PURPOSE: Because of the complexity and un-expectation of the courses and clinical features for the complex anal fistula, the management of it presents a difficult surgical challenge. Various techniques have been used, such as seton placement, advancement flap closure, muscle filling procedure, and fibrin glue injection. The classic lay-open and seton placement may distort the anal anatomy and result in poor functional outcomes, such as incontinence. Also, advancement flap techniques are associated with relatively high recurrence rates. This study assesses the results of surgery for a complex anal fistula, as performed in Hangun Hospital, Busan. Operative procedures were comprised of two or more separate procedures, including 1) a total fistulectomy, 2) muscle reconstruction, sometimes muscle transposition, 3) direct closure of the primary opening without making a mucosal advancement flap, and 4) a drainage procedure and/or other minor procedure. METHODS: Surgical procedures were performed on 22 patients (18 males) with a complex anal fistula between July 2004 and December 2004. The clinical and the manometric results were analyzed with respect to postoperative recurrence, delayed wound healing, and postoperative fecal incontinence. RESULTS: Nineteen of the 22 patients were completely healed without any sequelae. Treatment failure was encountered in one patient two months postoperatively, when an additional fistulotomy was performed to achieve a cure. There were two patients displaying delayed healing, who were successfully treated by curettage. No patient complained of postoperative fecal incontinence in either the clinical examination on the manometric study (mean resting pressure, 75.5+/-3.5 mmHg; maximal squeeze pressure, 175.7+/-10.3 mmHg). CONCLUSIONS: This short- term study suggests that a direct closure of the internal opening after a total fistulectomy can be an alternative surgical option for the treatment of a complex anal fistula.
Curettage ; Drainage ; Fecal Incontinence ; Fibrin Tissue Adhesive ; Humans ; Muscles ; Rectal Fistula ; Recurrence ; Surgical Procedures, Operative ; Treatment Failure ; Wound Healing

We are reporting a case of 25-year-old male patient with elastosis perforance serpiginosa who showed multipte serpiginous plaques on his neck. Some of the lesions showed hypopigmented, hard, scar-tissue like plaques in the central part. Histologic examination showed hyperplasia and transepidermal elimination of elastic tissue. By electron microscopy, also, we could prove that the elastic fibers were increased in the dermis.
Adult ; Dermis ; Elastic Tissue ; Humans ; Hyperplasia ; Male ; Microscopy, Electron ; Neck

BACKGROUND: It is important that patients with human immunodeficiency virus (HIV) remain under medical care to improve their health and to reduce the potential for HIV transmission. We explored factors associated with missed visits for HIV medical care according to age group. METHODS: Data were derived from a city-wide, cross-sectional survey of 812 HIV-infected adults in Seoul. Multiple logistic analyses were used to explore predictors of missed visits. RESULTS: Of the 775 subjects, 99.3% were treated with antiretroviral therapy (ART) and 12.5% had missed a scheduled appointment for HIV medical care during the past 12 months. Compared with the group aged ≥ 50 years, the 20–34-years and 35–49-years groups were strongly associated with missed visits (adjusted odds ratio [aOR], 5.0 and 2.2, respectively). When divided by age group, lower education level (aOR, 3.0) in subjects aged 20–34 years, low income (aOR, 3.5), National Medical Aid beneficiary (aOR, 0.3), and treatment interruption due to side effects of ART (aOR, 3.4) in subjects aged 35–49 years, and National Medical Aid beneficiary (aOR, 7.1) in subjects aged ≥ 50 years were associated with missed visits. CONCLUSION: In conclusion, younger age was a strong predictor of missed visits for HIV medical care. However, the risk factors differed according to age group, and the strongest predictor in each age group was related to socioeconomic status.
Acquired Immunodeficiency Syndrome ; Adult* ; Cross-Sectional Studies ; Education ; HIV ; Humans* ; Korea* ; Odds Ratio ; Risk Factors ; Seoul* ; Social Class

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).
Action Potentials ; Diabetic Neuropathies ; Early Diagnosis ; Humans ; Neural Conduction* ; Reference Values ; Sural Nerve ; Tibial Nerve

BACKGROUND: In July 2017, there was an outbreak of Campylobacter jejuni infection in three auxiliary police squads in Seoul, Korea. An epidemiological investigation was conducted to identify the cause and source of the illness. MATERIALS AND METHODS: A retrospective cohort study of all members of the three auxiliary police squads was conducted. Self-administered questionnaires were distributed to all members of the three squads and the food handlers. Rectal swabs were collected from symptomatic police and food handlers. RESULTS: The overall attack rate was 20.4%, and the epidemic curve indicated a point source type outbreak. Of the 257 auxiliary policemen who consumed the incriminated lunch, 55 met the case definition. Of 36 rectal swabs, 10 were positive for C. jejuni and had the same pulsed-field gel electrophoresis pattern. The major symptoms were loose stool (100%) and abdominal pain (59.3%); the median incubation period was 69 hours. In the univariate epidemiological analysis, watermelon (relative risk [RR], 5.75; 95% confidence interval [CI], 2.14–15.43), half-cut chicken soup (RR, 3.96; 95% CI, 1.49–10.54), steamed rice with millet (RR, 2.73; 95% CI, 1.29–5.77), and radish kimchi (RR, 2.57; 95% CI, 1.45–4.55) were positively associated with the illness. Inspection of the food service facility found that the drainpipe under the meat cleaning sink did not work. CONCLUSION This outbreak could have been caused by cross-contamination with C. jejuni from raw chicken via environmental sources.

