Incarceration of the gravid uterus is a rare but serious complication of pregnancy. Reported is the case of a gravid 2, para 0, abortus 1 with known uterine subserosal myoma(5.3 x5.5cm sized) 26-year-old woman presented with acute dysuria and urinary retention. The patient was 14 weeks and 3 days pregnant and presented several week history of urinary frequency and sensation of incomplete bladder emptying. Examination revealed a retroflexed uterus with cervical opening pointing toward the anterior abdominal wall. An ultrasound revealed a thin, elongated maternal bladder and a uterus incarcerated between the sacral promontary and the pubis. The incarceration was successfully reduced by tenaculum traction of the cervical posterior lip without surgical intervention and had a normal infant of appropriate weight at term.
Abdominal Wall ; Adult ; Dysuria ; Female ; Humans ; Infant ; Leiomyoma ; Lip ; Myoma* ; Pregnancy ; Sensation ; Traction ; Ultrasonography ; Urinary Bladder ; Urinary Retention ; Uterine Retroversion ; Uterus*

OBJECTIVE: The authors conducted this study to investigate the safety and efficacy of decompressive surgery alone in the treatment of lumbar spinal stenosis in the elderly population. METHODS: All charts and records of 323 patients aged 65 years or older who underwent lumbar spinal decompressive surgery without fusion for lumbar spinal stenosis in the period from September 2003 to August 2007 were reviewed. RESULTS: A total of 323 patients were identified. Mean age among patients were 72.6years. 197 patients(60.9%) underwent wide decompression, 95 patients(29.4%) had microscopic partial decompression, and 31 patients(9.5%) underwent bilateral decompression via unilateral approach. Perioperative morbidity seen was among 16 patients(4.9%). There were 5 patients(1.5%) reoperated for hematoma formation. Another 5 patients(1.5%) developed wound infection. Cerebrospinal fluid(CSF) leakage were noted among 3 patients(0.9%). 2 patients(0.6%) had urinary difficulty, and Steven Johnson syndrome developed in one patient(0.3 %). Clinical outcome was evaluated using Macnab's classification. 40 patients(12.4%) had excellent results, 241 patients(74.8%) had good results, 34 patients(10.3%) had fair results and 8 patients(2.5%) had poor outcome. CONCLUSION: Decompressive laminectomy alone is a relatively safe and effective treatment option for the elderly.
Aged ; Decompression ; Hematoma ; Humans ; Laminectomy ; Spinal Stenosis ; Wound Infection

BACKGROUND: Suction auto epidermal graft for the treatment of stable vitiligo has become popular clinically. In general, depigmented epidermis is removed by liquid nitrogen freezing for preparation of the recipient site. There have been some problems with the nitrogen freezing method, uneven repigmentation, appearance of Koebner's phenomenon on normal colored skin around the graft site, scar formation on recipients sites. In our view these resulted in unwanted damage to the dermis and epidermal and skin appendageal melanocytes of normal skin by freezing. OBJECTIVE: To introduce a method to remove the depigmented epidermis of recipient site with minimal unwanted damage to melanocytes and dermal tissue. METHODS: Using Ellman surgitron, irradiation equipment of 3.8MHz frequency the depigmented epidermis was removed with a blade electrode under rated electric power around 10 watts depending on the thickness of the epidermis. Operating mode was fully filtered current for minimal charring and destruction of tissue through pure micro-smooth cutting. RESULTS: In the case of removal of the epidermis with Ellman surgitron, oozing and inflammation decreased markedly compared with those applied with liquid nitrogen. And it was confirmed histopathologically that there was no significant unwanted destruction of healthy tissue. Moreover, the electrode of Ellman surgitron is designed to be apt to trace the margin of depigmented lesion. And Ellman surgitron features a continuously linear intensity setting for precise, predictable control to minimize tissue destruction and charring. So we were able to remove the epidermis of the shallow lesion looking like a pseudopod and of the thinnest part of the body like eyelid also. And we grafted normal epidermis successfully on the depigmented lesion. CONCLUSION: The removal of depigmented epidermis by radio-frequency gave satisfactory results in the suction auto epidermal graft by overcoming the defects shown as depigmented epidermis which were removed by liquid nitrogen freezing. And this method made patients comfortable because of less pain, a one day operation procedure and good results.
Cicatrix ; Dermis ; Electrodes ; Epidermis* ; Eyelids ; Freezing ; Humans ; Inflammation ; Melanocytes ; Nitrogen ; Skin ; Suction* ; Transplants* ; Trout ; Vitiligo

