OBJECTIVES: From February 1995 to April 1998, those patients who had visited for evaluation of infertility, shown abnormal endometrial pattern on hysterosalpingography underwent resectoscopic operation. We evaluated about its therapeutic effect, recurrence rate of uterine adhesion and effectiveness of its assisted method. METHOD: We have reviewed 45 cases of intrauterine adhesion, classified as a central type, marginal type and multiple type. We used 26F resectoscope made in Storz for operation and inserted Lippes loop or pediatric foley catheter for prevention of readhesion. For promoting reepithelialization, conjugated estrogens(premarin) 5mg daily for 30 - 50 days were given and then 10mg of medroxyprogesterone acetate(provera) were added daily for the last 10 days. We evaluated the uterine cavity condition preoperatively and postoperatively by using hysterosalpingography. RESULT: In 45 cases, 41 cases were followed up postoperatively. 21 cases were markedly improved, 12 cases were improved and 8 cases were not improved or recurred on hysterosalpingography. In 41 cases, for prevention of readhesion 20 cases were used pediatric foley catheter and 5 cases(25%) were recurred. 21 cases were used Lippes loop and 3 cases(14%) were recurred. Pregnancy outcome was as follows;15 cases were pregnant and 10 cases delivered a viable infant, 3 cases aborted spontaneously, 1 case was ectopic pregnancy and laparoscopic salpingectomy was done, 1 case was ongoing pregnancy. CONCLUSION: This report suggests that resectoscopic operation is very effective in the treatment of intrauterine adhesion(therapeutic rate of 81%) and that the use of Lippes loop seems like to have the less recurrence rate than the use of pediatric foley catheter in prevention of postoperative readhesion, but more experience and further follow-up are necessary to obtain more detailed conclusions.
Catheters ; Female ; Follow-Up Studies ; Humans ; Hysterosalpingography ; Infant ; Infertility ; Medroxyprogesterone ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Recurrence ; Salpingectomy

Bosworth fracture, fracture-dislocation of ankle with entrapment of fibula behind the tibia, is a rare condition. Diagnosis of this fracture-dislocation may not he easy, and closed reduction of this injury is difficult because of entrapment of fibula by the tieht interosseous membrane. We report a case of Bosworth fracture treated with the anti-glide plate technique.
Ankle ; Diagnosis ; Fibula ; Membranes ; Tibia

Osteoporosis represents reduced amount of bone mass per unit volume as compared with controls of the same age and sex. The purpose of this study was to show how bone mineral densities of spine and intertrochanteric area decrease with aging, to investigate the relationship between the bone mineral densities (BMD) of the two areas, and to obtain fracture threshold values. We measured BMD of lumbar vertebrae and intertrochanteric areas by Dual Energy X-ray Absorptiometry (DEXA) from 241 postmenopausal women. 190 normal postmenopausal women comprised non-fracture group and there were 50 fresh thoracolumbar fracture patient and 31 intertrochanteric fracture patients in whom the fractures were not caused by high energy trauma. The mean bone mineral density values of non-fracture group were significantly higher than those of fracture groups and significant correlation held between bone density of spine and that of intertrochanteric area in non-fracture group and fracture groups. The fracture threshold was 0.837 g/cm3 in spine fracture group and 0.792 g/cm3 in the intertrochanteric fracture group.
Absorptiometry, Photon* ; Aging ; Bone Density* ; Female ; Humans ; Lumbar Vertebrae ; Osteoporosis ; Spine

PURPOSE: The purpose of this study was to develop an instrument to measure sexual satisfaction in Korean adults. METHOD: Development of items for the instrument was done by a collecting, reorganizing, reducing and selecting process based on the literature. A total of 19 items were selected in this process. For evaluation of the appropriateness of the 19 items, questionnaires were given to an expert group consisting of 18 professionals (7 men and 11 women). Eighteen items having a response of 70% in 'very good' item or 'good' item were included as items for the instrument. With these 18 items, a 5 point Likert scale was developed, and reliability and validity tests of the scale were done. The subjects for the test were 1,127 Korean adults living in 11 areas in Korea. Data were collected from Dec. 1, 2000 to Feb. 28, 2001 and analyzed with SPSS/PC+ 10.0 program. Item analysis and factor analysis were used to assess the reliability and validity of the scale. Chronbach alpha and corrected item-total correlation were obtained to verify internal consistency, and principal component analysis with the varimax rotation was used to identify structure validity of the developed tool. RESULT: Reliability of the scale was .9503 and corrected item-total correlations of the items were distributed from .5208 to .7899. As a result of the factor analysis, the items were categorized into three factors. The cumulative variance of the three factors was 67.1%, and all of the variances of the factors were above 5%. Because factor 1 (8 items) indicated a special feeling of psychological satisfaction with sexual activity, it was named 'psychological factor'. Factor 2 (8 items) indicated a feeling of satisfaction in the interaction with sexual partner through communication and variation, therefore it was named 'interactional factor'. Factor 3 (2 items) was about the frequency and duration of sexual intercourse and indicated physical dimensions of satisfaction, so it was named 'physical factor'. The average score for sexual satisfaction of the 1,127 subjects was 65.32 (+/-12.71), and histogram of the score showed a normal distribution with skewness -.425. CONCLUSION: Finally, a Korean Sexual Satisfaction Scale(KSSS) was accepted as a 5 point Likert scale with 18 items after the statistical test for reliability and validity. In conclusion, KSSS is a useful instrument which is valid and reliable can be used to understand the sexuality of Korean adults.
Adult ; Coitus ; Humans ; Korea ; Male ; Principal Component Analysis ; Surveys and Questionnaires ; Reproducibility of Results ; Sexual Behavior ; Sexual Partners ; Sexuality

