Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.
Botulinum Toxins ; Botulinum Toxins, Type A ; Frustration ; Ganglion Cysts ; Humans ; Muscle Relaxation ; Nerve Block ; Neurotransmitter Agents ; Pain Perception ; Urinary Bladder

A pair of eyes of a 18 year-old girl with advanced congenital glaucoma was examined by light and electron microscopy. Results were as follows: 1. Trabecular meshwork and iris root showed fibrosis. 2. Schlemm's canal was absent. 3. Endothelium of the trabecular meshwork was degenerated. 4. Ciliary body was atrophied. 5. Inner layer of retina showed degeneration with the loss of nerve fiber layer and ganglion cell layer, which was replaced by Mueller cells. 6. Optic nerve showed atrophy from a loss of nerve fibers and there was proli feration of collagen tissue.
Adolescent ; Atrophy ; Ciliary Body ; Collagen ; Endothelium ; Female ; Fibrosis ; Ganglion Cysts ; Glaucoma* ; Humans ; Iris ; Microscopy, Electron ; Nerve Fibers ; Optic Nerve ; Retina ; Trabecular Meshwork

Since introduction of venous flap in 1980, many experimental studies and clinical applications of various kinds of venous flaps were reported. Venous flap has the following advantages : (1) nonbulky and goo-quality of flap (2) long & large vascular pedicle (3) easy & rapid elevation of flap (4) no sacrifice of major arteries (5) a single operative field. But, we also have some disadvantages of difficult handling of the pliable veins and the tmcertainty of flap survival. For the better result we had to design the size of the flap larger than that of defect and increase the number of draining vein to reduce the postoperative edema of the flap. We have treated the defects of soft tissue of the hand using free arterialized venous flap from the flexor aspect of the forearm & had an excellent results.
Arteries ; Edema ; Forearm ; Hand* ; Veins ; Wounds and Injuries*

Iridocorneal endothelial syndrome is a disease characterized by corneal endothelial degeneration, corneal edema, peripheral anterior synechia, iris stromal change, and secondary glaucoma. This syndrome is considered to have three major variations: Chandler's syndrome, progressive (essential) iris atrophy, and Cogan-Reese syndrome. We experienced three cases of iridocorneal endothelial syndrome with transient intraocular pressure elevation.

The introduction of beta-adrenergic blocking agents for the treatment of glaucoma was a major advance in the continued search for medications that effectively control the intraocular pressure with minimal side effect. Beta-adrenergic blocking agents block the aqueous pump of the ciliary epithelium resulting in decreased aqueous formation and drop in intraocular pressure. The fact that beta-adrenergic blocking agents had an affinity to intraocular tissues containing melanin granules has been reported. The purpose of this study is to know that mechanism of decrease of intraocular pressure and an affinity to melanin granules of the beta-adrenergic blocking agents. Two drops of 1% befunolol were instilled in the albino and pigmented rabbits, and the eyes were enucleated on 1, 2, 6 and 24 hours after instillation. These eyes were studied with electron microscopic examination. The results were as follows: 1. In the non-pigment epithelium of the ciliary body, mitochondria became swollen. 2. These changes appeared earlier and were more remarkable in albino rabbits than in pigmented ones. 3. In pigmented rabbits, these changes appeared slowly, but continued for longer duration and it seems to be due to affinity of beta-adrenergic blocking agents to the melanin pigment. 4. Swelling of mitochondria at the non-pigmented epithelium of the ciliary body after instillation of beta-adrenergic blocking agents seems to be the pharmacological mechanism of the drugs against aqueous formation in the ciliary body.
Adrenergic beta-Antagonists ; Ciliary Body ; Epithelium* ; Glaucoma ; Intraocular Pressure ; Melanins ; Mitochondria ; Rabbits

Purpose: The purpose of this qualitative study was to explore the transition experiences of the elderly from long-term care hospitals to their homes. Methods: The participants were eight elderly medicaid beneficiaries, who had been the subjects from the community care project in Korea. The data were collected with one-on-one interviews from April to November in 2020, and analyzed by phenomenological steps. Results: The seven themes derived in this study were ‘Space to escape’, ‘Reliable supporter opened the way to discharge’, ‘Comfortable life at home’,‘Obstacles to independent life’, ‘Struggling to live alone’, ‘Fence for community life’, and ‘Energizing in daily life’ Conclusion The results revealed the positive aspects of Community Care program in Korea. However, it is suggested that active communication between hospitals and community care institutions, and improvement of home environment to live in the community before discharge should be required. And system revision is needed to adjust activity in their home and support health problems of the elderly in the early stage of discharge. The results of this study can be referred to as the foundation of transitional care for the elderly.

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.
Enophthalmos ; Entropion* ; Eyelids ; Tendons

Generally accepted mechanisms of involutional entropion are as follows: 1. dysfunction of the inferior eyelid retractors, 2. migration of the preseptal orbicularis fibers upward, 3. reduced support of the lower lid against glove due to enophthalmos, 4. reduced horizontal support because of involutional changes in the lateral and medical canthal tendons. Sanford D. Hecht reported that the above four problems could be corrected simply and successfully by a full thickness excision of Bowlegs shape(Pentagon-shape). Five eyelids of involutional entropion were treated by the Boelegs procedure. The results were successful.
Enophthalmos ; Entropion* ; Eyelids ; Tendons

Abdomianl pregnancy is rare, occurring 9.2 cases per 1,000 ectopic pregnancies and encountered in 1 in 10,000-25,000 births. Omental pregnancy is extremely rare form of abdominal pregnancy that may cause life-threatening massive hemorrhage in case of rupture. The clinical characteristics is variable and physical examination by itself may be insufficient for diagnosis. Early and accurate diagnosis is necessary to decrease fetal and maternal mortality and morbidity, serious complications. We report a case of ruptured early omental pregnancy with a review of literature.
Diagnosis ; Female ; Hemorrhage ; Maternal Mortality ; Parturition ; Physical Examination ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Rupture

PURPOSE: Neuroendocrine differentiation and expression of drug resistance may affect the response to chemotherapy and the prognosis of advanced non-small cell lung cancer. We conducted retrospective study to evaluate the possibilities of neuroendocrine differentiation and drug resistance markers being used as prognostic factors in patients with non-small cell lung cancer. MATERIAL AND METHOD: Immunohistochemical staining of NSE, PgP and GST-pai with polyclonal antibodies in pathologic specimens of 47 patients with non-small cell lung cancer were done. The relationship between the expression of the markers and the response to cisplatin-based chemotherapy and the overall survival were assessed. RESULTS: NSE staining was positive in 17% and there was no difference between adenocarcinoma and squamous cell carcinoma. NSE positive patients showed increased response rate (63% vs 26%, p=0.049) and prolonged response duration (15.8mo vs 4.5mo, p=0.0007). But there was no difference in overall survival between NSE positive and negative groups. The PgP positive rate was 17% and GST-pai positive rate was 47%. No correlations were found among the expression of drug resistance, the sensitivity to chemotherapy and overall survival. CONCLUSION: Patients with non-small cell lung cancer with positive NSE showed increased response rate to chemotherapy and prolonged response duration but overall survival was not related to NSE expression. Expression of PgP and GST- were not important in predicting the prognosis in non-small cell lung cancer.
Adenocarcinoma ; Antibodies ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination* ; Glutathione Transferase* ; Glutathione* ; Humans ; Neurons* ; P-Glycoprotein* ; Phosphopyruvate Hydratase* ; Prognosis ; Retrospective Studies