OBJECTIVE: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous pelvic operation. METHODS: A retrospective study of the records of Hallym University Hospistal patients who underwent vaginal hysterectomy performed by the senior author. Between January 1990 and January 1997, 212 patients who had previous pelvic operation were studied with special reference to operative difficulties, previous operation type, intraoperative complications, surgical time, hospital stay. RESULTS: 1. Patients characteristics was that ; The average age was 44.5+/-6.6 years old, the average parity was 2.3 , the average stay of hospitalization was 7.5+/-0.89 days, the frequency of Morcellation was in 24.5%, the average surgical time including associated procedure was 82+/-16.2 minutes, the average uterine weight was 164+/-85.1gm. 2. The most common previous pelvic operation was cesarean section(95 cases). 3. The most common indication was uterine myoma(51.9%). 4. Surgical technique used to gain access to the pouch of Douglas was done anteriorly; 52 patients of previous cesarean section(24.5%) and 112 patients of others operation(52.8%) were easily opened by blunt dissection, 43 patients of previous cesarean section(20.3%) and 5 patients of others operation(2.4%) were required sharp dissection. posterioly ; 190 patients(89.6%) were easily opened by blunt dissection, 22 patients(10.4%) were required sharp dissection. 5. Significant complications were bladder injury(1 case) , postoperative transfusion due to bleeding(6 cases). No cases of postoperative laparotomy was done and other minor compications were fever(15 cases), bladder retention(11 cases), others. CONCLUSIONS: It was possible to perform vaginal hysterectomy safely in patients with previous pelvic operation. Vaginal hysterectomy remains the method of choice for removal of the uterus of the previous pelvic operations in the absence of other contraindications.
Cesarean Section ; Female ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Intraoperative Complications ; Laparotomy ; Length of Stay ; Operative Time ; Parity ; Pregnancy ; Retrospective Studies ; Urinary Bladder ; Uterus

Congenital epulis of the newborn refers to a very rare gingival tumor that occurs along the anterior alveolar ridge in newborn infants. We report a neonate with 3*2*1.5cm mass protruding from the mouth. This was a pinky, red solid pedunculated mass, attached to the maxillar left canine region of the alveolus at birth. The tumor's large size partially obliterated the oral cavity and caused oral feeding difficulty but did not cause respiratory problems. We described the postnatal MR imaging findings, electromicroscopic, histochemical and immunohistochemical studies of this tumor in order to search for the histogenesis of the tumor. In our case, histochemically, individual tumor cells contained numerous PAS positive cytoplasmic granules. Immunohistochemically, strong and diffuse cytoplasmic staining for vimentin and NSE was observed. Staining with S-100 protein, cytokeratin, desmin, CEA, factor VIII-related antigen, lysozyme, EMA were negative. After total excision of the lesion in our case, we had no complication or recurrence either early or late(up to one year).
Alveolar Process ; Cytoplasm ; Cytoplasmic Granules ; Desmin ; Gingival Neoplasms* ; Humans ; Infant, Newborn* ; Keratins ; Magnetic Resonance Imaging ; Mouth ; Muramidase ; Parturition ; Recurrence ; S100 Proteins ; Vimentin ; von Willebrand Factor

The purpose of this study was to analyze the stress distribution aspect of unrestored and restored combined shape (wedge shape occlusally and saucer shape gingivally) class V cavity, which found frequently in clinical cases. A maxillary second premolar restored with a combined shape class V composite restorations were modeled using the three dimensional finite element method. Static occlusal load of 170 N was applied on lingual incline of buccal cusp at the angle of 45degrees with the longitudinal axis of the tooth. And three dimensional finite element analysis was taken by ANSYS (Version 6.0, Swanson Analysis System Co., Houston, U.S.A) program which represent the stress distribution on unrestored and restored cavity wall and margin. The conclusions were as follows. 1. Compared to the unrestored cavity, Von Mises stress at the cementoenamel junction and line angle of the cavity base were reduced and in restored cavity. 2. Von Mises stress at the occlusal and cervical cavity margin and wall were increased in restored cavity in comparison with the unrestored cavity. 3. In the hybrid and hybrid/flowable composite resin restoration, Von Mises stress at the cementoenamel junction and line angle of the cavity base were reduced more than in the flowable restoration. 4. In the hybrid and hybrid/flowable composite resin restoration, Von Mises stress at the occlusal and cervical cavity margin and wall were increased more than in the flowable restoration.
Axis, Cervical Vertebra ; Bicuspid ; Finite Element Analysis ; Tooth ; Tooth Cervix

