Purpose : To evaluate the short term result of the tension-free vaginal tape (TVT) procedure in conjunction with vaginal hysterectomy in patients with concurrent stress incontinence and gynecological diseases. Materials and Methods: All patients (32 women) underwent the TVT procedure in conjunction with vaginal hysterectomy between June 2001 and April 2003. Preoperative histories, subjective questionnaires of the degree of incontinence, physical examinations, one hour pad tests and full urodynamic testing were evaluated. The postoperative clinical outcomes, patient satisfaction and complications were checked after 3-months. Results: Thirty-two women who met the study criteria were identified. The mean follow-up time, parity, age, operating time and length of hospital stay were 9.2 months, ranging from 3 to 18 months, 2.6, ranging from 1 to 5, 52.5 years, ranging from 40 to 68, 73 minutes, ranging from 55 to 122 minutes and 4.3 days, ranging from 3 to 9 days, respectively. From the questionnaires, 22 patients were found to be mildly incontinent, 7 moderately incontinent and 3 severely incontinent. All patients were cured of gynecological disease. All cases of mild, 5 of moderate and 2 of severe incontinence were cured. The three remaining patients improved. Twenty-eight patients were satisfied after the operation and 1 had intraoperative bladder perforation. Conclusions: The TVT procedure in conjunction with a vaginal hysterectomy for stress incontinence with other gynecologic disease is considered safe and efficacious, although a longer follow-up will be necessary to determine the long term effect.
Female ; Follow-Up Studies ; Genital Diseases, Female ; Humans ; Hysterectomy, Vaginal* ; Length of Stay ; Parity ; Patient Satisfaction ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence, Stress ; Urodynamics

Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7+/-7.0 and 40.6+/-6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7+/-2.6 and 23.4+/-2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean was 24.3+/-3.1 and 25.2+/-2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3+/-8.9 and 42.2+/-6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5+/-5.3 and 43.2+/-6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.
Anesthesia, General ; Dislocations ; Fasciculation ; Female ; Hematoma ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Lifting ; Male ; Mandible ; Mouth ; Temporomandibular Joint Disorders ; Temporomandibular Joint* ; Traction ; Vecuronium Bromide

Pseudohypoparathyroidism (PHP) is a group of genetic disorders in which the kidneys fail to respond to parathyroid hormone. Genetic defects in the GNAS complex locus lead to reduced Gsalpha (alpha-subunit of the heterotrimeric stimulatory G protein) activity in PHP type Ia patients. These patients exhibit characteristics of Albright hereditary osteodystrophy (AHO) and hypocalcemia, increased parathyroid hormone, and resistance to other Gsalpha protein-coupled hormones. AHO has a wide range of manifestations such as short stature, obesity, round face, subcutaneous ossification, and bone shortening in the hands and feet. In this study, we present the case of a 47-yr-old woman who was diagnosed with PHP type Ia with AHO. She showed tetany, dizziness, irritability to light, decreased visual acuity, cognitive impairment, and motor dysfunction. Direct sequencing identified a heterozygous missense mutation in exon 6 (c.466G>A, p.Asp156Asn) in GNAS1. To our knowledge, this case is the first report in Korea of PHP type Ia caused by a heterozygous missense mutation in exon 6 (c.466G>A, p.Asp156Asn) in GNAS1.
Dizziness ; Exons ; Female ; Foot ; Hand ; Humans ; Hypocalcemia ; Kidney ; Korea ; Mutation, Missense ; Obesity ; Parathyroid Hormone ; Pseudohypoparathyroidism* ; Tetany ; Visual Acuity

As salvage therapy for recurrent ovarian cancer, Taxol has been tried alone or combined with cisplatin, or carboplatin. Paclitaxel (Taxol) is an antineoplastic agent; isoloated from the back of the western yew which acts as an antimicrotubule agent. In our study, 28 patients were eligible and assessable, Taxol was administered at a dose of 175 mg/m2, infused over 3hr every 21 days. A total of 161 courses of Taxol were infused, and the median treatmemt cycle was 6.25 cycles (1 to 16 cycles). The overall response rate was 21.4%, but we found higher response rate in sensitive group to platinum combined therapy than resistant. The median survival duration was 10.2 months and the median duration of follow up was 25.0 months. The worst severe toxicity was grade 4 leukopenia and expirement with sepsis. 39% of patients experienced myalgia and 25% experienced nausea, vomiting and diarrhea. Other adverse effects were not important or considerable. Taxol has been shown to be the most useful agent in patients with advanced ovarian cancer who had shown sensitivity with platinum previously, and Taxol has yielded low response rate in platinum-resistant patients. Further more study is repuired about Taxol itself, its optimal dose, combinding use with other antitumor agent, and as first line therapy in the treatment of advanced ovarian carcinoma.
Carboplatin ; Cisplatin ; Diarrhea ; Drug Therapy* ; Follow-Up Studies ; Humans ; Leukopenia ; Myalgia ; Nausea ; Ovarian Neoplasms ; Paclitaxel* ; Platinum ; Salvage Therapy* ; Sepsis ; Vomiting

