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: The purpose of our study is to examine early radiographic findings and clinical signs of failure of the microstructure surface HA-coated acetabular cup. Material and methods: This study included 41 revisions of 204 THA with hydroxyapatite-coated acetabular cup from April 1992 to November 1996. Radiolucent line around cups, change in the cup angle and osteolysis were evaluated in serial radiographs. Acetabular cup was defined as loosening if any movement occurred at the bone and socket interface by manual rotation and extension force intraoperatively or migration of more than 2 mm and change of the cup angle by more than 5 degrees in radiographs. Results: The radiolucent line was observed in 12 of the 41 hips at an average of 55.4 months postoperatively and was most commonly located in zone III. All of the 12 hips showing radiolucent lines were classified as loosening by radiographically in 8 cases and intraoperatively in 4 cases. Radiographic loosening occurred at an average of 28.8 months after the appearance of a radiolucent line. Inguinal pain was noted in 18 of the 19 cases revised for acetabular cup loosening. Conclusion: The most important radiographic finding for the early diagnosis of loosening was progressive radiolucent lines, which occurred most frequently in zone 3.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Early Diagnosis ; Hip ; Osteolysis

We analysed the clinical findings in four families of hereditary retinoblastoma. All four children with retinoblastoma were male. Two of them were diagnosed after two years of age and the remainder were before seven months of age. The relatives affected with retinoblastoma were one father, one mother, one sibling, and one second cousin of patients respectively. To our knowledge, this is the first report of hereditary retinoblastoma with family history in Korea.
Child ; Fathers ; Humans ; Korea ; Male ; Mothers ; Retinoblastoma* ; Siblings

OBJECTIVE: The purpose of this study is to investigate the prognostic factors and appropriate treatment in patients with intracerebral hemorrhage secondary to ruptured middle cerebral artery(MCA) aneurysms. METHODS: Among 120 cases with ruptured MCA aneurysms during last 9 years from 1993 to 2002, 85 cases was analyzed according to hematoma distribution. All cases were included in one of three groups Group A(15 cases) having an intraparenchymal hematoma(IPH) larger than 5cc with or without subarachnoid hemorrhage(SAH). Group B(25 cases) having an intrasylvian hematoma(ISH) with or without SAH. Group C(45 cases) having a diffuse SAH without localized hematoma. Prognosis was evaluated postoperatively by applying Glasgow Outcome Scale(GOS) at discharge. RESULTS: In Group A, hypertension and Hunt-Hess(H-H) grade on admission, hematoma volume larger than 15cc and postoperative edema were corrleated with poor outcome. In Group B, old age, postoperative edema and delayed ischemic neurologic deficit(DIND) were related to poor outcome. Group C revealed better consciousness on admission and favourable outcome than Group A and B. CONCLUSION: We suggest that therapeutic consideration in Group A is focused on postoperative edema after early surgical intervention and in Group B is focused on postoperative edema with DIND after removal of residual clot in sylvian fisssure as much as possible by irrigation and suction.
Aneurysm ; Cerebral Hemorrhage* ; Consciousness ; Edema ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Prognosis ; Suction

No abstract available.
Antibodies* ; Kidney Transplantation* ; Kidney*

Plasma cell granuloma is a tumor-like disease characterized by non-neoplastic polyclonal proliferation of plasma cells and other mononuclear cells. This disease occurs most frequently in the lung and upper respiratory tract, while the involvement of the central nervous system is very rare. A 44-year-old female patient presented with nausea and progressive visual disturbance. Brain magnetic resonance imaging (MRI) revealed the mass along the right tentorium with low signal intensity in the T2 weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) sequence, and an isosignal intensity in T1 weighted image (T1WI), the latter of which was enhanced after administration of gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA). The thickest portion of the tentorium was partially excised via the combined suboccipital and infratentorial approach. The histopathological examination indicated a diagnosis of plasma cell granuloma. Postoperative steroid therapy was administered for remnant tumor control. Although a follow up MRI scan taken 20 months after the operation showed a slight decrease in tumor size, the lesion had extended to the falx and left frontal convexity along with parenchymal edema at 32 months after the operation and the clinical status was aggravated. The mass was removed from the left frontal convexity. Radiation therapy was given, together with steroid administration.
Adult ; Brain ; Central Nervous System ; Edema ; Female ; Follow-Up Studies ; Granuloma, Plasma Cell ; Humans ; Lung ; Magnetic Resonance Imaging ; Nausea ; Plasma ; Plasma Cells ; Respiratory System

BACKGROUND: The optimal immunosuppressive strategy for renal transplant recipients at high immunological risk requires clarification. We compared the 3 year outcomes of a sirolimus group (tacrolimus plus sirolimus) to those of a control group (tacrolimus plus mycophenolate mofetil). METHODS: This observational study was an extension of a prospective pilot study. We assessed acute rejection, glomerular filtration rate, adverse events, graft, and patient survival. RESULTS: Overall, 43% of the sirolimus group versus 78% of the control group were still on the initial immunosuppressive regimen at 3 years (P=0.005), and most discontinuations in each group were due to adverse events. No differences were observed between two groups with respect to acute rejection. The mean glomerular filtration rate at 36 months was greater in the sirolimus group than in the control group, but this was not statistically significant (64.0±6.8 mL/min/1.73 m² vs. 61.8±17.1 mL/min/1.73 m², P=0.576). Graft and patient survival were similar in both groups. Importantly, mean tacrolimus through levels were significantly lower in the sirolimus group than in the control group at each time point. No neoplasm was reported in the sirolimus group. In the control group, three cases of neoplasms developed during the study period. CONCLUSIONS: The sirolimus group had a greater number of discontinuations, particularly related to adverse events. Nevertheless, optimal concentration of sirolimus allowed reduced calcineurin inhibitor exposure in high immunologic risk patients, without increasing the risk of acute rejection and graft failure.
Calcineurin ; Glomerular Filtration Rate ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Observational Study ; Pilot Projects ; Prospective Studies ; Sirolimus* ; Tacrolimus* ; Transplant Recipients* ; Transplants

Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-year-old woman whose chief complaints were anosmia and frontal headache for 2 years. The gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed an extra-axial mass from ethmoid sinus to right frontal base region near the midline, with solid enhancement in lower portion and multicystic formation in upper portion. The tumor was totally resected via basal subfrontal approach. At operation, the tumor had cystic portion with marginal calcification and the anterior skull base was destructed by the tumor. The olfactory bulb was involved, and the tumor capsule did not contain neoplastic cells. The histopathological diagnosis was schwannoma. We report a rare case of anterior cranial fossa schwannoma with literature review.
Adult ; Cranial Fossa, Anterior ; Cranial Nerves ; Ethmoid Sinus ; Facial Nerve ; Female ; Gadolinium ; Headache ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma ; Olfaction Disorders ; Olfactory Bulb ; Olfactory Nerve ; Skull Base ; Trigeminal Nerve

Central neurocytoma is a rare, well-differentiated neuronal tumor and is usually located in the lateral or third ventricle of young adults. Its overall prognosis is excellent with a low proliferative index. The majority of previously reported malignant variants rarely did recurred after tumor removal and regarded as benign tumor despite of histopathological malignant feature. Nevertheless, we experienced a case of malignant variant of the central neurocytoma with high proliferative index(Ki-67 labeling index >30%), which showed recurrence immediately after surgery and died within 3 months POD. Here, we describe the case with a review of the literatures.
Humans ; Neurocytoma* ; Neurons ; Prognosis ; Recurrence ; Third Ventricle ; Young Adult

No abstract available.
Hyperuricemia* ; Kidney Transplantation*