Transvaginal cervical cerclage for the prevention of pregnancy loss in patients with cervical incompetence is well accepted. However, there is a small subject of patients with incompetence of cervix, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage and deep cervical damage or tears in the fornices. We experienced a case of the transabdominal cervical cerclage. 'Ihe patient had a past history of deep cervical laceration due to vaginal delivery. Therefore, we present here a surgical technique of transabdominal cerdage and report it with brief review of literatures.
Cerclage, Cervical ; Cervix Uteri* ; Female ; Humans ; Lacerations ; Pregnancy

Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistula formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelialized (5 mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejuna transfer.
Constriction, Pathologic ; Fistula ; Forearm ; Free Tissue Flaps ; Head ; Humans ; Neck

A statistical analysis was performed with 623 intracranial tumor cases of which diagnoses were confirmed at the Department of Neurosurgery of Seoul National University Hospital from Sep. 1957 to Apr. 1981. The authors classified the intracranial tumors according to Russell and Rubinstein's classification. Epidermiological factors were analysed in general, and especially for the changes after CT introduction. The results were as follows: 1. Intracranial tumors were found most frequently in middle age group(20.9%), and the ratio of male to female was 1.8:1. 2. Among the intracranial tumors, gliomas were found most frequently(20.9%), and followed by granulomatous lesions(15.7%), pituitary adenomas(14.3%), Meningiomas(10.9%), vascular tumors(10.0%), schwannomas(5.1%). 3. The incidence of gliomas was less than that of otjer countries, especially glioblastoma multiforme. Pituitary adenomas occupied 14.3% of all intracranial tumors and as a single entity these were the highest incidence. Granulomatous lesions occupied 15.7% of all intracranial tumors. 4. Intracranial tumors occurred more frequently in supratentorial region. The most frequent location was wellar and parasellar regions(19.9%), and followed by frontal(17.2%), cerebellar(14.4%), parietal(14.0%), temporal region(9.5%). 5. Gliomas are the most frequent tumors irrespective of age group and in children then comes granulomatous lesions, medulloblastomas, vascular tumors and in adults then comes pituitary adenomas, granulomatous lesions, meningiomas in that order. 6. Since the advent of CT scan, the detection rate of intracranial tumors was increased, but there was no specific change in proportion of tumors.
Adult ; Child ; Classification ; Diagnosis ; Female ; Glioblastoma ; Glioma ; Humans ; Incidence ; Korea* ; Male ; Medulloblastoma ; Meningioma ; Middle Aged ; Neurosurgery ; Pituitary Neoplasms ; Seoul ; Tomography, X-Ray Computed

No abstract available.
Otoacoustic Emissions, Spontaneous*

This is a report of 51 cases in renal allograft, which were treated at the Yeungnam University Hospital from February 1994 to July 1996 and compared the significance of changes of TNF-alpha in blood and urine as a diagnostic tool of acute rejection in renal allograft. The aim of this study was to investigate the value of plasma and urinary TNF-alpha in patients with renal allografts. Renal allografts divided them into four groups (control, acute rejection, acute tubular necrosis and systemic infection) that obtained plasma and urinary TNF-alpha. The sampling day of blood and urine in each group were as follows: in control group at the day of transplantation and postoperative 1, 5, 7 days respectively, in acute rejection group at before the day of initiation of therapy and the 1, 3 days after therapy, in acute tubular necrosis group at the day of low urine output and the 4 subsequent days, and in systemic infection group at the day of diagnosis and the 3 subsequent days. The results were as follows: Plasma TNF-alpha levels were significantly elevated in 68.4% (p<0.01) of acute rejection group and 100.0% (p<0.05) of systemic infection group but did not increase in acute tubular necrosis group (20.0%, p>0.05). In contrast, urinary TNF-alpha were detected in acute rejection group (42.1%, p<0.01) and acute tubular necrosis group (20.0%, p<0.05). Control and systemic infection groups were not detectable in urinary TNF-alpha. The results suggested that plasma and urinary TNF-alpha may be used as the complementary diagnostic tool of acute rejection in renal allograft patients.
Allografts* ; Diagnosis ; Humans ; Necrosis ; Plasma ; Tumor Necrosis Factor-alpha*

A 39-year-old female patient presenting with epigastric discomfort and jaundice was diagnosed as diffuse hilar cholangiocarcinoma with vascular tumor invasion. After preoperative management with percutaneous transhepatic biliary drainage and right portal vein embolization, the patient underwent modified hepatoligamentopancreatoduodectomy; this included extended right hepatectomy, caudate lobectomy, portal vein segmental resection, enbloc resection of hepatoduodenal ligament together with proper hepatic artery resection and with leaving a replaced left hepatic artery from the left gastric artery, and paraaortic lymph node dissection. Intraoperative frozen histologic examination revealed multiple paraaortic lymph node metastases, which was generally regarded as definite distant metastasis. There was no postoperative complication except for persistent drainage of ascites that occurred only during the immediate postoperative period. She did not receive postoperative adjuvant chemotherapy or radiotherapy. The patient is now living well 11 years 2months after surgery without recurrence. Although this patient revealed hilar vascular invasion and paraaortic lymph node metastasis, she survived more than 10 years without tumor recurrence. This implicate that aggressive surgical treatment of hilar cholangiocarcinoma can result in long-term survival even in the presence of paraaortic lymph node metastasis.
Adult ; Arteries ; Ascites ; Chemotherapy, Adjuvant ; Cholangiocarcinoma* ; Disease-Free Survival* ; Drainage ; Female ; Hepatectomy ; Hepatic Artery ; Humans ; Jaundice ; Ligaments ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Portal Vein ; Postoperative Complications ; Postoperative Period ; Radiotherapy ; Recurrence