As salvage therapy for recurrent ovarian cancer, Taxol has been tried alone or combined with cisplatin, or carboplatin. Paclitaxel (Taxol) is an antineoplastic agent; isoloated from the back of the western yew which acts as an antimicrotubule agent. In our study, 28 patients were eligible and assessable, Taxol was administered at a dose of 175 mg/m2, infused over 3hr every 21 days. A total of 161 courses of Taxol were infused, and the median treatmemt cycle was 6.25 cycles (1 to 16 cycles). The overall response rate was 21.4%, but we found higher response rate in sensitive group to platinum combined therapy than resistant. The median survival duration was 10.2 months and the median duration of follow up was 25.0 months. The worst severe toxicity was grade 4 leukopenia and expirement with sepsis. 39% of patients experienced myalgia and 25% experienced nausea, vomiting and diarrhea. Other adverse effects were not important or considerable. Taxol has been shown to be the most useful agent in patients with advanced ovarian cancer who had shown sensitivity with platinum previously, and Taxol has yielded low response rate in platinum-resistant patients. Further more study is repuired about Taxol itself, its optimal dose, combinding use with other antitumor agent, and as first line therapy in the treatment of advanced ovarian carcinoma.
Carboplatin ; Cisplatin ; Diarrhea ; Drug Therapy* ; Follow-Up Studies ; Humans ; Leukopenia ; Myalgia ; Nausea ; Ovarian Neoplasms ; Paclitaxel* ; Platinum ; Salvage Therapy* ; Sepsis ; Vomiting

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.
Aorta, Thoracic ; Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia ; Axis, Cervical Vertebra ; Diagnosis* ; Diaphragm ; Humans ; Magnetic Resonance Imaging*

Bronchogenic cyst is an uncommon congenital anomaly that arises from maldevelopment of the primitive foregut, and is usually found in the lung and mediastinum. Cutaneous or subcutaneous bronchogenic cysts are rare, and occur especially in the shoulder region. We report here on a 40-year-old woman with a soft, nontender, cystic mass on the upper posterior aspect of the right acromioclavicular joint; this had been recognized about 20 years before. She underwent incision and drainage of the lesion at a local clinic about 1 year ago, but the wound was not healed. MRI showed an irregular-shaped dark signal intensity lesion that measured 2 x 1.5 cm in the subcutaneous fat layer. Microscopically, the cyst was lined by pseudostratified ciliated columnar epithelium that displayed squamous metaplasia. The cyst wall revealed frequent smooth muscle bundles, occasional seromucous glands and multifocal lymphocytic infiltration. This is the first reported case of subcutaneous bronchogenic cyst of the shoulder in a Korean adult.
Acromioclavicular Joint ; Adipose Tissue ; Adult ; Bronchogenic Cyst* ; Drainage ; Epithelium ; Female ; Humans ; Lung ; Magnetic Resonance Imaging ; Mediastinum ; Metaplasia ; Muscle, Smooth ; Shoulder* ; Subcutaneous Fat ; Wounds and Injuries

Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).
Cranial Nerves ; Decompression ; Diplopia ; Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc ; Intracranial Pressure ; Spinal Stenosis ; Trochlear Nerve ; Trochlear Nerve Diseases

OBJECTIVE: To evaluate the causes, methods of delivery, and maternal complications in cases of fetal death in utero(FDIU) at Samsung Medical Center. METHODS: There were 92 cases of FDIU among 25,195 deliveries at Samsung Medical Center during 7 years from 1994 to 2001. In these cases, perinatal autopsy and placental biopsy was performed in 35 and 71 cases, respectively. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The overall incidence of FDIU was 0.37%. Most of FDIU occurred in 25 to 29 years old group(43.5%). Recurrence rate of FDIU was 3.3%. Most of FDIU were low birth weight(79.3%) and preterm(79.6%). The modes of delivery were induced labor(68.5%), laparotomy(18.5%), and the spontaneous delivery(13.0%). The causes of FDIU were chorioamnionitis(15.2%), placental abruption(14.1%), severe preeclampsia(11.9%), congenital and chromosomal anomaly(6.5%), but it was unexplained in 27.2%. There were 25 cases with maternal complications and the most common complications were intra-/postpartum fever(18.5%), postpartum hemorrhage(8.7%) and DIC(8.7%). CONCLUSION: The causes of FDIU could not be determined in only about 1/4 cases at Samsung Medical Center. Since FDIU recurred in 3.3%, thorough studies including perinatal autopsy and chromosomal study must be made on stillborn infants and placenta to determine the recurrent causes.
Adult ; Autopsy ; Biopsy ; Fetal Death* ; Humans ; Incidence ; Infant ; Medical Records ; Parturition ; Placenta ; Postpartum Period ; Recurrence ; Retrospective Studies