A retrospective study of 274 patients who presented with constipation was done. The following results were obtained by recording colonic transit time. The male to female ratio was 72 : 197, and most patients were in their third and fifth decade, each age group accounting for 21% of total number. Associated symptoms were anal discomfort(33%), abdominal discomfort (25%), hematochezia (23%), reduced stool caliber (11%), and tenesmus (8%). As a result, 223 patients had normal transit time and 51 patients had abnormal transit time. Eighty-six patients with normal transit time and 51 patients with abnormal transit time underwent barium enema or colonoscopic examination. Abnormal lesions such as polyps and diverticulums were found in 10 patients with normal transit time and 7 patients with abnormal transit time. Therefore barium enema and colonoscopic examination in the patients with abnormal transit time were meaningful (P=0.024). Eighteen out of 25 patients with normal transit time and 8 (67%) of 12 patients with abnormal transit time showed abnormal defecogram results. The rectocele was the most frequent cause of abnormality in defecogram. Abnormal anal manometry results were obtained in 5 (22%) of 23 patients with normal transit time and 3 (50%) of 6 patients with abnormal transit time. Three types were classified in the patients with abnormal transit time. With type II patients, anal manometry findings were normal and 2 patients showed abnormal results in defecogram. With type III patients, 5 (43%) of 12 patients showed abnormal results in defecogram and 3 (50%) of 6 patients had abnormal anal manometry findings. Conclusively, if abnormal transit time is found in the patients with chronic consipation, further evaluations such as barium enema or colonoscopic examination are necessary. And even in the patients without any abnormality in transit time, selected performance of defecogram and anal manometry depending on clinical symptoms are preferable.
Barium ; Colon* ; Constipation* ; Diverticulum ; Enema ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Manometry ; Polyps ; Rectocele ; Retrospective Studies

A construct DNA containing the cDNA for rat tyrosine hydroxylase(TH) and another construct DNA containing the cDNA for bovine L-dopa decarboxylase(DDC) were made and those genes were transferred by calcium phosphate transfection method into the immortalized rat fibroblasts. A both TH- & DDC-positive clone was identified by immunocytochemical staining. These cells produced L-dopa and dopamine and released them into the cell culture medium in vitro, which was confirmed by high performance liquid chromatography. These results have general implications for the application of gene therapy and specific implications for Parkinson disease.
Animals ; Calcium ; Cell Culture Techniques ; Chromatography, Liquid ; Clone Cells ; DNA ; DNA, Complementary ; Dopamine* ; Fibroblasts* ; Genetic Therapy ; Levodopa* ; Parkinson Disease ; Rats* ; Transfection ; Tyrosine ; Tyrosine 3-Monooxygenase

A construct DNA containing the cDNA for rat tyrosine hydroxylase(TH) and another construct DNA containing the cDNA for bovine L-dopa decarboxylase(DDC) were made and those genes were transferred by calcium phosphate transfection method into the immortalized rat fibroblasts. A both TH- & DDC-positive clone was identified by immunocytochemical staining. These cells produced L-dopa and dopamine and released them into the cell culture medium in vitro, which was confirmed by high performance liquid chromatography. These results have general implications for the application of gene therapy and specific implications for Parkinson disease.
Animals ; Calcium ; Cell Culture Techniques ; Chromatography, Liquid ; Clone Cells ; DNA ; DNA, Complementary ; Dopamine* ; Fibroblasts* ; Genetic Therapy ; Levodopa* ; Parkinson Disease ; Rats* ; Transfection ; Tyrosine ; Tyrosine 3-Monooxygenase

