Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

A case of multiple hamartomas of the unilateral chest wall in a four month old infant is presented. There have been a few reports on the CT findings of the chest wall hamartoma in infancy. We describe bone changes of the ribs and mineralization of this rare tumor on the CT scan, and the locations of two separate masses.
Hamartoma ; Humans ; Infant ; Miners ; Ribs ; Thoracic Wall* ; Thorax* ; Tomography, X-Ray Computed

BACKGROUND: Heparin-induced thrombocytopenia/ thrombosis (HITT) is recognized as the most frequent and fatal symptom complexes in patients receiving heparin therapy. The antibodies of HITT are not directly bound to heparin but bound to complexes of heparin and platelet factor 4 (PF4) derived from platelet alpha-granules. That is, HITT IgG antibody-heparin-PF4 immune complexes are bound to FcgammaRII receptor of platelets, which induced thrombocytopenia. Some researches showed the antibodies reactive to platelets could be IgM or IgA as well as IgG. So in this study, the authors tried to explain the molecular basis of heparin-PF4-isoantibody complexes . METHODS: In HITT patients who had received long-term heparin therapy, we determined HITT isoantibodies and titers using heparin:PF4 ELISA. When fifteen HITT patients with high titer antibodies (more than 1 : 100) were selected, reaction patterns of isoantibodies with the platelets were examined through serotonin release test and flow cytometry. RESULTS: All patients showed one or more isotype antibodies and the most frequent isotype was IgGl (nine patients) . In the presence of optimal concentra pion of heparin and PF4, ten patients had antibodies which activated platelets, and all of them were positive in serotonin release test. Reactive plasmas had IgGl, IgG3, IgA or IgM antibodies, and each of them except one had IgGl. These platelet activations could be blocked in vitro by anti-IV.3 antibody. Non-reactive plasmas were negative In serotonin release assay nor had TgGl. The plasmas 4hat had two or more isoantibodies showed a similar pattern of the IgG antibody by flow cytometry. CONCLUSIONS: The HITT antibodies can be all kinds of antibody isotopes, but IgA and IgM may not bind to the platelets directly. It seems to be possible only after reacting with heparin-PF4-IgG complexes.
Antibodies ; Antigen-Antibody Complex ; Blood Platelets ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Heparin ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Isoantibodies ; Isotopes ; Mesons ; Plasma ; Platelet Activation ; Platelet Factor 4 ; Serotonin ; Thrombocytopenia ; Thrombosis*

Recently transurethral incision of prostate (TUIP) is suggested to be a useful method in treating BPH weighting less 35gm, short prostatic urethra. mild bladder outlet obstruction by cystoscopy, and subjective obstructive symptoms with no concomitant prostate cancer. The therapeutic effects of TUIP is compared with those of transurethral resection of prostate (TURP) in small BPH (less than 35gm in weight). 1. The mean prostatic weight of TUIP group (14 cases) and TURP group (15 cases) was 23.9+/-7.2 gm and 25.3+/-7.1gm, each respectively. 2. Pre-and postoperative average flow rates were 4.1 and 10.3 ml/sec in TUIP group and 2.9 and 13.2 ml/set in TURP group. Pre- and postoperative maximum flow rates (MFR) were 7.4 and 13.0 ml/sec in the former and 5.6 and 19.4 ml/sec in the latter (p<0.01). 3. Voiding time (sec/100 ml) improved from 32.2 to 12.8 sec/100 ml in TUIP group and from 41.2 to 6.5 sec/100 ml in TURP group. The initiation time (sec) was shortened From 8.3 to 2.0 sec in the former and from 6.3 to 4.O sec in the latter. 4. In operative time, TUIP group necessitated 25+/-14 minutes, and TURP group. 52+/-10 minutes (p<0.001). 5. Mean duration of catheterization and hospitalization were 3.9 and 5.3 days in TUIP group, an 5.5 and 7.6 days in TURP group (p>0.05). 6. Improvements in the subjective symptoms were noted in 13 (92.2%) of 14 cases in TUIP group and 12 (80%) of 15 cases in TURP group. 7. In complications, l of hematuria requiring transfusion and 1 of incomplete incision in TUIP group and l of hematuria, 1 of retrograde ejaculation and 1 of urinary incontinence in TUIP group were experienced. In comparison to TURP. TUIP is easier in technique, less invasive with fewer complications and shows improvements in the subjective symptoms. Therefore. TUIP is a useful method in treating small BPH. especially in sexually active patients.
Catheterization ; Catheters ; Cystoscopy ; Ejaculation ; Hematuria ; Hospitalization ; Humans ; Male ; Operative Time ; Prostate* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Transurethral Resection of Prostate ; Urethra ; Urinary Bladder Neck Obstruction ; Urinary Incontinence

