With remarkable progress in upper GI endoscopy; it has been applied to therapeutid purpose. ln this paper, we present one suceessful case of endoscopic extraction of BADUG STONE by biopsy forceps and contraceytive condom., Using a biopsy forceps and condom inserted through the fiberscope, BADUG STONE' was eaaily made to roll into the self-opening trawl net' and safly removed.
Biopsy ; Condoms* ; Endoscopy ; Surgical Instruments

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium

PURPOSE: To describe our experience concerning clinical features, methods of treatment and outcomes of separation of the symphysis pubis during childbirth. MATERIALS AND METHODS: We experienced 26 cases during a period of 6 years from March 1992 to January 1998. Retrospectively, we analysed 23 cases which could be followed up for more than a year, each with separation of the symphysis pubis associated with childbirth. Method of treatment was pelvic sling and absolute bed rest in 18 cases of 23 cases, the others were treated with bed rest and early mobilization. RESULTS: Clinical symptoms and physical findings were similar in all cases. The duration of symptom was from 3 weeks to a year (mean=3.2 months), the size of the gap on simple X-ray ranged from 6 mm to 28 mm (mean=16 mm) initially and from 3 mm to 11 mm (mean=4.7 mm) finally. Outcomes were good in all cases with conservative treatment, although final radiologic fingings were normalized, widening, sclerosis, erosion or osteophytes. CONCLUSION: Separation of the symphysis pubis during childbirth was treated well with conservative treatments, although variable radiologic findings were noted in final X-ray finding.
Bed Rest ; Early Ambulation ; Osteophyte ; Parturition* ; Retrospective Studies ; Sclerosis

PURPOSE: To evaluate the clinical features of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy and the effect of Ahmed valve implantation. METHODS: The medical records of 217 eyes of 178 patients who had undergone pars plana vitrectomy for proliferative diabetic retinopathy were reviewed. The clinical data on preoperative, intraoperative, and postoperative factors of these patients were compared with that of those who developed neovascular glaucoma (20 eyes of 18 patients) after vitrectomy. The effect and complications of Ahmed valve implantation were also reviewed. RESULTS: The type 1 diabetes, the presence of NVD, grade of NVE, grade of preoperative PRP, presence of postoperative vitreous hemorrhage, and postoperative tractional retinal detachment were significantly correlated with the development of neovascular glaucoma. Ahmed valve implantation in these patients was effective in controlling intraocular pressure and improving visual acuity. Complications of the Ahmed valve implantation were hyphema, tube exposure, recurrent vitreous hemorrhage, hypotony, and choroidal effusion. CONCLUSIONS: The risk factors for the development of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy were evaluated. Ahmed valve implantation in these patients is considered an effective treatment for controlling intraocular pressure.
Choroid ; Diabetic Retinopathy* ; Glaucoma, Neovascular* ; Humans ; Hyphema ; Intraocular Pressure ; Medical Records ; Retinal Detachment ; Risk Factors ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

To evaluate the clinical usefulness of radionuclide(RI) cisternography in patients with hydrocephalus, we retrospectively analyzed RI cisternographic findings of 47 patients by using our classification which was modified from Baum's. and correlated them with CT(n=37) or MRI(n=10) findings and clinical outcome in selected patients with hydrocephalus(n=37). Modified RI cisternographic patterns of 37 patients were type I in three cases(8%), type II in seven(18%), type III-A in six(16%), no case of type III-B, type IV-A in 12(32%), and type IV-B in nine(24%). RI cisternography enabled to differentiate communicating hydrocephalus(27 cases, 73%) from noncommunicating hydrocephalus (10 cases, 27%). There was marked clinical improvement in 17 patients(46%), slight improvement in 11 patients(30%), and no improvement in nine patients(24%). The clinical outcome of patients with RI cisternographic type IV-B was worse than that of other types. CT and MRI could neither predict the clinical outcome nor differentiate type IV-B from Type IV-A(p>.05). Ventricular size index (VSI( was significantly higher in patients with type IV than that with other types(p<.001). RI cisternographic patterns of communicating hydrocephalus were relatively correlated with clinical outcome (r=-0.53, P=.001), VIS(r=0.59, p=.001), and dilatation of fourth ventricle(r=0.41, p<.05). We suggest that our modified classification of RI cisternographic patterns can provide more strict physiological assessment of the CSF dynamics and RI cisternography may be still useful to differentiate communicating hydrocephalus from noncommunicating hydrocephalus and to predict the clinical outcome in conjunction with CT/MR findings and clinical presentation.
Classification ; Dilatation ; Humans ; Hydrocephalus* ; Magnetic Resonance Imaging* ; Retrospective Studies

