No abstract available.
Rectal Fistula*

Purpose: To report a case of congenital trichomegaly.Case summary: A 7-year-old girl visited our clinic with decreased visual acuity. The uncorrected visual acuity was 0.2 in the right eye and 0.3 in the left eye. The length and number of upper and lower eyelashes were increased. The eyelash length was 10 mm on the peripheral edge and 15 mm in the central area. Trichiasis and ptosis were also noted. There were no abnormal findings in the additional fundus examination or visual evoked potential test. There was no family history of trichomegaly, no abnormalities in blood test results, and no medication history. The patient is currently undergoing follow-up treatment for low visual acuity and mild ptosis under the diagnosis of trichomegaly. Conclusions Trichomegaly is associated with family history, various congenital diseases, and acquired diseases. However, it may occur congenitally, without specific causes.

Congenital muscle fiber type disproportion (CFTD) has been described as a form of congenital myopathy characterized by the smallness and marked predominance of type 1 fibers in a muscle biopsy. Clinical manifestations include hypotonia, nonprogressive muscle weakness, joint contractures, and skeletal deformities. However, it has also been noted that the same pathologic alterations appeared in clinically diverse conditions. Recently, we experienced a family, a mother and two children, in which a muscle biopsy showed the mother to have muscle fiber type disproportion. This case was unusual in that there was a significant progression of weakness, an absence of neonatal hypotonia, and other commonly associated musculo-skeletal deformities. In this report, we describe the clinicopathologic features of the family with a brief review about muscle fiber type disproportion.
Adult ; Biopsy ; Child, Preschool ; Female ; Human ; Male ; Muscle Fibers/pathology* ; Muscular Diseases/pathology ; Muscular Diseases/genetics*

Although anal canal is the most common site for the development of malignant melanoma in the alimentary tract, it is extremely rare and melanoma can occur primarily at lower rectum. Anorectal melanoma constitutes 0.4% to 0.8% of colorectal malignancies and less than 2% of melanomas. The prognosis may depend on the extent of disease and depth of invasion. It generally seems to be very poor in spite of aggressive treatment. We have treated four patients of rectal melanomas out of 1,477 cases of all colorectal cancer between September, 1989 and January, 1997 ; a 39-year-old female with the intermittent blood-tinged stool, a 51-year-old male with hematochezia, a 59-year-old male with anal bleeding and a 65-year-old female with anal bleeding. They were treated by abdominoperineal resection with pelvic lymph node dissection and were confirmed histologically rectal melanomas.
Adult ; Aged ; Anal Canal ; Colorectal Neoplasms ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Lymph Node Excision ; Male ; Melanoma* ; Middle Aged ; Prognosis ; Rectum

BACKGROUND: The repetitive nerve stimulation (RNS) test is a useful tool in the evaluation of neuromuscular transmission disorders. In our laboratory, we frequently use Oh's method, which tests 5 kinds of muscles (flexor carpi ulnaris (FCU), abductor digiti quinti (ADQ), orbicularis oculi, nasalis and trapezius) with 3 kinds of low rate stimulation (LRS) and high rate stimulation (HRS). This method has the advantage of high sensitivity, but is time consuming and painful to patients. So, we tried to reestablish the stage of RNS to overcome this problem and to create a useful test. METHODS: We analyzed RNS data from 369 patients, retrospectively. The number of patients with myasthenia gravis (MG) was 357 and the number with myasthenic syndrome was 12. We compared the sensitivity of individual muscle as well as individual stimulation rate. And we analyzed the results of MG and myasthenic syndrome to verify the usefulness of HRS. RESULTS: The sensitivity of RNS (LRS) was 69.7% in MG (generalized symptom 86.4%, only ocular symptom 40.3%). The sensitivity was higher with 3 pps and 5 pps than with 2 pps, while the exclusion of 2 pps did not affect the sensitivity. We found only 3 cases (1.0%) with post-tetanic exhaustion (PTE) in MG patients with negative results on LRS. The distributions of resting CMAP and post-exercise CMAP were different between MG and myasthenic syndrome. In most cases of myasthenic syndrome, the resting CMAP of ADQ and FCU was below 4.0 mV and post-exercise CMAP of ADQ and FCU was above 50%. CONCLUSIONS: LRS may be done with only 3 and 5 pps, and HRS of the ulnar nerve was helpful only if there was a suspicion of myasthenic syndrome (resting CMAP<4.0 mV or post-exercise CMAP>50%, in ADQ & FCU) or a borderline decremental response in LRS.
Humans ; Muscles ; Myasthenia Gravis* ; Neuromuscular Junction Diseases ; Retrospective Studies ; Ulnar Nerve

