OBJECTIVE: Peripartum emergency cesarean hysterectomy of 28 cases at our hospital for 10years were reviewed that the clinical indication, history, and annual incidence change. METHODS: A retrospective descriptive analysis from January, 1988 to December, 1997 was carried out. RESULTS: There were 28 cases of emergency cesarean hysterectomy identified during this period among total 24, 689 deliveries. The annual incidence of emergency cesarean hysterectomy was significantly declined statistically(p<0.005). Cesarean hysterectomy was performed in 20 of 6, 671 cesarean section(0.30%) and in 8 of 18, 018 vaginal deliveries(0.04%), so more frequently after cesarean section than vaginal delivery. The cesarean hysterectomy rate was more frequent in multiparous women(0, 22%) than in nulliparous women(0, 02%). The most common indication of cesarean hysterectomy was 13 cases of uterine atony(46%), followed by 5 cases uterine rupture(18%), 5 cases of placenta previa with placenta accreta(18%), 3 cases of placenta previa(11%), 2 cases of uterine myoma(7%). No significant difference in length of operating time, amount of blood loss and operative complications were found between total abdominal hysterectomy and subtotal hysterectomy. The all patient who had cesarean hysterectomy recieved from 1200ml to 15840ml of blood transfusion with a mean of 3673ml. In aspect of fetal outcome, 3 cases of FDIU(Fetal death in utero) in uterine rupture and 1 case of stillbirth in preterm were found. The maternal complications were wound disruption, DIC, wound hematoma, ureter injury, vaginal stump bleeding, UTI(Urinary tract infection) and retroperitoneal bleeding, CONCLUSION: We conclude that the incidence of emergency cesarean hysterectomy declined with prediction of antenatal risk factor, preparing of sufficient fresh blood, prophylactic antibiotics, vigorous uterotonics and close observation after delivery.
Anti-Bacterial Agents ; Blood Transfusion ; Cesarean Section ; Dacarbazine ; Emergencies* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy* ; Incidence ; Peripartum Period* ; Placenta ; Placenta Previa ; Pregnancy ; Retrospective Studies ; Risk Factors ; Stillbirth ; Ureter ; Uterine Rupture ; Wounds and Injuries

BACKGROUND: Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. MATERIAL AND METHOD: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. RESULT: After surgical correction peak aortic gradient fell from 58.4+/-17.6, to 23.7+/-17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6+/-24.3 to 143.7+/-27.1 mmHg and from 1.78+/-0.4 to 1.76+/-0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10+/-0.2, to 1.27+/-0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2+/-24.9 to 57.1+/-27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. CONCLUSION: We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.
Aorta ; Aortic Valve Stenosis* ; Blood Pressure ; Child ; Equidae ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Male ; Myocardium ; Oxygen Consumption ; Reoperation ; Stroke Volume

Trichoepithelioma. so named by Jarisch(1894), is a rare benign neoplasm of the skin on face and eyelid. The solitary type which is the most usual form seen in the eyelid occurs mainly in adult, on the other hand multiple type begin to appear at adolescence or puberty as a dominantly inherited condition. A 21 year-old korean female was found to have trichoepithelioma in her left lower eyelid mangm.
Adolescent ; Adult ; Eyelids ; Female ; Hand ; Humans ; Puberty ; Skin ; Young Adult

Background: Bone grafts can provide an optimal environment for permanent tooth to erupt and enhance the stability of the alveolar maxilla. Although autologous bone is an optimal source for osteogenesis, its inevitable donor site morbidity has led to active research on bone substitutes. This study was designed to evaluate the safety and feasibility of using biphasic calcium phosphate (BCP; Osteon) as a bone substitute in dogs. Methods: Bilateral third and fourth premolars of four 15-week-old mongrel dogs were used. All teeth were extracted except the third premolar of the right mandible, which was used as a control. After extraction of the premolars, each dog was administered BCP (Osteon), demineralized bone matrix (DBM; DBX), and no graft in the hollow sockets of the right fourth premolar, left fourth premolar, and left third premolar, respectively. Radiographs were taken at 2-week intervals to check for tooth eruption. After 8 weeks, each dog was sacrificed, and tooth and bone biopsies were performed to check for the presence of tooth and bone substitute particle remnants. Results: Four weeks after the operation, permanent tooth eruptions had started at all the extraction sites in each dog. Eight weeks after the operation, all teeth had normally erupted, and histological examination revealed BCP particles at the right fourth premolar. Conclusion: In all four dogs, no delay in the eruption of the teeth or shape disfigurement of permanent teeth was observed on gross inspection and radiologic evaluation. On histological examination, most of the BCP and DBM were replaced by new bone. Bone substitutes can be used as graft materials in patients with alveolar clefts.

Systemic lupus erythematosus(SLE) is a multisystem disorder in which the various organs are damaged by deposition of autoantibodies and immune complex. Ocular man-ifestations of SLE are involvement of the eyelids, conjunctiva, cornea, episclera, retina and optic nerve. Retinal vascular manifestations are the most common form of ocular manifestation. Most frequently these consist of cotton wool spots, retinal hemorrhage, but occasionally more severe retinal vaso'occlusive disease has been noted. The authors experienced 22 year'old woman who had SLE and severe retinal vaso'occlusive disease. Her left eye was treated with focal photocoagulation and vitrectomy but the visual acuity was F.C. 60 cm due to ischemic state of parafoveal capillary network. Right eye maintain visual acuity of 0.9 by photocoagulation and vitrectomy for vitreous hemorrhage and tractional retinal detachment. As shown in this case, the SLE patients who developed vitreous hemorrhage due to extensive retinal vaso-occlusive disease may have very poor visual prognosis. So periodic ocular examinations and appropriate treatment for vascular occlusion can prevent serious visual loss in SLE.
Antigen-Antibody Complex ; Autoantibodies ; Capillaries ; Conjunctiva ; Cornea ; Eyelids ; Female ; Humans ; Light Coagulation ; Lupus Erythematosus, Systemic* ; Optic Nerve ; Prognosis ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retinaldehyde* ; Traction ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage ; Wool

