Anal incontinence following pelvic trauma, surgery, or neurologic disorders has significant medical and social implication. Both Chetwood in 1902 and Bistom in 1944 utilized coccygeal origin portion of the gluteus maximus muscle for the anal sphincter reconstruction. The gluteus maximus muscle is a broad, fan-shaped muscle with a wide origin from the ilium sacrum and coccyx and a narrow insertion along the iliotibial band of the lateral femur. Its blood supply is from the inferior gluteal artery and its innervation is from L-5, S-1 roots by means of the inferior gluteal nerve Incisions are placed at the inferior border of the ischial tuberosity. Subcutaneous tunnels are created about the rectum and gluteal and perirectal incisions. Two overacting slings are being created Their opposing pull creates sphincter or valve effect about the distal rectum. We have experienced 2 cases of irregular, deep soft tissue defects of the perianal region requiring muscle coverage with the gluteus maximus muscle overlapping slings. We think the use of the gluteus maximus muscle is one of the most useful method for reconstruction of the anal sphincter mechanism.
Anal Canal* ; Arteries ; Coccyx ; Femur ; Ilium ; Nervous System Diseases ; Rectum ; Sacrum

No abstract available.
Chronic Disease* ; Risk Factors*

PURPOSE: Acute measles encephalitis(ME) is characterized by an abrupt onset of fever and obtundation, frequently accompanied by seizures and multifocal neurological signs. The aim of this study was to clarify the clinical manifestation, progression and the brain SPECT patterns in patients with acute ME. METHODS: This study included 11 children with acute ME admitted to Chonbuk National University Hospital. Ten patients received a first dose of measles vaccine, one patient did not receive a first dose, and no patients received a second dose. ME was diagnosed based on characteristic clinical pictures, measles antibodies by ELISA and abnormal CSF findings. Brain MRI and brain SPECT were performed in 11 patients with acute ME. RESULTS: There were four males and seven females whose ages at onset ranged between 18 months and 14 years(mean : 10.5 years). The main clinical neurologic pictures were loss of consciousness(10) and seizure(five). The titer of IgG and IgM antimeasles antibodies in serum were positive in 10 patients. In CSF, nine patients had IgG antibodies and one patient had IgM antibodies. The concentration of protein(mean : 124+/-60 mg/dL) and WBC counts(mean : 158+/-157/microL) in CSF were elevated in all patients. In electroencephalographic examination, nine patients showed increased slow waves. Seven of 11 patients(63.6%) revealed high signal intensity on the brain MRI. In contrast, all patients showed hypoperfusion in brain SPECT examination. According to brain SPECT, the perfusion deficits were frequently observed in the frontal lobe(nine), temporal (nine), parietal(eight) and thalamus(eight). CONCLUSION: Brain SPECT is more sensitive than MRI for the evaluation of brain damage in early stages of acute ME.
Antibodies ; Brain* ; Child ; Electroencephalography ; Encephalitis* ; Enzyme-Linked Immunosorbent Assay ; Female ; Fever ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jeollabuk-do ; Magnetic Resonance Imaging ; Male ; Meals* ; Measles ; Measles Vaccine ; Perfusion ; Seizures ; Tomography, Emission-Computed, Single-Photon*

Extracellular matrix component is degraded by enzymes of thematrix metalloproteinases(MMPs). MMPs are produced by both hemopoietic and structural cells. Increased activity of MMP-3 in periodontium is strongly associated with inflammatory periodontal disease. The purpose of the present study was to estimate the effect of BMP-7 on regeneration of periodontium. The optical density was measured by microwell plate reader at 450 nm.The difference of the optical density and the relative activity ofMMP-3 according to the concentration were statistically analyzed by one way ANOVA. The results were as follows: 1.Tetracycline-HCl showed the tendency to inhibit the activity of MMP-3 at the concentration lower than 25microgram/ml. 2.Doxycycline-HCl inhibited significantly the activity of MMP-3 at the concentration lower than 100microgram/ml. 3.Minocycline-HCl inhibited the activity of MMP-3 at the concentration in the range of 10 to 200microgram/ml. Within the limit of the present study, the above results suggested that bone morphogenetic protein-7 may play a important role in development of periodontium.
Bone Morphogenetic Protein 7 ; Extracellular Matrix ; Matrix Metalloproteinases ; Periodontal Diseases ; Periodontium ; Regeneration

PURPOSE: To investigate the prevalence and related risk factors of infection with human papillomavirus(HPV) in young adults, and the interrelationships among the risk factors, school-based survey was conducted in Busan. METHODS: A total of 1,430 male and female students(aged 16~25) participated in the survey that included self-administered questionnaire and, for males, physician-performed collection of exfoliated genital cells, for females, self-collection of vaginal cells. The prevalences of 25 HPV types were evaluated by a polymerase chain reaction-based assay. RESULTS: HPV DNA detected more frequently in female students(15.2%) than in male students(8.7%). In female students, currently smoking cigarettes(OR=3.8, 95% CI=1.7~8.3) and having had penetrative sexual intercourse(OR=12.7, 95% CI=7.2~22.2) were the significant risk factors for HPV infection; in male students, there was nothing to show statistical significance. Smoking rate was 53.8% in males and 17.7% in females, and 55.6% of male students and 25.9% of female students reported having had a sexual intercourse. Smokers were more likely to have had a sexual intercourse than nonsmokers(OR=4.0, 95% CI=2.5~6.2, males; OR=9.1, 95% CI=5.6~14.7, females). CONCLUSIONS: According to the strong interrelationship between sexual intercourse and smoking, multilateral behavioral intervention is needed to prevent infection with HPV.
Adolescent* ; Busan ; Coitus ; DNA ; Female ; Humans* ; Male ; Papillomavirus Infections* ; Prevalence ; Risk Factors* ; Sexual Behavior ; Smoke ; Smoking ; Young Adult ; Surveys and Questionnaires

