1. Benign coloproctology: Treatment standards and something new_1) Pathophysiology of anal fissure

임청호 대한외과학회 2013 대한외과학회 학술대회 초록집 Vol.2013 No.11

Is There Any Relationship between the Chronicity of Chronic Anal Fissure and Endothelin-1?

임청호,신현근,강욱호,정승규,양형규 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.5

Purpose: Many kinds of substances are produced on vascular endothelial activation. The aim of this study is to confirm an increase in Endothelin-1 (ET-1), the most potent vasoconstrictor, which is produced by endothelial activation, in patients with chronic anal fissure and to infer the relationship between ET-1 and anal fissure chronicity. Methods: The study groups are divided into three different groups with 30 subjects each. Group 1 is comprised of healthy volunteers, group 2 of chronic anal fissure patients, and Group 3 of patients with higher than 3rd degree hemorrhoids. Blood samples were taken to measure the ET-1 levels in subject’s serum and to compare the results with those for the control groups. Results: Among the 90 subjects, 38 were male, and 52 were female. The average age was 36.8. The average ET-1 level marked 1.47 ± 0.78 pg/mL for male subjects and 1.16 ± 0.47 pg/mL for female subjects (P = 0.02). The average ET-1 level in the patient groups is as follow: 1.21 ± 0.44 pg/mL in group 1, 1.46 ± 0.83 pg/mL in group 2, and 1.20 ± 0.56 pg/mL in group 3 (P =0.14). Conclusion: Group 2, the chronic anal fissure patient group, showed a higher ET-1 level than groups 1 and 3, the control group and the hemorrhoid patient group, but this difference had no statistical significance.

The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses

임청호,Hyeon Keun Shin,Wook Ho Kang,Chan Ho Park,Sa Min Hong,Seung Kyu Jeong,June Young Kim,Hyung Kyu Yang 대한대장항문학회 2012 Annals of Coloproctolgy Vol.28 No.6

Purpose: The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method. Methods: According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO)closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool. Results: The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal. Conclusion: In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence.

혈관형치핵과 점막형치핵 간의 조직학적 차이점

임청호,신현근,이영찬,최동현,황재관,장한정,고용택,정승규,양형규,이헌경 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.6

Purpose: The aim of this study is to compare and analyze the histological differences between vascular and mucosal hemorrhoids, two structurally different types of hemorrhoids. Methods: Internal hemorrhoidal tissue samples were fixed in 10% Formalin solution, and coronal sections included 10-mm proximal and 5-mm distal of the dentate line. Routine Masson-Trichrome and H&E were performed to evaluate the thickness of the mucosa and changes in the structure and the densities of submucosal vessels, connective tissue, and muscle. Results: Compared with the corresponding tissues of mucosal hemorrhoids, the submucosal connective tissue and perivascular connective tissue of vascular hemorrhoids showed a loosened density, severe fragmentation, and an irregular arrangement. The submucosal vascular dilatation was more frequent and more severe in vascular hemorrhoids, but the number of vessels between both types of hemorrhoids did not show much difference. Hypertrophy and regular arrangement of the submucosal muscles were observed more frequently in the mucosal than in the vascular hemorrhoids. Conclusion: Compared to mucosal hemorrhoids, vascular hemorrhoids showed augmented damage in submucosal connective tissue and intense dilatation of vessels with a thinner mucosa. On the other hand, compared to vascular hemorrhoids, mucosal hemorrhoids showed hypertrophy of submucosal muscle and relatively minor alterations in vessels with a thicker mucosa. These histological differences may provide the basis for different etiologies between vascular and mucosal hemorrhoids. Purpose: The aim of this study is to compare and analyze the histological differences between vascular and mucosal hemorrhoids, two structurally different types of hemorrhoids. Methods: Internal hemorrhoidal tissue samples were fixed in 10% Formalin solution, and coronal sections included 10-mm proximal and 5-mm distal of the dentate line. Routine Masson-Trichrome and H&E were performed to evaluate the thickness of the mucosa and changes in the structure and the densities of submucosal vessels, connective tissue, and muscle. Results: Compared with the corresponding tissues of mucosal hemorrhoids, the submucosal connective tissue and perivascular connective tissue of vascular hemorrhoids showed a loosened density, severe fragmentation, and an irregular arrangement. The submucosal vascular dilatation was more frequent and more severe in vascular hemorrhoids, but the number of vessels between both types of hemorrhoids did not show much difference. Hypertrophy and regular arrangement of the submucosal muscles were observed more frequently in the mucosal than in the vascular hemorrhoids. Conclusion: Compared to mucosal hemorrhoids, vascular hemorrhoids showed augmented damage in submucosal connective tissue and intense dilatation of vessels with a thinner mucosa. On the other hand, compared to vascular hemorrhoids, mucosal hemorrhoids showed hypertrophy of submucosal muscle and relatively minor alterations in vessels with a thicker mucosa. These histological differences may provide the basis for different etiologies between vascular and mucosal hemorrhoids.

