Transvaginal bladder neck suspension by Raz is an acceptable procedure for the treatment of stress urinary incontinence with high cure rate, operative simplicity, short hospitalization and little morbidity. Recently we experienced 8 cases of stress urinary incontinence treated with Raz's procedure and 2 cases with coexisting cystocele were treated with 4-corner operation. All cases have been assessed prior to and following operation and the results were satisfactory. Herein, we report 10 cases of stress urinary incontinence treated by Raz's procedure and 4-corner operation with review of literatures.
Cystocele ; Hospitalization ; Neck* ; Urinary Bladder* ; Urinary Incontinence*

PURPOSES: To evaluate the effect of hormone replacement therapy(HRT) on serum insulin-like growth factors(IGFs) levels and to investigate if changes in serum IGFs reflect changes in BMD after HRT in postmenopausal women. MATERIAL & METHODS: IGF-I and IGF-II were measured by radioimmunoassay after Bio-spin P-10 seperation in sera obtained every 3 months from postmenopausal women who was taking premarin alone (premarin group; n=17) or premarin-medroxyprogesterone acetate(MPA group; n=42) for 1 year. Also, bone mineral density(BMD) were determined before and 1 year after HRT by dual energy X-ray absorptiometry(DEXA). All statistics were performed by Paired t-test, student's t-test, repeated measures ANOVA test, Pearson's coefficient. RESULTS: HRT increased BMD of the lumbar spine and proximal femur in both premarin group and MPA group, but any difference in degreee of increase in BMD was not noted between premarin group and MPA group. Compared with pretreatment levels, serum IGF-I levels decreased at 3, 6 and 12 months after therapy only in latter group whereas serum IGF-II levels increased at 6 and 12 months after HRT in both groups. Changes in serum IGF-I and IGF-II levels during therapy did not show any difference by the bone response to HRT. Changes in serum IGF-II levels after HRT did not correlated with the 1 year changes in BMD at any skeletal sites studied, but changes in serum IGF-I levels from pretreatment to 6 months after HRT was negatively correlated with change in BMD of Ward's triangle. CONCLUSION: HRT influences serum IGF levels in postmenopausal women and changes in serum IGF-I levels may predict the changes in BMD of Ward's triangle after HRT.
Bone Density* ; Estrogens, Conjugated (USP) ; Female ; Femur ; Hormone Replacement Therapy* ; Humans ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Postmenopause ; Radioimmunoassay ; Spine

In our series with old electrical burn around the the wrist, there are several characteristics: for example, bad scarring in palm and volar aspect of wrist and distal forearm, large multiple defects of the flexor tendons, low median and ulnar nerve palsy, and occasionally insufficient blood supply. Between 1992 and 1995, we treated 8 cases of 7 patients with staged reconstruction. 4 patients with bilateral involvements had below-elbow amputee of contralateral upper extremity. The common approachs in each were soft tissue coverage, staged tendon reconstructiuon, and opponensplasty. The length of time between the injury and tendon reconstruction was 9 months on an average. Soft tissue coverage consisted of: 1. free tissue transfer (n=3), 2. abdominal (n=3) or groin (n=2). Total numbers of flexor tendon reconstruction were 26. Among them, staged reconstruction using silicone prosthesis were done in 18 tendons and primary tendon graft following tenolysis were done in 8 tendons. The time between first and second stage tendon reconstruction was 4.13 months. In all cases, opponen-splasty using extensor indicis proprius (n=4), extensor pollicis longus (n=2), and extensor digiti mini- mi (n=l), were performed. Good functional improvement of the hand were obtained in all cases. Patient s satisfaction were much better than the degree of functional improvement of the hand.
Amputees ; Burns* ; Cicatrix ; Forearm ; Groin ; Hand ; Humans ; Prostheses and Implants ; Silicones ; Tendons ; Transplants ; Ulnar Neuropathies ; Upper Extremity ; Wrist*

