No abstract available.
Humans ; Hysterectomy*

The antiphospholipid antibodies are characterized by prolonged phospholipid-dependent coagulation test (known as APTT or Russel viper venom), thrombosis, thrombocytopenia, and fetal loss. The association of antiphospholipid antibodies with one or more of these characteristic clinical features has been termed the i antiphospholipid syndrome. We have experienced a case of successful live birth after treated a woman with heparin and aspirin who has experienced spontaneous abortion four times with antiphospholipid antibodies and present it with the review of literature.
Abortion, Spontaneous ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Aspirin ; Female ; Heparin ; Humans ; Live Birth* ; Pregnancy ; Thrombocytopenia ; Thrombosis

Millard presented the concept of rotation advancement for unilateral cleft lip repair, and today this method of cleft lip closure is acknowledged by most as optimal in principle. However, it has been noted that this procedure occasionally can produce a scar that is symmetrical on the lower two-thirds of philtral column. The scar crosses the upper one third of the philtrum obliquely. The purpose of our study is to determine the configuration of the philtrum. 200 newborn infants were examined from June 1998 to September 1998. Mean gestational ages were 39 weeks and 5 days. Mean birth weight was 3226 gm. Multiple parameters such as philtral shape, nostril sill shape, vermilion shape, curvature of Cupid's bow, mean philtral length, mean white roll length, mean Cupid's bow length, and mean distance between both commissures were applied. An arbitrary classification of the philtrum was established to divide these infants into five groups. As a result, the parallel philtral column from nostril base to vermilion border(Type lla) was found to be the most popular type. Most common vermilion shape was protrusion type. Normal curve of Cupid's was most common. Mean values of philtral length, white roll length, Cupid's length, and distance between commissures were 8.3+/-1.1 mm, 13.9+/-1.3 mm, 5.7+/-1.0 mm, 24.7+/-2.3 mm, respectively. We believe this classification system will be useful for newborn infants evaluation and analysis, systemic planning and application of proper cleft lip repair procedure.
Birth Weight ; Cicatrix ; Classification ; Cleft Lip ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Lip*

No abstract available.
Coronary Vessels* ; Electrocardiography* ; Spasm*

The aim of this study was to identify the usefulness of pelviscopy in treatment besides its diagnostic value. The advantages of pelviscopic surgery are low cost, rapid recovery, good cosmetic effect, low incidence of complication and postoperative adhesion. So most of the pelvic exploration in gynecologic patients are replaced by the pelviscopic surgery these days. Pelviscopic surgery was performed on 136 patients at the Department of Obstetrics and Gynecology, College of Medicine, Yenungnam University from May 1991 to July 1993. The results obtained were as follows : The age distribution of the patients was from 19 to 55 with age of 31.2 years, and the mean parity was 0.96, the most common indication of pelviscopic surgery was tubal pregnancy(66.9%), the second most common indications was ovarian cyst(10.3%) and the other indications were endometriosis, corpus iuteum cyst rupture, parovarian cyst, foreign body, tubal ligation, hydrosalpinx, uterine myoma and in 16.3%. The mean duration of hospitalization was 2.1 days without specific complications. According to these results, it was postulated that the pelviscopic surgery was a useful operative tool in gynecologic treatment and its application could be extended to many other areas of gynecology with safety by the development of surgical techniques and instruments.
Age Distribution ; Endometriosis ; Female ; Foreign Bodies ; Gynecology ; Hospitalization ; Humans ; Incidence ; Leiomyoma ; Obstetrics ; Parity ; Parovarian Cyst ; Rupture ; Sterilization, Tubal

A 57-year-old woman scheduled for cochlear implant removal exhibited preoperative electrocardiographic findings of early repolarization (ER). Four episodes of transient ST segment elevations during surgery raised suspicion for vasospastic angina (VA). In the post-anesthetic care unit, the patient complained of chest discomfort and received sublingual nitroglycerin with uncertain effect. The patient refused to proceed with postoperative invasive coronary angiography, resulting in inconclusive diagnosis. Intraoperative circumstances limit the diagnosis of VA, which emphasizes the need for further testing to confirm the diagnosis. When VA is suspected in patients with underlying ER, it is reasonable to consider invasive examination to establish the diagnosis and prevent recurrence of VA. If ST changes are observed during surgery in patients with preoperative ER, careful monitoring is recommended. Due to general anesthesia, the absence of patient symptoms limits the definitive diagnosis of those with suspected VA. Therefore, additional postoperative surveillance is recommended.
Anesthesia, General ; Cochlear Implants ; Coronary Angiography ; Diagnosis ; Electrocardiography ; Female ; Head ; Humans ; Middle Aged ; Neck ; Nitroglycerin ; Recurrence ; Thorax

OBJECTIVE: The synovium in rheumatoid arthritis(RA) is characterized by an increase in the thickness of lining layer and infiltration of cells into the sublining area. Histomorphologic studies of RA have indicated that initial destruction is more closely related to the presence of transformed appearing proliferating synovial cells than to the presence of subsynovial or periarticular inflammation. Based on the fact that synovial lining cells have some properties of transformed appearing cells, we examined the expressions of Fos, Jun and Myc oncoproteins in the synovial tissue from patients with rheumatoid arthritis and osteoarthritis. METHODS: Synovial tissues from 15 patients with RA and 15 with osteoarthritis(OA) were studied by the immunohistochemical staining technique. Nine of 15 RA specimen were from arthroscopic synovectomy and the other 6 were from total knee replacement arthroplasty. RESULT: In all specimen studied, Myc and Fos were expressed in the synovial lining cells and Myc, Fos and Jun were expressed in the sublining cells, including lymphocytes, other inflammatory cells and blood vessels. Lymphocytes in the diffuse infiltrates showed increased expression of three oncoproteins compared to lymphocytes in the nodular aggregates. When oncoprotein expressions in RA were compared to OA, Fos and Myc expressions in the synovial lining cell layer were significantly higher in RA than in OA and Jun, Fos and Myc expressions in inflammatory cells were significantly higher in RA than in OA. The expressions of Fos and Myc were significantly correlated with the degree of synovial hypercellularity. In RA, the expressions of all three oncoproteins were increased in synovectomy group than joint replacement group. CONCLUSION: We observe that there are increased expressions of Myc, Fos and Jun in RA synovium than OA. These changes are more prominent in synovectomy group than joint replacement group, which suggest the differential expression of oncoproteins according to disease progression.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Vessels ; Disease Progression ; Humans ; Inflammation ; Joints ; Lymphocytes ; Oncogene Proteins ; Oncogenes ; Osteoarthritis ; Synovial Membrane*

BACKGROUND: Many patients with isoniazid and rifampin-resistant pulmonary tuberculosis have organisms that are also resistant to other first-line drugs. Despite of aggressive retreatment chemotherapy, the results are often unsuccessful, with a failure rate approaching 40%. Recently, there has been a revival of resectional surgery for the treatment of multidrug-resistant pulmonary tuberculosis. METHODS: A retrospective analyses of the case records and radiographic findings were done. Between January 1991 and December 1995, 14 human immunodeficiency virus (HIV)-seronegative patients with multidrug-resistant pulmonary tuberculosis were selected for resection to supplement chemotherapy. All patients had organisms resistant to many of the first-line drugs, including both isoniazid and rifampin. RESULTS: Despite of aggressive therapy for median duration of 9.5 months, 12 of the 14 patients (86%) were still sputum smear and/or culture positive at the time of surgery. The disease was generally extensive. Although main lesions of the disease including thick-walled cavities were localized in one lung, lesser amounts of contralateral disease were demonstrated in 10 of 14 (71%). Types of surgery performed were pneumonectomy including extrapleural pneumonectomy in six patients, lobectomy or lobectomy plus in six patients, and segmentectomy in two patients. The resected lung appeared to have poor function; preoperative perfusion lung scan showed only 4.8% of the total perfusion to the resected portion of the lung. There were no operative deaths. Two patients had major postoperative complicatioas including empyema with bronchopleural fistula and prolonged air leak, respectively, Of the 14 patients, 13 (93%) remained sputum-culture-negative for M. tuberculosis for a median duration of 23 months and one remained continuously sputum smear and culture positive for M. tuberculosis. CONCLUSION: On the basis of comparison with historical controls, adjunctive resectional surgery appears to play a significant beneficial role in the management of patients with multidrug-resistant pulmonary tuberculosis if the disease is localized and there are adequate reserve in pulmonary function.
Drug Resistance ; Drug Therapy ; Empyema ; Fistula ; HIV ; Humans ; Isoniazid ; Lung ; Mastectomy, Segmental ; Perfusion ; Pneumonectomy ; Retreatment ; Retrospective Studies ; Rifampin ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary*

BACKGROUND: Thyroid surgery is usually performed under general anesthesia, but thyroid surgery under monitored anesthesia care (MAC) has become re-introduced. We report our experiences of 40 cases of thyroid surgery under MAC. METHODS: Forty patients were enrolled in this study. Bilateral superficial cervical plexus block (BSCPB) was performed by using 1% mepivacaine with 1 : 200,000 epinephrine. After BSCPB, patients were sedated with propofol and fentanyl. Postoperative pain, sore throat, hoarseness, and postoperative nausea and vomiting (PONV) were assessed. RESULTS: Mean postoperative pain VAS were 1.3, 1.2, 1.0, 0.8 and postoperative sore throat VAS 1.4, 1.4, 1.1, 0.9 at PACU (post-anesthesia care unit) and postoperative 3, 6, 12 h, respectively. The incidence of hoarseness was 25, 5, 2.5%, and 0% and PONV were 0, 5, 10%, and 7.5% at PACU and postoperative 3, 6, 12 h, respectively. CONCLUSIONS: Thyroid surgery under MAC may be a suitable alternative to general anesthesia.
Anesthesia ; Anesthesia, General ; Cervical Plexus ; Epinephrine ; Fentanyl ; Hoarseness ; Humans ; Incidence ; Mepivacaine ; Pain, Postoperative ; Pharyngitis ; Postoperative Nausea and Vomiting ; Propofol ; Thyroid Gland

We report a rare case of epithelioid trophoblastic tumor. The patient was initially thought to have endometrial carcinoma with high possibility of clear cell carcinoma on endometrial biopsy and pelvic MRI. The Pap smear showed feature of squamous cell carcinoma and was not consistent with the physical findings. The serum beta-hCG was 33.26 mIU/ml. The initial biopsy and pelvic MRI findings lead the clinicians to misdiagnose the case as a carcinoma.
Biopsy ; Carcinoma, Squamous Cell ; Endometrial Neoplasms ; Female ; Humans ; Magnetic Resonance Imaging ; Trophoblastic Neoplasms* ; Trophoblasts*