OBJECTIVES: From February 1995 to April 1998, those patients who had visited for evaluation of infertility, shown abnormal endometrial pattern on hysterosalpingography underwent resectoscopic operation. We evaluated about its therapeutic effect, recurrence rate of uterine adhesion and effectiveness of its assisted method. METHOD: We have reviewed 45 cases of intrauterine adhesion, classified as a central type, marginal type and multiple type. We used 26F resectoscope made in Storz for operation and inserted Lippes loop or pediatric foley catheter for prevention of readhesion. For promoting reepithelialization, conjugated estrogens(premarin) 5mg daily for 30 - 50 days were given and then 10mg of medroxyprogesterone acetate(provera) were added daily for the last 10 days. We evaluated the uterine cavity condition preoperatively and postoperatively by using hysterosalpingography. RESULT: In 45 cases, 41 cases were followed up postoperatively. 21 cases were markedly improved, 12 cases were improved and 8 cases were not improved or recurred on hysterosalpingography. In 41 cases, for prevention of readhesion 20 cases were used pediatric foley catheter and 5 cases(25%) were recurred. 21 cases were used Lippes loop and 3 cases(14%) were recurred. Pregnancy outcome was as follows;15 cases were pregnant and 10 cases delivered a viable infant, 3 cases aborted spontaneously, 1 case was ectopic pregnancy and laparoscopic salpingectomy was done, 1 case was ongoing pregnancy. CONCLUSION: This report suggests that resectoscopic operation is very effective in the treatment of intrauterine adhesion(therapeutic rate of 81%) and that the use of Lippes loop seems like to have the less recurrence rate than the use of pediatric foley catheter in prevention of postoperative readhesion, but more experience and further follow-up are necessary to obtain more detailed conclusions.
Catheters ; Female ; Follow-Up Studies ; Humans ; Hysterosalpingography ; Infant ; Infertility ; Medroxyprogesterone ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Recurrence ; Salpingectomy

Rupture of the major airway by blunt chest trauma is uncommon. It can potentially cause serious complications, such as tension pneumothorax or cardiovascular injuries, with an overall mortality rate reaching up to 30%. The etiology of trauma includes fall-down, traffic accidents, cycling and child abuse. Dyspnea was the most common feature, followed by hemoptysis, air leak and chest pain. It is well known that dyspnea after chest trauma is due to accumulation of secretions in the airway, mucosal and cartilaginous injuries and associated parenchymal injuries. In cases of recurrent dyspnea in children irrespective of trauma, we should consider asthma, foreign body aspiration, tracheal stenosis, bronchial tumor, mediastinal tumor, gastroesophageal reflux disease and vascular ring. In this case, we found granulation tissue repeatedly causing obstruction of the airway at the site of rupture after traffic accident. Dyspnea resolved after surgical resection of the granulation tissue. We report a case of recurrent granulation tissue showing dyspnea after bronchial rupture.
Accidents, Traffic ; Asthma ; Chest Pain ; Child ; Child Abuse ; Dyspnea ; Foreign Bodies ; Gastroesophageal Reflux ; Granulation Tissue ; Hemoptysis ; Humans ; Pneumothorax ; Rupture ; Thorax ; Tracheal Stenosis

PURPOSE: Among perinatal risk factors, neonatal seizures are one of the strongest independent discriminators of adverse outcome, representing high risks of mortality and neurologic morbidity. This study was undertaken to evaluate the neurologic outcome of neonatal status epilepticus according to underlying etiology, seizure pattern, onset time, and duration. METHODS: We reviewed retrospectively 36 neonates (19 males, 17 females) with status epilepticus who were admitted to the neonatal intensive care unit, Inha Hospital between July, 1988 and June, 2003. They were evaluated with neurologic examination, laboratory data, EEG findings, and neuroimaging studies etc. RESULTS: The mean gestational period of the patients was 37.0+/-3.6 weeks and birth weight was 2.70+/-0.82 kilogram. Fifty two point eight percent of the neonates were male and 66.7 percent were born at term. The most common cause of neonatal status epilepticus was hypoxic-ischemic encephalopathy. In preterm babies, intracranial hemorrhages showed an especially high frequency (P=0.034). Gestational age and birth weight did not show a correlation with neurologic complications. The incidence of neurological sequelae were significantly related to prolonged seizures lasting more than 1 hour (P=0.002). Neonates with seizures within the first 72 hours tended to be more frequent among those who developed adverse outcomes (P=0.016). Generalized tonic seizures had the worst prognosis, whereas those children who had subtle seizures had better outcomes than any other type (P< 0.05). Generalized tonic seizures were primarily represented on EEG by abnormal background, whereas subtle seizure showed a significantly more normal EEG than any other seizures (P< 0.05). CONCLUSION: Our results indicate that neonatal status epilepticus with early onsets, prolonged durations. And generalized tonic types can predict an increased risk for neurologic sequelae. So, those seizures must be perceived as medical emergencies and treated aggressively with antiepileptic drugs.
Child ; Male ; Female ; Infant, Newborn ; Humans ; Incidence ; Mortality ; Risk Factors