Data are presented which strongly indicate that the locus occupied by the mutant wz lies to the left of, or on the same locus of apricot (wa). The fact that wz shows a non-suppressor effect in combination with zeste as a typical phenomenon in mutants of sites 1, 2, and 3 of the white locus, also supports that wz is a mutant at or left of apricot (site 3). A "model" for the genetic fine structure of the mutants (wzm, wzl, and wz) is proposed and discussed to account for the mutability among those three mutants. Analysis of wz leads to the hypothesis that it is the result of an inversion (sites 3 and 4) at the white locus, by two mechanisms which are discussed briefly here.
Animals ; *Drosophila ; Female ; *Genes ; Male ; Models, Biological ; *Mutation ; *Recombination, Genetic

To assess the presence and the severity of renal scarring in primary vesicoureteral reflux (VUR), 11 children (3 girls and 8 boys, 19 kidneys) underwent intravenous pyelography (IVP) and 99m Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy and the following results were obtained : 1. Of 19 kidneys, renal margin was shown in 5(26.3% ) and renal scar was revealed only in 3 (15.8%) on IVP. 2. Renal margin in all ( 100.0% ) and renal scar in 12 (63.1%) of the kidney were revealed on 99m Tc-DMSA renoscintigraphy. 3. On the follow-up ranging from 6 months to 13 years after surgical reconstruction, 8 kidneys showed no reversible improvements in renal scar except one, in which progression of renal scar was noted. We concluded that 99m Tc-DMSA renoscintigraphy is more valuable than IVP in evaluating the degree of renal scar and the renal margin.
Child* ; Cicatrix* ; Female ; Follow-Up Studies ; Humans ; Kidney ; Urography ; Vesico-Ureteral Reflux*

A case of sacrococcygeal cystic teratoma in a 16 month-old female infant having suffered from urinary retention and severe constipation for 3 days was herein reported. Confirmative diagnosis was possible by barium enema and contrast media injection into cystic mass located in the presacrococcygeal region. Successful removal of the cystic teratoma with the patient in a prone position was performed. Uneventful postoperative course followed.
Barium ; Constipation ; Contrast Media ; Diagnosis ; Enema ; Female ; Humans ; Infant ; Prone Position ; Teratoma* ; Urinary Retention

PURPOSE: This retrospective study was conducted to evaluate the value of adminstration of IV gadopentetate dimeglumine for MR imaging of tuberculous spondylitis. MATERIALS AND METHODS: The authors reviewed MR images both with and without contrast enhancement of 22 patients with tuberculous spondylitis. Evaluation of signal characteristics, enhancement patterns, and difference of delineation between pre- and postcontrast enhancement was made on 4 compartments the vertebral body, intervertebral disc, paravertebral space, and extradural space. RESULTS: The spinal tuberculous lesions revealed relatively low or isosignal intensity on T1-weighted image and high signal intensity on T2-weighted image. The tuberculous lesions of vertebral body showed enhancement of mixed pattern, and rim enhancement pattern was predominant in the other 3 compartment, suggesting abscess. The contrast enhanced MR image showed better demarcation of the extents of tuberculous lesions comparing with noncontrast image, especially at the vertebral body and intervertebral disc. The nature of tuberculous involvement was better visualized at the extradural space and paravertebral space on postcontrast image. CONCLUSION: We conclude Gd-DTPA enhanced MR image can give informations for more detailed delineation, extents, and nature of involvement in the tuberculous spondylitis.
Abscess ; Gadolinium DTPA ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylitis*

Testicular biopsy to have been utilized as a diagnostic tool in male infertility were underwent experimentally to observe the effects on the morphology and the physiology of post-biopsied testis of 17 male rabbits. Bilateral orchiectomy was done at third day, 1st week, 2nd week and 4th week after open testicular biopsy, and biopsied testes were compared with contralateral control in histopathological views. The results were summarized as follows : 1. In seminiferous tubules of sham-operated tests, there was no significant pathologic changes. 2. The inflammatory reaction was most severe at third day after biopsy and completely disappeared at 4th week. 3. Increased thickness of tunica albuginea and fibrotic reaction were observed near the biopsy site. 4. Spermatogenesis did not only decrease near the biopsy site with atrophy of the seminiferous tubules but also mildly decreased on the far area, that all began to recover at 4th week. 5. No evidence of immunologic reaction and hyperplasia of Leydig cell were demonstrated. It was suggested that testicular injury after biopsy was developed by interference of local blood flow, obstruction of seminiferous tubules and inflammatory reaction, so that could be minimized by application of open testicular biopsy only to definitively indicated cases.
Atrophy ; Biopsy* ; Humans ; Hyperplasia ; Infertility, Male ; Male ; Orchiectomy ; Physiology ; Rabbits ; Seminiferous Tubules ; Spermatogenesis ; Testis*

No abstract available.