PURPOSE: The anterior vaginal wall sling (AVWS) was introduced to be a simpler and less morbid procedure than the fascial or synthetic slings. However, the long-term outcome of the AVWS has not been fully assessed. In this study, the long-term outcomes of AVWS in female stress urinary incontinence were determined. MATERIALS AND METHODS: A total of 54 patients, followed-up postoperatively for at least five years, were surveyed. The surgical outcome was evaluated by pre- and post-operative SEAPI scores, subjective satisfaction and complications. The preoperative clinical parameters were analyzed using a multivariate analysis to determine the factors influencing the success. RESULTS: After a follow-up period of at least 60 months (mean 72.3 months), 63% were cured, 24% showed improvement and 13% had unsuccessful outcomes. The multivariate analysis demonstrated no preoperative factors for the prediction of the outcome of the AVWS. In a subjective satisfaction assessment, 40.8% were extremely satisfied, 40.8% were satisfied, 9.3% felt fair, and 9.3% were dissatisfied. The short-term complications were; UTI (1 case) and operation related transfusion (1 case). The long-term complications were; de novo urge incontinence (3 cases), removal of suture material due to extra-vaginal protrusion (3 cases) and chronic pelvic pain (1 case), but there was no chronic retention. CONCLUSIONS: An AVWS has many benefits, such as low morbidity, easiness of familiarization and can be performed on patients with anatomical incontinence and internal sphincter deficiency. Nevertheless, the complete dry rate of AVWS is 63% for a follow-up of over 5-years. With regard to its long-term durability, this procedure is considered a less effective treatment modality for female stress urinary incontinence.
Female* ; Follow-Up Studies* ; Humans ; Multivariate Analysis ; Pelvic Pain ; Surgical Procedures, Operative ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

We report an autopsy case of the brain stem glioma that extended extensively in the brain stem itself and cephalad. This 18-year-old boy first presented with dizziness, vomiting and left side weakness with left facial palsy. Brain MRI revealed a diffusely infiltrative tumor involving whole medulla, pons and lower midbrain. A total of 4000 R was given with some alleviation of respiratory difficulty. He died one year after the onset. Autopsy revealed the tumor involving pons, a portion of medulla oblongata, and cerebellum. The tumor showed diffusely infiltrative pattern and extended along the periventricular area to the thalamus and corpus callosum. The cut surface was grayish white and solid. It also showed areas of myxoid degeneration and necrosis probably related to radiation therapy. Microscopically the tumor was a cellular and pleomorphic glioma that showed some astrocytic differentiation. It was diffuse without geographic necrosis.

No abstract available.
Nose*

The branch retinal vein occlusion is the second most common retinal vascular disease after diabetic retinopathy. Complications such as macular edema, retinal neovascularization, vitreous hemorrhage, epiretinal membrane may be associated. But, the retinal detachment may occur rarely in BRVO patients. We studied the clinical features of retinal detachment associated with branch retinal vein occlusion. We reviewed the medical records of 15 retinal detachment patients associated with branch retinal vein occlusion. Mean age was 54.7 years old and 10 patients(66.7%) were female. Hypertension was associated in 13cases(86.7%). The duration between the development of BRVO and the development of retinal detachment was shorter than 4 years in all cases and shorter than 2 years in 9 cases(60.0%). Retinal break was identified in 14 cases(93.3%), among which 13 cases(92.2%) were located inside the lesion of branch vein occlusion. The epiretinal membrane was frequently combined 8 cases(53.3%). The preoperative laser photocoagulation was done in 4 cases(26.7%). The primary surgical procedures included scleral buckling in 8 cases(53.3%), pars plana vitrectomy in 6 cases(40.0%), and scleral buckling with pars plana vitrectomy in 1 case(6.7%). Three cases(20.0%) required reoperations. The postoperative complications included the progression of cataract in 6 cases(40.0%), iatrogenic retinal tear in 3 cases(20.0%), epiretinal membrane in 2 cases(13.3%), and proliferative vitreoretinopathy in 1 case(6.7%). The anatomic retinal reattachment was achieved in 14 cases(93.5%) and the visual recovery in 11 cases(73.3%).
Cataract ; Diabetic Retinopathy ; Epiretinal Membrane ; Female ; Humans ; Hypertension ; Light Coagulation ; Macular Edema ; Medical Records ; Postoperative Complications ; Retinal Detachment* ; Retinal Neovascularization ; Retinal Perforations ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Scleral Buckling ; Vascular Diseases ; Veins ; Vitrectomy ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

The os calcis is fractured more frequently than any other tarsal bone. Fractures involving subtalar joint can, be associated with prolonged and severe disability. So there is no universal agreement in the treatment of these fractures. Calcaneal fractures of 64 feet in 56 patients who were treated at Severance Hospital, Yonsei University College of Medicine from Jan. 1971 to Dec. 1980 were analyzed in clinical and radiological aspects. The results obtained from this study were as follows; 1. Of 56 patients, 46 patients were male and 10 female. 2. The main cause of fractures of calcaneus was a fall from a height in 71.4 percents of cases, and spine injury was associated in 15 patients (26.8%) with calcaneal fractures. 3. The fractures were almostly closed (89.1%). 4. Fractures involving subtalar joint were in 52 feet (81.3%) and Rowe's type 5 were 38 fractures (39.4%). Of these type 5 fractures, 31 fractures were treated by closed reduction and axial pin fixation and then favourable results were obtained. 5. The most common complication after treatment was persistant foot pain. Pain beneath the lateral malleolus was the most common (8 feet), and correlated with the decrease of Bohler's angle.
Calcaneus ; Clinical Study ; Female ; Foot ; Humans ; Male ; Spine ; Subtalar Joint ; Tarsal Bones

No abstract available.

