OBJECTIVE: A number of preexisting clinical conditions are generally accepted as contraindications for total vaginal hysterectomy. The purpose of this study was to evaluate the validity of these contraindications. METHODS: The TVH-A group consisted of 230 patients who have undergone vaginal hysterectomy. These patients (1) had a large uterus (>280 gm), (2) were either nulliparous or had no previous vaginal delivery, or (3) had a history of previous abdominal or vaginal operation. The TVH-B group was composed of patients who did not present with any contraindications when they underwent vaginal hysterectomy. Patients of the TAH group underwent abdominal hysterectomy. The records for all patients were analyzed according to age, weight, parity, primary diagnosis, uterine weight, duration of operation, blood loss, analgesia, hospital stay, and postsurgical complications. RESULTS: No significant difference in age and weight was observed between the three groups. The average number of vaginal deliveries performed was lower in the TVH-A group. Uterine myoma, carcinoma in situ, and adenomyosis were common preoperative diagnoses in all groups. The most common contraindication for total vaginal hysterectomy in the TVH-A group was history of previous operation (54.8%); large uterus (44.8%) and nulliparity (21.3%) ranked second and third, respectively. Durations of operation, hospital stay, and pain were longer, bleeding volume was greater, and incidence of postoperative complications was higher in the TAH group than in the other groups (p<0.01). Previous cesarean delivery did not affect various operative characteristics among women undergoing vaginal hysterectomy (p<0.01). CONCLUSION: Our data indicate that a history of previous operation, large uterus, and nulliparity rarely constitute contraindications to vaginal hysterectomy.
Adenomyosis ; Analgesia ; Carcinoma in Situ ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Incidence ; Leiomyoma ; Length of Stay ; Parity ; Postoperative Complications ; Uterus

The anterior chamber paracentesis has its history about 4 centuries long in the ophthalmic operations. Author recently applied this method to 31 clinical cases consisting of hypopyon, hyphema, juvenile cataract and foreign body in anterior chamber. Attempt was made via the subconjunctival route on the cases of hyphema and lens material in the anterior chamber, in contrast with the ordinary corneal limbus puncture on the discission of anterior lens capsule, or irrigation of hypopyon. Application of paracentesis in my series was selected on the cases of blood over a half of anterior chamber, and large amount of hypopyon, etc., and the favorable rasults were achieved.
Anterior Chamber* ; Cataract ; Foreign Bodies ; Hyphema ; Limbus Corneae ; Paracentesis* ; Punctures

This study was carried out in order to clarify the selection criteria of the surgical approaches and validate their efficacy in patients with vestibular schwannoma. The evolution and modification of the transpetrosal approach was evolved into combined approaches to vestibular schwannomas. These approaches have been advocated to reduce the mortality and morbidity as well as to improve the surgical results especially in large acoustic neurinoma. Having been stimulated with the fascinating preliminary surgical results of the suboccipital and combined transpetrosal approaches, we have builded up a decision making policy based on the tumor size and the preoperative hearing status for the surgical approaches to vestibular schwannomas. Between May 1996 and September 1997, 21 patients with vestibular schwannoma including one case of NF II underwent either suboccipital or various transpetrosal approaches. There was no surgical mortality. Gross total removal was achieved in 20 patients(95%). Facial nerve function was preserved in 19(90%) and hearing function in 6(46%) among the 13 patients who underwent hearing preservation surgery. The authors confirmed the validity of various transpetrosal approaches in this study and conclude that our policy on the surgical approaches to vestibular schwannomas is quite reasonable.
Decision Making ; Facial Nerve ; Hearing ; Humans ; Mortality ; Neuroma, Acoustic* ; Patient Selection*

Three cases of hydatidiform mole with a coexisting fetus are described. In two cases, flow cytometric analysis of nuclear DNA content from paraffin-embedded, molar tissues and normal-appearing placental tissues showed diploid pattern. One case had karyotypes of 46, XX both in fetal skin fibroblasts and in molar tissues. Microscopically, the villi showed diffuse hydropic swelling with circumferential trophoblastic proliferations and consistent with the diagnosis of complete mole. Two patient had persistent gestational trophoblastic neoplasia on the follow-up. Therefore, in cases of hydatidiform mole with a coexisting fetus, dizygotic twin pregnancies composed of a normal pregnancy from one ovum and a complete mole pregnancy from the other ovum must be considered and the patients should be followed with serum beta-hCG measurements.
Pregnancy ; Female ; Humans

Ophthalmologists now realize the importance of the oculocardiac reflex from ocular manipulation. The occurrence of cardiac disturbances has been recognized since 1908. Several authors have believed the mechanisms of the reflex affecting the pulse rate. the conduction system and myocardial contractibility of the heart. For the purpose of the recognition of this reflex, authors performed ocular compression and muscle traction after atropine injection or retrobulbar anesthesia in 135 persons. The results were noted that the reflex is blocked by intravenous atropine injection or retrobular anesthesia. while not by subconjunctival anesthesia or intramuscular atropine injection.
Anesthesia ; Atropine ; Heart ; Heart Rate ; Humans ; Reflex ; Reflex, Oculocardiac* ; Traction

Background: To evaluate the feasibility, inter-reader reliability, and intra-reader reliability for various morphological features reported to be related to iliotibial band friction syndrome (ITBFS) on knee magnetic resonance imaging (MRI). Methods: A total of 145 patients with a clinical diagnosis and knee MRI findings consistent with ITBFS were included in the “study group” and 232 patients without knee pathology on both physical examination and MRI were included in the “control group”. Various morphologic features on knee MRI were assessed including the patella shape, patella height, lateral epicondyle anterior-posterior (AP) width, lateral epicondyle height, ITB diameter (ITB-d), and ITB area (ITB-a). Results: Patients in the study group had significantly higher lateral epicondyle height (13.9 mm vs. 12.92 mm, P = 0.003), ITB-d (2.9 mm vs. 2.0 mm, P = 0.022), and ITB-a (38.5 mm2 vs. 23.8 mm2 , P < 0.001) than the control group. ITB-a showed higher area under the curve index (0.849 with 74.1% sensitivity and 72.4% specificity at a 30.3 mm2 cutoff) than ITB-d (0.710 with 70.8% sensitivity and 61.2% specificity at 2.4 mm cutoff) and lateral epicondyle height (0.776 with 72.4% sensitivity and 67.8% specificity at 13.4 mm cutoff). However, only the interreader agreement for ITB-a (intraclass correlation coefficient = 0.65) was moderate, while the agreements for other morphologic features were good or excellent. Conclusions Lateral epicondyle height seems to be a reliable and feasible morphologic feature for diagnosis of ITBFS.

During ten years from Mar. 1973 to Feb. 1982, 2410 amputations of limbs have been experienced in Korea Veterans Hospital. 240 painful neuromas, which developed in 203 amputated limbs of 191 patients were treated with four different methods 1) Stretching and simple transection, 2) Transection and ligation, 3) Ligation and absolute alcohol injection and 4) Implantation into bone. After following up for average 5 years and 7 months, the following results were obtained. 1. The painful neuroma occured in 191 (7.9%) out of 2410 amputees. 2. The painful neuroma developed averege 2 years and 9 months after the first amputation. 3. After transection and ligation of the nerves, the painful neuroma recurred in 19.2% of the cases. The average interval taken to recur was 2 years and 6 months. 5. After ligation and absolute alcohol injection into the nerves, the painful neuroma recurred in 14.8% of the cases. The average interval taken to recur was 2 years and 6 months. 6. After implantation of the nerve into the bone, the painful neuroma recurred in 5.7% of the cases. The average interval taken to recur was 2 years and 2 months. 7. The best results were obtained after implantation of the nerves into the bone.
Amputation ; Amputees ; Ethanol ; Extremities ; Hospitals, Veterans ; Humans ; Korea ; Ligation ; Neuroma

The incidence of lung cancer and its mortality rate are increasing in Korea. At the time of diagnosis, 40% patients of lung cancer patients had metastatic lesions. The common metastatic sites are the contralateral lung, bone, liver, adrenal gland and the brain. Metastasis to oral mucosa is rarely encountered in lung cancer and metastasis to the gingiva is more uncommon. Approximately 1% of malignant carcinomas in the oral cavity are the result of metastases, and 10-25% of metastatic cancers originate from lung cancer. Clinically metastatic gingival lesions are benign including hemangioma, pyogenic granuloma, giant-cell granuloma or a peripheral fibroma. Often metastases to the gingiva are diagnosed too late and by the time they are detected, they have metastases to other organs. Here we report a case of small cell lung carcinoma that had metastased to the gingiva with review of relevant literature.
Adrenal Glands ; Brain ; Diagnosis ; Fibroma ; Gingiva* ; Granuloma ; Granuloma, Pyogenic ; Hemangioma ; Humans ; Incidence ; Korea ; Liver ; Lung ; Lung Neoplasms ; Mortality ; Mouth ; Mouth Mucosa ; Neoplasm Metastasis* ; Small Cell Lung Carcinoma*

No abstract available.
Liver Transplantation* ; Liver*

The authors have experienced seven cases of spontaneous intracranial dissecting aneurysm. Headache on the suboccipital region was the most common presenting symptom. Four patients had subarachnoid hemorrhage(SAH). Most of the patients were males:six men, one woman. The locations of the aneurysm were vertebral artery in six and basilar artery in one. An irregularly narrowed arterial segment with proximal and/or distal dilatation was the most significant angiographic findings. The introduction of MRI and DSA made the diagnosis of dissecting aneurysm easier in the suspicious cases with a traditional cerebral 4-vessel angiography. Five patients were treated surgically:Proximal clip occlusion of affected artery in three cases, trapping in one, wrapping combined with proximal clip occlusion in another. The surgical results were excellent in all the cases. There was no further dissection of affected artery on postoperative follow-up angiography.
Aneurysm ; Aneurysm, Dissecting* ; Angiography ; Arteries ; Basilar Artery ; Diagnosis* ; Dilatation ; Female ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Vertebral Artery