Rectovagianl fistula(RVF) is a congenital or acquired communication between the two epithelial-lined surface of the rectum and the vagina. We present our experience with 62 patients with RVF. There were various etiologies and repair methods of rectovaginal fistula. The purpose of this study was to retospectively review the clinical course of the patients we treated and to evaluate the efficacy of various treatment options. The mean age was 40.5 yr, The type of RVF was classified to one of two(simple and complex), according to their location, size and etiology. RVF was developed most commonly after radiotherapy due to cervical cancer(n=17), then after pelvic surgery due to malignancy(n=16), obstetric trauma after episiotomy at delivery(n=7), congenital malformation(n=4), inflammatory bowel disease(n=1), Bechet's disease(n=1), infections such as perianal fistula or abscess(n=2), direct invasion of carcinoma(n=3), after chemotherapy(n=1), and idiopathic(n=6). Three cases of them associated with rectovesicovaginal fistula. Surgical therapeutic option was divided to local repair, abdominal approach and tissue transposition by the type of RVF. Most simple RVFs were repaired with local approach through the vagina or rectum. Most complex RVFs were repaired through abdominal approach or tissue transposition. With an average follow up of 20 months, the treatment results were as follows: completely healed(n=36, 58.1%), persistent symptom(n=6, 9.7%), recurrence after repair(n=5, 8.1%), loss of search or death(n=15, 24.1%). Therefore we assist that the management of RVF depends on size, location, and cause. anal sphincter function and overall health status of the patient. Careful preoperative assessment of the fistula, surrounding tissues, and anal sphincter and exclusion of associated disease are essential. With through evaluation, thoughtful consideration of treatment options, and meticulous operative technique, patient can be assured of an optimal outcome.
Anal Canal ; Episiotomy ; Female ; Fistula ; Follow-Up Studies ; Humans ; Radiotherapy ; Rectovaginal Fistula* ; Rectum ; Recurrence ; Vagina

PURPOSE: The conventional surgical treatment for patients with potentially curable low rectal cancer is abdominoperineal resection. Recently there has been increasing interest in the use of preoperative radiation therapy and sphincter-saving procedure as primary therapy for selected low rectal cancers. We report our institutional experience with this approach. METHODS: From 1995 to 1997, Twelve patients with resectable distal rectal cancer were offered sphincter-saving procedure, excluding the patients whose pretreatment tumor presentation demonstrated fixation to anal sphincter or puborectalis muscle. The distance from the anal verge to the distal tumor margin at initial diagnosis ranged from 1 to 5 cm. Patients received a median 50.4 Gy and chemotherapy Surgery was carried out 4 to 8 weeks after radiation. RESULTS: No patient had toxic reaction that required interruption of chemoradiation. Four patients (33%) had complete pathologic response, but one patient with complete clinical response had residual cancer. Seven patients underwent hand-sewn coloanal anastomosis and five patients transanal excision en bloc. All patients were able to successfully undergo a sphincter-saving procedure. With a mean follow-up of 23 months (range, 6~32), the authors noted no recurrence or complication. Sphincter function was good in 92%. Daily bowel movements was two (range, 1~10). CONCLUSION: Preoperative chemoradiation appears promising in terms of better patient compliance, lesser toxicity, and downstaging tumor, making the sphincter-saving procedure feasible in carefully selected cases. Surgical resection remains essential to confirm and to achieve complete clinical remission. The results of preoperative chemoradiation and sphinctersaving procedure are encouraging, but more experience is needed to determine whether this approach ultimately has similar local control and survival rate compared to standard surgery.
Anal Canal ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm, Residual ; Patient Compliance ; Rectal Neoplasms* ; Recurrence ; Survival Rate

No abstract available.
Adult* ; Humans ; Tibia*

No abstract available.
Anemia, Aplastic* ; Pregnancy*

Panax ginseng (PG) has been used as an important analeptic in traditional medicine. This study was purposed to investigate the effect of PG on immune responses induced by glucocorticoid in mice. PG solution was injected into CV6 and BL23, which are the classical acupuncture points, for 7 days after injection with glucocorticoid. And then B and T cell proliferation and cytolytic activity of natural killer (NK) cells were measured. B cell proliferation by 'H-thymidine incorporation was decreased by about 25% in control group as compared with normal group. However, B cell proliferation was significantly increased 1.8-fold in CV6 group and 2.5-fold in BL23 group as compared with normal group. T cell proliferation by H- thymidine incorporation was decreased by about 15% in control group as compared with normal group. On the other hand, T cell proliferation was significantly increased 1.9-fold in CV6 group and 2.3-fold in BL23 group as cornpared with normal group. Furthermore in purified T cell, the proliferation was furtherly increased rather than in non-purified T cell. The activity of NK cell was remarkably decreased in control group as compared with normal group. However, the activities of NK cells in CV6 and BL23 groups were recovered to the above levels of normal group. On the other hand, the activity of NK cell in the blank locus group was slightly increased compared with control group. However this increasement was not reached the levels of CV6 and BL23 groups. And in the case of purified NK cell, the cytolytic activity of NK cell was respectively increased 1.6-fold in normal group, 1.4-fold in control group, 2.0-fold in blank locus group and 2.0-fold in CV6 group and 1.4-fold in BL23 group as compared to the non-purifed NK cell. These results suggest that PG aqua-acupuncture at CV6 and BL23 may proliferate B and T cells that is suppressed by glucocorticoid, and activate NK cell activity.
Acupuncture Points ; Acupuncture* ; Animals ; Cell Proliferation ; Hand ; Killer Cells, Natural ; Lymphocytes* ; Medicine, Traditional ; Mice* ; Panax* ; T-Lymphocytes ; Thymidine

