Many different kinds of anorectal physiologic studies were performed for the evaluation of defecation disorders. Some of these studies are anorectal manometry and pudendal nerve conduction study. In pudendal nerve conduction study, pudendal nerve terminal motor latency (PNTML) was considered to be very useful for the evaluation and management of these patients. However, evaluation of amplitude in pudendal nerve conduction study has been clinically seldom used. Therefore, the aim of this study was to evaluate the clinical significane of amplitude in pudendal nerve conduction study in patients with defecation disorders by comparing to manometric profiles. MATERIAL AND METHODS: Between February, 1997 and February, 1998 all patients who underwent pudendal nerve conduction study and anorectal manometry for the evaluation of defecation disorders (constipation and fecalincontinence) were analyzed. Latency as well as amplitude in pudendal nerve conduction study were compared in both groups to the pressure profiles in manometric study according to the subgroups of these patients. Statistical analysis were performed by a Chi-square or Student's t-test and significance was assumed when p<0.05. RESULTS: A total of 80 patients, forty constipation with a mean age of 55.3+/-14.5 (GI: range; 24~86) years and forty fecal incontinence with a mean age of 61.1+/-10.3 (GII: range; 37~74) years and a male to female ratio of 25:15 (GI), 28:12 (GII), were studied. PNTML in both sides in GI were significantly decreased in comparision to those of GII (GI: Rt, 2.17+/-0.7 ms Lt, 2.03+/-0.5 ms, GII: Rt, 2.50+/-0.7 ms, Lt 2.64+/-0.8 ms, p<0.05), However, there were no differences between the two groups in terms of amplitudes (GI: Rt 399.0+/-348 uV, Lt 426.8+/-403 uV, GII: Rt, 406.9+/-273 uV Lt, 392.9+/-291 uV, NS) in pudendal nerve conduction study. In manometric findings, even though maximal resting, mean, minimum and maximal pushing pressures were no differences in both groups, mean resting and maximal squeezing pressure were significantly increased in GI than those of GII (GI: 82.4+/-31 cmH20, GII: 60.5+/-25 cmH20 in mean resting pressure, GI: 213.1+/-108 cmH20, GII: 178.7+/-66 cmH20 in maximal squeezing pressure, p<0.05) When we analyzed the overall values of amplitudes according to the diagnosis, age, gender, and the value of PNTML, there were no statistically significant differences between the two groups. But, when the one side of PNTML shorter than the other side, it tended to have a high amplitude in that side than that of the other side in the same patient (the probability for trend was 74%). CONCLUSION: Constipation patient has a shorter PNTML, higher mean resting, and maximal squeezing pressure than fecal incontinene patient. The amplitude in pudendal nerve conduction study had a trend of inverse correlation to the latency in the same patient. Therefore, amplitude in pudendal nerve conduction study might be useful to monitor or predict the outcome after treatment in patients with defecation disorders.
Constipation ; Defecation* ; Diagnosis ; Fecal Incontinence ; Female ; Humans ; Male ; Manometry ; Pudendal Nerve*

