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

To delineate the coronary anatomy and the left ventricular function during early myocardial infarction, coronary arteriography and left ventriculography were performed prospectively in 28(34%) of 83 patients who were admitted to the coronary care unit at Severance Hospital from November 1983 to August 1984 within 30 days(median : 14 days;range : 4 hours to 30 days) after the onset of symptoms. The frequency of total occlusion of the infarct related artery was evaluated in the time course of infarction. To prove spontaneous recanalization, 3 patients who had total coronary occlusion underwent serial study within 11-20 days after the first study. We categorized the patients into two comparable groups according to the infarction site, coronary angiographic findings, and age. Comparison of clinical and angiographic findings between each group was made. The following results were obained. 1) There were 23 patients with transmural myocardial infarction(82.1%) and 5 with nontransmural infarction(17.9%). Among 23 patients with transmural infarction, 14 had anterior infarction(60.9%) and 9(39.1%) inferior infarction. 2) The mean age was 51.3 years(range : 31-79 years). The ratio of male to female was 3.7:1. 3) Fifteen patients(53.6%) had one-vessel disease, 10(35.7%) two-vessel disease and 2(7.1%) three-vessel disease, One patient(3.6%) had insignificant disease(less than 50% reduction in luminal diameter). Nontransmural infarction had a tendency to be associated with higher prevalence of multivessel disease than transmural infarction(80% vs 34.8%). 4) In 23 patients with transmural infarction, 12(52.2%) had complete occlusion and 11(47.8%) incomplete occlusion of the infarct related artery. Three patients(13.0%) had subtotal occlusion(90-99%) and 4(17.4%) had lesions of 70-89% luminal diameter narrowing. Three patients(13.0%) had 50-69% lesions and the remaining 1(4.4%) had insignificant obstructive lesions. 5) Of the 23 patients with transmural infarction, 12 were studied within 14 days and 11 in 15-30 days after the onset of symptoms. The frequency of total coronary occlusion was significantly higher in the patients studied within 14 days of symptom onset vs those studied in the 15-30 days period(83.3% vs 18.2%;p<0.001). Serial studies of 3 patients with total coronary occlusion at the initial study demonstrated occurrance of spontaneous recanalization in 2 patients. 6) The left ventricular-ejection fraction was higher in the patients with nontransmural infarction, inferior infarction, and incomplete coronary occlusion(65+/-14%, 58+/-16% and 57+/-17%) than that of the patients with transmural infarction, anterior infarction, and complete coronary occlusion(51+/-15%, 47+/-14% and 46+/-13, p<0.05). But there was no significant difference in left ventricular ejection fraction between the young(<45 year) and the old(> or =45 year) age groups. And also 0-1 vessel disease and 2-3 vessel disease groups did not show significant difference in ejection fraction. The degree of congestive heart failure was more severe in the patients with anterior infarction than in those with inferior infaction. multi-vessel disease group was significantly older than 0-1 vessel disease group(55+/-8 yrs vs 46+/-12 yrs, p<0.05), and the young age group had a tendency to be associated with higher prevalence of single vessel disease. 7) As for the complications of angiocardiography in this study, there was ventricular finbrillation in 2 patients(7.1%) without mortality. It is concluded that coronary arteriography can be safely performed within one month after acute myocardial infarction;high prevalence of one-vessel disease in acute myocardial infarction in the Korean adult patients admitted to a general hospital;lower incidence of total coronary occlusion in the late time course of infarction due to spontaneous recanalization;better left ventricular function in the patient groups with nontransmural infarction, inferior infarction and incomplete coronary occlusion.
Adult* ; Angiocardiography ; Angiography ; Arteries ; Coronary Care Units ; Coronary Occlusion ; Female ; Heart Failure ; Humans ; Incidence ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Prospective Studies ; Stroke Volume ; Ventricular Function, Left

Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

Regular hemodialysis has been established as a way of treatment for end stage renal failure. In adults, hemodialysis 5 hours each time, three times weekly with one square meter hemodialyzer is now widely accepted as a standard, and there are many reports on long term follow up studies. Quite a large difference are present, however, in our community mainly originated from patient's poor compliance in frequent dialysis with short interdialysis interval. The author analyzed 200 cases of chronic renal failure who have received hemodialysis treatments during the 5 year period from July 1976 to June 1981 at the hemodialysis unit of the hanyang University Hospital and the following results are obtained; 1. Actual one year survival rate was much higher in thrice(87.1%) than one(35.1%) or twice(54.1%) weekly dialysis. 2. Long term(more than 6 months) complications were also more frequent in once(85.7%) or twice(70.2%) weekly treatments than in thrice(22.2%). The predominant complications were congestive heart failure, pericarditis, and infections. 3. Those who recieved three times weekly dialysis had better rehabilitation grades than the patients groups of twice or once weekly treatment. 4. Of peridialysis distressful symptoms, nausea, vomiting dizziness were less frequent in the group three times a week dialysis. In contrast, headache, hypotension, muscle cramps, and weakness were not significantly related with frequency of hemodialysis. 5. Those who voided a large amount of urine output had better survival and less frequent requirement of blood transfusions. 6. Main causes of death were due to patient poor compliance, hyperkalemia and cerebrovascular acidents. 7. Economic problems were the major cause of dialysis interruption.
Adult ; Blood Transfusion ; Cause of Death ; Compliance ; Dialysis ; Dizziness ; Follow-Up Studies ; Headache ; Heart Failure ; Humans ; Hyperkalemia ; Hypotension ; Kidney Failure, Chronic* ; Kidneys, Artificial ; Muscle Cramp ; Nausea ; Pericarditis ; Rehabilitation ; Renal Dialysis* ; Renal Insufficiency ; Survival Rate ; Vomiting

