Myometrial pregnancy developing in an previous cesarean section scar is the rarest of all ectopic pregnancy and provavly one of the most dangerous because of the risk of rupture and hemorrhage. For a young patient wanting to maintain her fertility, an earlier diagnosis and more conservative treatment are highly desirable. We present a case of an ectopic pregnancy embedded in the myometrium of a previous cesarean section scar in which the patient preserved her fertility through more noninvasive method, transvaginal ultrasound-guided Methotrexate injection.
Animals ; Cesarean Section* ; Cicatrix* ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Methotrexate* ; Mice ; Myometrium* ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.
Female ; Fertility* ; Follow-Up Studies ; Hospitals, General ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Pain, Postoperative ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Sterilization ; Sterilization Reversal*

Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.
Endometrial Hyperplasia ; Female ; Humans ; Hysterosalpingography ; Hysteroscopy* ; Infertility ; Myoma ; Pathology* ; Polyps ; Ultrasonography ; Uterine Hemorrhage

BACKGROUND: Suicide is a self-destructive behavior that can occur throughout life. Recently the suicide rate has gradually increased in Korea. Suicide is the third most common cause of death in adolescents. The most important factOrs closely related to suicide were depression and hopelessness. This study aimed to analyze first, relationships between suicidal ideation, depression, hopelessness, social support and self-esteem, second, the differences between the demographic factors and suicidal ideation, depression, hopelessness, social support and self-esteem. METHODS: This study was surveyed with a questionaire to 220 students of colleges located in Pusan. The instruments were used in this study were Harters(1988) Self-Perception Profile for College Students, Harter and Robinsons(1988) Approval Support Scale for Adolescents, Becks(1961) Beck Depression Inventory, Becks(1974) Beck Hopelessness Scale and Reynolds(1987) Suicidal ideation Questionaire. RESULTS: Self-esteem had a relatively strong positive correlation with social support. Suicidal ideation had a strong positive correlation with depression. Depression had a negative correlation with self-esteem and social support. Suicidal ideation had a negative correlation with self-esteem and social support. CONCLUSIONS: According to this study, the major factors related to suicidal tendency of adolescents were depression, low self-esteem, and low social support. Then the strategy to improve self-esteem and to encourage social support should be implemented for adolescents to prevent suicide.
Adolescent ; Busan* ; Cause of Death ; Demography ; Depression ; Humans ; Korea ; Self Concept ; Self-Injurious Behavior ; Suicidal Ideation ; Suicide

BACKGROUND: Monoclonal antibodies (mAb) of rodent origin are produced with ease by hybridoma fusion technique, and have been successfully used as therapeutic reagents for humans after humanization by genetic engineering. However, utilization of these antibodies for therapeutic purpose has been limited by the fact that they act as immunogens in human body causing undesired side effects. So far, there have been several attempts to produce human mAbs for effective in vivo diagnostic or therapeutic reagents including the use of humanized xenomouse that is generated by mating knockout mice which lost Ig heavy and light chain genes by homologous recombination and transgenic mice having both human Ig heavy and light gene loci in their genome. METHODS: Genomic DNA fragments of mouse Ig heavy and light chain were obtained from a mouse brain lamda genomic library by PCR screening and cloned into a targeting vector with ultimate goal of generating Ig knockout mouse. RESULTS: Through PCR screening of the genomic library, three heavy chain and three light chain Ig gene fragments were identified, and restriction map of one of the heavy chain gene fragments was determined. Then heavy chain Ig gene fragments were subcloned into a targeting vector. The resulting construct was introduced into embryonic stem cells. Antibiotic selection of transfected cells is under the progress. CONCLUSION: Generation of xenomouse is particularly important in medical biotechnology. However, this goal is not easily achieved due to the technical difficulties as well as huge financial expenses. Although we are in the early stage of a long-term project, our results, at least, partially contribute the successful generation of humanized xenomouse in Korea.
Animals ; Antibodies ; Antibodies, Monoclonal ; Biotechnology ; Brain ; Clone Cells* ; DNA* ; Embryonic Stem Cells ; Gene Knockout Techniques* ; Gene Targeting ; Gene Transfer Techniques ; Genes, Immunoglobulin ; Genetic Engineering ; Genome ; Genomic Library ; Homologous Recombination ; Human Body ; Humans* ; Hybridomas ; Indicators and Reagents ; Korea ; Mass Screening ; Mice* ; Mice, Knockout ; Mice, Transgenic ; Polymerase Chain Reaction ; Rodentia

