Vesicouterine fistula is a rare disease that comprises 1 to 4% of all reported urogenital fistulas. Repeated cesarean section may be related to the formation of vesicouterine fistula. We experienced a case of vesicouterine fistula, and the patient's symptom was gross hematuria during her mensturation period after repeated cesarean section.
Cesarean Section ; Female ; Fistula ; Hematuria ; Pregnancy ; Rare Diseases

PURPOSE: The tension-free vaginal tape SECUR(R) (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. MATERIALS AND METHODS: We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC(R), n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. RESULTS: The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). CONCLUSIONS: Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.
Cough ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Patient Satisfaction ; Suburethral Slings ; Surgical Procedures, Minimally Invasive ; Treatment Outcome ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urodynamics

BACKGROUND: Researchers have reported that the prevalence of abdominal aortic aneurysm(AAA) is 1~4% in the entire population and 4~9% in the population older than 65 years. 40 to 50% of AAA patients die before arrival at a hospital; and mortality from a ruptured AAA is greater than 90%. Moreover, diagnosis is frequently delayed because the majority of patients are asymptomatic. Even if AAA is quickly diagnosed(ruptured or symptomatic) and operated on, survival rate is less than 50%. Recently, trials have been done to detect asymptomatic AAA by ultrasonography in the elderly population with a subsequent increase in the number of surgeries of asymptomatic AAA. Method: We measured the diameter of the abdominal aorta in all patients aged 65 years and older seen in the emergency room at Chuncheon Sacred Heart Hospital, Hallym University. We investigated the correlations between risk factors and prevalence of AAA and the diameter of the abdominal aorta. We also screened for age, gender, and history of smoking, hypertension, coronary heart disease, and CVA. RESULTS: 444 cases were enrolled in this study with 185 being male(41.7%) and 259 female(58.3%). Mean age was 73.91+/-7.02 years. Mean maximum diameter of the abdominal aorta was 2.08+/-0.37cm. Comparing maximum diameters, men averaged 2.17+/-0.37cm and women 2.01+/-0.35 cm (p<0.001); smokers 2.16+/-0.39cm and nonsmokers 2.05+/-0.35cm(p=0.007); hypertension history 2.10+/-0.42 cm and no hypertension history 2.06+/-0.33cm(p=0.246); coronary heart disease history 2.35+/-0.84cm and no coronary heart disease 2.07+/-0.35 cm(p=0.01); and CVA history 2.08+/-0.37 cm and no CVA history 2.08+/-0.37cm(p=0.997). CONCLUSION: There were notable differences in the maximum abdominal aortic diameter with gender and histories of smoking, hypertension, and coronary heart disease. Ultrasound screening of AAA should be strongly recommended in male smokers 65 years and older with a history of coronary heart disease. Overall, ultrasound screening of AAA for elderly patients should be carefully considered.
Aged ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Coronary Disease ; Emergencies ; Female ; Heart ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Survival Rate

PURPOSE: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. METHODS: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS > or = 5. RESULTS: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. CONCLUSION: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.
Adolescent ; Blood Pressure ; Craniocerebral Trauma ; Humans ; Medical Records ; Mortality ; Shock ; Shock, Hemorrhagic ; Tomography, X-Ray Computed ; Vena Cava, Inferior

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

GFAP (Glial Fibrillary Acidic Protein) was one of the intermediate filament group and used as an astrocyte marker. The numerous studies about GFAP immunoreactive cell's distribution were investigated for fetus, neonate and aged brains. There are several reports about that GFAP immunoreactive cells were appeared at early fetus and after birth. In cases of mammalian fetus radial glia cells migrated toward pial surface at early stage and revealed GFAP immunoreactivity by the immunostain. But in cases of rodents, they migrated at late gestation or after birth. This study, the GFAP immunoreactive cells' localizations and distribution in the fetuses (the 30 th, 45 th, 60 th, 90 th, 105 th, 120 th of gestation) and neonate mesencephalon of korean native goat were investigated by immunohistoche-mistry (ABC method). The results obtained in this study were summarized as followings; 1. Multipolar astrocytes at 60 days of gestation were found in midbrain, in 90 days of gestation were found in cerebral aqueduct. 2. Radial glial cell presented 60 days of gestation and process of GFAP immunoreaction was to stretch out from ventricular to pia mater and nonpolar immunoreactive cell was transformed to bipolar, monopolar and multipolar immunoreactive cell. 3. The number of GFAP immunoreactive cells of field were gradually decreased from 90 days of gestation till 105 days of gestation. But in 120 days of gestation and newborn were slightly increased. 4. Immunoreactivity of GFAP immunoreactive cells were gradually decreased from 95 days of gestation till 120 days of gestatioin. These results were suggested that radial glial cell of midbrain developed very earlier than that of cerebral aqueduct. However, cerebral aqueduct developed lately than that of midbrain, but faster developing than other.
Astrocytes ; Brain ; Cerebral Aqueduct ; Ependymoglial Cells ; Fetus* ; Goats* ; Humans ; Infant, Newborn* ; Intermediate Filaments ; Mesencephalon* ; Neuroglia ; Parturition ; Pia Mater ; Pregnancy ; Rodentia

