Sistema CAD/CAM en la confección de prótesis totales dentales / The CAD/CAM system in the fabrication of total dental prostheses

La técnica CAD/CAM es un sistema que ha facilitado los procesos de toma de impresiones totales e incorpora registros intraorales y requisitos apropiados para lograr bases protésicas adecuadas, lo cual permite óptimos resultados en clínica dental, como son el ahorro de tiempo y la comodidad para el especialista y el paciente, razones que llevan al profesional estomatológico a dar el paso hacia una odontología digital. El objetivo del estudio fue analizar el sistema CAD/CAM en la confección de prótesis totales dentales. La búsqueda se realizó en las bases de datos Google Scholar, Pubmed y Scopus, intentando responder a la pregunta orientadora: ¿Cuáles son los aspectos más significativos para el sistema CAD/CAM en la confección de prótesis totales dentales? Como resultados, se pudo interpretar que, consiguiendo registros tridimensionales producidos en un escáner, se proporciona una mejor adaptación de estructuras respecto a los métodos convencionales, por lo que induce estética y precisión, que son factores importantes en la odontología. Se concluyó que el sistema CAD/CAM disminuye el margen de error humano y conduce a mayores éxitos odontológicos, al brindar un mejor soporte para la toma decisiones y conseguir mejores resultados estéticos y funcionales en las prótesis totales de los pacientes(AU)

The CAD/CAM technique is a system that has facilitated the process of taking total impressions and incorporates intraoral records and appropriate requirements to achieve adequate prosthetic bases, which allows optimal results in the dental clinic, such as time savings and comfort for the specialist and the patient, reasons that lead the dental professional to take the step towards digital dentistry. The objective of the study was to analyze the CAD/CAM system in the fabrication of total dental prostheses. The search was carried out in Google Scholar, Pubmed and Scopus databases, trying to answer the guiding question: What are the most significant aspects for the CAD/CAM system in the manufacture of total dental prostheses? As results, it was possible to interpret that, by obtaining three-dimensional records produced in a scanner, it provides a better adaptation of structures compared to conventional methods, thus inducing esthetics and precision, which are important factors in dentistry. It was concluded that the CAD/CAM system reduces the margin of human error and leads to greater dental success by providing better support for decision making and achieving better esthetic and functional results in the total prostheses of patients(AU)

Influencia de la obesidad en los resultados del tratamiento quirúrgico de la estenosis lumbar degenerativa / Obesity Influence on the Surgical Treatment Results of Degenerative Lumbar Stenosis

Introducción: La estenosis lumbar degenerativa altera la calidad de vida y disminuye la capacidad funcional en adultos mayores. La obesidad representa un problema de la salud mundial actual. Objetivo: Detallar los efectos de la obesidad sobre el riesgo quirúrgico, los índices de complicaciones posoperatorias y los resultados funcionales en pacientes adultos mayores sometidos a cirugía electiva por estenosis lumbar degenerativa. Métodos: Estudio prospectivo-descriptivo, con pacientes adultos mayores intervenidos quirúrgicamente por diagnóstico de estenosis lumbar degenerativa y valorados un año después. Resultados: 55 pacientes, 23 obesos, 32 no obesos; relación de sexos 1,5:1 masculino-femenino, mayor cantidad de espacios intervenidos, tiempo quirúrgico y pérdida de sangre en obesos. Los obesos presentaron un mayor número de complicaciones postquirúrgicas y resultados funcionales menos buenos. Conclusiones: La obesidad constituye un mayor riesgo quirúrgico, que, aunque la diferencia en los resultados clínicos no sea muy importante, provoca intervenciones más prolongadas y mayor incidencia de complicaciones quirúrgicas(AU)

Introduction: Degenerative lumbar stenosis alters quality of life and decreases functional capacity in older adults. Obesity represents a current global health problem. Objective: To detail the effects of obesity on surgical risk, postoperative complication rates, and functional outcomes in older patients undergoing elective surgery for degenerative lumbar stenosis. Methods: Prospective-descriptive study with elderly patients who underwent surgery for a diagnosis of degenerative lumbar stenosis, who were evaluated one year later. Results: Fifty-five patients, 23 obese, 32 non-obese; sex ratio 1.5:1 male-female, higher number of intervened spaces, surgical time and blood loss in obese subjects. The obese patients showed higher number of post-surgical complications and less good functional results. Conclusions: Obesity constitutes a higher surgical risk, even when the difference in clinical results is not very important, it causes longer interventions and higher incidence of surgical complications(AU)

