OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study is to compare the efficacy of suturing methods of vaginal cuff between laparoscopic and vaginal approach. METHODS: One hundred and sixty one cases of laparoscopic hysterectomy were devided into two groups. In group A(n=67), vaginal cuff was sutured by laparoscopic suture technique and in group B(n=94), vaginal cuff was repaired by vaginal approach. RESULTS: There were no significant differences in uterine weight, hospital stay, pre-and postoperative hemoglobin level and complications including febrile morbidity in two groups. Operation time was significantly shorter in group B(p=0.05). CONCLUSION: Transvaginal repair of vaginal cuff showed shorter duration of operation time than laparoscopic suture technique in total laparoscopichy sterectomy.
Hysterectomy* ; Laparoscopy ; Length of Stay ; Suture Techniques

Complications after surgical treatment of trochanteric fracture such as varus deformity or delayed union are frequent and there are many difficulties to maintain the stability of fragments because of the cortical deficit or comminution on medial aspect of the neck and posterior trochanteric fragment. Evans, Dimon, Sarmiento and others suggested several methods of internal fixation, furthermore it is attempted recently to reduce the fragments anatomically with sliding compression hip screw and plate. 31 cases of interal fixation on trochanteric fracture were carried out from March, 1972 to February 1979 at the Orthopaedic Department of Seoul Adventist Hospital and their comparable results were as follows. 1. Acceptable placement of metals was noted 2 cases of 6 cases in Smith-Petersen nail with Thornton plate fixation, 2 cases out of 8 cases in Smith-Petersen nail with McLaughlin plate fixation and 9 cases out of 14 cases in sliding compression hip screw and plate fixation. 2. Complications after internal fixation such as varus deformity and delayed union were noted 1 case out of 3 cases in multiple pinning, 3 cases out of 6 cases in Smith-Petersen nail with Thornton plate fixation, 4 cases out of 8 cases in Smith-Petersen nail with McLaughlin plate fixation, 4 cases out of 14 cases in sliding compression hip screw and plate fixation. 3. Required weeks in union were 18 weeks in Multiple pinning, 20 weeks in Smith-Petersen nail with Thornton plate fixation, 25 weeks in Smith-Petersen nail with McLaughlin plate fixation and 16 weeks in sliding compression hip screw and plate fixation. 4. There are few complications in treatment of trochanteric fracture with surgical procedure using Sliding compression hip screw and plate.
Adult ; Clinical Study ; Congenital Abnormalities ; Femur ; Hip ; Humans ; Metals ; Neck ; Seoul

BACKGROUND: To evaluate the safety and the efficacy of amlodipine, a dihydropyridine calcium antagonist, monotherapy in the treatment of moderate essential hypertension. METHOD: Amlodipine 5mg once a day was administered as a starting dose in 30 patients with essential hypertension in the morning and a one step upward titration was performed (amlodipine 10 mg once a day) was done at the end of 4weeks treatment. Final evaluation was done at 12weeks with laboratory test and echocardiogram. RESULT: Within 4weeks treatment with dose of 5mg amlodipine once a day, the systolic blood pressure (SBP) was decreased(184.5+/-23.3/150.5+/-16.0mmHg,p<0.000), and the diastolic blood pressure(DBP) was also decreased significantly (109.9+/-04.6/92.3+/-11.5mmHg, P<0.001). After 12 weeks of treatment with a mean dosage of 6.6mg once a day, SBP and DBP was maintained comparing with basal level (147.0+/-15.8/88.1+/-0.9mmHg, respectively). The efficacy of amlodipine treatment was noted an excellent in 16 patients(53.3%), good in 4 patient(13.3%), fair in 4 patients(13.3%), and failed in 2 patients(6.7%). There was no significant change in heart rate before and after amlodipine treatment. (80.0+/-2.3/80.9+/-10.4 beats/minute n.s). Amlodipine had not significant effects on laboratory findings such as serum creatinine, BUN, ALT/AST, hemoglobin, leukocyte count,platelet and lipid profiles. There was facial flushing 2 patients, but no need to discontinue administration of amlodipine and all patients completed for 12weeks therapy. CONCLUSION: It is concluded that amlodipine is an effective antihypertensive agent, as monotherapy once a day in patients with moderate essential hypertension.
Amlodipine ; Blood Pressure ; Calcium ; Creatinine ; Flushing ; Heart Rate ; Humans ; Hypertension* ; Leukocytes

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVE: This study was performed to determine the relations of glycosylated hemoglobin (HbA1c) and parameters of nerve conduction study (NCS) in diabetic peripheral polyneuropathy patients. METHOD: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus. RESULTS: HbA1c level had an inverse relation to CV of median motor nerve (beta= 1.272, p<0.01), ulnar motor nerve (beta= 1.287, p<0.01), posterior tibial nerve (beta= 0.982, p<0.05), and deep peroneal nerve (beta= 1.449, p<0.05). CONCLUSION: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data.
Action Potentials ; Demyelinating Diseases ; Diabetes Mellitus ; Hemoglobin A, Glycosylated* ; Humans ; Hyperglycemia ; Linear Models ; Neural Conduction* ; Peroneal Nerve ; Polyneuropathies* ; Prospective Studies ; Sural Nerve ; Tibial Nerve

