OBJECTIVE: Large loop excision of transformation zone(LLETZ) is gaining popularity as an alternative to other ablative or cone methods for the treatment of cervical intraepithelial neoplasia(CIN). The optimal management of CIN after LLETZ, however, remains controversial and the reliable predictors of residual disease after LLETZ have not been consistently identified. This study was performed to identify factors to predict residual disease after LLETZ. METHODS: From August 1993 to July 1995, 133 patients who received subsequent hysterectomy after LLETZ in Department of Obstetrics and Gynecology at Seoul National University Hospital were retrospectively reviewed. Residual disease was defined as positive findings of CIN or further advanced findings in hysterectomy specimen. The age of patients, the severity of disease and the status of resection margin(RM) were analyzed for predictive values of residual disease. The Chi-square test, Fisher's exact test and Student t-test were used for statistical analysis. RESULTS: The residual disease after hysterectomy was negative in 85.7%(114/133) and positive in 14.3%(19/133). Among 19 cases with positive residual disease, 3 cases were revealed to be microinvasive cervical cancer. The mean age of patients with no residual disease was 42.5 years(range; 27-71) and that of patients with residual disease was 49.1 years(range; 33-72). Nine out of 94 cases(9.6%) with negative RM and 10 out of 39 cases(25.6%) with positive RM in LLETZ had residual disease. Two out of 14 cases(14.3%) with CIN II and 17 out of 119 cases(14.3%) with CIN III in LLETZ had residual disease. The success of LLETZ which means no residual disease was influenced by the age of patients(p=0.005) and the status of resection margin of LLETZ(p=0.032). CONCLUSION: The negative resection margin in LLETZ does not always guarantee that there is no residual disease. Close preoperative workup and more aggressive treatment plan(wide conization or hysterectomy) should be considered in patients who has higher possibility of positive residual disease such as old age and positive resection margin in LLETZ.
Cervical Intraepithelial Neoplasia* ; Conization ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms

BACKGROUNDS: It is to find out ins and outs of falls, and then to study risky factors that are preventable. METHODS: Total 260 elderly people living in Nonsan who are 60 years old and over were analyzed for data. Stereotyped of those are populational, social specific, physical functions, and basis diseases. And concerning falls, it was analyzed if they have had experience of up to 5 times within 3 years recently. RESULTS: The analyzed are total 260 people, men 112(43%), and women 148(57%). And the ones who answered they have had experience of falls are 108(41.6%), men 31(28.7%), and women 77(71.3%), showing a distinguishable difference between two groups. Women have had more experience than men have(p<0.001), and according to their age, the average age of those experienced falls showed to be higher than the one of those who have not(p=0.036). And according to their education, the ones who did not go to any schools have had more experience than those who did, showing the education has something to do with falls(p<0.001). The mean mass index(p=0.043) and average weight(p=0.023) also showed a mere difference between the group of the people who have had experience and the one of those who have not. Taking into account the fact that there were more women in the group who have had experienced falls, it is shown that there is nothing practical to pay attention to. In Activity of Daily Living(ADL) the experienced is 10.8(+/-4.2), and the unexperienced 9.1(+/-3.1), showing a mere difference between two groups(p<0.000). Concerning chronic diseases, there was no difference between those two groups, but individual patient histories showed that the experienced group had less rheumatic trouble than the unexpedenced(p=0.033). Looking at the difference of the causes for the falls according to their gender, the range of their movements(p=0.043), illumination(p=0.012), influence of alcoho1(p=0.001), and the shoes when they were falling down(p<0.001), the first aid treatments after falls(p=0.014), and influence of medications(p<0.001) showed a mere difference between men and women, while did not show any difference in seasons, time of falls, places, and the descriptions of the surfaces of the places. The mean number of falls within recent 3 years of the experienced was 1.79 times, and the comparison of the relation between the frequency and the causes of falls was done between the ones with experience of I fall, and the ones with experience of more twice falls. The average height(p=0.046) was much higher thai those with experience of more than 2 falls. There was also a mere difference between two groups in movements(p=0.009), illumination(p=0.005), influence of alcohol(p=0.003), the shoes (p=0.048), and first aid treatments after falls(p<0.001). CONCLUSION: The group with higher risk rate includes women, age, poor education, skinny physical figures, and lack of ability to act in daily life. Therefore, those results should be considered when a preventive program of falls for elderly people is designed.
Aged* ; Asian Continental Ancestry Group ; Chronic Disease ; Chungcheongnam-do ; Education ; Female ; First Aid ; Humans ; Male ; Middle Aged ; Prevalence* ; Seasons ; Shoes