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

Acute normovolemic hemodilution is widely used to conserve blood and to minimize the need for homologous blood transfusion during operation. To evaluate the effects of aeute isovolemic hemodilution on hemodynamics and oxygen transport, pulmonary artery catheter and radial artery catheter were introduced in 8 patients in whom maxillofacial or Wertheim's operation were performed. Blood(estimated from allowable blood loss) was withdrawn from radial artery, and simultaneously replaced by intravenous administration of 5% plasmanate and Hartmann solution. Acute isovolemic hemodilution decreased the hematocrit level from 33.2+/-3.7% to 29.6+/-2.9%. Cardiac output increased significantly, which was associated with decreased systemic vaacular resistance. Oxygen transport and oxygen consumption increased despite a decrease in oxygen carrying capacity. Heart rate, mean arterial perssure, mean pulmonary arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly during hemodilution. The results indicate that blood perfusion and oxygenation to tissue were well maintained in the hemodilution of the magnitude used in this study. Therfore it could be concluded that acute isovolemic hemodilution is a safe and relatively simple method of conserving blood and minimizing homologous blood transfusion.
Administration, Intravenous ; Arterial Pressure ; Blood Transfusion ; Cardiac Output ; Catheters ; Central Venous Pressure ; Natural Resources ; Heart Rate ; Hematocrit ; Hemodilution* ; Hemodynamics ; Humans ; Oxygen ; Oxygen Consumption ; Perfusion ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Radial Artery

Acute normovolemic hemodilution is widely used to conserve blood and to minimize the need for homologous blood transfusion during operation. To evaluate the effects of aeute isovolemic hemodilution on hemodynamics and oxygen transport, pulmonary artery catheter and radial artery catheter were introduced in 8 patients in whom maxillofacial or Wertheim's operation were performed. Blood(estimated from allowable blood loss) was withdrawn from radial artery, and simultaneously replaced by intravenous administration of 5% plasmanate and Hartmann solution. Acute isovolemic hemodilution decreased the hematocrit level from 33.2+/-3.7% to 29.6+/-2.9%. Cardiac output increased significantly, which was associated with decreased systemic vaacular resistance. Oxygen transport and oxygen consumption increased despite a decrease in oxygen carrying capacity. Heart rate, mean arterial perssure, mean pulmonary arterial pressure, central venous pressure, and pulmonary capillary wedge pressure did not change significantly during hemodilution. The results indicate that blood perfusion and oxygenation to tissue were well maintained in the hemodilution of the magnitude used in this study. Therfore it could be concluded that acute isovolemic hemodilution is a safe and relatively simple method of conserving blood and minimizing homologous blood transfusion.
Administration, Intravenous ; Arterial Pressure ; Blood Transfusion ; Cardiac Output ; Catheters ; Central Venous Pressure ; Natural Resources ; Heart Rate ; Hematocrit ; Hemodilution* ; Hemodynamics ; Humans ; Oxygen ; Oxygen Consumption ; Perfusion ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Radial Artery

OBJECTIVE: The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion. METHODS: Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups. RESULTS: The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars. CONCLUSIONS: These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.
Adult ; Bicuspid* ; Humans ; Incisor ; Lip ; Malocclusion ; Molar ; Multivariate Analysis ; Retrospective Studies

OBJECTIVE: The purpose of this study was to analyze initial displacement and stress distribution of the maxillofacial complex during dentoskeletal maxillary protraction with various appliance designs placed on the palatal region by using three-dimensional finite element analysis. METHODS: Six models of maxillary protraction were developed: conventional facemask (Type A), facemask with dentoskeletal hybrid anchorage (Type B), facemask with a palatal plate (Type C), intraoral traction using a Class III palatal plate (Type D), facemask with a palatal plate combined with rapid maxillary expansion (RME; Type E), and Class III palatal plate intraoral traction with RME (Type F). In Types A, B, C, and D, maxillary protraction alone was performed, whereas in Types E and F, transverse expansion was performed simultaneously with maxillary protraction. RESULTS: Type C displayed the greatest amount of anterior dentoskeletal displacement in the sagittal plane. Types A and B resulted in similar amounts of anterior displacement of all the maxillofacial landmarks. Type D showed little movement, but Type E with expansion and the palatal plate displayed a larger range of movement of the maxillofacial landmarks in all directions. CONCLUSIONS: The palatal plate served as an effective skeletal anchor for use with the facemask in maxillary protraction. In contrast, the intraoral use of Class III palatal plates showed minimal skeletal and dental effects in maxillary protraction. In addition, palatal expansion with the protraction force showed minimal effect on the forward movement of the maxillary complex.
Finite Element Analysis* ; Palatal Expansion Technique ; Traction