Postpartum hemorrhage is an important cause of maternal mortality and morbidity. Especially uterine atony is the most common cause of postpartum hemorrhage. Conventional method to control postpartum uterine atonic bleeding is based on the use of oxytocin and ergot preparations. Prostaglandin F2alpha analogue such as carboprost can be used to promote contraction when these agents fail to produce uterine contraction. Prostaglandin E1 analogue, misoprostol has uterotonic effect by oral or vaginal administration. They are used to induce labor and first or mid trimester abortion. In postpartum uterine atonic bleeding, misoprostols cannot be used via oral or vaginal route. Recently we have experienced that postpartum uterine atonic bleedings unresponsive to conventional methods were controlled by rectal misoprostols. So we report these cases with a brief review of literatures.
Administration, Intravaginal ; Alprostadil ; Carboprost ; Dinoprost ; Hemorrhage* ; Maternal Mortality ; Misoprostol* ; Oxytocin ; Postpartum Hemorrhage ; Postpartum Period* ; Uterine Contraction ; Uterine Inertia

OBJECTIVE: To assess the relationship between vaginal cytology and bone mineral density in postmenopausal women. METHODS: In 93 postmenopausal women, vaginal cytology smears were taken for maturation index, serum estradiol level and bone mineral density were also taken. the percentage of each cell type found By vaginal cytology was multiplied to its specific value:superficial cells, 1.0; intermediate cell, 0.6; parabasal cell, 0.2 and modified to maturation value. Bone mineral density was measured at lumbar spine using DEXA. RESULTS: The mean bone mineral density was 0.88+/-0.14g/cm2. Mean maturation value was 50.53+/-20.74 and it was related with age and bone mineral density. CONCLUSION: Maturation value of vaginal epithelial cell represents the influence of estrogen on bone mineral density.
Bone Density* ; Epithelial Cells ; Epithelium* ; Estradiol ; Estrogens ; Female ; Humans ; Spine

OBJECTIVES: A retrospective study was performed to clarify the change of lumbar bone mineral density(BMD) according to the duration of hormone replacement therapy(HRT) and the other factors such as age, years since menopause(YSM) and initial BMD in postmenopausal women. METHODS: From January, 1995 to December, 1998 we measured lumbar bone mineral density in 100 postmenopausal women in the department of obstetrics and gynecology, Inha University Hospital. These women had been followed for 2 years after taking HRT. We investigated whether there were any relation between the duration of HRT, age, YSM, initial BMD and change of BMD. RESULTS: Lumbar BMD was increased 2.06% after one year of HRT(p=0.0001) but there was no change of BMD at the 2nd year of HRT(p=0.847). The response to HRT was greatest in those who were oldest(r=0.209 ; p=0.039) and furthest YSM(r=0.209; p=0.039), and consequently among those who had the lowest BMD(r=0.590 ; p=0.0001). CONCLUSION: The bone mass was increased upto 2.06% at the 1st year of HRT but no more progressive increase was occurred. It suggest that intensive HRT is needed at 1st year of therapy. The risk of fracture is not decreased to that of the healthy population inspite of HRT, so the earlier therapy is necessary to prevent osteoporotic fracture despite of intervention.
Bone Density* ; Female ; Gynecology ; Hormone Replacement Therapy* ; Humans ; Obstetrics ; Osteoporotic Fractures ; Retrospective Studies

OBJECTIVES: To evaluate the effect of transdermal estrogen on arterial tone. METHODS: In 30 postmenopausal women, doppler ultrasound was used to assess blood flow characteristics in internal carotid arteries. As the pulsatility index(PI) represents impedance to blood flow distal to the point of sampling, pulsatility index of internal carotid artery was measured from the flow velocity waveform. Patients were studied pretreatment and at weeks 8, 12, and 24 of treatment with transdermal estradiol 50microgram/day. RESULTS: Blood pressure was not changed during transdermal estrogen replacement therapy. Serum estradiol was increased from 13.4+/-13.7pg/ml to 55.8+/-32.8pg/ml with week 8 of treatment and it was maintained until week 24. The mean pulsatility index was fallen to 0.1+/-0.1 during week 8 of therapy and a significant reduction in PI was maintained until week 24(p=0.0001). CONCLUSION: We believe that transdermal estrogen replacement therapy affects on the arterial tone and prevents cardiovascular disease in postmenopausal women.
Blood Pressure ; Cardiovascular Diseases ; Carotid Artery, Internal* ; Electric Impedance ; Estradiol ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Ultrasonography

A clinical observation was made on 116 patients of cryptorchidism who had been admitted to the Department of Urology, Gil Genersl Hospital during 34 months from March, 1992 to January l995. The results were as follows: 1. The age distribution varies from to 1 to 33 years and the most frequent group was l to5 years old(62%). 2. Bilateral cryptorchidism was found in 22 cases(19%), and in the case of unilatera1, right in 52 cases(44.8%) and left in 42 cases(36.2%). 3. Of the 138 testes, most frequent location was in the inguinal canal in 123 testes(89.1%). 4. Orchiopexy was perrormed on 130 testes(94.2%) by subdartos pouch technique and 7 testes were performed the orchiectomy 5. Among the associated anomalies, the most common anomaly was inguinal hemia in 131 cases and others were contralateral hydrocele, hypospadias, congenital heart disese and syndactyly.
Age Distribution ; Cryptorchidism* ; Female ; Heart ; Humans ; Hypospadias ; Inguinal Canal ; Male ; Orchiectomy ; Orchiopexy ; Syndactyly ; Testis ; Urology

