No abstract available.

No abstract available.

No abstract available.

Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.
Analgesia ; Anesthesia ; Anesthesia, General ; Atropine ; Child ; Diagnosis ; Female ; Hernia ; Hernia, Inguinal* ; Hope ; Humans ; Ketamine* ; Lidocaine* ; Ligation ; Male ; Medical Records ; Retrospective Studies

No abstract availble

No abstract available.
Acidosis, Renal Tubular*

OBJECTIVE: To determine the significance of high risk human papilloma virus (HPV) infection and involvement of the resection margins of cervical cone biopsy specimens removed by loop electrosurgical excision procedure (LEEP) in the management of cervical intraepithelial neoplasia (CIN III). METHODS: Records of 506 LEEP procedures performed due to abnormal Pap result between December 1995 and December 1998 were reviewed. Among them, 232 cases with histologically proven as CIN III in LEEP and follow-up Pap smear more than 6 months was available were assessed. All patients were assigned according to HPV infection and resection margin involvement in LEEP, and recurrence rate in the follow-up was compared with reference to post-LEEP treatment regimen, observation or hysterectomy in each group. RESULTS: Of 232 cases reviewed, 10 cases(4.3%) were ASCUS, 19 cases(8.2%) were LSIL, 199 cases(85.8%) were HSIL, and 4 cases(1.7%) were invasive cancer in initial Pap smear. Abnormal Pap result in the follow-up was as follows: 4 cases of ASCUS, no case of LSIL, and 6 cases of HSIL. Excluding ASCUS, the overall recurrence rate in the follow-up was 2.6%(6/232). HPV positive was 164(70.7%) and HPV negative was 68(29.3%) in the LEEP specimen. Of 164 HPV positive, 41 were followed up without further treatment and 123 with hysterectomy. There was no significant difference in the recurrence rate between the two groups(P=0.41). Of 68 HPV negative, 27 were only followed up and in 41, hysterectomy was done. And also, there was no significant difference(P=0.32). Of 232 cases, resection margin was positive in 167(72.0%) and negative in 65(28.0%). Of 65 margin negative, 29 were followed up without further treatment and 36 with hysterectomy. There was no significant difference in the recurrence rate between the two groups(P=0.36). Among 167 margin positive, 39 were only followed up and in 128 hysterectomy was done. Recurrence rate was significantly higher in followed up only group(P=0.04). CONCLUSION: HPV infection in LEEP specimen was not helpful in deciding post LEEP treatment modality in CIN III patient. But, when resection margin was positive, hysterectomy should be performed because by doing so, recurrence rate was significantly lower than when only follow up was done.
Biopsy ; Cervical Intraepithelial Neoplasia ; Follow-Up Studies ; Humans ; Hysterectomy ; Papilloma ; Recurrence