Resultados a largo plazo de la rehabilitación del piso pélvico en pacientes con incontinencia fecal / Long-term results of pelvic floor rehabilitation in patients with fecal incontinence

Resumen Introducción: La rehabilitación del piso pélvico es frecuentemente indicada a los pacientes con incontinencia fecal. Su efectividad a corto plazo ha sido demostrada. Sin embargo, sus resultados en el largo plazo son controversiales. Objetivo: Nuestro objetivo es evaluar los resultados funcionales y calidad de vida a largo plazo de los pacientes con incontinencia fecal tratados mediante rehabilitación del piso pélvico. Materiales y Método: Estudio cuasi-experimental. Se incluyeron los pacientes con incontinencia fecal tratados mediante rehabilitación del piso pélvico entre 2007-2014 en nuestro centro, sin necesidad de cirugía. Se midió el puntaje funcional de Wexner y de calidad de vida (FIQLS) antes (T1) y después del tratamiento (T2). Se realizó encuesta vía correo electrónico para obtener dichos puntajes entre 3-10 años posterior al tratamiento (T3). Resultados: De 215 pacientes, 182 cumplían criterios de inclusión. 96 (52,8%) de ellos respondieron la encuesta en T3. La mediana de seguimiento fue de 4,5 (3-10) años. La edad promedio al tiempo del estudio fue de 60,8 ±13,1 años. 88,4% fueron mujeres. La mediana del puntaje funcional fue 16 (6-20) en T1 y 7 (0-18) en T2, p = 0,000. La calidad de vida mejoró significativamente en sus 4 dimensiones entre T1 y T2. En T3, ambos puntajes presentaron mejores promedios que en T1, p = 0,000. No hubo asociación entre el tiempo de seguimiento y el resultado funcional en T3. Conclusión: Los pacientes con incontinencia fecal tratados mediante rehabilitación del piso pélvico mejoran significativamente su funcionalidad y calidad de vida. El beneficio disminuye en el tiempo, pero persiste mejor que previo al tratamiento.

Introduction: Pelvic floor rehabilitation is often indicated as first-line therapy for patients with fecal incontinence. Its short-term effectiveness has been demonstrated in these patients. However, long-term results are controversial. Aim: Our objective is to evalúate long-term functionality and quality of life in patients with fecal incontinence treated with pelvic floor rehabilitation. Materials and Method: Quasi- experimental study conducted at a single tertiary care center. We included patients with fecal incontinence treated by pelvic floor rehabilitation at our center between 2007-2014 who did not require surgery. Wexner functional score and quality of life using FIQLS were measured pre (T1) and post-treatment (T2). Poste - riorly, an-e-mail survey was conducted to retrieve scores three to 10 years after treatment (T3). Results: Of the 215 patients, 182 met the inclusion criteria. 96 (52.8%) patients responded at T3 and were therefore included. The median follow-up period was of 4.5 years (3-10). The mean age at the time of the study was 60.8 ± 13.1 years and 88.4% were women. The median Wexner score was 16 (6-20) in T1 and 7 (0-18) in T2, (p = 0.000). Quality of life improved significantly in its four dimensions when comparing T1 and T2. In T3, Wexner and the quality of life scores were significantly lower than T2. However, in T3, both scales had better means than T1, (p = 0.000). There was no association between the follow-up time and the functional result in T3. Conclusions: Patients with fecal incontinence treated by pelvic floor rehabilitation improve their functionality and quality of life significantly. This benefit decreases over time but remains above its baseline.

Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing / 中华创伤杂志(英文版)

PURPOSE@#In the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures.@*METHODS@#A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture. The included patients were in the adolescent age group (12-17 years), did not meet conservative follow-up criteria and had unstable fractures (>10° angulation and 18 years or 15 years had prolonged time to union ([11.1 ± 1.8] weeks). There were no non-unions, re-fractures or infections. No complications were observed during implant removal. None of the patients had sensorial radial nerve injury or tendon damage.@*CONCLUSION@#The locked intramedullary nailing technique, which is minimally invasive and provides biological fixation, was found to be successful and safe in the treatment of adolescent forearm fractures.

