Occasionally, patients with gastrointestinal Crohn's disease (CD) develop granulomatous skin lesions at sites remote from the gastrointestinal tract, separated from other ulcerations by normal skin, a phenomenon that has been referred to as metastatic cutaneous CD. Although metastatic CD of the vulval region has been often reported in English literature, we could not find such cases with family history. We report a case of vulval CD occurring in siblings.
Crohn Disease* ; Gastrointestinal Tract ; Humans ; Siblings* ; Skin ; Ulcer ; Vulva*

PURPOSE: We evaluated the effects of amitriptyline in patients with urinary frequency or pelvic pain syndrome and compared with propiverine hydrochloride (BUP-4(R)) and diazepam (Valium(R)). MATERIALS AND METHODS: One-hundred and sixty-eight patients with urinary frequency or pain were included and 38 out of 168 patients were lost to follow up. The patients with interstitial cystitis, UTI and neurogenic bladder were excluded. Amitriptyline group were instructed to take 25mg to 75mg of amitriptyline before bed. Propiverine hy drochloride and diazepam group were instructed to take 20mg, 4-6mg before bed, respectively. The clinical effects and side effects were evaluated after 4 weeks of medication. RESULTS: In the amitriptyline group, 73.1% in 78 patients with frequency, 68.3% in 60 pain, 65.6% in 32 nocturia, 53.8% in 26 weak urinary stream, 53.8% in 13 dysuria, 72.7% in 11 urgency showed symptom improvement. Urinary frequency and pain score were significantly decreased in the amitriptyline group. In the propiverine hydrochloride group, 66.7% in 21 patients with frequency, 38.8% in 18 pain showed symptom improvement. In the diazepam group, 37.5% in 24 patients with frequency, 31.3% in 16 pain showed symptom improvement. Side effects of amitriptyline had appeared in 24 (27.6%) out of 87 patients; 17 cases of dry mouth, 10 drowsiness, 2 agitation, 2 nausea, 1 constipation and 1 skin rash. CONCLUSIONS: Amitriptyline is useful in vague voiding symptoms especially in urinary frequency and chronic pelvic pain syndrome. It is equally effective in both men and women. Side effects are minimal and tolerable. A double-blind placebo-controlled trial is necessary for general acceptance in the future.
Amitriptyline* ; Constipation ; Cystitis, Interstitial ; Diazepam ; Dihydroergotamine ; Dysuria ; Exanthema ; Female ; Humans ; Lost to Follow-Up ; Male ; Mouth ; Nausea ; Nocturia ; Pelvic Pain* ; Rivers ; Sleep Stages ; Urinary Bladder, Neurogenic

OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

We aimed to evaluate the long term trantment of enalapril on the vascular response in the isolated aorta, and in anesthetized or pithed spontaneously hypertensive rats(SHR). In the isolated aorta, the increase in tension provoked by addition of KC1 16.7mM was attenuated by enalapril treatment(3mg/kg/day for 6 weeks), whereas the increment by addition of NE 0.1uM tension was not influenced. The frequency-dependent vasoconstricution induced by electrical field stimulation of aorta was also attenuated by enalapril treatment. In pithed SHR, the frequency-related hypertension provoked by electrical stimulation(10sec, 1ms with 40V) of sympathetic pregnglionic nerve was also attenuated by enalapril treatment. Neither dose-related vasorelaxation by acetylcholine addition in the aorta nor decrease of DBP by intravenously(i.v.)-injected aetylcholine was altered by enalapril treatment. However, beta2-agonist, salbutamol-induced vasorelaxation in enalapril-treated group, was more remarkable than that in control group. The hypotension by i.v.-but not by intracerebroventricularly-injected salbutamol strengthened by enalapril treatment. These results suggest that the suppression of development of hypertension by enalapril treatment may result from the reduction of adrenergic neurotransmission and activity to voltage dependent calcium channel by acting on vascular smooth muscle itself.
Acetylcholine ; Albuterol ; Aorta ; Blood Pressure* ; Calcium Channels ; Enalapril* ; Hypertension ; Hypotension ; Muscle, Smooth, Vascular ; Rats, Inbred SHR* ; Synaptic Transmission ; Vasodilation