PURPOSE: Fragile X syndrome is an X-llinked genetic disorder and is characterized by mental retardation, learning disability, behavior disorder, and autism with typical elongated face, large ears, and macro-orchidism. Recent reports have focused attention on the EEG finding of this syndrome, which is a particular paroxysmal pattern during sleep (mono or diphasic centrotemporal spikes) and awake state (background slowing). In this study, we analyzed the clinical characteristics of fragile X syndrome patients and observed whether a particular EEG pattern is associated with this syndrome or not. METHODS: 7 cases of fragile X syndrome, diagnosed at Sowha Children's Hospital and Cha General Hospital from August 1993 to February 1995, were analyzed retrospectively in terms of typical phenotypes and clinical & EEG characteristics. The patients were diagnosed by Southern blotting and polymerase chain reaction (PCR) method. RESULTS: 1) The subjects were all male and the mean age was 5.8 years old (2Y-11Y). 2) Typical phenotype of long elongated face, macro-orchidism, large ears, and large head are noted in 2/3 of the subject. 3) Developmental delay, mental retardation, learning disability, attention deficit, hyperactivity, and autism are noted in 2/3 of the subject. 4) Seizure is noted in one case and EEG was performed in 6 cases, regardless of the presence of seizures. Abnormal findings including centrotemporal sharps and background slowing are noted in one case, each. 5) By molecular diagnostic methods including Southern blotting and PCR, 3 cases of affected male and 4 of normal transmitting male were diagnosed. CONCLUSIONS: 1) The typical phenotype of fragile X syndrome is long elongated face, macro-orchidism, large ears and large head. 2) The non-physical characteristics of fragile X syndrome are developmental delay, mental retardation, learning disability, attention deficit, hyperactivity, and autism. 3) The characteristic EEG findings of fragile X syndrome known by literature are noted in 2 among 6 cases, which means the specificity is high even though the sensitivity is low. This allows us to propose this EEG pattern as an important "marker" in the diagnosis of fragile X syndrome. However, the number of the subject is too small to conclude now. Further accumulation of cases is reguired.
Autistic Disorder ; Blotting, Southern ; Diagnosis ; Ear ; Electroencephalography* ; Fragile X Syndrome* ; Head ; Hospitals, General ; Humans ; Intellectual Disability ; Learning Disorders ; Male ; Pathology, Molecular ; Phenotype ; Polymerase Chain Reaction ; Retrospective Studies ; Seizures ; Sensitivity and Specificity

PURPOSE: To evaluate the MR appearance of the accessory hepatic veins. MATERIALS AND METHODS: The study included 87 consecutive patients for whom abdominal MR images were obtained. The subjects who had liver lesion or hepatic vascular abnormalities were excluded. Couinaud classified accessory hepatic veins into inferior and middle right hepatic veins. Our major interests were evaluation of the incidence, morphology, and location of the accessory hepatic vein. RESULTS: Inferior right hepatic vein was demonstrated in 43 out of 87 patients(49%). The morphology was linear in 35 patients(80.5%), and V-shaped in 8 patients(19.5%). In 40 patients(93%), the inferior right hepatic vein was located in the posteroinferior aspect of the right lobe. Middle right hepatic vein was demonstrated in 7 out of 87 patients(8%). All were single linear in morphology, combined with the inferior right hepatic vein, and located between the right hepatic vein and inferior right hepatic vein. CONCLUSION: The accessory hepatic vein was demonstrated in 49% among the Korean adult population, and was located in posteroinferior portion of the liver, in 93%.
Adult ; Hepatic Veins* ; Humans ; Incidence ; Liver ; Magnetic Resonance Imaging*

BACKGROUND: Postoperative nausea and vomiting (PONV) are still very common complications after general anesthesia. Some studies have reported that reversal of neuromuscular block by neostigmine is an important factor contributing to PONV. Whereas other studies have shown that when neostigmine is given as a reversal for muscle relaxation using mivacurium, it does not contribute to the incidence and severity of PONV. This study was designed to compare the reversible effect of neuromuscular block using neostigmine with the spontaneous recovery of neuromuscular block on the incidence and severity of PONV. METHODS: Sixty female patients undergoing laparoscopic zygote intra-fallopian transfer were studied and were allocated randomly into two groups. In Group 1 (n=30), neuromusclar block produced by mivacurium was antagonized by 1.5 mg neostigmine and 0.4 mg glycopyrrolate intravenously, whereas Group 2 (n=30) received no drugs to facilitate antagonism of blockade. The incidence and severity of PONV was assessed up to 3 hours after the operation. RESULTS: Both groups were comparable, and no differences were found in age, weight, duration of anesthesia, and the amount of mivacurium given during surgery. There were no significant differences between the two groups in the incidence and severity of PONV. CONCLUSION: This investigation has shown that when neostigmine is given as a reversal for muscle relaxation with mivacurium, it does not contribute to the incidence and severity of PONV.
Anesthesia ; Anesthesia, General ; Female ; Glycopyrrolate ; Humans ; Incidence* ; Muscle Relaxation ; Neostigmine* ; Neuromuscular Blockade* ; Postoperative Nausea and Vomiting* ; Zygote

Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.

Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.