Tratamiento para fractura de olécranon en pacientes mayores: Revisión sistemática / Treatment for olecranon fracture in older patients: Systematic review

Introducción El tratamiento de las fracturas de olécranon puede tener diferentes resultados, según el tipo de intervención, las características de la fractura y del paciente. Esta revisión sistemática de la literatura pretende identificar los tratamientos para el manejo de este tipo de fractura en el adulto mayor y sus resultados funcionales. Materiales y métodos Se realizó una búsqueda sistemática de la bibliografía en las bases de datos Medline, Embase y Cochrane. Se incluyeron estudios clínicos en pacientes mayores con fractura de olécranon que incluyeran resultados funcionales en sus seguimientos. Resultados De un total de 432 referencias capturadas, se incluyeron nueve estudios 6 estudios observacionales retrospectivos y 3 prospectivos. En 3 estudios se usó exclusivamente tratamiento no quirúrgico y en 4 tratamiento quirúrgico, de los cuales 2 comparan la fijación de banda de tensión con placa y 2 proponen el uso de supersuturas y suturas de anclaje. En 2 estudios comparan el tratamiento quirúrgico con el tratamiento no quirúrgico. En la evaluación de los resultados funcionales el puntaje de la Escala de Incapacidades del brazo, hombro y la mano (DASH) fue la más usada. Discusión En pacientes de edad avanzada antes de optar por fijación quirúrgica, se evalúan factores que pueden tener implicaciones en los resultados clínicos y funcionales como el número de comorbilidades y la mala calidad ósea. Este trabajo puede servir de base para la elección de tratamientos no quirúrgicos bajo condiciones requeridas, para obtener mejores resultados funcionales.

Background The treatment of olecranon fractures may lead to different outcomes, depending on the type of intervention, the characteristics of the fracture, and the patient. This systematic review of the literature aims to identify the treatments for the management of this type of fracture in the elderly and its functional results. Methods A systematic search of the bibliography was carried out in the Medline, Embase and Cochrane databases. It included clinical studies on elderly patients with olecranon fractures, as well as the functional results in their follow-up. Results Of a total of 432 references were obtained, with nine studies including 6 retrospective observational studies, and 3 prospective studies. In 3 studies, non-surgical treatment was used, and in 4 surgical treatments, 2 were comparing tension band wiring and plate fixation, and 2 proposed the use of super sutures and anchoring sutures. In 2 studies, surgical treatment was compared with non-surgical treatment. In the evaluation, the functional outcomes, the score of the Scale of disabilities of the arm, shoulder, and the hand (DASH) was the most used. Discussion In patients of advanced age, before opting for surgical fixation, factors that may have implications for clinical and functional outcomes, such as number of comorbidities and poor bone quality are evaluated. This work can serve as a basis for the choice of non-surgical treatments under the necessary conditions, and to obtain better functional results.

Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica / Long-term results of patients with adenocarcinoma of the lower rectum treated with anterior intersphinteric ultra-low-resection

INTRODUCCIÓN: La resección anterior ultrabaja interesfintérica (RAUBIE), permite preservar la función esfinteriana en pacientes seleccionados con cáncer de recto (CR). No obstante, puede producir alteraciones en la función evacuatoria y esfinteriana. OBJETIVO: Analizar los resultados oncológicos y funcionales luego de una RAUBIE. MATERIAL Y MÉTODO: Estudio observacional, analítico, transversal, durante el período 2007 a 2016. Criterios de inclusión: Pacientes sometidos a RAUBIE por CR con intención curativa. Todos los pacientes tuvieron un seguimiento el año 2017. Para la evaluación funcional se usó la escala de Jorge-Wexner, LARS y Kirwan. Análisis estadístico: Estadística descriptiva y método de Kaplan-Meier. RESULTADOS: De 21 pacientes; catorce (67%) fueron varones, edad promedio: 59 años. Ubicación tumoral: 4 cm (2-6 cm) del margen anal. Dieciocho (85,7%) pacientes recibieron neoadyuvancia. Todos los márgenes quirúrgicos distales y radiales fueron negativos. Un paciente (4,8%) tuvo metástasis a distancia y no hubo recurrencia locorregional. Con una mediana de seguimiento de 76,3 (9,8-126,8) meses, la sobrevida global y libre de enfermedad a 5 años fue de: 100% y 95% (IC: 90,1-99,9%), respectivamente. Con una mediana de seguimiento de 90 meses (21,7-124,2); se realizó la evaluación funcional a 15/21 pacientes. El puntaje de Jorge-Wexner tuvo una mediana de 13 (4-17) puntos, la escala de LARS de 34 puntos y en la escala de Kirwan, cuatro pacientes (26,7%) mostraron una buena función (Kirwan I-II). CONCLUSIÓN: Si bien los resultados oncológicos de los pacientes sometidos a una RAUBIE son satisfactorios, se debería tomar en cuenta los resultados funcionales al momento de proponer esta alternativa quirúrgica.

