PURPOSE: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. MATERIALS AND METHODS: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. RESULTS: Postoperative UCLA scores improved from16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. CONCLUSION: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.
California ; Follow-Up Studies ; Humans ; Los Angeles ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Rotator Cuff ; Shoulder ; Sutures ; Tendons

The purpose of this study is to evaluate the effects of occlusive wet dressing by using hydrophilic polyurethane foam (Medifoam ) in the management of donor sites of split thickness skin graft. The outer layer of Medifoam is made of a polyurethane film, which is impermeable to water and microorganisms. It provides moist wound environment and effective bacterial barrier. The middle layer is polyurethane foam, the absorption layer. Its swelling ratio is 1020% and the layer contains wound promoters (Glycosamnioglycan, etc.). The inner layer is polyurethane film, which has micro pores whose size is below 20mum. It prevents epithelial ingrowth into the pore. We performed half side test to compare Medifoam to AHD (the hydrocellular dressing materials). We divided STSG donor site into AHD dressing site and Medifoam dressing site in random fashion. This study was performed in Seoul National University Hospital from April 2001 till August 2001 with 32 patients, who needed to skin graft. We investigated about pain, comfort, easiness of handling, and time for complete healing. The Medifoam dressed site had less pain, more comfortable, easier handling and more rapid wound healing. The average healing time of Medifoam is 9.4 +/- 1.9 days and AHD is 12.6 +/- 1.9 days(p< 0.001). So we concluded that the occlusive dressing with Medifoam is an effective dressing method in split thickness skin graft donor site. And we expect that it is also effective dressing material in many other wounds.
Absorption ; Bandages* ; Humans ; Occlusive Dressings ; Polyurethanes* ; Seoul ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing ; Wounds and Injuries

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.
California ; Follow-Up Studies ; Humans ; Los Angeles ; Magnetic Resonance Imaging ; Rotator Cuff ; Shoulder ; Sutures ; Tendons

OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Hemoglobins ; Hemorrhage ; Humans ; Korea ; Medical Records ; Placenta ; Placentation ; Postpartum Hemorrhage ; Postpartum Period

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel therapeutic strategy. This procedure stands on the cutting edge of minimal invasive abdominal surgery that accesses the abdominal organ through natural orifices such as mouth, anus and vagina with performing gastrointestinal endoscopy. There are many animal experiments and clinical trials of NOTES along with the development of better instruments. We report here on 4 cases of transgastric endoscopic cholecystectomy in canine and porcine models, and these procedures were done through natural orifices with performing conventional endoscopy and using endoscopic devices and laparoscopic trocars.
Anal Canal ; Animal Experimentation ; Cholecystectomy ; Endoscopy ; Endoscopy, Gastrointestinal ; Mouth ; Natural Orifice Endoscopic Surgery ; Surgical Instruments ; Vagina

OBJECTIVE: To study intrauterine or extrauterine misplacement of intrauterine devices in respect to their usage in diagnosis and therapy via retrospective analysis. METHODS: Data from 1993 to 2000 on a total of 32 patients from seven Catholic University branch hospitals who had been admitted to treat IUDs which had misplaced to intrauterine or extrauterine locations were analyzed for usage in a retrospective study. RESULTS: The data for intrauterine and extrauterine misplacement revealed no significant difference between from the statistical average in relation to age, parity and duration of insertion. In terms of removal method, all 15 patients with extrauterine misplacement underwent surgical extraction by open or laparascopic method under general anesthesia, but those patients with intrauterine misplacement had their device removed after cervical dilatation with a laminaria using local anesthesia. Concerning diagnosis, 81.2% of extrauterine misplacement were diagnosed using x-ray while 58% of intrauterine misplacement were diagnosed using vaginal US. The result of the Fisher's exact test showed a significant difference (p=0.043) in the rate of diagnosis for intrauterine and extrauterine misplacement of IUDs. Also, the results of multi-variable analysis performed for logistical regression analysis showed that intrauterine misplacement occurred 1.23 times more frequently than extrauterine misplacement. CONCLUSION: Further studies are required on a broader patient population, on more types of IUDs and with time variables taken into account. Despite more research, prevention of complications such as misplacement remains the most appealing situation, being influenced by such factors as technical skill of the physician inserting the IUD, appropriate duration of insertion and proper patient education.
Anesthesia, General ; Anesthesia, Local ; Diagnosis ; Female ; Hospitals, Satellite ; Humans ; Intrauterine Devices ; Labor Stage, First ; Laminaria ; Parity ; Patient Education as Topic ; Pregnancy ; Retrospective Studies

