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.

No abstract available.

Drosophila melanogaster (Oregon-R, Oak Ridge strain) males, 19 to 21 hours old, were X-rayed with a total dose of 1000r. or 3000 r. given in two equal fractions of 500 r. or 1500 r. at a dose rate of 500r. per minute, except for Experiment #2 in which they were given a single dose of 1000 r. at 24 +/- 1 degree C in several gas environments, with a time interval of 40 minutes between the two doses. At each Change of gas(es),the system was evacuated to remove all gases, then Hushed with helium for 1 minute. Tests using CO were carried out in the dark and the others m the light, both at 1 atmosphere of the gas or gas mixture. In order to study the genetic radiation damage and its modification by several gases the frequencies of dominant lethals and translocations induced in cells which were in different stages of spermatogenesis were scored using seven sequential 2-day mating over a two-week test period. Data are prtsented which indicate that: 1) The frequency of dominant lethals increased from sperm to spermatids and meiotic cells, then decreased in spermatogonial cells which were the least susceptible to X-rays. 2) The cycle of damage for dominant lethals is similar to that for translocations, but does not coincide with it completely, and the peaks of damage for both are located in the early postmeiotic stages, and the cycle of frequencies of translocations coincides with that of percentages of sterility of F1 the coincidence frequencies between translocations and the sterility demonstrates that the mechanisms of damage for both are related, at least in part. 3) The NO effect on sperm and late spermatids is more drastic than the oxygen effect, but a major fraction of the effect is to cause the death of the sperm. 4) The carbon monoxide (CO) during radiation increase genetic damage above the other gases tested, and it is possible to conclude that the duration(s) of 4 minutes of gases in post-treatments is too short to modify the damage. 5) There are few (or no) translocations recovered from premeiotic cells. 6) The Y-chromosome was involved in 10.8% of total breaks, or about 1/4 as frequently as the two autosomes tested, and chromosomes 2 and 3 equally participated in an interchange.
Animal ; Chromosome Aberrations/radiation effects ; Drosophila ; Male ; Meiosis/radiation effects* ; Radiation Genetics* ; Spermatozoa/radiation effects* ; Time Factors

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*

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

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*

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*

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

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*