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*

No abstract available.
Hernia, Inguinal*

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

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

The pathophysiology of functional gastrointestinal disorder(FGID) is not completely understood, but the importance of the 'Brain-Gut Axis(BGA)' model in FGID is being increasingly recognized. The BGA model is a bidirectional, hard-wired and homeostatic relationship between the central nervous system(CNS) and the enteric nervous system(ENS) via neural, neurohormonal and neuroimmunological pathways. In addition, the BGA model would provide a rationale for the use of psychotropics on FGID. The authors experienced two cases in which duloxetine, a serotonin-norepinephrine reuptake inhibitor, was effective in relieving FGID symptoms as well as psychiatric symptoms such as depression and hypochondriacal anxiety. Therefore we discuss the vignettes from the perspective of BGA theory. Duloxetine showed efficacy in these two patients by reducing visceral hypersensivity (bottom-up regulation) and by relieving depression and anxiety(top-down regulation).
Anxiety ; Depression ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Thiophenes

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*