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

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

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 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

OBJECTIVE: Several newly recognized Helicobacter spp. such as H. hepaticus, H. bilis, H. cholecystus, H. rappini, H. pullorum, can cause persistent hepatitis, hepatoma, cholangiopancreatitis, and cholecystitis in animals. Recently some studies have been reported that Helicobacter DNA can be found in the bile from the patients with diseased bile duct, although its clinical significance is still unclear. The aim of this study is to investigate the existence, and character of Helicobacter in the bile from the obstructed bile duct, and the relationship with pH and the other bacteria found in the bile. METHODS: Twenty-eight bile samples (15 from bile duct cancer, 6 from pancreatic head cancer, 7 from bile duct stones) were obtained from the PTBD route. Bile pH measurement, and Helicobacter culture in microaerophil uric and anaerobic conditions were performed. The primers chosen for polymerase chain reaction (PCR) amplification for detection and characterization were ureA (411 bp) and cagA gene (298 bp), respectively. And primer of 16s rRNA for all known bacteria including Helicobacter was used, and the kinds of bacteria were identified by RFLP. RESULTS: Helicobacter DNA was detected in 39.3%. The bile pH was not related with presence of Helicobacter (7.83 +/-0.41 vs 7.78+/-0.48). The prevalence of cagA was 35.7%, and 16s rRNA was found in 46.4%. The specific 16s rRNA band for Helicobacter was observed in 14.3%. All the culture were not successful. CONCLUSION: Although the Helicobacter spp. were not cultured, Helicobacter exists obviously in the bile from the diseased bile duct, and coexist with other bacteria. These results should stimulate studies to ascertain whether these Helicobacter play a role in the pathogenesis of bile duct diseases in human.
Animals ; Bacteria ; Bile Duct Diseases ; Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular ; Cholecystitis ; DNA* ; Head and Neck Neoplasms ; Helicobacter* ; Hepatitis ; Humans ; Hydrogen-Ion Concentration ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Prevalence ; Urea

Serious cytomegalovirus (CMV) infection occurs frequently in immunocompromised patients and is a common cause of death. Although primary infection in immunocompetent hosts is normally subclinical, mononucleosis-like syndrome that is characterized by malaise, protracted fever, mild liver function abnormalities, and lymphocytosis with atypical lymphocytes occurs in -10% of patients. Rarely fulminant infection may develop. In both the United States and the United Kingdom, ganciclovir and foscarnet are recommended for the treatment of serious CMV infections in immunocompromised patients. In contrast, there are no recommendations for treatment of severe CMV disease in immunocompetent patients. We describe a case of 45-year-old woman with CMV pneumonia with a fatal outcome for whom there was no evidence of prior immunodeficiency.
Cause of Death ; Cytomegalovirus* ; Fatal Outcome ; Female ; Fever ; Foscarnet ; Ganciclovir ; Great Britain ; Humans ; Immunocompromised Host ; Liver ; Lymphocytes ; Lymphocytosis ; Middle Aged ; Pneumonia* ; United States

Disseminated mucormycosis is a rare fungal infectious disease with a high mortality rate and is infrequently diagnosed ante mortem. It is most frequently seen in immunocompromised hosts such as diabetes mellitus, hematologic malignancies, or in the long-term use of steroids or chemotherapeutic agents. Tissue invasion by the hyphae of mucormycosis must be seen microscopically to establish the diagnosis. Treatment consists of correction of the predisposing condition, surgical debridement, and amphotericin-B therapy. A 35-year-old man was admitted through the emergency room due to fever and the right flank pain. He had received an allogenic bone marrow transplantation eight months ago and had been medicated with prednisolone and cyclosporine since the procedure. He was diagnosed with disseminated mucormycosis that involved the spleen, right kidney, and right lung. He is being successfully treated with amphotericin B, flucytosine, and liposomal amphotericin B.
Adult ; Amphotericin B ; Ants ; Bone Marrow Transplantation* ; Bone Marrow* ; Communicable Diseases ; Cyclosporine ; Debridement ; Diabetes Mellitus ; Diagnosis ; Emergency Service, Hospital ; Fever ; Flank Pain ; Flucytosine ; Hematologic Neoplasms ; Humans ; Hyphae ; Immunocompromised Host ; Kidney ; Lung ; Mortality ; Mucormycosis* ; Prednisolone ; Spleen ; Steroids

OBJECTIVES: The significance of the coccoid forms of H. pylori is still controversial and the questions of whether these forms are viable and infective or degenerative are still open. We induced conversion from rod to coccoid forms and studied morphological changes and antigenic evolutions during this conversion and, thereby, elucidated the viability of coccoid forms. METHODS: The H. pylori strain (C001) used for Western blotting was isolated from the patient with gastric cancer. The antigenic evolution during coccoid conversion of H. pylori was studied by Western blotting, using different sera from thirty patients known to be culture positive. These sera were used to reveal the total antigens of the strain cultured for 2 days (100% rod) and 15 days (> 99% coccoid). After SDS-PAGE, with 10% separating gel of total antigens (rod and coccoid), transblotting (Trans-Blot electrophoretic cell, Bio-Rad) was taken onto a nitrocellulose membrane (Bio-Rad). Then, the blots, with human sera diluted at 1/100, were developed with color reaction by goat serum anti-human IgG with alkaline phosphatase and BCIP. RESULTS: The antigenic profiles were not changed in 46.7% (14/30 cases) and were changed in 53.3% (16/30 cases) during coccoid conversion. Antigenic fractions changed during coccoid conversion were protein band at 120 kDa and band at 35 kDa, and were not detected in coccus forms. The rest of the profiles were identical between rod and coccoid forms. The protein which disappeared include CagA (120 kDa) and porin, or adhesin (35 kDa). The morphological changes during coccoid conversion were U shaped at day 7, doughnut shaped at day 9 and full coccoid at day 15. CONCLUSIONS: The results showed that coccoid forms of H. pylori retain cellular structures similar to rod form, and some of the antigens (CagA and porin) disappeared during coccoid conversion. Therefore, coccoid form might be viable and represent one of the stages of H. pylori biological cycle.
Adaptation, Physiological ; Antigens, Bacterial/isolation & purification* ; Gastritis/microbiology ; Helicobacter Infections/microbiology ; Helicobacter pylori/ultrastructure* ; Helicobacter pylori/immunology* ; Helicobacter pylori/growth & development ; Human ; Microscopy, Electron ; Stomach Neoplasms/microbiology ; Virulence