No abstract available.

No abstract available.
Prenatal Diagnosis*

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in synovial membrane, periarticular structure, skeletal muscle and perineural sheaths. Eventually, joints are destroied, ankylosed and deformed. Moderate anemia is occured frequently in rheumatoid arthritis patients, and these patients show abnormalities of iron metabolism such as lower serum iron concentration and occurance and distribution of iron in the synovial membrane. It has been suggested that the mechanism of iron deposits in rheumatoid arthritis is continuous oozing of blood from vascular granulation tissue into the synovial cavity and this lead the patient to anemia. We collected samples from serum and knee joint fluid in 21 cases of rheumatoid arthritis for chemical estimation of the ferritin concentration by radioimmunoassay, and compared with that of osteoarthritis. The following results were obtained: 1. The mean hemoglobin concentration(11.4gm %) in rheumatoid arthritis was lower than osteoarthritis(13.4gm %). 2. The mean serum ferritin concentration(118. 4ng/ml) in rheumatoid arthritis was lower than osteoarthritis(135. 6ng/ml), on the contrary in synovial fluid rheumatoid arthritis(279.8ng/ml) showed higher than osteoarthritis(190. 4ng/ml). 3. The mean ratio of synovial fluid ferritin on serum ferritin was 2. 36 in rheumatoid arthritis, in contrast with l. 4 in osteoarthritis. There was significant correlation between the ferritin concentration in synovial fluid and serum. 4. Serial check of ferritin concentration in synovial fluid during treatment would be thought meaningful criteria for determination of progress.and effectiveness of treatment.
Adult ; Anemia ; Arthritis, Rheumatoid ; Ferritins ; Granulation Tissue ; Humans ; Iron ; Joints ; Knee Joint ; Metabolism ; Middle Aged ; Muscle, Skeletal ; Osteoarthritis ; Radioimmunoassay ; Synovial Fluid ; Synovial Membrane

From Mar. 1984 to Mar. 1994, we carried out 18 revision operations in patients who received Girdlestone operation due to the infection of hip was 7 cases, tuberculosis of hip was 3 cases, deep infections after implant insertion of hip were 5 cases, and pyogenic sequela was 1 case. The mean conversion period was 27 months. The leg length discrepancy, range of motion of hip, and Trendelenberg gait were examined before and after conversion to a total hip arthroplasty. The last functional state was evaluated and radiological examination was performed. In summary and Conclusion; 1. The time of performing revision hip arthroplasty was assessed by clinical, radiologic and laboratory finding, and the average time of conversion to total hip arthroplasty was 7.6 months after Girdlestone operation. 2. There was no case of recurrence of infection after revision operations. 3. At last follow-up after revision hip arthroplasty, the mean Harris Hip Score was 87.2(69.6–92.2) point. 4. Six patients had no pain, 8 patients had mild pain, and 2 patients had moderate pain. Nine patients were able to walk without ambulatory aids and 7 patients needed crutch or cane for walking. 5. At the time of revision hip arthroplasty, the average shortening of the resected limb was 4.2cm(1.6–7.3cm), and after revision operation, the average shortening was reduced to 1.2cm(0.8–2.2cm) 6. The technical difficulties, such as increased bleeding, bone deficiency, scar tissue formation, and limb shortening were encountered in all cases. 7. The peroneal nerve injury was developed in one patient who had conversion hip arthroplasty at 13 months after Girdlestone operation.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Canes ; Cicatrix ; Extremities ; Follow-Up Studies ; Gait ; Hemorrhage ; Hip ; Humans ; Leg ; Peroneal Nerve ; Range of Motion, Articular ; Recurrence ; Tuberculosis ; Walking

