OBJECTIVES: The purpose of this study was to assess the clinical features, microbiologic results, and the efficacy of perineal hygienic care of pediatric vulvovaginitis. METHODS: Forty-two unselected premenarcheal patients with symptoms or signs of vulvovaginitis who were attended the outpatient pediatric and adolescent gynecology clinic at Pundang CHA General Hospital from August 1997, to September 1999 were systematically interviewed and examined using a standardized format, studied microbiologically, and followed the efficacy of perineal hygienic measures prospectively. RESULTS: The median age of the patients was 4.8 years (range 2.9 years to 10.9 years). Vaginal complaints of 42 patients were discharge(79%), genital pain or irritation(31%), odor(17%), pruritus(14%), and vaginal bleeding(7%). On physical examination, vaginal discharge and vulvar erythema were noted in 17(40%) and 22(52%) patients, respectively. Aerobic bacteria or yeast excluding vaginal normal flora were found in 24 of 42 patients(57%). Convincing evidence of specific pathogens was found in 9 of 42 patients(21%) including one case of pinworm infestation. Isolated pathogens were H. influenza(3), S. pyogenes(2), K. pneumonia(2) and N. gonorrhea(1). No patients were found to have chlamydial infection or trichomoniasis. In 14 patients, risk factors were identified such as swimming(14%), bubble bath(5%), sexual abuse(5%), genital trauma(5%) and foreign body(2%). After two weeks instructions of perineal hygienic care, 26(62%) of 42 patients revealed complete resolution of symptoms and signs of vaginitis without antibiotics. Efficacies of perineal hygienic care were 94%(17/18) in the patients with normal flora alone, 60%(9/15) in the patients with organisms suspected for nonspecific infection and 0%(0/9) in the patients with specific pathogens(p<0.05). CONCLUSION: Majority(62%) of the pediatric patients with symptoms or signs of vulvovaginitis were cured with perineal hygienic care alone. And the efficacy of hygienic measure were higher in the patients without specific pathogens(79%, 26/33). Therefore, proper physical examination, microbiologic study and appropriate instructions of perineal hygienic care were more important than empirical antibiotic treatment in initial management of pediatric vulvovaginitis.
Adolescent ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Enterobius ; Erythema ; Gynecology ; Hospitals, General ; Humans ; Outpatients ; Physical Examination ; Prospective Studies ; Risk Factors ; Vaginal Discharge ; Vaginitis ; Vulvovaginitis* ; Yeasts

Although myocardial bridge is not thought to have any hemodynamic significance in most cases, some have suggested that when it produces severe systolic narrowing, ischemia or infarction may result. Myocardial bridge in adults with hypertrophic cardiomyopathy may be associated with a higher incidence of sudden death, myocardial wall-motion abnormalities, and perfusion defects on thallium-201 scintigraphy. When myocardial bridge is associated with left ventricular hypertrophy, it is known to affect longer segment and cause more severe compression during systole. We report a case of hypertrophic cardiomyopathy with myocardial bridge at the middle part of the left anterior descending coronary artery, who also showed reversible perfusion defect on the thallium scan at the same coronary territory.
Adult ; Cardiomyopathy, Hypertrophic* ; Coronary Vessels ; Death, Sudden ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Infarction ; Ischemia ; Perfusion ; Radionuclide Imaging ; Systole ; Thallium

No abstract available.
Barium* ; Intussusception*

OBJECTS: The purpose of this study is to estimate the values of foot pressure of the stance phase during a gait cycle in hemiplegic gait. METHOD: Thirty patients who had a stroke and forty healthy adults were evaluated by the EMED-SF system to analyze the stance phase of hemiplegic gait. The stance phase was evaluated by 6 points according to the foot pressure and center of pressure proposed by Lee et al.2) RESULTS: 1) In hemiplegics, the stance time of involved limb decreased compared with that of the uninvolved limb and increased that of control groups (p<0.05). 2) In hemiplegics, the midstance time increased but the loading response and terminal stance decreased compared with the uninvolved limb and controls (p<0.05). 3) In hemiplegics, the midstance time decreased and the loading response and terminal phase increased according to the increased Brunnstrom stage (p<0.05). CONCLUSION: The results showed that an analysis of stance phase by the measurement of plantar pressure was a valuable parameter in the gait analysis of hemiplegic patients.
Adult ; Extremities ; Foot ; Gait ; Gait Disorders, Neurologic ; Humans ; Stroke

