OBJECTIVE: Fourteen cases of vaginal vault evisceration after total laparoscopic hysterectomy were presented. We review pertinent literature, discuss precipitating causes, clinical manifestations, and management that was performed. METHODS: We reviewed medical records of 14 women with vaginal vault evisceration after total laparoscopic hysterectectom between March 2000 and October 2012 at 4 hospitals of CHA University. RESULTS: Between March 2000 and March 2006, 1,887 women underwent total laparoscopic hysterectomy and 12 vaginal vault eviscerations (0.6%) were presented. Thereafter, only two new cases were presented. The precipitating event was coitus in nine cases (64%), sit-ups in two cases (14%), spontaneous (urine ascites), lymphatic ascites, and unknown in one case (7%) each. Prolapsed organs were small bowels, omentum, and salpinx. Common presenting symptoms were pain, bleeding, watery discharge, and protruded mass (bowels). Eleven women underwent transvaginal repair (79%) - two laparotomic (14%) and one laparoscopic (7%), and none have exhibited sequelae. CONCLUSION: Coitus was the triggering event in most cases. For vaginal vault evisceration following total laparoscopic hysterectomy, vaginal repair should be first considered.
Ascites ; Coitus ; Fallopian Tubes ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Medical Records ; Omentum

Failure to thrive (FTT) is a term generally used to describe an infant or child whose current weight or rate of weight gains is significantly below that expected of similar children of the same age, sex and ethnicity. It usually describes infants in whom linear growth and head circumference are either not affected, or are affected to a lesser degree than weight. FTT is a common problem, usually recognized within the first 1-2 years of life, but may present at any time in childhood. Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues. The most important part of the outpatient evaluation is obtaining an accurate account of a child's eating habits and caloric intake. Routine laboratory testing rarely identifies a cause and is not generally recommended. FTT, its evaluation, and its therapeutic interventions are best approached by a multi-disciplinary team includes a nutritionist, a physical therapist, a psychologist and a gastroenterologist. Long term sequelae involving all areas of growth, behavior and development may be seen in children suffering from FTT. Early detection and early intervention by a multi-disciplinary team will minimize its long term disadvantage. Appropriate nutritional counseling and anticipatory guidance at each well child visit may help prevent some cause of FTT.
Child ; Counseling ; Early Intervention (Education) ; Eating ; Energy Intake ; Failure to Thrive ; Head ; Humans ; Infant ; Outpatients ; Physical Therapists ; Stress, Psychological ; Weight Gain

Coexisting voiding and bowel dysfunction in children are common in the clinic. The idea that overactive bladder (OAB) and constipation arise from one single pathophysiology has been reinforced in many studies. In Korea, a nationwide multicenter study conducted in 2009 showed that overall prevalence of OAB in children, 5-13 years of age, was 16.59% and this number has increased more recently. The initial step to manage coexisting fecal retention and OAB in children is to characterize their bowel and bladder habits and to treat constipation if present. Although diagnosing constipation in children is difficult, careful history-taking using the Bristol Stool Form Scale, and a scoring system of plain abdominal radiography, can help to estimate fecal retention more easily and promptly. Non-pharmacological approaches to manage functional constipation include increasing fluids, fiber intake, and physical activity. Several osmotic laxatives are also effective in improving OAB symptoms and fecal retention. Additionally, correction and education in relation to toilet training is the most important measure in treating OAB with fecal retention.
Child* ; Constipation ; Education ; Humans ; Korea ; Laxatives ; Motor Activity ; Prevalence ; Radiography, Abdominal ; Toilet Training ; Urinary Bladder ; Urinary Bladder, Overactive*

