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 in English.
Hypogonadism ; Mosaicism ; Slipped Capital Femoral Epiphyses

The authors report the clinical results of ten cases of complex supracondylar fractures treated by external fixation with a mean follow up of 21 months. Six cases were closed comminuted fracture, and four cases were open fractures. By AO classification six cases were type C2, two type C3, one type Al, and one type A3. Four cases had associated vascular injury. Reduction was performed by closed method in eight cases, and two cases were reduced through open wound. All cases healed at average of 142 days. Final healing of all cases occurred with an average range of motion of 3°-119° except one case which required reapplication due to infected nonunion with a gap. In nine cases of the ten functional results were rated as "good", and one case was "fair" by Iowa Knee Rating Scale. In conclusion, definitive external fixation can be a good alternative treatment modality despite previous recommendations to limit external fixation to temporary application in cases of limb salvage, such as severe comminution or pre-existing infection.
Classification ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Iowa ; Knee ; Limb Salvage ; Methods ; Range of Motion, Articular ; Vascular System Injuries ; Wounds and Injuries

Traumatic dislocation of the hip presents serious problems that may lead to avascular necrosis, nerve palsy, post-traumatic arthritis even when reduction is promptly and adequately carried out. Among them avascular necrosis is the most important prognostic factor, so the early detection of this complication has critical significance for final result. Bone scan has been considered one of early diagnostic test, but recently MRI replaced its role for imaging in the detection of early AVN, treatment monitoring and prediction of prognosis. Authors prospectively studied the early finding of MRI to detect avascular necrosis of the femoral head and to predict prognosis in traumatic hip dislocation and fracture-dislocation. From December 1990 to November 1994, 12 case of dislocation and fracture-dislocation of the hip were studied . In follow up period ranging from 19 months to 65 months, 10 case had excellent or good result. All cases had abnormal MRI finding such as paraarticular edema, capsular bulging, joint effusion, femoral head fracture, but findings such as femoral head signal changes were dectected in only 3 cases. Among the 3 cases, 1 case had developed AVN and 2 cases were uneventful. Other complications were 3 cases of posttraumatic arthritis, 2 cases of incomplete sciatic nerve palsy, and 1 case of heterotrophic ossification. Although early MRI finding at posttrauma 2weeks gave less specific information, it could give good information for risk group and follow up control with more cases. Although it is expensive, MRI can be one of the most reliable reference in early diagnosis of AVN and prediction of prognosis in traumatic dislocation and fracture- dislocation of the hip with non-invasive method.
Arthritis ; Diagnostic Tests, Routine ; Dislocations ; Early Diagnosis ; Edema ; Follow-Up Studies ; Head* ; Hip Dislocation* ; Hip Joint ; Hip* ; Joints ; Magnetic Resonance Imaging* ; Necrosis ; Paralysis ; Prognosis ; Prospective Studies ; Sciatic Neuropathy

ACL plays an important role in stability of knee joint and its injury causes instability of joint which is known as the initiation of problem knee. Reconstruction of the anterior cruciate ligament would be preferred to the primary repair in treatment. And recently with the advance of arthroscopic technique and development of bone-patellar tendon-bone (BPB) graft material, the result of reconstruction is somewhat superior to that of primary repair. Authors compared the results of 20 primary repairs (Group I ) and 20 reconstructions (Group II) among 64 acute ACL injury treated Sung-Ae General Hospital from January 1989 to December 1994. The results were as follows: 1. Most common associated injuries were medial collateral ligament rupture and medial meniscal tear. 2. Group I showed postoperatively 13 negative anterior drawer test, 12 negative Lachmann test and 12 negative pivot shift test and group II showed postoperatively 17 negative anterior drawer test, 15 negative Lachmann test and 17 negative pivot shift test. (p<0.05) 3. In postoperative Lysholm knee scoring scale, group I showed 86 points and group II showed 93 points (p<0.05). 4. In postoperative KT-1000 arthrometer, 12 cases in Group I and 16 cases in Group II showed less than 2mm difference with sound side (p<0.05).
Anterior Cruciate Ligament ; Collateral Ligaments ; Hospitals, General ; Joints ; Knee ; Knee Joint ; Rupture ; Transplants

