Colorectoanal intussusception is a rare and distinct entity that differs from the more common rectal prolapse. Typically the intussusception occurrs with tumor at the apex of the intussuscepted segment acting as lead point. Here we present a case and review the literature of colorectoanal intussusception. The case presented here is that of an elderly woman with a proximal sigmoid colon cancer at its apex. Anterior resection was electively performed after reduction of the intussusception. It is important to differentiate a colorectoanal intussusception from the more common rectal prolapse because treatment may differ. The anorectum remains in its normal anatomic position in colorectoanal intussusception, whereas the anal canal is effaced with the prolapsed segment of bowel in rectal prolapse. Identification of a tumor at the apex of the intussuscepted bowel should also arouse suspicion that the condition is not a rectal prolapse.
Aged ; Anal Canal ; Colonic Neoplasms ; Female ; Humans ; Intussusception* ; Rectal Prolapse ; Sigmoid Neoplasms

No abstract available.
Thanatophoric Dysplasia*

No abstract available.
Hepatolenticular Degeneration*

We performed anorectal physiologic studies to evaluate the pelvic floor musculature and its innervation in 73 pregnant women(35 primiparous, 38 multiparous) who had been recruited into a study of pudendal nerve damage and its recovery in vaginal delivery as part of a prospective investigation. These women had all delivered by vaginal route with pros terolateral episiotomy. Pudendal nerve terminal motor latency was significantly increased 2~3 days after delivery but substantial recovery occurred in the first 2 months after delivery nearly to the pre-delivery value. Maximum average resting pressure was not affected by delivery. In contrast, maximum average squeeze pressure was decreased significantly 2~3 days after delivery and some recovery occurred in the first 6 months after delivery, which still remained significantly low relative to pre-delivery value. Perineal descent was significantly increased 2~3 days after delivery but substantial recovery occurred in the first 2 months after delivery, which still remained significantly low relative to pre-delivery value and thereafter no significant recovery was found. These results suggest pudendal nerve damage occurrs during vaginal delivery which recovers in the first 2 months after delivery but functional disturbance in pelvic floor sphincter muscuature persists thereafter, and we support avoidance of further vaginal delivery after previous damage to the innervation of pelvic floor sphincter musculature.
Episiotomy ; Female ; Humans ; Pelvic Floor ; Prospective Studies ; Pudendal Nerve*

PURPOSE: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer. MATERIALS AND METHODS: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. RESULTS: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR. CONCLUSION: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.
Chemoradiotherapy ; Deoxycytidine ; Fluorouracil ; Humans ; Leucovorin ; Lymphocyte Count ; Multivariate Analysis ; Pelvis ; Rectal Neoplasms ; Capecitabine

BACKGROUND: Inguinal hernia is one of the most common surgical diseases in pediatric patients. We reviewed pediatric inguinal hernia cases retrospectively to analyze the clinical characteristics. METHODS: We reviewed 200 herniorrhaphies in 194 patients who were under the age of 15 and who were operated on at Chungbuk National University Hospital from January 1992 to July 1997. RESULTS: 1) All of the cases were indirect inguinal hernias. Sliding hernias were noticed in 6 cases. High ligations were performed in all cases except 2 cases of Bassini operations. 2) Boys were affected 3.4 times more often than girls. 56.2% of the hernias occurred on the right side, 35.0% on the left side, and 8.8% bilaterally. Bilateral inguinal hernias occurred more often in girls (13.6%) than in boys (7.3%). 3) Hernias were noticed under the age of 1 year (47.9% of the cases). In most of those cases, operations were delayed. Especially, the operations were delayed more than 3 months for 82.1% of patients with hernias and under the age of 6 months. 4) On admission, most patients complained of inguinal or scrotal swelling and inguinal pain or discomfort. 5) Hospitalization occurred in 20.6% of the cases, 3 of which needed emergency operations. Hospitalization occurred in 47.5% of the cases under the age of 1 year; in those cases, hernias were noticed within the first 6 months, and in most of those cases, operations were delayed more than 3 months. 6) Postoperative complications occurred in 9 cases, i.e., 8 cases of scrotal swelling and 1 case of scrotal hematoma. There were no recurrent cases after operation (average follow-up of 33 months). 7) After unilateral inguinal hernia repairs, contralateral hernias developed in 10 patients including 4 patients who had had received their first hernia operations at other hospitals. The sex ratio was 9:1. Laterality of the first hernias were right in 5 cases and left in 5 cases. Contralateral hernias developed within an average of 4.8 months after the first operation; however, 6 cases developed within 6 months after the first operation. CONCLUSIONS: Education for early operation to prevent complications of hernias and careful evaluation of contralateral inguinal hernias in unilateral hernias are needed in the treatment of pediatric inguinal hernias.
Chungcheongbuk-do ; Education ; Emergencies ; Female ; Follow-Up Studies ; Hematoma ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Hospitalization ; Humans ; Ligation ; Postoperative Complications ; Retrospective Studies ; Sex Ratio

