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

The symptoms of the rheumatoid arthritis are variable enough to be ranged from mild to severe case. Synovectomy, fusion, and total knee replacement are to be applied according to the site and degree of involvement as surgical treatments. In the analysis, we compare the result of PCL retention TKR patients with those of PCL sacrificing TKR patients and of cemented TKR patients with those of cementless TKR patients. Function of the knee was evaluated using the knee score system of the Hospital for Special Surgery. From Nov, 1982 to Nov. 1990, total knee replacment was performed on 128 knees in 77 patients with rheumatoid arthritis at the Kyung Hee University Hospital and were followed for from two to ten years(average, four years eleven months). 1. The age at operation was ranged from 21 years to 72 years(average 53.2 years). There were seventy one female and six male patients. 2. The cruciate sacrificing prosthesis(group I ) were 42 cases and cruciate retention prosthesis(group II) were 86 cases. 3. The average preoperative range of motion was 85. 5 degree and the average post-operative range of motion was 107. 7 degree. Group I changed from 74. 7 degree to 105. 8 degree and Group II changed from 90. 5 degree to 108. 5 degree. 4. The average preoperative flexion contracture was 28. 7 degree and average post-operative flexion contracture was 7.8 degree. Group I changed from 37 degree to 8.4 degree and Group II changed from 24. 7 degree to 7. 5 degree. 5. The average preoperative tibiofemoral angle was varus 7. 4 degree in 69 cases and valgus 7. 6 degree in 59 cases. The average postoperative tibiofemoral angle was valgus 7. 2 degree. 6. The average preoperative knee Rating Score was 35. 2 point and the average postoperative score improved to 82. 7 point. Group I changed from 31. 3 point to 79. 4 point and Group II changed from 37 point to 84. 2 point. 7. 107 cases were cemented TKR and the 21 cases were cementless. There was no significant difference in those groups. 8. Additional operations were THR in eight cases, TER in five cases, TAR in four cases, TSR in one case, TWR in one case, Swanson prosthesis in one case, knee synovectomy in two cases, elbow synovectomy in three cases, and wrist synovectomy in two cases. 9. Complication included loosening in one case, partial ankylosis in three cases, and deep infection in one case.
Ankylosis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Contracture ; Elbow ; Female ; Humans ; Knee ; Male ; Prostheses and Implants ; Range of Motion, Articular ; Wrist

Frozen shoulders improve mostly by the conservative management, such as medication therapy and positive physical therapy. Despite the vast majority regain motion and have reduced pain with gentle but persistent exercises, patients do not always spontaneously recover motion. Arthroscopic manipulation may be recommanded in patients whose symptoms last more than 6 months or when the conservative treatment fails and severe stiffness is primarily originated. Nineteen cases of frozen shoulder underwent arthroscopic manipulation under the general anesthesia from February, 1990 to February, 1992. All but one case had shoulder pain and 13 cases(68.4%) had trivial trauma history at the time of symptom onset. One of the chief complaint was the limitation of motion; abduction: 19 cases, external rotation: 17 cases, flexion: 13 cases, extension: 11 cases, internal rotation: 8 cases and adduction: 7 cases. Average abduction range at the time of admission was 63.9°. In the average 23 months follow up(15 months to 3 year 2 months), painless was shown in 13 cases and significantly decreased pain in 6 cases, and all the patients were satisfactory with the results. The range of the abduction motion was changed from 64° to nearly normal. All of the patients improved by 1 month to 4 months, average 2.9 months. We propose arthroscopic manipulation could be recommended in the treatment of frozen shoulder if an appropriate conservative treatment is not effective.
Anesthesia, General ; Bursitis ; Exercise ; Humans ; Shoulder Pain ; Shoulder

No abstract available.
Anemia* ; Erythropoietin* ; Humans*

Cardiovascular diseases have been the most serious threat to life and health. The socioeconomic ramifications of heart disease have long been a source of vexing legal as well as medical problems with no easy resolution as yet in hand. Heart weight, one of the important factors for the diagnosis of cardiomegaly and various heart diseases, shows extreme variability according to the height, weight, age, sex, nutritional status of individuals as well as other various factors. The purpose of this investigation was to find a practical method for calculating expected normal range of heart weight in a given individual. The study was performed on 259 autopsy cases of normal Korean men and women, consisting of 123 men and 136 women in age from newborn to 77 years old. Height, body weight, and heart weight were measured and the body surface area was calculated by height (cm)0.725 x weight (kg)0.425 x 71.84 and height (cm)0.7763 x weight (kg)0.4081 x 71.84 in men and women, respectively. The results showed that the mean heart weight of men and women older than 20 years old were 316.20 +/- 51.15 g (n=96) and 275.87 +/- 44.69 g (n=108), respectively. Heart weight was gradually increased according to the age. The body weight (men: r=0.81, women: r=0.84) and body surface area (men: r=0.83, women: r=0.83) were better univariate predictors of normal heart weight than body height (men: r=0.78, women: r=0.75) and age (men: r=0.42, women: r=0.57). No significant difference was found in predictive precision between body weight and body surface area. Since the body surface area was calculated from body weight and height, measuring the body weight was essential for calculating expected normal range of heart weight in a given individual, and calculation of expected normal range of heart weight using body weight was simpler method than using body surface area.
Aged ; Autopsy ; Body Height ; Body Surface Area* ; Body Weight* ; Cardiomegaly ; Cardiovascular Diseases ; Diagnosis ; Female ; Hand ; Heart Diseases ; Heart* ; Humans ; Infant, Newborn ; Male ; Nutritional Status ; Reference Values ; Young Adult