BACKGROUND: As the incidence of coloanal diseases has been steadily increasing during the past few decades in Korea, we illustrate the necessity of a specialized colorectal clinic for the efficient management of such diseases. METHOD: Outpatients at our colorectal clinic were studied epidemiologically and clinically by retrospective studies between November 1986 to December 1996. RESULTS: During this period, the total number of outpatients were 30,590 of which 24% were new patients. The patient pool consisted of anal diseases (62%), colon diseases (28%) and other diseases (10%). In this study, we found that condyloma, perianal abscesses, anal fistulas were predominant in males compared to females while rectovaginal fistulas, functional bowel diseases, and perianal fissures were predominant in females. There was no sexual bias for rectal cancer. Colorectal diseases occurred in all age groups; however, the peak age was in the fourth or fifth decade where social activity was maximum. There was a variation in age incidence among different disease entities. The range of age for benign conditions such as hemorroids, perianal abscessess and functional bowel diseases were from the third to the fifth decades; however, malignant lesions such as colon cancer were frequently seen in older patients (> 40 years). Condyloma was frequently seen in younger patients (< 20 years). There were no monthly variations in the incidences of colorectal diseases. Yearly variations were not found for colorectal disease, but were found for cancer. Of the cancers, the incidence of rectal cancer was higher than s-colon cancer or colon cancer in year variations. The diagnostic time has been reduced significantly over the past decade. The mean time required for a diagnosis work up in the period from 1984 to 1986 was 9.4 days; the diagnostic time in the period from 1993 to 1996 was 4.7 days. CONCLUSIONS: The incidences of coloanal disease have increased recently in Korea; thus, the demand for an efficient outpatient colorectal clinic has inevitably increased. We concluding that a specialized clinic, such as our colorectal clinic, has become essential for properly managing the exploding number of coloanal patients in Korea.
Abscess ; Bias (Epidemiology) ; Colon ; Colonic Neoplasms ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Male ; Outpatients* ; Rectal Fistula ; Rectal Neoplasms ; Rectovaginal Fistula ; Retrospective Studies

PURPOSE: To evaluate the clinical usefulness of defecogrophy in diagnosing the etiology and pathophysiology of constipation. A retrospective study of 56 constipated patients who had no abnormalities in colonoscopy, barium enema and rectal exam were done. METHODS: Fifty-six patients (12 men, 44 women) with constipation underwent defecography and 37 of the patients underwent colonic transit studies. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum. RESULTS: Normal defecography finding was observed in thirteen of the 56 patients. Rectocele, spastic levator syndrome (nonrelaxing puborectalis syndrome), sigmoidocele, rectal prolapse, rectal intussusception were observed in 67% (38/56), 30% (20/56), 7% (4/56), 5% (3/56) and 2% (1/56) of the patients, respectively. More than one pathological finding was found in 23 (53%) patients. Of the 38 rectoceles, 17 cases were found to be associated with spastic levator syndrome. In solitary rectocele, the anorectal angles at rest, during straining were 92.65 9.08o, 108.09 14.35o, while 99.85 11.85o, 95.90 17.84o, in spastic levator syndrome. In 36 difficult bowel movements, 66% (24/36), 30% (11/36), 3% (1/36) were found to have rectocele, spastic levator syndrome, and sigmoidocele, respectively. Normal colonic transit time was observed in twenty six of the 37 patients. Abnormal findings included colonic inertia in 3 (8%) patients, hindgut dysfunction in 4 (11%) patients, and, outlet obstruction in 4 (11%) patients. Of the normal colonic transit time in 26, rectocele in sixteen, rectal prolapse in 1, spastic levator in 2 were observed. Rectoceles were observed in 2 out of 3 colonic inertia, in all 4 hindgut dysfunction, in 1 out of 4 outlet obstruction. CONCLUSIONS: Our findings suggest that constipation is often a disorder of defecation rather than a impairment of colonic motility. Defecography should be considered first of all in evaluating the pathophysiology of constipation, especially for whom complaining of difficult bowel.
Barium ; Colon ; Colonoscopy ; Constipation* ; Defecation ; Defecography* ; Enema ; Humans ; Intussusception ; Male ; Muscle Spasticity ; Rectal Prolapse ; Rectocele ; Rectum ; Retrospective Studies