INTRODUCTION: Intersphinteric resection (ISR) allows preserve sphincter function in selected patients with rectal cancer (RC). Notwithstanding, it can produce alterations in defecation. AIM: To analyze the oncological and functional results after an ISR. MATERIAL AND METHOD: Observational, analytical, cross-sectional study, in the period 2007-2016. Inclusion criteria: Patients submitted to ISR by RC with curative intention. All the patients had a follow-up in 2017. Analysis of functional evaluation were performed by Jorge-Wexner, LARS and Kirwan scale. Statistical analysis: Descriptive statistics and Kaplan-Meier method. RESULTS: Of 21 patients; Fourteen (67%) were male, average age: 59 years. Tumor location: 4 cm (2-6 cm) from anal verge. Eighteen (85.7%) patients received neoadjuvant therapy. All distal and radial margins were negative. One patient (4.8%) had distant metastases and there was no locoregional recurrence. With a median follow-up of 76.3 (9.8-126.8) months, the 5-year global and disease-free survival was: 100% and 95% (CI: 90.1-99.9%), respectively. With a median follow-up of 90 months (21.7-124.2); Functional evaluation was performed on 15/21 patients. The Jorge-Wexner score had a median of 13 (4-17) points, the LARS scale of 34 points and in Kirwan scale, four patients (26.7%) showed good function (Kirwan I-II). CONCLUSION: The oncological results of patients undergoing ISR are satisfactory, however, functional results should be taken into account when proposing this surgical procedure.

Functional outcomes in patients submitted to restorative proctocolectomy with ileal pouch anal anastomosis in a single tertiary center / Resultados funcionais em pacientes submetidos a proctocolectomia restauradora com anastomose íleoanal e bolsa ileal em um centro terciário

ABSTRACT Background: Functional results after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis are variable. We assessed functional results in patients with ileal pouch anal anastomosis and evaluated potential factors associated with poor functional results. Methods: Retrospective cohort study of 38 patients who were submitted to a restorative proctocolectomy with ileal pouch anal anastomosis, in the context of ulcerative colitis and familial adenomatous polyposis, in at tertiary referral center, in the period between 1993 and 2013. Clinical records were analyzed and telephone interviews with protocoled questionnaire to 32 patients (12 ulcerative colitis, 20 familial adenomatous polyposis) were performed. Pouch functional results were also evaluated based in the Oresland score. The functional results were analyzed at four points of the patient outcome. Results: In 25 patients were performed restorative proctocolectomy with ileal pouch anal anastomosis and in 7 patients total colectomy preceded protectomy with ileal pouch anal anastomosis. Protective ileostomy was performed in all patients. There was no mortality and post-operative complications related with the pouch was 12.5% but treated conservatively. The mean follow-up was 13.2 years. Pouch failure occurs in 9.4% (2 in familial adenomatous polyposis and 1 in ulcerative colitis). Familial adenomatous polyposis patients achieved the best outcome but the outcome was acceptable in both groups. The median Oresland score was good with small variations over the years, although the best score being reached at 5 years after the surgery. Conclusions: The long-term results in patients undergoing restorative proctocolectomy with ileal pouch anal anastomosis were good in both groups, although better in familial adenomatous polyposis. In both, the best score of functional results seems to be reached at 5 years after surgery.

