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.
Edema* ; Hydrops Fetalis*

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.
Adolescent ; Bone Density* ; Calcification, Physiologic ; Child* ; Humans ; Obesity* ; Osteocalcin ; Pediatric Obesity ; Puberty ; Sex Characteristics ; Sexual Maturation ; Skeleton

BACKGROUND: Surgical closure of the PDA in premature infants with complications or contraindications to indomethacin use, or recurrence of symptomatic PDA is a safe and effective procedure with low operative risk and minimal complications. MATERIAL AND METHOD: From April 1996 to August 1998, 11 premature infants with body weight under 1.5 kg at operation underwent operation for a symptomatic PDA (male:5, female: 6). Associated dise ases were congenital heart disease(7), hyaline membrane disease(6), intraventricular hemor rhage(4), pneumonia(4), pneumothorax(3), hyperbilirubinemia(2), necrotizing enterocolitis(2), renal failure(1), epilepsy(1), and hydrocephalus(1). Surgical techniques are hemoclipping(8) and ligation(3). The size of PDA was 3~6 mm (5.0+/-1.2). RESULT: Systolic and diastolic blood pressure rised and heart rates decreased after PDA closure. ABGA improved postoperatively. There were no surgical complications. Six infants with improved ABGA data were weaned from mechanical ventilatory support. The follow-up durations after discharge were 3 month to 12 month. Five deaths were not related to operation. The causes of death were hyaline membrane disease(2), bronchopulmonary dysplasia with pneumonia(1), sepsis(1), and con gestive heart failure with respiratory distress syndrome(1). CONCLUSION: Early operative closure is the treatment of choice in most premature infants with a hemodynamically significant shunt(PDA), recurrence of symptomatic PDA, complications of Indomethacin, or contraindi cations to Indomethacin.
Blood Pressure ; Body Weight ; Bronchopulmonary Dysplasia ; Cations ; Cause of Death ; Ductus Arteriosus, Patent ; Female ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Rate ; Humans ; Hyalin ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature* ; Membranes ; Recurrence

No abstract available.
Edema* ; Hydrops Fetalis*

Background: Understanding adolescents’ mental health during the coronavirus disease 2019 (COVID-19) pandemic and identifying those most at risk is an urgent public health challenge.This study explored the trend of suicide attempts and the association between loneliness, family financial stress, and suicide attempts during the COVID-19 pandemic among adolescents. Methods: Data of the 2020 to 2022 Korea Youth Risk Behavior Surveys for adolescents aged 13–18 years were used. Multivariate logistic regression analyses were performed to examine the association between suicide attempts, family financial stress, and loneliness during the COVID-19 pandemic. Results: The trend of suicide attempt rates was lowest in 2020 (1.9%, 1,034 out of 53,534) and it showed an increasing trend with rates of 2.2% (1,159 out of 53,445) in 2021 and 2.5% (1,271 out of 50,455) in 2022. The risk of suicide attempt was higher among adolescents who experienced financial stress (in 2020: adjusted odds ratio [AOR], 1.53, 95% confidence interval [CI], 1.26–1.88; in 2021: AOR, 1.63, 95% CI, 1.03–1.54) and felt lonely (in 2020: AOR, 2.19, 95% CI, 1.78–2.70; in 2021: AOR, 2.65, 95% CI, 2.16–3.26; in 2022: AOR, 1.3, 95% CI, 1.04–1.55) than those who did not. Conclusion The COVID-19 pandemic affected the suicide attempts of adolescents, with financial stress and feelings of loneliness closely linked to this impact. Although the pandemic nears its end, the persistent risk of suicide attempts among adolescents remains a concern. Therefore, it is imperative to implement targeted screening and interventions to address adolescent suicide risk.

