BACKGROUND: The ideal vaginoplasty must be successful functionally as well as have a natural appearance, and also must retain its functionality and appearance over the long term. Conventional vaginoplasty techniques have functional limitations and are associated with recurrent complications, but rectosigmoid vaginoplasty is known to have a high satisfaction rate due to its functional similarity with the vagina. We conducted the present study to assess the usability of rectosigmoid vaginoplasty over the course of long-term follow-up. METHODS: From March 1992 to February 2014, 84 patients were treated with rectosigmoid vaginoplasty; 44 had gender identity disorder, 29 had vaginal agenesis, 8 had female pseudohermaphroditism, and 3 had gynecologic malignancies after radical pelvic surgery. This retrospective study was based on a review of the patients' records, clinical examinations, complications, and questionnaires about appearance, function, and sexual intercourse. RESULTS: All patients who underwent rectosigmoid vaginoplasty were discharged within 2 weeks without surgical flap loss. The early complications were partial flap necrosis, difficulty in defecation, mucous hypersecretion, and postoperative ileus. The late complications were vaginal introitus contracture, vaginal prolapse, and difficulty in urination. The mean length and diameter of the neovagina 3.4 years after rectosigmoid vaginoplasty were 13.2 cm and 3.8 cm, respectively. On questionnaires about satisfaction, 70% of patients reported excellent satisfaction, 11% good, 12% fair, and 7% poor. CONCLUSIONS: Rectosigmoid vaginoplasty is useful, safe, and well-accepted operative method with good functional and cosmetic results, such as natural lubrication and adequate vaginal length and width obtained without requiring the use of a dilator.
46, XX Disorders of Sex Development ; Coitus ; Contracture ; Defecation ; Follow-Up Studies ; Gender Identity ; Humans ; Ileus ; Lubrication ; Methods ; Necrosis ; Retrospective Studies ; Surgical Flaps ; Urination ; Uterine Prolapse ; Vagina

Monckeberg's medial sclerosis is a degenerative process related to age, and is particularly associated with long-standing diabetes mellitus. The media of small and medium-sized muscular arteries are usually involved. Although its pathogenesis is still unknown, its presence can predict the risk of cardiovascular events and leg amputation in diabetic patients. In our two cases, Mnckeberg's medial sclerosis was shown as a bean-sized, pulsatile mass which occurred from an inferior labial branch of the facial artery. Neither paient had a history of diabetes mellitus or calcification in any part of the body, nor an abnormality with their calcium metabolism. Herein, we report a case of a man and a woman with Mnckeberg's medial sclerosis. This condition is so rare that it has not been reported in the Korean dermatologic literature before. Moreover, Mckeberg's medial sclerosis is very rarely found without diabetes mellitus.
Amputation ; Arteries ; Calcium ; Diabetes Mellitus ; Female ; Humans ; Leg ; Metabolism ; Sclerosis*

Pyoderma-pyostomatitis vegetans (PD-PSV) is a rare, benign, eosinophilic pustular and vegetating mucocutaneous disease characterized by skin lesions which typically involve the axillary and genital regions, the face and the scalp. PD-PSV was at first regarded as a subtype of bullous disease. However, due to the lack of abnormality under a immunofluorescent microscope, it could be diffentiated from bullous disease. A 48-year woman presented with a 6-month history of sharply-outlined, exudative, papillomatous and vesiculopustular vegetating plaques on the perioral, umbilicus and nasal mucosa, tips of her fingers and toes and perianal region. A skin biopsy taken from the lip and umbilicus showed papillary dermal edema and focal inflammatory cell infiltration composed of many eosinophils, intraepithelial microabscesses, focal spongiosis, and exocytosis. No abnormalities were found during an immunofluorescence study. The lesions were almost cleared with 20 mg of triamcinolone and 200 mg of cyclosporin medication during a 3-month treatment period.
Biopsy ; Cyclosporine ; Edema ; Eosinophils ; Exocytosis ; Female ; Fingers ; Fluorescent Antibody Technique ; Humans ; Lip ; Nasal Mucosa ; Scalp ; Skin ; Toes ; Triamcinolone ; Umbilicus

OBJECTIVE: To report a safe and minimal bleeding procedure of abdominal myomectomy and to assess perioperative morbidity associated with this procedure. METHODS: From January 1998 to April 2000, We Studies 33 gynecologic patients undergoing abdominal myomectomy at department of obstetrics and gynecology, Choon-Hae Hospital, retrospectively. Particular attention was given to intraoperative estimated blood loss, blood transfusion requirement and the febrile morbidity rate. RESULTS: Myomectomy was performed successfully in all patients for whom it was scheduled. Mean intraoperative estimated blood loss was 211.5+/-91.3 mL. Four cases (12%) had an estimated blood loss greater than 400 mL. Preoperative, intraoperative or postoperative transfusion occurred in 6 cases (18%). There were no other intraoperative complications. Febrile morbidity occurred in 6 (18%) cases. Two cases (6%) experienced wound infection. CONCLUSION: We conclude that this procedure is safe and appropriate alternative for most women who want to preserve or enhance fertility potential.
Blood Transfusion ; Female ; Fertility ; Gynecology ; Hemorrhage ; Humans ; Intraoperative Complications ; Leiomyoma ; Obstetrics ; Retrospective Studies ; Wound Infection

