The use of the interlocking intramedullary nails expand the possibilities for treatment of femoral shaft fractures, as illustrated by consistent and satisfactory clinical results. However, the technique is relatively complex compared to conventional nails and frequently poses technical problems. A retrospective review was undertaken of twenty-eight patients with femoral shaft fractures which had technical problems after undergoing the closed reduction and internal fixation with interlocking intramedullary nail procedure. We studied the types of the problems. Their causes, the frequency of problems with various kinds of nails, and discussed solutions of the problems. There were 21 additional comminutions and intraop erative splinterings, 8 angular deformities, 3 malpositioned nails, 3 loosened distal locked screws, 2 brocken drill bits, and 1 femoral neck fracture. Bone-union was attained in all cases (28 patients), but the period of treatment to attain bone-union was protracted to an average of 6.8 (5-12) months. In 3 cases, the knee joint range of motion was of limited flexion, 70 to 90 degrees, but in all other cases full range of motion was realized. 7 cases required 2 or more operations. The hospitalization period was for an average of 3.6 months. In conclusion, the importance of careful preoperative planning and experienced surgical technique cannot be overemphasized because we could see no significant difference in the occurence of technical problems in several kinds of the nail.
Congenital Abnormalities ; Femoral Neck Fractures ; Fracture Fixation, Intramedullary ; Hospitalization ; Humans ; Knee Joint ; Range of Motion, Articular ; Retrospective Studies

PURPOSE: Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence. METHODS: Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them. RESULTS: All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis. CONCLUSION: FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.
Anal Canal* ; Fatigue* ; Fecal Incontinence ; Healthy Volunteers ; Hemorrhoids ; Humans ; Logistic Models ; Male ; Manometry ; Sensitivity and Specificity

PURPOSE: The rectoanal reflex is a response of the anal sphincter to rectal distension, reflecting the functional nature of the anal sampling mechanism of rectal discrimination. The role of this reflex in the continence mechanism is believed to be important, but it exact role still remains to be proven, and the stratification of this reflex, along to the degree of functional impairment of the anal sphincter, is rarely performed. The aim of this study was to assess the differences between various parameters of this reflex among healthy volunteers and incontinent and constipated patients. METHODS: The rectoanal contractile and inhibitory reflexes were recorded in 20 normal controls (group A) and 25 constipated (group B) and 19 incontinent patients (group C). The latencies, areas under the reflex curves, amplitudes and recovery times of each reflex were individually estimated, and differences between the groups statistically analyzed. RESULTS: The inhibitory reflex was not detected in 2 cases from group B (8.0%) and 1 from group C (5.26%). The contractile reflex was not detected in 2 cases from group A (10.0%), 8 from group B (32.0%) and 10 from group C (52.63%). There were no significant differences in any of the parameters in a comparison of the three groups. In a two group comparison, the amplitude and area under the reflex curves of the inhibitory reflex differed significantly between groups B and C (P=0.0373, 0.0238), and the latency of the contractile reflex differed significantly between groups A and C (P=0.0476). CONCLUSION: Both the rectoanal reflexes showed significant differences between the three patient groups, although this was not the case with all parameters. An analytical assessment of the various parameters of those reflexes would, therefore, make it possible to stratify the functional impairment of anal continence.
Anal Canal ; Discrimination (Psychology) ; Healthy Volunteers ; Humans ; Reflex*

No abstract available.
Calcaneus*

Primary chondrosarcoma of the extraskeletal soft tissue is extremely rare. Extraskeletal chondrosarcoma was first described as entity in 1953 by Stout and Verner, who were able to collect a series of seven cases. Because of the rarity of this lesion in extremities, neither the clinical course nor the preferred method of treatment has been clearly established. Authors report a case of extraskeletal chondrosarcoma which occurred on the right forearm of a thirty-nine-year-old man. The lesion was completely excised with free resection margins. There was no recurrence or metastasis for four years follow up.
Chondrosarcoma ; Extremities ; Follow-Up Studies ; Forearm ; Methods ; Neoplasm Metastasis ; Recurrence