Statistical analysis according to W.H.O. classification for the patients admitted the Ped. Dept. of Han-Il Hospital was carried out during 4 years from Jan. 1974 to Dec. 1977. The following results were observed. 1. Total No. of patient during 4 years period were 1955, of which 1199 were male(61.33%, 756 were female(38.67%) and male to femal ratio was 1.57:1. 2. There was no significant variation. 3. According to age, preschool aged group as the most frequent group consistin of 488 cases(24.49%), school aged group and adolescent in the order of frequency. 4. On monthly distribution, there was no significant variation 5. Most frequent diseases in pediatric age group were respiratory tract one, 851 cases(39.29%) : infectious and parasitic ones, 553(25.53%) and neonatal disease, 204 cases(9.42%) in the order of frequency. 6. Among respiratory tract disease, pneumonia was the most frequent one, 587 cases(27.10%). 7. Among infectious and parasitic disease group, gastrointestinal infectious one was the most frequent, 224 cases(10.34%) : other viral disease and tuberculosis in the order of frequency. 8. Among neonatal diseases, prematurity was the most frequent one, 82 cases(3.79%).
Adolescent ; Classification ; Humans ; Male ; Parasitic Diseases ; Pneumonia ; Respiratory System ; Respiratory Tract Diseases ; Tuberculosis ; Virus Diseases

PURPOSE: Establishing the preoperative stage of colorectal cancer is of primary importance in determining the management and the operative procedure. A comparative study of preoperative evaluation of colorectal cancer is necessary for proper management. METHODS: This study reports a 7 years' experience using another two species of CT for preoperative staging. One species of CT (1989, Delta 2060, Technicare, USA) was used from January 1990 to December 1992; the other species of CT (1992, Highlight Advantage, General Electric Company, USA) was used from January 1993 to December 1997. This study included retrospective analysis of 237 cases of colorectal cancer from January 1990 to December 1997. In first group, the preoperative stage evaluation was done with a much older species of CT from January 1990 to December 1992; in the other group, the preoperative stage evaluation was done with a newer species of CT from January 1993 to December 1997. RESULT: The accuracy & sensitivity of preoperative staging between the two groups showed no significant differences. CONCLUSION: CT is recommended in the preoperative staging of rectal cancer and as an aid in choosing the appropriate therapy. In addition to CT, transrectal ultrasonography and MRI are recommend for improving the accuracy of preoperative staging in assessing local invasion by cancer.
Colorectal Neoplasms* ; Magnetic Resonance Imaging ; Rectal Neoplasms ; Retrospective Studies ; Surgical Procedures, Operative ; Ultrasonography

During temporomandibular joint (TMJ) formation, discomalleolar ligament (DML) and anterior malleolar ligament (AML) are formed within the dorsal end of the 1st branchial arch. But, DML is known as a remnant or the degenerated tissue through the TMJ development. There is few reports said that damage of AML and DML cause the damage of middle ear during surgical procedures. Especially, in case of anterior disk displacement of TMJ, aural symptom can be made via DML due to hyperextension anteriorly. A few studies have been reported about DML and AML in embryological and histological points of view, morphology and clinical aspects of DML and AML are still unclear. Four fetuses and sixteen adult hemi -sectioned heads were dissected to clarify the topographical relationship of AML and DML and to find out the anatomico -clinical relevance related with temporomandibular disorder. In fetal specimens, DML was firmly attached from the disk of the TMJ to the malleus. Also, AML in which distinguished into the superior and inferior lamellae was running anteriorly and continuous with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). DML attached to the malleus was observed in all adult specimens and was expanded broadly to the disk and capsule of the TMJ as shown the V -shaped ligament structures. The average distance between the anterior aspects of the malleolar head to the anterior wall of the tympanic cavity was 1.13 mm(0.75 ~1.59), and the length of the DML from the anterior aspect of the malleolar head to the attached site to the TMJ capsule at the PTF was 5.37 mm (4.53 ~6.07). The average width of the DML at the PTF was 6.06 mm (4.72 ~7.46). Most of the posterior attachments of the DML were the cases in which DML was directly attached to the malleus (68.7%). In all specimens, DML was attached to the disk and capsule of TMJ and attached to the anteromedial border of the PTF concurrently. In this study, two morphological patterns of AML were observed according to the presence of the bony ridge on the Huguiers canal in the PTF. The bony ridge of the Huguiers canal showed DML and AML separately in 56.3%, and the fused pattern of DML and AML was observed in 43.7%. AML was not distinguished with two lamellae in most specimens, superior ligament fibers were attached to the anteromedial border of the PTF and most of the inferior lamella was entering the gap in PTF and continuous with the SML. Average length from the anterior aspect of the malleolar head to the exit point of the AML on the PTF was 8.40 mm(6.62 ~11.42), and the shortest distance between the AML and chorda tympani was 2.01 mm(1.25 ~3.02). Taken all together, DML and AML were not the rudimentary, but the distinguishable structures in adults. Through the various morphological findings, DML and AML were separated ligamentous structures in which might be given rise from the divergent origin. And the anterior hyperextension of the disk of TMJ did not lead the movement of the malleus in the tympanic cavity, whereas, the movement of the malleus followed by the traction of the AML and SML was observed in a few cases. So, this results can be explained the possibility of the clinical symptom on the middle ear in case of the over -traction of the AML and SML.
Adult* ; Branchial Region ; Chorda Tympani Nerve ; Ear, Middle ; Fetus* ; Head ; Humans* ; Ligaments* ; Malleus ; Running ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; Traction

