Fecal incontinence (FI) is recurrent uncontrolled passage of fecal material in patients. The life expectancy of humans has increased. Elderly patients have a significant rate of FI. Therefore, the number of patients with FI will increase. For diagnosis of FI, the digital rectal exam, ultrasonography, and anal manometry are used. In addition, the severity of FI can be assessed using the FI score system by examining symptoms. Recent applications include three-dimensional ultrasonography and other novel approaches. The treatments for FI include biofeedback therapy, anal implant, artificial sphincter, nerve modulation, SECCA, stem cell therapy, and surgical intervention. Biofeedback therapy is a noninvasive procedure. Anal implant, stem cell therapy, and SECCA are all minimally invasive treatments. And more methods constitute intrusive treatment. None of these therapies has been conclusively demonstrated to be superior. Depending on the severity of the symptoms, a non-invasive approach or an intrusive treatment is most frequently employed. In this review, I will discuss the diagnosis and treatment options for FI.

No abstract available.
Dementia* ; Humans ; Urinary Incontinence*

No abstract available.
Crohn Disease ; Fistula ; Infliximab

OBJECTIVES: Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. METHODS: Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). RESULTS: During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. CONCLUSIONS: Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
Adoption ; Cost-Benefit Analysis ; Electronic Health Records ; Electronics ; Electrons ; Hospitals, General ; Humans ; Investments ; Korea ; Outpatients ; Tertiary Healthcare

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

Although there have been several reported cases of enterocolitis caused by Yersinia enterocolitica, its colonoscopic findings have not been reported in Korea. We recently experienced two cases of Y. enterocolitica enterocolitis, where the colonoscopic examinations were performed. Two patients visited our hospital due to right lower quadrant pain. The thickened terminal ileum and right side colon with enlarged mesenteric nodes were observed on ultrasonography using graded compression method. Y. enterocolitica was isolated from stool in both cases, The colonascopy revealed nodular elevations, erosion., hyperemia, and edema on the terminal ileum and small hyperemic erosions or aphthoid ulcers on the colon, especially on the right side of the colon. In one of the cases, the aphthoid ulcers could be also seen on the sigmoid colon. Their clinical symptoms and signs improved 3-5 days after their visit without using antibiotics. We report these cases with a review of the relevant literature.
Anti-Bacterial Agents ; Colon ; Colon, Sigmoid ; Colonoscopy ; Edema ; Enterocolitis* ; Esophagus* ; Humans ; Hyperemia ; Ileum ; Intestines* ; Korea ; Lymphadenitis* ; Stomach* ; Ulcer ; Ultrasonography ; Yemen* ; Yersinia enterocolitica* ; Yersinia*

The paraumbilical vein is one of the anastomotic channels between the portal and systemic circulatory systems, and rupture of the intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. We experienced a case of hemoperitoneum due to a ruptured paraumbilical vein revealed by ultrasonography (US), computed tomography (CT) and percutaneous transhepatic portography. The last mentioned demonstrated a dilated paraumbilical ve i n draining two branches of the left portal vein into the right external iliac vein, and we performed coil embolization at the site at which the presumed site of paraumbilical vein was presumed to cause hemoperitoneum. We describe this unusual case of hemoperitoneum due to a ruptured paraumbilical vein in a known liver cirrhosis patient in whom portal hypertension was treated by means of coil embolization.
Embolization, Therapeutic* ; Hemoperitoneum* ; Humans ; Hypertension, Portal* ; Iliac Vein ; Liver Cirrhosis ; Portal Vein ; Portography ; Rupture ; Ultrasonography ; Varicose Veins ; Veins*

It has been reported that cavernous hemangiomas in the spine are generally located in vertebral bodies. Wereport a case of epidural cavernous hemangioma, a very rare condition, at the C7-T2 level. MR images showed adumbbell-shaped mass, with iso and high signal intensity on T1- and T2-weighted images, respectively. The mass wasintensely enhanced following Gd-DTPA injection.
Gadolinium DTPA ; Hemangioma, Cavernous* ; Spine

BACKGROUND/AIMS: Computed tomography during arterial portography and computed tomography during hepatic arteriography (CTAP and CTHA), one of the most sensitive method in detection of hepatocellular carcinoma (HCC) nodules , is reported to reduce unnecessary operation of HCC. However, it is not clear whet her CT AP and CT HA can reduce early post operative recurrence rate of HCC. We performed this study to find any differences in early postoperative recurrence rate of HCC according to the imaging modalities used for preoperativest aging. METHODS: Ninety-seven patients with HCC who had underg one curative hepat icres ection from Dec.1994 to Mar. 1998 were included (median age = 52 years (26-78), M:F = 85:12). They were classified into 3 groups according to the imaging methods used for preoper ative staging: CTAP & CTHA group (n=56), Lipiodol CT group (n=24), and three phase helical CT group (n=16). No significant inter-group difference was found in preoperative status of the patients or characteristics of HCC. One-year recurrence rates were compared by log-rank test. RESULTS: HCC recurred in 17 of 97 patients (18.7%) within 12 months. A significant difference in 1- year recurrence rate was observed between the groups: helical CT , may be a superior imaging modality for preoperative staging of HCC that can reduce early postoperative recurrence rate.
Aging ; Angiography ; Carcinoma, Hepatocellular* ; Ethiodized Oil* ; Humans ; Portography ; Recurrence* ; Tomography, Spiral Computed*

Osteogenesis imperfecta is a rare congenital disease. It is a heterogeneous group of inherited disorders characterized by multiple bone fracture, blue sclera, hearing loss, abnormalities of dentition and widespread connective tissue ahnormality. We experienced a case of osteogenesis imperfecta diagnosed in utero by ultrasonogram and confirmed hy postnatal radiograph after delivery. We present the case with a hrief review of the literature.
Connective Tissue ; Dentition ; Fractures, Bone ; Hearing Loss ; Osteogenesis Imperfecta ; Sclera ; Ultrasonography