BACKGROUND: Lidocaine's sedative effect has not been known well. The purpose of this study was to evaluate its sedative and cardiovascular effects during induction of anesthesia. METHODS: Twenty patients were randomly allocated to group I or II, with or without lidocaine 1.5 mg/kg intravenously (IV) before induction, respectively. The BIS, blood pressure and heart rate were measured at before and 2 minutes after lidocaine IV injection, preintubation, and 1, 2, 3 and 5 minutes after tracheal intubation. The enflurane concentrations were continuously maintained at 2 volume%. RESULTS: The BIS of group I was more decreased at 1 and 2 minutes after intubation than those of group II. The systolic blood pressures of group I were less increased at 1 and 2 minutes after intubation than those of group II. The diastolic blood pressures and heart rates of group I were not different from those of group II at each stage of the procedure. CONCLUSIONS: Lidocaine reduced BIS and blunted the intubation-induced systolic hypertensive response. In addition it is thought that it has a sedative effect and is effective to maintain cardiovascular stability after tracheal intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Heart Rate ; Humans ; Hypnotics and Sedatives* ; Intubation ; Intubation, Intratracheal* ; Lidocaine*

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of 26.3 kg/m2 and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (23.1 kg/m2) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.
Adenoids ; Body Mass Index ; Child ; Diagnostic Errors ; Diet ; Fatty Liver ; Follow-Up Studies ; Humans ; Hypertrophy ; Liver ; Obesity ; Physical Examination ; Polysomnography ; Reference Values ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Sinusitis ; Sleep Apnea, Obstructive ; Snoring

Abdominal pregnancy that is a life threatening variant of ectopic pregnancy, has been a rare event with high maternal mortality. It is very difficult to diagnose a abdominal pregnancy clinically. We have experienced a case of early abdominal pregnancy diagnosed at emergency laparotomy and this case was presented with a brief review of the literatures.
Emergencies ; Female ; Laparotomy ; Maternal Mortality ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

Although the measurement of tear film break-up time (BUT) is the most frequently used diagnostic test for dry eye syndrome, there have been no reports for the relationship between clinical manifestations of dry eye patients and the degree of their BUTs. To investigate the relationship, we analyzed retrospectively clinical manifestations of 466 dry eye patients and categorized them into two groups in terms of BUT, the group of BUT <5 seconds and BUT >or=5 seconds, in various clinical manifestations. The two groups were compared by X2-test and the results were as follows. The two groups did not show statistically significant difference in sex, age, duration of symptoms, degree of corneal erosion, and time from the beginning of management to symptom improvement. Therefore we thought that there was no statistically significant correlation beteween the above-mentioned clinical manifestations of this study patients and their BUT's. There were more patients whose BUT were below 5 seconds than those having BUT above 5 seconds in group complaining foreign body sensation as a main symptom and in group having associated chronic conjunctivitis. (BUT, dry eye)
Conjunctivitis ; Diagnostic Tests, Routine ; Dry Eye Syndromes ; Foreign Bodies ; Humans ; Retrospective Studies ; Sensation ; Tears

PURPOSE: The long-term outcomes of augmentation cystoplasty were investigated in spinal cord injury (SCI) patients with a neurogenic bladder, and included a study of the complications and patients' satisfaction. MATERIALS AND METHODS: 19 SCI patients that underwent an augmentation cystoplasty, between 1988 and 1994, were retrospectively reviewed. The mean follow-up period was 120, ranging from 94 to 169 months. The changes in the intravesical pressure, bladder capacity and complications were investigated. Urological examinations, including history taking, medical records, radiological evaluations and urodynamic studies were undertaken. All the patients were interviewed by direct contact. RESULTS: Six months postoperatively, the urodynamic results showed significantly decreased intravesical pressures and increased bladder capacities. The intravesical pressure (cmH2O) was decreased from 89.0+/-16.49 to 28.0+/-5.69 (p<0.05), and the functional bladder capacity (ml) was increased from 125.0+/-53.30 to 480.0+/-43.33 (p<0.05). From the long-term follow-up, 10 years postoperatively, the results were similar to the previous data (21.0+/-3.88cmH2O and 510.0+/-60.27ml). The symptomatic urinary tract infections had disappeared, but the asymptomatic bacteriuria continued. The vesicoureteral reflux was eliminated, and the renal function normalized, in all patients. The hydronephrosis had disappeared in most patients (89%). A few postoperative complications were reported. Most patients were very satisfied symptomatically (89%), with no patient expressing dissatisfaction. A clean intermittent catheterization (CIC) was performed every 4 to 6 hours, with the mean volume of drained urine was 450, ranging from 400 to 600ml. CONCLUSIONS: Augmentation cystoplasty could be an excellent method of treatment in selected patients with SCI. There were no significant complications, and a high degree patients' satisfaction, on the long-term follow-up.
Bacteriuria ; Follow-Up Studies ; Humans ; Hydronephrosis ; Intermittent Urethral Catheterization ; Medical History Taking ; Postoperative Complications ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Tract Infections ; Urodynamics ; Vesico-Ureteral Reflux