Pemphigus vulgaris is autoimmune disease characterized by acantholysis and blister formation in the skin and mucosa. The introduction of corticosteroids has greatly reduced mortality, and a number of immunosuppressive agents, such as azathioprine and cyclophosphamide are recommended as adjuncts to oral steroids. A 38-year-old female patient of pemphigus vulgaris has been managed with daily oral cyclophosphamide as adjunct to prednisolone for about 11 months, and then transfered to our department due to amenorrhea for 4 months. Hormonal profile of FSH, LH and estradiol revealed in postmenopausal range and follow-up results of hormonal profile were not changed, and amenorrhea continues for total 13 months until now. So we report a case of premature ovarian failure complicated by long-term oral administration of cyclophosphamide.
Acantholysis ; Administration, Oral ; Adrenal Cortex Hormones ; Adult ; Amenorrhea ; Autoimmune Diseases ; Azathioprine ; Blister ; Cyclophosphamide* ; Estradiol ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Mortality ; Mucous Membrane ; Pemphigus* ; Prednisolone ; Primary Ovarian Insufficiency* ; Skin ; Steroids

Since the 1980's, prenatal care for pregnant women and their babies has improved maternal and neonatal health. However, despite prenatal care, the rate of some complications, such as major fetal anomalies, preterm labor, and low birth weight have not improved. Only 10.3% of Korean women of childbearing age take folic acid supplementation and approximately 14% still consume alcohol during pregnancy. Because in Korea about 50% of pregnancies are unintended, those women have higher exposure rates to alcohol, drugs, and ionizing radiation. Because most fetal anomalies occur between 5 to 10 gestational weeks, the initial prenatal care provided at 7 to 8 gestational weeks is too late to prevent fetal anomalies. Preconception care may identify and modify adverse health, behavioral, and social outcomes for women and their unborn babies. Recently, a number of preconception interventions have been reported to have evidence-based effectiveness in improving pregnancy outcomes. These include folic acid supplementation, avoiding alcohol intake, smoking cessation, counseling on potentially teratogenic drugs, infection control, immunizations, and control of chronic diseases such as diabetes, hypothyroidism, obesity. For the improvement of maternal and fetal health, guidelines for preconception care must be developed in Korea. All health care providers should understand the clinical importance of evidence-based preconception care.
Chronic Disease ; Counseling ; Female ; Folic Acid ; Health Personnel ; Humans ; Hypothyroidism ; Immunization ; Infant, Low Birth Weight ; Infant, Newborn ; Infection Control ; Korea ; Obesity ; Obstetric Labor, Premature ; Preconception Care ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Prenatal Care ; Radiation, Ionizing ; Smoking Cessation ; Teratogens

BACKGROUND: The recent studies shows that LV relaxation abnormalities are the important factors of heart failure in elders. To determine the association between LV diastolic functions and heart failure, we assessed LV diastolic functions in elderly patients with pulmonary congestion and in asymptomatic elders by using pulsed doppler echocardiography. METHODS: In order to assess LV diastolic function, we performed pulsed doppler echocardiography to elderly patients with pulmonary congestion and asymptomatic elders from Mar.2001 to Sep.2001. The following parameters were used as indices of LV diastolic function; Mitral E wave(E), Mitral A wave(A), Deceleration time(DT), Isovolumic relaxation time(IVRT), Systolic pulmonary venous flow(PVs), Diastolic pulmonary venous flow(PVd). RESULTS: In elderly patients groups, there was significant increase in deceleration time compared with asymptomatic elders(255.83+/-54.41 vs 210.80+/-48.53, p<0.05). There was significant increase in isovolumic relaxation time in elderly patient group compared with asymptomatic elders(123.06+/-25.07 vs 98.78+/-15.12, p<0.01). Although there was no significant difference, decreased E/A ratio and increased PVs/PVd were noted in both groups. CONCLUSIONS: The results shows that the impairments of LV diastolic function were noted in both groups. Especially DT and JVRT were significant increase in elderly patient group with pulmonary congestion. Therefore these parameters, such as DT, IVRT, can be helpful as predictive indices of diastolic heart failure in elders.
Aged* ; Deceleration ; Echocardiography, Doppler, Pulsed ; Estrogens, Conjugated (USP)* ; Heart Failure ; Heart Failure, Diastolic ; Humans ; Relaxation

Spinal metastasis is a common issue causing significant pain and disability in cancer patients. A multidisciplinary approach consisting of chemotherapy, radiotherapy, and surgical treatment is used for treating patients with metastatic spinal tumors. Due to recent advancements in medical and radiation oncology, like tumor genetics and stereotactic radiotherapy, this treatment strategy would change inevitably. Therefore, the decision-making systems developed for assisting physicians and surgeons to choose the most appropriate treatment for each patient with spinal metastasis need to evolve. In this review, the recent developments, validations, and modifications of these systems, as well as suggestions for future systems have been discussed. Recently, separation surgery combined with stereotactic radiotherapy (hybrid therapy) has gained popularity. Additionally, the evidence for hybrid therapy presented in the literature has been reviewed.

STUDY DESIGN: This was a retrospective cohort study. PURPOSE: We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. OVERVIEW OF LITERATURE: The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system’s potential predictive value for SAEs has been partially studied. METHODS: This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. RESULTS: SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p=0.029) and spinal alignment (p=0.001) scores were significantly related to VCF occurrence, whereas the pain (p=0.008) and posterolateral involvement (p=0.009) scores were related to SCC occurrence. CONCLUSIONS: Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence.
Cohort Studies ; Diagnosis ; Fractures, Compression ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Spinal Cord Compression ; Survival Rate