Comparison of Delorme-Thiersch Operation Outcomes in Men and Women With Rectal Prolapse

현기훈,윤서구 대한대장항문학회 2019 Annals of Coloproctolgy Vol.35 No.5

Purpose: The laparoscopic rectopexy has become increasingly popular with verified stability, surgical route selection should be tailored to individual patient characteristics rather than operative risk. The perineal approach is useful in young male patients who need to preserve fertility. This study aimed to compare the characteristics of men and women who underwent Delorme-Thiersch procedures and analyze the postoperative outcomes of the perineal approach by sex. Methods: We retrospectively reviewed the medical records of 293 patients who underwent Delorme-Thiersch operations in Seoul Song Do Colorectal Hospital between January 2011 and September 2017. Patient clinical characteristics and postoperative complications were analyzed by sex. We analyzed surgical outcomes with preoperative and 3-month postoperative incontinence questionnaires, constipation levels, and anal manometry. Results: In this study, men with rectal prolapse were younger than women with the same condition. American Society of Anesthesiologists physical status classifications were higher in women and women had more L-spine X-ray and pudendal nerve terminal motor latency test abnormalities. Anorectal manometry pressures were higher in men. Men also had longer operation times and hospital stays and more postoperative complications (8 T ring infections, 6 patients with bleeding, 3 with strictures, 2 with severe pain, and 2 with rectal perforations). The recurrence rate was higher among women. Conclusion: Men with rectal prolapse were younger, healthier, and had relatively better anorectal function than women. The Delorme-Thiersch operation in men promoted lower recurrence rates and was advantageous in preserving the fertility of young patients, but the incidence of complications was also higher in men. Adequate counseling and preparation for the possibility of complications are needed.

복강내 림프관종의 복강경적 절제

현기훈,박준호,최수윤,최원혁,정진철,김두진,김주섭,이삼열 대한내시경복강경외과학회 2011 Journal of Minimally Invasive Surgery Vol.14 No.2

An intra-abdominal cystic lymphangioma is a benign neoplasm that rarely occurs within the abdominal cavity. Intra-abdominal cystic lymphangioma is treated by a resection performed through a radical procedure. We report a case of a 37-year-old woman who had an asymptomatic mesenteric cyst that was discovered incidentally during a routine physical check-up. Treatment was completed without complications using a laparoscope.

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes

현기훈,양시준,임기윤,이종균,윤서구 대한대장항문학회 2018 Annals of Coloproctolgy Vol.34 No.3

Purpose: Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients. Methods: Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation. Results: No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation. Conclusion: LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

