PURPOSE: The anterior vaginal wall sling (AVWS) was introduced to be a simpler and less morbid procedure than the fascial or synthetic slings. However, the long-term outcome of the AVWS has not been fully assessed. In this study, the long-term outcomes of AVWS in female stress urinary incontinence were determined. MATERIALS AND METHODS: A total of 54 patients, followed-up postoperatively for at least five years, were surveyed. The surgical outcome was evaluated by pre- and post-operative SEAPI scores, subjective satisfaction and complications. The preoperative clinical parameters were analyzed using a multivariate analysis to determine the factors influencing the success. RESULTS: After a follow-up period of at least 60 months (mean 72.3 months), 63% were cured, 24% showed improvement and 13% had unsuccessful outcomes. The multivariate analysis demonstrated no preoperative factors for the prediction of the outcome of the AVWS. In a subjective satisfaction assessment, 40.8% were extremely satisfied, 40.8% were satisfied, 9.3% felt fair, and 9.3% were dissatisfied. The short-term complications were; UTI (1 case) and operation related transfusion (1 case). The long-term complications were; de novo urge incontinence (3 cases), removal of suture material due to extra-vaginal protrusion (3 cases) and chronic pelvic pain (1 case), but there was no chronic retention. CONCLUSIONS: An AVWS has many benefits, such as low morbidity, easiness of familiarization and can be performed on patients with anatomical incontinence and internal sphincter deficiency. Nevertheless, the complete dry rate of AVWS is 63% for a follow-up of over 5-years. With regard to its long-term durability, this procedure is considered a less effective treatment modality for female stress urinary incontinence.
Female* ; Follow-Up Studies* ; Humans ; Multivariate Analysis ; Pelvic Pain ; Surgical Procedures, Operative ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

Prolactin is elevated in the serum of patients with cervical carcimomas. It is suggested that such edtopically secreteted prolactin may be a potential marker for detecting early occult tumors or gauging the effectiveness of therapy for human cervicla carcinoma. We have immunohistochemical study to investigate the presence or absence of prolactin in 16 cases of nrmal cervical tissues and 26 cases of neoplastic formalin fixed cervical tissues. The results were as follows. 1. All cases of 10 normal uterine cervical tissues and all cases of 5 squamous metaplasia of the cervix revealed positive reaction to prolactin antisera. 2. One case of four moderate dyplasia of the cervix revealed positive reacion to prolactin antisera. 3. One case of five squamous cell carcinoma in situof the cervix revealed positive reaction to prolactin antisera. 4. All cases of 10 keratinizing sqyamous cell carcinoma of the cervix revealed positive reaction to prolactin antisera, but only 1 case non-keratinizing sqyamous cell carcinoma of the cervix revealed positive reaction to prolactin antisera. The results are suggested that prolactin may play a some role in the developement and growth of the cervical carcinoma. But further stydy of the biologic actions of prolactin in many cervical tissues is warranted.
Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Formaldehyde ; Humans ; Immune Sera ; Metaplasia ; Prolactin*

Uterine sarcoma whieh is originated from uterine muscle and/or connective tissues, is very rare malignant tumor and is the most lethel of all primary uterine tumors. This study was undertaken to correlate the clinieal findings, diagnoses, managements and ultimate outcome of each particluar grouy of uterine sarcoma at Depart,ment of Obstetrics and Gynecology in Korea University Hospital. The reaults were as follows, 1. The distribution of uterinesarcomaby histologic type was 5 cases (35.7%) for leiomyosarcoma, 5 cases (35.7%) for endometrial strornal sarcoma and 4 eases (28.6%) for mixed Mullerian tumor, 2. The mean age and yarity were 50.8 years and 3.1. 3. The most common syrrlptorn was irregular vaginal bleeding (64.3%), and lower abdominal pain (21.4%), abdominal palpable mass (14.3%) in order of frequency. 4. The distribution by YIGO clinical atage was 35.7% for stage I, 35.7% for stage II, 7.2% for stage IE and 21.4% for stage lV. The average survival time of each stage of disease was decreased with increasing stage. 5. The mean survival time was decreased with inereasing numbers of mitotic figure per 10 high power fields. 6. The mean survival time according to histologc type was 14.5 months for leiomyoaarcoma, 21.5 months for endometrial stromal marcoma, 5.8 months for malignant mixed Mullerian tumor, respectively.
Abdominal Pain ; Animals ; Connective Tissue ; Diagnosis ; Female ; Gynecology ; Korea ; Leiomyosarcoma ; Mice ; Myometrium ; Obstetrics ; Sarcoma* ; Survival Rate ; Uterine Hemorrhage ; Uterus*

