Eleven patients underwent posterior sagittal anorectoplasty(PSARP) as a secondary procedure. Two of them had rectovaginal fistula and another two had rectocutaneous fistula. Six of the rest complained of frequent fecal soiling and the last one had severe anorectal stricture after perineal anoplasty. Five patients had lived with colostomy until the second operations were carried out. The ages at the time of the secondary PSARP were between 7 months and 29 years. Distal colostogram and MRI were taken to evaluate distal colon, position of the rectum and voluntary muscle. All patients had normal sacrum except one who had anorectal stricture. Seven patients, six with fecal incontinence and the other one with rectovaginal fistula had mislocated anorectums. Three patients, two with rectocutaneous fistula, the other one with anorectal stricture, had abdominal approach to obtain enough length of colon for pull-through procedure. With the posterior midsagittal approach, we could manage all the problems, rectovaginal fistulas, rectocutaneous fistulas, strictures and malpositioned rectums, without difficulty. No patients had serious complications except wound infection in one. All patients were satisfied with the results after redo-PSARPs even though normal continence has been achieved in only one patient. Seven patients who had continuous soiling or rectocutaneous fistula, needed no more diapers even though four of them showed fecal staining under stressful condition and the other three showed intermittent fecal leaking less than once a day. The rest three of the patients maintained their continence with support of drugs and/or enemas because of constipation. The PSARP is a popular procedure as a primary operation; however, our results suggested that this procedure also gave us a good opportunity for management of serious complication developed after primary anoplasties.
Colon ; Colostomy ; Constipation ; Constriction, Pathologic ; Enema ; Fecal Incontinence ; Fistula ; Humans ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Rectovaginal Fistula ; Rectum ; Sacrum ; Soil ; Wound Infection

A case of 49 year-old male with dermatomyositis associated with stomach cancer and Sjogren's syndrome is reported. The skin changes were characterized by the presence of Gottron's sign and dusky erythematous and finely scaling macular eruptions with telangiectasias on the scalp, forehead, butterfly area of the face, both elbows and knees. Dryness of eyes and mouth, nuchaI rigidity, numbness on extremities and epigastric hunger pain were also noted. The family history and past history were not contributory. After that weakness on proximal muscles, nuchal rigidity, dysphagia and walking difficulty were more aggravated. On dental and ophthalmologic examinations, shiny appearance of tongue and oral mucosa, burning and dry sensation in the mouth was noted and diminished tear and saliva production was also discovered. On laboratory findings, ESR, serum enzymes, especially CPK 3 and LDH, urinary creatine excretion were increased. LE cell was not found and RA test was also negative. Electromyographic and nerve conduction studies revealed myopathic EMG and normal nerve conduetion in both motor and sensory. There are gastric ulcer, positive vallecular sign on esophagus and thread like narrowing on almost all main and minor ducts of parotid gland. Histologic findings revealed ulcerative adenocarcinoma of stomach, a mild focal infiltration of lymphocytes and degenerative changes in left deltoid muscle and diffuse and extensive dermal edema associated with inflammatory infiltrates and hydropic degeneration and atrophy on the facial skin. He was treated with prednisolone, aspirin and intravenous methotraxate but no favorable effect was noted. Authors reviewed relevant literature.
Adenocarcinoma ; Aspirin ; Atrophy ; Burns ; Butterflies ; Creatine ; Deglutition Disorders ; Deltoid Muscle ; Dermatomyositis* ; Edema ; Elbow ; Esophagus ; Extremities ; Forehead ; Humans ; Hunger ; Hypesthesia ; Knee ; Lymphocytes ; Male ; Middle Aged ; Mouth ; Mouth Mucosa ; Muscle Rigidity ; Muscles ; Neural Conduction ; Neutrophils ; Parotid Gland ; Prednisolone ; Saliva ; Scalp ; Sensation ; Sjogren's Syndrome* ; Skin ; Stomach Neoplasms* ; Stomach Ulcer ; Stomach* ; Tears ; Telangiectasis ; Tongue ; Ulcer ; Walking

Angiotensin-converting enzyme(ACE) is a ipeptidyl carboxypeptidase that is a membrane bound mainly on the luminal surface of pulmonary endothelial capillary cells. It functions to inactivate bradykinin, and also converts angiotensin 1 to angiotensin Activity of ACE was first identified in plasma by Skeggs and co-workers in ]956 In 1974 Lieberman discovered that elevated levels of serum ACE were associated with active sarcoidosis and that this assay would be usei to assist a diagnosis of sarcoidosis. The association of sarcoidosis and enhanced ACE activity was subsequently supported by data from other investigators. Increased serum ACE levels have also been observed in patients with nongranulomatous diseases and granulomatous diseases including leprosy. The author studied the serum ACE levels in leprosy patients(fourty-three with tuberculoid type and eighty-nine with lepromatous type) and twenty normal healthy controls by the spectrophotometric method described by Lieberman. Comparative studies of ACE levels in these two types of leprosy with normal healthy controls and relationship among the duration of treatment, age, and sex were also conducted. The results were summarized as follows: Ages of the selected patients were between 3Q to 77 years in tuberculoid leprosy (average 54 1), 23 to 75 years in lepromatous leprosy(average 53. 8) and 14 to 49 years in the control group(average 28 4) The duration of treatment in tuberculoid leprosy was between 1 and 39 years and average was 2p 7 years. Of lepromatous leprosy, duration of treatment was between 2 and 50 years and the average was 25. 4 years.
Angiotensins* ; Bradykinin ; Capillaries ; Diagnosis ; Humans ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Membranes ; Peptidyl-Dipeptidase A* ; Phenobarbital ; Plasma ; Research Personnel ; Sarcoidosis

BACKGROUND: Epidermal growth factor receptors (EGFR) have been reported to be absent in melanomas. But recently, the presence of EGFR on melanocytic cells was reported to be a marker of malignant transformation. OBJECTIVE: Our purpose was to investigate the presence of EGFF in melanocytic lesions and to determine whether EGFR presence correlates with the potential or malignant transformation of melanocytic cells. METHODS: We performed the immunohistochemical studies to reveal immunoreactivity of EGFR in 7 compound nevi, 10 intradermal nevi, and four melanomas using the Vectastain ABC immunoperoxidase stain system. RESULTS: Although the intensity of staining was slightly variable, all melanocytic cell types in the studied lesions of compound nevi, intradermal nevi, and melanoms had immunoreactive EGFR. Intense staining far EGFR of all nucleated layers of keratinocytes overlying a melanocytic lesion was also seen. But in the melanoma cells, the staining intensity was modarately deereased. CONCLUSION: Although we found no correlation of EGFR with the potential for malignancy in melanocytic lesions, the high level of expression within nevocytes and lesional keratinocytes suggests EGFR or transforming growth factor a, by acting through the EGFR, plays a role in the pathogenesis, maintenance, or evolution or these lesions.
Epidermal Growth Factor* ; Keratinocytes ; Melanoma ; Nevus ; Nevus, Intradermal ; Receptor, Epidermal Growth Factor* ; Transforming Growth Factors

BACKGROUND: Epidermal growth factor(EGF) usually stimulate she growth and proliferation of a variety of cell types in vitro and in vivo through binding to a peific cell surface receptor, a 170- kilodalton glycoprotein. The EGF receptor (EGFR) may be respansi ile for deranged keratinocyte proliferation and differentiation. OBJECTIVE: Our purpose was to investigate the pattern of EGFR expression in malignant epidermal tumors. METHODS: We performecl immunohistochemical studies to reveal immunoreactivity of EGFR in 7 basal cell carcinomas, 6 squamous cell carcinomas, and five nomal control skin using the Uectastain ABC immunoperoxidase stain system. RESULTS: In normal skin, EGFR showed strong staining of basal cells and lower keratinocytes of the stratum malpighii. As squaous cells matured, staining gradually beame weaker. In all cases of basal cell carcinoma studied, there was loss of membrane labelling of the tumor cells and but in half the cases there was little or no siaining of the lesional cells. In squamous cell carcinomas, variable patterns were seen. The better differentiated tumors showed an essentially no mal pattern of EGFR expression. However, less well differentiated areas showed loss of membrane staining, cytoplasmic accumulation of receptor, and a heterogeneiy of staining intensity. CONCLUSION: Dysregulation of the EGFR may be important in the levelopment, of cutaneous epithelial malignancies but that giossly abnormal forms of the receptor do not occur. The quantitative and qualitative changes in EGFR that we have demonstrated may well be of importance in the pathogenesis of these keratinocyte tumors.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cytoplasm ; Epidermal Growth Factor* ; Glycoproteins ; Keratinocytes ; Membranes ; Receptor, Epidermal Growth Factor* ; Skin

In 1988, the International Federatioa of Gynecology and Obstetrics(FIGO) Cancer Committee changed the staging of endometrial carcinoma from a clinical one to a surgicopathologic one. The emphasis in the new FIGO system was changed to the pathologic findings in the uterus, cervix, adnexae, and pelvic and/or periaortic nodes, and peritoneal cytologic findings. The major changes in this staging system were the use of the depth of myometrial invasion and the identification of tumor cells in peritoneal cytologic examination and of invasion in the retroperitoneal lymph nodes, Preoperative endocervical curettage was no longer necessary. This is a reflection of the increase in the primary surgical approach to the treatment of this disease and has allowed the identification of a number of prognostic factors on which postoperative therapy can be based. This retrospective study was based on a clinical review of 45 patients with endometrial carcinoma from Jan, 1985 through Jan, 1996 who underwent primary surgical evaluation at the Department of Obstetrics and Gynecology, Kyungpook National University Medical College. The results obtained are as follows; l. Age distribution of endometrial cancer was concentrated on the age group of 50-59(55.6%) and mean age was 53.9 years. 2. The mean parity and mean BMI(Body Mass Index) of endometrial cancer were 3.8 and 25.0(cm/kg2). 3. The Menstrual status at the time of development of endometrial cancer showed that 24 cases (53.3%) were postmenopausal, 11 cases (24.4%) were premenopausal and 10 cases(22.2%) were menstruating. 4. According to the clinical stage adopted by FIGO classification, stage I was found in 71.1%, stage II in 17.8%, stage III in 2,2%, stage IV in 0.0%. 5. Surgical restaging according to new FIGO classification(1988), stage IA was found in 4.4%, stage IB in 37.8%, stage IC in 28.9%, stage IIA in 0.0%, stage IIB in 0.0%, stage IIIA in 6.7%, stage IIIB in 4.4%, stage IIIC in 8.9%, stage IVA in 2.2% and IVB in 6.7%. 6. According to WHO histopathological classification, the percentage of the adenocarcinoma was 86.7%, adenoacanthoma 4.4%, papillary serous adenocarcinoma 2.2%, and adenosquamous cell carcinoma 6.7%. 7, The relationship between histologic grade and depth of invasion was somewhat correlated but no staistical significance. 8. There was no correlation between BMI(Body Mass Index) and histologic grade, depth of invasion. 9. Surgery upstaged 15.6% of clinical stage I patients and 62,5% of clinical stage II, but 37.5% of clinical stage II patients was downstaged. 10. All cases were primarily treated by surgery. Regarding the types of operation, total abdominal hysterectomy with bilateral salpingoophorectomy was performed in 44.4%, radical hysterectomy with both pelvic lymphadnectomy in 42.2%, total abdominal hysterectomy with bilateral salpingoophorectomy with selective pelvic lymph node dissection in 8.9%, and laparoscopic assisted vaginal hysterectomy in 2.2%. 11. The mean follow up interval was 38.6 months. 28 cases were followed up and 10 cases of surgical stage I revealed over 5 year salvage. 5-year survivals for surgical stage IA, IB, IC, III, and IV were 100, 100, 92.3, 88.9, and 100%, respectively.
Adenocarcinoma ; Age Distribution ; Cervix Uteri ; Classification ; Curettage ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Gynecology ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Staging ; Obstetrics ; Parity ; Retrospective Studies ; Uterus

BACKGROUND: Mutations in the p53 gene are the most frecjuent genetic alterations found in human cancers to date. Bvidense suggests that wild-type p53 is a tumor suppressor protein, crucial for the negative regulative of cell cycling, and requiring loss of function mutations for tumorigenesis. OBJECTIVE: Our purposr is to investigate the expression pattern of the p53 protein in the squamous cell carcinomas(SCCs) of the human skin. METHODS: We studied p53 protein expression, using DO7 mnoclonal antibody immunohi-stochemistry, in 29 SCCs of the skin. Also, we compared the p53 expression depending upon with or without a history of UV exposure. RESULTS: p53 immunoreactivity was observed in 48% (14 of 29) of SCCs and was not seen in normal skin. In 56% (16/29) SCCs the tumors were developed on UV-light exposure area. SCCs were divided on histopatal biological criteria in to three categories, well, moderately, or poorly differentiated. Although no significant differenie in the prevalence of p53 immunoreactivity was obierved between these groups, positive, strong staining was observed more frequently in poorly differentiated than in well-differe: treated tumors. CONCLUSION: Accumulat,i,on of p53 protein, suggestive in nessary cases of p53 gene mutation and hence loss of tumors upperesor function, may play a role in the tumorigenesis of SCCs.
Amoxicillin ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans* ; Prevalence ; Skin*

No abstract available.
Oncogenes*

In 1988, a new fascioutaneous flap, the Lateral supramalleolar flap, was introduced by Masquelet and Roman. The flap is designed on the lower third of the aspect of leg, and supplied by a cutaneous branch from the perforating branch of the peroneal artery. This perforating branch continues distally deep to the fascia along the anterior ankle and into the foot. This can be use as either proximally based rotation flap or distally based reversed pedicle island flap giving the flap an arc of rotation that allows coverage of the dorsal, lateral and plantar aspects of the foot, the posterior heel and the lower medial portion of the leg. The authors have recently used this flap for 13 cases of foot and ankle soft tissue defect reconstruction and all the cases, except two partial marginal necrosis, good postoperative course. In our opinion, this flap is useful for reconstruction of foot and ankle soft tissue defect which does not need nerve innervation. The main advantages of the flap are as follows 1. It may be a rather large flap(15×9cm2 ). 2. The pedicle is long(8cm) and easy to dissect. 3. The pivot of the pedicle is distal(sinus tarsi) and allows great local possibilities of coverage. 4. It does not require the sacrifice of a main artery.
Ankle ; Arteries ; Fascia ; Foot ; Heel ; Leg ; Necrosis ; Osteotomy ; Tibia

Isolated situs in versus of the stomach with otherwise normal position of the thoracic and abdominal vescera isan extremely rare anomaly occurring in two distinct forms. Majority of cases are associated with eventration of the diaphragm and are reported as being confused with spontaneous pneumothorax of pyopneumothorax at base of the right lung. The right sided stomach may produce interesting and confusing changes in liver scan. We have experienced 2 cases of the isolated dextrogastria.
Diaphragm ; Liver ; Lung ; Pneumothorax ; Stomach