Priciples of kont-tying have assumed a new and enhanced role in operative laparoscopy. The surgeon should be familiar with extracorporeal knot-tying techniques. For extracorporeal knot-tying, a knot pusher is used to properly secure the knot. But a knot pusher has some limitation for tightening of the knot. I developed an instrument which has a slit and hole.(slit for knot pushing and hole for knot tightening) for a secure knot. By using this instrument(Lee's knot presser) it is very easy and secure for knot-tying. The surgeon can confirm and control the knot tightening.
Laparoscopy

No abstract available.
Abortion, Spontaneous* ; Female ; Humans ; Incidence* ; Pregnancy

Fibular hemimelia is the most common congenital absence or hypoplasia of long bone. In addition to fibular absence or hypoplasia, this entity also includes various combined abnormalities of the lower limbs. We present here three cases of fibular hemimelia who underwent diagnosis and treatment in our hospital. Wee especially focus on the imaging findings of the plain radiographs, and we compare them with the findings found at another presentation.
Diagnosis ; Ectromelia* ; Extremities ; Fibula ; Lower Extremity

OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.
Female ; Hemoperitoneum ; Humans ; Liver ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Vital Signs

The clinical usefulness of polymerase chain reaction (PCR) for the diagnosis of trichomoniasis was evaluated in comparison with other conventional tests. PCR was used for specific detection of Trichomonas vaginalis by primers based on the repetitive sequence cloned from T. vaginalis (TV-E650). Between June 1996 and August 1997, 426 patients visited the department of obstetrics and gynecology, Hanyang University Kuri Hospital and were examined for trichomoniasis using wet mount examination, Papanicolaou (Pap) smear, culture and PCR. One hundred and seventy-seven patients (group A) visited with the symptoms of vaginal discharge and 249 patients (group B) visited for regular cervical Pap smear with no vaginal symptoms. From group A (n = 177), 3 infections (2.0%) were detected by wet mount, 6 infections (3.3%) by Pap smear and culture, and 17 infections (10.4%) by PCR. From group B (n = 249), 4 patients (1.6%) were found to have T. vaginalis by culture and 6 infections (2.4%) were detected by PCR. Therefore, in both groups, PCR for T. vaginalis showed a higher detection rate compared with conventional wet mount, Pap smear or culture. The detection by PCR was specific for T. vaginalis since no amplification was detected with DNAs from other protozoa and Candida albicans. The sensitivity and specificity of PCR were 100%. This method could detect T. vaginalis in vaginal discharge at a concentration as low as 1 cell per PCR mixture. These results indicate that PCR could be used as a specific and sensitive diagnostic tool for human trichomoniasis.
Female ; Human ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Trichomonas Vaginitis/diagnosis*

Hepatocellular carcinoma (HCC) during pregnancy is a rare event and reports are isolated and highly scattered. HCC during pregnancy carries a poor prognosis because of difficulty in diagnosis due to the fetus. The impact of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC during pregnancy remains controversial. At present, the screening of maternal serum alpha-fetoprotein(AFP) in the second trimester of pregnancy is a standard procedure for detection of fetal malformation. An elevated maternal serum AFP level may not always be of fetal origin and some maternal diseases could present an elevated maternal serum AFP. The ultrasonography for abdomen has been accepted as a simple and safe method for this group. We have experienced two cases of HCC during pregnancy over the last 5 years. One was diagnosed with a palpble abdominal mass which was revealed to be HCC at 12 weeks of pregnancy and died 2 months after the diagnosis without treatmemt. The second was incidentally found to have abnormal serum AFP at 17 weeks of pregnancy and underwent the extended right hepatic lobectomy without complication. We suggest that careful physical examination and abdominal ultrasonography seems to be the best screening tools for early diagnosis of HCC in pregnancies with high serum AFP level.
Abdomen ; Carcinoma, Hepatocellular ; Diagnosis ; Early Diagnosis ; Female ; Fetus ; Humans ; Mass Screening ; Physical Examination ; Pregnancy Trimester, Second ; Pregnancy* ; Prognosis ; Risk Factors ; Ultrasonography

The aim of this study was to prepare inclusion nanocomplexes of hyaluronic acid-β-cyclodextrin and simvastatin (HA-β-CD/SIM) and evaluate in vitro anti-inflammation effects on lipopolysaccharide (LPS)-activated synoviocytes and chondrogenic differentiation effects on rat adipose-derived stem cells (rADSCs). The β-CD moieties in HA-β-CD could incorporate SIM to form HA-β-CD/SIM nanocomplexes with diameters of 297–350 nm. HA-β-CD/SIM resulted in long-term release of SIM from the nanocomplexes for up to 63 days in a sustained manner. In vitro studies revealed that HA-β-CD/SIM nanocomplexes were able to effectively and dose-dependently suppress the mRNA expression levels of proinflammatory markers such as matrix metallopeptidase-3 (MMP-3), MMP-13, cyclooxygenase-2 (COX-2), a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α) in LPS-stimulated synoviocytes. HA-β-CD/SIM-treated rADSCs significantly and dose-dependently enhanced mRNA expressions of aggrecan, collagen type II (COL2A1), and collagen type X (COL10A1), implying that HA-β-CD/SIM greatly induced the chondrogenic differentiation of rADSCs. Conclusively, HA-β-CD/SIM nanocomplexes will be a promising therapeutic material to alleviate inflammation as well as promote chondrogenesis.
Aggrecans ; Animals ; Chondrogenesis ; Collagen Type II ; Collagen Type X ; Cyclooxygenase 2 ; In Vitro Techniques* ; Inflammation ; Interleukin-6 ; Rats ; RNA, Messenger ; Simvastatin* ; Stem Cells ; Thrombospondins ; Tumor Necrosis Factor-alpha