Supernumerary tooth, named mesodens, occur between the maxillary central incisors are generally found in pairs, although it is sometimes found singly. An inverted mesiodens may move toward the nasal cavity and erupt in the floor of the nose. Approximately 90% of all supernumerary tooth usually appear in the area of the maxilla, where they disrupt the position and eruption of normal teeth. A supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e., molars, premolars or anterior teeth.
Bicuspid ; Incisor ; Maxilla ; Molar ; Nasal Cavity* ; Nose ; Tooth ; Tooth, Supernumerary*

Among 7,500 patients whom we have performed gastrofiberoscopy from July 1979 to June 1,982, 226 cases of stomach cancer were diagnosed. The frequency was 3. 0%. The ratio of male to female was 2: 1, the peak incidence, 69 cases(30.5%) was in 5th decade. 1) The frequency of stomach cancer among the age were 0. 5% in 1st decade, 0.4% in 2nd decade, 1.2% in 3rd decade, 2.5% in 4th decade, 5.9% in 5th decade, 12.6% in 6th decade 16.8% in 7th decade. (continue...)
Female ; Humans ; Incidence ; Male ; Stomach Neoplasms* ; Stomach*

PURPOSE: The purpose of this study was to evaluate the morphologic changes of the injured hepatic acini following ligation of common bile duct and to investigate the pathophysiologic process of hepatic failure and biliary liver cirrhosis in the extrahepatic cholestasis. MATERIALS AND METHODS: The common bile ducts of 18 rabbits were ligated partially. The rabbits were killed and selective microangiography was carried out with infusion of barium suspension via portal vein 4 to 24 weeks after ligation. Selective microangiography was also carried out in two normal rabbits. The microangiographic findings were evaluated and correlated with histopathologic features. RESULTS: The sinusolds of the liver acinus showed distortion, varying degrees of luminal widening, and irregularities in architecture. Terminal branches of the portal vein (TPV) showed increased number of branches, luminal narrowing, tortuosity, distortion, and beaded appearance. Peribiliary plexi were found as thin curvilinear, barium-filled structures along the wall of the dilated bile duct. The microangiographic findings were well correlated with histopathologic findings. The grades of microangiographic and histopathologic findings were poorly correlated with the duration of the ligation of CBD. CONCLUSION: Changes in microvasculature of the liver acinus following partial ligation of common bile duct were demonstrated by microangiography. Although the microvascular changes were evoked secondary to the injury, they might have some active roles in the pathophysiologic process in the liver.
Barium ; Bile Ducts ; Cholestasis, Extrahepatic ; Common Bile Duct* ; Ligation* ; Liver Cirrhosis ; Liver Failure ; Liver* ; Microvessels ; Phenobarbital ; Portal Vein ; Rabbits

OBJECTIVE: The purpose of this study is to evaluate the effects of a self-stretching exercise on the pressure threshold of myofascial trigger point. METHOD: We examined the changes of pressure threshold in 66 patients with myofascial trigger points before and after a self-stretching exercise of shoulder girdle and also tested the visual analogue scale (VAS) of the subjective pain intensity. The self-stretching exercise of shoulder girdle includes a stretching exercise of four muscles in shoulder girdle simultaneously, including upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor, which is followed by 1) a sitting position, relaxed, 2) lateral bending of neck to contralateral side, 3) forward and downward stretching of ipsilateral arm with protrusion of scapula and internal rotation of arm maximally to the contralateral foot. Each stretching motion is maintained for 30 seconds. RESULTS: The results of the patients experiencing unilateral or bilateral myofascial neck and shoulder pain showed that the pressure threshold of trigger point increased in response to the self-stretching exercise as assessed by a pressure algometer. Also visual analogue scale (VAS) decreased in response to the self-stretching exercise. CONCLUSION: We conclude that the self-stretching exercise of shoulder girdle is an effective method for the simultaneous stretching of upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor.
Arm ; Foot ; Humans ; Muscles* ; Neck ; Scapula ; Shoulder Pain ; Shoulder* ; Superficial Back Muscles ; Trigger Points*

Tympanic membrane perforations are frequently encountered diseases and can be treated with several different methods, induding tympanoplasty with tympanic membrane grafting which requires more profound techniques and clinical care. A fat graft myringoplasty is a cost-effective techniquc managing small tympanic membrane perforations and is used when challenged by a myringoplasty failure, or following tympanostomy tube extrusion. It involves wedging a piece of fat from the ear lobule into the perforation with local anesthesia in a one-day-stay procedure. This study demonstrates the efficacy of this method in a persistent small tympanic membrane perforation.
Anesthesia, Local ; Ear ; Middle Ear Ventilation ; Myringoplasty* ; Transplants* ; Tympanic Membrane ; Tympanic Membrane Perforation ; Tympanoplasty

Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.