BACKGROUND/OBJECTIVES: Obesity is associated with chronic inflammation. The spleen is the largest organ of the lymphatic system and has an important role in immunity.Obesity-induced inflammatory responses are triggered by Toll-like receptor (TLR)-myeloid differentiation primary response 88 (MyD88) pathway signaling. Phenethyl isothiocyanate (PEITC) and 3,3′-diindolylmethane (DIM), major dietary glucosinolates present in cruciferous vegetables, have been reported to produce anti-inflammatory effects on various diseases. However, the effects of PEITC and DIM on the obesity-induced inflammatory response in the spleen are unclear. The purpose of this study was to examine the antiinflammatory effects of PEITC and DIM on the spleen and their mechanism in high fat/ cholesterol diet (HFCD)-fed C57BL/6 mice.MATERIALS/METHODS: We established an animal model of HFCD-induced obesity using C57BL/6 mice. The mice were divided into six groups: normal diet with AIN-93G diet (CON), high fat diet (60% calories from fat) with 1% cholesterol (HFCD), HFCD with PEITC 30 mg/kg/ day or 75 mg/kg/day (HFCD+P30, HFCD+P75), and HFCD with DIM 1.5 mg/kg/day or 7.5 mg/kg/ day (HFCD+D1.5, HFCD+D7.5). Enzyme-linked immunosorbent assay was used to evaluate proinflammatory cytokine secretion. Western blot and quantitative polymerase chain reaction were used to analyze protein and mRNA levels of nuclear factor kappa B (NF-κB) p65, interleukin 6 (IL-6), cyclooxygenase 2 (COX-2), TLR2, TLR4, and MyD88 in spleen tissue. RESULTS: Serum IL-6 levels were significantly higher in the HFCD group than in groups fed a HFCD with PEITC or DIM. Levels of NF-κB p65 protein and TLR2/4, MyD88, NF-κB p65, IL-6, and COX-2 mRNA were significantly higher in the HFCD group than in the CON group and were reduced by the PEITC and DIM supplements. CONCLUSIONS PEITC- and DIM-supplemented diets improved splenic inflammation by modulating the TLR2/4-MyD88 pathway in HFCD-fed mice. We suggest that dietary glucosinolates may at least partially improve obesity-induced inflammation of the spleen.

Mondor's disease is also called thrombophlebitis and it is not a common condition. The characteristics finding of Mondor's disease is a subcutaneous cord that is tender and tense. This disease commonly occurs in the breast and abdomen. The etiology of Mondor's disease is unknown, but the generally agreed on causes are trauma, excessive exercise and breast surgery. On rare occasions, this disease is related to malignancy, pregnancy, filariasis and so on. This disease is self limiting and it is usually treated conservatively and symptomatically. We treated one woman who had Mondor's disease on the anterior side of the left elbow. This is a very rare location for Mondor's disease and so clinicians need to be aware about the possibility of this unusual presentation for this disease.
Abdomen ; Breast ; Elbow ; Female ; Filariasis ; Humans ; Pregnancy ; Thrombophlebitis ; Transcutaneous Electric Nerve Stimulation

The objective of this retrospective study was to evaluate whether the transvaginal ultrasonographic analysis of endometrial pattern and thickness could predict the stage of menstrual cycle. Endometrial pattern and thickness were observed in those patients receiving infertility work up from April, 1 f94 to July, 1998 at Seoul National University Hospital. The study group was 185 patients with normal regular menstrual cycles. Among them, 44 patients received endometrial biopsy, and the date of endometrium was compared with the observed endometrial pattern and thickness. The observed endometrial pattern was presence or absence of central cavity echogenicity, triple line sign, endometrial hypoechogenicity, ring sign, endometrial hyperechogenicity and posterior acoustic sonic enhancement. The results were as follows; Central cavity echogenicity was seen throughout menstrual cycle. Triple line sign was observed in 81.1% of patients during early secretory phase. However, in mid to late secretory phase, triple line sign was appeared in only 6.8%. The percentage of positive endometrial hypoechogenicity was highest in early secretory phase. In contrast to hypoechogenicity, positive endometrial hyperechogenicty was highest in mid to late secretory phase. Ring sign was observed in 73.5% of the patients during early secretory phase with peak incidence. Posterior acoustic enhancement was seen in 72.7% of the patients during late secretory phase The sensitivity and specificity of being a secretory phase if the patients showed hyperechogenic endometrium, were 84.2%, 83.3% respectively. The sensitivity and specificity of being a secretory phase if the patients showed posterior acoustic enhancement were 93.8%, 58.3% respectively. Endometrial thickness was not correlated with endometrial dating. In conclusion, transvaginal ultrasonographical delineation of the endometrial pattern might to useful tool in predicting endometrial status during normal menstrual cycle. But, endometrial thickness could not predict the endometrial dating.
Acoustics ; Biopsy ; Endometrium ; Female ; Humans ; Incidence ; Infertility ; Menstrual Cycle* ; Retrospective Studies ; Sensitivity and Specificity ; Seoul

