Crypt glandular infection theory is accepted as an explanation of anal fistula's major cause. However, the pathogenesis of an anal fistula in Crohn's disease is different from that of a conventional anal fistula because a Crohn's anal fistula is caused by ulceration which, in turn, is caused by transmural inflammation of the rectal wall due to Crohn's disease. The difficulty with operating on anal fistulas in Crohn's disease lies in the fact that healing of the wound is inhibited because of continuous inflammation of the anorectal tissue due to Crohn's disease. Hence, there is a high possibility of incontinence due to sphincter muscle injury. Especially, because almost all Crohn's disease patients have frequent defecation and diarrhea, the patients will suffer more if incontinence occurs. Nowadays, even with increased understanding of the etiology of Crohn's disease, new medications, and aggressive surgical approaches, the result of treatment is still not satisfactory. Recently, since Korean eating habits have changed to include more western-style food in the diet, inflammatory bowel disease, such as Crohn's disease, is expected to increase. Consequently, the number of cases of anal fistulas in Crohn's disease is also expected to increase. The authors reviewed 20 confirmed cases of anal fistulas in Crohn's disease, which were treated from January 1993 to December 1995 at Song-Do Colorectal Hospital. The results are as follows: 1) Anal fistulas in Crohn's disease were present in 20(0.6%) of the 3378 cases of anal fistulas treated during the time period considered. 2) The male to female ratio for these 20 cases was 2: 1, and the most Prevalent age group was the 3rd decade, followed by the 2nd decade, the 4th decade, and the 5th decade in that order. 3) Three cases of anal fistulas whose origins could be explained by crypt glandular infection theory and which did not involve the rectum healed, although the healing was delayed. 4) Seventeen cases of anal fistulas whose origins could not be explained by crypt glandular infection theory and which involved the rectum did not heal after the operation. he results of the study show that anal fistulas whose origins can be explanined by crypt glandular infection theory and which do not involve the rectum can be cured by conventional fistula surgery. However, perirectal fistulas whose origins can not be explained by crypt glandular infection theory and which involve the rectum do not heal. Because there is the possibility of incontinence after a conventional operation, it is suggested that, in the cases of perirectal fistulas in Crohn's disease, better results, although not completely satisfactory, can be obtained by long-term seton drainage and diversion colostomy.
Colostomy ; Crohn Disease* ; Defecation ; Diarrhea ; Diet ; Drainage ; Eating ; Female ; Fistula ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Male ; Rectal Fistula* ; Rectum ; Ulcer ; Wounds and Injuries

To define the effectiveness of C-reactive protein (CRP) as indicator for early detection of the post-operative infection, it is essential to exclude possible normal changes of CRP influenced by surgery itself. We analyzed 44 patients who had done orthopaedic surgeries without any evidence of infection preoperative and postoperatively from May to Aug. 1995 at Dongsan medical center, Keimyung University. We checked the levels of Erythrocyte sedimentation rate (ESR) and CRP levels at preoperative and postoperative 1, 3, 5, 7, 9, 11, 13, 15, 17, 19 and 21st day in all cases. In all cases, ESR increased up to 60mm/hr maximally and CRP increased to more than 10mg/dl at least one occasion within the first 3 weeks postoperatively. However CRP showed more rapid changes than ESR. The mean value of the CRP was increased maximally (7.2mg/dl) at 3 day after operation and then decreased rapid until 11 day. ESR was also increased at 3 day after operation, but it sustained high level until 21 day after operation. CRP appears to be more sensitive and rapid indicator as an acute phase reactant for the operation itself because CRP revealed more earlier and accentuated change after the operation. The changes of CRP showed same pattern regardless of operation time, use of tourniquet, use of transfusion and gender. In conclusion, within 3 day after operation, the high titer of CRP can not to be an indicator for early detection of the infection, because normal high titer can be developed by surgery itself. If there notes persistent high titer or more increasing pattern of CRP after postoperative 3 day or abnormal high titer of CRP after 11 day postoperatively, infection may be highly suspicious.
Blood Sedimentation ; C-Reactive Protein ; Humans ; Tourniquets

The calcaneal fractures, the most common tarsal bone fracture are one of the difficult fractures in diagnosis and treatment because of its anatomic complexity and fracture pattern. The authors had taken pre-operative computed tomographies(CTs) and plain X-rays on calcaneal fractures prospectively since March 1992 and the calcaneal fractures were classified according to fracture patterns and locations. Twenty nine fracture were treated with open reduction and internal fixation. Following open reduction and internal fixation of displaced fractures mostly involving posterior facet of subtalar joint or closed reduction with axial pinning by Essex-Lopresti method, we have taken CT on 32 fractures and analyzed anatomic status and observed the relationship between anatomic status and clinical results. The results were as follows: 1. According to Sanders classification, type II was the most common(69%), and then type III(22%), type IV(6%), type I(3%) in frequently. 2. In the relationship between preoperative CT classification and postoperative reduction state, reduction state was in case of more communication. 3. We can expect excellent or good result when the postoperative displacement is within 2mm. 4. The Sanders classification appears to be helpful in predicting prognosis since preoperative CT significantly influenced the clinical outcome, as noted in the relationship between preoperative CT and clinical results.
Classification ; Diagnosis ; Methods ; Prognosis ; Prospective Studies ; Subtalar Joint ; Tarsal Bones

This paper was prepared to determine the effects of degree of initial angulation and the method of treatment toward the end results, and also to report cases of twenty-one children with a radial neck lowed up more than 12 months. The results are as follows: 1. An average follow up period was 34 months, and were ranged from 12 months to 70 months. 2. Displacement patterns of fracture were angulation in 5 cases, partial translocation in 11cases, and total displacement in 5 cases, and translocated fracture was most frequent. According to the degree of angulation, in 10 cases angulation was minor(below 30 degrees), in 8 cases moderate(30–60 degrees), and in 3 cases severe (above 60 degrees). 3. One case was treated by simple cast immobilization, 9 cases were treated by gentle closed reduction, 3 cases were by percutaneus pin reduction with K-wire, 7 cases were by open reduction and K-wires fixation, and 1 case was by closed reduction and incorporating cast immobilization. 4. The results of 20 cases were excellent in range of motion without specific complication. Without considering about the method of treatment, when angulation was severe, more time was required for recovery(Wilcoxon 2-simple test P < 0.02). When the degree of angulation was less than 60 degree, the functional recovery was faster with closed reduction than with open reduction, but with the angulation more 60 degree, there was no significant difference(Spearman correlation coefficient=0.599, P value < 0.05). In conclusion, the severity of initial displacement and the method of treatment were considered to be factors that could affect the recovery time.
Child ; Follow-Up Studies ; Humans ; Immobilization ; Methods ; Neck ; Range of Motion, Articular

Milia are small, superficial keratin cysts believed to be derived from the pilosebaceous follicle, which arise most commonly on the cheeks and eyelids. We report a case of milium occurring on the glans penis in a 18-year-old man, who had a solitary dome-shaped, 2x2 mm sized, yellowish papule. The histopathological examination showed a small keratin-filled, intradermal cyst. The cyst was lined by a stratified epithelium that was a few cell layers thick. This is the first case report in the Korean dermatological literature of milium occurring on the glans penis without coexistence of other dermatoses.
Adolescent ; Cheek ; Epithelium ; Eyelids ; Humans ; Keratins ; Male ; Penis ; Skin Diseases

Trichoadenoma is a rare, benign, cutaneous tumor with differentiation towards the infundibular portion of the pilosebaceous canal. Clinically, it occurs as a solitary tumor, and most commonly on the face. Histologically, it is characterized by numerous horn cysts lined with squamous epithelium and solid tumor islands in the dermis. A 25-year-old female patient presented with a solitary 0.7x0.7cm sized, skin-colored, central, depressed papule on the right cheek, which had been present for 7 years. Histopathologic findings showed the characteristic features of trichoadenoma.
Adult ; Animals ; Cheek ; Dermis ; Epithelium ; Female ; Horns ; Humans ; Islands

Trichoblastoma is a rare, benign skin tumor of adnexal origin that differentiates toward the hair germ, the embryonic precursor of a hair follicle. Clinically, it presents as a slow growing, solitary, well-circumscribed nodule located predominantly in the head and neck area, with a predilection for the scalp. The trunk, proximal extremities and perianal and genital regions may also be affected. We herein present a case of trichoblastoma which occurred on the trunk as a solitary subcutaneous mass with a central tiny pore in 53-year-old man.
Epidermal Cyst ; Extremities ; Hair ; Hair Follicle ; Head ; Humans ; Middle Aged ; Neck ; Scalp ; Skin

A 54 year-old woman underwent resection of pheochromocytoma under general anesthesia. Following induction of anesthesia with intravenous thiopental sodium, succinylcholine iodide was administered intravenously and endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and diethyl ether using a semi-closed carbon dioxide absorption circle system. The course of anesthesia was rather stormy, reflected by hypertension, arrhythmia and hypotension, but the patient tolerated anesthesia well.
Absorption ; Anesthesia* ; Anesthesia, General ; Arrhythmias, Cardiac ; Carbon Dioxide ; Ether ; Female ; Humans ; Hypertension ; Hypotension ; Intubation, Intratracheal ; Middle Aged ; Nitrous Oxide ; Oxygen ; Pheochromocytoma* ; Succinylcholine ; Thiopental

Salmeterol is a long acting, highly selective, beta2-adrenergic agonist. It prevents asthma symptoms in patients with mild or moderate disease and improves nocturnal asthma and sleep quality. We evaluated the bronchodilator and bronchoprotective effect and duration of action of inhaled salmeterol in patients wlth asthma. We compared the bronchodilator and bronchoprotective effects of salmeterol with salbutamol in 34 patients with asthma. Diagnosis of asthma was confirmed with methacholine challenge test or airway reversibility test. We performed the symptom index questionnaire, peak expiratory flow rate, pulmonary function test and methacholine challenge test. Symptom scores were more improved with salmeterol treatment than salbutamol treatment. After salmeterol inhalation, mean FEV1 increased from 1.95L(pre-treatment) to 2.04L(early stage in the treatment), 2.06L(late stage), 2.03L(follow up). There was no difference in FEV1 between early stage and late stage after salmeterol treatment. With salmeterol, there was a significant increases in PC30 on methacholine challenge test ( PC20 4.96 : 16.42). Salmeterol is a potent, long-acting bronchodilator, with a slower onset and longer duration of bronchodilation than salbutamol. It also has bronchoprotective effect and shows low incidence of adverse effects.
Albuterol ; Asthma ; Diagnosis ; Humans ; Incidence ; Inhalation ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Salmeterol Xinafoate ; Surveys and Questionnaires

We report a case of malignant melanoma of soft parts presented with a hard mass on the dorsum of the left second toe. Malignant melanoma of soft parts has also been known as clear cell sarcoma of tendons and aponeuroses, which indicates the histologic feature of clear cell predominance and the origin of tumor cells, tendinous or aponeurotic structures. Although our case presented with many characteristic clinicopathologic features of malignant melanoma of soft parts, diagnosing this case as malignant melanoma of soft parts was made with great difficulty because of a rather unusual finding that the major cell component of neoplasm was spindle shaped cells in stead of clear cells. Cases featuring this distinctive histopathologic finding have not been reported individually to our knowledge, but described briefly in the literature. We think this case deserves special attention because of its close resemblance to various sarcomas.
Cellular Structures ; Melanoma* ; Sarcoma ; Sarcoma, Clear Cell ; Tendons ; Toes