Many kinds of different treatment options for fecal incontinence such as biofeedback therapy, anterior or posterior sphincteroplasty, pelvic floor repair, gracilis or gluteus muscle transposition have been introduced. However, appropriate indications for these treatment options have not yet been delineated up to now. PURPOSE: The aim of this study was to access the preoperative severity of fecal incontinence by physiologic tests to give an idea that indications of appropriate selection criteria and parameters for assess the outcome could be simultaneously considered by preoperatively objective physiologic data. MATERIALS AND METHODS: From January 3, 1997 to, August 1, 1997 all patients with fecal incontinence who visited colorectal clinic in the Department of Surgery, Korea Veterans Hospital, were classified into two groups according to the severity of fecal incontinence (0~20): Group I (1~9), Group II (10~20) and compared them with the results of physiologic tests: anorectal manometry, endorectal ultrasound (ERU), cinedefecography, and pudendal nerve terminal motor latency (PNTML). Statistical analysis was performed by Student's-t test, and Chi-square test and p<0.05 was considered significant. RESULTS: The number of GI was 25, and GII was 22. There were no differences between the two groups in terms of age (GI: 57.7+/-14.5, GII: 61.4+/-14.0years), gender (male: female, 19:6, 16:6), cause (neurogenic; 11/25 (GI),7/22(GII), postanal surgery; 6/25,6/22) obstetric trauma (2/25, 2/22), anal trauma (1/25, 1/22) diabetes melitus (1/25, 2/22), rectal prolapse (2/25, 1/22), and others (2/25, 3/22), duration of fecal incontinence (64.4+/-82.2, 48.7+/-65.3 months), high pressure zone (3.3+/-1.7, 3.5+/-1.4 cm), mean resting pressure (50.5+/-27.0, 51.9+/-18.7 cm H2O), maximal resting pressure (88.4+/-50.6, 89.4+/-41.8 cm), maximal squeezing pressure (150.6+/-71.0, 129.7+/-59.5 cm H2O), rectoanal inhibitatory reflex (13/21, 8/21 positive), sensitivity (37.5+/-15.2, 41.8+/-29.0 cc), compliance (19.0+/-14.5, 21.4+/-39.4 cc/cm H2O) in anorectal manometric findings, anal sphincter defect (13/21, 15/22 positive), size of defect (60+/-26.30degrees, 71 +/-30.8degrees/360degrees), thickness of the external anal sphincter (3.46+/-0.78, 3.84 +/-1.02 cm), thickness of internal anal sphincter (1.58+/-0.79, 1.74+/-0.81 cm) in ERU, anorectal angle in rest (85.2+/-28.0degrees, 97+/-22.9degrees), squeeze (72+/-27.1degrees, 82 +/-19.7degrees), push (100+/-43.9degrees, 117.9+/-34.5degrees), length of perineal descent in rest (3.7+/-1.2, 3.6+/-1.7 cm), squeeze (2.9+/-1.5, 2.7+/-1.5 cm), push (7.9+/-3.5, 6.6+/-2.6 cm) in cinedefecography. However, rectal capacity in manometry (212.5+/-99.9, 155+/-51.5 cc, p<0.05), right PNTML (1.73+/-0.39, 2.71+/-0.83 ms, p<0.001), and left PNTML (1.83+/-0.43, 2.94+/-0.80 ms, p<0.001) were significantly increased in GII compare to those of GI. CONCLUSION: As the severity of fecal incontinence was increased, rectal capacity, right and, left PNTML were increased.
Anal Canal ; Biofeedback, Psychology ; Compliance ; Fecal Incontinence* ; Female ; Hospitals, Veterans ; Humans ; Korea ; Manometry ; Patient Selection ; Pelvic Floor ; Pudendal Nerve ; Rectal Prolapse ; Reflex ; Ultrasonography

No abstract available.
HLA-DR Antigens*

Computerized Tomography is now well established and important noninvasive method of diagnosting mediastinal mass lesions because of its superior imaging of their size, location and internal composition. Authors analyzed and present CT findings of 30 surgically proven mediastinal tumors and cysts that were studied and treated at the Yeungnam University Hospital during recent 6 years. The most common tumor was thymoma (9 cases), and teratoma (6 cases), lymphoma (6 cases), bronchogenic cyst (4 cases), neurogenic tumor (4 cases), pericardial cyst (1 case) were next in order of frequency. There were 5 cases of thymoma showing homogenous solid density mass, 2 cases were malignant thymoma and myasthenia gravis was present in 2 cases. A case of thymolipoma and a case of thymic carcinoma were included. All teratomas were cystic masses but pathognomonic fat, and calcified density were seen only in 4 cases. 5 cases were located in anterior mediastinum and 1 case was in posterior mediastinum. Lymphoma (3 Hodgkin's and 3 non-Hodgkin's) appeared as irregular lobulated mass in anterior mediastinum. Neurogenic tumor (2 ganglioneuroma and 2 neurilemmoma) appeared as homogenous density mass located in posterior mediastinum. Among the 4 bronchogenic cysts, 2 were located in retrotracheal area, 1 was located in subcarinal and 1 was in parathoracic area. One case of pericardial cyst was oval shaped cystic mass located in left pericardiac border.
Bronchogenic Cyst ; Ganglioneuroma ; Lymphoma ; Mediastinal Cyst ; Mediastinum ; Methods ; Myasthenia Gravis ; Teratoma ; Thymoma

