Twenty to twenty-five percent of patients are reported to experience problems with anorectal function after low anterior resection, complaining particularly urgency of defecation and minor fecal leakage, but the mechanisms underlying its cause and the recovery process are not well understood. We designed this study to elucidate the mechanism of anorectal functional problems and its recovery process after low anterior resection for rectal cancer by autonomic nerve preserving procedure. Standardized interviews and anorectal physiologic studies including balloon proctometry and manometry were performed in 32 patients preoperatively, and at 1 month, 3 months, 6 months and 1 year after the operation. Postoperatively stool frequency increased, the ability to defer defecation and discriminate stool characters were compromised, and anal incontinence scores increased, which recovered progressively by 6~12 months after the operation. Balloon proctometry showed that threshold volume, urgent volume and maximal tolerable volume decreased remarkably after the operation. The latter two parameters recovered considerably by 1 year after the operation. Rectal compliance also decreased significantly but it showed no evidence of recovery by 1 year after the operation. Anorectal manometry showed that maximum anal resting pressure decreased significantly after the operation which recovered significantly by 1 year after the operation. Maximum anal squeeze pressure showed no significant decrease after the operation. In most patients rectoanal inhibitory reflex was abolished after the operation, which recovered only in some cases by after 1 year. The group of short residual rectum(<4 cm, N=18) showed more impairment in continence and decrease in neorectal capacity and compliance than that of the long residual rectum(> or =4 cm, N=14). These results suggest impairment in fecal continence occurs due to decrease in rectal capacity, compliance, and anal canal pressure, and loss of rectoanal inhibitory reflex. Autonomic nerve preserving procedure could not prevent the decrease in resting anal pressure. Continence recovers clinically with increase in neorectal capacity, compliance and anal canal pressure but not with recovery of rectoanal inhibitory reflex. The length of the residual rectum seems to play an important role in the degree of impairment of continence and good continence can be expected when the residual rectum is more than 4 cm.
Anal Canal ; Autonomic Pathways ; Compliance ; Defecation ; Humans ; Manometry ; Rectal Neoplasms ; Rectum ; Reflex

No abstract available.
Chinchilla* ; Vestibular Nerve* ; Vestibular Nuclei*

Recently there has been remarkable improvement in the treatment of chondrosarcoma, accompanied with the development of diagnostic tools, operative technique, replacement materials and designs, anticancer-chemotherapy and radiotherapy. In well-deferentiated chondrosarcom, wide excision is the only treatment required. Nevertheless, in dedifferentiated chondrosarcoma, anticancerchemotherapy or radiotherapy is usually recommended after the wide excision. From 1984 to 1994, 22 patients diagnosed as chondrosarcoma had been treated at Seoul National University Hospital. We analysed anatomic distributions, size, methods of treatment and their results. The avereage age was 38 years and 10 months(15 years 73 years) and the average follow-up period was 3 years and 10 months(1 year and 6 months
Chondrosarcoma ; Classification ; Fibula ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Methods ; Neoplasm Metastasis ; Osteochondroma ; Radiotherapy ; Seoul ; Transplants

No abstract available.
Oxidoreductases*

This investigation is an experimental study of the bone healing and remodeling process after Vertical Ramus Osteotomy(abbreviated as VRO) with early mobilization in adult dogs. Nineteen dogs were divided into three groups. Normal Control Group(N=2) was free of surgery. Experimental Group I(n=5) received only VRO without any intentional movements of distal fragments, and Experimental Group II(n=12) got VRO and backward driving of distal fragments. Animals were killed serially and the operated sites were reviewed grossly and histopathologically after the plain radiographs and Magnetic Resonance Images(abbreviated as MRI) were taken. The obtained results are as follows : 1. The early bone healing after VRO occurred mainly by the fusion of endosteal and subperiosteal calluses, and osteoinduced calluses from the cortices of fragments in intramembranous bone formation process. And the cartilaginous bone formations, which were considered to be associated with early functional movements of the mandible, were evident at the junction of these calluses. 2. The overlapping cortices of each fragment were fused by the osteoinduced calluses after decreased mobility of fragments mainly achieved by the subperiosteal calluses at the ateral and posterior part of pterygomasseteric sling. 3. Osteocytes in the cortices of fragments were dead by ischeinia and the marrow tissues were predominantly replaced by fibrous tissues in early stages. Active revascularization in the cortex and formation of new bone in the marrow, seen as the cancellous bones, were observed almost simultaneously and they were maintained until the 8th week when bone unions were confirmed. 4. Morphology of the mandible was changed byremodeling of the bone with reattachments of adjacent muscles after the 8th week. Callus in the gap was changed more and more into the compact bone after the 8th week, which united the proximal and distal fragments securely. 5. Low or iso-signal intensity at the cortex of fragments in early stages of MRI was being increased from the 4th week till the 12th week after VRO. The marrow spaces had high signal intensities on the T2-weighted images in early stages, but they returned to normal T1 and T2 high signals after the 12th week. 6. Signal intensities of the interfragmentary gap were high at the early stages and were gradually decreased to low signals at the 24th week. Atrophy of the masseter muscles with the high signal spots suggesting the increased vascularity was seen from the 2nd week, but the recovery of muscular volume with disappearance of high signal spots were also observed after the 8th week. In summary, the overlapped fragments made by VRO were completely healed by true bony union in adult dogs, even though they had cortex to cortex overlapping and early mobilizations had been allowed. Development of caelluses through the intramembranous bone formation, and the cartilaginous bone formations at the union of them tore mainly involved in the early bone healing. Direct communication of the marrows of the both segments was not found in this investigation, and more advanced study will be needed to explain the details of the fate of bony union after VRO.
Adult* ; Animals ; Atrophy ; Bone Marrow ; Bony Callus ; Dogs* ; Early Ambulation* ; Humans ; Magnetic Resonance Imaging ; Mandible* ; Masseter Muscle ; Muscles ; Osteocytes ; Osteogenesis ; Osteotomy*