PURPOSE: Cecal diverticulitis is rare but relatively common in Asians including Koreans. Furthermore, most case of cecal diverticulitis can be diagnosed as an acute appendicitis preoperatively. The purpose of this study was to evaluate antibiotic treatment for cecal diverticulitis, identified during laparotomy under the diagnosis of acute appendicitis. METHODS: From January 1995 to June 2001, we reviewed 52 patients with cecal diverticulitis, who were diagnosed as having acute appendicitis preoperatively and treated by conservative treatment, i.e. appendectomy only and postoperative antibiotics. RESULTS: The results were as follows. The male to female ratio and mean age was 1.2:1 and 33.4 respectively. The mean operative time was 55.4 minutes. The mean hospital stay was 5.9 days. The site of the diverticulitis was mostly located at the cecum (92.3%). Other sites of diverticulitis were the ascending colon in 2 patients, and the cecum and ascending colon in another 2 patients. The number of diverticulitis found was one in 44 patients (84.6%) and multiple in 8 patients (15.4%). Postoperative complications occurred in 6 patients (11.5%). The most common postoperative complication was wound infection, which occurred in 4 patients. There was no recurrence during follow-up. CONCLUSION: When cecal diverticulitis is found incidentally at the time of an emergency operation for acute appendicitis, we conclude that an appendectomy only combined with postoperative antibiotics is a safe, effective, cost-efficient and cosmetic method.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Asian Continental Ancestry Group ; Cecum ; Colon, Ascending ; Diagnosis ; Diverticulitis* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Laparotomy ; Length of Stay ; Male ; Operative Time ; Postoperative Complications ; Recurrence ; Wound Infection

PURPOSE: Recently, analytical studies of the various parameters of rectoanal inhibitory reflex were reported and revealed that many of the parameters showed significant differences according to the anal continence function. The standardization of these studies is, however, not yet sufficient enough to apply to use those parameters in reflex test for clinical practice. The aim of this study was to check how the parameters react differently to various degrees of rectal distention and to determine the efficacy of each parameter in clinical applications of rectoanal inhibitory reflex. METHODS: Thirty-two subjects underwent repeated manometries for rectoanal inhibitory reflex with different volumes (40, 60, 80 cc) of rectal ballooning. Latencies, amplitudes, slopes, durations, and areas under the reflex curves of the reflexes were measured, and the differences among them according to the ballooning volume in each subject were analyzed statistically. RESULTS: The area under reflex curve, the amplitude, the duration, and the slope did not differ statistically with the ballooning volume (P values were 0.3959, 0.2142, 0.2080, 0.1453, respectively, by repeated measures two way ANOVA). However, the latencies did differ significantly (P=0.0131). CONCLUSIONS: Most of the parameters except latency were stable against different volumes of rectal ballooning. Among the stable parameters, the area under the reflex curve seemed to be the most useful in clinical applications of rectoanal inhibitory reflex.
Manometry ; Reflex*