Hypersensitivity to the stings of the Hymenoptera has been described since antiquity. The hypersensitive reactions to insect stings vary from minor skin reactions to severe and sometimes fatal anaphylaxis. Concerns about sting hypersensitivity have been increasing because of many incidents of allergic reactions of patients to the fire ant in the southern area of the United States as well as the harvester ant in some areas. We experienced one unique case with severe allergic reactions by ant of the Ectomomyrmex spp. of the subfamily Ponerinae, which is not a harvester ant. For three years the patient had been suffering from generalized allergic reactions such as anaphylaxis after the ant stings four-five attacks in a year. We determined that her reactions were due to specific IgE mediated type I hypersensitivity by the detection of a high level of specific IgE to the ant venom in her serum. The high level of specific IgG4 to the ant venom was also noted in her serum, however, the role of ant venom IgG4 was not clearly determined.
Adult ; Anaphylaxis/*etiology ; Ant Venoms/*immunology ; Case Report ; Enzyme-Linked Immunosorbent Assay ; Female ; Human ; Immunoglobulin E/*analysis ; Immunoglobulin G/*classification ; Support, Non-U.S. Gov't

No abstract available.
Anus, Imperforate* ; Bronchi* ; Esophageal Atresia*

Dermatomyositis is a disease of unknown etiology characterized by inflammation and degeneration of skeletal muscles and cutaneous abnormalities. Cardiac involvement in dermatomyositis-polymyositis is thought to be rare. In recent year, however, there has been an increasing number of reports on cardiac abnormalities in adult dermatomyositis and polymyositis due to development of noninvasive diagnostic techniques. Categorically, these abnormalities have included electrocardiographic changes, cardiac arrhythmias, congestive heart failure, coronary artery disease, and pericarditis. A 56-year-old woman was admittied to the Ewha womans University Hospital with dyspnea and palpitation. She was diagnosed as having dermatomyositis and followed up our department of Dermatology. Electrocardiogram showed a paroxysmal supraventricular tachycardia at as rate of 195/min. The patient was treated with 240mg/day verapamil p.o, 60mg/day prednisone p.o, there was marked improvement of symptoms. Systematic study of cardiac function utilizing echocardiography, Holter monitoring, thallium-201-scan, and gated blood pool studies were conducted in five newly diagnosed patients with dematomyositis-polymyositis. A significant elevation of serum CPK-MB is indicative of cardiac involvement. Cardiac involvement is a serious prognostic sign. We report a case with the review of the literature.
Adult ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Dermatology ; Dermatomyositis* ; Dyspnea ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Heart Failure ; Humans ; Inflammation ; Middle Aged ; Muscle, Skeletal ; Pericarditis ; Polymyositis ; Prednisone ; Prognosis ; Tachycardia, Supraventricular* ; Verapamil

This study was performed to investigate the body image perception by BMI and the dietary behaviors in 803 college students (408 males and 395 females). The degree of obesity was divided into an underweight group with BMI less than 18.5 kg/m(2), a normal group with BMI of 18.5~22.9 kg/m(2), an overweight group with BMI of 23~24.9 kg/m(2) and an obese group with BMI over 25.0 kg/m(2). The average ages of subjects were 22.9 years in males and 20.2 years in females. The average weight and height of male subjects were 175.3 cm and 69.6 kg, respectively and those of female subjects were 162.5 cm and 52.0 kg, respectively. The average BMIs of male and female subjects were 22.6 kg/m(2) and 19.7 kg/m(2), respectively. The distribution of subjects who perceived their current body image as ideal body image was 25.7% in males and 10.9% in females, showing that the body image satisfaction of male subjects was 1.5 times higher than that of female subjects. Body image perception for their own bodies was mostly shown as the average or standard shape both in males and females with 64.2% and 54.2%, respectively, but males showed a higher perception rate than females and 31.1% of females and 19.5% of males perceived their bodies as lean shape (p < 0.01). The body image satisfaction was 4.20 in males and 3.70 in females, showing more satisfaction in the male subjects (p < 0.001). The correlation between body image and physical variables in male subjects indicated that CBI and IBI showed statistically significant correlation and also BMI showed statistically significant correlation with IBI (p < 0.001) and CBI (p < 0.001). The frequency of eating out increased as the frequency of skipping meals increased (p<0.001) and the frequency of having snacks increased as the frequency of eating out increased (p < 0.01). The correlation between body image and physical variables in female subjects showed that CBI and IBI (p < 0.001) had statistically significant correlation. Body weight showed statistically significant correlation with CBI (p < 0.001), BMI (p < 0.001) and height (p < 0.001). The frequency of eating out increased as height (p < 0.01) and the frequency of skipping meals (p < 0.001) increased. When both male and female subjects wanted leaner body shapes, they preferred much leaner shapes despite their current body images belonging in the normal range. Additionally subjects preferred the body image in the normal range in cases when their current body images were lean. In particular, more female subjects had strong desires to become leaner in their body images than male subjects, which could be analyzed as a risk factor for physical harm. From the above results, it is considered that both male and female subjects need to establish proper recognition and dietary behaviors for their body images and also need nutritional education and counseling for desirable weight control methods.
Body Image* ; Body Mass Index* ; Body Weight ; Counseling ; Eating ; Education ; Female ; Humans ; Male ; Meals ; Obesity ; Overweight ; Reference Values ; Risk Factors ; Snacks ; Thinness

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*