Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25~56) years. The mean follow-up after operation was 33 (range, 8~62) months. The etiology of the fistula in the majority of patients was obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should be performed.
Colostomy ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Manometry ; Postoperative Complications ; Radiotherapy ; Rectovaginal Fistula* ; Recurrence ; Rubber ; Ultrasonography ; Wound Infection

Diabetes mellitus (DM) is an important cause of organic impotence in man. The exact pathogenesis remains debatable although it has been focused on cavernosal neuropathy and/or endothelial dysfunction. This study was designed to investigate the effect of DM on penile erection, especially in association with nitric oxide synthase (NOS) in corpus cavernosum of diabetic rats. NOS studies of rat penis were performed in diabetic (DM was induced for 3, 6, 9, 12 weeks, respectively, by intraperitoneal administration of streptozotocin, 60mg/kg), in control and neurotomy group (3 weeks after bilateral cavernous nerve transection). The experiments consisted of nicotinamide dinucleotide phosphate (NADPH) diaphorase activity with spectrophotometric assay for NOS catalytic activity, NADPH diaphorase staining for the identification of NOS containing nerve fibers, and Western blotting analysis with anti-brain NOS antibody for the expression of neuronal NOS. Finally, these results were compared with erectile response to cavernous nerve stimulation in diabetic and in control rats. In assay of NADPH diaphorase activity, NOS activity decreased significantly in penis of diabetic rat as compared to that of controls. Between the diabetic groups, NOS activity was not seen significantly different, and in neurotomy groups it was similar to that of diabetic groups. On histochemical staining of penile tissues, the number of NADPH-positive nerve fibers in control group (a mean of 127+/-6 fibers recorded in 4 random fields on each corporal side) contrasted significantly with that of the bilateral cavernous nerve ablation group (a mean of 12+/-2). In diabetic group, the number of NOS-containing nerve fibers was gradually reduced along with duration of diabetes (from 92+/- 3 at 3 weeks to 28+/-3 at 12 weeks). In addition, analysis of blot density of neuronal NOS by Western blotting showed similar findings: 16% at 3 weeks and 8% at 12 weeks in diabetic group, 5% in neurotomy group and 27% in controls, based on the density of the rat cerebellum. Furthermore, erection response to cavernous nerve stimulation was also decreased in diabetic rats along with DM duration. The results, indicated that reduction of cavernous NOS, particularly, its neuronal form at the level of NO production plays an important role on the pathogenesis of erectile impotence in diabetic rats although the role of endothelial N0S in DM remains to be elucidated. Furthermore, cavernosal NADPH diaphorase staining and/or NOS activity may allow to characterize certain pathological condition, which comprise neurogenic impotence.
Animals ; Blotting, Western ; Cerebellum ; Diabetes Mellitus ; Erectile Dysfunction ; Male ; NADPH Dehydrogenase ; Nerve Fibers ; Neurons* ; Niacinamide ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I* ; Penile Erection* ; Penis ; Rats* ; Streptozocin

BACKGROUND: Generally ulcerative colitis has a character that has a continuous pathological lesion from the rectum toward the cecum. Ulcerative appendicitis with a skipped appendiceal orifice lesion, which is unusual in ulcerative colitis, has been infrequently reported, and its clinical characteristics have not been identified. PURPOSE: This study was carried out to evaluate the incidence rate and the clinical characteristics of ulcerative appendicitis. METHODS: One hundred consecutive patients with ulcerative colitis who had been treated from Jan. 1997 to Aug. 1998 at Song-Do Colorectal Hospital were used for the study. Data evaluated included age, sex, involved site, clinical type, clinical severity of the disease, and endoscopic severity of the disease. RESULTS: Nineteen (19%) of the 100 patients had skipped lesions around the appendiceal orifice; the other 81 did not. There were no significant differences between these two groups with respect to the age and the sex distributions, the involved site, the clinical type, and the clinical severity. There was a correlation between the endoscopic grades, based on the Riley classification, of the lesions at the rectum and at the appendiceal orifice. Seven patients (36.8%) of the 19 patients with appendiceal orifice lesions showed an extended lesion from the appendiceal orifice to the cecum. CONCLUSIONS: We suggest that appendiceal lesions in ulcerative colitis are not infrequent. Even though no significant differences in the clinical characteristics of ulcerative colitis with ulcerative appendicitis, compared with those of ulcerative colitis without ulcerative appendicitis, were found, we suggest that more profound study of ulcerative appendicitis probably contribute to understand the pathophysiology of ulcerative colitis.
Appendicitis ; Cecum ; Classification ; Colitis, Ulcerative* ; Humans ; Incidence ; Rectum ; Sex Distribution ; Ulcer*

