Conventional hemorrhoidectomy is still the main stairway to the treatment of the third or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy, open hemonhoidectomy is claimed to decrease postoperative pain and wound infection, but to have disadvantage of long period of wound healing. Semi-closed hemorrhoidectomy has the advantage of rapid wound healing without increased risk of wound infection, but more painful postoperative course than open hemorrhoidectomy is suggested. To assess this conventional concept, two hundreds of patients were randomly allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the average time for disappearance of wound edema was 4.9days, average time for disappearance of wound pain was 9.0days, average time for painless defecation was 14.1 days, average time for complete wound healing was 28.4days. The main complications were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires curettage, the skin tags were resected under local anesthesia. Anal discharge and pruritus were spontaneously disappeared after the healing of the wound. In group B, the average time for disappearance of wound edema was 6.1 days, average time for disappearance of wound pain was 6.3days, average time for painless defecation was 9.2days, average time for complete wound healing was 20.7days. The main complications were skin tags, more prevalent than group 4, requiring resection under local anesthesia. No infectious complications were noted in both groups. Consequently, the old concept that open hemorrhoidectomy has advantage of less painful postoperative course than semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers more rapid loss of pain and more rapid healing of the wound than open hemorrhoidectomy, without increased risk of infectious complications. In conclusion, semi-closed hemorrhoidectomy is superior method to open hemorrhoidectomy in third or fourth degree hemorrhoids.
Anesthesia, Local ; Curettage ; Defecation ; Edema ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Pain, Postoperative ; Pruritus ; Skin ; Wound Healing ; Wound Infection ; Wounds and Injuries

Eosinophilic pustular folliculitis was first reported by Ofuji and Ogino in 1970, which is characterized by eruptions of aggregated pustules containing numerous eosinophils and by blood eosinophilia. Most cases were confined to Japan and the authors first observed two cases of typical eosinophilic pustular folliculitis in Korea. In case 1, the skin lesions were grouped uniforrn follicular papules on the erythematous base which intermingled with vesicopustules at the edge of the patches on the mandibular area, the neck and the anterior chest having tendency to central healing and peripheral extension like dermatophytosis. In case 2, the skin lesiens vere groupod uniform follicular papules of 1-2mm in diameter to form patches of 5-10 cm in diameter on the back, the a,nterior chest and the upper examities, some of which were topped with pustules or crusts. In both cases, blood eosinophilia were prominent and the histopathclogic findings showed dermal infiltration and abscesses of predominently eosinophilic leukocytes localized to follicles. The authors made the diagnosis of eosinophilic pustular folliculitis from the characteristic clinical and histopathologic findings.
Abscess ; Diagnosis ; Eosinophilia ; Eosinophils* ; Folliculitis* ; Japan ; Korea ; Leukocytes ; Neck ; Skin ; Thorax ; Tinea

Malignant histiocytosis is a rare, usually fatal malignant neoplasm. We present a case of a 62 year-old female with malignant histiocytosis involving the skin, lymph nodes and bone marrow. The patient achieved a complete remission for 1 year after the completion of COPP chemotherapy (cyclophosphamide, vincristine, procarbazine and prednisone). We propose that COPP chemotherapy is a valuable therapeutic regimen for malignant histiocytosis.
Bone Marrow ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Histiocytic Sarcoma* ; Humans ; Lymph Nodes ; Middle Aged ; Procarbazine ; Skin ; Vincristine

A 68-year-old male patient who was diagnosed as cutaneous mycosis fungoides with plaques, nodules and tumor has been treated with photochemotherapy. Oral methoxsalen followed by ultraviolet light(PUVA) resulted in clinical and histopathologic improvement of skin lesions. Photochemotherapy units consists of boxes with 12 UVA lamps. The initial dose was 8. 4 joules/cm2. The maintenance dose was 10. 5 joules/cm2. The total dose at present time is 1203. 82 joules/cm2. We prppose that PUVA therapy may be a valuable therapeutic regimen for mycosis fungoides.
Aged ; Humans ; Male ; Methoxsalen ; Mycosis Fungoides* ; Photochemotherapy* ; PUVA Therapy ; Skin

BACKGROUND/AIMS: Despite recent advances in liver surgery, complication and mortality rate in hepatectomy are still high compared to other abdominal surgeries. Intraoperative stress such as bleeding, vascular occlusion, excessive mobilization and prolonged operation time is the most important factor in postoperative complications. Anterior approach avoiding hepatic mobilization and vascular occlusion in right hepatic lobectomy is a useful method for decreasing intraoperative stress. We investigated the effectiveness of anterior approach in right hepatic lobectomy. METHODS: We studied 33 cases of right hepatic lobectomy for malignant tumor between January 1993 and June1997. Thre were 13 cases of Anterior approach (group A) and 20 cases of classic right hepatic lobectomy (group B). We analyzed liver function test, arterial ketone body ratio(AKBR), operation time, blood transfusion during operation, hospital stay, and postoperative complications. RESULTS: Total bilirubin levels at first and seventh postoperative days were 2.1+/-0.6mg/dl, 0.9+/-0.2mg/dl in group A and 2.7+/-1.3mg/dl, 1.0+/-0.3mg/dl in group B. AST were 189+/-65.3 IU/L, 43+/-13.5 IU/L in group A and 325+/-67.8 IU/L, 51+/-18.2 IU/L in group B. ALT were 169+/-30.5 IU/L, 52+/-17.4 IU/L in group A and 295+/-70.3 IU/L, 52+/-16.6 IU/L in group B. AKBR at intraoperative and immediate postoperative period were 0.58+/-0.06, 0.62+/-0.03 in group A and 0.38+/-0.04, 0.40+/-0.08 in group B. Neither operation time (in group A : 380.5+/-61.1 minutes, in group B : 342.9+/-54.8 minutes), transfusion volume during operation (group A : 1222+/-802cc, group B : 1410+/-476cc), nor hospital stay (group A : 22.8+/-3.5 days, group B : 19.1+/-1.4 days) were different between the two groups. Complication rate was lower in group A compared to that of group B (30.8% vs. 40.0%). There was 1 mortality in group B and no mortality in group A. CONCLUSIONS: It is suggested that right hepatic lobectomy through the anterior approach is a useful surgical procedure to reduce intraoperative surgical stress and postoperative complications.
Bilirubin ; Blood Transfusion ; Hemorrhage ; Hepatectomy ; Length of Stay ; Liver ; Liver Function Tests ; Mortality ; Postoperative Complications ; Postoperative Period