PURPOSE: A crucial event in the acute regulation of steroidogenesis by tropic hormone is the delivery of cholesterol from cytosol into the mitochondrial inner membrane where it is converted to pregnenolone by the cytochrome P45O cholesterol side chain cleavage enzyme. Recently, it has been observed that the acute production of steroid hormone depends on a rapidly synthesized, cycloheximide sensitive and highly labile protein that appeared in response to tropic hormone. This protein was named as Steroidogenic Acute Regulatory(StAR) protein. The purpose of this experiment was to detect the StAR protein in human testicular tissue. MATERIALS AND METHODS: Human testicular tissues were obtained during the surgery in patients with cryptorchidism, infertility, and prostate cancer Northern blotting hyridization and RT-PCR were performed to detect the StAR mRNA in human testicular tissues. In addition, immunohistochemical staining was performed to test the presence of the StAR protein in human testicular tissues. RESULTS: The StAR mRNA was detected as a weak band in prostate cancer and infertility patients, but not detected in cryptorchidism patients by Northern blotting hybridization. In RT-PCR of human testicular tissues for StAR mRNA, RT-PCR products(about 2000p) were shown to have in cryptorchidism, infertility, and prostate cancer patients. In immunohistochemical staining of human StAR protein, immunoreactivity of human StAR protein was positive in the interstitial tissues of human testis. CONCLUSIONS: The StAR protein that plays a key role in the steroidogenesis was detected in human testicular tissues and this protein will be effective in pathogenesis and treatment of the diseases that are associated with steroid hormones.
Blotting, Northern ; Cholesterol ; Cholesterol Side-Chain Cleavage Enzyme ; Cryptorchidism ; Cycloheximide ; Cytochromes ; Cytosol ; Humans* ; Infertility ; Male ; Membranes ; Pregnenolone ; Prostatic Neoplasms ; RNA, Messenger ; Testis

OBJECTIVES: The aim of this study was to estimate musculo-skeletal symtoms of municipal sanitation workers and to evaluate working conditions of municipal sanitation workers to search for the factors related to musculo-skeletal symptoms. METHODS: We conducted a descriptive cross-sectional survey. The study subjects were comprised of 543 municipal sanitation workers in some divisions of Seoul and the Gyeonggi province. Musculo-skeletal analysis was done by using the modified criteria of NIOSH musuclo-skeletal symptoms, RULA and, REBA. Statistical analysis was done by using the chi-square test, multiple logistic regression analysis. RESULTS: 72.2% of the subjects complained musculo-skeletal symptoms (39.6% on the upperlimbs, 30.0% on the lumbar region, 27.4% on the legs). For the musculo-skeletal symptoms criteria (1~3), street cleaners complained of more musculo-skeletal symptoms than the solid waste collectors, after classifying the jobs of sanitation workers. On logistic regression analysis of the musculo-skeletal "symptoms criteria1" positive groups, age was related to the criteria positive (prevalence odds ratio=1.018, 95% CI: 0.993-1.046). The worktime was significantly related to 'criteria positive 1 and, 2' (prevalence odds ratio=2.165 (95% CI: 1.156-4.131), 2.187 times (95% CI: 1.071-4.651)). The RULA score, the subtotal A score of RULA, the REBA score and , the total A REBA score of the upperlimbs of solid waste collectors were higher than those of the street cleaners. CONCLUSIONS: In spite of the lower ergonomic evaluation score of the street cleaner, the street cleaners complained of more musculo-skeletal symptoms than did the solid waste collectors due to more frequent repetitive motions, a longer work time (over 10 hours) etc. It is suggested that the sanitation workers need to use the proper methods to avoid musculo-skeletal disease.
Cross-Sectional Studies ; Human Engineering ; Humans ; Logistic Models ; Lumbosacral Region ; National Institute for Occupational Safety and Health (U.S.) ; Sanitation ; Solid Waste ; Task Performance and Analysis ; Upper Extremity

Catel Manzke syndrome is characterized by hyperphalangy of the index fingers associated with Robin malformation sequence. The etiology of Catel Manzke syndrome is still uncertain, with the majority of cases being sporadic. Careful observation to recognize upper airway obstruction secondary to the Robin sequence should be made a part of routine care for newborns with this disorder. Failure to thrive is related to respiratory or cardiac problems. The vast majority of case have normal intelligence. With advancing age, the accessory bone fuses to the proximal phalangeal epiphysis. We report a neonate with the Pierre Robin triad, accessory bone between the second metacarpal and its proximal phalanx of the Rt hand, camptodactyly, coarctation of aorta and hydronephrosis of Lt kidney.
Airway Obstruction ; Aortic Coarctation ; Epiphyses ; Failure to Thrive ; Fingers ; Hand ; Humans ; Hydronephrosis ; Infant, Newborn ; Intelligence ; Kidney ; Pierre Robin Syndrome ; Songbirds

