PURPOSE: The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates. METHODS: We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014. RESULTS: There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel. CONCLUSION: The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.
Botulinum Toxins ; Chungcheongnam-do ; Constriction, Pathologic ; Defecation ; Fecal Impaction ; Follow-Up Studies ; Hirschsprung Disease ; Humans ; Infant, Newborn* ; Medical Records ; Pathology ; Retrospective Studies ; Soil

Implant success is achieved by the synergistic combination of numerous biomechanical factors. This report examines the mechanical aspect of implants. In particular, it is focused on macrodesign such as thread shape, pitch, width and depth, and crestal module of implants. This study reviews the literature regarding the effect of implant thread geometry on primary stability and osseointegration under immediate loading. The search strategy included both in vitro and in vivo studies published in the MEDLINE database from January 2000 to June 2014. Various geometrical parameters are analyzed to evaluate their significance for optimal stress distribution, implant surface area, and bone remodeling responses during the process of osseointegration.
Bone Remodeling ; Dental Implants ; Osseointegration*

OBJECTIVES: In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables. MATERIALS AND METHODS: Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model. RESULTS: The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively. CONCLUSIONS: After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05) and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.
Acrylic Resins ; Glass ; Humans ; Longevity ; Retrospective Studies ; Silicon Dioxide ; United States Public Health Service

BACKGROUND/AIMS: Colonic perforation appears to be the most dangerous complication during colonoscopy. This study was designed to determine the optimal management for this infrequent accident. METHODS: We reviewed the medical records of 17,510 colonoscopies which were performed during recent one-year period and found eightcolonic perforations (0.05%). RESULTS: Six perforations (0.04%) related to 16,695 diagnostic procedures, whereas two (0.25%) occurred from therapeutic procedures (p=0.05). Operative measures were applied in six (75.0%) patients showing signs of peritonitis. Five patients received primary closure without diversion, and resection with primary anastomosis was performed in one patient who had underlying tuberculous colitis. In addition, one patient was treated conservatively with bowel rest and intravenous antibiotics. Endoscopic clipping was applied in one patient with rectal perforation. Seven patients recovered uneventfully, and one 69-year-old male patient died of cardiogenic shock after the operation. CONCLUSIONS: Although colonic perforation occurs infrequently during colonoscopy, it may sometimes results in a fatal outcome. Primary closure without diversion appears to be appropriate in most cases without comorbid colonic disease.
Aged ; Anti-Bacterial Agents ; Colitis ; Colon* ; Colonic Diseases ; Colonoscopy ; Fatal Outcome ; Humans ; Male ; Medical Records ; Peritonitis ; Shock, Cardiogenic

Isolated diaphragmatic metastasis arising from colorectal cancer has been reported only one case in the literature presently. Here, we presented a new case and discussed the possible pathogenesis and the treatment options. A 42-year-old male patient had received anterior resection for sigmoid colon cancer. Although the increased serum CEA level was detected 20 months after the surgery, metastatic lesion could not be detected by repeated colonoscopy, CT scan, bone scan or PET scan for 35 months. We could detect a suspicious metastatic lesion on the liver by CT scan at 56 month after the surgery. During a second-look operation, we found a solitary metastasis on the diaphragm and removed it along with the 1 cm tumor-free resection margin. Although the prognosis associated with skeletal metastasis is poor, the complete resection of isolated diaphragmatic metastasis and subsequent appropriate adjuvant chemotherapy may achieve a cure the disease provided that other metastatic lesions are absent.
Adenocarcinoma* ; Adult ; Carcinoembryonic Antigen ; Chemotherapy, Adjuvant ; Colon* ; Colonoscopy ; Colorectal Neoplasms ; Diaphragm ; Humans ; Liver ; Male ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Prognosis ; Sigmoid Neoplasms ; Tomography, X-Ray Computed