The new operative technique of ventriculotransverse sinus shunt for hydrocephalus is introduced in this paper. This method has been applied to 6 hydrocephalic patients with Pudenz-Heyer low pressure valve in our department of Kyungpook National University Hospital from June 1990 to to May 1992. 4 cases including 2 high pressure hydrocephalus of all the patients improved in neurologic deficit within 2 weeks postoperatively. 2 Cases of normal pressure hydrocephalus installed the same shunt showed no improvement without any shunt valve dysfunction, so the shunts were revised to ventriculoperitoneal shunts. The choice of transverse sinus rather than superior sagittal sinus for CSF recipient of shunt seems more reasonable anatomically and physiologically. And this procedure could first apply to the poor risk patients with local anesthesia in such cases with old age, deteriorated, and to the patients requiring revision of the other shunting. To confirm the effect and perspect for continuous using this new technique, more patients applying this method and long term follow-ups of them should be needed.
Anesthesia, Local ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Neurologic Manifestations ; Superior Sagittal Sinus ; Ventriculoperitoneal Shunt

The new operative technique of ventriculotransverse sinus shunt for hydrocephalus is introduced in this paper. This method has been applied to 6 hydrocephalic patients with Pudenz-Heyer low pressure valve in our department of Kyungpook National University Hospital from June 1990 to to May 1992. 4 cases including 2 high pressure hydrocephalus of all the patients improved in neurologic deficit within 2 weeks postoperatively. 2 Cases of normal pressure hydrocephalus installed the same shunt showed no improvement without any shunt valve dysfunction, so the shunts were revised to ventriculoperitoneal shunts. The choice of transverse sinus rather than superior sagittal sinus for CSF recipient of shunt seems more reasonable anatomically and physiologically. And this procedure could first apply to the poor risk patients with local anesthesia in such cases with old age, deteriorated, and to the patients requiring revision of the other shunting. To confirm the effect and perspect for continuous using this new technique, more patients applying this method and long term follow-ups of them should be needed.
Anesthesia, Local ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Neurologic Manifestations ; Superior Sagittal Sinus ; Ventriculoperitoneal Shunt

PURPOSE: To investigate the alteration of lower extremity movement during maintaining balance test with their eyes closed in chronic ankle instability (CAI) patients compared to healthy group with and without plantar cutaneous sensation. METHODS: Ten healthy volunteers (age, 23.40±2.22 years; height, 165.42±6.67 cm; weight, 60.93±13.42 kg) and 10 CAI patients (age, 23.90±2.56 years; height, 166.89±10.50 cm; weight, 67.43±12.96 kg), were recruited. Subjects immersed both feet in an ice water for 10 minutes and performed three trials of a single-leg stance balance test with their eyes closed while standing on a force plate for 10 seconds. RESULTS: CAI group showed increased knee flexion, reduced knee external rotation, and hip internal rotation compared to the healthy group from single-limb stance with eyes closed after diminished plantar cutaneous sensation. However, there was no significant interaction between group and time. CONCLUSION: These findings indicate that the postural kinematic analyses revealed that individuals with CAI used different strategy of controlling their lower extremities, which alters transverse plane motion of hip and knee compared to the healthy group in order to compensate for their ankle deficits after freezing the plantar cutaneous.
Ankle ; Foot ; Freezing ; Healthy Volunteers ; Hip ; Humans ; Ice ; Knee ; Lower Extremity ; Sensation ; Water

A 25-year old Korean male was admitted to Seoul National University Hospital on July 5, 1982 because of fever, epigastric discomfort and diarrhea. Laboratory examination revealed moderate eosinophilia, and large operculated helminth eggs in stool repeatedly. Other laboratory test resulted in normal range and bacteriological cultures were nefative. Under the impression of intestinal fluke infection, bithionol treatment with magnesium purgation was tried. From the diarrheal stool after treatment, a total of 79 small adult trematodes was collected, and identified as Fibricola seoulensis. The patient had eaten raw viscera of 2 snakes 9 days before admission in a rural village in Korea. It was assumed that this is the first record that described human infection by an adult diplostomatid fluke.
parasitology-helminth-trematoda ; Fibricola seoulensis ; case report ; eosinophilia ; fever ; epigastric discomfort ; diarrhea ; magnesium

