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

Objective: The purpose of this study was to analyze the symptoms of depression, anxiety, and childhood trauma in functional gastrointestinal disorder (FGID) patients who visited the brain-gut axis clinic. Methods: The study participants included 99 individuals who were diagnosed with FGID by gastroenterologists, 88 individuals who had no FGID but showed symptoms of FGID based on the Rome criteria, and 79 individuals who did not show any symptoms or were diagnosed with FGID. Symptoms of depression, anxiety, and childhood trauma were evaluated by the Korean version of Beck-depression inventory-II (K-BDI-II), Korean version of Beck anxiety inventory (K-BAI), and Korean version of childhood trauma questionnaire (K-CTQ), respectively. Results: The BDI score, BAI score, and CTQ score were significantly different between the groups. The group also had higher odds for developing anxiety as compared to the control group (odds ratio [OR] = 10.215, 95% confidence intervals [CI]: 2.49−41.76). Additionally, the FGID group had higher odds for developing symptoms of depression (OR = 5.554, 95% CI: 2.06−14.97) and experiencing physical violence (OR = 3.128, 95% CI: 1.53−6.38) than the non-FGID group. Conclusion This study showed that FGID patients were more likely to have symptoms of depression, severe anxiety, and childhood trauma, which were the risk factors of FGID.

OBJECTIVE: The purpose of this study was to investigate the characteristics of psychological factors that are related to irritable bowel syndrome (IBS) and their effects on the quality of life (QOL) of firefighters in South Korea. METHODS: This study examined data collected from 1217 firefighters in South Korea. After identifying firefighters with IBS according to the Rome III diagnostic criteria for functional gastrointestinal disorders (FGIDs), we collected demographic data and psychological variables through self-administered questionnaires. In order to observe the distribution of the high-risk group in the Korean occupational stress scale (KOSS) subcategories, we conducted logistic multiple linear regression. The correlations between psychological factors and QOL were analyzed and we performed a stepwise regression analysis. RESULTS: The groups (firefighters with and without IBS) showed differences by sex, working period, task, working pattern, Patient Health Questionnaire-9, Generalized Anxiety Disorder Questionnaire-7, Korean Occupational Stress Scale, Rosenberg's Self-Esteem Scale, and the World Health Organization Quality of Life-BREF. IBS risk was higher in the following KOSS subcategories: job demand (OR 1.79, 95% CI: 1.11–2.89), interpersonal conflict (OR 2.21, 95% CI: 1.25–4.33), organizational system (OR 1.87, 95% CI: 0.58–3.30), and lack of reward (OR 2.39, 95% CI: 1.08–5.26). The final regression model explained 42.6% of the variance in overall quality of life. CONCLUSION: The findings of this study indicate that a number of psychological factors increase the likelihood of irritable bowel syndrome (IBS) and affect QOL. Therefore, when diagnosing IBS in the future, mental health aspects should be considered in addition to physical health.
Anxiety Disorders ; Depression ; Firefighters* ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome* ; Korea* ; Linear Models ; Mental Health ; Psychology* ; Quality of Life* ; Reward ; World Health Organization

PURPOSE: The objective of this study is to determine whether application of ventilation in line with compression rate in performance of CPR for cardiac arrest patients was helpful in maintaining an adequate ventilation rate. METHODS: Volunteers who received education on the revised 2010 CPR guidelines were randomly assigned to either a conventional ventilation (CV) group or a compression-adjusted ventilation (CAV) group. During performance of CPR, compression rate and ventilation rate were measured every minute, and the participants' roles were changed every two minutes; CPR was performed for a total of eight minutes. RESULTS: A total of 57 volunteers participated in this study. No statistically significant difference was observed between the compression rate of the CV group and that of the CAV group. However, regarding adequacy of the ventilation rate, greater improvement was observed in the CAV group, compared with the CV group (adequate ventilation: 86.2% vs. 46.4%, p<0.001). In addition, the median value of the ventilation rate was 8.4/min (IQR: 7.7-9.6) in the CV group and 9.5/min (IQR: 9.0-10.0) in the CAV group (p=0.003). CONCLUSION: When no other valid approach is available, use of the CAV method is conducive to maintenance of an adequate ventilation rate.
Cardiopulmonary Resuscitation ; Heart Arrest ; Humans ; Manikins ; Ventilation

There has been a great improvement in height and weight of Korean children owing to economic development over the last 25 years. This study aimed to evaluate the penile length of Korean children today and to compare it with a previous Korean study reported in 1987. The cross-sectional study was conducted with 909 Korean boys aged 0-14 years who had been brought to outpatient clinics of five tertiary hospitals (Busan, Ulsan, and Changwon) between September 2013 and May 2015. The stretched penile length (SPL) was measured and the testicular size was measured using orchidometry (mL). Student's t-test or Mann-Whitney U test was used to compare the result of our study and the study reported in 1987. SPL of Korean children gradually increased from 4.1 ± 0.8 cm at 0-1 year old to 9.6 ± 3.0 cm at 13-14 years old, the most rapidly during the age of 13. While body weight and testicular size significantly increased from 1987 in most of age groups, there were no significant changes in SPL although there was in some age groups. Height decreased in the infants < 1 year old and increased in the children > 6 years old. With the great economic development over the last quarter century in Korea, height, body weight, and testicular size of children significantly increased but there was no significant change in SPL except penile growth pattern.
Ambulatory Care Facilities ; Anthropometry ; Body Height ; Body Weight ; Child* ; Cross-Sectional Studies ; Economic Development ; Humans ; Infant ; Korea ; Male ; Penis ; Tertiary Care Centers ; Ulsan

