Many kinds of different treatment options for fecal incontinence such as biofeedback therapy, anterior or posterior sphincteroplasty, pelvic floor repair, gracilis or gluteus muscle transposition have been introduced. However, appropriate indications for these treatment options have not yet been delineated up to now. PURPOSE: The aim of this study was to access the preoperative severity of fecal incontinence by physiologic tests to give an idea that indications of appropriate selection criteria and parameters for assess the outcome could be simultaneously considered by preoperatively objective physiologic data. MATERIALS AND METHODS: From January 3, 1997 to, August 1, 1997 all patients with fecal incontinence who visited colorectal clinic in the Department of Surgery, Korea Veterans Hospital, were classified into two groups according to the severity of fecal incontinence (0~20): Group I (1~9), Group II (10~20) and compared them with the results of physiologic tests: anorectal manometry, endorectal ultrasound (ERU), cinedefecography, and pudendal nerve terminal motor latency (PNTML). Statistical analysis was performed by Student's-t test, and Chi-square test and p<0.05 was considered significant. RESULTS: The number of GI was 25, and GII was 22. There were no differences between the two groups in terms of age (GI: 57.7+/-14.5, GII: 61.4+/-14.0years), gender (male: female, 19:6, 16:6), cause (neurogenic; 11/25 (GI),7/22(GII), postanal surgery; 6/25,6/22) obstetric trauma (2/25, 2/22), anal trauma (1/25, 1/22) diabetes melitus (1/25, 2/22), rectal prolapse (2/25, 1/22), and others (2/25, 3/22), duration of fecal incontinence (64.4+/-82.2, 48.7+/-65.3 months), high pressure zone (3.3+/-1.7, 3.5+/-1.4 cm), mean resting pressure (50.5+/-27.0, 51.9+/-18.7 cm H2O), maximal resting pressure (88.4+/-50.6, 89.4+/-41.8 cm), maximal squeezing pressure (150.6+/-71.0, 129.7+/-59.5 cm H2O), rectoanal inhibitatory reflex (13/21, 8/21 positive), sensitivity (37.5+/-15.2, 41.8+/-29.0 cc), compliance (19.0+/-14.5, 21.4+/-39.4 cc/cm H2O) in anorectal manometric findings, anal sphincter defect (13/21, 15/22 positive), size of defect (60+/-26.30degrees, 71 +/-30.8degrees/360degrees), thickness of the external anal sphincter (3.46+/-0.78, 3.84 +/-1.02 cm), thickness of internal anal sphincter (1.58+/-0.79, 1.74+/-0.81 cm) in ERU, anorectal angle in rest (85.2+/-28.0degrees, 97+/-22.9degrees), squeeze (72+/-27.1degrees, 82 +/-19.7degrees), push (100+/-43.9degrees, 117.9+/-34.5degrees), length of perineal descent in rest (3.7+/-1.2, 3.6+/-1.7 cm), squeeze (2.9+/-1.5, 2.7+/-1.5 cm), push (7.9+/-3.5, 6.6+/-2.6 cm) in cinedefecography. However, rectal capacity in manometry (212.5+/-99.9, 155+/-51.5 cc, p<0.05), right PNTML (1.73+/-0.39, 2.71+/-0.83 ms, p<0.001), and left PNTML (1.83+/-0.43, 2.94+/-0.80 ms, p<0.001) were significantly increased in GII compare to those of GI. CONCLUSION: As the severity of fecal incontinence was increased, rectal capacity, right and, left PNTML were increased.
Anal Canal ; Biofeedback, Psychology ; Compliance ; Fecal Incontinence* ; Female ; Hospitals, Veterans ; Humans ; Korea ; Manometry ; Patient Selection ; Pelvic Floor ; Pudendal Nerve ; Rectal Prolapse ; Reflex ; Ultrasonography