PURPOSE: The purpose of this study was to identify the factors influencing parenting stress in primiparas. METHOD: The participants in this study were 198 primiparas of infants aged 1-6 months who visited well baby clinics in 5 hospitals. The data were collected from April 15 to June 15, 2003. RESULTS: The mean score for parenting stress was 2.4 of a possible 5 and thus considered average. The score for parenting stress was significantly correlated with the level of maternal perception of the infant and the level of social support. The score for parenting stress was significantly different according to the education level of the primiparas and prenatal management. For the primiparas, social support(20%) and maternal perception of the infant(9%) were significant predictors explaining parenting stress. CONCLUSIONS: Nursing interventions to improve maternal perception of the infant and increase social support should be provided for primiparas in order to reduce parenting stress.
Education ; Humans ; Infant ; Nursing ; Parenting* ; Parents* ; Child Health

BACKGROUND/AIMS: Tenofovir disoproxil fumarate (TDF) exhibits similar antiviral efficacy against treatment-naïve and lamivudine (LAM)-resistant chronic hepatitis B (CHB). However, there are few clinical reports on the antiviral effects of TDF-LAM combination therapy compared to TDF monotherapy in patients with LAM-resistant CHB. METHODS: We investigated the antiviral efficacy of TDF monotherapy vs. TDF-LAM combination therapy in 103 patients with LAM-resistant CHB. RESULTS: The study subjects were treated with TDF alone (n=40) or TDF-LAM combination therapy (n=63) for ≥6 months. The patients had previously been treated with TDF-based rescue therapy for a median of 30.0 months (range, 8-36 months). A virologic response (VR) was achieved in 99 patients (96.1%): 95.0% (38/40) of patients in the TDF monotherapy group and 96.8% (61/63) of patients in the TDF-LAM combination therapy group. The VR rates were not significantly different between the TDF monotherapy and TDF-LAM combination therapy groups (88.9 vs. 87.3% at month 12, and 94.4 vs. 93.7% at month 24, log-rank p=0.652). Univariate and multivariate analyses revealed that none of the pretreatment factors were significantly associated with VR. CONCLUSIONS: TDF monotherapy was as effective as TDF-LAM combination therapy for maintaining viral suppression in the vast majority of patients with LAM-resistant CHB, which suggests that TDF add-on therapy with LAM is unnecessary.
Adult ; Aged ; Aged, 80 and over ; Antiviral Agents/pharmacology/*therapeutic use ; DNA, Viral/blood ; Drug Administration Schedule ; Drug Resistance, Viral/drug effects ; Drug Therapy, Combination ; Female ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Kidney Function Tests ; Lamivudine/*therapeutic use ; Liver Function Tests ; Male ; Middle Aged ; Polymerase Chain Reaction ; Tenofovir/*therapeutic use ; Treatment Outcome

BACKGROUND: Several studies have been reported that the presence of Helicobacter DNA in human bile sample, although its pathological role is not clear. The purpose of this study was to evaluate the presence and identification of Helicobacter species in human bile samples obtained from patients with biliary tract diseases. METHODS: 58 bile samples (35 intrahepatic duct stones, 10 bile duct cancer, 13 pancreatic cancer) were obtained by percutaneous transhepatic biliary drainage (PTBD). DNA was isolated from bile sample. The primers were designed to amplify region of Helicobacter genus specific 16S rRNA. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was developed to differenciate the presence of H. pylori, H. bilis, H. rappini and H. muridarum. RESULTS: Forty-two of 58 (72.4%) bile samples obtained from patients with biliary tract disease showed positive PCR band for Helicobacter genus specific 16S rRNA. H. pylori was found in 83.3% of positive samples. Either H. bilis or H. rappini was in 16.7%. H. muridarum, however, was not detected. CONCLUSION: Helicobacter genus was detected in human bile samples obtained from patients with biliary tract diseases using PCR method, and the major species was H. pylori. In addition, RFLP technique was used successfully to identify Helicobacter species.
Bile Duct Neoplasms ; Bile* ; Biliary Tract Diseases ; DNA ; Drainage ; Helicobacter pylori ; Helicobacter* ; Humans* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

