study of 17 patients with post-hemorrhoidectomy secondary hemorrhage was done. Fourteen patients (82 percent) underwent surgery primarily for hemorrhoidal disease, two patients (12 percent) had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient (6 percent) had a hemorrhoidectomy with fistulectomy. The variables analyzed included age, gender, incidence, recurrence, hospitalization, bleeding tendency, blood transfusion, and management. RESULTS: The male to female ratio was 1.83:1 (P>0.05), and the mean age was 38.9 (range 19~55) years. The incidence of post-hemorrhoidectomy secondary hemorrhage was 0.98 percent. The mean interval from the operation to hemorrhage was 8.9 (range 4~18) days. The period of mean hospitalization was 4.5 (range 2~8) days. As predisposing factors, 3 patients had suspected liver disease with normal platelet count. The mean 1.90 gm/dl of Hgb at the time of secondary hemorrhage was lower than the preoperative values. One patient (5.9 percent) required 3 units of red blood cell transfusions. Treatment modalities included observation alone in three patients (18 percent), and suture ligation in the operating theater in fourteen patients (82 percent). None of the patients developed recurrent bleeding. CONCLUSIONS: Post-hemorrhoidectomy secondary hemorrhage is an inevitable and a troublesome complication. The patient will need to be transferred rapidly to a hospital and resuscitated if necessary. The author favors suture ligation in controlling secondary hemorrhage. Suture ligation offers a good outcome with virtually no risk of recurrent bleeding. Post- hemorrhoidectomy secondary hemorrhage usually occurs at home between the fourth and eighteenth postoperative day and takes place in 0.98 percent of hemorrhoidectomies. In the author's opinion, post-hemorrhoidectomy secondary hemorrhage usually is not a preventable complication.
Blood Transfusion ; Causality ; Erythrocyte Transfusion ; Female ; Fissure in Ano ; Hemorrhage* ; Hemorrhoidectomy ; Hemorrhoids ; Hospitalization ; Humans ; Incidence ; Ligation ; Liver Diseases ; Male ; Platelet Count ; Recurrence ; Retrospective Studies ; Sutures

BACKGROUND: It has been a standard practice in many institutions to combine light general anesthesia with epidural block for abdominal and pelvic surgery. We attempted to prove the effectiveness of prehydration and to find an suitable epidural local anesthetic dose in terms of hemodynamic stability for upper abdominal surgery. METHODS: For preliminary studies, 11 patients scheduled for elective upper abdominal surgery had received general anesthesia immediately after epidural anesthesia. After epidural injection of 10~16 mL of 2% plain lidocaine into the T9~10 intervertebral space, the changes in blood pressure were observed. Thirty-two patients scheduled for elective upper abdominal surgery were divided into two groups. In group A (study group), after prehydration with Hartmann solution (10 mL/kg), 5~7 mL of 2% plain lidocaine was injected into T8~9 or T9~10 intervertebral space and general anesthesia was then induced. Group B (control group) received general anesthesia only. RESULTS: There were no significant differences in hemodynamics between the epidural with general anesthesia and the control group except SVR (systemic vascular resistance). SVR in group A increased in contrast to the group B in which it remained unchanged. CONCLUSIONS: The combined epidural and general anesthesia, using prehydration and 0.5~1 mL/segment of 2% plain lidocaine at the T8~9 or T9~10 intervertebral space was safe without significant hemodynamic changes.
Anesthesia, Epidural ; Anesthesia, General* ; Blood Pressure ; Hemodynamics* ; Humans ; Injections, Epidural ; Lidocaine

No abstract available.
Humans ; Inpatients*

No abstract available.
Humans ; Infant, Newborn* ; Streptococcus pneumoniae* ; Streptococcus*