To pursue a desirable format for the pathological diagnosis of liver cirrhosis, the authors attempted to classify 369 biopsy-proven cirrhosis on the basis of etiology and made effort to find out the morphological characteristics of each category. About 735 of total cases were HBsAg seropositive postnecrotic cirrhosis. Alcholic cirrhosis ws the second most frequent type, although accounted only 6.8%. In about 15%, the etiology was not known. Excluding the congenital biliary atresia, chronic biliary obstruction appeared to be a rare cause of cirrhosis among these biopsied cases. Of the HBsAg positive postnecrotic cirrhosis, the eAg seropositive cases tended to be micronodular and to show a higher necroinflammatory activity, in contrast to eAg seronegative cases and those complicated by hepatocellular carcinoma (HCC), suggesting that the loss of eAg is followed by a decrease of the destructive activity, active regeneration of hepatocytes and finally the development of HCC. alcoholic cirrhosis was micronodular in 64% and revealed histologic evidences of alcoholic liver disease in most cases. The results indicate that etiological diagnosis can be made in most cases of cirrhosis by the morphological characteristics and the precise clinical informations, including those on the NANB virus and the inborn error of metabolism, and that the pathological diagnosis should be more comprehensive, implicating the etiology, the nodular size and the necroinflammatory activity.
Carcinoma, Hepatocellular

Colorectoanal intussusception is a rare and distinct entity that differs from the more common rectal prolapse. Typically the intussusception occurrs with tumor at the apex of the intussuscepted segment acting as lead point. Here we present a case and review the literature of colorectoanal intussusception. The case presented here is that of an elderly woman with a proximal sigmoid colon cancer at its apex. Anterior resection was electively performed after reduction of the intussusception. It is important to differentiate a colorectoanal intussusception from the more common rectal prolapse because treatment may differ. The anorectum remains in its normal anatomic position in colorectoanal intussusception, whereas the anal canal is effaced with the prolapsed segment of bowel in rectal prolapse. Identification of a tumor at the apex of the intussuscepted bowel should also arouse suspicion that the condition is not a rectal prolapse.
Aged ; Anal Canal ; Colonic Neoplasms ; Female ; Humans ; Intussusception* ; Rectal Prolapse ; Sigmoid Neoplasms

BACKGROUND: Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy. METHODS: ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection. RESULTS: The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age. CONCLUSIONS: A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.
Arthritis ; Blood Sedimentation ; C-Reactive Protein ; Constriction, Pathologic ; Erythrocytes ; Female ; Humans ; Intervertebral Disc ; Low Back Pain ; Lower Extremity ; Male ; Radiculopathy ; Spinal Stenosis

Granular Cell Myoblastoma is typically encountered in the skin, subcutaneous tissue nr oral cavity, but was rarely been found in the large intestine. In a series of 110, the two were in the cecum(18). Both patients, 36-and 43-year-old women, underwent radial excision of the lesion because of the clinical impresaion of the malignancy. The other Three patients with granular cell myoblastoma of the cecum, all asymptomatic and found incidentally, have been reported. From the available data, one was a man(22) and two were women (26,27). They were 17 (27), 40(26) and 71(22) years of age. One lesion, in the cecum, was excised at laparotomy that was performed under the irnpression of acute appendicitis, and disclosed a small polypoid submucosal nodule in the cecum incidentally(27). Another lesion, in the cecum, was excised at laparotomy following the discovery of a small cecal defect on barium enema examination 9260. The other lesion, in the cecum, was found at autopsy(22), This paper reports a case of granular cell myoblastoma of the cecum, including its colonoscopic finding.
Adult ; Appendicitis ; Barium ; Cecum* ; Enema ; Female ; Granular Cell Tumor* ; Humans ; Intestine, Large ; Laparotomy ; Mouth ; Skin ; Subcutaneous Tissue

PURPOSE: Although breast reconstruction provides some advantages for women following mastectomy, few Korean breast cancer patients currently receive such reconstruction. Routine provision of breast reconstruction requires simplicity and easy availability for the procedure. This paper reports the possibility of performing breast reconstruction by insertion of a tissue expander by the breast surgeon. METHODS: We studied 22 cases of breast cancer patients who were treated in the Breast service of KangNam Cha Hospital. Nine cases were the group of immediate expander insertion and 13 were the group of MRM only. We evaluated age, histopathologic stage, starting time of chemotherapy, operation time, drainage amounts and periods, medication periods, time of discharge and depression score. RESULTS: The mean age of the expander insertion group was 41, which was younger than that of the MRM only group by 3 years. Histopathologic state was better in the expander insertion group and the time for chemotherapy start was almost the same between the two groups. Mean operation time in the expander insertion group was 2 hours and 41 minutes, and it was longer than the MRM only group by 1 hour, but it included additional wasting time to check the results of frozen biopsy. Periods for drainage were longer and amounts were larger, but this only delayed the medication period and time for discharge by two days. There were no other complications and mental suffering was alleviated. CONCLUSION: Tissue expander insertion for breast reconstruction could be offered on a routine basis by breast surgeons without problems. Breast reconstruction will become a more essential process for breast cancer patients to improve the quality of life. It is ideal if the same surgeon participates in both oncology and reconstruction surgery.
Biopsy ; Breast Neoplasms* ; Breast* ; Depression ; Drainage ; Drug Therapy ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Quality of Life ; Stress, Psychological ; Tissue Expansion Devices*