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

By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.
Adult ; Cesarean Section ; Embolism ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period* ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Reproduction ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Wounds and Injuries

Adenoid cystic carcinoma is a rare disease of which incidence is 10-15 % of bartholins gland carcinoma. The clinical presentation is characterized by a vulval mass that existed for a prolonged period to the onset of symptoms, usually infection, pain, and burningsensation Histologically, this tumor is characterized by cribriform pattern cell growing and perineural invasion. The obtaining of clear surgical margins is the most important aspect of treatment. Here we report a case of adenoid cystic carcinoma of the Bartholins gland with a brief review of literature.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Incidence ; Rare Diseases

We immunized sixty two healthy subjects with the five different viral titers (300, 500, 1000, 1500 and 2000 plaque forming unit; pfu) of the MAV/06 strain of live attenuated Varicella-zoster virus (VZV) in order to gain sufficient information on safety and immuogenicity as a vaccine strain. Humoral immunity of all vaccine recipients was tested by the fluorescent antibody to membrane antigen (FAMA) assay and Enzyme-linked immunosorbent assay (ELISA) for the quantitative detection of IgG antibody. We tested neutralized antibody in 62 subjects by plaque reduction neutralization test (PRNT50). All of thirty two subjects with initial seronegative response had antibody by FAMA method at four weeks after immunization with four different preparations of dosage. The geometric mean titers (GMTs) of VZV antibody to membrane antigen was 160.9 in 6 subjects with 1500 pfu group; 83.3 in 14 subjects with 1000 pfu group: 116.2 in 7 subjects with 500 pfu groups and 72.0 in 6 subjects with 300 pfu group. Thirty subjects who had VZV antibody at the time before immunization demonstrated elevated antibody titer by FAMA assay and PRNT50 test. Side reactions of the vaccination was not demonstrated in all cases.
Chickenpox* ; Enzyme-Linked Immunosorbent Assay ; Herpesvirus 3, Human ; Immunity, Humoral ; Immunization ; Immunoglobulin G ; Membranes ; Neutralization Tests ; Vaccination

Diurnally fluctuating hereditary progessive dystonia is a rare movement disorder characterized by marked diurnal fluctuation of symptoms and dramatic response to levodopa. We report two advanced female patients of two families who presented with progressive dystonia and gait disturbance. Both patients have a family history and showed excellent response to levodopa.
Dystonia* ; Female ; Gait ; Humans ; Levodopa ; Movement Disorders

The lack of specificity of an abnormal findings visualized on a conventional radiocolloid liver imaging remains a significant limitation of the examination. The purpose of this investigation is to clarify an equivocal abnormal finding visualized on a conventional liver and spleen imaging by using combination of scintiangiography and histogram as a quantiative assessment. Histo-analysis of peak colloidal distribution in the liver and spleen was undertaken as a complement of conventional liver imaging. The following useful patterns was emerged: 1. In hepatitis, the splenic uptake was slightly higher than in normal group. This change was usually not recognized in conventional imaging. 2. In liver cirrhosis, the liver uptake was markedly low whilst splenic uptake was very high, resulting in splenic shift and very low liver-spleen uptake ratio. 3. In hepatoma, the liver uptake was not definitely changed but splenic uptake was considerably high, so that the liver-spleen uptake ratio was very low. 4. In liver metastasis, both liver and splenic uptakes were within normallimits and the liver-spleen uptake ratio was not changed.
Carcinoma, Hepatocellular ; Colloids ; Complement System Proteins ; Evaluation Studies as Topic ; Hepatitis ; Liver ; Liver Cirrhosis ; Neoplasm Metastasis ; Radionuclide Imaging ; Sensitivity and Specificity ; Spleen

