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

PURPOSE: The purpose of the study is to investigate the correlation between the symptoms and the incidence of anatomical variant without mucosal abnormality. MATERIALS AND METHODS: Out of 892 patients with CT performed for the evaluation of sinus disease symptoms between March 1991 and March 1993, we observed the anatomic variations in 82 symptomatic patients without mucosal abnormality(male:female=43:39, mean age 36. 4 years). The control group included 88 patients with facial bone CT performed for the evaluation of trauma during the same period while patients with recent paranasal sinusitis were excluded. (male:female=76:12, mean age 22. 4 years). The scouis were performed with 5-ram section thickness from posterior margin of sphenoid sinus to anterior margin of posterior ethmoid and then with 3 mm thickness from anterior margin of posterior ethmoid to anterior margin of frontal sinus. The artatomic variations included nasoseptal deviation, concha bullosa, Hailer cells, Agger nasi cells, etc. RESULTS: The anatomic variations were demonstrated in 71 our of 82 symptomatic patients(86. 5%), whereas they were seen 26 of 88 patients(29. 5%) in control group. CONCLUSION: Our data suggest that there is a possible causal relationship between anatomic variations and symptomas. Even though without accompaning mucosal abnormalities, anatomic variations could contribute simply to its symptomas. ^natomic variants may obstruct or narrow the airway, leading to turbulating air flow or interrupting ucociliary movement, and finally may produce a series os symptoms.
Facial Bones ; Frontal Sinus ; Humans ; Incidence ; Sinusitis ; Sphenoid Sinus

Transurethral laser induced thermotherapy by Prostalase is a new modality being evaluated for the treatment of BPH. We performed transurethral laser induced thermotherapies on 30 patients from April 1993 to December 1993. After treatment, 27 patients of them were followed up (urinary retention in 13 cases, non-urinary retention in 14 cases). Mean age of patients was 72 year-old. Prostalase in system was run for 40 minutes with single session without anesthesia. We evaluated patients with Boyarsky symptom score, urine flow rate. volume of residual urine, prostatic volume. Mean Boyarsky symptom score decreased from 16.5 to 7.8 for a 52.7% improvement on non-retention group, mean Boyarsky symptom score decreased from 16.7 to 6. 2 for a 62.8% improvement on retention group at 6 months after treatment. Mean peak flow rate increased 84.7% from a preoperative average of 7.2ml/s to 13.3ml/s at 6 months on non- retention group, mean peak flow rate increased 61.7 % from a postoperative 1-month average of 10.2ml/s to 16.5ml/s at 6 months on retention group. Prostatic volume decreased 22.4 % from a preoperative average of 37.5gm to 29.1 gm at 3 months on non-retention group, prostatic volume decreased 23.5% from a preoperative average of 42.0gm to 32.1gm at 3 months on retention group. There have been no urinary tract infection or retrograde ejaculation. Acute urinary retention occurred in 2 patients, gross hematuria in 1, urinary incontinence in 1. Our study number is small, but we think transurethral laser thermotherapy (Prostalase) to be a safe and less morbid alternative to transurethral resection of prostate.
Aged ; Anesthesia ; Ejaculation ; Hematuria ; Humans ; Hyperthermia, Induced* ; Male ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate ; Urinary Incontinence ; Urinary Retention ; Urinary Tract Infections

Since CT scanning was introduced in the diagnosis of calcaneal fracture, we became to understand more clearly the pathoanatomy of the injury. However we have to determine if we would or would not take CT scanning by simple radiography in the acute setting and most of the surgeons still use simple radiography in evaluating postoperative result. And also we have to determine the accuracy of reduction and position of screws by simple radiography intraoperatively. The purpose of this report is to determine the accuracy of simple radiography in assessing the pathological anatomy of the intraarticular calcaneal fracture by experimental and clinical studies. This is a combined experimental and clinical studies using four below knee amputation specimens and 15 patients with 19 displaced intraarticular calcaneal fractures treated at Hanil General Hospital between Jan. 1996 and May 1997. The lateral view of the foot was the best radiographic view for visualizing the degree of depression of the posterior facet. With regard to the location of a fracture line, findings of Broden views correlated well with findings on CT in 17 of 19 fractures. With regard to gapping between fragments, the axial view was not satisfactory in the majority of cases(15 of 19 cases). There was no case which showed more than 2 mm of discrepancy between the findings on Broden view and CT. We conclude that we may obtain most of the important informations about the pathological anatomy of the intraarticular calcaneal fracture by simple radiography.
Amputation ; Depression ; Diagnosis ; Foot ; Hospitals, General ; Humans ; Knee ; Radiography* ; Tomography, X-Ray Computed

