Since Whitehead had described a circular hemorrhoidectomy in 1882, many surgeons adopted it for decades for patients with protruding anal deformity. After a few decades of performing Whitehead operation, devastating complications such as anal stricture, fecal incontinence, and wet anus with mucosal eversion had been reported on the literatures and then it was buried as an abandoned procedure by surgeons for a long period. Recently, a few prominent anal surgeons reported that they could avoid such devastating complications by introducing diverse modifications of the original Whitehead's operation. The authors analyzed 22 patients who had undergone original Whitehead circular hemorrhoidectomy with the technique of preserving most of the perianal skin and W-shaped circular incision during the period from 1991 to 1996, with special regard to the com plications such as anal stricture and anal mucosal eversion which have been debated on so far and reviewed the articles about these issues. In immediate postoperative period, suture failure and resultant non-surgery requiring, mild anal stricture were documented in 3 of the 22 cases(13.6%). On long-term follow-up with the mean period of 44 months (18~79 months) in 14 cases, except those 8 cases that were lost, with phone-call questionaire, 13 patients(93%) had quite normal anal functions. The authors would like to suggest that the original Whitehead's circular hemorrhoidec tomy is a valuable surgical technique to manage the protruding anal deformity if surgeons can avoid well known complications such as anal stricture and anal mucosal eversion by choosing a correct location of initial W-shaped incision to preserve as much perianal skin as possible.
Anal Canal ; Congenital Abnormalities ; Constriction, Pathologic ; Fecal Incontinence ; Follow-Up Studies ; Hemorrhoidectomy* ; Humans ; Postoperative Period ; Skin* ; Sutures

PURPOSE: To assess the role of blood vessels in the formation of peritumoral abnormal signal intensity which exaggerates the size of malignant tumor on MR images. MATERIALS AND METHODS: We performed MR-microangiographic-pathologic correlation using implanted VX-2 carcinoma in 16 rabbit thighs 1-28 days after tumor implantation. The shape and distribution of abnormal vessels were analyzed on microangiography and on histologic examination in correlation with peritumoral abnormal signal intensity on MR images. RESULTS: Dilated peritumoral blood vessels gave rise to irregular, tortuous tumor vessels penetrated into the tumor. With the tumor growth, hypervascular tumor vessels in peritumoral area and central avascular areas were increased. These hypervascular areas on microangiography were corresponded with abnormal signal intensity on MR images. CONCLUSION: Hypervascularity could be a cause of peritumoral abnormal signal intensity which exaggerates the size of experimentally induced malignant musculoskeletal tumors on MR images.
Blood Vessels* ; Thigh

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

Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

Objective: The COVID-19 is overwhelming health care systems globally. Hospital isolation may generate considerable psychological stress. However, there has been scarce evidence on psychological interventions for these patients due to maintain staff safety. We investigated the feasibility and effectiveness of telephone based interventions for psychological problems in hospital isolated patients with COVID-19. Methods: Psychiatrists visited the ward where the patients were hospitalized and interventions were given by using a ward telephone for 30 minutes. All patients were approached to receive a two-week psychological intervention program and/or pharmacotherapy whenever needed. Psychological problems were assessed at baseline, one, and two weeks. For the assessment of anxiety and depressive symptoms, the Hospital Anxiety and Depression Scale was administered to patients once a week. Insomnia severity index and Beck Depression Inventory 9 item were checked weekly to assess insomnia and suicide idea. Results: Of 33 enrolled, clinically meaningful psychological symptoms were found in 6 (18%) patients for anxiety; 13 (39%) for depression; 10 (30%) for insomnia; and 3 (9%) for suicidal ideation. In 9 patients (27%), psychotropic medications were prescribed to manage anxiety, agitation, depressed mood, insomnia, impulsivity, and suicide idea.Compared to baseline, significant improvements were found in anxiety, depression, and suicidal ideation at one week.There were no statistical differences between the values evaluated at baseline and at two weeks. Conclusion Our report at least indicates potential usefulness of telephone based interventions in hospital isolated patients with COVID-19, and will hopefully form the basis for future randomized clinical trials.

Juvenile dermatomyositis is an uncommon autoimmune disease with classic heliotrope discoloration of eyelids, erythematous skin rash of joints and proximal muscle weakness. Quite different from adults, malignancy is rarely accompanied in juvenile dermatomyositis. However vasculitis, muscle atrophy, calcification and gastrointestinal involvement are often observed in juvenile dermatomyositis. A six year old boy was admitted with chief complaints of general weakness and skin rash. Muscle biopsy was performed which was consistent with dermatomyositis. The patient was treated with intravenous immunoglobulin, steroid, methotrexate and physiotherapy. We report a case of juvenile dermatomyositis.
Adult ; Autoimmune Diseases ; Biopsy ; Dermatomyositis* ; Exanthema ; Eyelids ; Humans ; Immunoglobulins ; Joints ; Male ; Methotrexate ; Muscle Weakness ; Muscular Atrophy ; Vasculitis

PURPOSE: To investigate the risk factors related to the location of visual field defects in normal tension glaucoma. METHODS: Eighty-one eyes diagnosed as normal tension glaucoma in patients with early glaucomatous visual field defects were divided into central visual field defects and peripheral visual field defects. The difference between the 2 groups based on the intra-individual comparison were assessed with several ocular risk factors such as sex, age, hypertension, diabetes mellitus, smoking, laterality, intraocular pressure, central corneal thickness, cup-disc ratio, peripapillary atrophy, mean deviation, pattern standard deviation, best corrected visual acuity, and refractive errors. RESULTS: The incidence of hypertension in the central visual field defects group (60.6%) was higher than in the peripheral visual field defects group (22.9%, p = 0.001). The central corneal thickness in the central group (533.1 +/- 18.2 microm) was thinner than in the peripheral group (545.0 +/- 30.0 microm, p = 0.003). Hypertension was the only risk factors for central visual field defects (p = 0.001). In both the central group and peripheral group, upper visual field defects were more common than lower defects. CONCLUSIONS: Hypertension in patients with normal tension glaucoma was a factor involved in central visual field defects. Additionally, numerous visual field defects were mainly found the superior portion.
Atrophy ; Diabetes Mellitus ; Eye ; Humans ; Hypertension ; Incidence ; Intraocular Pressure ; Low Tension Glaucoma ; Risk Factors ; Smoke ; Smoking ; Visual Acuity ; Visual Fields

No abstract available.

No abstract available.