Eleven patients underwent posterior sagittal anorectoplasty(PSARP) as a secondary procedure. Two of them had rectovaginal fistula and another two had rectocutaneous fistula. Six of the rest complained of frequent fecal soiling and the last one had severe anorectal stricture after perineal anoplasty. Five patients had lived with colostomy until the second operations were carried out. The ages at the time of the secondary PSARP were between 7 months and 29 years. Distal colostogram and MRI were taken to evaluate distal colon, position of the rectum and voluntary muscle. All patients had normal sacrum except one who had anorectal stricture. Seven patients, six with fecal incontinence and the other one with rectovaginal fistula had mislocated anorectums. Three patients, two with rectocutaneous fistula, the other one with anorectal stricture, had abdominal approach to obtain enough length of colon for pull-through procedure. With the posterior midsagittal approach, we could manage all the problems, rectovaginal fistulas, rectocutaneous fistulas, strictures and malpositioned rectums, without difficulty. No patients had serious complications except wound infection in one. All patients were satisfied with the results after redo-PSARPs even though normal continence has been achieved in only one patient. Seven patients who had continuous soiling or rectocutaneous fistula, needed no more diapers even though four of them showed fecal staining under stressful condition and the other three showed intermittent fecal leaking less than once a day. The rest three of the patients maintained their continence with support of drugs and/or enemas because of constipation. The PSARP is a popular procedure as a primary operation; however, our results suggested that this procedure also gave us a good opportunity for management of serious complication developed after primary anoplasties.
Colon ; Colostomy ; Constipation ; Constriction, Pathologic ; Enema ; Fecal Incontinence ; Fistula ; Humans ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Rectovaginal Fistula ; Rectum ; Sacrum ; Soil ; Wound Infection

No abstract available.
Cerebral Hemorrhage* ; Eclampsia* ; Female ; Pregnancy

PURPOSE: The effects of pain on brain is not well known. Also, differences between somatic and visceral pains have not been fully elucidated. This study was conducted to investigate changes in the expression of c-Fos protein after somatic and visceral pains were induced by formalin. METHODS: Male rats(n=65) were underwent one of three procedures : (i) Control group, rats were left undisturbed in their cages; (ii) Somatic pain group, rats were injected subcutaneously with 0.1 ml of 10% formalin in the plantar surface of right hindpaw; (iii) Visceral pain group, rats were administered with same amount of formalin, as described above, in the rectum. Rats were sacrificed at increasing times(30 minutes, 1 hour, 2 hours, 6 hours, 1 day, 3 days and 7 days) after noxious formalin stimuli to hindpaws and rectums. Rat brains were removed and sliced in rat brain matrix. Brain slices were coronal sectioned at interaural 5.70-6.70mm. Serial sections were immunohistochemically reacted with polyclonal c-Fos antibody. The numbers of c-Fos protein immunoreactive neurons in cingulate cortex, primary somatosensory area, and hippocampus were examined and analyzed statistically with Mann-Whitney U test. RESULTS: 1) The numbers of c-For protein immunoreactive neurons in cingulate cortex, primary somatosensory area and hippocampus peaked at 2 hours after somatic pain stimuli and reached almost normal conditions at 7 days. 2) The numbers of c-Fos protein immunoreactive neurons in cingulate cortex, primary somatosensory area and hippocampus peaked at 1 day after visceral pain stimuli and reached almost normal conditions at 7 days. 3) The numbers of c-Fos protein immunoreactive neurons of somatic pain groups were higher than that of visceral groups at all times and the difference of numbers peaked at 2 hours after pain stimuli. CONCLUSION: Reactions of somatic pain stimuli influenced more changable than visceral pain stimuli to brain. Conduction velocities of somatic pain were more faster than those of visceral pain. Higher numbers of c-Fos protein immunoreactive neurons were found in specific regions. These results provide some basic knowledge in understanding the mechanism and control of pain.
Animals ; Brain* ; Formaldehyde* ; Gyrus Cinguli ; Hippocampus ; Humans ; Male ; Neurons* ; Nociceptive Pain ; Rats* ; Rectum ; Visceral Pain

Bilateral absence of the patella as an isolated congenital abnormality is an extremly rare condition. Three members in a family were found to be afflicted with the condition. Clinical examination failed to reveal any stigmata of hereditary osteo-onychodysplasia.
Christianity ; Congenital Abnormalities ; Humans ; Nail-Patella Syndrome ; Patella

We report one case of aseptic necrosis of both talus which has developed without any evidence of previous trauma. Aseptic necrosis of the talus is known to occur after any trauma which result in iterruption the blood supply to talus. Atraumatic aseptic necrosis of talus is extremely rarre condition. Some cases of atraumatic aseptic necrosis of talus were repoted by some authers, in whom Garcia described the first case in 1928. Most of the reported atraumatic aseptic necrosis were due to long term steroid therapy for unrelated medical problems and others were related to Alcoholism, Sepsis and Tuber culosis. ln this case we think for it may be caused or contributed by steroid therapy.
Alcoholism ; Necrosis ; Sepsis ; Talus

Leukemia cutis, skin lesions in leukemia, are clinically divided into specific and nonspecific types. Specific skin lesions demonstrate malignant cell infiltrate when the biopsy is done. We have encountered a typical case of specific skin lesions of leukemia cutis associated with acute lymphocytic leukemia in a 18-year-old male patient. There were multiple, pinhead to rice sized, skin colored to lemon yellow colored, discrete papules on the face, neck and trunk. A review of the literature is presented with a brief discussion of this case.
Adolescent ; Biopsy ; Humans ; Leukemia* ; Male ; Neck ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Skin