PURPOSE: This study was performed to evaluate the surgical and the oncological outcomes of preoperative radio-chemotherapy (PRCT) in patients with low rectal cancer. METHODS: We reviewed 26 (M:F=17:9) patients who underwent PRCT between September 1999 and December 2001. Inclusion criteria were lower rectal cancer (4~5 cm from AV), more than T3 or N1 in preoperative staging using CT scan and transrectal ultrasound, and no distant metastasis. Patients received a mean of 47.3 (45.0 ~56.0) Gy of radiation therapy for 5 weeks and concomitant intravenous or oral chemotherapy using 5 FU and leucovorin. Surgery was performed in about 5~6 weeks after completion of radiotherapy. Total mesorectal excision and autonomic nerve preservation was the routine procedure. Adverse events during PRCT were assessed according to the NCI Common Toxicity Criteria (version 2.0, 1997). RESULTS: The mean age was 49 (28~65) years old. The median follow-up period was 31 (20~44) months. The most frequent adverse event was diarrhea (8, 30.8%), followed by nausea and vomiting (5, 19.2%), dermatitis (5, 19.2%), anemia (4, 15.4%), leucopenia (2, 7.7%), and mucositis (1, 3.8%). The mean location of the tumor was elevated from 4.5 cm to 5.5 cm after PRCT. Downstaging of the tumor was identified in 69.2% of the T-level and 63.2% of the N-level. The serum CEA level was decreased from 14.5+/-5.0 ng/ml to 3.5+/-0.5 ng/ml after PRCT (P=0.034). A sphincter-saving resection (SSR) was possible in 16 cases (61.5%). The mean distal resection margin was 2.2+/-0.7 cm in SSRs. Small bowel obstruction was the most frequent complication (6 cases, 23.1%), followed by hydronephrosis 2 (7.7%), a recto-vaginal fistula (1, 3.8%), and a recto-vesical fistula (1, 3.8%). There were no mortalities. Five (19.2%) recurrences developed in distant area, one (3.8%) in a local area, and one in both a local and a distant area. The patients with N-level downstaging revealed a significantly low recurrence rate (8.3% vs. 57.1%; P=0.03). CONCLUSIONS: PRCT can be performed with an acceptable toxicity and complication rate. It is effective in downstaging of the tumor and in increasing the sphincter-saving rate. However, a prospective, randomized, controlled trial should be performed to prove the oncological benefit.
Anemia ; Autonomic Pathways ; Dermatitis ; Diarrhea ; Drug Therapy ; Fistula ; Follow-Up Studies ; Humans ; Hydronephrosis ; Leucovorin ; Mortality ; Mucositis ; Nausea ; Neoplasm Metastasis ; Preoperative Care ; Radiotherapy ; Rectal Neoplasms ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

PURPOSE: Ileostomy may affect various aspects of life style of the patient. Moreover the complication after ileostomy formation or closure may lower the life quality of the patient. The purpose of this study is to investigate ileostomy related complications and elucidate associated factors. METHODS: We recruited 103 patients who underwent ileostomy in Asan Medical Center between July 1989 and June 2000. All ileostomies are constructed through the rectus muscle at the right lower quadrant of the abdomen. To mnimize peristomal skin irritation, at least two to three centimeters of the ileum lies above the skin level. We analyzed complications after ileostomy formation in relation to underlying diseases, types and purpose of ileostomy. Also, we analyzed complication after ileostomy closure in relation to underlying diseases, time interval and method of take-down. Results are compared using chi-square test. Statistical significance was assigned to a P value of<0.05. RESULTS: Complications of ileostomy formation were developed in 17 (16.5%) cases; 8 peristomal dermatitis, 3 wound infection, 2 prolapse, 1 stenosis, 1 perforation, 1 bleeding, 1 high output ileostomy. There was no significant difference of complication rate in relation to underlying diseases, types and purpose of ileostomy. Ileostomy take-down was performed in 55 (53.4%) cases of 103 patients. Complications related with ileostomy take-down were developed in 18 (32.7%) cases; 7 wound infection, 5 intestinal obstruction, 2 incisional hernia, 2 enterocutaneous fistula, 1 anastomosis leakage, 1 bleeding. There was no significant difference of complication rate in relation to time interval or method of take-down. However, complication rate of ileostomy take-down was significantly increased in patient with inflammatory bowel disease. CONCLUSIONS: Ileostomy formation is simple and safe surgical procedure. We couldn't find any factor affecting the morbidity of ileostomy formation or closure. However, complication rate after ileostomy closure, especially in patient with inflammatory bowel disease, is relatively high.
Abdomen ; Chungcheongnam-do ; Constriction, Pathologic ; Dermatitis ; Hemorrhage ; Hernia ; Humans ; Ileostomy* ; Ileum ; Inflammatory Bowel Diseases ; Intestinal Fistula ; Intestinal Obstruction ; Life Style ; Prolapse ; Quality of Life ; Skin ; Wound Infection

