To evaluate the results and clinical impact of defecography in patients with anorectal diseases, 304 defecographic examinations from 304 patients were reviewed. The defecographic results were screened for the anorectal angle and perineal descent at rest, squeezing and during straining. Changes of rectal configuration and canal width during straining were reviewed. 304 patients had defecation problems such as terminal constipation, defecation defficulty, blood or mucus discharge, tenesmus, obstruction sensation etc. They were performed anorectal physical examination and anal manometry etc., and were later treated by operation and conservative management. Normal anorectal angle were measured to be 101°, 91°, 131°at rest, during squeezing and straining respectively. In the spastic pelvic floor syndrome, increase of anorectal angle less than 10 ° from rest to straining was observed. Incontinent patients had a larger anorectal angle (mean: 128°) at rest. 7.8cm of perineal descent was found in descending perineal syndrome in comparison to 4.0cm in normal. Normal anal canal width was measured 1.4cm only during straining but identified in incontinent patients at rest (mean:1.2cm). Abnormal rectal configuration was found in 254 defecographic examinations: rectoceles were observed in 235 cases and were associated with rectal prolapse in 115 cases, and rectal prolapses were found in 134 cases. In conclusion, the anorectal angle was valuable in evaluation of spastic pelvic floor syndrome and fecal incontinence. Degree of perineal descent was abnormally increased in descending perineal syndrome. In the cases of the rectoceles and rectal prolapses, defecography is helpful in preoperative evaluation of rectal wall change and postoperative follow up.
Anal Canal ; Constipation ; Defecation ; Defecography* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Manometry ; Mucus ; Muscle Spasticity ; Pelvic Floor ; Physical Examination ; Rectal Prolapse ; Rectocele ; Sensation

No abstract available.
Intervertebral Disc*

No abstract available.
Echocardiography* ; Mass Screening*

An unusual case of embryonal rhabdomyosarcoma of the bladder in a 77 year old man, who presented with difficult urination, gross hematuria and vague lower abdominal pain. Herein, we report a case of rhabdomyosarcoma. which revealed early recurrence and rapid growing up after partial cystectomy.
Abdominal Pain ; Adult* ; Aged ; Cystectomy ; Hematuria ; Humans ; Recurrence ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Embryonal ; Urinary Bladder* ; Urination

Leiomyoma is rare. Most of patients present with urinary tract infection, hematuria, dyspareunia, or complaint of mass. A case of leiomyoma on urethrovaginal septum in a 36 years old female was presented. The presenting symptom was a protruding mass at the anterior vaginal wall The mass was removed surgically and confirmed as a leiomyoma pathologically.
Adult ; Dyspareunia ; Female ; Hematuria ; Humans ; Leiomyoma* ; Urinary Tract Infections

PURPOSE: Incorrect umbilical venous catheter(UVC) position results in an increased incidence of complications and rnisleading pressure measurements. Most modern catheters are radiopaque and are easily seen on plain film radiographs but the exact relation of the catheter tip to vascular anatomic landmarks is not available. We assessed the ability of ultrasonography to locate the tip of UVC. And we described the relationship between the locations of the tip of UVC on the ultrasonography and the anatomical landmark seen on the radiography. METHODS: From February 1997 to June 1997, 40 newborns admitted to NICU at Guro Hospital, Korea University, and required UVC insertion for clinical care. UVC position was checked by anteroposterior and cross table lateral radiography. And then ultrasonographic assessment was performed using Hewlett Packard Sonos-1000(Hewlett Packard, UK) with a 5 MHz transducer. The ultrasonographic examinations were documented on hard copy and compared with current plain film radiographs. The sensitivity, specificity, positive predictive value, negative predictive value for the radiography as a test to detect properly positioned UVC were calculated. RESULTS: 1) In 23 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8-T10), but ultrasonographic examination showed that 3 UVCs were malpositioned(false positive value 13%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 76.9%, specificity of 78.6%, positive predictive value of 87% and negative predictive value of 64.7%. 2) In 13 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8- T9), ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 0%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 51.9%. 3) In 18 of 40 newborns the UVCs were properly positioned by cross table lateral radio- graphy(less than 7mm between diaphragm and tip of UVC), but ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 10.5%). Detection of properly located UVC by cross table lateral radiography had a sensitivity of 69.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 63.6%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy and provides more information than traditional radiography. Use of ultrasonographic guidance at the time of UVC insertion allows the catheter position to be immediately adjusted, with confirmation of the amended position, obviating the need for repeated radiological evaluations. When ultrasonography is unavailable, proper placement of UVC can be estimated by use of radiography to position the tip of UVC between the eighth and ninth thoracic vertebral body by anteroposterior radiography and less than 7mm above or below the diaphragm by cross table lateral radiography.
Anatomic Landmarks ; Catheters* ; Diaphragm ; Humans ; Incidence ; Infant, Newborn* ; Korea ; Radiation, Ionizing ; Radiography* ; Sensitivity and Specificity ; Transducers ; Ultrasonography