BACKGROUND: The aim of this study was to investigate the relationship of the left ventricular (LV) systolic function, the LV dimension and the LV mass with the QT dispersion in patients with stable angina, and we also wanted to compare this relationship between patients with and without significant coronary stenosis on coronary angiography. MATERIAL AND METHOD: 174 patients complained of typical angina and they had no associated ST segment or cardiac enzyme abnormalities. The patients were divided into 2 groups based on the results of coronary angiography: the patients with angiographic coronary stenosis > or =50% made up group I (n=101), and the patients with angiographic coronary stenosis <50% made up group II (n=73). An echocardiogram for assessing the LV ejection fraction (EF), the LV dimension and the LV mass and a 12-lead electrocardiogram for assessing the QT dispersion were performed before the coronary angiography. RESULT: The QT dispersion was significantly greater in group I than that in group II (39.8 ms vs. 33.3 ms; p<0.05). For all the patients, all the parameters of LV dimension and LV mass had statistically positive correlation to the QT dispersion, but the LV mass was the only independently significant parameter that was correlated with the increased QT dispersion (p<0.05). For group I, none of the echocardiographic parameters had significant correlation with the QT dispersion. However, the LV dimension and LV mass had significantly positive correlation with the QT dispersion, and the LV mass was also the only independently significant parameter that was correlated with increased QT dispersion in group II (p<0.05). CONCLUSION: Our study demonstrated a significantly positive correlation of the QT dispersion to the LV dimension and the LV mass in patients with stable angina. These findings are present only in patients without significant coronary stenosis.
Angina, Stable ; Angiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Electrocardiography ; Humans

This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males. METHODS: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML). RESULTS: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach. CONCLUSIONS: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.
Age of Onset ; Constipation ; Defecation ; Fecal Incontinence ; Female ; Humans ; Incidence ; Male* ; Manometry ; Prolapse ; Prospective Studies ; Pudendal Nerve ; Rectal Prolapse*

BACKGROUND AND AIMS: A superficially invasive cancer in the colon is considered a candidate for an endoscopic resection. Therefore, detecting a superficially invasive cancer and differentiating it from a massively invasive cancer is an important key in selecting proper treatment. In order to accomplish this purpose, exact knowledge of the characteristics of submucosal invasive cancers is required. In this study, attempts to define those endoscopic features and draw guidelines for treatment were made. METHODS: Recently, 23 submucosal invasive cancers were experienced. All of them were detected by an endoscopic examination, and were treated by endoscopic therapy and/or surgical resection. These cancers were reviewed and analyzed with emphasis on size, configuration, differentiation, and treatment. RESULTS: The most common sizes ranged from 10 mm to 19 mm (47.8%). There were two minute lesions below 5 mm. The most common type of lesions was sessile (43.5%). Most lesions showed redness and 60.9% showed hardness. Many cases had characteristic features such as nodules (47.8%), bleeding easily upon touch (39.1%), erosion (39.1%), and white spots (34.8%). Other characteristic features were expanded figures, depressions, and mucosal convergence. Moderately-differentiated adenocarcinomas were predominant (8/15, 53.3%), and there were four polypoid cancers (4/17, 23.5%). In 43.5% of the lesions, only endoscopic treatment was enough. Forty-four percent of all patients treated endoscopically needed additional surgical resections because of uncertainty with respect to complete excision of the cancer and/or a poorly-differentiated adenocarcinoma with lymphatic invasion. There was no lymph node metastasis in any of the patients who underwent surgical resections, and three of them had no residual tumors, as the endoscopic treatment had completely excised the cancer. CONCLUSIONS: Accurate information on submucosal invasive cancers and recognition of the endoscopic characteristics of submucosal invasive cancers are necessary for their detection and management in an early stage. Moreover, it is possible to differentiate superficially invasive cancers from massively invasive ones by their characteristic features. Therefore, in selected patients with superficially invasive cancers, surgical resections can be avoided.
Adenocarcinoma ; Colon* ; Dental Caries ; Depression ; Hardness ; Hemorrhage ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Uncertainty