Primary malignant melanornn of the vagina is rare, with only about 130 reported cases worldwide. They presumably arise from melanocytes that are present in the vagina in 3% of normal wornen. Vaginal melanoma accounts for less than 1% of melanomas and less than 3% of primary malignant tumors of the vagina. Most of patients complain vaginal bleeding, vaginal discharge, foreign body sensation in order. The best treatment of vaginal melanoma rernains eni.gmatic, Many authors indicate that radical surgery may be the pcferred approach and the number of reported cases treated with radical surgery is increasing. But other author comment that no significant change in survival is apparent with radical surgery. Overall prognosis is poor as most patients have deeply penetrating lesions at the time of diagnosis. Recently, not only the effort to increase the survival rate but the quality of life including sexual function after treatment is becoming an important issue about treatment ot cancer patients. We experienced a case of primary malignant melanoma of the vagina treated with radical surgery and restored the sexual function by vulvovaginal reconstruction using gracilis myocutaneous flap. So we report this case with brief literature review.
Diagnosis ; Foreign Bodies ; Humans ; Melanocytes ; Melanoma* ; Myocutaneous Flap ; Prognosis ; Quality of Life ; Sensation ; Survival Rate ; Uterine Hemorrhage ; Vagina* ; Vaginal Discharge

OBJECTIVE: To evaluate luteinizing hormone(LH) in patients with infertility and recurrent spontaneous abortion. MATERIAL AND METHOD: LH was tested by solid phase immunoradiometric assay based on monoclonal and polyclonal anti-LH antibodies. RESULTS: Of 100 infertile patients, the number of less than 5 mIU/ml, 5~10 mIU/ml, greater than 10 mIU/ml in LH level was 67(67%), 22(22%), 11(11%), respectively. Of 100 patients with recurrent spontaneous abortion, the number of less than 5 mIU/ml, 5~10 mIU/ml, greater than 10 mIU/ml in LH level was 79(79%), 18(18%), 3(3%), respectively. There was a significant difference between patients with infertility and recurrent spontaneous abortion only in the group with LH level greater than 10 mIU/ml(p=0.325). CONCLUSIONS: High LH in the follicular phase is known to decrease pregnancy rate and increase abortion rate. But in this study the incidence of high LH in patients with recurrent spontaneous abortion was low. On the contrary, there was a significant increase of LH in infertile patients. So recurrent spontaneous abortion does not seem to be related to high LH level.
Abortion, Induced ; Abortion, Spontaneous* ; Antibodies ; Female ; Follicular Phase ; Humans ; Immunoradiometric Assay ; Incidence ; Infertility* ; Lutein* ; Luteinizing Hormone* ; Pregnancy ; Pregnancy Rate

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) in Asians is characterized by frequent involvement of the spinal cord and optic nerve and low prevalence rates, but even the most fundamental epidemiologic findings and unique clinical features of MS patients in Korea have not been studied extensively. We performed this study to establish the clinical spectrum of MS patients in Korea. METHODS: Sixty-two MS patients (25 men and 37 women) who satisfied the diagnostic criteria for definite MS were reviewed retrospectively using medical records from two university hospitals and one general hospital. The MS patients were classified into the three clinical subtypes according to the involved site (opticospinal, spinal, and conventional MS). RESULTS: The age at MS onset was 35.2+/-13.3 (mean+/-SD) years, and the predominant initial clinical manifestations were myelopathy (54.8%) and optic neuropathy (33.9%). The single most common involved lesion site was the spinal cord (35.5%). Spinal (35.5%) and opticospinal (25.8%) MS were the most common type, and they had a frequent relapsing-remitting course and long lesions extending over two vertebral segments (as assessed using spinal cord MRI). The interval between the first symptom and relapse was 35.6+/-71.1 months, and the number of relapses was 3.8+/-2.6. The spinal form of MS was associated with a higher age at onset and a higher male-to-female ratio than the other types. Positive rates of CSF oligoclonal bands and IgG index and the number of patients with characteristic brain MRI lesions were low. However, the abnormal rate of visual evoked potentials was relatively high (64.4%). CONCLUSION: The clinical features of MS patients in Korea are different from those in Western patients, but similar to those in Far East Asian patients. The value of the various diagnostic tools used for MS should therefore be reevaluated, at least for Korean patients.
Asian Continental Ancestry Group ; Brain ; Evoked Potentials, Visual ; Far East ; Hospitals, General ; Hospitals, University ; Humans ; Immunoglobulin G ; Korea* ; Magnetic Resonance Imaging ; Male ; Medical Records ; Multiple Sclerosis* ; Oligoclonal Bands ; Optic Nerve ; Optic Nerve Diseases ; Optic Neuritis ; Prevalence ; Recurrence ; Retrospective Studies ; Spinal Cord ; Spinal Cord Diseases

