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

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: 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

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

No abstract available.
Cell Line* ; Cytokines* ; Nitric Oxide*

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion(5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.
Adolescent ; Adult ; Carcinoma, Papillary/diagnosis/*pathology/surgery ; Female ; Follow-Up Studies ; Human ; Male ; Pancreatic Neoplasms/diagnosis/*pathology/surgery

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: 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