The toxic effect of azalea extract, especially on cardiovascular system, in relatively unclear. The purpose of this study is to study the possible underlying mechanism and effect of toxic ingredient of azalea on cardiovascular system. The 71 healthy rabbits were divided into 10 groups: In group as preliminary study; 4 cc of normal saline was administered intravenously (N); 0.7 gm/kg and 1.0 gm/kg of azalea extract was administered respectively in the same route, volume (A1, A2); atropine was administered intravenously (A); after pretreatment with atropine (0.04 mg/kg) to block parasympathetic system, azalea extract was injected like the above groups (AA1, AA2); normal saline, 0.7 gm/kg and 1.0 gm/kg of azalea extract were administered respectively with 0.2 cc (1:1000) epinephrine (E0, E1, E2). We measured the following indices at I minute interval during first 10 minutes and then 10 minute interval during next 30 minutes: RR interval, QTc interval, maximal systolic and diastolic pressure drop with occurring time and presence of significant arrhythmia. The results were as follows: 1. The changes of RR interval, QTc interval were significantly increased in groups by Azalea extract. The blood pressure change was significantly decreased in groups by Azalea extract. There were no significant differences according to dosage of Azalea extract. 2. The changes of RR interval, blood pressure were significant differences between administration of atropine and Azalea extract after pretreatment with atropine, but not in the change of QTc interval. 3. There were no significant differences in the change of RR interval, ATc interval, blood pressure drop according to pretreatment with atropine. 4. The interaction between epinephrine and Azalea extract was not noted by the effect of epinephrine itself. 5. The ST change by 0.7 gm/kg, 1.0 gm/kg of Azalea extract was revealed in 1 case (14.0%), 7 case (100%), respectively. 6. Most of all cases with arrhythmia, ventricular tachycardia, ventricular fibrillation, were noted in the group by epinephrine, except on case by Azalea extract (1.0 gm/kg). It was idioventricular rhythm. In conclusion, azalea extract has negative inotropic and chronotropic effect with arrhythmogenic potential possibly through direct myocardial ischemia or injury but we can't be absolutely exclusive of actions of autonomic nervous system, especially parasympathetic nervous system.
Arrhythmias, Cardiac ; Atropine ; Autonomic Nervous System ; Blood Pressure ; Cardiovascular System* ; Epinephrine ; Myocardial Ischemia ; Parasympathetic Nervous System ; Rabbits ; Tachycardia, Ventricular ; Ventricular Fibrillation

OBJECTIVES: Insertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients. METHODS: PubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature. RESULTS: In total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding. CONCLUSION: The findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.
Dacryocystorhinostomy* ; Endoscopy ; Hemorrhage ; Humans ; Intubation* ; Population Characteristics ; Postoperative Complications ; Silicon* ; Silicones* ; Stents