PURPOSE: To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone. MATERIALS AND METHODS: Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction. RESULTS: In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305+/-0.717 diopters (D) and -0.356+/-0.639 D, respectively, compared to 0.215+/-0.541 and 0.077+/-0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599). CONCLUSION: Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.
Aged ; Biometry/methods ; Case-Control Studies ; Cataract Extraction ; Epiretinal Membrane/*surgery ; Eye ; Female ; Humans ; *Lens Implantation, Intraocular ; *Lenses, Intraocular ; Male ; Optics and Photonics ; Phacoemulsification/*methods ; Postoperative Period ; Refraction, Ocular/physiology ; Retrospective Studies ; Treatment Outcome ; Vision Tests ; Visual Acuity ; Vitrectomy/*methods

OBJECTIVE: The sacroiliac joint complex is often related with functionally incapacitating pain in old aged people. The purpose of this study is to delineate the investigation strategies and to determine the long-term effect of radiofrequency (RF) neurotomies for pain arising from sacroiliac joint dysfunction(SIJD) METHODS: Sixteen patients were diagnosed as having chronic pain from SIJD by comparative controlled blocks on L5 dorsal rami, sacroiliac joints and deep interosseous ligaments. After confirming the positive response (more than 50% of pain relief), sensory stimulation was applied to detect the `pathological' branches. Subsequently, RF neurotomies were performed on the selected nerve branches. Surgical outcome was graded as successful, moderate improvement, and failure after a 6month follow-up period. RESULTS: Stimulation intensity was 0.45V to elicit pain response in the L5 dorsal rami and lateral sacral branches. The number of RF-lesioned nerve branches was 6per patient. The average number of lesions for each branch was 1.3. Most commonly selected branches were L5 dorsal ramus (88%) and S2-upper division (88%). Ten patients (63%) reported a successful outcome according to the outcome criteria after 6months of follow-up, and five patients (31%) reported complete relief (100%). Five patients (31%) showed moderate improvements. One patient reported failure. CONCLUSION: RF neurotomy of lateral sacral branches is an excellent treatment modality for the pain due to SIJD, provided that comparative controlled block shows a positive response.
Chronic Pain ; Follow-Up Studies ; Humans ; Ligaments ; Sacroiliac Joint*

PURPOSE: We analyzed our experience of surgically corrected impalpable testes to evaluate our results and to determine the best possible surgical approach for impalpable testes. MATERIALS AND METHODS: Medical records of 97 boys who had undergone surgery for impalpable testes were reviewed with respect to the age at presentation, localization procedure, surgical approach, testicular location and volume. Minimal follow-up was 6 months. RESULTS: The average age at presentation was 47.7 months. Surgical locations of testes included preperitoneum in 46 testes, intraabdomen in 18 testes and inguinal canal in 1 testis. Fifty-three testes were absent at exploration. Surgical procedures consisted of 59 orchiopexies, 53 excision of blind-ended spermatic vessel and 6 orchiectomies. The average volume of abdominal testes was reduced to 44.0% of contralateral normally descended testicular volume. Compensatory hypertrophies were seen in 45 contralateral testes among 53 unilateral absent testes. The inguinal exploration was successful in defining the location of all the testes in the last 41 consecutive boys. Laparoscopy did not help to avoid surgical exploration. Of 38 impalpable testes at office examination, 18 testes turned out to be palpable when examined under anesthesia while ultrasonography detected 14 testes with 1 false positive finding. Of 51 regular orchiopexies 49 testes showed excellent or acceptable results. Of 8 Fowler-Stephens orchiopexies 3 testes resulted in atrophies. CONCLUSIONS: Most pexed impalpable testes showed successful results in terms of testicular position and growth. However, there were more testicular atrophies in cases whose spermatic vessels were ligated. Inguinal exploration with or without intraperitoneal extension was successful in the management of impalpable testes in this series.
Anesthesia ; Atrophy ; Cryptorchidism ; Follow-Up Studies ; Hypertrophy ; Inguinal Canal ; Laparoscopy ; Male ; Medical Records ; Orchiectomy ; Orchiopexy ; Testis* ; Ultrasonography

