The main cause of vesicovaginal fistula is gynecologic or obstetric manipulation, but vesicovaginal fistula as a complication of genitourinary tuberculosis is extremely rare. The diagnosis is confirmed by the histological findings, and treatment is surgical repair with antituberculous medication. We report here on the presentation and management of extensive tuberculosis that led to formation of a vesicovaginal fistula in an adult.
Adult ; Diagnosis ; Humans ; Tuberculosis ; Vesicovaginal Fistula*

PURPOSE: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. MATERIALS AND METHODS: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. RESULTS: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). CONCLUSION: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.
Biopsy ; Carcinosarcoma ; Follow-Up Studies ; Humans ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors

Epidural nerve block is the most widely practiced procedure in the pain clinic. Accidental dural puncture during epidural nerve block also has been associated with postdural puncture headache and total spinal anesthesia. Especially, total spinal anesthesia is the most serious complication of epidural nerve block and can lead to a life threatening conditions. We have experienced two cases in whom total spinal anesthesia occurred during epidural nerve block for neck and lower back pain control. Immediately after epidural nerve block, the patients became unresponsive and apneic with loss of muscle tone in all extremity. We performed resuscitations and about 3 hours later the patients recovered completely without any complication.
Anesthesia, Spinal* ; Extremities ; Humans ; Low Back Pain ; Neck ; Nerve Block* ; Pain Clinics ; Post-Dural Puncture Headache ; Punctures ; Resuscitation

No abstract available.
Glomerulonephritis, Membranous*

It is well established that mast cell proliferation and maturation are regulated by two principle cytokines, IL-3 and the c-kit ligand stem cell factor (SCF). Previous reports have demonstrated that bone marrow-derived IL-3-dependent mast cells exhibit the characteristic apoptosis on removal of IL-3. To know how the number of mast cells is controlled, we observed the effects of nitric oxide (NO) on the murine bone marrow-derived cultured mast cells (BMCMC). Apoptosis was measured by the analysis of flow cytometric data and electrophoretic evidence of DNA fragmentation. Our data showed that sodiurn nitroprusside (SNP)-a NO releasing substance- induced apoptosis in BMCMC. Cell cycle analysis showed that the number of the G,/G, and S phase decreased markedly, while the percentage of cell in G,/M phase was increased. Also, SNP alone induced cell death, whereas SNP in combination with SCF markedly decreased cell death of BMCMC. SNP-induced apoptosis was partially inhibited by the treatment of BMCMC with SCF. Our results suggest that NO might have sorne role in the regulation of the number of mast cells.
Apoptosis ; Bone Marrow* ; Cell Cycle ; Cell Death ; Cytokines ; DNA Fragmentation ; Interleukin-3 ; Mast Cells* ; Nitric Oxide* ; Nitroprusside ; S Phase ; Stem Cell Factor

BACKGROUND: Although anticardiolipin antibody(aCL)-related stroke is far more frequently identified in younger populations, the role of aCL in the pathogenesis of cerebral infarction may be important also in the old, stroke-prone population. We studied the clinical profiles of aCL- related stroke in elderly patient to look at its role on the pathogenesis of ischemic stroke. METHODS: We analyzed unselected patients with acute ischemic stroke and age matched controls for the presence of aCL, prospectively. Also, we studied the characteristics of these patients based on the conventional risk factors and other clinical, laboratory and radiological features in them. RESULTS: aCL was positive 30 (14.7%) of 203 stroke patients, but 11 (6.1%) in 193 control patients. The proportion of patients having more than one of the risk factors was significantly greater in aCL-positive (24/30, 80.0%) than in aCL-negative patients (100/173, 57.8%). The incidence of aCL positivity was significantly greater in patients having one or more risk factors (24/124, 19.3%) than in patients not having any of the risks (6/79, 7.6%). Two of the patients had prolonged aPTT, and only one had a lupus anticoagulant. A positive ANA and false-positive VDRL were not found in our patients. Radiological findings confer subcortical infarction. CONCLUSION: The elevated aCL are a risk marker for stroke also in the elderly population. Our aCL-positive patients generally had multiple risk factors for stroke and are associated with subcortical infarctions, contrary to previous studies. The role of aCL as a disease marker for ischemic stroke in elderly patients warrants further investigations.
Aged* ; Antibodies, Anticardiolipin* ; Cerebral Infarction ; Humans ; Incidence ; Lupus Coagulation Inhibitor ; Prospective Studies ; Risk Factors ; Stroke*