Satoyoshi syndrome(generalized Komuragaeri disease) is a rare disorder of unknown cause, characterized by progressive, painful, intermittent muscle spasms and alopecia. Endocrinopathy with amenorrhea, secondary skeletal abnormalities, and diarrhea or unusual malabsorption are frequently seen. It seems that autoimmunity may play a role in its pathogenesis. We report a 13-year-old girl with characteristic manifestations of the syndrome. She was treated with intravenous gammaglobulin and Prednisolone. Painful muscle cramps were gradually improved, but the scalp condition did not change. Satoyoshi syndrome should be considered in children with unexplained muscle spasms and alopecia.
Adolescent ; Alopecia* ; Amenorrhea ; Autoimmunity ; Child ; Diarrhea ; Female ; Humans ; Muscle Cramp ; Prednisolone ; Scalp ; Spasm*

Labial adhesions are postnatal fusion of the labia minora in the midline of varying degrees. They are postulated to be the result of low estrogen levels in the prepubertal child and possibly of a chronic inflammatory process. Topical treatment with conjugated estrogens has been the mainstay of therapy. We experienced one case of labial adhesion in an infant who was treated with estrogen cream for three weeks without any complication. Here we present this case with a brief review of the literature.
Child ; Estrogens ; Estrogens, Conjugated (USP) ; Humans ; Infant

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

An 8-year-old male was admitted because of dysphagia and substernal pain suffered while eating followed by postprandial vomiting for 2 years. He was always hungry due to postprandial vomiting and willing to eat again just after vomiting. After this meals, he used to jump up and down to shake off the substernal discomfort. A narrowing of the gastroesophageal junction was noted by esophagogram. Manometry revealed high Lower esophageal sphincter (LES) pressure (51.6mmHg), incomplete LES relaxation during swallowing, loss of esophageal peristalsis and a positive pressure of the esophageal body compared to intragastric pressure. After the 1st balloon dilatation, symptoms were much improved even though LES pressure still remained high (37.2mmHg). About 2 months after the 1st balloon dilatation, symptoms relapsed and we managed him with a 2nd balloon dilatation. Symptoms were more improved than after the 1st dilatation and LES pressure normalized as well. Since the 2nd dilatation, symptoms have not recurred for 3 years. We present an 8-year-old boy with achalasia successfully managed by the use balloon dilatation.
Child ; Deglutition ; Deglutition Disorders ; Dilatation* ; Eating ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Humans ; Male ; Manometry ; Meals ; Peristalsis ; Relaxation ; Vomiting

Glycine and gamma-aminobutyric acid (GABA) are localized and released by the same interneurons in the spinal cord. Although the effects of glycine and GABA on analgesia are well known, little is known about the effect of GABA in strychnine-induced hyperalgesia. To investigate the effect of GABA and the role of the glycine receptor in thermal hyperalgesia, we designed an experiment involving the injection of muscimol (a GABAA receptor agonist), baclofen (a GABAB receptor agonist) or glycine with strychnine (strychnine sensitive glycine receptor antagonist). Glycine, muscimol, or baclofen with strychnine was injected into the cisterna magna or lumbar subarachnoidal spaces of mice. The effects of treatment on strychnine-induced heat hyperalgesia were observed using the pain threshold index via the hot plate test. The dosages of experimental drugs and strychnine we chose had no effects on motor behavior in conscious mice. Intracisternal or intrathecal administration of strychnine produced thermal hyperalgesia in mice. Glycine antagonize the effects of strychnine, whereas, muscimol or baclofen does not. Our results indicate that glycine has anti-thermal hyperalgesic properties in vivo; and GABA receptor agonists may lack the binding abilities of glycine receptor antagonists with their sites in the central nervous system.
Animals ; Baclofen/*administration & dosage/pharmacology ; Drug Delivery Systems ; GABA Agonists/administration & dosage/pharmacology ; GABA Antagonists/administration & dosage/pharmacology ; Glycine/*administration & dosage/pharmacology ; Hot Temperature ; Hyperalgesia/chemically induced/*drug therapy ; Injections, Spinal ; Male ; Mice ; Mice, Inbred ICR ; Muscimol/*administration & dosage/pharmacology ; Pain Threshold ; Random Allocation ; Strychnine ; gamma-Aminobutyric Acid/metabolism