ABSTRACT
Purpose@#Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method. @*Methods@#We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively. @*Results@#The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%). @*Conclusion@#Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.
ABSTRACT
Objectives@#To identify the clinical utility of the Korean version of the Barkley Deficits in Executive Functioning Scale (K-BDEFS) assessing executive functioning. @*Methods@#The patient group included 144 adult attention-deficit/hyperactivity disorder (ADHD) patients visiting the Adult ADHD Outpatient Clinic of the National Center for Mental Health. Adult ADHD Self-Report Scale version 1.1, Mini International Neuropsychiatric Interview, and K-BDEFS were used. The control subjects were 144 age, sex, and education-matched general adults who participated in the study of the validity of the K-BDEFS in Samsung Medical Center. @*Results@#An analysis of the mean total K-BDEFS score, executive functioning symptom count, and ADHD-executive function (EF) index score revealed a significant difference between the adult ADHD and control group (p<0.05). Five subscales of the K-BDEFS, which assess the specific domains of the executive function, revealed a significant difference between the ADHD group and control group (p<0.05). The area under curve (AUC) of the K-BDEFS total score, the EF symptom count, and the ADHD-EF index were 0.943, 0.949, and 0.908, respectively, in the analysis using the receiver operating characteristic curve. All AUC values were over 0.90. Therefore, KBDEFS is a reliable and valid screening instrument for diagnosing adult ADHD. In an assessment of the sensitivity and specificity of the cutoff scores, a cutoff of 183.5 points for the K-BDEFS total score, 26.5 points for the EF symptom count, and 23.5 points for the ADHD-EF index showed a reliable sensitivity and specificity above 80%. @*Conclusion@#To the best of the authors’ knowledge, this is the first study to examine the predictive validity and clinical utility of K-BDEFS in adult ADHD. The results suggest that the K-BDEFS could be used as a valid and reliable tool for the diagnosis and clinical intervention of adult ADHD.
ABSTRACT
PURPOSE: This study analyzes the clinical characteristics of thyroid cancer patients over 70 years of age following thyroidectomy. We identified the differences among previous studies and investigated the significance of thyroidectomy for elderly thyroid cancer patients. METHODS: Information was abstracted from the charts of fifty-six patients treated during the period of Jan. 1995 to Dec. 2015. The abstraction included gender, age, surgical method, location with size of the main lesion, extent of lymph node metastasis, pathological features, gene mutation, complication, stage and most recent visit. RESULTS: Our study showed a frequent occurrence (96.4% of the study group) of papillary thyroid cancers in elderly patients. There were three cases of postoperative complications. None had recurrence, and there was only one death due to complications of pneumonia. There were 11 advanced cases of cancer stage IV. CONCLUSION: Previous studies show that postoperative prognosis of elderly thyroid cancer patients is favorable. Average life expectancy is rising in South Korea, and therefore, the number of elderly thyroid cancer patients is increasing. Our study is meaningful in that it confirms the results of previous studies by surveying elderly patients over a 20 year period. It is deemed necessary that thyroidectomy be performed on elderly patients.