Bilateral nonfunctioning adrenal cortical carcinoma is an extremely rare disease with poor prognosis. We report a case of asynchronous bilateral nonfunctioning adrenal cotical carcinoma. The patient was a 55 year-old man who had complained of discomfort in the right upper quadrant and flank area. There was no endocrinological abnomaliries. Abdominal CT revealed about 9.5 x 7.0 cm sized right adrenal mass. Under the impression of nonfunctioning adrenal cortical carcinorna, right radical adrenalectomy was performed. After 1 year from operation, 5.0 x 7.0 x 6.0 cm sized new mass was detected in the left adrenal gland with metastasis to the peritoneum.
Adrenal Glands ; Adrenalectomy ; Adrenocortical Carcinoma* ; Humans ; Middle Aged ; Neoplasm Metastasis ; Peritoneum ; Prognosis ; Rare Diseases ; Tomography, X-Ray Computed

Tetralogy of Fallot constitutes the highest proportion of cyanotic congenital heart disease and has four basic abnormal anatomical pictures including ventricular septal defect, pulmonary stenosis, aortic overriding and right ventricular hypertrophy. The work of Edward, et al(1965), Guntheroth, et al(1965) and Lev and Eckner(1964) has shown that the anatomical picture in a combination of just first two morphological characteristics, the aortic overriding and right ventricular hypertrophy being a consequence of the ventricular septal defect and pulmonary stenosis. Basic signs involve two categories, one is change of shunt rate depending on pulmonary stenosis, ventricular septal defect and systemic vascular resistance, and the other is physiological response to the chronically lowered PaO2. Thus the pathophysiological status presents to us more problems than other congenital heart disease in the care of patients during operation and anesthesia. Therefore, the anesthesiologist must understand the basic pathophysiology, various findings of examination, symptoms and signs, the problems during anesthesia and postoperative care. The purpose of this study was to evaluate the anesthetic management in total corrective surgery of tetralogy of Fallo which was performed at Severance Hospital. Out of consecutive 160 cases of tetralogy of Fallot in our past ten years experiences from 1971 to 1980, we selected the clinical results on anesthetic care of 12 cases which received total corrective surgery under hypothermia and extracorporeal circulation. The results were as follows: 1) Out of 121 cases, 82 cases were male(67.8%) and female was 39 cases(32.2%). The group aging from 6 to 10 year old was the highest proportion (44.6%) and the next proportion was the group aging from 11 to 15(22.3%). 2) Out of 121 cases, 91 cases were cyanotic(75.2%). On the diagnostic distribution, tetralogy of Fallot without any other anomaly was the most common(66.9%). 3) As for premedicants, secobarbital was the highest proportion(28.1%). For anesthetic maintenance, methoxyflurane with nitrous oxide was the most common(43.8%). 4) During cardio-pulmonary bypass, high flow perfusion was commonly used and the highest mean arterial pressure was 89.09+/-1.21 mmHg and the lowest mean arterial pressure was 36.33+/-1.21mmHg. 5) The major complications after operation and anesthesia were dysrhythmia(13.1%), pleural effusion(10.3%), main wound infection(10.3%), hemorrhage(8.3%), acute renal failure(8.3%), heart failure(6.9%), low output syndrome(4.1%) and cerebral infarction due to air emboliam(2.7%). 6) Out of 121 cases were expired and hospital mortality was 23.1%. The causes of death were heart failure(50%), acute renal failure(14.3%) and cerebral infarction(14.3%). in conclusion, anesthetic care for total corrective surgery of teralogy of Fallot should be based upon the understanding of the pathophysiology of disorder itself.
Female ; Humans ; Mortality