PURPOSE: Differentiation of parathyroid and thyroid nodule is often difficult even with aids of ultrasonography and computed tomography. Tc-9m sestamibi (MIBI) scintigraphy is useful in the detection of hyperfuntioning parathyroid nodules. However, its role in the differentiation between parathyroid and thyroid nodules including malignancies is not well studied. Therefore, the purpose of this study is to evlauate the role of Tc-99m MIBI imaing in the differentiation of parathyroid adenoma from thyroid malignancy. METHODS: Six patients (4 women, 2 men, mean age 43 years) with parathyroid adenoma and 4 patients (2 women, 2 men, mean age 56 years) with thyroid papillary cancer were enrolled. Ten and 180 minutes after injection of 740 MBq Tc-99m MIBI, pinhole image of the anterior neck was obtained. Nodule-to-thyroid ratio (N:T) was measured from same sized region of interests over nodule and normal thyroid bed. Retention Index (RI) was calculated as N:T 10 minus N:T 180 divided by N:T 10. RESULTS: as those with thyroid cancer (1.09 ± 0.35, 1.24 ± 0.36, respectively, P>0.05 ). However, RI of parathyroid patients was higher than thyroid cancer patients (0.64 ± 0.29, -0.12 ± 0.20, respectively, P<0.05). CONCLUSION: Parathyroid adenoma showed higher retention rate of Tc-99m MIBI than thyroid cancer. Therefore, differntiation of parathyroid and thyroid nodule could be possible using Tc-99m MIBI scintigraphy.

No abstract available.
Humans

Isoflurane, which has only recently been introduced into clinical practice, is a nonflammable halogenated ether used as an inhalation anesthetic. It has pharmacological, physical, and clinical properties similar to those of halothane and enflurane: however, it differs from botn in several important aspecs. The potent neuromuscular blocking action of sioflurane in desirable, because it reduces the requirement for muscle relaxants and allows lower doses of anesthesis. To quantitatively clarify the neuromuscular blocking effect of isoflurane, neuromuscular function was monitored by "Train of Four" stimulus with and without administration of muscle relaxants under halothane and isoflurane anesthesis, respectively, in 60 patients. The patients were divided into 4 groups(halothane anesthesia without muscle relaxants, halothane anesthesis with muscle relaxants, isoflurane anesthesia without muscle relaxants and isoflurane anesthesia with muscle relaxants). Twich responses of thenar muscle were monitored and analysed for the value of maximaum twich depression by halothane and isoflurane anesthesia, respectively, and the onset time, degree of maximal neuromuscular blockade, duration of action and recovery index of pnscuronium bromide under halothane and isoflurane anesthesia, respectively. The results were as follows: 1) Isoflurane exhibited a neuromuscular blocking effect 2,3 times more potent than halothane. 2) Neuromuscular depression by halothane and isoflurane was not accompanied by "fade". 3) The recovery time from nuromuscular blockade by succinylcholine in isoflurane anesthesia was increased significantly compared with halothane anesthesia. 4) The duration of action and the recovery index were increased significantly in isoflurane anesthesia compared with halothane anesthesia.
Anesthesia ; Depression ; Enflurane ; Ether ; Halothane ; Humans ; Inhalation ; Isoflurane* ; Neuromuscular Blockade ; Succinylcholine

PURPOSE: The aim of this study was to evaluate the clinical efficiency of cardiac troponin T(cTnT) in detecting myocardial damage in neonatal asphyxia and to compare the diagnostic value of cTnT with creatine kinase MB(CK-MB). METHODS: Sixty-three neonates were enrolled in this study, consisting of 27 asphyxiated infants(asphyxiated group; 1-min or 5-min Apgar score< or=6) and 36 healthy infants(control group). The two groups were divided to 4 subgroups as follows; group I(17 preform asphyxiated neonates), group II (10 full-term asphyxiated neonates), group III(16 preterm healthy neonates), group IV(20 full-term healthy neonates). Serum cTnT was measured within 24 hours, at 24-47 hours, and 48-72 hours after birth, respectively. Serum CK-MB was measured within 24 hours after birth. RESULTS: 1) cTnT within 24 hours in asphyxiated group was significantly higher than in the control group(P<0.05). 2) cTnT in group II was not significantly higher than in group I (P>0.05), whereas CK-MB in group II it was higher than in group I (P<0.001). Between group III and IV, cTnT and CK-MB showed significant differences(P<0.05). 3) cTnT did not change with gestational age or birthweight. CK-MB was correlated to birthweight and gestational age. 4) Twelve asphyxiated infants had at least one abnormal cTnT(>0.2 microgram/L). Ten of them(83%) had a tricuspid insufficiency of moderate or severe degree. CONCLUSION: cTnT is a more heart-specific serodiagnostic marker than other markers in asphyxiated neonates with suspected myocardial damage.
Asphyxia* ; Creatine Kinase ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Parturition ; Troponin T* ; Troponin*