No abstract available.
Nevus, Epithelioid and Spindle Cell*

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

Purpura fulminans is one of rare consumptive coagulopathy in children. The most common predisposing conditions of purpura fulminans are infectious disease like streptococcal infection and chickenpox. This disease is characterized by ecchymotic lesions that are usually distributed symmetrically on the lower extremities and buttocks. These ecchymotic lesions undergo necrosis, unless there is effective treatment. We experienced 3 cases of purpura fulminans which improved almost completely after early heparin administration. In the case 1, a 12 month old girl, purpura fulminans developed during sepsis and gastroenteritis. In the case 2, a 4 month old boy, purpura fulminans developed during acute sepsis. We reported 3 cases with a brief review of related literature.
Buttocks ; Chickenpox ; Child ; Communicable Diseases ; Dacarbazine ; Female ; Gastroenteritis ; Heparin ; Humans ; Infant ; Lower Extremity ; Male ; Necrosis ; Purpura Fulminans* ; Purpura* ; Sepsis ; Streptococcal Infections

No abstract available.
Spinal Cord Diseases*

Since it's introduction in 1956 as a general anesthetic agent, halothane has enjoyed worldwide acceptance as a relatively safe and useful inhalational anesthetic. It is described as a universal anesthetic agent by Johnstone, but the question of its potential hepatotoxicity has not been definitely established. At our hospital, the patient whose liver function was in normal limit and had no history of the hepatitis, jaundice, exposing to hepatotoxic drug or alcoholism, and have received general anesthesia with halothane for biliary surgery as first operation from June 1979 to August 1980 were studied to evaluate the change of the liver function before and after kalothane anesthesia. The results were as follows; 1) In two cases, the liver funtion test showed the evidence of the hepatic damage. 2) The change of SGOT and bilirubin was statistically significant, but there was no significant change of SGOT, alkaline phosphatase and T.T.T. 3) We thought that the changes of liver function test were due not only to halothane but also to the other factors. So, it may be good that repeated exposure to halothane is avoided.
Alcoholism ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, General ; Aspartate Aminotransferases ; Biliary Tract* ; Bilirubin ; Halothane* ; Hepatitis ; Humans ; Jaundice ; Liver Function Tests* ; Liver*

Core decompression is still widely used in avascular necrosis of the femoral head but the results are unpredictable and the indications are not settled yet. The reparative process of the decompressed femoral head is poorly understood. Seven cases in 5 patients were undertaken THRA following failed decompression and these were studied for the radiological and pathological changes of the core tracts. The lesions of failed cases were involved more than 1/3 of femoral head on MRI and all cases were stage II A or B. The extent of the necrotic area in MRI was enlarged with crack, sclerosis and sometimes gas collection. Depression of the subchondral plates were also observed. Capillary ingrowth or neovascularization was not found at all and there were only fibrosis, inflammatory response and foreign body reactions.
Capillaries ; Decompression* ; Depression ; Fibrosis ; Foreign Bodies ; Head* ; Humans ; Magnetic Resonance Imaging ; Necrosis* ; Sclerosis

OBJECTIVE: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs. METHOD: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program. RESULTS: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation. CONCLUSION: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.
Adult ; Brain ; Brain Injuries* ; Comprehension ; Glasgow Coma Scale ; Humans ; Incidence ; Language Disorders* ; Language Therapy ; Mass Screening ; Prognosis ; Writing

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

The ankle is a complex, weight bearing joint consisting of tibia, fibula, talus, and many soft tissue structures, which play an important role biomechanically. The injuries to the ankle joint include not only fractures of bone but significant injuries of ligaments and other soft tissues. It is very important to understand the mechanisms of trauma in order to make definite diagnosis and proper treatment. The author' analysed 127 eases(126 patients) of the ankle fractures which were admitted and treated in Orthopaedic Department,Hanyang University Hospital from January 1978 to December 1985. The results obtained from this study were as follows: 1. Of the 127 cases, male was 90 cases(70.87%), female was 37 cases(29.13%), and average age of the patients was 37.6 years. 2. Open fractures were 12 cases(9.4%) and closed fractures were 115 cases(90.6%). 3. According to the classification of Lauge-Hansen, the most common type of the ankle fracture was supination-external rotation type (35.43%). 4. Of the 127 cases, 63 cases were treated by closed reduction and 64 cases by open reduction. 5. The average period of the cast immobilization after open reduction was 7.8 weeks, where as that of closed reduction was 10.5 weeks. 6. According to clinical and radiological assessment of the result of the treatment, open reduction was better than closed reduction. 7. The best result of the treatment was noticed in supination-adduction type, according to the classification of Lauge-Hansen. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus and distal fibuIa was important in treatment of the ankle fracture.
Ankle Fractures ; Ankle Joint ; Ankle ; Classification ; Clinical Study ; Diagnosis ; Female ; Fibula ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Joints ; Ligaments ; Male ; Talus ; Tibia ; Weight-Bearing

One of the serious and challenging problems confronting orthopaedic surgeons is an open un-united fracture of tibia. Especially, there are some difficulties in getting bone union on the condition of combining soft tissue defect with infection. In the management of infected un-united fracture of tibia with significant soft tissue loss we attempted a two-stage reconstruction : the first stage consisted of radical sequestrectomy, soft tissue reconstruction, and external fixation, and the 2nd stage consisted of various types of bone grafting and bone fixation. Fifteen patients with open infected un-united fractures of tibia treated with staged reconstruction from September 1982 to August 1987 at Department of Orthopaedic Surgery, Dae-Jeon's St. Mary's Hospital, Catholic University Medical College, were analyzed in clinical aspects and the results of treatment obtained were as follows : 1. Satisfactory bone union was obtained in an average of 6 months after bone graft with a range of 4 months to 12 months. 2. The duration from the injury to bone union was 13 months on an average with a range of 8 months to 19 months. 3. The soft tissue rer.onstruction at the first stage were performed with local flap in 11 cases and muscular flap in 2 cases and musculocuteneous flap in 2 cases. 4. The time interval between 1st stage and 2nd stage was from 1.5 months to 3 months. 5. At the 2nd stage, bone graft were performed with autogenous cancellous bone graft in 11 cases, vascularized osteocutaneous fibular graft in 2 cases and ipsilateral vascularized fibular transference in 2 cases. In summary, a two-stage reconstruction for open infected un-united fracture of tibia is a advisable procedure that leads to bone union with satisfactory return of function.
Bone Transplantation ; Fractures, Open ; Humans ; Surgeons ; Tibia ; Transplants ; United Nations