This study was conducted to observe immunological abnormalities, vscular changes and abnormal maturation, pathway of keratinocyte in the psoriasis, by comparing drposits of IgG, fibrinogen(FG) and fibronectin(FN) in the invnlved and uninvolved skin of 19 psoriaics before treatment, the involved skin of 12 among the above patients after treatment, and the skin of 8 normal controls. The study was carried out by using direct immunofluorescence technique with anti-IpG, anti-FG, anti-FN antibodies. The results are summarized as follows: 1. In the uninvolved skin of 19 psoriatics before treatment, no depasition of IgG was observed while deposition of FG was present at the dermo-epidermal junction in 5.3% of the patients and dermis(10.5 %). Deposition of FN was found at the dermo-epidermal junction(52%), papillary dermis(57.9%) and dermal blood vessels(52.6%). 2. In the involved skin of 19 psoriatics before treatment, deposition of IgG was observed in the horny layer in 84.2% of the patients, upper epidermis(15.8%) and depositicin of FG was present in the horny layer(52.6%), upper epidermi(63.1%), dermo-epidermal junction(15.8%), upper dermis(15.8%) and dermal blood vessels(5.3%). Leposition of FN was found in the horny ayer(26.3%), upper epidermis (36.8%), dermo-epidermal junction(78.9%), upper dermis(89.5%) and ermal blood vessels(68.4%). 3. In the involved skin of 12 psoriatics after treatment, IgG was wealily deposited in the horny layer in 16.7% of the patients and deposition of FG was observed in the horny layer(8.3%), upper epidermis (16.7%), dermo-epidermal junction(8.3%) and dermis(8.3%). Deposition of FN was found in the upper epiderrnis(8.3%), dermo-epiderrnal junction(58.3%), dermis(66.%) and dermal blood vessels (33.3%) 4. In the normal skin of 8 control subjects, no deposition of IgG and, FG was observed while deposition of FN was found at the inummo-epidermal junction in 37.5% of the persons, upper dermis(25%) and dermal blood vessels(12.5%)
Antibodies ; Blood Vessels ; Epidermis ; Fibrinogen ; Fibronectins* ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin G ; Immunoglobulins ; Keratinocytes ; Psoriasis ; Skin

The anterior interosseous nerve is the largest muscular branch of the median nerve and typically supplies the flexor digitorum profundus (radial part), flexor pollicis longus, and the pronator quadratus. Isolated paralysis in the distribution of the interosseou nerve of the forearm has been reported by several workers. This syndrome is distinguished by the absence of sensory involvement combined with partial median nerve paresis. This is a syndrome which is casily overlooked or misconstrued, unless the exact motor distribution of the anterior interosseous nerve is understood. We experienced a case following hard exercise in which the anterior interosseous nerve was compressed by the fibrous compression band on the underside of the flexor digitorum superficialis.
Equipment and Supplies ; Forearm ; Median Nerve ; Paralysis ; Paresis

Accessory hamstring muscle is rare in incidence. In the popliteal region, it often simulates soft tissue tumor since it may be manifest as popliteal swelling. We experienced a case of accessory hamstring muscle which simulated popliteal tumor on physical examination.
Incidence ; Physical Examination

Supracondylar fracture of the Humerus is the most common fracture of the elbow in children and frequently there are accompanying complications. A total of 78 children with supracondylar fracture of the humerus were treated at the Wallace Memorial Baptist Hospital, Busan, Korea, during a recent 5 year period. Of these, 33 patients were treated by lateral skeletal traction through olecranon pin and 14 of these were followed up for more than 6 months. 1. The average age was 7.2 years and the male and female ratio was 2.4:1. The left humerus was involved in 49 patients (62.5%). 2. Of all fractures, 94.4% were the extension type and 5.6% were the flexion type. 3. Satisfactory results wire obtained in 31 of 33 cases who were treated by lateral skeletal traction. Among these, 14 cases were followed up for more than 6 months. Final results were analyzed according to Mitchells classification; excellent results were obtained in 11 cases (78.6%), good results in 3 cases (21.4%) and there were no unsatisfactory results. 4. In 11 cases in which immediate closed reduction or Dunlops traction followed by closed reduction was unsuccessful, satisfactory results were obtained in 10 of 1 1 cases by using lateral skeletal traction. Therefore, we think that it is possible to treat most of the manual reduction failure patients by lateral skeletal traction. 5. There were two treatment failures using lateral skeletal traction. In one case, the brachialis muscle was buttonholed by the proximal fragment, and in the other case, the patient was treated 8 days after injury and marked hematoma formation between the fracture fragment was noted. 6. During treatment by lateral skeletal traction, infection developed through the pin tract in 2 cases. These were treated by the administration of antibiotics and there were no complications such as osteomyelitis nor did this effect the final results. 7. Incomplete radial nerve palsy developed in 3 cases. However, in all cases recovery was spontaneous with 4 weeks. 8. The average hospital stay for patients treated by lateral skeletal traction was 14.2 days. Prologed hospitalization is ane of the chief disadvantages of lateral skeletal traction. However, if we can minimized the number of hospital days by early cast immobiiization when the fracture is stable, lateral skeletal traction will prove to be a good method which can be expected to yield unlformly satisfactory results which are not surpassed by any other method of treatment. Since this method has been instituted at this hospital, very few patients have undergone open reduction because of fracture malalignment.
Anti-Bacterial Agents ; Busan ; Child ; Classification ; Elbow ; Female ; Hematoma ; Hospitalization ; Humans ; Humerus ; Korea ; Length of Stay ; Male ; Methods ; Olecranon Process ; Osteomyelitis ; Paralysis ; Protestantism ; Radial Nerve ; Traction ; Treatment Failure