Vaginitis is one of the most common disease in gynecologic field in recent days. About 90% of these patients suffer from the infection of the vagina caused by Gardnerella vaginalis, Candida, or Trichomonas, either alone or in combination. For the effective diagnosis and management, it is essential to get an accurate identification of the causative agent. Applying simple and easy diagnostic methods such as pH of vaginal discharge, amine test and microscopic examination of wet mount preparation of normal saline and 10% KOH to 549 cases of randomly selected patients visiting Out-patient Department of Obstetrics and Gynecology of Yeungnam University Hospital through May 1st to Sept. 31st, 1987, the following results were obtained. 1. In the Gardnerella vaginitis vaginal pH was more than 5.0 in 81.0% of total cases, positive amine test in 62.8%, decreased lactobacilli in 77.4% & decreased WBC counts in 70.1%, In the Trichomonas vaginitis vaginal pH more than 5.0 was noted in 93.3% of the cases, negative amine test in 90%, decreased showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 90%, decreased lactobacilli in 90% & increased WBC counts in 93.3%, whereas Candida vaginitis and normal groups showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 100%, normal distribution of lactobacilli in 89.7%, normal WBC counts in 72.4%. 2. The accuracy rates of physical diagnosis by wet mount preparation of normal saline and 10% KOH revealed 26.3%, 47.5%, 70.0% in Gardnerella vaginitis, Candida vaginitis, and Trichomonas vaginitis, respectively. The vaginal pH and amine test showed 83.2% of accuracy rate in Candida vaginitis group, 60.6% in Gardnerella vaginitis group and 83.3% in Trichomonas vaginitis group. 3. In 23 cases of Gardnerella vaginitis showing vaginal pH of 3.0 or 4.0 and positive amine test, the clue cells were observed in 10% or less in 12 cases, 30% in 5 cases, 50% in 4 cases and 50% or more in 2 cases. In summary vaginal pH and amine test could be useful in screening and differentiating the different types of infectious vaginitis. Furthermore by adding microscopic examination of normal saline and 10% KOH wet mount preparation to them, they not only could obtain higher diagnostic accuracy rate but would be more valuable in selecting the patients requiring cultures to confirm the diagnoses.
Candida ; Diagnosis ; Gardnerella ; Gardnerella vaginalis ; Gynecology ; Humans ; Hydrogen-Ion Concentration* ; Mass Screening ; Obstetrics ; Outpatients ; Trichomonas ; Trichomonas Vaginitis ; Vagina ; Vaginal Discharge* ; Vaginitis*

Trichorrhexis nodosa(TN) denotes small node-like swelling with a loss of cuticle of the hair shaft through which the hair readily fractures. The basic cause of TN is mechanical or chemical trauma, and a contributing factor is an inherent weakness of the hair shaft. We report a case of localized TN in a 37-year-old male. He had an ovoid hair patch with multiple small white-gray dotted and stubby hairs localized to the right occipital scalp. TN is known to be the commonest of all hair shaft anomalies (Price, 1975). However TN is rarely reported, and there have been only four reports in Korean dermatological literature, to our knowledge, which might be due to underdiagnosis of this disorder. We postulated that diagnostic difficulty lies in the discrepancy between terminology and gross morphological findings.
Adult ; Fibrinogen ; Hair ; Humans ; Male ; Scalp