친환경 가변가구의 개념과 디자인 요소 정립에 관한 연구

현기훈(Gi Hun Hyun),오철훈(Cheol Hoon Oh) 한국디자인문화학회 2015 한국디자인문화학회지 Vol.21 No.2

현대 사회는 친환경적인 삶을 기본으로 다양한 공간과 가구, 제품의 요구와 그들을 이용함으로써 사회적인 이슈에 적합하게 대응하며 살아가고 있다. 가구는 인간과 자연에 무해한 재료의 사용 및 에너지 절감을 위한 친환경 가구를 중심으로 나타나기 시작했다. 또한 공간의 효율을 바탕으로 발전한 가변가구는 도시인구의 증가와 1인가구의 확대로 공간의 축소와 과거보다 복잡하고 다양한 사용자의 요구에 적합하게 나타났다. 이처럼 사회적 욕구로 나타난 시스템가구의 발전에 힘입어 교체가 자유롭고 다양한 유닛을 가진 가구는 마치 친환경 가구의 일부분으로 인식되기 시작했다. 과연 가변가구가 스스로 친환경 가구라고 정의 할 수 있는가의 의문에 따라 가구를 비교 분석한 결과 가변가구의 팽창구조(Inflating structure)나 접이 구조(Folding structure)는 시스템가구의 재사용성과는 무관한 구조를 지니고 있어 이들 가구의 재료에 대한 재활용성에 대한 새로운 해결이 있어야 친환경가구라 할 수 있을 것이다. 이렇듯 기연구된 자료에서 나타나는 구조적 분석에서의 가변가구들은 각 분류에 적합한 친환경적 방법에 대한 연구가 필요로 된다. 반면 친환경적 행위의 대상을 비교해 보면 일반적으로 가구는 생산자의 행위가 주요 요소가 되며 친환경 가구의 사용을 통한 소비자의 인성적 친환경을 유도하고 있다. 반면 시스템가구나 가변가구에서는 일반적인 가구에 대한 생산자의 제작행위가 중요함과 동시에 가구의 선택하여 사용하는 사용자의 새로운 공간변화의 기호를 해결하기 위한 가구의 분해, 변경, 재조립 등의 소비자의 적극적 가구변형에 대한 참여가 중요하게 나타난다는 특징이 있다. 사용자의 적극적 참여가 특징인 친환경 가구의 방향성을 제시함으로써 친환경 가변가구의 개념과 디자인 요소를 정립할 수 있었다. 이렇듯 친환경 가변가구는 생산자와 소비자의 친환경적 행위를 중요한 가치로 가지며 가구 전 과정에 걸쳐 인간과 자연에 환경오염을 최소화하며 에너지 효율이 좋은 재료의 친환경적인 조형가변, 효율가변가구로써, 다양한 유닛을 가지고 모듈화 되어있어 구조의 친환경성인 공간가변, 다목적가변가구가 있으며 이들 가구는 간단한 이동, 쉬운 결합, 주변 사물과의 조화 등을 특징으로 하고 있다. 친환경가변가구의 개념을 생산자(제작자)중심의 친환경 가구의 친환경을 위한 각각의 요소들과 가변가구의 특징인 사용자(소비자)가 참여하고 동참을 이끌어 내면 소비자 스스로가 가구의 친환경적 요소를 지닌 제품이며, 소비자는 적극적으로 친환경 생활에 대한 참여의지가 증대될 것이다. 친환경가변가구는 생산자의 친환경적 생산의지와 소비자의 친환경적 행동을 극대화 시켜주는 역할로써 친환경 가구디자인의 중요한 유형으로 나타날 수 있을 것이다. People in modern society are living while properly responding to social issues by choosing space, furniture and other products based on eco-friendliness and other social needs. Use of materials harmless to humans and nature, eco-friendliness and saving energy have been major trends in making furniture in recent years. The advent of adjustable furniture designed to maximize space efficiency reflects efforts to meet various sophisticated consumer needs in the era of micro residential space in light of expansion of urban population and of one-person households. Thanks to the development of system furniture that has been introduced to meet these social needs, the furniture that is easily adjustable with various with modular units started to be regarded a part of eco-friendly furniture. The comparative analysis of furniture based on the question whether adjustable furniture can be defined as eco-friendly furniture draws a conclusion that the inflating or folding structure of adjustable furniture has nothing to do with the reuse of system furniture and thus requires a new solution involving reusability of furniture materials to be able to be classified into eco-friendly furniture. As such, the adjustable furniture in structural analysis seen in previous research materials requires further study regarding eco-friendly methodologies that are appropriate in each of categories. Meanwhile, comparing targets of eco-friendly activities, the furniture, in general, adopts manufacturer’s activities as a major factor and induces consumer’s conscious eco-friendliness through the use of eco-friendly furniture. On the other hand, the system furniture or adjustable furniture is characterized by consumer’s active participation in adjusting furniture such as disassembly, modification and reassembly designed to meet various spatial needs while manufacturing activities of furniture makers are just as important as well. Presenting the right direction of eco-friendly furniture that features active user participation was able to define the concept and design factors of eco-friendly adjustable furniture. The eco-friendly adjustable furniture thus takes eco-friendly activities of both producers and consumers as an important value, minimizes environmental impact throughout the lifecycle of furniture, and serves as multi-purpose furniture with a variety of modular units that facilitate relocation, easy disassembly and reassembly and harmony with other objects in surrounding area. If we are able to induce user(consumer) participation as well as various factors for eco-friendliness of producer (manufacturer)-oriented eco-friendly furniture, consumers will be regarded as one of the eco-friendly factors and the intent of their participation in eco-friendly life will be much enhanced. The eco- friendly adjustable furniture can be classified into a major type of eco-friendly furniture as long as it plays it role in maximizing eco-friendly activities among consumers as well as the intent of producers to make furniture in an eco-friendly manner.

Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?

이근희,현기훈,윤서구,이종균 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.5

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.

