A 59-year-old male farmer, an alcohol addict, has experienced repeated bullous skin lesions on the erythematous base over the exposed areas of tbe skin, especially on the face and hands, after sun-light exposure. The face showed hyperpigmenation, hypertrichosis and sclerodermoid changes. And also there were hypopigmented scars on the dorsum of the hands and cIaw-1ike fingers. Characteristic laboratory findings were as follows: Urine appeared portwine color and fluoresced under the Woods Iight. A 24-hour urine collection contamed 4l32ug of uroporphyrin and 3815ug of corproporphyrin. BSP retention(7% in 45 Min.) was increased, and A/G ratio(0. 8:1) was inverted. Gamma globulin(44, 9%) was markedly increased on serum electrophoresis. Roentgenograms revealed minimal tuberculosis on the chest P-A and superficial gastritis on the upper G-I series. Electrocardiogram showed left ventricular hypertrophy. Pathological findings of the specimen obtained from sclerodermoid lesion of the forehead revealed hypermelanosis in the basal cell layer and amorphous, basophilic collagen degeneration in the upper dermis, on the other hand loss of sinusoids due to swelling of hepatocytes and chomic inflammatory cell infiltrate in the interlobular septa were noticed on the specimen taken from the liver. For treatment, phlebotomy and metabolic alkalinization were trjed.
Basophils ; Cicatrix ; Collagen ; Dermis ; Electrocardiography ; Electrophoresis ; Fingers ; Forehead ; Gastritis ; Hand ; Hepatocytes ; Humans ; Hyperpigmentation ; Hypertrichosis ; Hypertrophy, Left Ventricular ; Liver ; Male ; Middle Aged ; Phlebotomy ; Skin ; Thorax ; Tuberculosis ; Urine Specimen Collection ; Wood

No abstract available.
Thorax* ; Tomography, X-Ray Computed*

Purpose: To analyze the causes and to prevent dislocations of the hip joint that occur in patients who underwent revisions of total hip arthroplasties by changing only the polyethylene liners and femoral heads, subsequent to primary total hip arthroplasties. Materials and Methods: We evaluated 28 patients who underwent acetabular component revisions of total hip arthroplasties subsequent to primary total hip arthroplasties. The average age of the patients was 55 years old and all 28 patients had operations through the posterolateral approach. In 17 of the cases, the acetabular cups, polyethylene liners, and femoral heads were changed; in 10 cases, just the polyethylene liners and femoral heads were changed; and in 1 case, only the polyethylene liner was changed. Results: We observed 7 cases of hip dislocations that occurred among a total of 28 cases after revisions of total hip arthroplasties. In all 7 cases, the polyethylene liners and femoral heads were changed, but not the acetabular cups. In additional, in all 7 cases of dislocation, the patients were non-compliant and started weight-bearing prematurely after revisions of the total hip arthroplasties Conclusion: We observed new dislocations in the 7 cases in which the polyethylene liners and femoral heads were changed. The main reasons were inadequate soft tissue tension and hip joint laxity. Therefore, it is necessary to increase the neck length, use elevated rim polyethylene liners, readjust the acetabular cups to their optimal positions, and apply hip abduction braces to patients early after revision of total hip arthroplasties in order to lessen the danger of dislocations.
Acetabulum* ; Arthroplasty ; Braces ; Dislocations* ; Head ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Neck ; Polyethylene ; Risk Factors* ; Weight-Bearing

The surgical construction of vagina could certainlty be done by skin grafting or flaps, but it involves hospitalization, discomfort,scarring of donor area and vaginal tract, hygiene problem. The tissues of the vagina are soft and distensible and it is reasonable to assume that these same tissues could be stretched, elongated or dilated with gradual external pressure. So, we performed the expansion of vaginal lining by self designed set of graduated dilators. The patients was a 27-years-old female whose chief complaint is amenorrhea and incapability to engage in sexual intercourse. On physical examination, this patients had a feminine figure with a normal vulva but only a vaginal dimple was observed. The patient was educated to carry out the mechanical dilation of this dimply by pressure 15 minutes twice a day. In the evening, with insertion of a dilator, the patient was asked to sit on a bicycle chair for 10 minutes. After 8 weeks, the overall outcome of vaginoplasty was successful. The vaginal tract was 8 cm in length and the largest vaginal speculum could be passed into vagina. The patient was able to engage in sexual intercourse without lubrication. The progressive dilatation of vaginal lining is non-invasive and probably the simplest way to treat the patients with congential vaginal atresia. So we recommend this method as the first treatment strategy before surgery.
Amenorrhea ; Coitus ; Dilatation* ; Female ; Hospitalization ; Humans ; Hygiene ; Lubrication ; Physical Examination ; Skin Transplantation ; Surgical Instruments ; Tissue Donors ; Vagina ; Vulva

No abstract available.
Arteriovenous Fistula* ; Biopsy*

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

PURPOSE: Retrieved sperm or testicular tissues are sometimes cryopreserved at the time of a vasovasostomy or vasoepididymostomy. It is possible to use cryopreserved sperm with intracytoplasmic sperm injection(ICSI) in the case of failure of pregnancy or surgical correction. The need for sperm cryopreservation at the time of a vasovasostomy or vasoepididymostomy was evaluated. MATERIALS AND METHODS: A total of 61 patients underwent a vasovasostomy and 42 underwent a vasoepididymostomy, performed by one urologist(J.T.S), between May 1994 and April 1999. Follow up data were available for 42 and 32 cases of vasovasostomy and vasoepididymostomy, respectively. Sperm cryopreservation was carried out at the time of the vasovasostomy in 6 cases(6/42) and the vasoepididymostomy in 18(18/32). RESULTS: The overall patency rates were 92.9(39/42) and 37.5%(12/32) for the vasovasostomy and vasoepididymostomy, respectively. The pregnancy rates in the case of successful surgical correction were 56.4%(22/39) and 41.6%(5/12) for the vasovasostomy vasoepididymostomy, respectively. Only in 8 cases(8/18) were the cryopreservated sperm used after a failed vasoepididymostomy. CONCLUSIONS: A vasovasostomy exhibited a higher patency and pregnancy rates than a vasoepididymostomy. Routine sperm cryopreservation in men undergoing vasovasostomy is not recommended. Sperm cryopreservation during an operation is recommended for surgical and pregnancy failures, in men undergoing vasoepididymostomy. Intraoperative sperm cryopreservation in men undergoing vasoepididymostomy will maximize the postoperative fertility options.
Cryopreservation* ; Fertility ; Follow-Up Studies ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Spermatozoa* ; Vasovasostomy*

No abstract available.
Cesarean Section* ; Female ; Pregnancy

The transesophageal echocardiography (TEE) has been used for the assessment of right and left ventricular function, valvular structure and function, regional wall motion abnormalities and localization of intravascular catheters, cannular and prosthesis. We inserted the pulmonary artery catheter (PAC) under the guidance of intraoperative TEE because of the difficulty of placing PAC with the pressure tracing method in two patients. The PAC was inserted from right atrium to right ventricle with the basal four chamber view and advanced to pulmonary artery through pulmonary valve with the longitudinal view of TEE. We observed typical pulmonary arterial wave form to confirm the correct position. We suggest that the TEE can be used for successful placement of a PAC to facilitate manipulation of the catheter as an alternative method in the patients whose PAC can not be positioned with the pressure tracing method.
Catheters* ; Echocardiography, Transesophageal* ; Heart Atria ; Heart Ventricles ; Humans ; Prostheses and Implants ; Pulmonary Artery* ; Pulmonary Valve ; Ventricular Function, Left

No abstract available.
Hernia*