No abstract available.
Steatocystoma Multiplex*

No abstract available.
Histiocytic Necrotizing Lymphadenitis* ; Lymphohistiocytosis, Hemophagocytic*

PURPOSE: Acute pyelonephritis in children may lead to permanent renal scarring with a risk of later hypertension and renal failure and so needs prompt diagnosis and appropriate treatment. The main aim of this study was to evaluate the value of 99mTc-dimercaptosuccinic acid(DMSA) renal scan in detecting renal involvement of acute urinary tract infection(UTI) and determining the sensitivity to find coexisting vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: A total of 192 children(97 males, 95 females) admitted with bacteriologically proven and symptomatic UTI between May 1994 and April 1997 were analysed. DMSA renal scan was performed in all cases. 70 children underwent VCUG. Findings of DMSA renal scan were analysed according to age, sex, previous history of UTI and VUR. RESULTS: 89 children(46%) were under the age of 1 year. There was a preponderance of UTI in boys under the age of 1 year(66.3%) and in girls over the age of 1 year(63.1%). Of the 192 children studied, 155 children(80.7%, 81 males, 74 females) had first episode and the remaining 37 children(19%, 16 males, 21 females) had previous history of symptomatic UTI. Abnormalities in DMSA renal scan were found in 67(43.2%) of 155 children with the first UTI and in 30(89%) of 37 children with recurrent UTI. Bilateral DMSA abnormalities were noted in 8(5.2%) of 155 children with the first UTI and in 11(29.7%) of 37 children with recurrent UTI. Of the 70 children who underwent VCUG, VUR was seen in 41(58.6%) children. Of the 41 children with VUR, 31(90.2%) children had abnormal DMSA images. VUR was demonstrated in 37(75.5%) of 49 children with abnormal DMSA images and especially in 100% of 14 children with bilateral abnormal DMSA images. CONCLUSIONS: A high proportion of abnormal DMSA images was found in children with recurrent UTI and children with VUR, especially high grade or bilateral reflux. DMSA renal scan is a sensitive method for evaluating the functional defect of involved kidney and predicting coexistent VUR according to its image appearance in patients with UTI.
Child* ; Cicatrix ; Diagnosis ; Female ; Humans ; Hypertension ; Kidney ; Male ; Pyelonephritis ; Renal Insufficiency ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

PURPOSE: Acute pyelonephritis in children may lead to permanent renal scarring with a risk of later hypertension and renal failure and so needs prompt diagnosis and appropriate treatment. The main aim of this study was to evaluate the value of 99mTc-dimercaptosuccinic acid(DMSA) renal scan in detecting renal involvement of acute urinary tract infection(UTI) and determining the sensitivity to find coexisting vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: A total of 192 children(97 males, 95 females) admitted with bacteriologically proven and symptomatic UTI between May 1994 and April 1997 were analysed. DMSA renal scan was performed in all cases. 70 children underwent VCUG. Findings of DMSA renal scan were analysed according to age, sex, previous history of UTI and VUR. RESULTS: 89 children(46%) were under the age of 1 year. There was a preponderance of UTI in boys under the age of 1 year(66.3%) and in girls over the age of 1 year(63.1%). Of the 192 children studied, 155 children(80.7%, 81 males, 74 females) had first episode and the remaining 37 children(19%, 16 males, 21 females) had previous history of symptomatic UTI. Abnormalities in DMSA renal scan were found in 67(43.2%) of 155 children with the first UTI and in 30(89%) of 37 children with recurrent UTI. Bilateral DMSA abnormalities were noted in 8(5.2%) of 155 children with the first UTI and in 11(29.7%) of 37 children with recurrent UTI. Of the 70 children who underwent VCUG, VUR was seen in 41(58.6%) children. Of the 41 children with VUR, 31(90.2%) children had abnormal DMSA images. VUR was demonstrated in 37(75.5%) of 49 children with abnormal DMSA images and especially in 100% of 14 children with bilateral abnormal DMSA images. CONCLUSIONS: A high proportion of abnormal DMSA images was found in children with recurrent UTI and children with VUR, especially high grade or bilateral reflux. DMSA renal scan is a sensitive method for evaluating the functional defect of involved kidney and predicting coexistent VUR according to its image appearance in patients with UTI.
Child* ; Cicatrix ; Diagnosis ; Female ; Humans ; Hypertension ; Kidney ; Male ; Pyelonephritis ; Renal Insufficiency ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

No abstract available.
Acrodermatitis*

BACKGROUND: There are numerous therapeutic options for molluscum contagiosum (MC) and these may be broadly subdivided into surgical procedures (curettage, squezzing), chemical application (silver nitrate, cantharidin) and immunological therapies (imiquimod). However, in young children it is quite difficult to treat the condition due to pain associated with these procedures. Therefore, physicians need to consider more tolerable treatment options in pediatric patients. OBJECTIVE: We evaluated 20 children with MC for clinical effectiveness and side effects of imiquimod application. METHODS: Twenty children with MC were asked to apply 5% imiquimod cream three times per week at nights every other day for between 8~12 weeks. RESULTS: Nine of the 20 patients (45%) achieved complete clearance after a mean treatment period of 6.9 weeks. Partial clearance was observed in 10 patients (50%) and no response in 1 patient (5%). No patients dropped out due to adverse effects. Twelve children (60%) reported erythema and five children (25%) reported itching. CONCLUSION: Therapy with imiquimod cream was found to be effective, safe and painless in the treatment of MC in children. However, large-scale, double-blind, controlled prospective studies are needed to confirm the effectivenss of Imiquimod cream.
Child* ; Erythema ; Humans ; Molluscum Contagiosum* ; Pruritus