Mycophenolate mofetil (MMF) is a immunosuppressive agent increasingly used in organ transplantation and autoimmune disease. We report a case about use of MMF in SLE patient with rapidly worsening renal function. A 24-year old female was admitted due to 1-week history of generalized edema. Despite use of diuretics and conventional supported care, generalized edema was more aggravated and serum creatinine was elevated up to 5.2 mg/dL. Ten days after the initial admission, we started hemodialysis. After hemodialysis, improvement of generalized edema was achieved. Eighteen days after initial hemodialysis, we started corticosteroids and MMF because she shows persistent heavy proteinuria and oliguria. After use of corticosteroids and MMF, clinical improvement of renal complication was achieved in this patient. About 6 weeks later, we could discontinue hemodialysis. On two year follow up duration, she shows good renal function and no evidence of lupus flare-up signs. We suggest MMF is one of therapeutic options for patients with severe lupus nephritis, especially those refractory or intolerant to conventional cytotoxic agents.
Acute Kidney Injury* ; Adrenal Cortex Hormones ; Autoimmune Diseases ; Creatinine ; Cytotoxins ; Diuretics ; Edema ; Female ; Follow-Up Studies ; Humans ; Lupus Nephritis* ; Oliguria ; Organ Transplantation ; Proteinuria ; Renal Dialysis ; Transplants ; Young Adult

PURPOSE: Because depth of invasion by T3 rectal cancer can vary according to the extent of mesorectal invasion, the prognosis for invasive T3 rectal cancer is reported to be very different from that for minimal invasive cancer. Recently, with more emphasis on circumferential resection margin (CRM) status, the T stage, rather than the N stage, seems to be a more valuable prognostic marker in rectal cancer. Therefore, the aim of this study is to determine the prognostic significance of the CRM in invasive T3 rectal cancer. METHODS: Through reviewing 324 consecutive patients with rectal cancer who underwent a curative resection between January 1995 and December 2002 at Busan Paik hospital, 195 patients with invasive T3 rectal cancer, who had not received preoperative neoadjuvant therapy were selected. The patients were classified into a negative CRM group (negative group, n=173) or a positive CRM group (positive group, n=22), and the patients were subgrouped according to the presence of lymph-node (LN) metastasis and CRM status as negative LN and negative CRM (L-/CM-), negative LN and positive CRM (L-/CM+), positive LN and negative CRM (L+/CM-) and positive LN and positive CRM (L+/CM+). All pathological specimens were re-reviewed by a single pathologist, and the distance between the most advanced edge and the outermost aspect of the specimen was re-measured by using a microscope. Local relapse rates, disease free survival, and overall survival were compared using the Kaplan- Meier method. Multivariate analyses to identify independent prognostic factors were performed using the logistic regression model. RESULTS: Local recurrence rates in the positive group and the negative group were 38.6% and 15.3%, respectively (P=0.004, log-rank test). The multiple logistic regression model demonstrated positive CRM (hazard ratio 4.4, P=0.0007) and N2 nodal status (hazard ratio 2.4, P=0.02) as predictors of local recurrence. In the subgroup analysis, the overall recurrence rates and survival rates were, respectively, 12.3% and 86.5% in the L-/CM- subgroup, 53.1% and 50.3% in the L-/CM+ subgroup, 52.7% and 50.0% in the L+/ CM- subgroup, and 58.7 % and 33.8% in the L+/CM+ subgroup (log rank test for trend; P=0.0001 and P=0.0001, respectively). CONCLUSIONS: In the event of predicted CRM involvement in invasive T3 rectal cancer, adjuvant therapy should be performed to improve local control. Also, larger prospective studies are needed to clarify the prognostic role of the CRM in invasive T3 rectal cancer because the number of cases in this study was small, especially in the number of CRM positive cases.
Disease-Free Survival ; Humans ; Logistic Models ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Survival Rate

Multiple epiphyseal dysplasia is caused by heterogenous genotypes involving more than six genes. Recessive mutations in the DTDST gene cause a phenotype of recessive multiple epiphyseal dysplasia (rMED). The authors report a 9-yr old Korean girl with the rMED phenotype having novel compound heterozygous mutations in the DTDST gene, which were inherited from both parents. This is the first Korean rMED case attributed to DTDST mutations, and expands the spectrum of diseases caused by DTDST mutations.
Animals ; Anion Transport Proteins/*genetics ; Asian Continental Ancestry Group/genetics ; Child ; DNA Mutational Analysis ; Female ; *Genes, Recessive ; Genotype ; *Heterozygote ; Humans ; Korea ; *Mutation ; Osteochondrodysplasias/*genetics ; Phenotype