A pressure sore, such as quadriplegia, is developed in patients who have been idle in bed for a long time, particularly in the spinal cord. The treatment is particularly difficult in cases of multiple recurrent sores, osteomyelitis with pathologic fractures, other underlying conditions such as diabetes mellitus, immuno-suppression, or radiotherapy. Over the last 20 years, the development and popularization of rectus abdominis flap have significantly increased for reconstruction of a wide variety of difficult clinical problems. From March 2000 to Dec 2001, 6 neurologically impaired patients underwent reconstruction of chronic pressure sores utilizing an inferiorly based rectus abdominis musculocutaneous flap. Postoperative follow-up ranged from 6 to 15 months. The average thickness of rectus abdominis muscle in quadriplegic patient is less than half of that in healthy patient. In most cases, mild venous congestions are developed, but these were resolved by medical treatment. All wounds have healed without any significant complications such as flap loss, infection, hernia, and sepsis. In conclusion, rectus abdominis muscle for these reconstructions provides a simple, reliable solution to often difficult reconstructive problem. We recommended this highly viable, versatile and reliable flap as one to be considered in planning the reconstruction of the quadriplegia patient with pressure sores when other local and regional flaps are unavailable.
Diabetes Mellitus ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Fractures, Spontaneous ; Hernia ; Humans ; Myocutaneous Flap ; Osteomyelitis ; Pressure Ulcer* ; Quadriplegia* ; Radiotherapy ; Rectus Abdominis* ; Sepsis ; Spinal Cord ; Wounds and Injuries

BACKGROUND: Atrial fibrillation (AF) is known as a major independent risk factor of cardioembolic stroke. The aim of this study is to compare topographic characteristics of the middle cerebral artery (MCA) territory infarction between in patients with AF and without AF, which explain the cardioembolic infarction as a main manifestation in patients with AF. METHODS: We retrospectively investigated patients with MCA territory infarcts on routine MRI. Thirty-two patients with AF (AF group) and forty-two patients with normal sinus rhythm (NSR group) were compared. Topographic patterns and vascular status of intracranial vessels were analyzed in two groups. RESULTS: In AF group, possible or probable cardioembolic stroke was 78%. The significant stenosis of extra- or intracranial artery was 19% in AF group. The simultaneous involvement of cortical and basal ganglia (p < 0.01) and silent infarctions on contralateral hemisphere (p < 0.01) were more frequent in AF group. The involvement of insular cortex was common in both groups. CONCLUSIONS: In our study, cardioembolism is the most probable cause of cerebral infarction in AF group. Above find-ings may be applied to the proper management of cerebral infarction associated with AF.
Arteries ; Atrial Fibrillation* ; Basal Ganglia ; Cerebral Infarction ; Constriction, Pathologic ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Retrospective Studies ; Risk Factors ; Stroke

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

BACKGROUND: Recently, open heart surgerys using homograft are progressively increasing in complex cardiac anomalies, and even though the use of homograft tissues harvested from hearts of transplant recipients and brain-death patients are allowed and their use is increasing, the supply of homograft tissue is very limited. MATERIAL AND METHOD: The large diameter homografts are difficult to apply directly for RVOT reconstruction of small neonatal and infant hearts due to the size mismatching. Therefore, were surgically down-sized the large diameter tricuspid homograft into bicuspid conduits by means of a longitudinal incision of the oversized homograft, excision of one cusp, and oversewing of the"Bicuspid homograft"wrapped around a Hega dilator of the appropriate size. RESULT: 3 patients(Male 1, Female 2: tetralogy of Fallot with pulmonary atresia), ranging in age from 5 months to 4 years and ranging in weight from 5.5Kg to 12.95Kg underwent reconstruction of the RVOT with bicuspid conduits obtained by appropriate tailoring from large-diameter homografts. The mean follow-up period was 4.3 months(range, 2 to 6 months). There were no complications related to the homograft tissues. CONCLUSION: In the short term follow-up, the bicuspid homografts provided good competence and excellent hemodynamics although a long term follow-up is needed to assess the functions of the bicuspid homografts in RVOT. We believe this technique may be a more effective alternative than the use of synthetic conduits when the use of an appropriate-sized homograft is not possible.
Allografts ; Bicuspid* ; Bioprosthesis ; Female ; Follow-Up Studies ; Heart ; Hemodynamics ; Humans ; Infant ; Mental Competency ; Tetralogy of Fallot ; Transplantation ; Transplantation, Homologous