갑상선 종양환자에서의 보체성분 C4A 그리고 C4B의 분포

임청호,김영철,이영하,장수일,정태호,이인선 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.4

목적 : 갑상선 종양환자에서 보체성분 C4A와 C4B phenotype의 이상유무를 조사연구하기 위하여본 실험에 착수하였다. 대상 및 방법 : 1991년 3월부터 1993년 3월까지 만 2년간 경북대학교 병원 일반외과에서 수술한 88명의 환자들을 대상으로 하여 분석검토하였다. 양성종양인 여포선종 22예, 여포선암 25예, 유두암 27예, 그리고 수질암 환자 15 예로부터 혈액을 채취하였으며 보체성분 C4A와 C4B 단백질의 분석은 Takeuchi등^21)의 방법에 따라 혈청을 Carboxy peptidase와 Neuraminidase로 처리하고 agarose gel 전기영동법을 사용하여 보체성분을 분리하고 면역적 고정법으로 C4A와 C4B 각 분획을 검사하였다. 결과 및 결론 : 여포선종 22예에서는 대조군과 비교하여 C4A와 C4B 분회에서 차이를 나타내지 않았으며 여포암 25예에서는 C4A에서 3-Q0 phenotype와 C4B에서 2-2 phenotype은 대조군에 비하여 높은 발현빈도를 나타내었다. 27예의 유두암에서는 C4A와 C4B phenotype 모두에서 대조군에 비하여 유의한 차이를 보이지 않았다. 그리고 악성도가 높은 수질암 15예에서는 C4A에서 3-QO phenotype이 유의하게 높게 발현되었으며 C4B에서는 5-1 phenotype이 높게 발현되어 갑상선의 악성종양에서는 3-QO phenotype의 발현빈도가 높다는 것이 주목되었다. This study was carried out to analyze see if there are any peculiar phenotypes of complement C4A and C4B distribution in patients with thyroid cancer. Complotypes were analyzed by electrophoretic separation on agarose gel and then identified by the immunofixation technique. 22 cases of follicular adenoma, 25 cases of follicular cancer, 27 cases of papillary cancer, and 15 cases of medullary cancer were participated. Comparing to the control group, follicular cancer patients showed moderately high frequencies of 3-Q0 phenotype in C4A and 2-2 phenotype in C4B. In papillary cancer, un-remarkable differences were detected In medullary cancer, high frequencies were observed in the C4A : 3-Q0 and C4B : 5-1 phenotype. In the thyroid cancer patient, complotype C4A : 3-Q0 phenotype requires further investigation.