PURPOSE: This study was to evaluate the efficiency of routine performance of a batch of tests in the clinical staging work-up of cervical carcinoma. MATERIALS AND METHODS: The medical records were reviewed for 1,393 consecutive cervical carcinoma patients who underwent pretreatment staging work-up in Seoul National University Hospital from January 1988 to December 1997. The impression stage -which is designated ten tatively by the findings of pelvic examination and biopsy-, the results of staging work-up, and the finally allotted FIGO clinical stage were reviewed. The annual trend of stage distribution and the positive yields of tests were evaluated. RESULTS: Annual trend shows that Ia is increasing. The positive yield of chest x-ray was 0.22% (3/1, 379; Ib: 1, IIa: 1, IIb: 1), intravenous pyelography (IVP) 2.50% (31/1, 242; Ib: 2, IIa: 4, IIb: 17, IIIb: 8), cystoscopy 0.55% (6/1, 093; IIb: 4, IIIb: 2), and proctosigmoidoscopy 0.086% (1/1, 157; Ib: 1). After completing the staging work-up, 29 patients (2.08%) were upstaged. The routine performance of IVP in impression stage Ia and cystoscopy in impression stage IIa or less was considered inefficient. The routine performance of proctosigmoidoscopy was considered inefficient because of its very low yield. CONCLUSION: The selective performance of tests according to the impression stage during staging work-up is recommended to minimize the unnecessary treatment delay, cost, and patients' discomfort.
Cystoscopy ; Gynecological Examination ; Humans ; Medical Records ; Seoul ; Sigmoidoscopy ; Thorax ; Urography ; Uterine Cervical Neoplasms

Endoscopic endoprosthesis is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. But the placement of conventional endoprosthesis is difficult and is associated with significant complications such as hemorrhage, perforation and dysfunction of the prosthesis. Recently, self -expand- able metal prosthesis have also been utilized for malignant esophageal stenosis, and palliation of this modality seems to be more effective than other modalities. However the main problems with these metal stents are tumor ingrowth leading to reobstruction, migration, and eophageal trauma by the distal, hard skirt of the stent. EsophaCoil stent is a simple coil with close loops made from a single flat wire of nickel titanium alloy. The radial force of this material is much stronger than stainless steel, expansion time is faster and the stent is able to dilate even extremely resistant strictures. This new metalic stent seems to have several advantages over the current commnerically available ones. We report our experiences with this EsophaCoil stent and review of literature.
Alloys ; Constriction, Pathologic ; Deglutition Disorders ; Esophageal Stenosis* ; Hemorrhage ; Nickel ; Prostheses and Implants* ; Stainless Steel ; Stents ; Titanium

Endoscopic variceal ligation(EVL) is effective in both emergent and elective treatment of esophageal varices and can be used as a safe alternative to sclerotherapy. However, as yet no transparent ligating device is widely available, the endoscopic view through the present commercial ligating device is so narrow that it is often difficult to both approach the target and accurately define and position the bleeding site. To assess the benifit of transparent EVL device, total 143 patients, 632 sessions, underwent EVL treatment. In 545 sessions the non-transparent, conventional-type ligating devices (Stigmann-Goff ligating devices) were used, whereas in 87 sessions the transparent ligating devices used. 35 patients underwent EVL under active bleeding conditions; in 29 patients a conventional ligation devices, whereas in 6 patients a transparent ligating devices were used. The remaining l08 patients were either electively treated by EVL. The visual fields decreased to 20-30% with the conventional devices, but no change of visual fields were noted with the transparent devices. In electively treated cases by EVL, the times need to ligate one band were not significantly different in the conventional devices (average, 18.5 sec) compared with that in the transparent devices (average, 16.7 sec), but in active bleeding conditions it took a significantly longer times in the conventional devices (mean, 30.7 sec) compared with that in the transparent devices (average, 19.4 sec). The hemostatic success rates in active bleeding conditions were 89.7%(26/29) using the conventional devices, 100%(6/6) using the transparent devices. In conclusion this newly developed transparent ligating device provides an improved visual field and shortens ligating time, especially in active bleeding condition. Therefore EVL using transparent device is more effective method in treatment of esophageal varices, especially active bleeding conditions.
Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Ligation* ; Sclerotherapy ; Visual Fields