PURPOSE: Primary gastrointestinal lymphoma is the most common form of extranodal lymphoma. The clinical features, histological distributions, treatment results and prognosis of the primary intestinal lymphoma were evaluated. METHODS: A retrospective study was performed on 62 patients with primary intestinal lymphoma, as defined by Lewin's criteria, from May 1990 to February 2002. The WHO classification and Ann Arbor staging system were used for histological classification and staging, respectively. RESULTS: The sex ratio of the patients was 43: 19 (male: female), and the median age was 54 years. Abdominal pain, a palpable mass, and bleeding were the most frequent symptoms on presentation. The ileocecal area was the most frequent pathological site. Fifty-three cases were non- Hodgkin's lymphoma of B-cell origination; all of the remaining were T-cell originated. The mean survival period of B-cell and T-cell originated were 59.3 and 14.3 months, respectively (P<0.05). The 5 year survival rates of the patients in stage IE and IIE, and stage IIIE and IVE, were 52.4 and 32.6%, respectively (P=0.03). Six patients received surgery, 17 chemotherapy, and 39 surgery with adjuvant chemotherapy. Among the patients confined to stage IE and IIE, the 3 year survival rates of the surgery and surgery with adjuvant chemotherapy groups were 34 and 84%, respectively (P=0.0049). CONCLUSION: Primary gastrointestinal lymphoma of B-cell origination was predominant in relation to the WHO classification and revealed a better prognosis when compared to the T-cell originated lymphoma. For the patients with localized intestinal lymphoma, multimodality treatment (surgery with adjuvant chemotherapy) is preferred to the sole administration of chemotherapy.
Abdominal Pain ; B-Lymphocytes ; Chemotherapy, Adjuvant ; Classification ; Drug Therapy ; Hemorrhage ; Hodgkin Disease ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Prognosis ; Retrospective Studies ; Sex Ratio ; Survival Rate ; T-Lymphocytes

PURPOSE: The purposes of this study are to determine the incidence of postoperative ileus after colorectal surgery, to analyze its clinical features, and to identify the risk factors for its development. METHODS: We reviewed the cases of 263 patients with mechanical ileus among 3,237 patients who underwent colorectal surgery in our clinic between June 1989 and December 2000. RESULTS: A total of 263 (8.1%) patients of postoperative ileus were documented, 193 (73.4%) cases occurred during the 1st. year. Postoperative ileus is influenced by the initial site of surgery; the rectum has more impact than the colon (P=0.028). The causes of postoperative ileus were adhesion, recurrence of cancer, and parastomal hernia. Adhesion (81.1%) was the most common cause of ileus, and cancer recurrence (18.0%) was the second. However, in postoperative ileus requiring surgery, cancer recurrence increased with time (2 year: 58.1%). The cases receiving postoperative adjuvant radiation therapy presented a significant increase in the incidence of postoperative ileus (10.3% vs 6.7% P=0.01) and in the requirement for surgical treatment (4.6% vs 2.7%, P=0.04). Patients with a temporary stoma presented a significant increase in the incidence of postoperative ileus than patients with a permanent stoma (P=0.001). The frequency of prior episodes of ileus was the strongest predictor of recurrence. CONCLUSIONS: There is a high risk of adhesion-related problems after colorectal surgery. The risk factors are associated with rectal surgery, postoperative radiation therapy, and a temporary stoma.
Colon ; Colorectal Surgery* ; Hernia ; Humans ; Ileus ; Incidence ; Intestinal Obstruction* ; Postoperative Complications ; Rectum ; Recurrence ; Risk Factors

BACKGROUND AND OBJECTIVES: The intrapulmonary shunt, after a liver transplantation, is expected to improve, but the frequency, and predictors, of improvement are not well known. We studied the frequency of the improvement in the intrapulmonary shunt, and the relation between this improvement and the clinical parameters, using contrast echocardiography in liver transplant candidates. SUBJECTS AND METHODS: Preoperative and postoperative contrast echocardiography, with intravenous agitated saline, was performed in 25 liver transplant candidates(M:F=9:6, mean age=6+/-10). The extent of the intrapulmonary shunt was semi-quantitatively assessed on a grade scale from 0 to 4+, according to the degree of appearance of the contrast in the left heart chambers. The etiology of the underlying chronic liver disease, Child-Pugh classification scores, pulmonary function tests and arterial blood gas analyses were all evaluated. The change in the shunt grade after the liver transplantation, and the association of these changes, with clinical parameters, were also evaluated. RESULTS: Twenty-four(6%) f the 25 patients showed positive results for the intrapulmonary shunt on preoperative contrast echocardiography. At follow up, the shunt was visible in only 5(1%) atients. All 24 patients whose preoperative echocardiography revealed a positive intrapulmonary shunt showed an improvement in the intrapulmonary shunt after the liver transplantation. There was a significant correlation between the improvements in the shunt and the Child-Pugh classification scores(r=0.59, p=0.02). CONCLUSION: Contrast echocardiography is a feasible, noninvasive, method for the detection of changes in the intrapulmonary shunt before and after a liver transplantation, and the intrapulmonary shunt is improved after a liver transplantation in most patients.
Blood Gas Analysis ; Classification ; Dihydroergotamine ; Echocardiography ; Follow-Up Studies ; Heart ; Humans ; Liver Diseases* ; Liver Transplantation* ; Liver* ; Respiratory Function Tests