The tracheostomy is increasingly being performed. In most cases, the tracheostomy sites are left to heal by secondary intention, so it leaves a depressed and wide scar that is cosmetically disfigured. Another problem os that the scar is also attached directly to the trachea itself and will move vertically with the trachea during the act of swallowing. Even though the tracheostomy scar is cosmetically acceptable, the mobility and retraction of the scar is a continual nuisance to the patient. We performed a retrospective study on 9 patients who had undergone revision of the depressed thracheostomy scar by the Renner Method from June, 1997 to February, 1999. The method includes transverse fusiform incision of the original scar and excision of the depressed portion of the scar to the level of the trachea itself. To prevent attachment of the skin and trachea, a bilateral subcutaneous flap and muscle flap were simply advanced to the midline and overlapped. Then the rest of scar that was not depressed was deepithelized and flipped to augment the soft tissue volume in the central depressed area. Satisfactory results were achieved in all patients without hematoma, infection, hypertrophic scar, and keloid formation. We believe this simple Renner method is one of the best ways of performing posttracheostomy scar revision.
Cicatrix* ; Cicatrix, Hypertrophic ; Deglutition ; Hematoma ; Humans ; Intention ; Keloid ; Retrospective Studies ; Skin ; Trachea ; Tracheostomy

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.
Follow-Up Studies ; Intubation* ; Lacerations ; Lacrimal Apparatus Diseases ; Postoperative Complications ; Silicones* ; Stents ; Sutures

No abstract available.

PURPOSE: We evaluated the efficacy and safety of a tension free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: Forty-one women (32 with genuine stress urinary incontinence and 9 with mixed urinary incontinence) underwent a TVT procedure under spinal, epidural or general anesthesia. Three women experienced previously failed anti-incontinence surgery and nine women experienced previous pelvic surgery. The mean follow-up period was 17.1 0.4 months. RESULTS: The mean operation time was 31.8 1.2 minutes and mean hospital stay was 1.7 0.2 days. There were no significant intra- and postoperative complication. Four patients (9.8%) had immediate postoperative voiding difficulties necessitating an extra procedure (cutting or release of the tape) under local anesthesia. Six patients (14.6%) with de novo detrusor instability were improved by anticholinergics medication and release of the tape. Six (66.7%) of 9 women with urge incontinence were significantly improved or cured after surgery. Success rate was 97.6% in postoperative 3 months, 95.1% in postoperative 12 months. The patients satisfied with this procedure were 38 (92.7%) in postoperative 3 months and 37 (90.2%) in postoperative 12 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.
Anesthesia, General ; Anesthesia, Local ; Cholinergic Antagonists ; Female* ; Follow-Up Studies* ; Humans ; Length of Stay ; Postoperative Complications ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Depression* ; Electrocardiography ; Exercise Test ; Heart Rate* ; Heart* ; Humans ; Myocardial Ischemia* ; Sensitivity and Specificity

PURPOSE: The effect and safety of new intravaginal pelvic floor electrical stimulation, with a distal microchip (PIC16C74), for precision and comfort, in the treatment of female stress, urge and mixed incontinence, were evaluated. MATERIALS AND METHODS: Thirty-eight incontinent women were divided into three groups: stress incontinence (13), urge incontinence (12) and mixed incontinence (13). Evaluations, both before and after treatment, including history taking, a physical examination, a stress provocation test, a 1-hour pad test, voiding diaries, female lower urinary tract symptom and quality of life questionnaires, were conducted. All patients were treated by pelvic floor electrical stimulation, twice a week, for 6 weeks. The success rate, complications, satisfaction and quality of life were evaluated 1 month later. RESULTS: The overall success rate was 60.5%. 53.8 (7/13), 66.7 (8/12) and 61.5% (8/13) success rates were found in patients with stress, urge, and mixed type incontinence, respectively. Success rates of 58.8 (10/17) and 55.6% (5/9) were also found in grades I and II, respectively. There were no significant differences in the success rates between the types and grades of incontinence. 73.7% (28/38) of the patients were satisfied with the treatment, and their quality of life improved from 2.4 to 7.2, on the visual analog scales. CONCLUSIONS: It was concluded that the new intravaginal electrical stimulation, with the microchip (PIC16C74), is an effective and safe treatment for female urinary incontinence, although a longer follow-up period will be required to determine the long term effects.
Electric Stimulation* ; Female* ; Follow-Up Studies ; Humans ; Pelvic Floor* ; Physical Examination ; Quality of Life ; Surveys and Questionnaires ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urinary Tract ; Visual Analog Scale

BACKGROUND: The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.
Catheters ; Cholinergic Antagonists ; Drainage ; Female* ; Follow-Up Studies ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Sensation ; Urinary Bladder ; Urinary Incontinence*

Foreign bodies in genitourinary tract are common and almost of then are within the bladder. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Foreign bodies(a thermometer and a piece of cloth) in the bladder were inserted as a mean of masturbation in two cases, and a cooper wire in the posterior urethra was introduced by iatrogenic causes in one case. In one case, four magnets were inserted into the bladder for the purpose of forceful penile erection. Clinical history, symptom, radiologic study, and endoscopic examination were required to diagnose foreign body. They were easily removed by endoscopic manipulation or open surgical procedure.
Foreign Bodies* ; Humans ; Male ; Masturbation ; Penile Erection ; Thermometers ; Urethra ; Urinary Bladder ; Urinary Tract*

A 38-year-old woman with systemic lupus erythematosus had developed a cutaneous lesion of linear scleroderma on the forehead 4 years after the diagnosis of lupus erythematosus. This case of coexistence of the two diseases can be regarded as a clinical variant of the connective tissue disease-overlap syndrome.
Adult ; Female ; Humans ; Korea ; Lupus Erythematosus, Systemic/*complications ; Scleroderma, Localized/*complications

No abstract available.