PURPOSE: The surgical treatment of anal stenosis includes internal sphincterotomy, rotaton flap and advancement flap according to the stenosis degree, recently, Christensen performed house shaped advancement flap and reported fair results. We compared and analyzed the surgical methods and results in patients with moderate and severe anal stenosis who underwent house shaped advancement flap and C-anoplasty. METHODS: We have performed this study with 6 cases using the house shaped advancement flap and 6 cases using the C-anoplasty. The out come was assessed by clinical characteristics, surgical method, operation time, duration of hospitalization, healing time, postoperative complications, results. RESULTS: The average operation time was 38 min in those house shaped advancement flap cases and 63 min in C-anoplasty cases. The average time of hospitalization was 6 days and 9 days, respectively, and the average time of healing was 28 days and 46 days, respectively. In those house advancement flap cases, surgery could be done in 2 directions at the same time in 4 cases and 3 directions in 2 cases; as for those C-anoplasty cases, surgery could be done in 1 direction in 4 cases and 2 directions in 1 case. Two complications were observed in C-anoplasty, one flap infection and one flap necrosis, and in house shaped advancement flap, no complication was observed. CONCLUSIONS: House shaped advancement flap have several advantages compared to the C-anoplasty, and since house shaped advancement flap could be performed in 2 to 3 directions or even 4 directions at the same time, the anus could sufficiently expanded in severe anal stenosis patients. The house shaped advancement flap might be one of the good method in treating anal stenosis.
Anal Canal ; Constriction, Pathologic* ; Hospitalization ; Humans ; Necrosis ; Postoperative Complications

Statement of problem: One of common problems associated with dental implant is the loosening of abutment screws that retain the implants. Purpose: This study was performed to investigate the influence of abutment screw length and repeated tightening on screw loosening in dental implant. Material and method: Forty nine Hexplants (13mm length, 4.3mm diameter, Ti grade IV, Warantec. Co. Ltd. Seongnam, Korea) and cementation type abutments(straight abutment) and abutment screws (0.4mm/pitch) were divided into 7 groups, depending on abutment screw length. Each implant and abutment was tightened to 30Ncm by torque controller(MGT50, MARK-10 Inc., USA) and the removal torque values were measured during 10 consecutive closure/opening trials Results and Conclusion: The results of comparing the removal torque value are as follows: 1. There is no significant difference in the removal torque value between groups in 10 consecutive closure/opening trials(p=0.97). 2. If the fractured abutment screw is engaged in longer than 2.425 thread length, there is no significant difference in the preload between the fractured abutment screw and the new abutment screw when both are equally tightened to 30 Ncm 3. The removal torque value in the 1st trial(24.510 Ncm) was lower than that in the 2nd,3rd,4th,5th,6th,7th trials and the removal torque value in the 2nd trials(25.551 Ncm) was maximum and was decreased in following trials. The removal torque value in the 1st trial was significantly lower than that in the 2nd,3rd,4th trials and was significantly higher than that in the 8th,9th,10th trials(p<0.05). 4. In the 2nd,3rd,4th,5th,6th,7th trials, the abutment screw was mainly influenced by settling effect and the higher preload was obtained. In the 8th,9th,10th trials, the abutment screw was mainly influenced by adhesive wear and the progressively lower preload was obtained.
Adhesives ; Cementation ; Dental Implants* ; Gyeonggi-do ; Torque

The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.
Barium ; Constriction, Pathologic* ; Cricoid Cartilage ; Deglutition Disorders ; Dilatation* ; Female ; Gastrostomy* ; Humans ; Lye* ; Middle Aged ; Suicide

