OBJECTIVE: This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. MATERIAL & METHODS: The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. RESULTS: During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. CONCLUSION: Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.
Blood Transfusion ; Cesarean Section ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Prenatal Care ; Risk Factors ; Urinary Tract ; Uterine Inertia

Paraovarian cysts arise in the mesosalpinx, between the ovarian hilum and the fallopian tube. Clinical significance of paraovarian tumors is considerably less frequent than ovarian tumors, and malignant paraovarian lesions are exceedingly rare. Paraovarian carcinomas or borderline malignancy mostly occur in young women. Abdominal enlargement and pelvic pain are the usual complaints. Usually they have a capsule, are unilateral and are connected to the broad ligament. Little is known about the biological behavior of the paraovarian borderline malignancies, since these lesions are so rare. The appropriate therapy for this unusual lesion have not been fully defined. We had experienced a case of papillary serous adenocarcinoma of borderline malignancy and report this case with a brief review of literature.
Adenocarcinoma ; Broad Ligament ; Fallopian Tubes ; Female ; Humans ; Pelvic Pain

Amyloidosis is not a single entity but rather a group of diseases characterized by the presence of extracelluar deposition of insoluble, fibrillar, proteinaceous material with a well-defined, beta-pleated sheet ultrastructure, mainly in tissues derived from the mesoderm. Approximately 9% to 15% of amyloid tumors are localized. The larynx is the most usually involved site in the head and neck. It is estimated that less than 1% of the benign tumors is found in the larynx. We report a case of laryngeal amyloidosis with a review of its clinical patterns, diagnostic tools, pathologic findings and treatments.
Amyloid ; Amyloidosis ; Head ; Larynx ; Mesoderm ; Neck

0.05). Amnesia during local injection was observed in eight patients (34.8%). Compared with the preoperative anxiety score, the intraoperative anxiety score was decreased.CONCLUSION: In this study, we found cardiovascular and respiratory stability in intravenous sedation using dexmedetomidine with pethidine, in plate and screw removal, after orthognathic surgery. Furthemore, intravenous sedation using dexmedetomidine with pethidine shows adequate analgesic and sedative effects.]]>
Amnesia ; Anxiety ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Meperidine ; Orthognathic Surgery ; Oxygen

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.
Barotrauma ; Catheters ; Constriction, Pathologic ; Emergencies ; Epidural Space ; Female ; Hemiplegia ; Humans ; Intervertebral Disc ; Leg ; Lower Extremity* ; Sensation ; Spinal Stenosis ; Young Adult

No abstract available.

Aneurysmal ruptures associated with middle cerebral artery(MCA) anomalies, such as a duplicated MCA and an accessory MCA, are quite rare. The authors reviewed the clinical relevance and possible etiology of these anomalies.
Aneurysm ; Aneurysm, Ruptured ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Rupture*

Patients with cardiogenic embolic stroke may experience an early, recurrent cerebral embolism. Fortunately, limited evidence suggests that anticoagulatory agents or thrombolytic agents may prevent recurrent cardiogenic emboli and halt progression of so-called "progressing stroke" However, because of the possibility of the intracerebral hemorrhage, use of such agents has generally been considered cautiously with timing, dosage and patient selection. Serious complications of anticoagulation for presumed embolic stroke are hemorrhage in the area of infarction. We experienced two patients with nonseptic cerebral embolism of cardiac origin. They were managed with anticoagulant or thrombolytic therapy, but resulted in clinical deterioration or death from spontaneous subdural hemorrhage. In each patient, an initial CT scan excluded the presence of hemorrhage but a second CT scan after clinical deterioration, documented subdural hemorrhage.
Cerebral Hemorrhage ; Cerebral Infarction* ; Fibrinolytic Agents ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Hemorrhage ; Humans ; Infarction ; Intracranial Embolism ; Patient Selection ; Stroke ; Thrombolytic Therapy* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Cardiac troponins are associated with increased mortality, even among patients with no coronary artery disease. Elevated cardiac troponin levels are frequently observed in patients without significant coronary lesions, although the mechanism underlying this finding is unclear. The aim of our study was to evaluate the association between the levels of cardiac troponin and coronary flow reserve (CFR). SUBJECTS AND METHODS: We evaluated serum cardiac troponin-I in 19 patients (9 female; age 61.9+/-10.9 year-old). All patients had an ejection fraction >40% and angiographically normal coronary arteries. Simultaneous measurements of fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and CFR measurements using an intracoronary temperature- and pressure-sensing guidewire under basal conditions and during maximal hyperemia were performed in three vessels: the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). RESULTS: All patients were followed for a median of 13 months. FFR, IMR, and CFR measurements were performed successfully in all subjects. Mean CFRs of LAD, LCX, and RCA were 1.98+/-1.20, 2.75+/-2.11, and 4.44+/-2.51, respectively. Mean IMRs of LAD, LCX and RCA were 33.28+/-18.78, 29.11+/-26.70, and 30.55+/-23.65, respectively. There was a poor correlation between CFR and troponin-I values in each vessel. In selecting the lowest value of CFR in each patient as the corresponding value, the lowest CFR was not associated with troponin-I levels (r=-0.219, p=0.367). CONCLUSION: In patients without significant coronary lesions, the correlation between CFR and troponin-I level was not significant using a thermodilution technique. Further study of a larger population with longer-term follow-up may be needed to more fully understand microvascular dysfunction.
Arteries ; Coronary Artery Disease* ; Coronary Vessels ; Female ; Follow-Up Studies ; Humans ; Hyperemia ; Microvessels ; Mortality ; Thermodilution* ; Troponin I ; Troponin* ; Vascular Resistance

Twenty eight patients with negative but technically satisfactory four-vessel angiography-admitted to our department from 1985 to 1995 were followed for long term evaluation. The aim of this retrospective study of patients with SAH of unknown etiology was to evaluate the clinical features, long-term prognosis in mortality rate and risk of rebleeding, and the daily functional capacity. Twenty eight out of 1035(2.7%) spontaneous subarachnoid hemorrhage patients were found to have subarachnoid hemorrhage(SAH) of unknown etiology. Twenty eight patients were confirmed as SAH, by computed tomography or lumbar puncture. CT scan was undertaken in all cases(in 28 cases within 5 days of hemorrhage). SAH of unknown etiology classified as Hunt and Hess grade I was 60.7% of cases, but there were no patients with Grade V. Arterial hypertension was present on admission in 35.7% of cases. We only performed the angiogram once in 16 of 28 patients, but there were no rebleedings caused by aneurysm. The period of follow-up ranged from 2 to 11 years, with the mean of 4.3 years. Only one of 28 patients(3.6%) experienced late rebleeding, and again had normal cerebral panangiography. Two patients(7.1%) showed a moderate disability in activities of daily living, one patient(3.6%) was mild disabled, and two(7.1%) had died of pneumonia. Based on the ADL grade, Grade I was 28.6% at the time of discharge however, during follow-up, increased up to 81.5%.
Activities of Daily Living ; Aneurysm ; Follow-Up Studies* ; Humans ; Hypertension ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Spinal Puncture ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed