PURPOSE: A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids. METHODS: We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common. CONCLUSIONS: A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.
Female ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Length of Stay ; Male ; Pain, Postoperative ; Postoperative Complications ; Return to Work ; Vision, Ocular

The authors reported a case of niclofolan intoxication occurred during the trial of clonorchiasis treatment. The case, a 15 years old Korean schoolboy, took niclofolan(Bilevon) of total 473 mg(11 mg/kg) in 11 divided doses during 20 days. And the case suffered from neurologic symptoms such as severe headache, dizziness, nausea, vomiting, blurred vision, papilledema, retinal hemorrhage, an epsiode of seizure attack and elevated intracranial pressure, and hepatotoxic symptoms such as hepatomegaly, increased serum transaminases, and shoulder pain, excessive sweating and weight loss. Therapy was concentrated to the management of the elevated intracranial pressure. Hepatotoxic manifestations subsided within one month. The clinical signs related to elevated intracranial pressure persisted two months. Body weight regained after 2 months. And the symptoms of headache, dizziness and vomiting were complained intermittently until 4 months after onset. However, no subsequent clinical problems related with this episode has been noted until this record.
parasitology-helminth-trematoda ; Clonorchis sinensis ; clonorchiasis ; intoxication ; niclofolan ; jaundice ; weakness ; hepatomegaly ; headache ; intracranial pressure ; nausea ; vomiting ; blurred vision ; ocular pain ; papilledema ; retinal hemorrhage ; case report

BACKGROUND: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. METHODS: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. RESULTS: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). CONCLUSIONS: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Cyanoacrylates ; Dizziness ; Female ; Gastrectomy ; Headache ; Humans ; Incidence ; Logistic Models ; Male ; Nausea ; Orthostatic Intolerance ; Pain, Postoperative ; Risk Factors ; Syncope ; Vision, Ocular ; Vomiting ; Walking

A 49-year-old male presented with horizontal binocular diplopia without facial pain or skin lesion. Limitation of medial gaze in the left eye was revealed on neurological examination, which is accompanied by peripheral facial nerve palsy ipsilaterally. The diagnosis had been made based on the diffusion restriction lesion of left pontine tegmentum. We may denominate a “seven-and-a-half syndrome” and clinician should maintain a high level of awareness of the various syndromes associated with pontine lesions.
Diagnosis ; Diffusion ; Diplopia ; Facial Nerve ; Facial Pain ; Facial Paralysis ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Ocular Motility Disorders ; Paralysis ; Pontine Tegmentum ; Skin ; Telescopes

In recent years the immunocompromised population has increased rapidly to include people with acquired immune deficiency syndrome (AIDS), drug abusers, and transplant patients. Accordingly, the incidence of intracranial fungal infection has increased. Our institution experienced 2 cases of internal carotid artery (ICA) occlusion due to invasion of the cavernous sinus by an intracranial fungal infection. The first case was a 60-year-old man who presented with headache, eye pain, conjunctival injection, right-sided diplopia, and blurred vision. Infected tissues within the frontal and ethmoid sinuses were removed via bifrontal craniotomy and endoscopic sinus surgery through the Caldwell Luc approach. The second case was a 63-year-old woman who developed right-sided facial pain after a tooth extraction. The infection was not controlled despite continuous use of antifungal agents, resulting in death from sepsis. We believe that when intracranial fungal infection is suspected in a patient with orbital symptoms and a focal neurologic deficit, immediate angiographic investigation of possible ICA occlusion is warranted. Aggressive treatment with antifungal agents is the only way to improve prognosis.
Acquired Immunodeficiency Syndrome ; Antifungal Agents ; Carotid Artery, Internal ; Cavernous Sinus ; Craniotomy ; Diplopia ; Drug Users ; Ethmoid Sinus ; Eye Pain ; Facial Pain ; Female ; Headache ; Humans ; Incidence ; Middle Aged ; Neurologic Manifestations ; Orbit ; Prognosis ; Sepsis ; Tooth Extraction ; Transplants ; Vision, Ocular

PURPOSE: To report a case of choroidal metastasis of breast cancer that was treated with modified photodynamic therapy. CASE SUMMARY: A 45-year-old woman visited our clinic with blurred vision of the right eye, which began 1 month before. The patient previously suffered from a low back pain for 1 year. The best corrected visual acuity was 20/20 in both eyes. Fundus examination revealed an elevated yellowish mass-like lesion at the superonasal area in the right eye. Ultrasonography of the right eye showed a highly echogenic choroidal mass with moderate to high internal reflectivity. Fluorescein angiography showed hypofluorescence during the prearterial and arteriovenous phase, and well circumscribed hyperfluorescence during the venous phase. Radiologic examination was performed upon suspicion of metastasis. The examination revealed breast cancer with lung, spine and ovary metastasis. Subsequently, biopsy of the breast mass revealed an invasive ductal carcinoma. Based on these results, the patient was diagnosed with choroidal metastasis from breast carcinoma. The patient received systemic chemotherapy, and modified photodynamic therapy (PDT) was performed on the metastatic choroidal mass. Six days after modified PDT, the mass size was unchanged, and serous retinal detachment developed at the macula and inferior retina. However, 22days after treatment, the mass size markedly decreased and the serous retinal detachment was improved.
Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Choroid ; Eye ; Female ; Fluorescein Angiography ; Humans ; Low Back Pain ; Lung ; Middle Aged ; Neoplasm Metastasis ; Ovary ; Photochemotherapy ; Retina ; Retinal Detachment ; Spine ; Triazenes ; Vision, Ocular ; Visual Acuity