No abstract available.
Sarcoma*

No abstract available.
Craniosynostoses*

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

OBJECTIVE: Linkage analysis is a very useful method for prenatal diagnosis of Hemophilia B, especially when a mutation was not identified. Seven polymorphic markers were studied in Korean populations to evaluate the efficiency for prenatal and carrier diagnosis. METHODS: Subjects of this study was 100 healthy Korean women (200 X-chromosomes). Polymerase chain reacton-restriction fragment length polymorphism (PCR-RFLP) method was used to detect SalI, MseI, NruI, DdeI, XmnI, TaqI and HhaI polymorphisms. RESULTS: SalI (-) allele showed the frequency of 0.355 and SalI(+) allele 0.645. MseI(-) allele was 0.645 in frequency and MseI(+) allele was 0.355. SalI and MseI polymorphisms were in complete linkage disequilibrium. And no increase was expected in overall heterozygosity with these two polymorphisms. NruI(-) allele frequency was 0.855 and NruI(+) was 0.145. There was no polymorphism of DdeI, XmnI and TaqI marker systems in Korean population. In HhaI polymorphism, allele frequencies were estimated that HhaI(-) is 0.82 and HhaI(+) is 0.18. CONCLUSION: Only SalI, NruI and HhaI polymorphisms are useful for the diagnosis of hemophilia B in Korean population. Expected heterozygosity for above 3 poylmorphic markers was estimated to be 0.723, and 71 of 100 female subjects were heterozygous for at least one marker system. Korean population showed relatively low extent of polymorphisms compared to Caucasians, Blacks and Japanese. For the effective prenatal diagnosis of hemophilia B with linkage analysis, other polymorphic markers should be evaluated.
African Continental Ancestry Group ; Alleles ; Asian Continental Ancestry Group ; Diagnosis ; Factor IX* ; Female ; Gene Frequency ; Hemophilia B ; Humans ; Linkage Disequilibrium ; Prenatal Diagnosis

No abstract available.
Ulcer*

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.
Hospitals, Veterans ; Humans ; Korea ; Sigmoidoscopes ; Sigmoidoscopy*

The Korean Neuropsychiatric Association has decided that the existing nomenclature "Schizophrenia" should be replaced with "Attunement disorder" in order to mitigate prejudices from the general public. In this process, "attunement" was meant to express the harmonious relationship and organic integration among the various substructures of global mental functioning. However, the term "attunement" and related concepts had occupied an important position in discourses surrounding the fundamental concept of schizophrenia. In this regard, the historical vicissitudes of the term "attunement" in the context of schizophrenia research was discussed. The term "attunement" is an English translation of Heideggerian expressions "Befindlichkeit" and "Stimmung". It is used by Heidegger to convey the emotional experience of Dasein's inextricable entanglement with the surrounding interpersonal world. Heidegger's philosophical works formed the theoretical foundation for the so-called Phenomenological-anthropological psychiatry. Psychiatrists influenced by this approach argue that patients with schizophrenia suffer from a sense of alienation and bewilderment resulting from loss of normal attunement. In addition, they stress that the loss of attunement brings about distorted self-experience, which leads to strange and uncanny life experiences exiled from intersubjectivity based society. From the phenomenological perspective, mind or consciousness is not a solipsistic Cartesian reason confined to the brain, but an intentional existence embedded in the interpersonal and intersubjective worlds. In the developmental period, intentional relationship between the consciousness and the world has been acquired from repeated shared experiences with other people via intersubjectivity. The intersubjective experiences also contribute to maintenance of solid attunement even after reaching mature adulthood. Whatever the reason, losing the tacit understanding of the world will cause disintegration of the foundation of intersubjectivity and confusion with regard to the certainties of self and the world. This state was described as "Attunement disorder". Recent emphasis on neurobiological understanding of schizophrenia has impeded the proper appreciation of Phenomenological-anthropological understanding of schizophrenia, one of the valuable heritages of psychiatry. Meanwhile, the concept of phenomenological understanding or embedded cognition has recently gained renewed attention among neuroscientists studying neurobiological correlates of consciousness. Standing on the pivotal point witnessing the conceptual change from "Schizophrenia" to "Attunement disorder", reappraisal of the past heritage from modern perspectives would be a valuable endeavor for advancement of psychiatry.
Brain ; Cognition ; Consciousness ; Emigrants and Immigrants ; Humans ; Life Change Events ; Prejudice ; Psychiatry ; Schizophrenia