PURPOSE: BRAF mutation and expression of extracellular signal regulated kinase (ERK) are linked with colorectal carcinogenesis through the serrated pathway. BRAF and ERK1/2 play important roles in the activation of mitogen-activated protein (MAP) kinase signaling pathways. The present study investigated the clinicopathologic outcomes of BRAF mutation and ERK1/2 expression in patients with colorectal cancer (CRC) and the possibility of using them as prognostic indicators. METHODS: Dual-priming oligonucleotide-based multiplex polymerase chain reaction for BRAF(V600E) mutation and immunohistochemical analysis of ERK1/2 were performed using 65 formalin-fixed, paraffin-embedded samples from patients with CRC. We analyzed the dependences of the clinicopathologic features on BRAF mutation and ERK1/2 expression. RESULTS: Out of 65 samples from CRC patients, BRAF mutation was detected in 3 (4.6%). The 3 patients with BRAF mutation presented with T3 CRC with lymph node metastasis (stage III) showing moderately or poorly differentiated histology. ERK1 and ERK2 were positively detected in 73.8% and 15.4% of the patients with CRC, respectively. ERK1 expression was significantly correlated with lymph node metastasis (P = 0.049). ERK2 expression was significantly correlated with tumor emboli (P < 0.05), tumor invasion (P = 0.035), lymph node metastasis (P = 0.017), and stage (P = 0.02). CONCLUSION: BRAF mutation and ERK1/2 expression may be associated with advanced or more aggressive CRC. These molecular markers might play prognostic roles in CRC developed through the serrated pathway.
Adenocarcinoma* ; Carcinogenesis ; Colorectal Neoplasms ; Humans ; Lymph Nodes ; Multiplex Polymerase Chain Reaction ; Neoplasm Metastasis ; Phosphotransferases*

Leigh Disease, or subacute necrotizing encephalopathy (SNE), is a degenerative disorder characterized by lesions of the gray and white matter in the bran and spinal cord. The pathogenesis was known as mitochondrial enzyme defect of the respiratory chain system. We experienced 2 cases of Leigh disease. The first case, a seven-month old girl who was presented with weak respiration and failure to thrive, showed lactic acidemia and increased lactic acid in CSF fluid, high signal intensity in the bilateral putamen and head of caudate of nucleus at T2 weighted MR imaging. The second case, a 3-year-old girl with ataxic gait and bilateral ptosis also showed lactic acidemia, increased lactic acid in CSF fluid and high signal intensity in the bilateral basal ganglia. Respiratory difficuly developed in both cases and died within 1 month after visiting our hospital. The diagnosis was made by lactic acidosis and specific MRI finding. We report these cases with a brief review of its related literature.
Acidosis, Lactic ; Basal Ganglia ; Child, Preschool ; Diagnosis ; Electron Transport ; Failure to Thrive ; Female ; Gait ; Head ; Humans ; Lactic Acid ; Leigh Disease* ; Magnetic Resonance Imaging ; Putamen ; Respiration ; Spinal Cord

The incidence of spontaneous cerebellar hemorrhage is a range of between 0.3% and 0.7% in several large series and accounts for 10% of all intracranial hemorrhages. The course and prognosis of spontaneous intracerebellar hemorrhage, regardless of treatment, is poor. The Cosman-Robert-Wells(CRW) stereotactic instrument is recently developed modification, based on an arc-radius design, of the Brown-Roberts-Wells(BRW) stereotactic frame utilizing the exising fixation and fiducial components of the BRW stereotactic system localize and verify target data. During the year of 1989 through 1991, 25 patients with spontaneous cerebellar hemorrhage operated on using CRW stereotactic instrument and fibrinolysis. The age incidence was most frequent in 7th decade. 19 cases(76%) obtained a favorable outcome after operation and 4 cases(16%) death. 2 cases subsequently developed postoperative rebleeding and a case infection. The short operating time, the relatively low risk involved, and the lack of danger to healthy brain support the use of CT-guided stereotactic removal and fibrinolysis. In our opinion, CT guided sterotactic removal is simple, effective and safe method for spontaneous cerebellar hematoma.
Brain ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Humans ; Incidence ; Intracranial Hemorrhages ; Prognosis ; Tomography, X-Ray Computed

OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.
Cesarean Section ; Defecation* ; Female ; Humans ; Physiology* ; Postpartum Period* ; Pregnancy ; Pudendal Nerve*

Achalasia is a rare motor disorder of the esophageal smooth muscle in which the lower esophageal sphincter dose not relax properly with swallowing, and the normal peristalsis of the esophageal body is replaced by abnormal contractions. Achalasia has been described as party of several distinct multisystem syndromes suggesting a generalized neuromuscular disorder as the mode of origin. An 11-year-old female was admitted because of paresthesia on the trunk and both legs for 5 days. She had suffered from chest discomfort, dysphagia, postprandial vomiting, and weight loss for 6 months. She was diagnosed as having achalasia by means of the esophagography and esophageal manometry. Her chest discomfort, dysphagia and vomiting much improved after the endoscopic balloon dilatation. The authors present an 11-year-old female with achalasia complained of paresthesia and sucessfully managed by the balloon dilatation.
Child ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Female ; Humans ; Leg ; Manometry ; Muscle, Smooth ; Neurologic Manifestations* ; Paresthesia ; Peristalsis ; Thorax ; Vomiting ; Weight Loss