RESUMO Introdução: Os resultados funcionais após proctocolectomia restauradora em casos de colite ulcerativa e polipose adenomatosa familiar são variáveis. Avaliamos os resultados funcionais em pacientes com anastomose ileoanal e bolsa ileal bem como os fatores potenciais associados a resultados funcionais fracos. Métodos: Estudo retrospectivo de coorte com 38 pacientes submetidos a proctocolectomia restauradora com anastomose ileoanal e bolsa ileal, no contexto de colite ulcerativa e polipose adenomatosa familiar, em um centro de referência terciário, no período entre 1993 e 2013. Analisamos os registos clínicos e realizamos entrevistas telefónicas com um questionário protocolado a 32 pacientes (12 colite ulcerativa, 20 polipose adenomatosa familiar). Também foram avaliados os resultados funcionais da bolsa, com base no escore de Oresland. Os resultados funcionais foram analisados em quatro pontos do desfecho de cada paciente. Resultados: Em 25 pacientes foi realizada proctocolectomia restauradora com anastomose ileoanal e bolsa ileal, e em 7 pacientes uma colectomia total precedeu a protectomia com anastomose ileoanal e bolsa ileal. Todos os pacientes foram submetidos a uma ileostomia protetora. Não ocorreram óbitos e as complicações pós-operatórias relacionadas com a bolsa chegaram a 12,5%, mas foram tratadas conservadoramente. O seguimento médio foi de 13,2 anos. Ocorreu defeito na bolsa em 9,4% (2 em polipose adenomatosa familiar e 1 em colite ulcerativa). Os pacientes com polipose adenomatosa familiar obtiveram o melhor resultado; contudo, em ambos os grupos o resultado foi considerado aceitável. A mediana do score de Oresland foi boa, tendo sido observadas pequenas variações ao longo dos anos, embora o melhor score tenha sido verificado 5 anos após a cirurgia. Conclusões: A longo prazo, os resultados para os pacientes submetidos a proctocolectomia restauradora com anastomose ileoanal e bolsa ileal foram bons em ambos os grupos, embora tenham sido considerados melhores nos pacientes com polipose adenomatosa familiar. Nos dois grupos, o melhor escore de resultados funcionais parece ser alcançado por volta dos 5 anos após a cirurgia.

Resultados funcionales de la doble artrodesis en deformidad del retropié: serie de casos / Functional results of Double arthrodesis in hindfoot arthrosis: Case series

Introducción La doble artrodesis es una técnica quirúrgica para el tratamiento de la artrosis del retropié con resultados equivalentes a la triple artrodesis. El objetivo fue describir los resultados funcionales en pacientes con diagnóstico de artrosis severa del retropié por diferentes causas. Materiales & Métodos Estudio tipo serie de casos de pacientes intervenidos con doble artrodesis entre 2012-2016. La mejoría clínica y funcional se evaluaron a través de la escala análoga del dolor (EVA) y la escala AOFAS del retropié; el estado actual de salud fue evaluado mediante la escala SF-12. Resultados Se incluyeron 14 pies en 12 pacientes (2 Hombres; 10 Mujeres) con un promedio de 62 años (Rango: 38-75 años). Se obtuvo una tasa de fusión del 93% y la principal causa etiológica fue la insuficiencia del tibial posterior. Todos los pacientes presentaron una mejoría significativa del dolor con una mediana EVA de 10 en el prequirúrgico (RIQ 9-10) a una mediana de 2 en el postquirúrgico (RIQ 0-4). El promedio de la escala AOFAS en el prequirúrgico fue 55 puntos en comparación a 76 puntos del postquirúrgico. El estado de salud actual con la escala SF12 reportó una puntuación promedio de 69.3 ± 19.7 en el componente físico y de 88.3 ± 15.6 en el componente mental. Discusión La doble artrodesis es una opción eficaz para el tratamiento de la artrosis del retropié mejorando la calidad de vida, intensidad de dolor y funcionalidad de los pacientes sometidos a esta intervención. Nivel de Evidencia: IV.