The addition of epinephrine to local anesthetics for peipheral nerve blocks reduces the risk of local anesthetic toxicity by delaying systemic absorption and prolongs block duration. But there is general agreement that epinephrine causes a decrease in plama K+ in humans that can be associated with a variety of cardiac dysrhythmias. Clonidine, a selective 2 adrenergic agonist, has been reported to increase the local anesthetic effect. And the addition of clonidine to local anesthetics in peripheral nerve block prolongs block duration and postoperative analgesia. The admixture of clonidine or epinephrine to bupivacaine for brachial plexus block was studied with regard to plasma potassium concentrations and hemodynsmie changes. Thirty-three patients of ASA physical statue I and II received an admixture of clonidine (150g; n=11), epinephrine (200g; n=11), or normal saline (placebo; n=11) to 30 ml of 0.5% bupivacaine in a randomized, double blind fashion. There were no differences in arterial blood pressure and heart rate among the three groups. In patients who had received epinephrine admixture, decrease of plasma potassium at 15min after block was significant compared with patients who had received clonidine. Clonidine may be a useful adjunt to loeal anesthetics in those patients in whom the administration of epinephrine is contraindicated.
Absorption ; Adrenergic Agonists ; Analgesia ; Anesthetics ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Brachial Plexus* ; Bupivacaine* ; Clonidine* ; Epinephrine* ; Heart Rate ; Humans ; Nerve Block ; Peripheral Nerves ; Plasma* ; Potassium*

OBJECT: Pre-ALL is a very rare preteukemic state, which percedes acute lymphocytic leukemia, while MDS(pre-ANLL), usually the well-known type of preleukemic state, precedes acute non-lymphocytic leukemia. Initially it shows transient pancytopenia without any evidence of leukemia in bone marrow findings, followed by acute lymphocytic leukemia after recovery from pancytopenia of a short period within weeks or months. We report a case with pre-ALL in childhood. CASE: A 15-month-old male baby was admitted with the complaints of fever and cough for 5 days and pallor for 2 weeks prior to admission. On admission, CBC showed pancytopenia without any evidence of leukemia, which was recovered spontaneously in a short period, and then was followed by acute lymphocytic leukemia of CALLA negative, early pre-B cell type. During antileukemic chemotherapy, he had suffered from severe bacterial infections and was finally died of sepsis 8 months after first admission. CONCLUSION: We report a case of pre-ALL in childhood, which was preceded by CALLA negative, early pre-B cell ALL, with a review of the literatures, briefly.
Bacterial Infections ; Bone Marrow ; Cough ; Drug Therapy ; Fever ; Humans ; Infant ; Leukemia ; Male ; Pallor ; Pancytopenia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Sepsis

No abstract available.
Hallermann's Syndrome*

BACKGROUND: Volatile anesthetics exert direct depressant and vasodilator effects on vascular smooth muscle. These effects may result in clinically relevant hemodynamic changes. However, the mechanism is not well known whereby volatile anesthetics inhibit the vasoconstrictor actions of catecholamines at vascular smooth muscle. METHODS: The present study examined the direct effects of isoflurane on responses of isolated rabbit thoracic arteries to the norepinephrine(a mixed alpha1- and alpha2-adrenoceptor agonist) and phenylephrine(a selective alpha1-adrenoceptor agonist) applied exogenously. The role of extra- and intracellular Ca2+ in norepinephrine-induced contractions was also examined. RESULTS: Norepinephrine and phenylephrine produced maximal responses of about the same magnitude; however, norepinephrine was more potint than phenylephrine. Isoflurane depressed only the upper portion(10(-5)~10(-4)M) of norepinephrine dose-response curves. The depression of contraction caused by isoflurane on the dose-response curves of norepinephrine and phenylephrine was more marked with phenylephrine than with norepinephrine; isoflurane(2~3%) caused a concentration-dependent attenuatian of the responses evoked by 10(-5) to 10(-3)M phenylephrine. Ryanodine(a selective inhibitor of sarcoplasmic reticulum Ca2+ channels) attenuated the contractile response to norepinephrine. In the Ca2+-free medium the contractile response to norepinephrine was attenuated as compared to control. CONCLUSIONS: Theses results suggest that isoflurane attenuates the contractile responses of isolated rabbit thoracic arteries to norepinephrine and phenylephrine probably interfering with postjunctional alpha1-receptor function.
Anesthetics ; Catecholamines ; Depression ; Hemodynamics ; Isoflurane* ; Muscle, Smooth, Vascular ; Norepinephrine* ; Phenylephrine ; Rabbits* ; Receptors, Adrenergic, alpha ; Sarcoplasmic Reticulum ; Sympathetic Nervous System ; Thoracic Arteries

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.
Hospitals, Veterans ; Humans ; Korea ; Sigmoidoscopes ; Sigmoidoscopy*

Surgical oncologist plays a pivotal role in treating patients with cancer in the era of precision medicine. In this article, we summarized traditional roles of surgical oncologists and suggested further additional ones for the modern day in the multidisciplinary approach to gastric cancer treatment.

No abstract available.
Thymus Neoplasms*