PURPOSE: This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure. METHODS: Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months. RESULTS: On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 +/- 0.20 vs. 2.25 +/- 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (> or =4 cm) after the procedure (P = 0.001) CONCLUSION: In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.
Defecography ; Female ; Follow-Up Studies ; Humans ; Manometry ; Rectocele

PURPOSE: Unlike males, inguinal hernia surgery in females is an uncommon surgical procedure. The efficacy of laparoscopic surgery for female hernia must be proven. This study compared the clinical characteristics of male and female hernia as well as the efficacy of laparoscopic surgery with that of open surgery in female hernia. METHODS: From March 2007 to February 2011, one surgeon (C.S.) at the authors' institution operated on 965 patients (male/female=884/81) who were each more than 19 years old. The female patients were divided into the laparoscopic (n=67, TEP/TAPP=66/1) and open surgery groups (n=14). RESULTS: The mean age of the female patients was lower than that of the male patients. The incidence of bilateral and direct hernia was higher in the male patients but the incidence of femoral hernia was higher in the female patients (0.6 vs. 8.6%, p<0.001). Among the 81 female patients, the mean age of the patients with femoral hernia was higher than that of the patients with other types of hernia (56.4+/-12.5/43.0+/-15.1, p<0.026). The operation times and pain scores of the two groups 7 days after surgery were comparable. CONCLUSION: The findings revealed a higher incidence of femoral hernia in the female patients than male patients. Patients with a femoral hernia were older than those with other types of hernia. Therefore, laparoscopic surgery must be considered for elderly female patients who have a high incidence of femoral hernia.
Aged ; Female ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Incidence ; Laparoscopy ; Male

No abstract available.
Thoracic Wall* ; Thorax*

BACKGROUND AND OBJECTIVES: With the currently available diagnostic procedure, hearing impaired children are diagnosed at an early age and hearing aids are fitted soon thereafter. Thus, appropriateness of using available correction methods for adult ears and ear models for determining and predicting hearing aid characteristics for these children need to be examined. The objectives of this study are to create a database of resonance frequency and length of external auditory canal (EAC) in all age groups and to adjust the peak frequency response of hearing aid system to take account of the changing resonance peak frequency as child gets older. MATERIALS AND METHOD: We studied 437 ears with no age limitation. We measured rear ear unaided response (REUR) with Rastronics frequency response analyzer and external ear canal length using silastic tube under microscopic or otoscopic finding. Statistical analyses were performed to determine age differences. RESULTS: Ear canal length increased with age, and an adult value was achieved by the age of 14 years. Resonance frequency decreased with age, and reached to an adult value by the age of 9 years. There was significant relationship between ear canal length and resonance frequency. CONCLUSION: Alteration in resonance frequency with age may have practical implications by affecting the insertion gain of hearing aid system in children. The data may be used as useful adjustment factors to correct the current hearing aid system in children.
Adult ; Child ; Ear ; Ear Canal* ; Hearing ; Hearing Aids ; Humans

BACKGROUND: At the initiation of immunologic response, platelets rapidly release chemical mediators which may induce rejection of transplanted organ. The purpose of this study was to investigate the effect of antiplatelet agents in murine cardiac and skin transplantation models. METHODS: In the minor major histocompatibility (MHC) mismatch model, BALB/c (H2d) mice underwent heart transplantation from B10.D2 (H2d) mice. In the major MHC mismatch model, CBA (H2k) mice were used as the recipients and C57BL/10 (H2b) mice as donors. The recipients were divided into four groups and each group was treated with distilled water (DW), sarpogrelate, cilostazol, or clopidogrel respectively. For skin transplantation, the recipients in the minor MHC mismatch model were divided into four groups similar to those in cardiac transplantation. The recipients in the major MHC mismatch model were divided into DW-treated and sarpogrelate-treated groups. All treatments were done by the per oral route of administration. RESULTS: For graft survival in the minor MHC mismatch model of cardiac transplantation, sarpogrelate-treated group showed increased median survival time (MST) compared to the other groups (DW-treated group 17.5 days, sarpogrelate-treated group 88 days, cilostazol-treated group 13 days, clopidogrel-treated group 23 days). Similar results were observed in the major MHC mismatch model. In the major MHC mismatch model, the expression of adhesion molecules (L-selectin, intercellular adhesion molecule-1 [ICAM-1], Mac-1, lymphocyte function associated antigen-1 [LFA-1]) was significantly higher in DW-treated group compared to sarpogrelate-treated group (P<0.05) In the minor MHC mismatch model, MST in the antiplatelet-treated skin graft group was not remarkably prolonged compared to DW-treated group. In the major MHC mismatch model, sarpogrelate-treated group showed prolonged survival compared to DW-treated group (MST 25 vs. 19 days, P<0.05). There was no statistically significant difference in the proportion of activated T cells and regulatory T cells. CONCLUSIONS: The tendency for a better survival of grafts was observed in the sarpogrelate-treated skin and heart transplant group compared to DW-treated group. However, further mechanistic study is necessary to these results.
Animals ; Blood Platelets ; Graft Survival ; Heart ; Heart Transplantation ; Histocompatibility ; Humans ; Intercellular Adhesion Molecule-1 ; Lymphocytes ; Mice ; Platelet Aggregation Inhibitors ; Rejection (Psychology) ; Skin ; Skin Transplantation ; Succinates ; T-Lymphocytes ; Tetrazoles ; Ticlopidine ; Tissue Donors ; Transplants ; Water

