No abstract available.
Congenital Hypothyroidism*

The authors performed a retrospective review to find out optimal treatment plan in infantile fistula-in-ano. There were seventy-one patients in a 2-year period. All were male and other clinical characteristics were similar to previous reports. The onset in 60 patients(97%) of the cases was in the first 1 year of alee, especially in the first 3 months(52%). We investigated patterns of disease progression in multiple-lesion cases(19cases 29%). In 5 out of 9 cases of which we could identify the patterns, new lesion developed from 1 month to 4 months after index lesion. Fifty Patients underwent fistulotomy under principle of early surgical intervention, No recurrence was found except 2cases who needed second operation during 30 months of median follow-up(23~48 months). In 21 patients whose parents did not want operation, we performed simple drainage and followed-up. Six out of 12 patients who could be communicable had no fistula-related symptoms from 20 months to 31 months. This suggests that simple drainage has therapeutic effect in some portion of infantile abscess. We conclude that simple drainage should be initial treatment of choice in infantile perianal abscess. We suggest that definite operation for recurrent abscess and fistula with relatively mild symptoms should be delayed until 1-year of age because of interval ccurrence of multiple lesions and therapeutic effect of simple drainage.
Abscess ; Child ; Disease Progression ; Drainage ; Fistula ; Humans ; Infant* ; Male ; Parents ; Rectal Fistula ; Recurrence ; Retrospective Studies

BACKGROUND: It is generally accepted that most colorectal cancers develop from adenomas, so the detection and removal of them can reduce the incidence of colorectal cancers. Sigmoidoscopy is the effective tool for detecting and removing adenomatous polyps in the rectosigmoid region, but its major limitation is that sigmoidoscopy alone can not detect considerable portion of colorectal adenomas. METHODS: From October, 1996 to August, 1997, we performed 2017 sigmoidoscopies and 1683 colonoscopies. We analysed the anatomical distribution of adenomas and compared the detection rate of adenomas between two groups. In 32 cases, adenomas detected by sigmoidoscopy were followed by colonoscopy in less than 2 months. RESULTS: We found 125 cases of adenomas in 2017 sigmoidoscopies and 281 cases of adenomas in 1683 colonoscopies. In 281 cases of adenomas found by colonoscopy, 151 cases had rectosigmoid adenomas only and 25 cases had rectosigmoid and proximal adenomas, 105 cases had proximal adenomas only. The detection rate of adenomas by sigmoidoscopy was significantly lower than that by colonoscopy in the rectosigmoid region(6.1% vs. 10.5%, p=0.002). In 32 cases of adenomas found by sigmoidoscopy that were followed by colonoscopy, 7 cases of proximal adenomas and 6 cases of additional rectosigmoid adenomas were detected. CONCLUSION: Sigmoidoscopy cannot detect adenomas in the proximal colon beyond the sigmoid, it also can miss a significant portion of adenomas in the rectosigmoid.
Adenoma* ; Adenomatous Polyps ; Colon ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Incidence ; Mass Screening* ; Sigmoidoscopy*