Coexisting voiding and bowel dysfunction in children are common in the clinic. The idea that overactive bladder (OAB) and constipation arise from one single pathophysiology has been reinforced in many studies. In Korea, a nationwide multicenter study conducted in 2009 showed that overall prevalence of OAB in children, 5-13 years of age, was 16.59% and this number has increased more recently. The initial step to manage coexisting fecal retention and OAB in children is to characterize their bowel and bladder habits and to treat constipation if present. Although diagnosing constipation in children is difficult, careful history-taking using the Bristol Stool Form Scale, and a scoring system of plain abdominal radiography, can help to estimate fecal retention more easily and promptly. Non-pharmacological approaches to manage functional constipation include increasing fluids, fiber intake, and physical activity. Several osmotic laxatives are also effective in improving OAB symptoms and fecal retention. Additionally, correction and education in relation to toilet training is the most important measure in treating OAB with fecal retention.
Child* ; Constipation ; Education ; Humans ; Korea ; Laxatives ; Motor Activity ; Prevalence ; Radiography, Abdominal ; Toilet Training ; Urinary Bladder ; Urinary Bladder, Overactive*

Purpose: To evaluate the relationship between the position and direction of a silicone tube in the nasal cavity after silicone tube intubation and clinical features. Methods: This study included 70 eyes of 52 patients who were diagnosed with nasolacrimal duct obstruction and had silicone intubation surgery. The position and direction of the silicone tube were compared after tube intubation and before extubation. An intranasal swap culture was performed before tube intubation, and the removed silicone tubes were cultured. Results: The length of the silicone tube decreased from 8.7 ± 3.1 mm after intubation to 7.3 ± 3.1 mm before extubation, and the direction of the tube moved backward in the nasal cavity (p < 0.05). The bacterial culture rate changed from 94.3% before intubation to 75.7% before extubation. The most common Gram-positive bacteria (both preoperative and postoperative) was coagulase- negative Staphylococcus aureus. The most common Gram-negative bacteria were converted from Klebsiella aerogenes to Stenotrophomonas maltophilia. The fungal culture rate changed from 7.1% to 51.4%, and the culture rate increased when the silicone tube direction was moved backward (p < 0.05). The length and direction of the silicone tubes were not correlated with clinical symptoms or changes in eyelid height. Conclusions The length of the silicone tube in the nasal cavity decreased, and the tube tended to move in a posterior direction after silicone tube intubation. Considering the increase in the intra-nasal fungal culture rate, it is better to place the silicone tube in the anterior part of the nasal cavity from the inferior meatus. To clarify further the fungal infection and its clinical findings, a study of cultures with respect to location in the lacrimal system would be required.

Femoral arteriography has assumed in recent years a greater clinical and surgical significance, especiallysince the advent of arterial grafting for occlusive arterial disease. Evaluation of the site and extent ofocclusion, the state of distal arterial tree and degree of collateral circulation can best be obtained byserialographic studies. Authors analyzed 28 cases of clinically and radiologically diagnosed Buerger's disease inGURO hospital radiology, College of medicine, Korea university, during last 6 months from March to August, 1984.The results are as follows; 1. The age distribution were between 20 and 50 years old, and most commonly involvedage group was 20-29. 2. The most frequent finding was the obstruction of peripheral artery with or withougcollateral vessel and almost all patient had occlusion more than 1 segmental branch. 3. The most frequentlyinvolved arteries in Buerger's disease were trifurcation area below the knee joint, anterior and posterior tibialartery and peroneal artery. Peroneal artery was less commonly involved than anterior or posterior tibial artery.
Age Distribution ; Angiography ; Arteries ; Collateral Circulation ; Humans ; Knee Joint ; Korea ; Thromboangiitis Obliterans ; Tibial Arteries ; Transplants ; Trees

With its dynamic composition and function, the gut microbiome plays a key role in human development and long-term health. The first 2 years of life are crucial to the early establishment of the gut microbiome. During early life, the gut microbial composition rapidly changes and multiple factors influence the initial colonization, development, and function of the neonatal gut microbiome. In addition, alterations in early-life gut microbial composition linked to necrotizing enterocolitis in infancy, as well as some chronic diseases in later, including obesity, inflammatory bowel disease, cancer, allergies, asthma, and neurological diseases associated with the gut-brain axis. In this review, we focus on both maternal and infant factors known to influence early-life gut colonization.