BACKGROUND: The SF-6D, derived from the SF-36, is a preference-based instrument measuring health-related quality of life (HRQOL). Using this tool, we measured the HRQOL of persons disabled by stroke dwelling in Gyeongju city and identified factors affecting the HRQOL. METHODS: As of March 2008, 991 persons who had had a stroke and were aged 50 and over were identified on the Gyeongju city disabled registry. Interviewers specifically trained for this face-to-face survey gathered pertinent information including general and clinical characteristics from June to October 2008. In addition, the health status was measured using the Modified Rankin Scale, the Barthel ADL index, and the SF-36. The SF-6D index was derived from the SF-36. We analyzed the known-group construct validity and convergent validity. Finally, we performed multiple regression analyses to identify factors affecting the HRQOL. RESULTS: Of the 991 potential subjects, 498 persons participated in the interviews (response rate: 50.3%). The SF-6D indices for females and those aged 70 and over were lower than indices for males and those aged 60 and less. Correlation coefficients between the Modified Rankin Scale, the Barthel index, and the SF-6D index were relatively high (-0.533 and 0.555, respectively) and statistically significant (P<0.001). Multiple regression analyses showed that sex, age, smoking, alcohol use, comorbidity, the Modified Rankin Scale, and the Barthel index had an effect on the SF-6D index of persons with stroke, and the Barthel index was the most important factor. CONCLUSIONS: Our results indicate that the SF-6D can be a valid tool for evaluating health states of persons disabled by stroke, and functional limitation was the main factor affecting the HRQOL.
Activities of Daily Living ; Aged ; Comorbidity ; Disabled Persons ; Female ; Humans ; Male ; Quality of Life ; Smoke ; Smoking ; Stroke ; Value of Life ; Surveys and Questionnaires

PURPOSE: Advanced gastric cancer, the most common malignancy in Korea is a kind of systemic disease. At dignosis, 50~80% of patients have systemic cancer. Therefore, the most patients require systemic chemotherapy. Cisplatin and 5-FU have been suggested to be active in the treatment of gastric cancer, a high response rate was observered with a combination of 5-FU infusion and cisplatin, and the biochemical modulation of 5-FU by leucovorin has been demonstrated to enhance the activity of 5-FU in gastrointestinal tract cancer. MATERIALS AND METHODS: The patients with advanced gastric cancer whose disease had relapsed or unresectable were treated with 5-FU(800 mg/m2 12 hr IV infusion, D 1~5), leucovorin(20 mg/m2 IV, D 1~5, max. 30 mg), cisplatin(100 mg/m2 15min IV dripping, D1). The cycles of treatment were repeated at 3-weeks intervals. RESULTS: Between Sep. 1994 and Aug. 1996, previously untreated 44 patients(39 eligible patients) were admitted to this study, the median age was 55 years(range 17~73) and male to female ratio was 20:19. The rate of complete remission was 5%(2/39), the rate of partial remission was 21%(8/39). The median-response duration was 26 weeks(5+~38+ ). The median-time to progression was 25 weeks(4+~62+). The range of overall survival time was from 4 to 62+ weeks. 24 weeks survival rate was 71.5% but the median survival time was not reached. The leukopenia and anemia were the main hematologic toxicities. Non-hematologic side effects were nausea, vomiting, diarrhea, stomatitis, peripheral neuropathy. These toxicities were observed commnonly, but tolerable. Two treatment-related deaths were associated with sepsis. CONCLUSION: Based on these results, FLP combination chemotherapy seems to be a moderate efficacy for advanced gastric cancer with tolerable toxicities. To confirm the efficacy further, the long-term follow up and a large scale of clinical studies are needed.
Anemia ; Cisplatin* ; Diarrhea ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Fluorouracil* ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Humans ; Korea ; Leucovorin* ; Leukopenia ; Male ; Nausea ; Peripheral Nervous System Diseases ; Sepsis ; Stomach Neoplasms* ; Stomatitis ; Survival Rate ; Vomiting

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

Minimally invasive surgery, which has been extensively used to treat gastric adenocarcinoma, is now regarded as one of the standard treatments for early gastric cancer, and its suitability for advanced gastric cancer is being investigated. The use of cutting-edge techniques for minimally invasive surgery enables surgeons to deliver various treatment options to minimize a patient's distress and to maintain oncologic safety. Ongoing multicenter prospective studies aim to validate the efficacy of these surgical techniques and to expand the indications of minimally invasive surgery for the treatment of gastric cancer. In this review, we summarize the current status and issues regarding minimally invasive surgery for the treatment of gastric cancer.
Gastrectomy/*methods/trends ; Humans ; Laparoscopy/*methods/trends ; Multicenter Studies as Topic ; Patient Selection ; Randomized Controlled Trials as Topic ; Republic of Korea ; Robotic Surgical Procedures/*methods/trends ; Sentinel Lymph Node Biopsy/methods/trends ; Stomach Neoplasms/*surgery