Ankylosing spondylitis is a chronic inflammatory disease of unknown etiology that affects spine, sacroiliac joint, and the large joints of the extremities, and lead to fibrous or bony ankylosis and deformity. The rigid ankylosed spine of ankylosing spondylitis is prone to fracture by minimal trauma, and the resulting fractures likely to be unstable and damage to spinal cord or cauda equina. The authors report a case of paraplegia in ankylosing spondylitis after open reduction of the femoral trohanteric fracture.
Ankylosis ; Cauda Equina ; Congenital Abnormalities ; Extremities ; Femur ; Joints ; Paraplegia ; Sacroiliac Joint ; Spinal Cord ; Spine ; Spondylitis, Ankylosing

The method of treatment of acromioclavicular dislocation is controversial, and conservative and surgical treatment have been reported to be both successful. Recently, many surgeons tend to treat the acromioclavicular dislocation with anatomical reduction of acromioclavicular joint and rigid internal fixation because of many disadvantages of conservative methods. We report 24 cases of acute acromioclavicular dislocation treated with modified Phemister method from March 1989 to December 1992. The follow-up ranged from 12 months to 31 months with 16.5 months on average. The results are as follows. l. Among 24 cases, 21 cases are males and 20 cases are in 3rd decade to 5th decade. 2. The most common cause of injuries is falling down, followed by traffic accident. 3. Associated injuries are fractures in 5 cases, spleen rupture in 1 case. 4. Except 1 case with spleen rupture, 23 cases were treated within 2 weeks after injury. 5. Preoperative difference in C-C distance on stress view is 8.6mm on average, ranged from 6mm to 18mm. 6. Clinical results were excellent in 11 cases, good in 10 cases, fair in 2 case, and poor in 1 case. 7. Complications were pin migration in 1 case and symptomatic acromioclavicular arthritis in 1 case.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Arthritis ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Methods ; Rupture ; Spleen ; Surgeons

In general. femoral neck fracture in young adult presents poor prognosis due to the high velocity injury, high angle shear fracture, and poor candidate for arthroplasty. In addition to the relative rarity of the injury, the high incidence of aseptic necrosis and nonunion have been reported in the management of these fractures. 25 cases of femoral neck fracture in young adult were treated with multiple pinning and analyzed at Sung-Ae general hospital from 1987 to 1994 after 28 months follow up in average with review of charts, X-ray and clinical result. There were 18 male and 7 female, 5 cases of them had significant polytrauma to other organs or skeletal system, authors tried to treat them as soon as possible to decrease the interval time between fracture and fixation (the average time was 39.7 hours.) Union occurred in all of Garden stage I (4 cases) and II (4 cases), but in Garden stage III (7 among 8 cases) and IV (7 among 9 cases) the union rate was lower. Average union time was 16.5 weeks. The incidence of complications (12%, 3 among 25 cases) was higher in displaced fractures group (Garden stage III, IV) and also in poorly reduced group of Garden’s alignment index. In conclusion, the prognosis of femoral neck fractures in young adult was related with mainly initial reduction and rigid fixation than the initial injury.
Agriculture ; Arthroplasty ; Female ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hospitals, General ; Humans ; Incidence ; Male ; Multiple Trauma ; Necrosis ; Prognosis ; Young Adult

The fat embolism syndrome is a complication which encounters rarely after fractures of pelvis and long bones of lower extremity of severe injury of soft tissue, and may results in microinfarctions in lungs, brain, heart, kidneys and other important organs when fat globules flow from bone marrow into small vessels. And that is the one of the main cause of death within 72 hours after major trauma of long bones. Diagnosis of fat embolism syndrome was made by clinical criteria by Gurd, but, majority of cases didn't show characteristic clinical symptoms or signs. Recently CT and MRI of the brain are adopted to the diagnosis of FFS as a new method. Authors experiences six cases of fat embolism syndrome from Mar. 1991 to Mar. 1994 and analyzed the brain MRI findings. We concluded that the brain MRI findings such as diffuse brain swelling, petechial hemorrhage and microinfarctions were helpful to diagnose clinically apparent or subclinical fat embolism syndrome.
Bone Marrow ; Bones of Lower Extremity ; Brain Edema ; Brain ; Cause of Death ; Diagnosis ; Embolism, Fat ; Heart ; Hemorrhage ; Kidney ; Lung ; Magnetic Resonance Imaging ; Methods ; Pelvis

No abstract available.
Rubella* ; Vaccination*