BACKGROUND/AIMS: The caudal anesthesia for anal surgery is simple and effective. Also, it is relatively safe because there is no headache or other neurologic complications. But, during the operation under caudal anesthesia, the unwanted symptoms such as lower abdominal pain or hypotensive symptoms were experienced in some patients. These unwanted symptoms may occur due to anal and lower rectal dilatation. The precise mechanism is unknown. But we speculated that some sensory nerve endings in rectal submucosa may be involved in this mechanism. So, we think that it is possible to prevent or reduce these symptoms if we block these sensory nerve endings effectively with local anesthetics. Therefore, the aim of this study is to see whether the locally injected lidocaine can reduce or prevent the unwanted symptoms during anal surgery under caudal anesthesia. METHODS: There were 100 consecutive patients in this study who had hemorrhoidectomy with Jack-knife position under caudal anesthesia at our clinic. We divided evenly these 100 patients into two groups, injection and control groups(in each group, 50 patients were included.). In injection-group, We injected 10 cc(100 mg) of 1% lidocaine solution cir cumferentially into the lower rectal submucosa at the beginning of the operation. In control-group, we did not inject lidocaine solution initially, but the lidocaine injection was done during the operation in the same manner in the injection-group if the severe unwanted symptoms occurred. We used Parks-type retractor to dilate the anus and recorded the patient,s complaints. RESULTS: In injection-group, male to female ratio was 33:17, mean age was 42.1 years(20~69) and mean operation time was 38.3 minutes(15~80). In control-group, male to female ratio was 25:25, mean age was 43.7 years(17~65) and mean oeration time was 38.5 minutes(15~80). Lower abdominal pain was present in 11 patients(22%) among injection-group and in 37 patients(74%) among control-group(p=0.000). Hypotensive symptoms such as nausea, vomiting, sweating and dizziness were present in 1 patient(2%) among injection-group and in 8 patients(16%) among control-group(p=0.014). We injected lidocaine solution into lower rectal submucosa during the operation in 18 patients with severe symptoms among control-group. The effect of the injected lidocaine solution in 18 control patients was good in 13(72%) and fair in 5(28%). With regard to factors influencing the occurrence of symptoms, there was a tendency of higher occurrence in male, the younger-aged and the longer-operation groups. CONCLUSION: The lower rectal submucosal lidocaine injection reduced the unwanted symptoms such as lower abdominal pain and hypotensive symptoms during the anal surgery under the caudal anesthesia.
Abdominal Pain ; Anal Canal ; Anesthesia, Caudal* ; Anesthetics, Local ; Dilatation ; Dizziness ; Female ; Headache ; Hemorrhoidectomy* ; Humans ; Lidocaine* ; Male ; Nausea ; Sensory Receptor Cells ; Sweat ; Sweating ; Vomiting

BACKGROUND: Polyethylene glycol(PEG) has been the most widely used colonic lavage solution. But large volume and salty taste of PEG solution is a problem which can lead to the noncompliance and the poor bowel cleansing. Recent reports have suggested that sodium phosphate solution of much smaller volume is more effective in colon cleansing ability and more easier to complete. Therefore, this study was designed to compare two solutions for colonoscopy and to determine the differences in either patient compliance or cleansing ability. METHOD: Eighty-two patients were randomized to take either oral sodium phosphate solution or 2 liter of PEG solution. Patient's discomfort and tolerance during ingestion was asessed by questionnaire and one colonoscopist who did not know the type of solution, assessed colonic preparation status. RESULTS: Among 25 patients experiencing two separate colonoscopies with PEG solution and sodium phosphate solution respectively, 19(76%) patients preferred sodium phosphate solution. Sodium phosphate solution was found to be easier to take. Sodium phosphate caused thirst more frequently(p=0.013) than PEG solution. Particulate stool and water retention status were similar in two groups. Gas bubble formation that disturbs luminal observation was more frequently found in sodium phosphate preparation group(P=0.00). Sodium phosphate was more effective in right colon cleansing ability than PEG preparation(P=0.04). The Colonoscopist assessed sodium phosphate as "good" in 47.2% vs 58.6% after PEG preparation as a whole, but there was no statistical difference. CONSLUSION: Sodium Phosphate solution is better tolerated and more easier to take than PEG solution. Gas bubble formation is a correctable problem, but right colonic cleansing effect is not. Our results showed that sodium phosphate is likely to be more effective in colonic cleansing effect comparing to polyethylene glycol solution.
Colon ; Colonoscopy ; Eating ; Humans ; Patient Compliance ; Phenobarbital ; Polyethylene Glycols* ; Polyethylene* ; Surveys and Questionnaires ; Sodium* ; Therapeutic Irrigation ; Thirst ; Water

The distance fmm skin to the lumber epidural space was measured in 60 male patients receiving epidural analgesia. The mean distance was found to be 4.45cm. The epidural depths were identified most frequently at 4.0 to 4.5cm deep and over 90% of total cases were less than 5.5cm deep. The epidural depths had correlations with weight and PI(P < 0.001), but not correlated with height.
Adult* ; Analgesia, Epidural ; Epidural Space* ; Humans ; Male* ; Skin*