No abstract available.
Colorectal Neoplasms* ; Electrophoresis* ; Genes, ras* ; Humans* ; Point Mutation* ; Polymerase Chain Reaction*

The goal of fracture treatment is to restore the patient to pre-injury function level. But the outcome assessment after orthopedic interventions has usually focused on physician-defined parameters of technical success, such as fracture union, alignment and range of motion rather than patient function and quality of life. However, the correlation among improvements in these parameters and functional status, psychosocial well being is inconsistent and weak in the elderly. Therefore authors assessed the functional status after surgical intervention of hip fractures in the elderly with functional recovery score(FRS). Independence in basic activities of daily living, in instrumental activities of daily living, in mobility, freedom from pain and intact memory were assessed in 133 hip fractures in the elderly. The hip fractures in the elderly resulted in 24.8% loss of function after the first year. The older the age, the more the loss of function after surgery of hip fractures. The more functional loss was observed in female patients and in patients with poor postoperative radiological results, but statistically insignificant (P>0.05). The more functional loss was observed in patients with underlying medical disease preoperatively and it was statistically significant (P<0.05). We recommend the evaluation of functional status in the elderly after hip fractures.
Activities of Daily Living ; Aged* ; Female ; Freedom ; Hip Fractures* ; Hip* ; Humans ; Memory ; Orthopedics ; Quality of Life ; Range of Motion, Articular

In evaluating the esophago-gastric junction, many difficulties are well known in a single contrast study, andit may often be resolved with double contrast technique. By double contrast technique, the special en face viewfor the esophago-gastric junction was obtained in 298 cases at Inje Medical College Paik Hospital from Jan. 1981 to June 1981. Five basic patterns were recognized and classifed from type I to V. Their incidences were obtained.-type I ; 18%, type II; 50%, type III; 23% type IV ; 7%, type V; 2%. The most common position of patients is left lateral, and zero degree is the most common at elevation of fluoroscopic table. Type III is the most common typeof the esophage-gastric junction in inspiration, and type I expiration. Any significant deviations from thesenormal geometry of the esophago-gastric junction as displayed by double contrast study, indicate an abnormality.More special attentions are required to evaluate a minute pathologic condition of the esophago-gastric junction.
Attention ; Humans ; Incidence

This paper reports a case of a twisted small bowel obstruction in a 74-year-old man that occurred after a double tract reconstruction (DTR) in a laparoscopic proximal gastrectomy (PG) for early gastric cancer. The patient had inadequate oral intake and reflux symptoms for 10 days after discharge. Imaging analysis revealed a narrowed small bowel with twists between the esophagojejunostomy and gastrojejunostomy sites. A fully covered stent was placed in the narrowed small bowel for 2 weeks. The patient was then discharged after stent removal without any dietary problems. The authors’ experience shows that twisted small bowel after a DTR in PG can be treated by endoscopy.