We have studied the effect of sedation with diazepam on arterial oxygen saturation during spinal anestheia in two groups of patients: Group I: Received diazepam (0.2 mg/kg i.v.) after the level of spinal anesthesia was determined, and breathed the room air. The level of sedation was controlled such that the patient was drowsy but aroused easily and capable of communication. An additional dose of diazepam was given when required. (n=15) Group II: Received diazepam (0.2 mg/kg i.v.) in the same manner as Group I but with supplementary oxygen inhalation (3l/min) through the nasal catheter. (n = 15) The results were as follows: Two of 15 patients of Group I who were given sedation during spinal anesthesia and who breathed room air developed moderate hypoxemia, with a SaO2 of 88-89%. There were no episodes of hypoxemia in Group II patients who received supplementary oxygen inhalation. We concluded that oxygen should be administered routinely to patients receving diazepam as a sedative during spinal anesthesia for the prevention of hypoxemia, unless a pulse oximeter is available to monitor SaO2.
Anesthesia, Spinal* ; Anoxia ; Catheters ; Diazepam* ; Humans ; Inhalation ; Oxygen*

The application of stereotactic techniques and endoscopy dates back to the beginning of this century and is almost as old as neurosurgery itself. However, endoscopic techniques progressed slowly for several reasons. A reappraisal of endoscopic techniques become popular about 1985. The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, blood clot can be approached with endoscope. Authors present its intraaxial application in basal ganglionic hematoma in three patients. Conventional stereotactic guidance of neuroendoscope was done and the hematoma was gently removed through continuous irrigation and suction under video-guidance. The clinical course was uneventful. Brief overview is given of this intraaxial neuroendoscopic procedure.
Endoscopes ; Endoscopy ; Ganglion Cysts* ; Hematoma* ; Humans ; Necrosis ; Neuroendoscopes ; Neurosurgery ; Stereotaxic Techniques ; Suction

OBJECT: This study is to examine the validity of constitutional classification of Sa-sang medical theory. This theory classifies the human constitution to 4 types according to classical oriental philosophy on yin and yang. SUBJECTS AND METHOD: Subjects were 312 medical students and 288 neurotic patients with diagnosis of neurotic, stress related and somatoform disorders and minor depressive episodes according to ICD-10. Medical students were classified to 4 Sa-sang constitutions by Noh Jung Woo scale, by Dr. Kim Dal Lae himself and Questionnaire for the Sa-sang Constitution Classification(QSCC II). For assessmnent of symptoms and signs, Korean version of SCL-90, a constitution scale and personality scale which were designed for this study were used. These instruments were found to be reliable and valid through statistical analysis. Subjects were asked to rate these scales. The data were analysed with factor analysis and factor scores were compared among 4 Sa-sang constitutions by ANOVA and t-test. The data from patient group were analysed with factor analysis and the results were compared with the Sa-sang medical theory. RESULTS: Results of classification by 3 ways were inconsistent showing a significant difference among them. Among them, QSCC II was most reliable. In QSCC II, only the factor scores of factors of homophobia-obsession, weakness-sensitiveness-indigestion- chillness-skin syndrome, sexual weakness, passive-unsociable personality, introverted personality and rational personality, were significantly high in So-um (small yin) group of medical students. A factor of warmnes and active-sociable personality were significantly high in Tae-um(big yin) group. Also active-sociable and affective pesonality was partly related with So-yang(small yang) group. CONCLUSION: These results suggest that those present classification methods are inconsistent, that these methods are proving only parts of Sa-sang medical theory, and that objective and scientific studies are needed for reliability and validity of Sa-sang medical theory.
Classification ; Constitution and Bylaws* ; Diagnosis ; Humans ; International Classification of Diseases ; Philosophy ; Surveys and Questionnaires ; Reproducibility of Results ; Somatoform Disorders ; Students, Medical ; Weights and Measures

No abstract available.
Thymus Neoplasms*