Laparoscopic cholecystectomy has recently been accepted as a procedure of choice for treating cholelithiasis. Its complication rates were known to be comparable to classical cholecystectomy. Hemobilia is very rare after cholecystectomy but is one of the lethal complications that may occur weeks to months after the operation. Therefore, it is important to keep in mind that hemobilia due to communications between cystic duct and cystic artery or right hepatic artery pseudoaneurysms, can occur in the patients who have history of laparoscopic cholecystectomy when they have upper gastro-intestinal bleeding. Selective hepatic arteriography can be an important diagnostic and therapeutic modality having high success rate (81-96%). We report a case of hemobilia caused by cystic artery pseudoaneurysm following laparoscopic cholecystectomy which was undergone 1 month before admission, and will discuss the mechanism and the treatment of the pseudoaneurysm associated with hemobilia.
Aneurysm, False ; Angiography ; Arteries ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Cystic Duct ; Hemobilia* ; Hemorrhage ; Hepatic Artery ; Humans

A patient with encephalopathy associated with autoimmune thyroid disease (EAATD), which is one of the most important differential diagnoses of treatable dementia, presents with various neurological symptoms, such as repetitive epileptic seizures, altered mental status, and cognitive dysfunction. Steroid treatment is effective for EAATD. The incidence of EAATD increases considerably with age, particularly in female patients. Most patients with EAATD have normal thyroid function test results or mild hypothyroidism. Patients with EAATD with Graves' disease are very rarely reported. Here, we report a case of a 63-year-old woman who complained of declining cognitive ability and ataxia. She was diagnosed with EAATD accompanied by Graves' disease. Her neurological symptoms improved after intravenous steroid administration.
Ataxia ; Brain Diseases ; Dementia ; Diagnosis, Differential ; Epilepsy ; Female ; Graves Disease* ; Humans ; Hypothyroidism ; Incidence ; Middle Aged ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland*

Hemorrhagic conversion (HC) of a cerebral infarct is a radiological sign of reperfusion to the infarcted tissue. Recently the concept on HC needs to be revised in relation to advanced therapeutic trials for acute ischeniic strokes. To investigate the clinical significance of HC of a bland cerebral infarct, we analyzed the clinical and neuroimaging files of 70 stroke patients showing HC on the brain CT and/or MRI scans. We also studied the best-possible stroke mechanisms on clinicolaboratory grounds, the factors that might have contributed to HC, and the prognostic impact of HC. Of 70 patients with HC, 51 had infarcts in the carotid artery system, 18 in the vertebrobasilar system, and 1 in cerebral venous system. Definite cardioembolic sources were identified in 21 patients (30%). HC was associated with antithrombotic therapy in 21 patients (30%). Other stroke mechanisms included migraine (23 cases), moyamoya disease (2, cases), thrombotic thrombocytopenic purpura (I case), postoperative vasospasm (1 case), and dural sinus thrombosis (I case). We identified a subset of 14 patients with HC of isolated subcortical infarcts but without definite embolic sources. Sixty-four of 70 patients (91.5%) remained clinically stable or improved after HC, suggesting a relative safety of HC in this retrospective study. In conclusion HC follows cerebral infarctions caused by various non-embolic mechanisms as well as by embolism. HC was not a bad prognostic sign in tl-iis small series.
Brain ; Carotid Arteries ; Cerebral Infarction ; Embolism ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Migraine Disorders ; Moyamoya Disease ; Neuroimaging ; Purpura, Thrombotic Thrombocytopenic ; Reperfusion ; Retrospective Studies ; Sinus Thrombosis, Intracranial ; Stroke

