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

PURPOSE: To assess the effect of the remnants after lens extraction on posterior capsular opacification with lens epithelial cell culture through in vitro capsular bag model. METHODS: After isolating porcine lens capsules, sterile non-toxic PMMA (polymethyl- mathacrylate) tension ring was inserted into the capsule. These were placed in organ culture medium up to 6 weeks. The grade of cell coverage of the posterior lens capsule was recorded to check the proliferative activity. RESULTS: In the process of cell culture, outgrowth of the epithelial cells was observed across the posterior capsule after a lag period. The rate of cell coverage was dependent upon the added factors. The proliferative activity was the greatest in the group where lens cortical and nuclear materials were added, and other groups showed no difference from a control group. CONCLUSIONS: To reduce posterior capsular opacification, it is important that we should not leave the lens cortical material behind during cataract surgery.
Capsules ; Cataract Extraction* ; Cataract* ; Cell Culture Techniques ; Epithelial Cells* ; Organ Culture Techniques ; Polymethyl Methacrylate

We report a case of fatal aortic tumor embolism presenting as acute paraplegia. A four-year-old girl was referred from a local hospital with sudden paraplegia and a poor medical condition. A neighbor had noticed her fall from a bike, and she could not walk. She had no previous illness. Emergency spine MRI revealed no remarkable findings. During the process of evaluation, her general condition deteriorated progressively. Chest and abdominal CT showed a large mass in the left lung field, and a diagnosis of aortic occlusion was made. An emergency transfemoral embolectomy was attempted. However, the patency of the aorta was not recovered. On pathological examination of tissues taken from the embolectomy, a pleuro-pulmonary blastoma was found. The patient died 22 hours after the onset of her symptoms. We describe a possible mechanism for the tumor embolism. To the best of our knowledge, this is the first case report of aortic occlusion caused by an embolic malignancy, presenting as acute paraplegia.
Aorta ; Diagnosis ; Embolectomy ; Emergencies ; Female ; Humans ; Lung ; Magnetic Resonance Imaging ; Neoplastic Cells, Circulating* ; Paraplegia* ; Spine ; Thorax ; Tomography, X-Ray Computed

To investigate the genetic variation within pspA from 17 clinical isolates of Streptococcus pneumoniae representing 12 capsular serotypes, we used specific PCR primers LSM12 and LSM2 derived from the DNA sequence of pspA of S. pneumoniae Rxl (type 2). We have found that all 17 isolates of S. pneumoniae have a pspA gene whose size ranges from 1.8 to 2.3 kb. RFLP analysis of the PCR-amplified pspA genes of the isolates exhibited distinct restriction patterns. Even within the same capsular type, the individual isolates of S. pneumoniae generally differed in PspA molecular masses and showed variabilities in the pspA gene locus. The nucleotide sequence of the pspA gene of S. pneumonaie KNIH1156 (type 19F) isolated from a blood specimen was determined. The sequence revealed an open reading frame of 1,827 bp nucleotides. Predicted size of the mature PspA was approximately 63 kDa. Deduced amino acid sequence of PspA of S. pneumonaie KNIH1156 revealed 57.0% identity with that of S. pneumonaie Rxl. Comparison of the nucleotide and amino acid sequences of PspA S. pneumoniae KNIH1156 (type 19F) with those of Rxl (type 2) showed considerable differences in the a-helical coiled-coil region of the two PspAs. These results suggest that the PspA of S. pneumoniae KNIH1156 has antigenic variations distinguished from those of Rxl strains.
Amino Acid Sequence ; Base Sequence ; Cloning, Organism ; Genetic Variation ; Korea* ; Nucleotides ; Open Reading Frames ; Pneumonia ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis* ; Staphylococcal Protein A* ; Streptococcus pneumoniae* ; Streptococcus*

The nevus of Ota is a benign nevus characterized by the deposition of pigment in an area of distribution of the first and second branches of the trigeminal nerve. In general it rarely causes ophthalmological problems. We experienced a 23-year-old male patient who complained sudden visual loss in the left eye with the characteristics of the nevus of Ota. On examination we found the altitudinal field defect which we believe is an unusual finding of the nevus of Ota.
Humans ; Male ; Nevus ; Nevus of Ota* ; Trigeminal Nerve ; Young Adult

An external thrombotic hemorrhoid is a very painful disease with a high incidence rate. The chief complaints encountered by the surgeon are protrusion and pain. However, because the spontaneous healing rate is very high, there is no consensus on whether conservative management or surgery is a more effective treatment policy. In an attempt to resolve this problem, we performed a clinical analysis of fifty patients with external thrombotic hemorrhoids who were treated by conservative management at Song-Do Colorectal Hospital from October 1996 to December 1996. We recorded the time required for the protrusion and the pain to disappear and performed manometry to check the sphincter pressure and tissue pathology to determine the pathogenesis of the external thrombotic hemorrhoid. The results are as follows: 1) Based on pathology, the cause of the external thrombotic hemorrhoids was venous thrombosis due to venous stasis, not a hematoma due to venous rupture. 2) Manometry showed that the resting sphincter pressure and the squeezing sphincter pressure for the patients with external thrombotic hemorrhoids was higher than those of the control group, which was the reason for the venous stasis. In conclusion, because an external thrombotic hemorrhoid is just a thrombosis due to venous stasis, the thrombosis can be improved by using methods such as a warm sitz bath and analgesics to decrease the sphincter pressure. Hence, conservative management should be the preferred treatment in almost all cases.
Analgesics ; Baths ; Consensus ; Hematoma ; Hemorrhoids ; Humans ; Incidence ; Manometry ; Pathology ; Rupture ; Thrombosis ; Venous Thrombosis

PURPOSE: Peritendinous adhesion is one of the most notorious complication after the flexor tendon injury. In this study, Alloderm(R)(LifeCell Corp., Branchburg, N.J.), which is the decellularized human dermal analogue with its intact native basement membrane components, was used for the prevention of peritendinous adhesions following flexor tendon repair. METHODS: Thirty New Zealand white male rabbits were divided equally into 3 groups. In all groups, the flexor digitorum profundus of the third finger of the right back foot was cut totally and repaired by modified Kessler suture technique. Following tendon repair, Alloderm(R) was wrapt around the repaired tendon in the first group and sodium hyaluronate gel was sprayed to the operation field in the second group. In the control group, no external material was applied. The right back foot were immobilized for 6 weeks to optimize the formation of adhesion ingrowth. After death, the third finger that repaired tendons and sheaths was removed en bloc. We checked range of motion. and studied histologically for all groups. RESULTS: The experimental groups had better range of motion than the control group. We checked that the range of motion was 73.5 degrees in Alloderm(R) group, 55.9 degrees in the hyaluronic acid group, and 38.3 degrees in the control group. in the histological study, the experimental group had less adhesions compared with the control group. CONCLUSION: This study concludes that Alloderm(R) can decrease peritendinous adhesions following flexor tendon repairs in rabbits. We think the method could be used in clinical cases.
Basement Membrane ; Fingers ; Foot ; Humans ; Hyaluronic Acid ; Male ; New Zealand ; Rabbits* ; Range of Motion, Articular ; Suture Techniques ; Tendon Injuries ; Tendons

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD +/- 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.
Adolescent ; Child ; Child, Preschool ; Craniocerebral Trauma/*epidemiology/radiography ; Female ; Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Male ; Prospective Studies ; Republic of Korea/epidemiology ; Severity of Illness Index ; Sex Factors

BACKGROUND AND AIMS: A superficially invasive cancer in the colon is considered a candidate for an endoscopic resection. Therefore, detecting a superficially invasive cancer and differentiating it from a massively invasive cancer is an important key in selecting proper treatment. In order to accomplish this purpose, exact knowledge of the characteristics of submucosal invasive cancers is required. In this study, attempts to define those endoscopic features and draw guidelines for treatment were made. METHODS: Recently, 23 submucosal invasive cancers were experienced. All of them were detected by an endoscopic examination, and were treated by endoscopic therapy and/or surgical resection. These cancers were reviewed and analyzed with emphasis on size, configuration, differentiation, and treatment. RESULTS: The most common sizes ranged from 10 mm to 19 mm (47.8%). There were two minute lesions below 5 mm. The most common type of lesions was sessile (43.5%). Most lesions showed redness and 60.9% showed hardness. Many cases had characteristic features such as nodules (47.8%), bleeding easily upon touch (39.1%), erosion (39.1%), and white spots (34.8%). Other characteristic features were expanded figures, depressions, and mucosal convergence. Moderately-differentiated adenocarcinomas were predominant (8/15, 53.3%), and there were four polypoid cancers (4/17, 23.5%). In 43.5% of the lesions, only endoscopic treatment was enough. Forty-four percent of all patients treated endoscopically needed additional surgical resections because of uncertainty with respect to complete excision of the cancer and/or a poorly-differentiated adenocarcinoma with lymphatic invasion. There was no lymph node metastasis in any of the patients who underwent surgical resections, and three of them had no residual tumors, as the endoscopic treatment had completely excised the cancer. CONCLUSIONS: Accurate information on submucosal invasive cancers and recognition of the endoscopic characteristics of submucosal invasive cancers are necessary for their detection and management in an early stage. Moreover, it is possible to differentiate superficially invasive cancers from massively invasive ones by their characteristic features. Therefore, in selected patients with superficially invasive cancers, surgical resections can be avoided.
Adenocarcinoma ; Colon* ; Dental Caries ; Depression ; Hardness ; Hemorrhage ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Uncertainty

BACKGROUND AND AIM: While detection and removal of polyps on the basis of the adenoma-carcinoma sequence has been a principal procedure for endoscopists, a new type of early colorectal cancer has been recognized and has become a hot issue. This new ailment is a depressed-type early colorectal cancer, which has the characteristics of rapid growth and early invasion of the submucosa. Though once considered to be mere conjecture, many researchers claim that this cancer is a de novo carcinoma despite of its rare occurrence. Recently, 4 depressed-type neoplastic lesions were presented, which signifies the importance of recognizing that this type of cancer exists and is characterized by rapid growth and early invasion of the submucosa. METHODS: The 4 recently experienced depressed neoplastic lesions were reviewed and analyzed with respect to their endoscopic and clinicopathologic characteristics. The sizes of the lesions were measured in the fully inflated state of the bowel by using an endoscopic ruler. RESULTS: The sites of predilection were the descending and sigmoid colon. All of the lesions were under 10 mm, with 75% being below 5 mm. The largest lesion was an 8-mm, well-differentiated mucosal carcinoma. The overall malignancy rate was 25%. Light redness was observed in all patients. Distortion with air transformation of the mucosal fold was also recognized in all the patients. The main treatment was endoscopic mucosal resection, which amounted to 50%. CONCLUSIONS: Depressed colorectal neoplasms are real. They can be determined by their characteristic endoscopic features, such as light redness and distortion with air transformation of the mucosal fold. Because of their characteristics of rapid growth and early invasion of the submucosa, it is important to detect and manage them in an early stage, when their sizes are below 10 mm.
Colon, Sigmoid ; Colorectal Neoplasms* ; Humans ; Polyps