Tracheoesophageal fistula (TEF) occurs in approximately 1 in 3,000 to 5,000 live births. TEF arises from failure of normal division of proximal foregut into separate respiratory and digestive tracts at 4 weeks' gestation. TEF and esophageal atresia are interrelated anomalies, and TEF usually occurs with esophageal atresia. These are usually diagnosed shortly after birth. However, the diagnosis is often delayed in TEF without esophageal atresia, because babies with this anomaly are usually normal in size and seldom have other anomalies. Therefore, sometimes TEF without esophageal atresia is found during operation for an unrelated condition when positive pressure ventilation causes massive inflation of the gastrointestinal tract. We report a case of TEF in adult patient found during general anesthesia for emergency exploratory laparotomy.
Adult ; Anesthesia, General* ; Diagnosis ; Emergencies* ; Esophageal Atresia ; Gastrointestinal Tract ; Humans ; Inflation, Economic ; Laparotomy* ; Live Birth ; Parturition ; Positive-Pressure Respiration ; Pregnancy ; Tracheoesophageal Fistula*

No abstract available.
Adenoma* ; Cervix Uteri* ; Female

No abstract available.
Adenoma* ; Cervix Uteri* ; Female

OBJECTIVE: To evaluate the cytohistologic correlation and the clinical significance among patients with atypical squamous cells of undetermined significance(ASCUS), low-grade squamous intraepithelial lesion(LSIL), and high-grade squamous intraepithelial lesion(HSIL) identified on cervical Pap smear screening. MATERIALS AND METHODS: Pathologic reports of patients who have underwent cervical Pap smear screening at Korea university Ansan hospital from January 1997 to December 1998 were evaluated. Cytologic diagnosis was classified by the Bethesda System (TBS). Among these patients, the patients whose histologic diagnosis was established by cervical punch biopsy, LEEP, conization, and hysterectomy were targetted. Cytohistologic correlation were analysed in ASCUS, LSIL, and HSIL respectively. RESULTS: During 2 year period (1997-1998), total 3587 Pap smears were taken. The median rate of abnormal cytology was 7.2%, with 4.6% of ASCUS, 0.8% of LSIL, 1.3% of HSIL, and 0.5% of squamous cell carcinoma. The median ratio of ASCUS versus SIL was 2.2. Smears with ASCUS showed 46.9% with chronic cervicitis, 40.6% with LSIL(35.9% with koilocytotic atypia, 4.7% with mild dysplasia), 10.9% with HISL, and 1.6% with invasve squamous cell carcinoma on biopsy. Smears with LSIL showed 38.1% with LSIL(9.5% with koilocytotic atypia, 28.6% with mild dysplasia), and 28.6% with HSIL on biopsy. Smears with HSIL showed 27.8% with LSIL, 63.9% with HSIL, and 8.3% with invasive squamous cell carcinoma on biopsy. CONCLUSIONS: Smears with ASCUS showed 53.1% with SIL and cancer on biopsy. But most of theses cases revealed koilocytotic atypia rather than dysplasia, so conservative management such as repeated Pap smear is desirable. On the other hand, because smears with LSIL showed dysplasia rather than koilocytotic atypia on biopsy, more active management such as colposcopic directed biopsy is required.
Biopsy ; Carcinoma, Squamous Cell ; Conization ; Diagnosis ; Gyeonggi-do ; Hand ; Humans ; Hysterectomy ; Korea ; Mass Screening ; Uterine Cervicitis