PURPOSE: We assessed the feasibility of testis-sparing surgery in children with testicular tumors. MATERIALS AND METHODS: Twenty-five pediatric patients who had a testicular tumor were enrolled for retrospective analysis. Testis-sparing surgery was planned in the cases with clinical features that preoperatively suggested the tumors to be benign, which was later determined intraoperatively by frozen section examination. The preoperative-fetoprotein (AFP) and transscrotal ultrasound (US) were evaluated along with the final pathology. We reviewed the immediate and late surgical complications, as well as the tumor recurrence after surgery. RESULTS: Teratoma, epidermoid cyst, yolk sac tumor, and Leydig cell tumor accounted for finding in 40%, 32%, 24%, and 4% of the patients, respectively. Based on the preoperative US, 18 patients had benign-looking tumors. According to the age-matched AFP references, 17 patients showed normal ranges preoperatively. Out of 14 patients, whose US and AFP level suggested the tumors to be benign, 10 (71.4%) were eligible for testis- sparing surgery on retrospective review. Testis-sparing surgery was performed in 5 patients, who showed the same pathology in frozen sections (3 epidermoid cysts, 2 teratomas). None of the 5 patients exhibited perioperative complications, and no recurrence or atrophy was observed at a mean follow-up of 39.8 months. CONCLUSIONS: Out of 14 patients, whose US and AFP analyses were available, 10 (71.4%) were eligible for testis-sparing surgery. Testis-sparing surgery was done in five out of the 10 patients without any complication or recurrence. Testis-sparing surgery is a feasible option in children with testicular tumors if the AFP level is within a normal range and the US suggests benign characteristics.
Atrophy ; Child* ; Endodermal Sinus Tumor ; Epidermal Cyst ; Follow-Up Studies ; Frozen Sections ; Humans ; Leydig Cell Tumor ; Pathology ; Recurrence ; Reference Values ; Retrospective Studies ; Teratoma ; Testicular Neoplasms* ; Testis ; Ultrasonography

The authors experienced a case of plasma cholinesterase variant who received succinylcholine, atracurium and reversal with pyridostigmine, and showed prolonged neuromuscular blockade postoperatively, and was ventilated artificia1ly until complete recovery. The patient and her two children later gave samples of blood. The patients blood revealed very low plasma cholinesterase activity of 0.11 IU/L(normal range; 5-12 IU/L) and dibucaine number of 33. In consideration of her childrens plasma cholinesterase activities and dibucaine numbers, we suggest that she has genetically abnormal plasma cholinesterase and probably her genotype is E E or E E.
Atracurium ; Child ; Cholinesterases ; Dibucaine ; Genotype ; Humans ; Neuromuscular Blockade* ; Plasma* ; Pyridostigmine Bromide ; Succinylcholine

PURPOSE: We evaluated the efficacy and safety of sacral neuromodulation for treating the patients suffering with an overactive bladder(OAB) or chronic pelvic pain(CPP) that was refractory to conservative therapies. MATERIALS AND METHODS: Between November 2002 and May 2006, a total of 30 patients underwent testing with sacral nerve modulation via either a traditional percutaneous approach or a staged procedure to predict the efficacy of this treatment for refractory OAB and/or CPP. 17 patients had 50% or greater improvement in their presenting symptoms and they underwent a procedure to implant a permanent sacral nerve stimulator. The results of the treatment were evaluated according to the 3 day-voiding records, the severity of pain, the patients' perception of their bladder condition and the benefits of the treatment. RESULTS: Twelve patients had CPP and 5 had OAB. The number and severity of their urgency episodes were improved. However, the number of times they passed urine was not significantly changed. The number of incontinence episodes was reduced for the 7 patients who suffered with urge incontinence. For 12 patients with CPP, the severity of their average pain was significantly decreased. There was a reduction in the number of the patients with a moderate or more severe bladder condition, from 17 to 10, after sacral neuromodulation. The overall rate of the patients' perceiving treatment benefit was 53%. The complications were lower limb numbness in 2 cases, wound infection in 1, foreign body sensation in 1, anal pain in 1 and lead migration in 1. CONCLUSIONS: Sacral Neuromodulation using Interstim(R) significantly improves the OAB symptoms and CPP in the patients who did not respond to other therapies.
Cystitis, Interstitial ; Foreign Bodies ; Humans ; Hypesthesia ; Lower Extremity ; Pelvic Pain* ; Sensation ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Wound Infection

STATEMENT OF PROBLEM: when using resin for class II restoration, micoleakage by instrumentation can be regarded as the primary negative characteristic. A review of the available literature suggests that using flowable resin as liner to decreased microleakage. PURPOSE: The aim of this study was to determine the influence of the nanofilled flowable resin lining on marginal microleakage after load cycling in class II composite restoration fillings using nanofiller resin. MATERIAL AND METHODS: 24 extracted premolars were prepared with class II cavity. F group was restored the nanofilled resin with the nanofilled flowable resin as liner. NF group was restored the nanofilled resin only. After restoration, an experiment was performed on 2 groups using a 300N load at 104, 105 and 106 cycles. Prior to and before each load cycling, it was gauged length on total marginal microleakage, axial marginal microleakage and buccal, gingival, lingual marginal microleakage. Data were analyzed with the Mann-Whitney test & Kruskal-Wallis test. RESULTS: There were statistically significant differences between 2 groups and between individual groups. (P < .05) The result showed less microleakage in teeth restored by the nanofilled resin, which was lined by the nanofilled flowable resin. CONCLUSION: There was significant reduction in microleakage when the nanofilled flowable resin lining was placed underneath the nanofilled resin in class II composite restoration fillings.
Bicuspid ; Tooth