With its dynamic composition and function, the gut microbiome plays a key role in human development and long-term health. The first 2 years of life are crucial to the early establishment of the gut microbiome. During early life, the gut microbial composition rapidly changes and multiple factors influence the initial colonization, development, and function of the neonatal gut microbiome. In addition, alterations in early-life gut microbial composition linked to necrotizing enterocolitis in infancy, as well as some chronic diseases in later, including obesity, inflammatory bowel disease, cancer, allergies, asthma, and neurological diseases associated with the gut-brain axis. In this review, we focus on both maternal and infant factors known to influence early-life gut colonization.

The influence of nutrition during early life on physical growth as well as mental development has been thoroughly discussed in the literature. The physical dimensions of the body are greatly influenced by nutrition, particularly during the period of rapid growth in early childhood. Nutritional status affects every pediatric patient's response toillness. Good nutrition is important for achieving normal growth and development. It is indicated that permanent impairment of the central nervous system may result from dietary restriction of imbalance during certain periods of life. If children under 3 years of age show a good nutritional status, it may be assumed that they are well nourished. Several common diseases of children such as iron deficiency, chronic constipation and atopic dermatitis are known food related diseases. Patients with chronic illness and those at risk of malnutrition should have detailed nutritional assessments done. Components of a complete nutritional assessment include a medical history, nutritional history including dietary intake, physical examination, anthropometrics (weight, length or stature, head circumference, midarm circumference, and triceps skinfold thickness), pubertal staging, skeletal maturity staging, and biochemical tests of nutritional status. The use of age, gender, and disease-specific growth charts is essential in assessing nutritional status and monitoring nutrition interventions. Nutrition assessment and dietary counseling is helpful for the cure of disease, and moreover, the prevention of illness.
Central Nervous System ; Child ; Chronic Disease ; Constipation ; Counseling ; Dermatitis, Atopic ; Growth and Development ; Growth Charts ; Head ; Humans ; Infant ; Iron ; Malnutrition ; Nutrition Assessment ; Nutritional Status ; Physical Examination

CT is a highly accurate method of detecting and clarifying the narure of space-occupying lesions within theliver nd pancreatic disease. It was found to be a reliable, non invasive method for detecting the lesion. A normalrange of attenuation values were obtained from 71 CT examinations of the upper abdomen, that is liver, spleen,pancreas, aorta, before and after contrast enhancement in whom no radiologic or laboratory abnormality of theseorgans were detected from March to Sept. 1983. The results were as follows; 1. The age distribution was from 28years to 71 years. The sex ratio was 45 male to 26 female. 2. Mean Hounsfield Units (HU) in liver before contrastenhancement and after contrast enhancement liminute, 3 minutes, 5 minutes, 10 minutes were 56.1±3.85, 75.0±4.77,82.0±3.71, 84.3±2.76 and 88.2±3.95 HU respectively. 3. Mean Hounsfield Units in pancreas before contrastenhancement and after contrast enhancement 1 minute, 3 minutes, 5 minutes, 10 minutes were 43.0±4.30, 66.5±4.27,71.2±2.39, 74.4±3.00 and 79.2±2.(0 HU respectively. 4. Mean Hounsfield Units in spleen before contrastenhancement and after contrast enhancement 1 minute, 3 minutes, 5 minutes 10 minutes were 53.0±4.31, 71.4±2.84,75.3±2.70, 80.5±3.04 and 83.2±2.14 HU respectively. 5. Mean Housfield Units in aorta before contrastenhancement and after contrast enhancement 1 minute, 3 minutes, 5 minutes 10 minutes were 45.1±5.39, 86.7±6.86,92.5±5.33, 106.8±4.12 and 114.1±5.02 HU respectively. 6. The most significant finding was that the livernormaly had the highest attenuation values of any of the organs measured. When another viscera in upper abdomenhad a attenuation value greater than that of the liver, this reflected abnormal lesions.
Abdomen ; Age Distribution ; Aorta ; Female ; Humans ; Liver ; Male ; Methods ; Pancreas ; Pancreatic Diseases ; Sex Ratio ; Spleen ; Viscera