PURPOSE: Hemorrhoidal tissues are normal anatomic structures present in every individual, and they act as cushions and are anchored to the internal anal sphincter by a connective tissue system. When the anchoring connective tissues undergo bears degenerative changes, the hemorrhoids not only bulge but also descend into the lumen of the anal canal. The veins also become distended. The previous hemorrhoidectomy methods (excision and ligation methods) tend to remove excessive amounts of hemorrhoidal tissues, possibly causing incontinence or stenosis. This study introduces a modified hemorrhoidectomy method. METHODS: A retrospective study was done with 650 patients (358 males, 292 females) who underwent hemorroidectomies from Jan. 1997 to Jan. 2000. Under saddle-block anesthesia, the patient was placed in a prone jack-knife position. After narrow incisions on the mucosa of the selected pile, a bilateral submucosal dissection was performed. The pedicle was ligated by transfixing sutures 2 or 3 times with 2-0 chromic catgut to lift up the mucosa. RESULTS: The mean operation time per hemorrhoidal pile was 12.7 minutes, and the mean hospital-stay was 4.3 days. Acute and delayed postoperative anal bleeding occurred in 7 (1.1%) and 3 (0.5%) patients, respectively. The symptoms of both subsided spontaneously. Ninety-three (93) patients (14.3%) reguired nelaton catheterization for voiding difficulty, and one patient (0.2%) showed mild anal stenosis. The most frequent complaint was skin-tag formation (148 cases, 22.8%). In 140 cases, the skin tag was removed under local anesthesia. CONCLUSIONS: It is desirable to keep the normal structure of the anal canal by removing as little of the cushions as possible. Our 'lift-up submucosal hemorrhoidectomy' shows good results and is an easy operative method when compared with Parks' original method.
Anal Canal ; Anesthesia ; Anesthesia, Local ; Catgut ; Catheterization ; Catheters ; Connective Tissue ; Constriction, Pathologic ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ligation ; Male ; Mucous Membrane ; Retrospective Studies ; Skin ; Sutures ; Veins

Porokeratosis is a group of disorders characterized by epidermal keratinization associated with cornoid lamella. Porokeratosis has been described as having five distinct clinical subtypes: Mibelli or plaque type, disseminated superficial actinic porokeratosis, linear porokeratosis, punctate porokeratosis, porokeratosis palmaris et plantaris disseminata. We describe a 61-year-old Korean woman presented with porokeratosis palmaris et plantaris disseminata.
Female ; Humans ; Middle Aged ; Porokeratosis*

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of conttolled ovarian hyperstimulation. Though there have been numerous protocols for the prevention of OHSS, it has not been completely preventable until now. This study was performed to identify clinical predictors for early and late OHSS. METHODS: A retrospective analysis of all IVF cycles in 1993 up to June 1996 was performed. OHSS was diagnosed using the criteria of Rabau modified by Schenker. All cases of OHSS reported in this study presented with marked ovarian enlargement, ascites, oliguria, hemoconcentration and electrolyte disturbance. Ovarian stimulation was carried out using a combination of gonadotrophin releasing hormone-agonist, follicle-stimulation hormone and human menopausal gonadotrophin. 27 patients has moderate or severe OHSS presenting 3-7 days post-human chorionic gonadotrophin (hCG), and 21 patients had severe OHSS presenting 12-17 days post-hCG. RESULTS: No patient with early OHSS went onto develop late OHSS, and no patient with late OHSS had demonstrated early OHSS. Logistic regression showed that early OHSS was predicted by the number of oocytes retrieved and the estradiol concentration on the day hCG injection (P<0.05). Late OHSS was predicted by the transferred embryos, B-hCG on 14 day after hCG injection (P<0.05). CONCLUSION: Early OHSS was an acute effect of the hCG administered prior to egg retrieval in women with high estradiol and large number of retrieved oocytes. Our analysis of the risk factors for early OHSS indicates that cryopreservation of all embryos will not alter the risk of early OHSS even though it should prevent late OHSS. Late OHSS was induced by the rising serum concentration of hCG produced by the early pregnancy, the number of transferred embryos must be adjusted carefully, since it was associated with multiple gestation.
Ascites ; Chorion ; Cryopreservation ; Embryonic Structures ; Estradiol ; Female ; Humans ; Logistic Models ; Oliguria ; Oocytes ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Ovum ; Pregnancy ; Retrospective Studies ; Risk Factors

Uterine anomalies have been reported in 4% of women with infertility and in up to 15% of those with recurrent abortion. One of the major intrauterine disorder associated with infertility and recurrent abortions is intrauterine septum, The reproductive outcome of 41 patients of intrauterine septum (7 complete, 34 incomplete) with repeated abortions or infertility was assessed after the uterine septotomy. 5 of 7 patients with comlete uterine septum undergone uterine septotomy (3; hysteroscopic metroplasty, 2; abdominal metroplasty) had total 6 pregnancies and all of them had live biths. 28 patients with incomplete uterine septum got the hysteroscopic intrauterine septotomy and the viable pregnancy rate was 62% (3 ongoing pregnancies, 13 live biths of total 26 pregnancies). 6 patients with incomplete uterine septum had not the operation and 5 patients had 5 live births after total 6 pregnancies with 1 spontaneus abortion. Even though, the number of cases were small, the live birth rate in the group of septotomy of the patients of complete uterine septum (100%, 6/6) was higher than that in the group of not-done (50%, 1/2). The live birth rate in the group of not-done of the patients with incomplete uterine septum (83%, 5/6) was higher than that in the group of hysteroscopic uterine septotomy (62%, 16/26), but 5 of 6 had short uterine septal length (<1 cm), 1 had 1.5 cm septal length in the group of not-done. All the patients with successful pregnancy outcome had no other co-factors at the diagnostic laparoscopy, but the 5 primary infertility patients with no live birth even after treatment (all were with incomplete septum; 3 undergone hysteroscopic septotomy, 2 not-done with one abortion) had other co-factors such as endometriosis, peritoneal or tubal facor. In conclusion, hysteroscopic uterine septotomy would be useful for the patients with habitutal abortion or infertility and more advanced managemnet protocols should be applied to the patients having other co-factors if there was no pregnancy even after the uterine septotomy.
Abortion, Habitual* ; Endometriosis ; Female ; Humans ; Hysteroscopy* ; Infertility* ; Laparoscopy ; Live Birth ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

PURPOSE: The aim of this study was to evaluate the effectiveness of local anesthesia compared to spinal anesthesia and the usefulness of pentothal induction before infiltration of a local anesthetic agent. METHODS: A concurrent non-randomized prospective study was conducted on 52 patients who underwent a hemorrhoidectomy. For the spinal anesthesia (SA) group (n=29), 0.5% heavy bupivacaine (Marcaine(R)), 5 mg (1 ml), was used, and for the local anesthesia (LA) group (n=23), pentothal, 3.3 mg/kg, was administrated intravenously prior to infiltration of a mixture of local anesthetics (2% lidocaine, 14 ml, with 0.5% bupivacaine, 7 ml). RESULTS: There were no differences between the two groups in terms of operating time, postoperative pain, headache, urinary difficulty, nausea or vomiting, pain-free interval after operation, analgesic requirements, and patient's or surgeon's satisfaction. Postoperative ambulation was earlier in the LA group than in the SA group. CONCLUSIONS: Local anesthesia after pentothal induction can be used effectively for a hemorrhoidectomy and may be a safe alternative to spinal anesthesia.
Anesthesia, Local* ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine ; Headache ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Nausea ; Pain, Postoperative ; Prospective Studies* ; Thiopental* ; Vomiting ; Walking

No abstract available.
Interleukin-6* ; Myxoma*

Endometriosis is defined as the abnormal growth of endometrial tissue outside the uterine cavity, but in rare cases may also occur on the skin. Cutaneous endometriosis frequently develops at the site of a prior abdominal or pelvic procedure, although apparent spontaneous occurrence has been reported. We present a case of non-symptomatic, cutaneous endometriosis in the episiotomy scar. The patient had no evidence of concurrent pelvic endometriosis.
Cicatrix* ; Endometriosis* ; Episiotomy* ; Female ; Humans ; Skin