No abstract available.
Humans

Activation of T cells for an immune response requires the participation of antigen presenting cells (APC) that express class II major histocompatibility complex gene products on their surface. Until recently, the macrophages have been considered to be the prime candidates for this role, but it is now recognized that other cells, including dendritic cells, B cells, activated T cells and endothelial cells, can present antigen effectively. Particularly, among them, dendritic cells (DC) are considered to be very efficient APC for various T -cell dependent immune responses in comparison with other types of APC. Nonlymphoid dendritic cells including Langerhans cells and interstitial dendritic cells strongly express the MHC class II products and have characteristic dendritic morphology. As far as we know, there is no study on the ontogeny of MHC class II -immunoreactive dendritic cells in the rat tongue. The aim of the present study is to investigate the ontogeny and morphological characterization of dendritic cells in the tongue of growing and developing rats. The distribution and morphology of the dendritic cells in the rat tongue were studied from the fetal 15 -day until 180 days after birth by means of immunocytochemical methods using anti -rat MHC class II monoclonal antibodies. The results were as follows: 1. MHC class II -immunoreactive dendritic cells were first found in the muscle layer of 17 -day fetus, and in the epithelium and lamina propria of the tongue at birth. 2. The number of MHC class II -immunoreactive dendritic cells was gradually increased with age, particularly, in the epithelium at 14th day, in the lamina propria at 14th day, and in the muscle layer at 21st day after birth. 3. Numbers of MHC class II -immunoreactive dendritic cells were higher in the dorsal part than in ventral part of the tongue at all developmental stages. Especially, dendritic cells were twice higher numbers in the epithelium, a little higher numbers in the lamina propria and almost same numbers in the muscle layer. 4. With age, shapes of MHC class II -immunoreactive dendritic cells were changed from round to dendritic and aggregated together. In conclusion, the above results suggest that the increases of the number and the changes of the morphology in MHC class II -immunoreactive dendritic cells, with age may influence on effects of cell -mediated immune responses.
Animals ; Antibodies, Monoclonal ; Antigen-Presenting Cells ; B-Lymphocytes ; Dendritic Cells* ; Endothelial Cells ; Epithelium ; Fetus ; Growth and Development* ; Langerhans Cells ; Macrophages ; Major Histocompatibility Complex ; Mucous Membrane ; Parturition ; Rats* ; T-Lymphocytes ; Tongue*

PURPOSE: To analyse the sequential sonographic findings of cystic PVL and to evaluate relationship between sonographic grading of PVL and patterns of neurologic outcomes. MATERIALS AND METHODS: Authors have retrospectively analysed the sequential sonographic findings of 36 cases of PVL in the preterm neonates. Initial sonographic features done within 3 days of life were divided into 3 patterns such as normal, localized, and diffuse hyperechogenic flare. Grading of PVL confirmed by follow-up studies was classified as involvement of one lobe (grade 1), two lobes (grade 2) and more than extent of grade 2(grade 3). The relationship between sonographic grading of leukomalacia and later neurologic outcomes were also analysed. RESULTS: Initial sonographic patterns according to grading of PVL were normal pattern in seven of nine (77.8%) of grade 1, diffuse hyperechogenic flares in five of eight cases of grade 2 and in 13 of 16 cases of grade 3. There was a significant difference bewteen the grades and frequency of pattern of diffuse hyperechoic flare (p=0.021). Average detection timing of cystic PVL was 38.4+/-18.9 days in grade 1, 29.8+/-14 days in grade 2, and 19.1+/-5.6 days in grade 3 with a significant statistical difference between the detection time and grades (p=0.037). Cerebral palsy has occurred in 62.5% of grade 1 and 100% of grade 2 and grade 3 (p=0.043). Frequency of spastic quadriplegia was higher in grade 3 (76.5%) than in grade 1 (25%) and grade 2 (12.5%) (p=0.001). CONCLUSION: Most of grade 1 cystic PVL revealed normal pattern of white matter echogenicity in initial ultrasonography and needed follow up examination over one month period. Spastic quadriplegia occured mainly in patients with grade 3 cystic PVL.
Cerebral Palsy ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Newborn* ; Leukomalacia, Periventricular* ; Quadriplegia ; Retrospective Studies ; Ultrasonography*

It is constant controversy that exercise influence muscle regeneration in peripheral neuropathy. The aim of this experiment is to show that treadmill running exercise under well-controlled conditions is to improve of regeneration in rat gastrocnemius muscles after sciatic nerve crushing injury. Male Sprague-Dawley rats (1 month old, weight 150~180 g) were submitted to bouts of exercise on a treadmill up a 10 degrees decline and speed is 20 m/min for 60 min per day and gastrocnemius muscles were analysed at different exercise periods (5, 10, 15, 20 and 40 days) by immunohistochemistry in comparison with injured non-exercised muscles. Rats were sacrificed at 12th (5 days exercise), 19th (10 days exercise), 26th (15 days exercise), 33rd day (20 days exercise), 61st day (40 days exercise) after sciatic nerve crushing injury. It showed that type II myofibers (target fibers) on center area had reinnervation at sciatic nerve crush injury at 26th day in exercise rats, as at 33rd day appeared giant type II myofibers, myofibers grouping observed in regenerative muscle character, component ratio of closed normal muscle showed at 61st day. Giant type II myofibers showed at 33rd day in non-exercise rats, however did not nearly normal muscle at 61st day. Therefore we concluded that treadmill running exercise is able to improve regeneration processes in gastrocnemius muscles after sciatic nerve crushing injury of rats.
Animals ; Benzeneacetamides ; Humans ; Immunohistochemistry ; Male ; Muscles ; Myosins ; Peripheral Nervous System Diseases ; Piperidones ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Running ; Sciatic Nerve