Long Term Follow-up for Modified Whitehead Hemorrhoidectomy

PURPOSE: Walter Whitehead introduced new method for treating circumferential hemorrhoids with good results for the first time in 1882, but his procedure has been neglected by most surgeons because of complications, such as anal stricture, incontinence, ectropion, etc. METHODS: We retrospectively inves tigated and analyzed 52 cases involving modified Whitehead hemorrhoidectomies (WH) and 60 cases involving submucosal hemorrhoidectomies (SH) performed at Seoul Adventist Hospital from Jan. 1989 to Dec. 1994. We only selected patients whose follow-up durations were more than 5 years. The chi-square test and t-test were used for the statistical analysis. RESULTS: The results are as follows: 1) The sex ratio of males to females was 1.36 to 1 in the WH group and 1.31 to 1 in the SH group. 2) The peak age was in the 4th decade (40.0% in the WH group and 35.0% in the SH group), the mean age was 39.1 years in the WH group and 37.3 years in the SH group, and the age distribution ranged from 17 years to 75 years in both groups. 3) The average postoperative hospital stay was 9.83 days in the WH group and 8.43 days in the SH group (p=0.001). 4) The average follow up duration was 71.3 months in the WH group and 76.9 months in the SH group. 5) In the WH and the SH groups, the postoperative complications were, respectively, recurrence (1.9%:0%, p=0.281), defecation difficulty (7.7%:1.7%, p=0.124), incontinence (1.9%:3.3%, p= 0.645), ectropion (1.9%:0%, p=0.281), anal pain (15.4%:8.3%, p=0.245), and anal bleeding (9.6%: 13.3%, p=0.540). 6) Some patients complained about complications 7 years after the operation. These were 1 defecation difficulty and 1 incontinence in the WH group and 1 defecation difficulty and 2 incontinences in the SH group. CONCLUSIONS: The results of a long term follow-up for postoperative complications after a modified Whitehead operation were no worse than those for a submucosal hemorrhoidectomy. Thus, if one uses proper surgical technique, one should be able to get better results: fewer complications and more complete healing of the hemorrhoid.

Comparison of Laparoscopic and Open Appendectomies

BACKGROUND: Kurt Semm, a German gynecologist, was first to describe a laparoscopic appendectomy for an incidental appendectomy in gynecologic surgery. At that time, it was limited to an incidental appendectomy performed during gynecologic surgery. The development of laparoscopic instruments and more experience has allowed surgeons to perform laparoscopic surgery easier than before. Nowadays, laparoscopy allows surgeons to perform appendectomies in a safe and effective way, and it reduces the risk of performing unnecessary appendectomies. METHODS: We reviewed the records of 201 patients who had an appendectomy at our hospital from February 1997 to December 1997. A laparoscopic appendectomy was carried out in 51 cases, and an open appendectomy was carried out in the others. RESULTS: 1) There was not a significant difference between the two groups in regard to age and sex. The male-to-female ratios were 1.32:1 in laparoscopic appendectomy group and 1.17:1 in the open appendectomy group. The mean ages were 30.3 years in laparoscopic appendectomy group and 29.7 years in open appendectomy group. 2) There was not a significant difference in pathologic severity between the two groups. The majority had suppurative appendicitis in both groups. Postoperative complications were less frequent in the open appendectomy group. 3) The mean operative times were 55.6 minutes in the laparoscopic appendectomy group and 42 minutes in the open appendectomy group. 4) The mean hospital stays were 4.69 days in the laparoscopic appendectomy group and 6.96 days in the open appendectomy group. 5) The mean postoperative periods until normal activity were 8.79 days in the laparoscopic appendectomy group and 12.85 days in the open appendectomy group. 6) The postoperative use of analgesics was less frequent in the laparoscopic appendectomy group. 7) Conversion to an open laparotomy occurred in 3 cases. CONCLUSIONS: We think that a laparoscopic appendectomy is a safer, more effective, more cosmetic, and less invasive procedure than an open appendectomy.

The Preliminary Report of Rapid Production of Pancreas Cancer and Cholangiocarcinoma by Cyclic Injection of Carcinogens in Syrian Hamster initiated with N-nitrosobis(2-oxopropyl)amine / 한국간담췌외과학회지

BACKGROUND/AIMS: It is well known that N-nitrosobis(2-oxopropyl)amine(BOP)-induced pancreas cancer and cholangiocarcinoma in Syrian hamster is similar to that of humans in morphological, biological and immunological aspects. The cyclic administration of BOP and ethionine, choline-deficient diet and methionine is known to rapidly induce the ductal type of carcinoma in pancreas and bile duct. Authors studied whether the rapid production of this cancer can occur in Syrian hamster and what its features are. METHODS: Sixteen Syrian hamsters aged 6-7 weeks and weighing 100 gm were used. All hamsters received 70 mg/kg body weight of BOP followed by three cycles of dl-ethionine, choline-deficient diet, l-methionine and 20mg/kg BOP. Hamsters were killed 9, 10 and 11 weeks after the beginning of the experiment and their gross and histologic features were observed. RESULTS: Nine cases, killed withan 10weeks after the begining of experiment, showed no development of cancer. Of seven Syrian hamsters, killed more than 10weeks after the begining of experiment, the incidences of BOP-induced cancer included one case(14.3%) of pancreas cancer and five cholangiocarcinomas( 71.4%). The morphological change of pancreas carcinogenesis was shown at first in cell mitosis and atypia(6 weeks) and then in atypical ductal hyperplasia(9 weeks) and carcinoma in situ(10 weeks). The change in cholangiocarcinoma, first progressed with ductular proliferation and surrounding fibrosis(6 weeks) followed by focal cholangiocarcinoma(10 weeks) and multiple invasive cholangiocarcinomas( 11 weeks). CONCLUSION: Pancreas cancer and intrahepatic cholangiocarcinomas can be induced rapidly within 10 weeks by cyclic injections of carcinogens in Syrian hamsters initiated with Nnitrosobis( 2-oxopropyl)amine and the morphologic changes can be observed.

A Clinical Decision Support System for Diagnosis of Hearing Loss / 예방의학회지

A decision support system (DSS) was developed to support doctor's decision-making in diagnosing hearing loss. The final diagnosis encompassed 41 diseases with the problem of hearing loss. The system was developed by integrating model-oriented DSS technique and artificial intelligence technology. The system can be used as both diagnosis tool and teaching tool for medical students. Furthermore, the Al technology obtained from this study may also be used in developing DSS for hospital management.