Norwegian or crusted scabies is a rare, highly contagious atypical form of scabies caused by the mite Sarcoptes scabiei var. homonis. It is usually associated with advanced age, immunosuppression, physical debility, and developmental disabilities. We report here a case of Norwegian scabies in an institutionalized patient with chronic kidney disease (CKD) and Down syndrome. A 56-year-old male presented at our department with pruritic rash and general weakness of 2 months' duration. Examination showed hyperkeratotic, scaly, crusted erythematous plaques on the hands, trunk, and back of the patient. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites. The patient was treated with hemodialysis and repeated applications of 1% lindane lotion for 2 weeks. He reported significant relief of pruritus and resolution of the skin lesions after the treatment. In addition to uremic pruritus, infectious skin diseases such as Norwegian scabies should be considered in the institutionalized patients with advanced CKD and resistant pruritus.
Developmental Disabilities ; Down Syndrome ; Exanthema ; Hand ; Humans ; Hydroxides ; Immunosuppression ; Kidney Failure, Chronic ; Lindane ; Male ; Middle Aged ; Mites ; Potassium ; Potassium Compounds ; Pruritus ; Renal Dialysis ; Renal Insufficiency, Chronic ; Sarcoptes scabiei ; Scabies ; Skin ; Skin Diseases, Infectious ; Weights and Measures

PURPOSE: The efficacy of the prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), digital rectal examination (DRE) and transrectal ultrasonography (TRUS) for diagnosing prostate cancer in Koreans was investigated. MATERIALS AND METHODS: The medical records from a selected population of 346 patients (30 to 93 years old, mean age 66.0) who had visited the department of Urology in Seoul National University Hospital from January 1994 to December 2000 were reviewed retrospectively. All patients a transrectal ultrasonography-guided biopsy. The student's t test was used for statistical analysis. RESULTS: Prostate cancer was detected in 119 (34.4%) out of 346 patients. PSA, PSAD, TRUS, and DRE showed a sensitivity of 95.8%, 88.2%, 66.4% and 61.3%, a specificity of 26%, 49.3%, 66.5% and 55.9%, and a positive predictive value of 40.4%, 47.7%, 51% and 42.2%, respectively. The positive predictive value from the combination of PSAD and TRUS was 67%, which was the highest when two among the four methods were selected and combined. The detection rate for prostate cancer was 23% (31 out of 135 patients) when the PSA level was between 4 and 10ng/ml, and was 20.9% (18 out of 86 patients) when PSA level was between 4 and 10ng/ml and the DRE findings were negative. CONCLUSIONS: In detecting prostate cancer, PSA showed the highest sensitivity and TRUS showed the highest specificity and positive predictive value. PSAD might be a useful method for diagnosing prostate cancer when combined with TRUS. A TRUS-guided biopsy should be done in patients when the PSA level is between 4 and 10ng/ml in Korea.
Biopsy ; Digital Rectal Examination* ; Humans ; Korea ; Mass Screening* ; Medical Records ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity ; Seoul ; Ultrasonography* ; Urology

PURPOSE: Development of renal scarring is associated with delayed diagnosis and treatment of urinary tract infection(UTI). This study was performed to clarify how soon treatment should be started to inhibit renal scarring after onset of UTI and the factors associated with renal scarring in children with a first episode of febrile UTI. METHODS: We retrospectively reviewed 163 patients with a first episode of febrile UTI under the age of 2 years from April 2000 to April 2004. All patients had a DMSA renal scan and voiding cystourethrogram done in the diagnostic period, 6 months after which a follow-up renal scan was done. After patients were divided into 2 groups according to the duration of fever prior to start of treatment, the duration of fever after start of treatment, and total duration of fever, initial and follow-up DMSA scan findings were analyzed among the different groups. We compared the factors associated with renal scars between the groups with and without renal scars. RESULTS: The initial DMSA renal scan identified abnormal finding in 23% of the patients who were treated < or =24 hr from the onset of disease and in 43% of those with fever more than 24 hr. Renal scars developed in 33% of patients who were treated < or =24 hr and 38% of those with fever >24 hr prior to treatment. Renal scars developed in 34% of patients with remission of fever < or =48 hr after treatment and in 50% of those with fever >48 hr after treatment. The risk for renal scars was significantly higher in children who had total duration of fever >72 hr(67%) than in those with shorter duration(19%). In children with renal scars, VUR was most highly associated with an increased risk of renal scar formation. CONCLUSION: Although children with a first episode of febrile UTI are treated within 24hr after onset of the fever, renal damage cannot be prevented completely and it is mainly associated with VUR.
Child* ; Cicatrix* ; Delayed Diagnosis ; Fever ; Follow-Up Studies ; Humans ; Retrospective Studies ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux