No abstract available.
Epidermal Cyst* ; Melanins*

PURPOSE: Divided end-loop colostomy is recommended in some cases of unresectable rectal cancer or anal incontinence, because a conventional loop colostomy is difficult to managing due to bulky stoma volume for a long period. In such case of the divided end-loop colostomy, severe inflammation may occur at the stoma site by poor conditions of the patient so that cause to be retracted or detached, and distal loop may be disrupted. To avoid these problems, we designed subtotally divided end-loop colostomy and studied its clinical effectiveness retrospectively. METHODS: About a 3 cm diameter, round skin incision as presumed colostomy size was made at the left lower abdomen, and entered the abdominal cavity by splitting the rectus muscle fibers. The caudal side of colon can be identified by confirming the fusioned taenia at the rectosigmoid colon level. After pulling out the colonic loop, the distal colon far from the lesion was subtotally divided by a GIA staple or manual suture, which cut obliquely 80% or 90% from the antimesenteric side of the distal loop while maintaining the 10% or 20% mesenteric side of the colonic loop. Then an end-loop colostomy is matured with a small fistularization of the distal loop as the undivided mesenteric side of colon. RESULTS: In 8 cases, subtotally divided colonic loop using a GIA staple. But in 9 cases, divided manually because of makedly thickened, edematous colonic wall resulting from prolonged obstruction. There were several mild complications, i.e. transient dermatitis in 5 cases, transient bulky stoma due to edema in 4 cases, mild retraction of stoma in 2 cases, and mild prolapse of stoma in 1 case. There were no major functional abnormalities during the follow-up period. CONCLUSIONS: Although we need to get further clinical experiences, the subtotally divided end-loop colostomy seems to be a useful alternative surgical procedure for unresectable rectal cancer.
Abdomen ; Abdominal Cavity ; Colon ; Colostomy* ; Dermatitis ; Edema ; Follow-Up Studies ; Humans ; Inflammation ; Prolapse ; Rectal Neoplasms* ; Retrospective Studies ; Skin ; Sutures ; Taenia

Herpes simplex virus type 2 (HSV2) meningitis primarily develops during or following a primary genital HSV2 infection that was acquired from sexual contact or through the birth canal during delivery from mother. We describe a 15 year old virgin without history of previous herpes simplex infection who developed 2 episodes of HSV2 meningitis. Although recurrent meningitis due to HSV is primarily seen in young or sexually active adults. HSV2 meningitis should be in the differential diagnosis of recurrent meningitis in adolescent patients.
Adolescent* ; Adult ; Diagnosis, Differential ; Female ; Herpes Simplex ; Herpesvirus 2, Human ; Humans ; Meningitis* ; Mothers ; Parturition ; Simplexvirus*

BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. METHODS: We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. RESULTS: There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. CONCLUSION: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.
Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Fontan Procedure ; Humans ; Mortality ; Retrospective Studies

A 13-year-old girl, who had undergone the total correction of partial atrioventricular septal defect at the age of 4 years, was admitted with severe tricuspid regurgitation in echocardiography. She had received one-and-a-half ventricle repair during follow-up. Her right ventricle showed global akinesia, and the ejection fraction of the left ventricle was 25% with paradoxical interventricular septal motion. We performed right ventricular exclusion adjunct to the Fontan procedure. She is doing well two years after the operation without complications.
Adolescent ; Echocardiography ; Female ; Follow-Up Studies ; Fontan Procedure* ; Heart Ventricles* ; Humans ; Magnetic Resonance Imaging ; Tricuspid Valve Insufficiency