Introduction Double arthrodesis is a surgical technique for the treatment of hindfoot arthrosis with results equivalent to triple arthrodesis. The objective was to describe the functional results in patients with a diagnosis of severe hindfoot arthrosis for different causes. Methods Serial series of cases of patients operated with double arthrodesis between 2012-2016. Clinical and functional improvements were assessed through the analog pain scale (VAS) and AOFAS scale of the hindfoot; The current health status was assessed using the SF-12 scale. Results We included 14 feet in 12 patients (2 Men, 10 Women) with an average of 62 years (Range: 38-75 years). A fusion rate of 93% was obtained and the main etiologic cause was posterior tibial insufficiency. All patients had a significant improvement in pain with a median EVA of 10 in the preoperative period (IQR 9-10) and a median of 2 in the postoperative period (IQR 0-4). The average AOFAS scale in the preoperative period was 55 points compared to 76 postoperative points. The current health status with the SF12 scale reported an average score of 69.3 ± 19.7 in the physical component and 88.3 ± 15.6 in the mental component. Discussion Double arthrodesis is an effective option for the treatment of hindfoot arthrosis, improving the quality of life, intensity of pain and functionality at these patients. Level of evidence: IV

Tratamiento con placa precontorneada bloqueada de fracturas desplazadas del tercio medio de la clavicula / Precontoured locking plate treatment for displaced midshaft clavicle fractures

Introducción: El objetivo de este trabajo es analizar los resultados de un grupo de pacientes con fracturas mediodiafisarias desplazadas de clavícula tratadas con placa precontorneada bloqueada. Se analizaron la tasa de consolidación ósea, los resultados funcionales y las complicaciones. Materiales y Métodos: Cuarenta y seis fracturas de clavícula desplazadas de tipo 2B de Edimburgo fueron tratadas con placa bloqueada precontorneada. Los pacientes eran 36 hombres (uno con fractura bilateral) y nueve mujeres, con una edad promedio de 33 años (rango 17-56). Los pacientes fueron evaluados con radiología y el puntaje de Constant, el test QuickDASH y la escala analógica visual para dolor. Resultados: El seguimiento promedio fue de 30 meses (rango 12-46). Cuarenta y cinco fracturas consolidaron y una no. El puntaje de Constant promedio fue de 96 (rango 56-100) y el de QuickDASH promedio, 2 (rango 0-32). El dolor en el seguimiento fue de 0,3 puntos (rango 0-6). Se registraron 10 complicaciones en nueve pacientes (21%), aunque solo tres (6,5%) fueron consideradas mayores. En siete pacientes (15%), se retiró la placa por intolerancia (uno de ellos fue el paciente con mala consolidación, se registró como segunda complicación en el mismo paciente). Conclusiones: La reducción y estabilización de las fracturas desplazadas del tercio medio de la clavícula con placas precontorneadas y bloqueadas son un tratamiento eficaz con un bajo índice de complicaciones mayores relacionadas, a veces, con errores técnicos.

Introduction: The aim of this paper is to analyze the results in a group of patients with displaced diaphyseal fractures treated with precontoured clavicle locking plate. The rate of bone healing, functional outcome and complications were analyzed. Methods: Forty-six displaced clavicle fractures (Edinburgh type 2B) were treated with precontoured locking plate. Thirty- six were men (one with bilateral fracture) and 9 were women, with an average age of 33 years (range 17-56). Patients were assessed with radiology and the Constant score, the QuickDASH test, and the visual analogue scale for pain. Results: The average follow-up was 30 months (range 12-46). Forty-five fractures healed and one did not. The Constant score averaged 96 points (range 56-100) and the QuickDASH test averaged 2 points (range 0-32). Pain was 0.3 points (range 0-6). There were 10 complications in 9 patients (21%), but only three (6.5%) were considered major. In 7 patients (15%) the plate had to be removed due to intolerance (one of them was a patient with malunion, registering as a second complication in the same patient). Conclusions: The reduction and stabilization of displaced midshaft fractures of the clavicle with precontoured clavicle locking plate is an effective treatment with a low rate of major complications, sometimes related to technical errors.