In order to group the pelvic obliquity into clinically useful classification and to develop appropriate guidelines for treatment, we evaluated 55 patients who had been treated between 1985 and 1993 for pelvic obliquity after poliomyelitis. Age at surgery ranged from 15 years to 49 years (average 27 years). Fixed pelvic obliquity after poliomyelitis was classified into two major types according to the level of the pelvis relative to the short limb and into four subtypes in each type according to the direction and severity of scoliosis. Forty-six patients had obliquity with the pelvis down (type I), and nine patients had the pelvis up (type II) on the short limb side. Subtype A: straight spine with localized lower lumbar compensatory angulation, mainly at the L4-5 intervertebral space. Subtype B: mild scoliosis with convexity to the short limb side, Subtype C: mild scoliosis with convexity opposite to the short limb side. Subtype D: moderate to severe paralytic scoliosis, which has a convexity to the short limb side in type I and opposite to the short limb side in type II. In the pelvis of type I-A, I-B and I-C deformities, abduction contracture of the hip was released on the side of affected short limb, and lumbodorsal fasciotomy was performed on the contralateral side of short limb, where iliolumbar angle converged and the pelvis was elevated, if necessary. In most cases, hip instability existed on the side of short limb and it was treated with triple innominate osteotomy, which also contributed to leg length equalization by lengthening. In type II-A, II-B and II-C deformities, it was necessary to perform a triple innominate osteotomy on the side of affected short limb with adducted unstable hip in most cases. Lumbodorsal fasciotomy was performed above the iliac crest of elevated hemi-pelvis with short limb, where iliolumbar angle converged. In case of abduction contracture of contralateral hip, contracted fascia was released. In the pelvis that had a type I-D or type II-D deformities, treatment might include bony surgeries such as spinal fusion or triple innominate osteotomy, with appropriate soft tissue release. We propose a systemic and comprehensive classification for fixed pelvic obliquity after poliomyelitis. According to this classification, we and decide to combine corrective surgeries, and find the side where the surgery should be performed.
Classification ; Congenital Abnormalities ; Contracture ; Extremities ; Fascia ; Hip ; Humans ; Leg ; Osteotomy ; Pelvis ; Poliomyelitis ; Scoliosis ; Spinal Fusion ; Spine

Percutaneous transhepatic biliary drainage has played a major role in treatment of patients with bilairy tractdisease, especially obstruction by malignant disease. Percutaneous transhepatic biliary drainage was performed 128 times in 107 patients of obstructive jaundice for recent 2 years and 8 months from July, 1981 to March, 1984 at departement of radiology, Seol National University Hospital. The resuls were as follows; 1. The male to femaleratio was 2:1 and the age ranged from 19 to 88 with average of 54. 2. The causes of obstructive jaundice included 94 malignant diseases and 13 benign diseases. Malignant diseases were 48 cases of bile duct cancer, 20 cases of metastasis, 20 cases of pancreatic cancer, 4 cases of gallbladder cancer, 1 case of ampulla Vater cancer, and 1case of duodenal cancer. Benign diseases were 8 cases of comon bile duct stone and 3 cases of benign stricture and2 cases of cholangitis. 3. The most common indication was palliative drainage of obstruction secondary to malignant tumor in 78 cases. 4. The overall success rate was 93.7%. Internal drainage was acheved in 34 (26.5%)and external drainage was accomplished 86(67.2%). 5. Decline in serum bilirubin level was found in 100cases(5.6%). Percutaneous transheatpic biliary drainage is a proven technique for non-operative biliarydecompression and established alternative to surgery.
Bile Duct Neoplasms ; Bile Ducts ; Bilirubin ; Cholangitis ; Constriction, Pathologic ; Drainage ; Duodenal Neoplasms ; Gallbladder Neoplasms ; Humans ; Jaundice, Obstructive ; Male ; Neoplasm Metastasis ; Pancreatic Neoplasms