BACKGROUND: Decision about life sustaining treatments ought to be based on the patient's informed preferences. This study was to see if there were any differences in acceptance by patients, their primary care givers and doctors for end-of-life care according to situations, and if any, to analyse the factors related with different attitudes. METHODS: A structured questionnaire survey of end-of-life care preferences was performed on 162 cancer patients and their primary care givers in four university hospitals and one general hospital from March 1, 1999 to February 29, 2000. A similar survey was done for doctors practicing at the above hospitals during the same period to investigate their attitudes toward providing end-of-life care to an assumed nearly bed-ridden patients. ANOVA, t-test and Wilcoxon rank sum test were used to compare acceptance of intervention among the groups or according to the various situations. Factors presumed to be related to the acceptance were sought and analysed by stepwise multiple regression. RESULTS: The difference in acceptance of intervention between the primary care giver group and the doctor group was not significant in almost every situation, showing significantly higher than the patient group (P<0.001). All three groups showed higher acceptance when a therapeutic intervention rather than a diagnostic test was proposed (P<0.001), when expected survival was 30 days rather than 7 (P<0.01), and when the therapeutic intervention was thought as non-invasive rather than invasive (P<0.001). The less anxious the patient was, the higher the acceptance from the patient. Patients with a religion had higher acceptance rate than non-religious patients. Primary care givers who expected cure of the disease accepted more of the postulated care than those who did not (P<0.05). Wives or mother-in-laws of patients showed lower acceptance than those in other relationship (P<0.05). The longer the patient had been diagnosed with cancer, the higher the acceptance of the primary care giver (P<0.1). Direct relatives showed higher acceptance than that of collaterals (P<0.1). Family doctors specializing in family medicine had lower acceptance than doctors of other specialties and interns (P<0.05). CONCLUSION: The acceptance of intervention by patients was lower than that of primary care givers and doctors and depended on the expected survival and the type of intervention.
Attitude to Death ; Diagnostic Tests, Routine ; Hospitals, General ; Hospitals, University ; Humans ; Palliative Care ; Primary Health Care* ; Spouses ; Surveys and Questionnaires

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/*surgery ; *Anterior Cruciate Ligament Reconstruction ; Arthroscopy/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/*surgery ; Middle Aged ; Rupture ; Second-Look Surgery ; Treatment Outcome ; Young Adult

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.
Biopsy, Fine-Needle ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Simple ; Medical Records ; Mitosis ; Phyllodes Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Surgical Procedures, Operative

BACKGROUND: A mixture of local anesthetics such as lidocaine and bupivacaine has frequently been used in clinical practice. The rationale behind this is to take advantage of lidocaine's rapid onset and bupivacaine's perpetuation in anesthesia. The purpose of this study was to examine the changes in the onset and recovery of nerve blocking action exerted by the different combinations of these two in the mixture. METHODS: Isolated sciatic nerve preparations obtained from adult male Sprague-Dawley rats were used in this study. Recordings of A-fiber compound action potentials (A-CAPs) were made at the end of the isolated nerve while single pulse stimuli (0.5 msec, supramaximal intensity, 2 Hz) were applied to the opposite end of the nerve. Seven different composition of lidocaine-bupivacaine mixtures were prepared (0 : 6, 1 : 5, 2 : 4, 3 : 3, 4 : 2, 5 : 1, 6 : 0 vol./vol.), where basal concentrations of lidocaine and bupivacaine were 0.2% and 0.05%, respectively. Amplitudes of A-CAPs were measured before, during and after perfusion of mixture solution. The time needed for A-CAPs amplitude to decrease to 10% of the basal value after starting perfusion (onset time) and that needed to reach to 50% of the basal value after ceasing the perfusion (recovery time) were measured. RESULTS: With increasing concentration ratios of lidocaine to bupivacaine in the mixture as mentioned above, the following onset and recovery times were obtained (6.0 +/- 0.3, 5.6 +/- 0.3, 6.0 +/- 0.5, 8.3 +/- 0.5, 7.3 +/- 0.6, 7.8 +/- 0.3, and 10.8 +/- 0.8, minutes; 38 +/- 4, 63 +/- 12, 87 +/- 19, 100 +/- 13, 104 +/- 18, 137 +/- 27, and 157 +/- 18 minutes, respectively). CONCLUSION: Onset times were, in general, exponentially decreased with the increase in the lidocaine concentration. However, recovery times were lineary increased with the increase in the bupivacaine concentration. So, it should be kept in mind that rapid onset can only be obtained with the expense of substantial reduction in the duration of local anesthetic effect of the mixture, and vice versa.
Action Potentials ; Adult ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Bupivacaine ; Humans ; Lidocaine ; Male ; Nerve Block ; Neural Conduction* ; Perfusion ; Rats, Sprague-Dawley ; Sciatic Nerve