BACKGROUND: Despite the necessity of job retention in achieving return-to-work (RTW) goals, many workers leave their jobs after returning to work. The objective of this study was to examine the impacts of RTW type and period on job retention in Korean workers with occupational injuries and diseases. METHODS: Data were derived from the Panel Study of Worker's Compensation Insurance, including data from 2,000 systemically sampled workers who had finished recuperation in 2012; three waves of survey data were included in the analyses. Workers who returned to work (n = 1,610) were included in the analysis of the relationship between RTW type and job retention, and 664 workers who returned to their original workplaces were included in the analysis of the relationship between RTW period and job retention. The participants completed a questionnaire, and administrative data were provided by workers' compensation insurance. RESULTS: A Cox proportional-hazards regression analysis showed an increased hazard ratio (HR) for non-retention of 2.66 (95% confidence interval, 2.11–3.35) in reemployed workers compared to that in workers returning to their original workplaces. Among workers returning to their original workplaces, HRs for non-retention were increased in workers with a RTW period of 13–24 months (3.03 [1.52–6.04]) and > 24 months (5.33 [2.14–13.25]) compared to workers with a RTW period of ≤ 3 months. CONCLUSION: RTW type and period were significantly related to job retention, suggesting that policies for promoting job retention rate should be implemented.
Insurance ; Occupational Diseases ; Occupational Health ; Occupational Injuries ; Return to Work ; Workers' Compensation

PURPOSE: To evaluate the clinical usefulness of the MR urography (MRU) in the diagnosis of hydroureteronephrosis. MATERIALS AND METHODS: Twenty-five patients with hydronephrosis (26 cases) underwent MR urography, using a 1.5T MR scanner (Signa Horizon, GE Medical Systems, Milwaukee, U.S.A). The causes of hydronephrosis included benign ureteral stricture (12), ureteral stones (8) and malignant strictures (6), and were confirmed by operation, biopsy, conventional urography or clinical follow up. For MRU, a fat suppressed, respiratory-triggered, heavily T2-weighted fast spin echo (FSE) pulse sequence was used, and the 3-dimensional MR images were subsequently processed by a maximum-intensity-projection algorithm. We evaluated the success rate of MRU and its accuracy in determining the level and cause of obstruction, and compared the degree of hydroureteronephrosis seen on MRU with that seen on conventional urography. RESULTS: In all cases, a urogram was successfully obtained. In determining the degree of hydroureteronephrosis and the level of obstruction (in the upper ureter in 11 cases, in the mid-ureter in four, and in the lower ureter in 11), MRU findings matched those of conventional urography. In 24/26 cases (92%), MRU accurately determined the cause of urinary tract obstruction ; the two exceptions were in cases involving ureteral stones. CONCLUSION: MRU is a promising, noninvasive diagnostic method for evaluating hydroureteronephrosis, especially in children, pregnant women and patients with an allergic reaction to iodinated contrast material.
Biopsy ; Child ; Constriction, Pathologic ; Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Hypersensitivity ; Pregnant Women ; Ureter ; Urinary Tract ; Urography*

PURPOSE: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. MATERIALS AND METHODS: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. RESULTS: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average 8.2+/-0.9 (range, 7~10) to 2.7+/-1.7 (range, 0~6) and the AOFAS score improved from 46.4+/-14.6 points (range, 23~69) to 80.1+/-9.3 points (range, 65~95) at final follow-up. Anterior draw test improved 15.2+/-3.4 mm (range, 12~23 mm) to 8.8+/-2.6 mm (range, 6~13mm),varus stress test improved from 13.9+/-4.6degrees (range,10-18degrees) to 6.2+/-4.7degrees (range,2-18degrees) at final follow up. CONCLUSION: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.
Animals ; Ankle ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Exercise Test ; Follow-Up Studies ; Foot ; Humans ; Ligaments ; Orthopedics ; Prostheses and Implants

PURPOSE: To compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis, which was not treated conservatively. MATERIALS AND METHODS: Between January 2008 and October 2009, We divided to two groups, endoscopy (group A) 11 cases, open bursectomy (group B) 11 cases. The average follow up period was 15 months (range, 12 to 18), the mean age was 66 (range, 38 to 79). We compared patients satisfaction, complete healing time, operation time, complications and recurrence. RESULTS: Group A had significant difference in terms of the clinical satisfactions, complete healing time. operation time, complications. Group A showed satisfaction (excellent 9, good 2), mean complete healing time 11.9 (8~14) days, operation time 37 (25~45) minutes, 1 case recur. Group B showed satisfaction (excellent 4, good 3, fair 1, poor 3), complete healing time 32.7 (14~98) days, operation time 22 (18~26) minutes. complication were one case of skin necrosis, one case of wound dehiscence, two cases of superficial peroneal nerve injury, no recurrence. Significant advantages of endoscopic method include lower morbidity and rapid wound healing period (p<0.05). CONCLUSION: Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favourable results compared to the open resection. Significant advantages of this method include lower morbidiy and rapid wound healing.
Animals ; Ankle ; Bursitis ; Endoscopy ; Follow-Up Studies ; Humans ; Necrosis ; Peroneal Nerve ; Recurrence ; Skin ; Wound Healing