Approximately 5% of patients infected with Herpes zoster experience motor complications, such as muscle atrophy or paresis, caused by motor neuron involvement. The majority of paretic cases are associated with involvement of cranial nerves or of spinal nerves that innervate the muscles of extremities. We report the case of an 82-year-old female patient with cutaneous Herpes zoster involving the T10-11 sensory dermatomes, complicated by ipsilateral abdominal protrusion. Electromyography on the left external oblique muscle revealed marked denervation potentials, implying motor neuron involvement. One month after the onset of abdominal protrusion, the patient's motor symptoms markedly improved. Clinicians should consider the possibility of motor neuron involvement with Herpes zoster, even in cases of zoster involving thoracic branches of spinal nerves.
Aged, 80 and over ; Cranial Nerves ; Denervation ; Electromyography ; Extremities ; Female ; Herpes Zoster ; Humans ; Motor Neurons ; Muscles ; Muscular Atrophy ; Paresis ; Spinal Nerves

Approximately 5% of patients infected with Herpes zoster experience motor complications, such as muscle atrophy or paresis, caused by motor neuron involvement. The majority of paretic cases are associated with involvement of cranial nerves or of spinal nerves that innervate the muscles of extremities. We report the case of an 82-year-old female patient with cutaneous Herpes zoster involving the T10-11 sensory dermatomes, complicated by ipsilateral abdominal protrusion. Electromyography on the left external oblique muscle revealed marked denervation potentials, implying motor neuron involvement. One month after the onset of abdominal protrusion, the patient's motor symptoms markedly improved. Clinicians should consider the possibility of motor neuron involvement with Herpes zoster, even in cases of zoster involving thoracic branches of spinal nerves.
Aged, 80 and over ; Cranial Nerves ; Denervation ; Electromyography ; Extremities ; Female ; Herpes Zoster ; Humans ; Motor Neurons ; Muscles ; Muscular Atrophy ; Paresis ; Spinal Nerves

When teeth are extracted, patient face social, psychological and aesthetic problems which can be minimized by fabricating a interim immediate denture. Interim immediate denture manufactured using digital technology can be completed with reduced number of patients’ visits and simple laboratory process. Implant-supported removable partial denture (ISRPD) has been suggested as alternative treatment option when fixed implant prosthesis is not feasible. In this case, interim immediate dentures were fabricated using digital technology for patient after teeth extraction and treatment using ISRPD by installing implants and surveyed crowns is found to be successful with better support, stability and maintenance of removable partial dentures.

Takayasu's arteritis is an inflammatory vasculitis that primarily affects the aorta and its major branches. Involvement of the thoracic and abdominal aortas, although rare, causes marked hypertension and may lead to severe heart failure. We report the improvement of cardiac function after axillofemoral bypass grafting in a 59-year-old woman who had this condition.
Aorta ; Aorta, Abdominal ; Female ; Heart ; Heart Failure ; Humans ; Hypertension ; Middle Aged ; Takayasu Arteritis ; Transplants ; Vasculitis

BACKGROUND: Rhinocerebral mucormycosis (RCM) is an uncommon and fatal clinical syndrome resulting from an opportunistic infection caused by a fungus of the order Mucorales in immunocompromized patients. The mortality and morbidity in the patients with intracranial involvement is invariably high, and it was reported that most survivors had early diagnosis and received aggressive treatment. Therefore, we retrospectively reviewed four patients of pathologically confirmed mucormycosis to find out the clues for early diagnosis of RCM and for prediction of fatal intracranial involvement. METHODS: The clinical, radiological features and histo-pathological involvement sites in the patients with intracranial involvement were compared to those without intracranial involvement. RESULTS: All the patients had uncontrolled diabetes and were admitted with orbital involvement. On the precise physical examination, mucosal involvement was found in all patients; three of them in only nasal mucosa and one in oral palatal mucosa. Despite the vigorous antifungal therapy, two patients had intracranial involvement and expired. MRI finding of extensive sphenoid sinusitis adjacent cavernous sinus preceded the intracranial involvement of RCM, which was not found in the patients without intracranial involvement. CONCLUSIONS: Our findings suggest that early observation of oral or nasal mucosal changes might be an important clinical clue for differentiation of RCM from other causes of rhino-oculo-cerebral symptoms in uncontrolled diabetic patients, and that extensive sphenoid sinusitis might be an important radiological feature for predicting the fatal intracranial involvement of RCM.
Cavernous Sinus ; Diabetes Mellitus ; Early Diagnosis* ; Fungi ; Humans ; Magnetic Resonance Imaging ; Mortality ; Mucorales ; Mucormycosis* ; Mucous Membrane ; Nasal Mucosa ; Opportunistic Infections ; Orbit ; Physical Examination ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; Survivors