갑상선 종양환자에서의 보체성분 C4A 그리고 C4B의 분포

임청호,김영철,이영하,장수일,정태호,이인선 慶北大學校 醫科大學 1994 慶北醫大雜誌 Vol.35 No.4

연소자 및 고령자위암의 병리생물학적 비교

임청호(Chung Ho Lim),윤영국(Young Kook Yun),황일우(Ilwoo Whang) 대한외과학회 1986 Annals of Surgical Treatment and Research Vol.30 No.3

거상고정식 점막하 치핵절제술

양형규,임청호,신현근,강충훈,정승규,최재표 대한대장항문학회 2005 Annals of Coloproctolgy Vol.21 No.3

Purpose: Hemorrhoidal tissues are normal anatomic structures present in every individual, and they act as cushions and are anchored to the internal anal sphincter by a connective tissue system. When the anchoring connective tissues undergo bears degenerative changes, the hemorrhoids not only bulge but also descend into the lumen of the anal canal. The veins also become distended. The previous hemorrhoidectomy methods (excision and ligation methods) tend to remove excessive amounts of hemorrhoidal tissues, possibly causing incontinence or stenosis. This study introduces a modified hemorrhoidectomy method. Methods: A retrospective study was done with 650 patients (358 males, 292 females) who underwent hemorroidectomies from Jan. 1997 to Jan. 2000. Under saddle-block anesthesia, the patient was placed in a prone jack-knife position. After narrow incisions on the mucosa of the selected pile, a bilateral submucosal dissection was performed. The pedicle was ligated by transfixing sutures 2 or 3 times with 2-0 chromic catgut to lift up the mucosa. Results: The mean operation time per hemorrhoidal pile was 12.7 minutes, and the mean hospital-stay was 4.3 days. Acute and delayed postoperative anal bleeding occurred in 7 (1.1%) and 3 (0.5%) patients, respectively. The symptoms of both subsided spontaneously. Ninety-three (93) patients (14.3%) reguired nelaton catheterization for voiding difficulty, and one patient (0.2%) showed mild anal stenosis. The most frequent complaint was skin-tag formation (148 cases, 22.8%). In 140 cases, the skin tag was removed under local anesthesia. Conclusions: It is desirable to keep the normal structure of the anal canal by removing as little of the cushions as possible. Our 'lift-up submucosal hemorrhoidectomy' shows good results and is an easy operative method when compared with Parks’ original method.

내치핵 치료에서 ALTA (aluminum potassium sulfate and tannic acid, Ziohn) 주사요법과 점막하 치핵절제술의 조기 임상 결과 비교

이영찬,신현근,임청호,양형규,강정현,이강영,김남규 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.3

Purpose: The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid,Ziohn) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids. Methods: From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV)were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared. Results: The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P<0.001). However,there was no significant difference in the satisfaction level between two groups. One case of treatment failure was found in the ALTA injection group. There was no difference in complications between the injection group (n=4) and the operation group (n=5) (P=0.725). Conclusion: When compared with a submucosal hemorrhoidectomy, ALTA injection showed less post-treatment pain and less analgesics use. Overall complication rates were not different between the two groups. We found the early outcomes of ALTA injection for the treatment of internal hemorrhoids to be comparable to those of surgery. Thus, large-scale and longterm follow-up studies are needed to clarify the proper indications for ALTA injection.

캡부착 내시경이 대장내시경의 질을 향상시키는데 도움을 주는가?

최동현,신현근,이영찬,임청호,정승규,이석환,양형규 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.2

Purpose: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. Methods: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient’s pain were compared. Results: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation,diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3±4.0 min vs. 7.6±4.3 min, P<0.001), as well as for female (6.1±2.8 min vs. 9.1±4.7 min, P<0.001) patients. There were no statistically significant differences in the total colonoscopy time (13.1±6.3 min vs. 14.5±5.2 min, P=0.066), the polyp detection rate (38.6% vs. 33.3%, P=0.408), the adenoma detection rate (28.1% vs. 25.4%, P=0.654), and the VAS scale of pain (2.48 vs. 2.74, P=0.353) between the CAC and the CC groups. Conclusion: The transparent cap is effective in shortening the cecal intubation time, especially in female patients.