Several cases of ruptured pregnant uterine horn have been documented. However, there have been few reported cases of ectopic tubal pregnancy in a unicornuate with rudimentary horn. So we report this case with a brief review literature.
Animals ; Female ; Horns* ; Pregnancy ; Pregnancy, Tubal* ; Uterus*

OBJECTIVES: The purpose of this study was to investigate the characteristics of psychosocial factors related to functional dyspepsia(FD) and their effects on quality of life(QOL) in firefighters. METHODS: This study examined data collected from 1,217 firefighters. We measured psychological symptoms by Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder questionnaire(GAD-7), Korean Occupational Stress Scale(KOSS), Ways of Coping checklist(WCCL), Rosenberg's Self-Esteem Scale(RSES) and World Health Organization Quality of Life Scale abbreviated version(WHOQOL-BREF). Chi-square test, independent t-test, Pearson's correlation test, logistic regression analysis, and hierarchical regression analysis were used as statistical analysis methods. RESULTS: For the group with FD, the male participants showed significantly higher frequency(p=0.006) compared to the female participants. The group with FD had higher scores for depressive symptoms(p<.001), anxiety (p<.001), and occupational stress(p<.001), and did lower scores for self-esteem(p=.008), quality of life(p<.001) than those without FD. The FD risk was higher in the following KOSS subcategories: job demand(OR 1.94, 95% CI : 1.29-2.93), lack of reward(OR 2.47, 95% CI : 1.61-3.81), and occupational climate(OR 1.51, 95% CI : 1.01-2.24). In the hierarchical regression analysis, QOL was best predicted by depressive symptoms, self-esteem, and occupational stress. Three predictive variables above accounts for 42.0% variance explained of total variance. CONCLUSIONS: The psychosocial factors showed significant effects on FD, and predictive variables for QOL were identified based on regression analysis. The results suggest that the psychiatric approach should be accompanied with medical approach in future FD assessment.
Anxiety ; Anxiety Disorders ; Depression ; Dyspepsia* ; Female ; Firefighters* ; Humans ; Logistic Models ; Male ; Psychology* ; Quality of Life* ; World Health Organization

Typhlitis is one of the most ominous complications in immunocompromised patients. Neutropenic enterocolitis or typhlitis is a clinical syndrome characterized by fever, diarrhea and abdominal pain that occurs in neutropenic patients. It has been reported as a complication of childhood leukemia, but is now known to occur in adults with solid malignancies, acquired immunodeficiency syndrome (AIDS) or bone marrow transplantation (BMT). The association of typhlitis and propylthiouracil has not been previously reported. We report a case of a 42-year-old female patient with typhlitis due to propylthiouracil patient with hyperthyroidism.
Abdominal Pain ; Acquired Immunodeficiency Syndrome ; Adult ; Bone Marrow Transplantation ; Diarrhea ; Enterocolitis, Neutropenic ; Female ; Fever ; Humans ; Hyperthyroidism* ; Immunocompromised Host ; Leukemia ; Propylthiouracil* ; Typhlitis*

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.
Classification* ; Constriction, Pathologic* ; Drug Therapy ; Fluorescein ; Fluorouracil ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Silicon ; Silicones ; Tears

Severe cough may contribute to serous coplications such as pneumothorax, pneumomediastinum, rib fracture, subconjunctival hemorrhage, subdural hemorrhage and cough syncope. However abdominal wall hematoma is a rare complication. Because it usually presents with abdmoianal pain, abdominal wall hematoma needs to be differentiated from the acute surgical abdomen. A 78-year-old woman was admitted with right lower quadrant abdominal pain and a palpable mass for several days. She experienced abdominal pain after violent coughing associated with an upper respiratory tract in fection. Abdominal computed tomography revealed an approximately 7×4 cm sized, ill-defined, soft tissue density lesion in the right lower posterolateral abdominal wall. An abdominal wall hematoma was diagnosed. After admission, she had persistent right lower abdominal pain and an increasing mass. The mass was surgically removed and she was discharged without complications. In summary, when a patient complains of abdmonial pain after severe coughing, an abdominal wall hematomas as a differential diagnosis must be considered.
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Abdominal Wall* ; Aged ; Cough ; Diagnosis, Differential ; Female ; Hematoma* ; Hematoma, Subdural ; Hemorrhage ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Respiratory System ; Rib Fractures ; Syncope