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

BACKGROUND: Even though lasers have been used in hemorrhoidectomies, there has been much debate about their effect. PURPOSE: A prospective randomized study was performed comparing the efficacy of a Nd:YAG laser with that of scalpel excision when performing a ligation excision, semi-closed hemorrhoidectomy. METHODS: Sixty patients, who had more than three piles, with 3rd or 4th grade hemorrhoids, were enrolled into this study. Hemorrhoidectomies were performed under low spinal anesthesia. The ligation excision, semi-closed hemorrhoidectomy technique was used. Data evaluated included age, sex, operative time, postoperative pain scores, postoperative analgesic requirement, wound-healing time, and postoperative complications. Of the sixty patients enrolled into this study, 30 received laser excision and the other 30 scalpel excision. RESULTS: There were no significant differences between the two groups, except for operative time (laser, 34.6 8.4 min; scalpel, 24.1 4.8 min). Postoperative complications, such as urinary retention, fecal impaction, skin tags, and postoperative fissure, were more common in the laser group. CONCLUSIONS: A hemorrhoidectomy using a Nd:YAG laser takes longer than a conventional hemorrhoidectomy and neither reduces the postoperative pain nor shortens the wound-healing time. For achieving an effective treatment in hemorrhoids by using lasers, improved laser instruments are required, along with more detailed study of lasers and their effects.
Anesthesia, Spinal ; Fecal Impaction ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Lasers, Solid-State ; Ligation ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Prospective Studies ; Skin ; Urinary Retention

PURPOSE: Melanosis coli, which is a relatively common disease encountered during colonoscopy, is a brownish or blackish pigmentation of the colon and is associated with the ingestion of anthraquinone compounds. Its histopathological pathogenesis is recognized as colonic epithelial apoptosis. This study was designed to identify the relation between melanosis coli and the colonic transit time, as well as the relation between melanosis coli and other clinical characteristics. METHODS: We reviewed the clinical records of 80 patients with melanosis coli who had been diagnosed by colonoscopy between Jan. 1997 and Sep. 1998. The colonic transit time was checked in 26 cases of patients with melanosis coli and in 28 cases of patients with constipation without melanosis coli by using the multiple marker bolus technique. RESULTS: 1) The frequency of melanosis coli in patients undergoing a total colonoscopy was 1.25% (80/6422). 2) The age distribution was 20 to 76 years old (mean: 49). The grade of melanosis coli seemed to be related with age. 3) The four causative agents related with melanosis coli were anthraquinone compounds (69.2%), tea (12.3%), herbs (12.3%) and health foods in that order. 4) The duration of medication was from 2 months to 20 years (mean: 48 months). The grade of melanosis coli seemed to be related with the duration of medication. 5) The colonic transit time was normal in 11 cases (42.3%) and delayed in 15 cases (57.5%) of melanosis coli and normal in 10 cases (35.7%) and delayed in 18 cases (64.3%) of patients with constipation without melanosicoli. 6) Colon polyps were detected in 12 cases (15%). However, no relation between the incidence of colon polyps and either the grade of melanosis coli or the duration of medication was noted. CONCLUSIONS: Melanosis coli is a marker of ingestion of some drugs, such as anthraquinone compounds, and/or some kinds of acidic polysaccharides. Melanosis coli is not an indicator of colonic motility disorder or a danger signal for colon polyps or cancer.
Age Distribution ; Aged ; Apoptosis ; Colon ; Colonoscopy ; Constipation ; Eating ; Food, Organic ; Humans ; Incidence ; Melanosis* ; Pigmentation ; Polyps ; Polysaccharides ; Tea

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

Nowadays, inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, is increasing; however, infectious colitis, such as amebic colitis, is decreasing, so many doctors are not apt to be interested in infectious colitis. In addition, recently amebic colitis has been relatively rare in Korea, and the colonoscopic and the pathologic findings of amebic colitis are very similar to those of other inflammatory bowel diseases. As a consequence, the diagnosis is very difficult if the cyst or the trophozoite of the ameba is not found in the stool examination or in the tissue pathology. The authors experienced three cases in which initial diagnoses of tuberculous colitis, ulcerative colitis, and a simple ulcer were made based on colonoscopic and X-ray findings. However a colonoscopic biopsy revealed a trophozoite form of ameba in the tissue. Hence, a diagnosis of amebic colitis could be made with confidence. Based on these results, we insist that infectious colitis should be included in the differential diagnosis when making a diagnosis of inflammatory bowel disease. In addition, it is extremely important to consider all kinds of infectious colitis, such as amebic colitis.
Amoeba ; Biopsy ; Colitis* ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis ; Diagnosis, Differential ; Dysentery, Amebic* ; Inflammatory Bowel Diseases ; Korea ; Pathology ; Trophozoites ; Ulcer