PURPOSE: Anal manometry is one of the most commonly used tests to evaluate fecal continence function. Advanced pressure parameters of the tests, such as fatigue rate index (FRI), resting rectoanal pressure gradient (RPG), cough index (CI), and radial asymmetry (RA) are recently devised to make up the inaccuracy of conventional parameters, but without solid verification. The object of this study is to investigate such parameters including conventional ones in incontinent patients compared with those in controls and to determine the significance of each parameter. METHODS: Forty-four patients with anal incontinence and 42 controls were studied. We examined conventional pressure parameters (mean resting pressure [MRP], maximum squeeze pressure [MXSP]) and advanced parameters (RPG, FRI, CI, RA), and compare those parameters with normal controls. Multiple logistic regression analysis and receiver operating characteristic curve analyses were also performed. RESULTS: No difference was detected in demographic factors between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 31.1+/-20.7 mmHg vs. 41.4+/-18.6 mmHg, P=0.0170; MXSP, 203.1+/-84.3 mmHg vs. 258.5+/-105.9 mmHg, P=0.0086). Among advanced parameters, RPG and FRI were significantly different (2.83+/-1.54 vs. 4.08+/-1.53, P=0.0003; 9+/-21.6 sec vs. 75.6+/-12.1 sec, P=0.0333), but CI and RA were not so different (0.74+/-0.45 vs. 0.61+/-0.33, P=0.1326; 22.7+/-7.0% vs. 21.1+/-7.6%, P=0.3244). Only RPG was significant in multiple logistic regression analysis (P=0.019). Areas under ROC curves were 0.65 for MRP, 0.65 for MXSP, 0.82 for RPG, and 0.73 for FRI. CONCLUSION: Among anal manometric pressure parameters, RPG and FRI as advanced parameters are more accurate than any other parameters in detecting fecal incontinence.
Cough ; Demography ; Fatigue ; Fecal Incontinence ; Humans ; Logistic Models ; Manometry ; ROC Curve

PURPOSE: Although the pudendal nerve terminal motor latency (PNTML) is normally used, there is no definite test that accurately reflects the function of the pudendal nerve. This study was undertaken to determine the relative accuracy of the various methods in measuring the function of the pudendal nerve. METHODS: Thirty one female patients (age 51.3+/-15.7) with a defecation disorder (constipation 20, fecal incontinence 11) were evaluated prospectively using a neurophysiologic test and balloon reflex manometry. Five parameters such as the right and left PNTML, anal mucosal electrosensitivity, latency and the amplitude of the rectoanal contractile reflex (RACR) were analyzed statistically for their correlation. RESULTS: There was no significant inter-test correlation among the parameters. However, the intra-test correlations between the parameters such as the right and left PNTML (r=0.9629, P<0.001)/latency and the RACR amplitude (r= -0.3770, P=0.0366) were found to be significant. CONCLUSION: The accuracy of these tests in evaluating the pudendal neuropathy could not be determined. However, because it can be assumed that a measurement of the RACR in addition to RNTML is technically accurate, it there will need to be more study for it to be used as an alternative to a PNTML measurement.
Defecation ; Fecal Incontinence ; Female ; Humans ; Manometry ; Prospective Studies ; Pudendal Nerve* ; Pudendal Neuralgia ; Reflex

PURPOSE: Currently, various tools are used for the diagnosis of nonrelaxing puborectalis syndrome (NRPRS), one of major causes of chronic constipation. Defecography, electromyography (EMG), balloon expulsion test, and a colon transit time study one examples of such tools, but none can be said to be the most accurate and effective one. A diagnosis is only made when two or more examinations show positive findings simultaneously. The aim of this study is to assess the correlation between EMG and the manometric defecation index (DI), which is a relatively new parameter, for the diagnosis of NRPRS. METHODS: Forty-two chronically cornstipated patients without any history of anal or abdominal surgery underwent both anorectal manometric and EMG tests. The manometric defecation index (DI) was defined as the ratio between the peak rectal pressure and the peak anal pressure when the pressures were measured simultaneously during push by the catheter with longitudinally arranged side holes. The ratio of EMG activity was defined as the ratio between the peak amplitude during push and the peak amplitude during rest when EMG activities were measured by using an anal plug electrode. The two variables were compared prospectively, and their correlation was analyzed. RESULTS: The manometric DI and the ratio of EMG activit in 42 patients were 0.80+/-0.75 and 1.50+/-0.65, respectively. The correlation coefficient between the two variables was -0.50 (P= 0.001). CONCLUSIONS: The manometric DI and the ratio of EMG activit were correlated significantly. Therefore, it can be said that the anorectal manometric test can replace the EMG test for diagnosis of NRPRS, which has less convenient access for most colorectal surgeons.
Catheters ; Colon ; Constipation ; Defecation* ; Defecography ; Diagnosis* ; Electrodes ; Electromyography ; Humans ; Prospective Studies ; Time and Motion Studies