OBJECTIVE: To compare the differences of diagnostic rates, of the two widely used test positions, in measuring vestibular evoked myogenic potentials (VEMP) and selecting the most appropriate analytical method for diagnostic criteria for the patients with vertigo. METHODS: Thirty-two patients with vertigo were tested in two comparative testing positions: turning the head to the opposite side of the evaluating side and bowing while in seated position, and bowing while in supine positions. Abnormalities were determined by prolonged latency of p13 or n23, shortening of the interpeak latency, and absence of VEMP formation. RESULTS: Using the three criteria above for determining abnormalities, both the seated and supine positions showed no significant differences in diagnostic rates, however, the concordance correlation of the two positions was low. When using only the prolonged latency of p13 or n23 in the two positions, diagnostic rates were not significantly different and their concordance correlation was high. On the other hand, using only the shortened interpeak latency in both positions showed no significant difference of diagnostic rates, and the degree of agreement between two positions was low. CONCLUSION: Bowing while in seated position with the head turned in the opposite direction to the area being evaluated is found to be the best VEMP test position due to the consistent level of sternocleidomastoid muscle tension and the high level of compliance. Also, among other diagnostic analysis methods, using prolonged latency of p13 or n23 as the criterion is found to be the most appropriate method of analysis for the VEMP test.
Compliance ; Hand ; Head ; Humans ; Muscle Tonus ; Patient Positioning ; Supine Position ; Vertigo ; Vestibular Evoked Myogenic Potentials*

OBJECTIVE: To compare the differences of diagnostic rates, of the two widely used test positions, in measuring vestibular evoked myogenic potentials (VEMP) and selecting the most appropriate analytical method for diagnostic criteria for the patients with vertigo. METHODS: Thirty-two patients with vertigo were tested in two comparative testing positions: turning the head to the opposite side of the evaluating side and bowing while in seated position, and bowing while in supine positions. Abnormalities were determined by prolonged latency of p13 or n23, shortening of the interpeak latency, and absence of VEMP formation. RESULTS: Using the three criteria above for determining abnormalities, both the seated and supine positions showed no significant differences in diagnostic rates, however, the concordance correlation of the two positions was low. When using only the prolonged latency of p13 or n23 in the two positions, diagnostic rates were not significantly different and their concordance correlation was high. On the other hand, using only the shortened interpeak latency in both positions showed no significant difference of diagnostic rates, and the degree of agreement between two positions was low. CONCLUSION: Bowing while in seated position with the head turned in the opposite direction to the area being evaluated is found to be the best VEMP test position due to the consistent level of sternocleidomastoid muscle tension and the high level of compliance. Also, among other diagnostic analysis methods, using prolonged latency of p13 or n23 as the criterion is found to be the most appropriate method of analysis for the VEMP test.
Compliance ; Hand ; Head ; Humans ; Muscle Tonus ; Patient Positioning ; Supine Position ; Vertigo ; Vestibular Evoked Myogenic Potentials*

Chylous ascites is extravasation of lymphatic fluid and retention in the peritoneal cavity due to traurna or obstruction of the lymphatic system. Chylous ascites is very rare complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) and is associated with trauma to the lymphatics during catheter insertion in the early stage of CAPD and repeated mild trauma to the lyrnphatics during longterm dialysis. Chylous ascites in the CAPD is suspected when the drained peritoneal fluid is milky white and confirmed by demonstration of the specific components of chyle, such as elevated triglyceride and low cholesterol than plasma and should be differentiated from pseudochyle and bacterial peritonitis. We report a case of chylous ascites in a patient undergoing CAPD at 2 months later of initiation of CAPD, which was not improved by conservative management. So CAPD catheter was removed and renal replacement therapy was changed to hemodialysis.
Ascitic Fluid ; Catheters ; Cholesterol ; Chyle ; Chylous Ascites* ; Dialysis ; Humans ; Lymphatic System ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Plasma ; Renal Dialysis ; Renal Replacement Therapy ; Triglycerides

Cone-Beam Computed Tomography ; Cosmetics ; Humans ; Maxilla ; Osteotomy ; Osteotomy, Le Fort ; Recurrence

PURPOSE: The butterfly-shaped pigment dystrophy is an extremely rare autosomal dominant retinal disorder. The authors present a case of butterfly-shaped pigment dsytrophy not reported previously in Korea. CASE SUMMARY: A 45-year-old man had bilateral blurred vision for 2 years. His visual acuity was 0.2 in the right eye, and 0.3 in the left and was uncorrected. Funduscopically, yellow pigment deposits were present at the level of retinal pigment epithelium (RPE) in the central macula of both eyes. Fluorescein angiography (FA) revealed a central, dark, butterfly-shaped lesion surrounded by a region of hyperfluorescence, Spectral domain optical coherence tomography (OCT) showed thick elevation of the RPE with hyperreflectivity and disruption of the inner and outer segment (IS/OS) interface of the photoreceptors. The patient had normal color vision, visual field and electroretinograms and reduced electrooculograms. CONCLUSIONS: In general, butterfly-shaped pigment dystrophy is known to have good visual prognosis. However, in some cases the disease can be a chronic progressive disorder with secondary involvement of the photoreceptors, as exemplified this patient. The authors anticipate more detail regarding the natural course of this disease will be obtained through spectral domain OCT.
Butterflies ; Color Vision ; Eye ; Fluorescein Angiography ; Humans ; Middle Aged ; Prognosis ; Retinal Pigment Epithelium ; Retinaldehyde ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity ; Visual Fields