A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment.
Alum Compounds ; Aluminum ; Hemorrhoidectomy ; Hemorrhoids ; Potassium ; Recurrence ; Tannins

The difference between anal fistulas involving the ischioretal space and pelvirectal space is that in the former the involvement of the anal fistula is low the levator ani muscle whereas in the latter it is above the levator ani muscle. The levator ani muscle posterior midline incision method, which is introduced here, is thought not to injure the anal sphincter; thus, it does not affect the anal function. The method also allow the surgeon to assess readily and accurately whether or not the fistula has invaded the pelvirectal space.
Fistula ; Muscles ; Rectal Fistula

No abstract available.
Fournier Gangrene*

There are many techniques for performing a hemorrhoidectomy. The author introduces the submucosal hemorrhoidal artery ligation technique and the shortening suture technique. In the author's expericence, the submucosal hemorrhoidal artery ligation technique reduces not only the secondary bleeding rate but also the hemorrhoid recurrence rate after a hemorrhoidectomy. The shortening suture technique reduces the postoperative anal stricture rate by folding skin into the anal canal and prevents a skin tag after a hemorrhoidectomy.
Anal Canal ; Arteries* ; Constriction, Pathologic ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids* ; Ligation* ; Recurrence ; Skin ; Suture Techniques* ; Sutures*

PURPOSE: Postdural puncture headache is one well-known complications of spinal anesthesia. The development of postdurals puncture headaches is related to needle size, the direction of the needle bevel, the number of dural punctures and the age of the patient. However, the effect of the sitting position after spinal anesthesia (saddle block) on the incidence of postdural puncture headaches is not yet known. This study was performed to compare the incidence rates of headaches between a saddle block group (sitting position group) and a low spinal anesthesia group (supine position group). In addition, this study was performed to identify the predisposing factors influencing postdural puncture headaches (age, sex, seasonal variation, onset of headache, location of headache). METHODS: The authors analyzed 960 anal-surgery patients who were operated on using a saddle block or low spinal anesthesia at Hang Cinic from Jan. 2000 through Dec. 2000. The authors compared the incidence rates of headaches between the saddle block group (480 cases) and the low spinal anesthesia group (480 cases). RESULTS: 1) The incidence of postdural puncture headaches was not significantly different between the two groups (2.5% in the saddle block group, and 2.3% in the low spinal anesthesia group) (P>0.05). 2) The postdural puncture headache incidence rate was higher for younger patients (20~30 years) and for females. (M:F=7:16) (P<0.05). 3) The onest of postdural puncture headaches was at the postoperative 2nd day in 16 cases (70%) and at the postoperative 3rd day in 6 cases (26%). 4) The incidence rate of postdural puncture headache was higher in the summer (5 cases in June, and 3 cases in July, 4 cases in August). 5) The headache were located in the frontal region in 16 cases (70%) and in the occipital region in 3 cases (13%). CONCLUSIONS: There is no significant difference in the incidence rates of postdural puncture headaches between the saddle block group and the low spinal anesthesia group. Postdural puncture headaches had a tendency to occur more frequently in young female patients and during the summer season. In addition, a more intensive study of the use of saddle block anesthesia for ambulatory anal surgery is required.
Anesthesia ; Anesthesia, Spinal* ; Causality ; Female ; Headache ; Humans ; Incidence* ; Needles ; Post-Dural Puncture Headache* ; Punctures ; Seasons

Urinary tract infections are common clinical problems in children, even though lots of treatment strategies have been tried. Many studies of the application of probiotics for urinary tract infection in female adults exist, but there is a lack of studies in children. The aims of this study were to screen probiotic strains for inhibiting the uropathogens in vitro, to find candidates for in vivo study. Nine strains of E. coli were isolated from children with urinary tract infection and six uropathogens were obtained from Korean Colletion for Type Cultures and American Type Culture Collection. Also 135 lactic acid bacteria (LAB) strains were isolated from healthy children, and were identified through physiologic, biochemical methods, 16S rDNA PCR, and data analysis. And with agar disk diffusion assay technique the antimicrobial activities of these LAB strains against those uropathogens were examined. Three strains of separated LAB strains demonstrated major antimicrobial activity against all the uropathogens. In the agar disk diffusion assay technique, antimicrobial activities increased most in the 4th day culture broth with separated Lactobacillus. In summary, some LAB can be used as candidates to develop the probiotic microorganisms that inhibit uropathogens in children, and are expected to be applied to treatment and prevention of pediatric urinary tract infection.
Agar/chemistry ; Anti-Infective Agents/pharmacology ; Child ; Culture Media/metabolism ; Diffusion ; Escherichia coli/*metabolism ; Feces ; Humans ; Korea ; Lactic Acid/*metabolism ; Microbial Sensitivity Tests ; Polymerase Chain Reaction ; Probiotics/*metabolism ; RNA, Ribosomal, 16S/metabolism ; Urinary Tract Infections/*microbiology/therapy

No abstract available.
Cartilage* ; Rabbits* ; Ribs*

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The colonoscopic polypectomy has become a valuable procedure for removing precursors of colorectal cancer, but some complications can be occurred. The most common complication after colonoscopic polypectomy is bleeding, which is reported to range from 1% to 6% and which can be immediate or delayed. Because the management of delayed postpolypectomy bleeding could be difficult, the use of preventive technique and reductions of risk factors are essential. METHODS: From January 2007 to December 2008, delayed hemorrhage occurred in 18 of the 1,841 polypectomy patients examined by one endoscopist. These cases were reviewed retrospectively for risk factors, pathologic findings, and treatment methods. RESULTS: Delayed bleeding occurred in 18/1,841 patients (0.95%). The mean age was 55.9 +/- 10.9 years, and the male-to-female ratio was 8:1. The most common site was the right colon (11 cases, 61.1%), and the average polyp size was 9.2 +/- 2.8 mm. Delayed bleeding was identified from 1 to 5 days after resection (mean, 1.6 +/- 1.2 days). The most common macroscopic type of polyp was a sessile polyp (10 cases, 55.6%), and histologic finding was a tubular adenoma in 13 cases (72.2%). Seventeen cases were treated with clipping for hemostasis and 1 case with epinephrine injection. CONCLUSION: The right colon and a sessile polyp were associated with an increase in delayed postpolypectomy bleeding. Reducing risk factors and close observation were essential in high risk patients, and prompt management with hemoclips was effective.
Adenoma ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Epinephrine ; Hemorrhage ; Hemostasis ; Humans ; Polyps ; Retrospective Studies ; Risk Factors

An intersphincteric fistula is the most common type of fistula, about 70% of all fistulas, and is often encountered by the surgeon during anal surgery. The operative procedures include a simple fistulotomy, a fistulectomy, a cutting seton technique, and a sphincter-saving technique. Most posterior-located intersphincteric fistulas can be successfully treated by using the lay-open technique, but using that technique in cases of lateral- or anterior-located fistulas may result in incontinence or anal deformity. In this respect, a sphincter-saving technique has more advantage in sparing anal function than other procedures in cases of lateral or anterior fistulas, but the recurrence rate is high. The delayed open method with seton techniques have a low recurrence rate, but do not preserve anal function well. As mentioned above, the operative method for treating intersphincteric fistulas should be suitable for keeping sphincter tone and should have a low recurrence rate. This article discusses the rationale for and the estimated effectiveness of many operative methods for treating intersphincteric fistulas.
Congenital Abnormalities ; Fistula ; Imidazoles ; Nitro Compounds ; Recurrence ; Surgical Procedures, Operative