Miller-Dieker Syndrome (MDS) is a contiguous gene deletion syndrome of chromosome 17p13.3, characterized by classical lissencephaly (lissencephaly type 1) and distinct facial features. Children with MDS present with severe developmental delay, epilepsy and feeding problems. The lissencephaly represents the severe end of the spectrum with generalized agyria, or agyria and some frontal pachy- gyria. Prenatal diagnosis is available and consists of fetal chromosomal analysis by karyotyping or fluorescence in situ hybridization (FISH), on chorion villus sampling or amniocentesis. Sonographic diagnosis in general cannot be accomplished earlier than late second trimester, when the characteristic cerebral anomalies can be noted. The progressive microcephaly and failure of development of both sulci and gyri are suggestive of lissencephaly. We report the case of a pregnant woman of 24 weeks gestation who presented with ventriculomegaly on antenatal sonography and hydrocephalus, and corpus callosum agenesis on fetal MRI, which was diagnosed as MDS by karyotyping and FISH on amniocentesis.
Agenesis of Corpus Callosum ; Amniocentesis ; Child ; Chorion ; Classical Lissencephalies and Subcortical Band Heterotopias* ; Diagnosis ; Epilepsy ; Female ; Fluorescence ; Gene Deletion ; Humans ; Hydrocephalus ; In Situ Hybridization ; Karyotyping ; Lissencephaly ; Magnetic Resonance Imaging ; Microcephaly ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Prenatal Diagnosis ; Ultrasonography

OBJECTIVE: The aim of our study was to assess whether isolated oligohydramnios is associated with adverse perinatal outcomes in low-risk term pregnancy. METHODS: Women delivered between March 2001 and July 2003, who underwent ultrasonography from 37 to 41(+6) weeks gestation were analyzed. Women undergoing labor induction for oligohydramnios were matched by gestational age and parity to women with normal amniotic fluid index measurements. Oligohydramnios was defined as an amniotic fluid index (AFI) 5.0 cm with respect to maternal age, parity, nulliparity, gestational age at delivery. The study (N=21) and control groups (N=100) had similar the primary outcome (rate of total cesarean delivery and rate of cesarean delivery for fetal distress) as well as the secondary outcome variables such as birthweight, Apgar score<7 at 5-min, meconium stained amniotic fluid, and NICU admission >8 day. There were no differences between pregnancies with 5th percentile of AFI with respect to maternal age, parity, nulliparity, and the secondary outcome variables such as birthweight, Apgar score<7 at 5-min, meconium stained amniotic fluid, and NICU admission >8 day. However, pregnancies with 5th percentile of AFI. Rate of cesarean delivery for fetal distress was not significantly different in the two groups. CONCLUSION: We demonstrated that oligohydramnios in low-risk term pregnancy does not affect the increased perinatal morbidity and mortality. Therefore, isolated oligohydramnios may not be a marker for fetal compromise in low-risk term pregnancy, and induction of labor may not be warranted in most cases.
Amniotic Fluid ; Apgar Score ; Birth Weight ; Female ; Fetal Distress ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Maternal Age ; Meconium ; Mortality ; Oligohydramnios* ; Outcome Assessment (Health Care) ; Parity ; Pregnancy ; Pregnancy* ; Pregnant Women ; Ultrasonography

Dowling-Degos disease (DDD) is an autosomal dominant genodermatosis and this disease is a genetically determined disturbance of epidermal proliferation. It is characterized by acquired, slowly progressive pigmented lesions that primarily involve the great skin folds and flexural areas such as the axilla, neck, limb flexures, the inframammary area and the inguinal folds. The vulva is an unusual location for DDD. A 41-year-old woman presented with a 10-year history of multiple, small, reticulated and brownish macules distributed symmetrically on the bilateral external genital regions. We found no other similarly pigmented skin lesions on her body, including the flexural areas. There was no known family history of similar eruptions or pigmentary changes. The histologic examination showed irregular rete ridge elongation with a filiform or antler-like pattern and basilar hyperpigmentation on the tips. Fontana-Masson staining showed increased pigmentation of the rete ridges and the S100 protein staining did not reveal an increased number of melanocytes in the epidermis. From these findings, we diagnosed this lesion as DDD.
Adult ; Axilla ; Dichlorodiphenyldichloroethane ; Epidermis ; Extremities ; Female ; Humans ; Hyperpigmentation ; Melanocytes ; Neck ; Pigmentation ; Skin ; Skin Diseases, Genetic ; Skin Diseases, Papulosquamous ; Vulva

PURPOSE: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures METHODS: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. RESULTS: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. CONCLUSION: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.
Burns ; Cicatrix ; Contracture ; Forearm ; Free Tissue Flaps ; Humans ; Lower Extremity ; Necrosis ; Skin ; Tendons ; Transplants ; Wrist