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

To determine the impact of intake large amount whole cow's milk (WCM) on iron status during early childhood (18~36 months), selected indices of complete blood count(CBC) and iron status were compared between the WCM large amount intake group (n=20)and small amount intake group (n=20). WCM large amount intake children's mean hemoglobin and mean hematocrit were 9.6+/-1.7 g/dL and 30.8+/-4.5% respectively. These range of peripheral blood with other indices of CBC disclosed the hypochromic microcytic anemia. WCM large amount intake children's some indices of CBC-hemoglobin, hematocrit, MCV, MCH-were significantly lower than those of small amount intake children (P<0.01). WCM large amount intake children had significantly lower mean iron, transferrin saturation and ferritin (P<0.01) and greater mean total iron binding capacity (P<0.05) than did small amount intake children. It is concluded that intake large amount of WCM for long duration impacts on the iron status of 18~36 months old children disadvantageously. It should be avoided for the protection of irreversible recognitive impairment and behavioral change.
Anemia ; Anemia, Iron-Deficiency ; Child ; Ferritins ; Hematocrit ; Humans ; Iron* ; Milk* ; Transferrin

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

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

PURPOSE: Neonatal hyperbilirubinemia has benign courses in most cases, but the possibility of toxicity of hyperbilirubinemia required courses examination of every newborn infant to identify the severity of hyperbilirubinemia progress. This study aims to see how the body surface area of newborns influences the decline rate of serum bilirubin level in conventional phototherapy. METHODS: Based on the charts of the Pediatrics Department, Dae-Dong Hospital from January 2003 to December 2006, we analyzed 168 neonates diagnosed as neonatal hyperbilirubinemia (serum bilirubin > or =15 mg/dL) in retrospective way. We excluded newborn infants under 37 weeks of gestation and under 2,500 g birth weight and classified neonates into four groups by the calculation results of body surface area:males above 75 percentile (group A), males below 25 (group B), females above 75 (group C), and females below 25 (group D). RESULTS: Out of 168 samples, the number of group A, B, C, D was 30, 20, 20, 15 respectively. In conventional phototherapy, the mean decline rates of serum bilirubin of group B and D recording 2.09 mg/dL/day and 1.77 mg/dL/day, were significantly faster than those of group A and C recording 1.63 mg/dL/day and 1.41 mg/dL/day (P<0.01). No significant differences were found in different duration of phototherapy between groups below 25 percentile and those above 75 in both genders. CONCLUSION: In conclusion, body surface area influences of infants the decline rate of serum bilirubin level in conventional phototherapy.
Bilirubin* ; Birth Weight ; Body Surface Area* ; Female ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn ; Male ; Pediatrics ; Phototherapy* ; Pregnancy ; Retrospective Studies

Osteochondromadevelop most commonly at distal femur, proximal humerus and proximal tibia, but the rib osteochondroma was reported less commonly. In this report, scapular snapping syndrome complicated by adventitious bursa and soft tissue pseudotumor surrounding the osteochondroma of the 6th rib body was treated successfully by surgical excision of them. We report this rare case with reviewing the relevant literature.
Femur ; Humerus ; Osteochondroma* ; Ribs* ; Shoulder* ; Tibia

Granular corneal dystrophy is primary heredofamilial dystrophy of the cornea, which is characterized by the presence of plemorphic milk-white spots in the superficial stroma in the central cornea. This corneal dystrophy was first ,described by Arthur Groenouw in 1890. Since then. many other types of familial corneal dystrophies have been discribed by morphological characteristics. In 1938 BUcklers classified the corneal dystrophy into 3 types; granular, macular and lattice dystrophy, whose nemenclature is now generally accepted. Now we report 2 cases of granular corneal dystrophies which involved 2 sisters in a family.
Cornea ; Humans ; Siblings

PURPOSE: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer. MATERIALS AND METHODS: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. RESULTS: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR. CONCLUSION: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.
Chemoradiotherapy ; Deoxycytidine ; Fluorouracil ; Humans ; Leucovorin ; Lymphocyte Count ; Multivariate Analysis ; Pelvis ; Rectal Neoplasms ; Capecitabine

Injuries to extensor tendons can be as serious as those of digital flexors. These injuries require accurate approximation, appropirate splinting and careful mobilization. Scarring which always occurs following injury can provoke greater problems in digital extensor injuries than in flexor tendons. The loss of 2mm of excursion of extensor tendon at level of the proximal interphalangeal joint may results in a 50 percent loss of motion of the finger. A special problem associated with extensor tendon healing is loss of gliding. This study was carried was carried out to evaluate the results of the extensor injuries according to their etiology, location and type of treatment. Seventy six lesions in fifty patients treated for extensor tendon injuries were analysed for the comparison of the results of specific treatment. The follow up was from 1 to 3 years with average of 19 months. Following results were obtained. l. Among 50 patients, 16 cases (32%) were acute and 34 cases (68%) were chronic. 2. The etiology were crushing in 19 cases (30%), knife or glass in 20 cases (40%), and avulsion in 8 cases (16%) etc. 3. Mallet finger were observed in 14 tendons, buttonhole in 10 tendons. Nine tendons were injured at the metacarpophalangeal level and 16 tendons were injured at wrist level. 4. Percentage of satisfactory result which means less than 15 degrees of extension loss were 68.1 % in primary repair and plication, and 30.7% in tendon transfer or graft. 5. Prognosis was better when the lesion was proximal to MP joint, and results were more favorable in primary repair and plication than tendon transfer graft.
Cicatrix ; Fingers ; Follow-Up Studies ; Glass ; Humans ; Joints ; Prognosis ; Splints ; Tendon Injuries ; Tendon Transfer ; Tendons ; Transplants ; Wrist

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therfore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving the joint motion, maintaining the health of muscle supplying motor power about the joint and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. Among them the results of total knee arthroplasty (TKA) have improved steadily during the past decade due to refinements in design, fixation, and surgical technique. At orthopedic department of seoul national university hospital, we performed 31 total knee replacement in 18 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1988. Following results were obtained. 1. Knee score increased from 37.8 to 76.9. 2. Tibio-femoral angle was corrected from 0.9° valgus to 5.3° valgus. 3. Conplications were peroneal nerve palsy in 3 knees, instability in 1 knee, tuberculous arthritis in 1 knee. 4. In 25 out of 31 knees, good functional results were obtained.
Adult ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Orthopedics ; Paralysis ; Peroneal Nerve ; Range of Motion, Articular ; Seoul ; Synovial Membrane