Ouarian tumors of low malignant potential(OTLMP) or borderline tumors account for approximately 10% of all ovarian neaplasms. Borderline tumors have some but not all of the histologic characteristics af ma lignancy : stratification of epitheliial cells, with some degree of nuclear atypia a,nd inereased mitotic actitity but. without stromal invasion. We reviwed 20 published Rnglish written articlea from 1978 to 1992 and Korean gynecologic cancer regestry of 1990. In this review, we tried to concentrate on several debating is sues in OTLMP: 1) What kind of surgery is needed for each stages?, 2) Is postoperative adjuvant t.herapy needed?, 3) Jf needed, which type? Following result were obtained from the besis of 1516 patients with OTLMP. Patients withh OTLMIP are younger than those with invasive ovarian cancers', mean age was in their forties. The majority of patients(74.5%) had stage I disease, and the incidence dropped ahruptly to 9.4% for stage ll, 15.7% for stage III and 0.4% for stage IV. The most cammon histologic subtype was serous(56.7%), followed by muci noua(38.1%), However, interestingly in Korea and Japan, the mucinous type was the most common one. The primary treatment for OTLMP was surgery, and the conservative surgery to preserve fertility in young women was sufficient for stage I disease with careful follow-up. The majority of patients(79.1%) with stage I disease were treated by surgery alone. Adjuvant such as chemotherapy (CT) and/or radiotherapy(RT) could prolong the recurrence of disease a little later, but failed to increase diaease-free survival significantly in stage I disease. In stageII disease, the surgery should be a total abdominal hysterectomy and bilateral salpingo-oophorectomy with multiple sampling of the peritoneal cavity. About a third of patients with stageII disease received no adjuvant therapy and the others received CT and/or RT, however, there was no difference in outcome of recurrence and survival. In advanced stage. 15% of patients received no adjuvant therapy after initial debulking surgery, and the rest of patients received CT and/or RT. No differences in recurrence and survival between each groups were noticed , too. The status of second-look laparotomy(SLL) did not depend on the stage of the disease. Positive rate of SLL for stage I diaease was not statistically different from that for the combined stages II-IV. Survival for stage I at 5 years was reported to range from 80 to 100%, and even stage III had survival ranging from 64 to 96%. Long-term survival at 15~20 years was also good. Although it is quite difficult to make conclusions because of the lack of prospective randomized studies from this review, it appears clear that surgical removal of the tumor and careful follow-up of patients are all that are necessary in stage I disease and further multi-center prospective study for the effect of adjuvant therapy in advanced disease is definitely needed.
Drug Therapy ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Incidence ; Japan ; Korea ; Mucins ; Peritoneal Cavity ; Prospective Studies ; Recurrence

The transition from preinvasive to invasive disease is a crucial juncture in the development of cervical cancer. The clinical experience that microvasive lesions carry a better prognosis justifies a sepetate diagnostic category. Besides clinical and cliagmostic problerns, the rnicroinvasive cervical cancer presents morphological peculiarities. To investigate the clinieal and pethological aspects of micrenvasive eervical carcinornn, a retrospective study was made on 40 cases, histologically reconfirrned surgical specimens, which had been treated during the period from March, 198I3 to March, 1992 at, Departrnent of Obstetrics and Gynecology, Pusan Paik Hospital, Inje University. The results obtained were as follows ; 1. Mean age of 40 patents was 44.6 year old, all were rnultipatous. Nineteen cases helonged to I s, and 21 cases to I a2. 2. Main presenting symptoms were leukorr hea and/or genital bleeding and the majority of patients showed cervical erosion on groas finding, 3. The corresponding rate of Pap, smear to histologic diagnosis was approximately 67.5%, However, corresponding rate within one histologie grade was about 85%. 4, Aecording to the eolpuacapie examination, less than half of the examined cases revealed suspected abnormal findings suggeeting invasive lesion. 5. As to the reports of punch biopsy, 64.8% of cases showed microinvasive and/or inuasive lesian. With additional diagnostic conization of cervix, the preoperative diagnosis were correct in 82.5%. 6. Histopathological reevaluatin ef surgiral specimens revealed positive correlation between depth of stromal invasion and width of leaior, confluent growth pattern, numher of invasive foci, and invasion of capillary-like spaee, respectively.
Biopsy ; Busan ; Cervix Uteri* ; Conization ; Diagnosis ; Female ; Gynecology ; Hemorrhage ; Humans ; Obstetrics ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms

BACKGROUND: Punch grafts and punch elevation can be useful for the correction of deep pitting or round atrophic acne scars. The traditional punch elevation technique gives inadequete results. Even round scars leave a retraction space and do not always heal well. OBJECTIVES & METHODS: To improve the cosmetic results of traditional punch elevation and thus promote the use of punch elevation instead of punch grafting, we performed punch elevation with purse-string sutures on 10 patients with acne, pox & atrophic scars. We performed dermabrasion or CO2 laserbrasion after 8 weks. RESULTS: Nicely fit margins of the punch elevation site with purse-string suture left no retraction spaces and enhanced the aesthetic results. CONCLUSION: Punch elevation is a simple, satisfactory method of improving cosmetic results in scars. The Purse-string suture technique can make it a more valuable tool for surgery of facial scars, because it overcomes of disadvantages the punch elevation.
Acne Vulgaris* ; Cicatrix* ; Dermabrasion ; Humans ; Suture Techniques ; Sutures* ; Transplants