Cardiac contusion is an increasingly recognized entity in patients with nonpenetrating chest injury. Unifortunately, the diagnosis of cardiac trauma, particularly cardiac contusion, is imprecise and may be confounded by the presence of associated injuries, hypoxia, shock, and metabolic abnormalities. Symptomatic cardiac injury follwing blunt chest trauma is relatively rare, and valvular injury is even rarer. The valves most commonly affected are mitral and tricuspid. Although tricuspid regurgitations are usually asymptomatic and can resolve spontaneously, recent developments in echocardiography made possible the precise diagnosis of valvular injuries noninvasively, The authors report the case of tricuspid regurgitation incidentally detected by echocardiography in a construction worker who had suffered multiple fractures.
Anoxia ; Contusions ; Diagnosis ; Echocardiography* ; Humans ; Shock ; Thoracic Injuries ; Thorax ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

No abstract available.
Antibodies* ; Fetus* ; Heart Block* ; Heart*

PURPOSE: The purpose of this study is to evaluate the surgical outcomes of the clavicle lateral end fracture fixed with an oblique T locking compression plate (LCP). MATERIALS AND METHODS: Fourteen clavicle lateral end fractures were fixed with the oblique T-LCP and followed up for at least 1 year after the surgery. Thirteen cases were unstable Neer type II fractures and one case was nonunion of the Neer type I fracture. The mean age was 46 years of age (range, 26~70). In ten cases, augmenting sutures with the absorbable suture material were placed in the coraco-clavicular ligament and around the plate and the clavicle to improve the stability of fracture fixation. Autogenous iliac bone graft was done in four cases. The clinical outcomes were evaluated by using UCLA scoring system and KSS (Korean Shoulder Score). RESULTS: The mean UCLA score was 33.5 and the mean KSS was 94.9. Average time of bone union was 11.9 weeks (range, 6~28), including 1 case with a delayed union. There was no complication such as loss of fixation or nonunion. CONCLUSION: Fixation with the oblique T-LCP is a good option providing reliable functional results in clavicle lateral end fractures.
Clavicle ; Fracture Fixation ; Ligaments ; Shoulder ; Sutures ; Transplants

Purpose: To report a rare case of slow progression of carotid cavernous fistula (CCF) with central retinal vein occlusion (CRVO).Case summary: A 66-year-old man presented with conjunctival injection and proptosis in the right eye. Best-corrected visual acuity was 0.8 and 0.5 in the right and left eye, respectively, and conjunctival vessel enlargement and subconjunctival hemorrhage were observed in the right eye on slit lamp examination. Due to suspicion of CCF, computed tomography, computed tomography angiography, magnetic resonance imaging, and magnetic resonance angiography were performed. These analyses showed no vascular abnormalities associated with arteriovenous shunt, so the patient was followed up closely. About 1 month later, his conjunctival vessel engorgement became severe and CRVO derived from venous stasis by CCF occurred, so transfemoral cerebral angiography was performed and a diagnosis of CCF was made. Intravitreal anti-vascular endothelial growth factor injection was performed for CRVO, and best corrected visual acuity improved to 1.0 in the right eye. Conclusions Slowly progressing CCF can be accompanied with rare intraocular disease, such as CRVO, so appropriate diagnosis through detailed evaluation is important for treatment.

Background: Oral retinoids are used to treat various dermatological conditions, and their use is increasing in women of childbearing age. However, there is limited knowledge on the incidence of adverse outcomes after retinoid exposure during pregnancy. We aimed to evaluate the risk of adverse outcomes associated with oral retinoid exposure during pregnancy. Methods: We conducted a retrospective cohort study using the NHIS mother-child linked healthcare database in South Korea. We included all women who gave live birth from April 1, 2009 to December 31, 2020 and their children. The exposure was defined as having ≥ 1 prescription of isotretinoin, alitretinoin, and acitretin from one month before pregnancy to the delivery. The outcomes of interest were adverse child outcomes including major congenital malformations, low birth weight, and neurodevelopmental disorders (autism spectrum disorder and intellectual disorder), and adverse pregnancy outcomes including gestational diabetes mellitus, preeclampsia, and postpartum hemorrhage. Propensity score-based matching weights were used to control for various potential confounders. For congenital malformation, low birth weight, and adverse pregnancy outcomes, we calculated relative risk (RR) with 95% confidence interval (CI) using a generalized linear model and for neurodevelopmental disorders, we estimated hazard ratio (HR) with 95% CI using the Cox proportional hazard model. Results: Of 3,894,184 pregnancies, we identified 720 pregnancies (0.02%) as the oral retinoid-exposed group. The incidence of major congenital malformation was 400.6 per 10,000 births for oral retinoid-exposed group and 357.9 per 10,000 births for unexposed group and the weighted RR was 1.10 (95% CI, 0.65–1.85) in oral retinoid-exposed group compared with unexposed group. The neurodevelopmental disorder showed a potential increased risk, with the weighted HR of 1.63 (95% CI, 0.60–4.41) for autism spectrum disorder and 1.71 (95% CI, 0.60–4.93) for the intellectual disorder, although it did not reach statistical significance. For low birth weight and adverse pregnancy outcomes, no association was observed with oral retinoid exposure during pregnancy. Conclusion This study found no significantly increased risk of congenital malformations, autism spectrum disorders, and intellectual disability associated with oral retinoid exposure during pregnancy; however, given the limitations such as including only the live births and increased point estimate, potential risk cannot be fully excluded.