Anorectal Malformation: Postoperative Care and Functional Results

Postoperative management of anorectal malformation consists of colostomy management and then management after definitive surgery. Colostomy management requires attention to certain details, i. e. complete decompression of the distal limb to avoid secondary megarectosigmoid and prevention and treatment of urinary tract infections in patients with rectourethral fistula. Management after definitive surgery requires the care of catheters placed in the rectourethral fistula or cloacal defect. Prevention and treatment of various complications after definitive operation, i. e. wound infection, anal stenosis or stricture, anal mucosal prolapse, and management of functional disorders, i.e. constipation, fecal incontinence and urinary incontinence are also necessary. In this review, recent trends for the prevention and treatment of the above mentioned problems after operation for anorectal malformation are presented.

Functional and Oncologic Outcome of Coloanal Anastomosis in Low Lying Rectal Cancer

PURPOSE: Sphincter preservation is one of the main goal in the treatment of rectal cancer, but surgical management of cancer of the lower third of the rectum continues to evolve. The aim of this study was to evaluate the oncologic safety and to assess the functional results of coloanal anastomosis following ultra low anterior resection (CAA/ uLAR) in distal rectal cancer. METHODS: Thirty-six patients underwent coloanal anastomosis following ultralow anterior resection between January 2000 and February 2005. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 6 cm in length. All patients were followed up for fecal incontinence and frequency of bowel movement after diverting ileostomy closure. All patients were evaluated for local or systemic recurrences. RESULTS: The mean age of the patients was 58.7 (34~82) years. The median follow-up period was 24.5 (6~55) months. The types of anastomosis were straight anastomosis (n=25), colonic J pouch formation (n=10) and coloplasty (n=1). The twenty-nine patients of thirty-one patients underwent diverting ileostomy were performed ileostomy repair. The twenty-two patients had frequency after ileostomy repair. There is no statistical correlation of reservoir type and frequency (P=0.604). But the relationship between adjuvant radiation and frequency is statistically correlated (P=0.012). Postoperative complications were anastomotic leakage (n=5), but mostly radiological minor leakage, transient paralytic ileus (n=2), and anastomotic stenosis (n=1). The local recurrence rate is 3% and systemic recurrence occurred in 5 patients (14%), most patients were in Astler-Coller stage C. CONCLUSIONS: Ultralow anterior resection and coloanal anastomosis in low lying rectal cancer did not seem to affect recurrence. This procedure has poor functional outcome in early period but normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation.

The Effect of Hip Fusion in Living Activity / 대한정형외과학회잡지

Hip fusion has provided disease eradication, stabilization, pain relief and strenuous activity, but the possible complication of pseudarthrosis as well as loss of all motion is a drawback. Total hip replacement arthroplasty has not been a good procedure for active young patients. This study was perforrned to clarify the indications, the best position, the functional results of hip fusion and the effect of hip fusion on the adjacent joint. The authors reviewed 32 cases of hip fusion performed at the Department of Orthopedic Sugery, Seoul National University Hospital during the period of 11 years from April 1973 to June 1984 and the following results were obtained. 1. The average age of the patients at the time of operation was 20.3 years. 2. Tuberculosis of the hip was the most common cause (56.2%). 3. The satisfactory fusion was obtained in 26 cases (81,2 %). 4. The average position of fusion was 20±9 degrees of flexion, 1±5 degrees of abduction and 10±4 degrees of external rotation. 5. Although there was a disability due to limitation of motion after hip fusion, leg length discrepancy was reduced from 3cm (preoperative) to 2.5cm (postoperative) and scoliosis was decreased from 18' of Cobbs angle (preoperative) to 12' of Cobbs angle (postoperative). 6. After hip fusion, walking capacity was increased and back pain was reduced. 7. Age was barely correlated with absolute clinical scores, but better functional results were obtained in younger patients than in older patients. 8. The results were excellent or good in 24 cases (75%).

Traumatic Dislocation of the Hip with Ipsilateral Femoral Shaft Fracture / 대한정형외과학회잡지

Traumatic dislocation of the hip with ipsilateral femoral shaft fracture was a rare injury. In this paper, 3 cases of these combined injuries are reported together with a review of the literature. After closed reduction of the two dislocated hips, the shaft fractures were treated, one with the Kiintscher nail, and the other with blade plate & screws. The remain was treated by Watson-Jones method. In the follow-up study, a fair result in one case and good results in two cases were obtained. Complications in 2 cases were peroneal nerve palsy. One case had pathologic ossification and one developed traumatic arthritis.