No abstract available.
Fractures, Spontaneous*

No abstract available.
Spinal Stenosis*

Since rupture of the Achilles tendon was first reported by Pare in 1575, various caues and diagnostic and therapeutic methods have been described by many workers. Almost all these workers agree that with early diagnosis and early treatment the prognosis is good. But the incidence of misdiagnosis by the physician as well as the patient's own neglect of his condition is disconcertedly high one. Nevertheless, negiected rupture of the Achilles tendon may lead to good results by proper selection of tbe operative method. In this report 16 cases of neglected ruptures of the Achilles tendon, in which treatment had been delayed more than 3 weeks were reviewed. A follow-up study of more than 6 months was made on 14 of these cases treated during the 5 year period from February 1973 to August 1977. The results are summarized as follows: 1. The causes responsible for the neglected ruptures were misdiagnosis by the physician in 62.5% and the patient's own neglect of his condition in 25% of the cases. The patient, in many cases, failed to seek medical treatment because of the rapid disappearance of pain, the absence of an open wound, ability of mild ankle plantar flexion, and the ability to walk. 2. Neglected rupture of the Achilles tendon occured most commonly in man of 4th decade. 3. Left side injuries were more common than right side injuries with a ratio of 9:7. 4. Ruptures by indirect injury were more common than by direct injury with a ratio of 9:7, and were most common during recreation and sports activities. 5. The most frequent site of rupture was 2 to 6 cm above the insertion of the tendon with 81% of the cases. 6. The end-to-end suture with pull-out wire method and Lindholm's operative method gave good (Excellent or Satisfactory) results in neglected rupture of the tendon as well. 7. Even in cases of neglected Achilles tendon rupture, normal function can be regained in approximately 6 months post-operatively if proper method of treatment is selected.
Achilles Tendon ; Ankle ; Clinical Study ; Diagnostic Errors ; Early Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Methods ; Prognosis ; Recreation ; Rupture ; Sports ; Sutures ; Tendons ; Wounds and Injuries

Today, the exact causal relationship between prolapsed intervertebral disk and sciatica remains unclear. Murphy has proposed that inflammation rather than mechanical pressure is the basis of back pain and sciatica, and that causal irritant is likely to be a chemical product of disk degeneration. The administration of steroids into the epidural space reduces the inflammatory process of the neural structure is well known. We have studied the effect of injection of methylprednisolone acetate (Depomedrol) comparing with the effect of operative treatment. One hundred and eleven cases suffuring from diskogenic low back pain had been treated at Wallace Memorial Baptist Hospital during 2.5 years period from May 1979 to Nov. 1981. The results were as follows: 1. Sixteen patients (14%) stated that they had no relief from the injection, 24(22%) were moderately improved, 52(47%) were markedly improved and 19(17%) were completely relieved of symptoms. 2. The candidates for laminectomy which were confirmed by myelogram had complete improvement in 12%, marked improvement in 39%, moderate improvement in 21%, no relief in 28%.
Back Pain ; Epidural Space ; Humans ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Laminectomy ; Low Back Pain ; Methylprednisolone ; Protestantism ; Sciatica ; Steroids

No abstract available.
Spine*