Chronic low back pain (CLBP) has become more prominent with globally increasing life expectancy. Its cause is more attributable to degenerative changes than to traumatic lesions. Although the diagnosis of CLBP is recently on higher demand, lack of clinical features and non-informative imaging findings in patients with CLBP are challenging to clinicians to establish the diagnosis. Therefore, understanding of the new concept of pathogenesis, elimination of prejudice, and evidence-based diagnostic steps are required to resolve the question of pain source. Analysis of pain distribution patterns and careful history taking can be utilized as an initial guide to divide CLBP into somatic and radicular pain. Zygapophyseal joint pain and sacroiliac joint pain representing somatic pain can be further investigated using medial branch and sacroiliac joint blocks. However, comparative blocks are essential to decreased false positive rate. Infiltration of a small volume of local anesthetics can increase the specificity of the procedures. Discogenic pain stemming from internal disk derangement can be confirmed by pressure-controlled discography. Automated discography is recommended to provide the constant rate of dye injection with obviating the fluctuation of intradiscal pressure. Evidencebased concept and diagnostic procedures can provide more accurate and efficient methods to establish the diagnosis of CLBP.
Anesthetics, Local ; Diagnosis ; Evidence-Based Medicine ; Humans ; Life Expectancy ; Low Back Pain* ; Nerve Block ; Nociceptive Pain ; Prejudice ; Sacroiliac Joint ; Sensitivity and Specificity ; Zygapophyseal Joint

The purpose of this study was to measure the marginal fidelities and the fracture strength of IPS Empress 2. and In-Ceram. ceramic crowns. After constructed of 12 experimental dies for each group, ceramic crowns were fabricated on the metal master dies prepared on the maxillary right premolar. Marginal gaps were measured on the specimen between the margin of each crown and finishing line of the metal master die by using stereo-microscope(SZ-ST. Olympus, Japan) and all specimens were cemented on the metal master die with Bistite II.(Tokuyama soda Co, LTD., Japan) resin cement. Finally, marginal gaps were measured again. To measure of the fracture strength, buccal incline on the functional cusp of specimens were loaded until the catastrophic failure occurred by using the AGS-1000 D.(Shimadzu, Japan). The result of marginal fidelities and fracture strength were statistically analyzed with the SPSS version 8.0 programs. The results of this study were as follows : 1. No significant difference was found in the mean marginal fidelities and fracture strength between the IPS Empress 2. and In-Ceram. 2. In comparison of marginal fidelities between before and after cementation, there was significant difference(P<0.05). The IPS Empress 2 system was shown in this study that had good marginal fidelities and fracture strength compared to In-Ceram ceramics. Although this system was acceptable to clinical applications, the system still has to be considered long-term researches about marginal fidelities and fracture strength due to the lack of data about the clinical researches.
Bicuspid ; Cementation ; Ceramics ; Crowns* ; Resin Cements

Bladder exstrophy is a rare condition with an incidence of between 1 in 10,000 and 1 in 50,000 live births and the male-to-female ratio ranges 2.3:1 to 6:1. The basic defect of bladder exstrophy is an abnormal overdevelopment of the cloacal membrane, preventing medial migration of the mesenchymal tissue and proper lower abdominal wall development. Although there are some recent successful reports of the one-stage repair of bladder exstrophy that involves complete primary repair of exstrophy and total disassembly of the epispadiac penis, staged repair still represents the most common operation for correction of this anomaly. A successful initial closure of the infant born with bladder exstrophy is the single most important determinant of continence in the staged repair of exstrophy patient. We report a case of bladder exstrophy with successful initial closure of bladder using posterior iliac osteotomy and paraexstrophy skin flap.
Abdominal Wall ; Bladder Exstrophy* ; Humans ; Incidence ; Infant ; Live Birth ; Male ; Membranes ; Osteotomy ; Penis ; Skin ; Urinary Bladder*