탄력 및 비탄력과 탄력을 결합한 테이프 적용이 견갑골 운동이상증을 가진 만성 뇌졸중 환자의 어깨 통증과 고유수용감각, 상지 기능 수준에 미치는 영향

양성화,한효진,현기훈,Yang, Seong-hwa,Han, Hyo-jin,Hyun, Ki-hoon 대한정형도수물리치료학회 2019 대한정형도수물리치료학회지 Vol.25 No.1

Background: Scapular dyskinesis is one of the risk factors for upper extremity injury in patients with chronic stroke. Taping can used as an adjunctive treatment for this. The aim of this study was to investigate the effects of rigid tape in conjunction with elastic tape and elastic tape only on shoulder pain, proprioceptor, and function of chronic stroke patients with scapular dyskinesis. Methods: Participants were randomly assigned to elastic tape (ET) group (n=10) and both tape (BT) group (n=10). Both ET and BT groups performed therapeutic exercise on the upper extremity with taping applied for 4 weeks. Therapeutic exercise was performed 30min/day, 5 times/week. Clinical outcome measures used Numerical pain rating scale with a faces pain scale for pain, angle at shoulder join position sense (JPS) for proprioceptor, and Fugl-meyer assessment upper extremity for function. Results: Clinical outcomes were measured at initial baseline, after 4weeks. There were statistically significant differences in pain, JPS, and function after 4 weeks in both groups (p<.05). There was no significant difference in pain and JPS between the groups, and There was a statistically significant difference in function in the BT group compared to the ET group (p<.05). Conclusions: This results suggest that accurate clinical assessment and appropriate taping can improve proprioceptor and function of the upper extremity in patients with chronic stroke.

High Expression of Urokinase-Type Plasminogen Activator Is Associated with Lymph Node Metastasis of Invasive Ductal Carcinoma of the Breast

김은영,도성임,현기훈,박용래,김동훈,채승완,손진희,박찬흔 한국유방암학회 2016 Journal of breast cancer Vol.19 No.2

Purpose: In the present study, we evaluated the levels of urokinase- type plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) by performing immunohistochemical staining to determine whether they were reliable prognostic markers in patients with breast cancer. Methods: Demographic and clinicopathological parameters of 214 patients with invasive ductal carcinoma (IDC) and 80 patients with ductal carcinoma in situ (DCIS) who were diagnosed and treated from 2006 to 2010 were analyzed. Tissue microarray was constructed and immunohistochemical staining was performed for each specimen. Results: Univariate analyses showed that age at diagnosis, history of hormone replacement therapy, radiation therapy, skin and chest wall invasion, Paget disease, lymphovascular invasion, estrogen receptor positivity, and triple-negative subtype were significantly associated with patient prognosis (p<0.005). Patients with DCIS showed higher PAI-1 expression than patients with IDC (82.5% and 36.2%, respectively; p=0.012). Lymph node metastasis was more frequent in patients with high uPA levels than in patients with low uPA levels (p=0.001). Conclusion: Our results suggested that PAI-1 was involved in tumor progression in the early stages of breast cancer, such as DCIS. In addition, our results suggested that high uPA levels were associated with the lymph node metastasis of IDC.

경추 신전-견인 운동이 경증 거북목증후군 환자의 경추정렬, 통증, 기능장애에 미치는 영향

한효진,이재남,현기훈,양영식,Han, Hyo-jin,Lee, Jae-nam,Hyun, Ki-hoon,Yang, Young-sik 대한정형도수물리치료학회 2019 대한정형도수물리치료학회지 Vol.25 No.2

Background: The purpose of this study was to determine the effects of cervical extension-traction exercise on cervical alignment, pain, and neck disability in patients with mild turtle syndrome. Methods: Thirty two outpatients with mild turtle neck syndrome were recruited and randomly divided into two groups. Participants in the experimental group was applied cervical extension-traction exercise (CETE, n=16) and in the control group applied cervical stabilization exercise (CSE, n=16) for three times a week for 4 weeks. Results: Cobb angle and Jochumsen depth were CETE showed significant difference within the group post test (p<.05). And the CETE was significantly higher than the CSE. In the pressure pain threshold, both CETE and CSE showed significant differences within post test (p<.05). And the CETE was significantly higher than the CSE. Neck disability index were significant (p<.05) in the CETE post test. There was no significant difference between the two groups. Conclusion: Our results of this study showed that applying cervical extension-traction exercise to patients with mild turtle syndrome improved cervical alignment, pain and neck dysfunction.

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial

조경진,황도연,이현주,현기훈,김태정,박덕훈 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.5

Purpose: This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.Methods: One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).Results: Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).Conclusion: Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

액와접근법을 이용한 무기하 내시경 갑상선 절제술 후 국소 부위 통증 조절 장치(On-Q^Ⓡ PainBuster^Ⓡ)와 자가 통증 조절 장치의 무작위 대조 연구에 대한 예비 자료

이경원,박찬흔,박용래,현기훈,윤지섭,Kyung-Won Lee,Chan-Heun Park,Yong-Lai Park,Ki-Hun Hyun,Ji-Sup Yoon 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.4

Purpose: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q^Ⓡ PainBuster^Ⓡ (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. Methods: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. Results: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. Conclusion: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroi-dectomy.