OBJECTIVES: The purpose of this study was to assess the clinical features, microbiologic results, and the efficacy of perineal hygienic care of pediatric vulvovaginitis. METHODS: Forty-two unselected premenarcheal patients with symptoms or signs of vulvovaginitis who were attended the outpatient pediatric and adolescent gynecology clinic at Pundang CHA General Hospital from August 1997, to September 1999 were systematically interviewed and examined using a standardized format, studied microbiologically, and followed the efficacy of perineal hygienic measures prospectively. RESULTS: The median age of the patients was 4.8 years (range 2.9 years to 10.9 years). Vaginal complaints of 42 patients were discharge(79%), genital pain or irritation(31%), odor(17%), pruritus(14%), and vaginal bleeding(7%). On physical examination, vaginal discharge and vulvar erythema were noted in 17(40%) and 22(52%) patients, respectively. Aerobic bacteria or yeast excluding vaginal normal flora were found in 24 of 42 patients(57%). Convincing evidence of specific pathogens was found in 9 of 42 patients(21%) including one case of pinworm infestation. Isolated pathogens were H. influenza(3), S. pyogenes(2), K. pneumonia(2) and N. gonorrhea(1). No patients were found to have chlamydial infection or trichomoniasis. In 14 patients, risk factors were identified such as swimming(14%), bubble bath(5%), sexual abuse(5%), genital trauma(5%) and foreign body(2%). After two weeks instructions of perineal hygienic care, 26(62%) of 42 patients revealed complete resolution of symptoms and signs of vaginitis without antibiotics. Efficacies of perineal hygienic care were 94%(17/18) in the patients with normal flora alone, 60%(9/15) in the patients with organisms suspected for nonspecific infection and 0%(0/9) in the patients with specific pathogens(p<0.05). CONCLUSION: Majority(62%) of the pediatric patients with symptoms or signs of vulvovaginitis were cured with perineal hygienic care alone. And the efficacy of hygienic measure were higher in the patients without specific pathogens(79%, 26/33). Therefore, proper physical examination, microbiologic study and appropriate instructions of perineal hygienic care were more important than empirical antibiotic treatment in initial management of pediatric vulvovaginitis.
Adolescent ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Enterobius ; Erythema ; Gynecology ; Hospitals, General ; Humans ; Outpatients ; Physical Examination ; Prospective Studies ; Risk Factors ; Vaginal Discharge ; Vaginitis ; Vulvovaginitis* ; Yeasts

BACKGROUND: Elevated plasma homocysteine concentrations are an independent risk factor for vascular disease. The metabolism of homocysteine is closely related to vitamin B12 and folic acid. The purpose of this study is to evaluate the correlation between homocysteine and vitamin B12 as well as folic acid in patients with coronary artery disease. METHODS: Sixteen patients, in whom coronary angiography revealed more than 50% of stenosis at least in one coronary vessel, were enrolled as the patient group, and sixteen hypertensive subjects were selected as the control group. Blood was collected in the peripheral vein to measure the concentrations of homocysteine, vitamin B12, and folate. We evaluated the correlation between homocysteine, vitamin B12 and/or folate in both groups. RESULTS: Total plasma homocysteine concentrations were higher in the coronary artery disease group than in the control group. There were no significant differences in the folate and vitamin B12 levels between the coronary artery disease group and the control group. In the control group, the concentrations of homocysteine showed negative correlation with both vitamin B12 and folate concentrations, but similar trends were not observed in the coronary artery disease group.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Folic Acid* ; Homocysteine* ; Humans ; Metabolism ; Plasma* ; Risk Factors ; Vascular Diseases ; Veins ; Vitamin B 12*

No abstract available.
Barium* ; Intussusception*

Although myocardial bridge is not thought to have any hemodynamic significance in most cases, some have suggested that when it produces severe systolic narrowing, ischemia or infarction may result. Myocardial bridge in adults with hypertrophic cardiomyopathy may be associated with a higher incidence of sudden death, myocardial wall-motion abnormalities, and perfusion defects on thallium-201 scintigraphy. When myocardial bridge is associated with left ventricular hypertrophy, it is known to affect longer segment and cause more severe compression during systole. We report a case of hypertrophic cardiomyopathy with myocardial bridge at the middle part of the left anterior descending coronary artery, who also showed reversible perfusion defect on the thallium scan at the same coronary territory.
Adult ; Cardiomyopathy, Hypertrophic* ; Coronary Vessels ; Death, Sudden ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Infarction ; Ischemia ; Perfusion ; Radionuclide Imaging ; Systole ; Thallium