We describe a Korean family presenting with pediatric-onset, progressive, generalized dystonia with bilateral striatal necrosis and the homoplasmic G14459A mutation in the mitochondrial ND6 gene. The G14459A mutation has been reported in families presenting with Leber hereditary optic neuropathy (LHON) alone, LHON plus dystonia, or pediatric-onset dystonia. The proband had shown dysarthria, progressive generalized dystonia, and spasticity at 5 yr. Brain MRI demonstrated bilateral striatal necrosis. Additional investigation of family members revealed the presence of homoplasmic G14459A mutation in asymptomatic individuals. The clinical manifestation of the homoplasmic G14459A mtDNA mutation within the same family showed asymptomatic or pediatric-onset dystonia, without optic neuropathy. This study reemphasizes that the G14459A mutation is a candidate mutation for maternally inherited dystonia, regardless of optic neuropathy, and supports the hypothesis that nuclear genes may play a role in modifying the clinical expression of mitochondrial disease.
Adult ; Asian Continental Ancestry Group/*genetics ; Base Sequence ; Brain/pathology ; Dystonia/complications/diagnosis/*genetics ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Mitochondrial Diseases/complications/diagnosis/*genetics ; NADH Dehydrogenase/*genetics ; Necrosis ; Optic Atrophy, Hereditary, Leber/genetics ; Pedigree ; *Point Mutation ; Republic of Korea

We studied the intradural variations of spinal nerve rootlets in 100 cases of Korean adults. The results of the study are as follows ; 1. The incidence of intrasegmental variations (abberrant rootlets) is high in cervical segments and decreased toward lumbosacral segments. The incidence is higher in posterior rootlets than anterior, except cervical sesments. 2. The incidence of intersegmental variations is higher in posterior rootlets than anterior, and generally high in cervical and lumbar segments. 3. We divide the intersegmental variations into supernumerary rootlets, dividing rootlets, and anastomosing rootlets, and among them the incidence of anastomosing rootlets is higher. We divide the anastomosing rootlets into parallel anastomosing rootlets, uniting anastomosing rootlets, and rearrangement anastomosing rootlets. 4. The anterior to posterior anastomosing of spinal nerve rootlet is present in 4 of cases studied.
Adult ; Humans ; Incidence ; Spinal Nerves*

Agenesis of the dorsal pancreas is one of the rare congenital anomalies of the pancreas. Six cases of them have been reported. We have experienced an autopsy case of agenesis of the dorsal pancreas associated with fetal death in the uterus. Grossly, the body and tail of the pancreas and uncinate process were not found and those were partially replaced by adipose tissue. No abnormality was noted in the other organs. Microscopically, pancreatic tissue with autolytic change was identified only in the head portion of the pancreas.

No abstract available.
Cystic Adenomatoid Malformation of Lung, Congenital* ; Lung*

OBJECTIVE: Moyamoya disease (MMD) is an uncommon cerebrovascular disorder, characterized by progressive occlusion at the terminal portion of the internal carotid artery. Incidence of the disease is high in East Asia and familial MMD accounts for about 15% of the disease. Although the pathogenesis is unknown, association of HLA class I or II alleles with MMD has been reported with conflicting results. We investigated whether there is a difference in HLA class II association between familial and non-familial forms of the disease. METHODS: A total of 70 Korean children with MMD, including 16 familial cases (10 probands), and 207 healthy controls were studied. Among familial cases, only 10 probands were used for the HLA frequency analysis. High resolution HLA-DRB1 and DQB1 genotyping was performed using polymerase chain reaction (PCR)-sequence specific oligonucleotide hybridization and PCR-single strand conformation polymorphism methods. RESULTS: The phenotype frequencies of HLA-DRB1*1302 (70.0%) and DQB1*0609 (40.0%) were significantly increased in familial MMD compared to both controls [vs. 15.5%, corrected p (pc) = 0.008, odds ratio (OR) = 12.76; vs. 4.3%, pc = 0.02, OR = 14.67] and non-familial MMD patients (vs. 14.8%, pc = 0.02, OR = 13.42; vs. 1.9%, pc = 0.02, OR = 35.33). The frequencies of DRB1 and DQB1 alleles in non-familial MMD patients were not significantly different from those in controls. CONCLUSION: Our findings suggest that the genetic polymorphism of HLA class II genes or other closely linked disease relevant gene(s) could be a genetic predisposing factor for familial MMD.
Alleles ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Child ; Chimera ; Far East ; Genes, MHC Class II ; HLA-DQ Antigens ; HLA-DR Antigens ; HLA-DRB1 Chains ; Humans ; Incidence ; Moyamoya Disease ; Odds Ratio ; Phenotype ; Polymerase Chain Reaction ; Polymorphism, Genetic