Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.
Clavicle ; Congenital Abnormalities ; Exostoses ; Exostoses, Multiple Hereditary ; Head ; Humans ; Male ; Osteochondroma ; Shoulder Impingement Syndrome ; Shoulder ; Tears ; Tendons ; Young Adult

BACKGROUND: Although satisfactory mid- to long-term results of rotational acetabular osteotomy for early osteoarthritis secondary to acetabular dysplasia have been reported, there is still controversy about the long-term effects of this surgery in more advanced osteoarthritis. The purpose of this study was to investigate the radiographic progression of osteoarthritic changes after rotational acetabular osteotomy in acetabular dysplasia according to the preoperative Tönnis grade and evaluate its effects after minimum 10-year follow-up. METHODS: We performed 71 consecutive rotational acetabular osteotomies in 64 patients with symptomatic acetabular dysplasia between November 1984 and April 2005. Of these, 46 hips (four hips with Tönnis grade 0, 30 with grade 1, and 12 with grade 2) whose clinical and radiographic findings were available after minimum 10-year follow-up were evaluated in this study. The mean age at the time of surgery was 39.0 years (range, 18 to 62 years) and the average follow-up duration was 17.3 years (range, 10.0 to 27.7 years). Clinical and radiographic evaluations were performed according to the preoperative Tönnis grade. RESULTS: The average Harris hip score improved from 71.8 (range, 58 to 89) to 85.1 (range, 62 to 98). The radiographic parameters also improved in all Tönnis grades after the index surgery. Although the improvement of radiographic parameters was not different between preoperative Tönnis grades, the incidence of osteoarthritic progression was significantly different between grades (zero in Tönnis grade 0, four in Tönnis grade 1, and 10 in Tönnis grade 2; p < 0.001). The mean age at the time of surgery was also significantly older in osteoarthritic progression patients (p < 0.002). Kaplan-Meier survivorship analysis, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 100% in Tönnis grade 0, 85.7% in Tönnis grade 1, and 14.3% in Tönnis grade 2 (p < 0.001). CONCLUSIONS: The outcome of rotational acetabular osteotomy in most hips with Tönnis grade 0 and 1 was satisfactory after an average of 17 years of follow-up. The incidence of osteoarthritic progression was higher in Tönnis grade 2 and older age. Our results support that early joint preserving procedure is essential in the case of symptomatic dysplastic hips.
Acetabulum* ; Follow-Up Studies* ; Hip ; Humans ; Incidence ; Joints ; Osteoarthritis* ; Osteotomy* ; Survival Rate

PURPOSE: This study aimed at investigating sexual behavior patterns of elderly residents of urban areas in South Korea and their correlation with lower urinary tract symptoms. MATERIALS AND METHODS: From May, 2009 to October, 2009, 154 males and 299 females over 60 years old who visited senior welfare centers of Seoul were administered a questionnaire on sex life patterns and voiding symptoms. RESULTS: Among the 154 males, 59 (38.3%) had sexual intercourse at least one time per month. The remaining 95 males (61.7%) did not have sexual intercourse, because of impotence for 52 males (52.6%), no sexual desire for 28 males (29.4%), and sex partner's problems for 15 males (15.7%). The higher International Prostate Symptom Score was, the lower International Index of Erectile Dysfunction-5 was (p=0.035). Among 299 females, 37 (12.4%) had sexual intercourse at least one time per month. The remaining 262 females (87.6%) did not have sexual intercourse, because of no spouse for 163 females (63.2%), no sexual desire for 48 females (18.6%), the spouse's impotence for 34 females (13.2%), and the spouse's bad health for 10 females (3.9%). It was found that self-diagnosis of overactive bladder affects sex life negatively. CONCLUSIONS: The sexual behaviors of the elderly included varying activity. Sexual intercourse were significantly associated with lower urinary tract symptoms. Our results suggest that the counseling with the elderly about sexual health is as important as it is with non-elderly individuals.
Aged ; Coitus ; Counseling ; Erectile Dysfunction ; Female ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Surveys and Questionnaires ; Reproductive Health ; Republic of Korea ; Sexual Behavior ; Spouses ; Urinary Bladder, Overactive ; Urinary Tract

PURPOSE: To evaluate the results and complications of antegrade intramedullary interlocking nailing in humerus shaft fractures. MATERIALS AND METHODS: We evaluated the clinical outcomes, radiologic results and complications in 47 patients with humerus shaft fracture treated with antegrade intramedullary interlocking nailing, and followed up until bony union. Bony union was confirmed by serial plain radiographs and the clinical outcomes were assessed according to the ASES scoring system. RESULTS: Bony union was confirmed in 41 (87.2%) out of a total 47 patients, and the mean union period was 14.5 weeks. Major complications were as follows: 6 non-union, 3 delayed union, 2 intraoperative posterior cortex fracture in the distal humerus and 2 permanent shoulder pain, including 1 case of adhesive capsulitis. The clinical outcomes were as follows: 29 excellent, 11 good, 4 fair and 3 poor. Satisfactory outcomes were demonstrated in 40 patients (85.1%). CONCLUSION: Anterograde intramedullary interlocking nailing as treatment for humerus shaft fracture showed satisfactory bony union and clinical outcomes. It is considered an efficacious treatment, especially in patients with associated injury, such as multiple fractures and segmental fracture.
Bursitis ; Fracture Fixation, Intramedullary ; Humans ; Humerus ; Nails ; Shoulder Pain