Dextran is a highly viscous polysaccharide liquid used for uterine distention during hysteroscopic surgery. Although generally safe, this agent has been recognized to cause non-cardiogenic pulmonary edema, intravascular coagulopathy, renal insufficiency, and anaphylactic reaction. We report the case of pulmonary edema following hysteroscopic surgery with dextran 40 and discuss the major side effects and the possible etiologies of the reported complication.
Anaphylaxis ; Dextrans* ; Hysteroscopy* ; Pulmonary Edema* ; Renal Insufficiency

Tympanic membrane perforations are frequently encountered diseases and can be treated with several different methods, induding tympanoplasty with tympanic membrane grafting which requires more profound techniques and clinical care. A fat graft myringoplasty is a cost-effective techniquc managing small tympanic membrane perforations and is used when challenged by a myringoplasty failure, or following tympanostomy tube extrusion. It involves wedging a piece of fat from the ear lobule into the perforation with local anesthesia in a one-day-stay procedure. This study demonstrates the efficacy of this method in a persistent small tympanic membrane perforation.
Anesthesia, Local ; Ear ; Middle Ear Ventilation ; Myringoplasty* ; Transplants* ; Tympanic Membrane ; Tympanic Membrane Perforation ; Tympanoplasty

The most common cause of orbital in/fection is a sinusitis, and if this orbital complication is not provided with appropriate and intensive treatments, serious status such as visual loss or life-threatening may occur. Osteomyelitis rarely results from sinusitis, and in cases where it happens, the frontal sinus is the most frequently involved site. However, zygomatic osteomyelitis has not been reported so far. We present a case of maxillary sinusitis which was initiated by oroantral fistula, and developed to preseptal and postseptal abscess, penetrating into the orbital septum. The case was complicated by zygomatic osteomyelitis. This case was successfully treated by draining pus by endonasal endoscopic sinus surgery, infraorbital incision, and was followed by antibiotic therapy for about 8 weeks.
Abscess* ; Frontal Sinus ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit ; Oroantral Fistula ; Osteomyelitis* ; Sinusitis ; Suppuration

Supernumerary tooth, named mesodens, occur between the maxillary central incisors are generally found in pairs, although it is sometimes found singly. An inverted mesiodens may move toward the nasal cavity and erupt in the floor of the nose. Approximately 90% of all supernumerary tooth usually appear in the area of the maxilla, where they disrupt the position and eruption of normal teeth. A supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e., molars, premolars or anterior teeth.
Bicuspid ; Incisor ; Maxilla ; Molar ; Nasal Cavity* ; Nose ; Tooth ; Tooth, Supernumerary*

Subperiosteal abscess of the mastoid region and Bezold's abscesses have become very rare since introduction of antibiotics. Subpriosteal abscess is usually seen in children who have acute mastoiditis. Its occurrence in adults or in associated with chronic otitis media is even more unusual. Bezold's abscess, a complication of acute otitis media in adult who has well pneumatized air cells in the tip of the mastoid, is also rarely seen in the current era of antibiotics. This paper reports a case of postauricular subperiosteal and Bezold's abscess complicating chronic suppurative otitis media with cholesteatoma in a 37-year old woman with review of literatures.
Abscess* ; Adult ; Anti-Bacterial Agents ; Child ; Cholesteatoma* ; Female ; Humans ; Mastoid ; Mastoiditis ; Otitis Media ; Otitis Media, Suppurative*

BACKGROUND AND OBJECTIVES: Recently, canal down mastoidectomy tends to be more frequently selected for complete eradication of the lesion and prevention of recurrence. Therefore, the problems attendant to the open mastoid continue to be of concern. Although various techniques have been used to solve the cavity problems, no single procedure has yet been devised that entirely accomplished this purpose. We evaluated the effects of partial mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips. MATERIALS AND METHODS: Twenty four cases were performed with mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips obtained from meatoplasty. There were 11 cases for control which were performed with canal down mastoidectomy without obliteration. We compared these two groups in the duration of epithelialization, accumulation of debris, presence or absence of drainage, shape of remodeled canal and caloric response and evaluated survival or atrophy of flap and absorption of cartilage chips. RESULTS: Obliteration group showed more rapid healing and epithelialization and less accumulated epithelial debris. Atrophy of flap or absorption of cartilage was not observed. There was no draining ear but vertigo with nystagmus on caloric stimulation developed in both groups. CONCLUSION: This partial mastoid obliteration technique used easy and quick application instead of complete restoration of canal wall, and it may be also valuable in providing rapid epithelialization and reducing mastoid bowl volume with relatively round canal shape. Furthermore, epitympanic obliteration using cartilage chips may be an effective method to prevent formation of attic retraction pocket.
Absorption ; Atrophy ; Cartilage* ; Drainage ; Ear ; Methods ; Recurrence ; Vertigo