Acute Anal Pain due to Ingested Bone Fragments

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.

Post-hemorrhoidectomy Secondary Hemorrhage

PURPOSE: Post-hemorrhoidectomy secondary hemorrhage is a rare but serious complication after a hemorrhoidectomy. This study analyzed the factors associated with secondary hemorrhage following a surgical hemorrhoidectomy. METHODS: A total of 1,751 patients received a semiclosed hemorrhoidectomy for symptomatic hemorrhoidal disease from May 2001 to January 2004. A retrospective study of 17 patients with post-hemorrhoidectomy secondary hemorrhage was done. Fourteen patients (82 percent) underwent surgery primarily for hemorrhoidal disease, two patients (12 percent) had hemorrhoids removed in addition to a sphincterotomy for anal fissure, and the remaining patient (6 percent) had a hemorrhoidectomy with fistulectomy. The variables analyzed included age, gender, incidence, recurrence, hospitalization, bleeding tendency, blood transfusion, and management. RESULTS: The male to female ratio was 1.83:1 (P>0.05), and the mean age was 38.9 (range 19~55) years. The incidence of post-hemorrhoidectomy secondary hemorrhage was 0.98 percent. The mean interval from the operation to hemorrhage was 8.9 (range 4~18) days. The period of mean hospitalization was 4.5 (range 2~8) days. As predisposing factors, 3 patients had suspected liver disease with normal platelet count. The mean 1.90 gm/dl of Hgb at the time of secondary hemorrhage was lower than the preoperative values. One patient (5.9 percent) required 3 units of red blood cell transfusions. Treatment modalities included observation alone in three patients (18 percent), and suture ligation in the operating theater in fourteen patients (82 percent). None of the patients developed recurrent bleeding. CONCLUSIONS: Post-hemorrhoidectomy secondary hemorrhage is an inevitable and a troublesome complication. The patient will need to be transferred rapidly to a hospital and resuscitated if necessary. The author favors suture ligation in controlling secondary hemorrhage. Suture ligation offers a good outcome with virtually no risk of recurrent bleeding. Post- hemorrhoidectomy secondary hemorrhage usually occurs at home between the fourth and eighteenth postoperative day and takes place in 0.98 percent of hemorrhoidectomies. In the author's opinion, post-hemorrhoidectomy secondary hemorrhage usually is not a preventable complication.

Quality of Life after Treatment of Laryngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Head and neck cancer strikes at some of the most basic human functions, including verbal communication, social interaction, eating and breathing. Traditionally, the success of cancer treatment has been assessed by objective measures such as disease-free intervals, cure rates, and complication rates. Recently, however, there has been an increased awareness of the need to evaluate treatment effects on the individual's quality of life (QOL). The purpose of this study is to assess quality of life following various types of treatment for laryngeal carcinoma. MATERIAL AND METHODS: We assessed a quality-of-life after treatment of laryngeal carcinoma patients using WHOQOL-BREF questionnaires which was employed by the WHOQOL-group. Fifty-seven patients with laryngeal carcinoma were contacted with the completion of the survey: Radiotherapy only (n=24), conservative laryngectomy (n=16) and total layngectomy (n=17). RESULTS: This study demonstrates that there was no significant difference in QOL in physical health, social relationship and environment between the radiotherapy-only-group and the operation-group (conservative & total laryngectomy). However, the radiotherapy-only group had significantly better (p<.05) QOL on the psychological health domain, especially regarding body image and negative feelings than those of the operation group. CONCLUSION: The negative feeling, the body image change and the poor ability of communication have a negative impact on QOL in the operation group, especially in the total laryngectomee. Providing positive psychosocial adjustment training and voice rehabilitation programs for those who underwent total laryngectomy would be a great help in enhancing their quality of life.

A Case of Fibrous Histiocytoma in Infratemporal Fossa and Parapharyngeal Space / 대한이비인후과학회지

Fibrous histiocytomas (FHs) are skin or deep tissue tumor that include a heterogenous group of tumors. The common origin of these tumors are a histiocyte and these tumors are composed of fibroblasts and histiocytes. FHs commonly occurs in the sun-exposed skin and subcutaneous tissue, but its incidence in the head and neck is rare. We experienced a case of FH in the infratemporal fossa and parapharyngeal space in a 29-year-old woman. The patient showed hyperesthesia in the right chin and some facial swelling. We could successfully remove the mass without sacrifice of important structures by infratemporal fossa approach with osteotomy of mandible.

A Clinical Study of Bipolar Diathermy (BICAP) in Hemorrhoids

Many nonsurgical techniques are currently employed for outpatient treatment of hemor rhoids. Sclerotherapy, rubber band ligation, cryotherapy, laser therapy, infrared photocoagula tion and direct current therapy have been utilized in the management of hemorrhoids in the outpatient setting, but bipolar diathermy(BICAP) has not been introduced in korea yet. This study is a clinical analysis of 472 patients of hemorrhoids treated with BICAP bipolar diathermy at outpatient department from July 1996 to June 1997. Among them, 396 patients had been followed up for 3 to 15 months. Male to female ratio was 2.2:1 and mean age of male and female was 42.8 and 39.7 years, respectively. Duration of symptoms in 216 patients(57.6%) was below 5 years. The most frequent degree of internal hemorrhoids was second degree(62.7%), followed by third degree(23.9%), first degree (7.8%) and fourth degree(5.5%). Major presenting symptoms were prolapse combined with bleeding(45.8%), prolapse(21.2%) and bleeding(19.7%). In 62.9% of patients 3 piles were treated. Associated anorectal diseases with hemorrhoids, such as skin tags, thrombi and anal polyps were present in 179 patients. Among them, 126 patients were operated as outpatient operation procedure with BICAP therapy. Previous medical managements of hemorrhoids, such as use of rectal suppositories(32%), injection of sclerosing agents(8.6%) and hemorrhoidectomy(7.8%) were done in 240 patients(51%). Number of treatments was one session(88.7%), two sessions(10%), three sessions(1.1%) and four sessions(0.2%) in order of frequency. Mild to moderate anal discomfort was experienced during BICAP therapy by 215 patients(46%), mild sensation of local heat by 95 patients(20%) and mild bleeding by 10 patients(2%). No postdiathermy discomfort was observed in 337 patients(85.1%). However, postdiathermy bleeding and pain were present in 41 patients (10.4%) and 18 patients(4.5%), respectively. Results of followed up patients for 3 to 15 months were asymptomatic in 270 patients(68.2%), improved in 88 patients (22.2%), and no changed in 38 patients(9.6%). Among 18 patients with fourth degree hemorrhoids, only 2 patients(11%) became asymptomatic, 5 patients(28%) improved and 11 patients(61.9%) were not changed in their symptoms. Six patients experienced recurrent hemorrhoids requiring hemorrhoidectomy. In conclusion, bipolar diathermy(BICAP) for hemorrhoids is safe, easy to apply, painless, needs no anesthesia and bowel preparation with short time and repeated treatments and can be applied to first, second, third and some patients of fourth degree hemorrhoids. The effect of treatment was satisfactory in about 90%. Side effects were minimal compared to other nonoperative treatments. Therefore, the auther believes that bipolar diathermy(BICAP) is a desirable nonoperative treatment for internal hemorrhoids.