PURPOSE: The purpose of this study was to evaluate the results of treating senile osteoporotic peritrochanteric fracture with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: Between November 2006 and December 2007, 21 patients older than 65 years of age with intertrochanteric and subtrochanteric fractures were treated with PFNA. The mean duration of follow-up was 12.9 months and the mean age was 74.5 years. RESULTS: The mean operation time was 48.8 minutes (range: 25-90 minutes). The time to ambulation averaged 7.9 days. Eighty point nine percent (17 cases) of the patients returned to their previous walking status at 6 months after operation. The average T-score was -3.3. Eighteen cases (85.7%) achieved acceptable reduction and the mean time to radiologic bony union was 17.4 weeks. The average amount of PFNA blade sliding was 4 mm and the neck-shaft angle was changed to 1.3 degrees varus displacement at the final follow-up. The complications included pulmonary edema in 1 case and protrusion of the PFNA blade into the hip joint in 1 case. CONCLUSION: Because of the reduced operation time, favorable walking ability and low rate of complications, PFNA is an acceptable alternative for fixation of senile osteoporotic peritrochanteric fracture.
Displacement (Psychology) ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip Joint ; Humans ; Nails ; Osteoporosis ; Pulmonary Edema ; Walking

PURPOSE: Glomus tumors are uncommon benign neoplasms arising from the neuromyoarterial apparatus, usually seen in the nail bed of fingers. Most of this mass presents typical symptoms such as severe pain, point tenderness and hypersensitivity to cold like neuroma, gout or causalgia. Concerning about the origin, there were few written reports about extra-digit glomus tumor, especially that occurred in the skeletal muscule. METHODS: A 48-year-old female complained of painful tender mass in her right calf aggravated several months ago. Her MRI and femoral angiogram showed a well defined hypervascular tumor such as hemagioma or hemagioendothelioma in the right calf. Surgical treatment was performed, and it proved glomus tumor in soleus muscle histologically. RESULTS: After the operation, patient didn't complain of her symptoms any more and there was no evidence of recurrence during 1 year follow-up period. CONCLUSION: Authors have found only eight cases of intramuscular glomus tumor reported in the literature and present here the ninth case of an intramuscular glomus tumor and first case of soleus muscle.
Causalgia ; Female ; Fingers ; Follow-Up Studies ; Glomus Tumor* ; Gout ; Humans ; Hypersensitivity ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Skeletal* ; Neuroma ; Recurrence

PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.
Age of Onset ; Arteries ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Korea* ; Lower Extremity ; Phlebitis ; Risk Factors ; Smoke ; Smoking ; Specialization ; Thromboangiitis Obliterans* ; Tobacco ; Upper Extremity ; Veins

Herein, the case of a 43-year-old woman, with a relapsing-remitting variant of multiple sclerosis (MS), which began when she was 34 years of age, and gave rise to severe neurological complications, including progressive paralysis in both legs and visual deterioration, is reported. Despite heavy immunomodulatory treatment, her condition relapsed and became aggravated. At this point, the decision was made to perform autologous hematopoietic stem cell transplantation (HSCT). The enrichment of CD34+ cells was followed by depletion of the peripheral T cells. The post-transplantation course was uneventful, and autoimmune thrombocytopenia developed within 7 months of the HSCT. The patient was treated with cyclosporine (CsA) and oral prednisolone, but subsequently developed systemic sclerosis (SSc). The administration of CsA following the syngeneic/autologous HSCT caused a T lymphocyte-dependent autoimmune disease, which resembled graft-versus-host disease (GVHD). It is quite probable the auto-reactive lymphocytes, which were paradoxically elicited by the CsA during the reconstitution of the immune system, partly contributed to the occurrence of the other autoimmune disease, SSc. To our knowledge, this is the first description of a MS patient, having undergone CD34+-selected autologous HSCT followed by the administration of CsA, who subsequently developed SSc.
Adult ; Autoimmune Diseases ; Cyclosporine ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immune System ; Leg ; Lymphocytes ; Multiple Sclerosis* ; Paralysis ; Prednisolone ; Purpura, Thrombocytopenic, Idiopathic ; Scleroderma, Systemic* ; T-Lymphocytes

BACGROUND: The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass. METHODS: The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured. RESULTS: Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P <0.05) and fat intake was positively correlated with fat mass (P <0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (gamma = 0.26; P <0.01, gamma = 0.15; P <0.05, gamma = 0.31; P <0.01). WHR was positively correlated with age (gamma =0.26; P <0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (gamma = 0.24; P <0.01, gamma = 0.20; P <0.01, gamma = 0.16; P <0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (beta = 0.072; P <0.01, beta = 0.0035; P <0.05) and WHR (beta = 6.9E-04; P <0.05, beta = 4.0E-05; P <0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR. CONCLUSION: The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.
Body Mass Index ; Diet ; Hip ; Humans ; Insulin-Like Growth Factor I ; Korea ; Male ; Mass Screening ; Smoke ; Smoking ; Testosterone*