BACKGROUND: Antepartum, intrapartum, and postpartum preventive measures with antiretroviral drugs, appropriate delivery methods, and discouraging breastfeeding significantly decrease the risk of mother-to-child transmission of human immunodeficiency virus (HIV) infection. Herein, we investigated the pregnancy outcomes in HIV-infected Korean women. METHODS: We retrospectively reviewed medical records of childbearing-age HIV-infected women between January 2005 and June 2017 at four tertiary care hospitals in Korea. RESULTS: Among a total of 95 HIV infected women of child-bearing age with 587.61 years of follow-up duration, 15 HIV-infected women experienced 21 pregnancies and delivered 16 infants. The pregnancy rate was 3.57 per 100 patient-years. Among the 21 pregnancies, five ended with an induced abortion, and 16 with childbirth including two preterm deliveries at 24 and 35 weeks of gestation, respectively. The two preterm infants had low birth weight and one of them died 10 days after delivery due to respiratory failure. Among the 14 full-term infants, one infant was small for gestational age. There were no HIV-infected infants. CONCLUSION: The pregnancy rate of HIV-infected women in Korea is lower than that of the general population. Although several adverse pregnancy outcomes were observed, mother-to-child transmission of HIV infection was successfully prevented with effective preventive measures.
Abortion, Induced ; Breast Feeding ; Female ; Follow-Up Studies ; Gestational Age ; HIV ; HIV Infections ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Korea* ; Medical Records ; Parturition ; Postpartum Period ; Pregnancy Outcome ; Pregnancy Rate* ; Pregnancy* ; Respiratory Insufficiency ; Retrospective Studies ; Tertiary Healthcare

PURPOSE: This study was conducted to examine various clinical factors for their ablity to predict mortality in geriatric patients following trauma. METHODS: In this retrospective study, medical records from Chun Cheon Sacred Heart hospital were reviewed for patients 65 years and older who sustained trauma. The following variables were extracted and examined, independently and in combination, for their ablity to predict death: age, gender, mechanism of injury, blood pressure, and respiration, pulse rate, as well as Glasgow Coma Score, Revised Trauma Score, and Injury Severity Score. These patients had entered the hospital following trauma during a 2-year period (1999-2000). RESULTS: the Injury Severity Score (more than 28), the Glasgow Coma Score (less than 9), and the Revised Trauma Score (less than 8) were variables that correlated with mortality. Mortality rates were higher for men than for women. Admission variables associated with the highest risks of death included hypotension (mean blood pressure < 78 mmHg); pedestrian and motorcycle traffic accident; skull fracture, subdural hemorrhage, and diffuse axonal injury; and hemothorax and lung contusion. CONCLUSION: Admission variables in geriatric trauma patients can be used to predict the outcome and may also be useful in making decisions about triage, and treatment of the patient.
Accidents, Traffic ; Blood Pressure ; Coma ; Contusions ; Diffuse Axonal Injury ; Female ; Gangwon-do ; Heart ; Heart Rate ; Hematoma, Subdural ; Hemothorax ; Humans ; Hypotension ; Injury Severity Score ; Lung ; Male ; Medical Records ; Mortality ; Motorcycles ; Respiration ; Retrospective Studies ; Skull Fractures ; Triage

The distribution of the nerve growth factor (NGF), the glial fibrillary acidic protein (GFAP) and the ciliary neurotrohic factor (CNTF) was performed in coronal sections of the mesencephalon, rhombencephalon and spinal cord in the developing Mongolian gerbils. Generally, NGF specifically recognizes neurons with the NGF receptor, whereas GFAP does the glia, and CNTF does the motor neurons. The receptor expression was examined separately in gerbils between embryonic days 15 (E15) and postnatal weeks 3 (PNW 3). The NGF-IR was first observed in the spinal cord at E21, which might be related to the maturation. The GFAP reactivity was peaked at the postnatal days 2 (PND2), while the highest CNTF-reaction was expressed at PNW 2. The GFAP stains were observed in the aqueduct and the spinal cord, which appeared to project laterally at E19. The CNTF was observed only after the birth and found in both the neurons and neuroglia of the substantia nigra, mesencephalon, cerebellum and the spinal cord from PND1 to PNW3. These results suggest that NGF, GFAP and CNTF are important for the development of the neurons and the neuroglia in the central nervous system at the late prenatal and postnatal stages.
Animals ; Brain Stem/enzymology/*metabolism ; Ciliary Neurotrophic Factor/*metabolism ; Embryonic and Fetal Development/physiology ; Female ; Gerbillinae/*embryology ; Glial Fibrillary Acidic Protein/*metabolism ; Immunohistochemistry/veterinary ; Mesencephalon/embryology/metabolism ; Nerve Growth Factor/*metabolism ; Pregnancy ; Rhombencephalon/embryology/metabolism ; Spinal Cord/embryology/*metabolism