BACKGROUND AND OBJECTIVES: A rescue percutaneous coronary intervention (PCI) has been used to treat the patients after failed thrombolysis in acute myocardial infarction. However, short- and long-term benefits of rescue PCI has not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, success rate of the procedure, and long-term survival rate after rescue PCI. MATERIALS AND METHODS: Clinical and angiographic outcomes of 31 patients (Group I; 59.7+/-11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7+/-9.7 years, 79.7% male), primary PCI at Chonnam National University Hospital between January 1997 and December 1999. RESULTS: There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P<0.05). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P<0.05). The coronary angiographic findings were not different between two groups. Thrombolysis in Myocardial Infarction flow of Group I was lower than in Group II (Group I; 1.14+/-0.93 vs. Group II; 1.61+/-1.14, P<0.05). Primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P<0.05). Baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2+/-8.9% vs. Group II; 50.8+/-11.7, P<0.05), which improved in both groups (Group I; 51.7+/-7.9% vs. Group II; 60.7+/-13.4%, P<0.05) at six months after the procedures. The survival rate of Group I was 93.5%, 93.5% and 90.3% and that of Group II was 94.5%, 93.7% and 91% at 1 month, 6 and 12 months, respectively. CONCLUSION: Rescue PCI was associated with the risk factor of smoking and the high incidence of cardiogenic shock. The success rate of rescue PCI was comparable with primary PCI and left ventricular function was improved after rescue PCI on long-term clinical follow-up with relatively high survival rate.
Coronary Artery Disease ; Follow-Up Studies ; Humans ; Incidence ; Jeollanam-do ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Risk Factors ; Shock, Cardiogenic ; Smoke ; Smoking ; Survival Rate ; Ventricular Function, Left

BACKGROUND: Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. METHODS: Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5+/-9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). RESULTS: The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4+/-7.57 mm in Group A and 20.8+/-6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). CONCLUSION: The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.
Angioplasty, Balloon ; Atherosclerosis ; Coronary Vessels ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Percutaneous Coronary Intervention ; Phenobarbital ; Prevalence ; Risk Factors ; Stents*

Cysticercosis is a relatively common disease in Korea. Racemose cysticercosis, a peculiar form of the neurocysticercosis usually occurs as meningeal forms and rarely involves the cerebral parenchyme. The authors present a case of cerebral parenchymal racemose cysticercosis in a 55 year-old man with generalized seizure. Brain CT and MRI showed a large multilobulated cyst in the right frontal lobe. At surgery, we removed cyst covered by milkish white, multiple septated membranes completely. Histological dignosis of surgical specimen was racemose cysticercosis without scolex.
Brain ; Cerebrum ; Cysticercosis* ; Frontal Lobe ; Humans ; Korea ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Neurocysticercosis ; Seizures

A 2.5-year-old female patient who has a prior history of partial seizures was admitted by generalized tonic-clonic status epilepticus secondary to tapering of phenobarbital. Tonic-clonic status epilepticus was refractory to phenytoin, phenobarbital, valproic acid, diazepam, and pentobarbital. After 4 days of unsatisfactory control of seizure activity, isoflurane was administered for 4 hours. Inspired isoflurane concentration of 1.3% were required to control seizures. Heart rate and blood pressure were supported with infusions of dopamine and fluid. After discontinuation of isoflurane, the patient developed partial seizures but seizure activity was controlled with anticonvulsants. She was discharged alive from the hospital after weaning of the ventilator.
Anesthesia, General* ; Anticonvulsants ; Blood Pressure ; Diazepam ; Dopamine ; Female ; Heart Rate ; Humans ; Isoflurane ; Pentobarbital ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus* ; Valproic Acid ; Ventilators, Mechanical ; Weaning

Thrombotic thrombocytopenic purpura(TTP) is a clinical syndrome of unknown etiology and characterized by microangiopathic hemolytic anemia, thrombocytopenia, fluctuating neurological status, renal dysfunction and fever. Systemic lupus erythromatosus(SLE) is also multisystemic disease that some of clinical features may mimic TTP. Therefore both diseases have led to diagnostic confusion. We experienced two cases with SLE who subsequently or initially developed TTP. In case 1, a 44-year old woman had 1-year previous history of SLE and presented with dyspnea. After diagnosis of thrombotic microangiopathy by renal biopsy, she was managed with steroid, cyclophosphamide pulse therapy, fresh frozen plasma infusion and plasmapheresis. She was treated by aggressive treatment; nevertheless, she died on 15th admission day. In case 2, a 22-year old man was admitted because of nausea and vomiting. SLE with TTP was diagnosed by ARA criteria and the finding of microangiopathic hemolytic anemia. He was treated with plasmapheresis, fresh frozen plasma infusion and steroid therapy. He showed clinical response to the therapy, and has shown no recurrence of disease until now on. In conclusion, we suggest that early diagnosis and prompt therapy such as plasmapheresis and plasma infusion are very important in SLE with TTP.
Adult ; Anemia, Hemolytic ; Biopsy ; Cyclophosphamide ; Diagnosis ; Dyspnea ; Early Diagnosis ; Female ; Fever ; Humans ; Nausea ; Plasma ; Plasmapheresis ; Purpura, Thrombocytopenic* ; Purpura, Thrombotic Thrombocytopenic ; Recurrence ; Thrombocytopenia ; Thrombotic Microangiopathies ; Vomiting ; Young Adult

Pulmonary atelectasis is a common complication following surgery under general anesthesia. However, collapse during anesthesia and surgery is rare, and usually is not diagnosed until the surgical procedure is well under way. Total or segmental lung collapses are usually resulted from the obstruction of bronchial pathway by secretions such as mucus, blood and pus etc. We experienced acute lung collapse of right upper lobe during left thoracotomy. We assumed that the cause of the atelectasis was an obstruction of right superior lobar bronchus by mucus. The possible cause of lung collapse is described.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Bronchi ; Inhalation* ; Lung ; Mucus ; Pulmonary Atelectasis* ; Suppuration ; Thoracotomy*