ABSTRACT
Rectosigmoid vaginoplasty is a frequently used surgical method in male-to-female sex reassignment surgery. However, severe side effects, such as sepsis, may occur owing to stricture, mucorrhea, and rectovaginal fistula. Herein, we present the case of a 29-yearold patient who underwent complete reconstruction of an obstructed rectosigmoid vaginal orifice. The patient had undergone male-to-female sex reassignment surgery with rectosigmoid vaginoplasty 8 years previously. The vaginal introitus was completely obstructed, and mucous secretions of the rectum remained in the blind pouch. Therefore, she developed several complications, including panperitonitis, sepsis, and repeated obstruction. We performed complete resection of the scar and reconstructed the orifice of the neovagina using a pudendal thigh island flap. The patient’s lifethreatening condition subsided with the successful release of the vaginal orifice. Vaginal orifice stricture is a frequent complication of rectosigmoid vaginoplasty. A pudendal thigh flap can be used to effectively and safely release this stricture and reconstruct the neo-orifice of the rectosigmoid vagina without recurrence.
ABSTRACT
In branchial lymphoepithelial cyst (BLEC), which is also known as branchial cleft cyst, the remnants of a branchial arch develop into a cyst, causing swelling. The first case of BLEC in the parotid gland was reported by Hildebrant in 1895. Since then, BLEC in the parotid gland has continued to be reported, but in rare cases. A 45-year-old man presented to our hospital with a swelling of the left cheek of approximately 6 months’ duration. The patient underwent a superficial parotidectomy and was pathologically diagnosed with BLEC. Of note, this was the first case of non-human immunodeficiency virus (HIV)-related BLEC of the parotid gland in South Korea. BLEC is a benign condition, but its treatment depends on the presence of HIV infection. In HIV-negative patients, BLEC does not require a further work-up to evaluate metastasis. Our case report describes the diagnosis and treatment of BLEC in a patient without HIV.
Subject(s)
Humans , Middle Aged , Branchial Region , Branchioma , Cheek , Diagnosis , HIV , HIV Infections , Korea , Neoplasm Metastasis , Parotid Gland , Salivary GlandsABSTRACT
The proliferation of high-technology infusion devices has greatly influenced the practice of anesthesia by allowing precise delivery intraoperatively and postoperatively of intravenous anesthetics, analgesics, and vasopressors. During continuous drug administration to pediatric patients, unfavorable pharmacologic effects have occured. These effects were attributed to variations in flow from infusion devices. The intent of this investigation was to evaluate the influence of infusion devices on the accuracy and continuity effused fluid. Hartmann's solution was run through eight infusion pump at 5, 10, 15, 20, 25, 30, 40, 60, 80 and 100ml/hr. The volume of the fluid was measured for one hour at each flow rate using a infusion device analyzer(IDA-2) in vitro. Flow accuracy(ml/hr) was calculated by dividing the effused volume by the effusion time ; this value was subsequently expressed as a percentage of the desired flow rate. Flow continuity was expressed by the coefficient of variance(CV); analysis of variance with SAS was used for comparisons. Results were as follows ; 1) The flow accuracy values ranged from 98.8% to 114.2% of the desired rate. 2) Seven infusion pumps had flow rates within 5% of the desired rates at each flow rate but one pump had more than 10% of desired rate. 3) Each of the respective infusion pumps produced various levels of flow continuity and ranged from 0.7% to 2.5%(CV value). Conclusion , further evaluations are needed to differentiate continuity from other infusion devices(e.g., syringe infusion pump) in vitro and evaluations are needed to define the clinical significance in vivo. Future use of flow-rate data will likely be of significant value in establishing policies and procedures for the utilization of infusion devices and guidelines for product selection.