PURPOSE: The circular stapled hemorrhoidectomy established by A. Longo involves reducing the mucous membrane prolapse and blocking the end branches of the upper hemorrhoidal artery through transverse incision of a suitable section of the mucosa between the rectum and the anal canal. This study was undertaken to determine the efficacy and the safety of a circular stapled hemorrhoidectomy by comparing it with a conventional Milligan-Morgan hemorrhoidectomy. METHODS: One hundred thirty (130) patients with prolapsed hemorrhoids underwent surgical treatment with either a conventional (n=66)(conventional group) or a circular stapled (n=64) (stapled group) hemorrhoidectomy. The operation time was recorded, and the resected specimen was examined. The patients assessed their postoperative pain. Time to first bowel movement, hospital stay, and postoperative complications were analyzed. All patients received follow-up examinations at the out-patient clinic, and the time to return to work and the degree of their satisfaction were checked. RESULTS: The stapled group had a shorter average operation time (19.2 min. vs 26.1 min., P=0.016). The postoperative pain score in the stapled group was significantly lower than it was in the conventional group (P<0.05). Time to first bowel movement and hospital stay were not significantly different between the groups. Return to work was significantly faster in the stapled group (6.5 days vs 15.8 days, P<0.05). The degrees of satisfaction for the two groups were similar, and postoperative complications in the two groups were both similar and acceptable (6.1% vs 11.0%, P>0.05). CONCLUSIONS: A circular stapled hemorrhoidectomy offers a significantly less painful alternative to the conventional technique and is associated with an earlier return to normal activity. However, the long-term outcome needs to be evaluated further.
Anal Canal ; Arteries ; Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Mucous Membrane ; Outpatients ; Pain, Postoperative ; Postoperative Complications ; Prolapse ; Rectum ; Return to Work

When clinicians faced with an insufficient volume of supporting bone on ideally esthetic and biomechanical position for dental implantation, guided bone regeneration(GBR) was indicated. Although GBR has wide application at clinic, proper time of membrane removal remains qustionable in using non-resorbable membrane, such as non-expanded polytetrafluoroethylene(PTFE). The aim of this study was to compare the effect of maintenance period of PTFE membrane on bone regeneration in rabbit calvarial defects. Eight adult New Zealand white female rabbits were used in this study. Four defects were surgically made in their calvaria. Using a trephine bur, 4 'through and through' defects were created and classified into 3 groups, which were consisted of control group(no graft), experimental group 1(autogenous bone)and experimental group 2(deproteinized bovine bone; OCS-B(R)). The defects were covered with PTFE membrane(Cytoplast(R)). Membranes were removed after 1, 2, 4 and 8 weeks post-GBR procedure in 2 rabbits repectively. All rabbits were sacrificed after 8 week post-GBR procedure. Specimens were harvested and observed histologically. The results were as follow; 1) The use of graft material and membrane was necessary in GBR procedure. 2) When PTFE membranes were removed early, the most favorable bone regeneration was revealed in experimental group I, followed by experimental group II and control group. 3) On GBR, it is recommended that membrane should maintain for 4 weeks with autogenous graft. As well, the use of xenograft need longer maintenance period than autogenous bone. Further evaluations will be needed, such as histomorphologic research, more species and different kinds of graft materials. And on the basis of these studies, clinical researches would be required.
Adult ; Bone Regeneration* ; Dental Implantation ; Dental Implants ; Female ; Heterografts ; Humans ; Membranes* ; New Zealand ; Polytetrafluoroethylene ; Rabbits ; Skull ; Transplants

Varying types of polyps could occur in the vermiform appendix. However, it is very unusual. Collins found 57 cases (0.08%) of benign mucosal polyps in the 71,000 cases of appendectomy specimens. There has been no reported case of appendiceal polyp in the literature in Korea. The authors experienced two cases of polyp in the vermiform appendix. The first case was a 51 year-old male patient who received a left hemicolectomy due to colonic polyposis. The second case was a 71 year-old male patient who was treated by appendectomy under the clinical diagnosis of acute appendicitis. The microscopic type of both cases were hyperplastic polyp.
Male ; Humans

For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.
Adult ; Aged ; Clavicle/injuries/radiography/*surgery ; Female ; Follow-Up Studies ; Fracture Fixation, Internal/*instrumentation/*methods ; Fractures, Comminuted/radiography/*surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Range of Motion, Articular ; Young Adult