The anorectal function was evaluated in 25 patients with rectal cancer who underwent a low anterior resection (LAR). The result of anorectal manometry was analyzed with respect to the bowel habit. Patients were examined preoperatively and 3, 6, 9, and 12 months postoperatively by both anorectal manometry and interview. The examinations included information on defecation frequency, incontinence, and inability of deferment. The defecation frequency was significantly increased until 6 months postoperatively (p < 0.05). The maximum resting pressure (MRP) was significantly decreased until 1 year after surgery (p < 0.05). However, the maximum squeezing pressure (MSP) and the length of high pressure zone (HPZ) were not significantly decreased postoperatively. There was no significant difference in the sensation of balloon between the preoperative period and the postoperative period. The sensation of fullness was markedly decreased until 6 months postoperatively (p < 0.05). The rectoanal inhibitory reflex (RAIR) was positive in all patients preoperatively, and 24 out of 25 patients showed a positive reflex postoperatively with various sensitivity. The appearance of an external sphincter assist was not correlated with bowel habit. Patients with the lowest anterior resection (LLAR) had a higher incidence of early phase incontinence than patients with the low anterior resection. In conclusion, the increased defecation frequency during the postoperative period appeared to be related with the decreased MRP and the sensation of fullness based on a manometric assessment. Although the manometric finding did not normalize with respect to every manometric factor evaluated, the bowel habit was generally recovered clinically in 12 months postoperatively. We should always consider other variables, such as postoperative rectal mucositis or respective bowel habit, in addition to the result of anorectal manometry for the postoperative evaluation.
Defecation ; Humans ; Incidence ; Manometry ; Mucositis ; Postoperative Period ; Preoperative Period ; Rectal Neoplasms ; Reflex ; Sensation

Palliative resection in colorectal cancer seems to be questioned due to high mortality and morbidity in spite of relief of cancer symptom and lengthening of survival time. We studied to identify benefits of palliative resection in advanced colorectal cancer. We retrospectively reviewed 96 patients who underwent palliative surgery during June 1989 to December 1995 at Asan Medical Center and evaluated quality of life(QOL), rates of morbidity and mortality, chemotherapy response rates, duration of symptom free and survival time. The overall rate of palliative surgery in total colorectal cancer patients was 9.1%(96/1055) and the most common location of primary tumor was rectum. The causes of palliative surgery were hepatic metastases(44), peritoneal disseminations(20), local invasions(17), combined causes(14) and lung metastases(one) in descending order. Postoperative complication was 13.3% (6/45) after resection surgery and 25.5%(13/51)after non-resection surgery. Mortality rates was 0 and 9.8 percent, respectively. Improvement of QOL was 75.6% and 72.5%, respectively. However, 30 cases(65.2%) showed still moderate or severe degree of poor QOL in non-resection group compared with 11.1% of resection group postoperatively. Response rates of postoperative adjuvant chemotherapy was higher(31.8% vs. 7.4%) and median relief of preoperative cancer symptom was longer(6.2 vs. 3.0 months) in resection group. One year survival rates were 42% in resection surgery and 16.7% in non-resection surgery Palliative resection can improve QOL, response rates of postoperative adjuvant chemotherapy, relief of preoperative cancer symptom and survival rates without increase of morbidity or mortality. So if feasible, palliative resection should be encouraged in selected patients.
Chemotherapy, Adjuvant ; Chungcheongnam-do ; Colorectal Neoplasms* ; Drug Therapy ; Humans ; Lung ; Mortality ; Palliative Care ; Postoperative Complications ; Rectum ; Retrospective Studies ; Survival Rate

Purpose: To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. Methods: A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. Results: The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. Conclusions Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.

Purpose: To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. Methods: A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. Results: The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. Conclusions Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.

BACKGROUND/AIMS: The symptoms of inflammatory bowel disease (IBD) fluctuate considerably over time. However, it has not been determined whether these symptoms are affected by the menstrual cycle in female IBD patients. This study analyzed the effects of the menstrual cycle on IBD symptom variation. METHODS: This was a prospective study of 91 study subjects (47 IBD patients and 44 healthy controls) who reported daily symptoms and signs throughout their menstrual cycles. RESULTS: IBD patients had significantly more frequent gastrointestinal symptoms, such as nausea (30% vs 7%, p=0.006), flatulence (53% vs 22%, p=0.003), and abdominal pain as compared to controls (68% vs 38%, p=0.006). The IBD patients also experienced more frequent systemic premenstrual symptoms than the controls (79% vs 50%, p=0.003). More severe abdominal pain (p=0.002) and lower mean general condition scores (p=0.001) were noted during the menstrual phase as compared to the pre- or post-menstrual phase in both groups. IBD patients experienced more frequent premenstrual gastrointestinal symptoms than controls, but their IBD symptoms did not change significantly during the menstrual cycle. CONCLUSIONS: Knowledge of the cyclic alterations in gastrointestinal and systemic symptoms may be helpful in determining the true exacerbation of disease in female IBD patients.
Abdominal Pain ; Female ; Flatulence ; Humans ; Inflammatory Bowel Diseases ; Menstrual Cycle ; Nausea ; Prospective Studies