Expandable metallic stents(EMS) were implanted in 7 patients with malignant (4 cholangio- carcinnoma, 1 pancreatic cancer, 1 ampullary carcinoma and 1 lymph node metastasis) biliary stricutres and 17 patients with benign(13 intrahepatic strictures of primary intrahepatic stone patients, 2 postoperative stricutres, 1 ampullary stenosis followed by endoscopic sphineterotomy and 1 bilioenteric anastomosis) biliary stricutures. In the fifteen patients out of 17 patients with benign biliary stricture, relief of cholangitis, improvement of liver function or loss of pruritus was observed. But in the 2 patients with.biliary cirrhosis, no clinical improvement was noted. In the malignant strictures with cholangio-carcinoma, the occlusion of EMS occurred in 3 patients and the duration of stent patency was average 2 months in those patients.
Cholangitis ; Constriction, Pathologic ; Fibrosis ; Humans ; Liver ; Lymph Nodes ; Pancreatic Neoplasms ; Pruritus ; Stents*

PURPOSE: Liver transplantation (LT) is regarded as an important management option for fulminant hepatitis (FH), which is associated with considerable mortality under conservative management. The aim of this study was to evaluate the outcome of children with FH according to management. METHODS: We reviewed medical records of patients presented with FH from January 1994 until April 1999. The children were grouped according to the treatment. Group A was classified for supportive treatment only and group B for supportive treatment plus LT. Children were considered as candidates for LT if the level of factor V decreased to below 20% of normal or the patient's condition deteriorated despite intensive care during the initial 48 hours. Underlying disease, duration after jaundice, grade of encephalopathy, laboratory findings, treatment and outcomes were analyzed. RESULTS: The study group comprised 7 females and 8 males aged from 8 months to 15 years old (median age of 4 years). The causes of FH were Wilson disease (4 cases), Epstein-Barr virus infection (1 case), drug (1 case) and idiopathic (9 cases). There were 5 children in group A and 10 in group B, and there were no significant differences in age, sex ratio, underlying diseases, grade of hepatic encephalopathy and laboratory findings between the two groups. One out of 5 in group A and 9 out of 10 in group B survived. But all the children in group A who met the criteria for LT and received only supportive care died. One out of 10 in group B died because of grade IVa hepatic encephalopathy which advanced to brainstem herniation. CONCLUSION: This study showed that patients who were managed with supportive care only, although LT was indicated, died and that 9 out of 10 who received LT survived. Therefore, we suggest LT should be considered in the management of FH.
Adolescent ; Brain Stem ; Child* ; Factor V ; Female ; Hepatic Encephalopathy ; Hepatitis* ; Hepatolenticular Degeneration ; Herpesvirus 4, Human ; Humans ; Critical Care ; Jaundice ; Liver Transplantation* ; Liver* ; Male ; Medical Records ; Mortality ; Sex Ratio

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.
Adrenalectomy ; Adrenocorticotropic Hormone ; Female ; Humans ; Hydrocortisone ; Ketoconazole* ; Octreotide* ; Pituitary Irradiation

This study was designed to examine the effects of two antidepressant drugs on the expression of c-fos mRNA in cultured embryonic rat hippocampal neurons. The drugs used were imipramine and amitriptyline. On the fourth day of culture, hippocampal neurons were treated with variable concentrations of each drug. Competitive RT-PCR(Reverse Transcriptase-PCR) analysis was used to quantify the c-fos mRNA expression induced by each drug. Experimental results showed that acute and direct treatment with imipramine and amitriptyline with relatively low concentrations(imipramine < or =10micrometer, amitriptyline < or =10micrometer) had no inductive effect on the expression of c-fos mRNA in the rat hippocampal neurons. However, after treatment with relatively high concentrations(imipramine > or =100micrometer, amitriptyline > or =100micrometer) c-fos mRNA was not detected. These findings suggest the followings. Firstly, the action mechanisms of these drugs on the hippocampal neurons might not be mediated by c-fos but by other immediate-early genes(IEGs). Secondly, their actions may be mediated indirectly via other areas of the brain. Thirdly, the expression of c-fos might be inhibited by high concentrations of these drugs, or the high concentrations could induce cell death. Finally, though cell death remains to be confirmed, the inhibition of c-fos induction or cell death could play a role in the cognitive impairments known to be adverse effects of some antidepressants. This study is believed to be a first step toward understanding the mechanisms of learning and memory. Further studies are needed to investigate the expression of various IEGs and changes in the hippocampal neurons of rat resulting from chronic treatment with antidepressant drugs.
Amitriptyline ; Animals ; Antidepressive Agents* ; Brain ; Cell Death ; Imipramine ; Learning ; Memory ; Neurons* ; Rats* ; RNA, Messenger*