There are substantial variations of relative risks (RR) in smoking-related mortality by country and time. We hypothesized the RRs in smoking-related mortality might differ depending on serum concentrations of persistent organic pollutants (POPs). We evaluated the associations of cigarette smoking with total mortality in 610 elderly (aged > or = 70 yr) (702 elderly for organochlorine pesticides [OCPs]) after stratification by serum concentration of POPs, in the National Health and Nutrition Examination Survey (NHANES) 1999-2004 followed through 2006. Summary measures of POPs subclasses showed significant or marginally significant interaction with cigarette smoking on the risk of total mortality. P values for interaction were 0.069 for polychlorinated dibenzo-p-dioxins (PCDDs), 0.008 for polychlorinated biphenyls (PCBs), and 0.024 for OCPs. The effect of smoking on total mortality showed different patterns according to the serum concentration of some POPs. Former or current smokers had 1.4 to 2.9 times higher mortality rates compared with never smokers among participants with higher serum concentrations of POPs (2nd or 3rd tertiles). However, when the level of PCBs or OCPs were low (1st tertile), there were little positive associations between smoking and mortality. Our study suggests that the background exposure to several POPs may be related to variability in smoking-related total mortality.
Aged ; Aged, 80 and over ; Environmental Exposure ; Environmental Pollutants/*blood ; Female ; Humans ; Hydrocarbons, Chlorinated/blood ; Male ; Nutrition Surveys ; Pesticides/blood ; Polychlorinated Biphenyls/blood ; Proportional Hazards Models ; Risk ; Smoking/*mortality ; Tetrachlorodibenzodioxin/analogs & derivatives/blood

There are substantial variations of relative risks (RR) in smoking-related mortality by country and time. We hypothesized the RRs in smoking-related mortality might differ depending on serum concentrations of persistent organic pollutants (POPs). We evaluated the associations of cigarette smoking with total mortality in 610 elderly (aged > or = 70 yr) (702 elderly for organochlorine pesticides [OCPs]) after stratification by serum concentration of POPs, in the National Health and Nutrition Examination Survey (NHANES) 1999-2004 followed through 2006. Summary measures of POPs subclasses showed significant or marginally significant interaction with cigarette smoking on the risk of total mortality. P values for interaction were 0.069 for polychlorinated dibenzo-p-dioxins (PCDDs), 0.008 for polychlorinated biphenyls (PCBs), and 0.024 for OCPs. The effect of smoking on total mortality showed different patterns according to the serum concentration of some POPs. Former or current smokers had 1.4 to 2.9 times higher mortality rates compared with never smokers among participants with higher serum concentrations of POPs (2nd or 3rd tertiles). However, when the level of PCBs or OCPs were low (1st tertile), there were little positive associations between smoking and mortality. Our study suggests that the background exposure to several POPs may be related to variability in smoking-related total mortality.
Aged ; Aged, 80 and over ; Environmental Exposure ; Environmental Pollutants/*blood ; Female ; Humans ; Hydrocarbons, Chlorinated/blood ; Male ; Nutrition Surveys ; Pesticides/blood ; Polychlorinated Biphenyls/blood ; Proportional Hazards Models ; Risk ; Smoking/*mortality ; Tetrachlorodibenzodioxin/analogs & derivatives/blood

Acitretin, the principal and free acid metabolite of etretinate, is used to treat patients with several types of psoriasis. The common side effects encountered with acitretin therapy are cheilitis, conjunctivitis, xerosis, dryness of the nasal mucosa with minor nosebleeds, pruritis, and desquamation of the palms and soles. Granulation tissue is a well recognized side effect of oral acitretin. This reaction is characterized by ulceration, hemorrhagic crusting and excess granulation tissue. It occurs between the third and 12th weeks of therapy, most commonly affects the hands and feet. We present a case of multiple granulation tissues associated with acitretin therapy.

No abstract available.
Pulmonary Embolism*

Calcaneal petechiae (black heel) is a traumatic lesion affecting the back or posterolateral aspect of the heel. An asymptomatic, pigmented, macular lesion is found on one or both heels immediately above the hyperkeratotic border of the foot. It is caused by any sport, such as basketball, tennis, or football, that leads to slamming of the foot against the shoe. Calcaneal petechiae is probably more common than is realized. As it is usually symptomless, it may be disregarded or only observed by chance. The importance of the lesion lies in its clinical resemblance to a malignant melanoma. We report a case of calcaneal petechiae which was confused clinically with a melanoma.
Child ; Male ; Female ; Humans