OBJECTIVE: Incompetent internal os of cervix is one of the most common causes of midtrimester abortion in which interventions such as, transvaginal cerglage and transabdominal cervicoisthmic cerclage (TCIC) have been performed to prolong pregnancy. Transabdominal cerclage is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. Due to technical difficulties and the fact that a cesarean section is necessary for delivery, has not been a procedure easily adopted. The purpose of our study was to compare the effectiveness of selected Modified McDonald cerclage (MTVC) and TCIC was compared in patients who had history of a previously failed transvaginal cerclage in other hospital. MATERIALS AND METHODS: Pregnancy outcomes of 13 patients who underwent TCIC from November 1997 to January 2002 and those of 28 patients who underwent MTVC from January 2000 to January 2002 were compared. Statistical analysis was done using Chi-square test and Mann-Whitney. RESULTS: The fetal salvage rates for total 13 cases of TCIC and 28 cases of MTVC were 100% (13/13) and 85.7% (24/28), respectively. The fetal salvage rates between these two groups were not statistically different. The mean gestational age at the time of operation in TCIC group was 13.15 (+/-1.63) weeks, mean gestational weeks delayed until delivery was 23.85 (+/-3.24) weeks and mean fetal body weight was 2780.77 (+/-667.33) gm. Comparably, the mean gestational age at the time of operation in MTVC group was 15.00 (+/-2.05) week, mean gestational weeks delayed until delivery was 9.96 (+/-6.65) week and mean fetal body weight was 2530 (+/-1071.26) gm. CONCLUSION: In patients who had a history of failure of TVC, the effectiveness of TCIC and MTVC had no statistical significance. Treatment with MTVC should be considered since TCIC is technically difficult and requires cesarean section.
Cervix Uteri* ; Cesarean Section ; Cicatrix ; Female ; Fetal Weight ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second

Insulinoma is the most common functioning tumor of pancreas even though its prevalence is rare. The diagnosis and the treatment of insulinoma is very important because the tumor can induce critical and permanent neurologic deficit. We experienced ten patients with insulinoma and treated by surgical interventions at the Department of Surgery, Yonsei university college of medicine from 1983 to 1996. All the data were analysed retrospectively. The mean age of patient was 45 years (range: 17 to 69) and the sex ratio of male to female was 1:2.3. The most common clinical manifestation was weakness. The preoperative mean levels of fasting blood sugar, plasma insulin, C-peptide, insulin to glucose ratio were 41(mg/dl), 40.07(U/ml), 4.03(ng/ml), 1.51, respectively. The detection rates of localizing tools on our cases were showed as follows: THPVS(100% in 5 cases), EUS(67% in 3 cases), MRI(33% in 3 cases), CT scan(33% in 9 cases), angiography(33% in 6 cases) and US (20% in 10 cases). The intraoperative ultrasound(IOUS) was performed in the last three cases to try to find occult insulinoma and the relationship with main duct of pancreas in operative field. The types of surgical interventions were enucleation in 5 patients, distal pancreatectomy in 4 patients, pancreatoduodenectomy in 1 patient. The tumors were located in nearly equal frequencies over the entire pancreas: head(30%), neck & body (30%), tail(40%). All of the tumors were single and 90% of them were solid and benign. The mean diameter of the tumors was 1.5cm. Symptoms of hypoglycemia and laboratory values such as fasting blood sugar, plasma insulin, C-peptide, insulin glucose ratio were improved in all the patient after operation. We suggest that the THPVS is the most sensitive preoperative test for localizing insulinomas and recommend the IOUS as a tool for detecting occult or multiple insulinoma and identifing the relationship with main duct of pancreas in operative field.
Blood Glucose ; C-Peptide ; Diagnosis ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulin ; Insulinoma* ; Male ; Neck ; Neurologic Manifestations ; Pancreas* ; Pancreatectomy ; Pancreaticoduodenectomy ; Plasma ; Prevalence ; Retrospective Studies ; Sex Ratio

Heterotopic pregnancy is a rare event, occurring less than 1 : 30,000 pregnancies in natural conception cycles. With assisted reproduction techniques, however, this incidence increase to between 1 : 100 and 1 : 500. It is known to present with a variety of symptoms and signs after leading to a delay in establishing the correct diagnosis. Delay in diagnosing and surgery can jeopardize both maternal well-being and survival of the intrauterine fetus. Prompt diagnosis and appropriate surgery contribute to the favorable outcome for the mother and surviving infant. We experienced a case of heterotopic pregnancy after in vitro fertilization and embryo transfer, which carried the intrauterine pregnancy to term delivery following rupture of the tubal pregnancy, with hypovolemic shock. So we report this case with review of literatures.
Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Fetus ; Humans ; Incidence ; Infant ; Mothers ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Reproductive Techniques ; Rupture ; Shock