The use of lyophilised bone from calves as a heterograft was introduced by Maatz and Bauermeister in 1957 as an alternative to autografts and freeze-dried homografts which were then in general use. The Kiel bone was known to possess no antigenecity and serial radiographs revealed that it is incorporated into the recipient site by a process of creeping substitution from surrounding bone. In patients with benign bone tumors, the surgical dead space was filled with Kiel bone graft in the departments of orthopedic surgery, Pusan national university hospital. The results were followed up for more than 14 months, and were evaluated by the palin film findings. The results were as follows : l. Of the 22 cases, satisfactory result was obtained in 18 cases(81,8%). 2. The mean lesion size(diameter of lesion/diameter of bone)of success cases was 61.6%, and the mean lesion size of failed cases was 82.8%. 3. The duration from the Kiel bone graft to the evidence of new bone formation and remodelling was 10.5 months on an average with a range of 7months to 15months, and the duratin from the Kiel bone graft to the complete resorption of the Kiel bone was 45.7 months on an average with a range of 29 months to 66 months. 4. The causes of the failed cases were thought to be incomplete removal of the lesion, decreased vascularity due to repeated surgery, large size of the lesion, and the potentiality of tumor, 5. It was difficult to evaluate success rate according to underlying disease because the number of the cases was not large enough, but giant cell tumor showed high recurrence rate.
Allografts ; Autografts ; Busan ; Clinical Study ; Giant Cell Tumors ; Heterografts ; Humans ; Orthopedics ; Osteogenesis ; Pipemidic Acid ; Recurrence ; Transplants

Intracavitary metastasis is an uncommon secondary cardiac malignancy and metastasis to the right atrium and ventricle is even less common. Prior reports have demonstrated an association of this disease entity with sudden death. We report a recent experience of intracavitary cardiac metastasis of a primary hepatoma in a 24-year-old woman who presented with a exertional dyspnea and a syncopal episode.
Carcinoma, Hepatocellular* ; Death, Sudden ; Dyspnea ; Female ; Heart Atria ; Humans ; Neoplasm Metastasis* ; Syncope ; Young Adult

PURPOSE: Nocturia, from which the patients feel the most discomfort, is one of the frequently complained urologic symptoms combined with insomnia. Studying the etiology and classification of nocturia is not enough. In this study, we analyzed the voiding diary and urodynamic study to investigate the etiology of nocturia. We classified the type of nocturia based on the etiology. MATERIALS AND METHODS: We reviewed the urodynamic study (UDS) as well as the three days voiding diary of 152 patients with nocturia. We classified nocturia into three groups based on the voiding diaries and the results of UDS: Pure nocturnal polyuria in which the voided urine volume during the hours of sleep is more than 35% of the 24-hours urine volume, detrusor overactivity defined as existing uninhibited contraction on filling cystometrogram, and mixed (nocturnal polyuria with detrusor overactivity). Polyuria (24-hours urine output >2,500cc) was classified separately. RESULTS: The mean number of nocturia was 3.3 (3.1 for men, 3.4 for women). octurnal polyuria, detrusor overactivity and mixed were 50.0%, 7.9% and 17.1% respectively. Nocturnal polyuria was not related with detrusor overactivity, bladder outlet obstruction and impaired detrusor contractility, but significantly increased with age (p<0.01) and in men (p<0.05). Detrusor overactivity was not related to impaired detrusor contractility, but was significantly related to the bladder outlet obstruction (p<0.05) and increased with age (p<0.01) and in men (p<0.01). Seventeen (11.2%) had polyuria. CONCLUSIONS: In 75% of nocturia patients, there were nocturnal polyuria, detrusor overactivity or mixed type and 11.2% of them had polyuria. Therefore we conclude that these three causes were the main etiology of nocturia, and nocturia could be classified and treated based on these results.
Adult* ; Classification* ; Humans ; Male ; Nocturia* ; Polyuria ; Sleep Initiation and Maintenance Disorders ; Urinary Bladder Neck Obstruction ; Urodynamics