The purpose of tracheotomy is to obtain secure airway for difficult airway management and long-term lung ventilation. Tracheotomy is an invasive procedure with the possibility of severe complications, but it is the last choice for difficult airway management. To perform tracheotomy is difficult in patients with anatomically distorted trachea, screened trachea by mass, fibrosis or adhesion and obesity. We report the experience of successful tracheotomy in the patient of severely distorted airway due to previous surgeries with the aid of the light illumination of fiberoptic bronchoscope.
Airway Management ; Bronchoscopes* ; Fibrosis ; Humans ; Lighting ; Lung ; Obesity ; Trachea ; Tracheotomy* ; Ventilation

There are diverse neurologic manifestations in patients with idiopathic or pseudohypoparathyroidism. Although one knows that hypocalcemia provokes symptoms of tetany, there is little knowldege about the paroxysmal dystonic choreoathetosis(PKC). We report two patients with paroxysmal symptoms resulting from hypocalcemia associated with idiopathic hypoparathyroidism and pseudohypoparathryoidism respectively, which were misdiagnosed and treated as epilepsy. They showed repetitive paroxysmal dystonic choreoathetotic movements that lasted for several seconds and typically induced by sudden voluntary movement. The ne-uroimaging showed bilateral symmetrical calcifications., mainly in the basal ganglia. In the clinical setting, these types of paroxysmal movements may be readily misdiagnosed as partial seizure or tetany. Therefore, not only the laboratory work up for hypocalcemia, but careful history taking and clinical observation is important in differential diagnosis of epilepsy and paroxysmal movements in the patient with hypocalcemia.
Basal Ganglia ; Diagnosis, Differential ; Epilepsy ; Humans ; Hypocalcemia ; Hypoparathyroidism* ; Neurologic Manifestations ; Pseudohypoparathyroidism ; Seizures ; Tetany

Acute propanil pesticide poisoning is rare and propanil is known to have a low toxicity. Propanil metabolite induces the conversion of Fe2+ in hemoglobin to Fe3+, forming methemoglobin. Patients with low metHb levels are asymptomatic, but severe methemoglobinemia produces headache, dizziness, decreased consciousness, convulsion, and death. Thus, delayed diagnosis in patients with severe methemoglobinemia can be lethal. We describe the case of a 60-year-old man who died of acute propanil pesticide poisoning. He presented with severe methemoglobinemia. Early methylene blue therapy is recommended for propanil pesticide poisoning patients with symptoms and signs of methemoglobinemia.
Consciousness ; Delayed Diagnosis ; Dizziness ; Headache ; Humans ; Methemoglobin ; Methemoglobinemia* ; Methylene Blue ; Middle Aged ; Poisoning* ; Propanil* ; Seizures

Hypertension (HT) is a well-known risk factor for stroke, either hemorrhagic or ischernic like small artery disease (SAD) and large artkry territory infarction (LAI). And it sometunes causes both types of stroke in a single patient. We investigated the vascular nsk factors (controlling HT) that nught be related to their stroke types in 307 acute stroke patients with HT: 152 patients with intracerebral hemorrhage (ICH), 77 with SAD, and 78 with LAL These factors were compared between the groups using the univanate statistical methods. The most significant ICH-related factor was the lower serum level of triglyceride, compared to ischemic stroke. And ischemic stroke-rqlated profile included longer duration of HT, smoking, diabetes mellitus(DM), higher level of uric acid. And lower level of HDL-cholesteroL Increased hematocrit, DM and smoking were particularly related to LAI. These findings suggest that a well-balanced control of the above-mentioned risk factors is warranted to prevent future stroke, in addition to strict control of HT. And management of hypertensive stroke patients should be differentiated and individualized a6cording to the coexisting stroke type-related profiles.
Arteries ; Cerebral Hemorrhage ; Hematocrit ; Humans ; Hypertension ; Infarction ; Risk Factors* ; Smoke ; Smoking ; Stroke* ; Triglycerides ; Uric Acid