We experienced a case of DiGeorge syndrome in a 25-day-old male infant presented with micrognathia, short neck, fish-shaped mouth and intractable seizures with a loading dose of phenobarbital & dilantin. The serum calcium level was 3.7mg/dl, ionized calcium level was 0.62mmol/L, and parathyroid hormone carboxy-terminal level was 0.01ng/ml. We treated with it calcium gluconate infusion, low phosphorous formula milk feeding, and 1,25 (OH) 2D3. The serum calcium level was normalized in 3 days but fever and diarrhea symptom continued for 3 weeks. T-cells decreased, no thymus shadow was visible in chest MRI, and no reaction to delayed hypersensitivity skin test was detected at 9 months old. He has been followed up at the outpatient department, showing normal calcium level with the supplementation of calcium gluconate and 1,25 (OH) 2D3 for 10 months. A brief review of literatures was made.
Calcium ; Calcium Gluconate ; Diarrhea ; DiGeorge Syndrome* ; Fever ; Humans ; Hypersensitivity, Delayed ; Hypocalcemia ; Infant ; Magnetic Resonance Imaging ; Male ; Milk ; Mouth ; Neck ; Outpatients ; Parathyroid Hormone ; Phenobarbital ; Phenytoin ; Seizures ; Skin Tests ; T-Lymphocytes ; Thorax ; Thymus Gland

PURPOSE: To investigate the usefulness of the serum Creatine kinase(CK), especially brain typical creatine kinase(CK-BB) as an indicator of brain damage extent, mortality and long term nurologic sequelae, the study was done. METHODS: CK and CK isoenzyme activites were measured at 6-10 hours after birth in 160 asphyxiated newborn infants who admitted in Eulji General Hospital from August 1990 to July 1994. Infants were followed up for 1 years after birth to evaluate survival and neurologic outcome. RESULTS: 1) There was low correlation between CK-BB and 5 minute Apgar score(r=0.245, p=0.0026). 2) There was intermediate correlation between CK-BB and Lactic dehydrogenase (LDH)(r=0.470, p<0.0001). 3) Infants who died within 24 hours after birth had significantly higher CK-BB activity(144.9+/-98.5U/L) than survivors(82.2+/-159U/L), (p=0.0160). Infants who died within 72 hours after birth had significantly higher CK-BB activity(130.2+/-108.4U/L) than survivors(80.5+/-161.1U/L), (p=0.0209) 4) Infants who died within 24 hours after birth had significantly higher CK-BB%(23.4+/-17.4%) than survivors(9.6+/-11.9%), (p=0.0042). Infants who died within 72 hours after birth had significantly higher CK-BB%(20.0+/-15.4%) than survivors(9.3+/-11.8%), (p= 0.0027). Infants who died within 28 days after birth had significantly higher CK-BB% (12.7+/-13.4%) than survivors(9.7+/-12.3%), (p=0.0500). 5) In the cases of neonatal seizure in 24-48 hours after birth, CK-BB was higher than in the cases of no seizure or seizure in 48 hours after birth. 6) CK-BB was well correlated to the grade of hypoxic ischemic encephalopathy. 7) CK-BB, CK-BB% and 5 minute Apgar score showed similar positive and negative predictive values for survival rate, abnormal findings of imaging studies and neurologic outcomes. CONCLUSIONS: CK-BB is a good predictive value for the death within 24 and 72 hours after birth and the neonatal seizure in 24-48 hours after birth. CK-BB% is a good predictive value of the death within 24, 72 hours and 28 days after birth. CK-BB, CK-BB% and 5 minute Apgar score showed similar predictivity for neurologic outcomes during 1 years after birth.
Apgar Score ; Asphyxia* ; Brain ; Creatine Kinase* ; Creatine* ; Hospitals, General ; Humans ; Hypoxia-Ischemia, Brain ; Infant ; Infant, Newborn ; Isoenzymes* ; Mortality ; Oxidoreductases ; Parturition ; Seizures ; Survival Rate