We reported herein a rare case of a 65-year-old female who lead intestinal tuberculosis of about 2 months duration, with little late development of metastatit berculosis abscess of the skin. The lesions were egg tow wolnut-sized abscesses or nodules occu in, on the back, right flank and lower abdomen with no pain or mild tenderness. Physical exami saion was unremarkable on dissemination of other sites. The tuberculin test was negative. The skin esions were diagnosed by clinical, histopathologic features, and positive results for Mycobactc iuntuberculosis in smear.; and cultures in the pus discharge: as well as polymerase chain reaction nethod on the nodular lesion. A barium enema showed the findings of intestinal tuberculosis, with positive culture in the stool. A combined treatment was intituted. During the initial 4 month, utaneous lesions did not respond and in some cases worsened with the multidrug of isoniazicr fampin, pyrazinamide and streptomycin, all of which were surgically excised. Thereafter, the drugs of isoniazid and rifampin were further administered for ahout 14 months, with the complete resecution of both lesions and the systemic symptomatolo. There was no relapse at follow-up after 6 months.
Abdomen ; Abscess* ; Aged ; Barium ; Enema ; Female ; Follow-Up Studies ; Humans ; Isoniazid ; Ovum ; Polymerase Chain Reaction ; Pyrazinamide ; Recurrence ; Rifampin ; Skin* ; Streptomycin ; Suppuration ; Tuberculin Test ; Tuberculosis*

OBJECTIVE: The authors evaluate the differences in the pedicle screw pull-out strength between an unaugmented screw and a screw augmented by high pressurized PMMA in an embalmed human lumbar cadaveric spine. METHODS: Pedicle screws were inserted in the 50 pedicles of cadaver lumbar spine after measuring the bone mineral density(BMD) of the specimens. The pedicle screw was inserted without augmentation on the left pedicle and with augmentation by a vertebral reconstruction with high pressurized PMMA on the right side. The pedicle screw was inserted before the hardening of bone cement on the right side. A computed tomographic scan was done to evaluate the location of the PMMA and PMMA/ screw interface. After that, a screw pullout strength test was performed. RESULTS: There were positive correlations between the pull-out strength and BMD in the control group (r=0.7339). The average pull-out strength of the augmented group was 168% greater than that of the control group(p<0.05). The pull-out strength of the augmented group was correlated with in the volume of the PMMA. CONCLUSION: A pedicle screw that is augmented with PMMA will provide a more rigid fixation than that of an unaugmented screw, especially in the low BMD group of the specimens.
Cadaver* ; Humans ; Polymethyl Methacrylate ; Spine

The blue rubber bleb nevus syndrome(CRBNS) is a rare disorder characterized by distinctive vascular malformations of the skin and gastrointestinal tract. The syndrome is associated commonly with iron deficiency anemia due to gastrointestinal bleeding. Most cases are sporadic, although a few have been reported with autosomal dominant inheritance. We report a case with clinical characteristics of the blue rubber bleb nevus syndrome. The patient had typical skin manifestations of the BRBNS and chronic iron deficiency anemia. However, we could not find any gastrointestinal vascular malformations radiologically.
Anemia, Iron-Deficiency ; Blister* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nevus* ; Rubber* ; Skin ; Skin Manifestations ; Vascular Malformations ; Wills

No abstract available.
Bronchoscopy*

Timely diagnosis and subsequent appropriate intervention is important in respiratory diseases. Chest radiograph is the most commonly performed radiologic examination and is the imaging study that the majority of non-radiologist physicians are most likely to encounter in their clinical practice. Chest radiography, however, can be very complex and difficult to interpret accurately due to abnormalities that might be quite subtle. Failure to detect lung cancer on the chest radiograph, which has become one of the most frequent causes of missed diagnoses in radiology, is a major cause that brings up medicolegal suits. There are no reliable radiographic criteria to distinguish lung cancer from benign diseases. Being knowledgeable about thoracic imaging will help to minimize errors. The diagnosis of lung cancer is commonly delayed because of masking by a tuberculosis lesion. In diagnosing tuberculosis, clinicians should be aware of endobronchial tuberculosis, anthracofibrosis, multidrug resistant tuberculosis, and non-tuberculous mycobacterial diseases. If pneumonia was not resolved, endobronchial lesions such as a foreign body or cancer, bronchioloalveolar cell carcinoma, and atypical pathogens might be considered. In patients with chronic coughing, eosinophilic bronchitis also should be suspected in addition to postnasal drip syndrome, cough variant asthma, and gastroesophageal reflux disease. Most common pitfalls can be avoided by physicians who are familiar with diverse patterns of respiratory disease in diagnosis. Through an increased familiarity with variable manifestations of pulmonary diseases and a high index of suspicion, the diagnosis of respiratory diseases will be improved.
Asthma ; Bronchitis ; Cough ; Diagnosis* ; Eosinophils ; Foreign Bodies ; Gastroesophageal Reflux ; Humans ; Lung Diseases ; Lung Neoplasms ; Masks ; Pneumonia ; Radiography ; Radiography, Thoracic ; Recognition (Psychology) ; Thorax ; Tuberculosis

INTRODUCTION: This study was performed to evaluate the diagnostic usefulness of simultaneous determination of 3 tumor markers {serum carcinoembryonic antigen(CEA), squamous cell carcinoma antigen (SCC Ag) and neuron specific enolase(NSE)} in lung cancer patients. METHOD: In 113 patients with primary lung cancer(70 with squamous cell carcinoma, 30 with adenocarcinoma, 13 with small cell carcinoma) and 103 patients with benign lung diseases, serum CEA and NSE were measured by enzyme immunoassay, and SCC Ag was measured by microparticle enzyme immunoassay. RESULTS: 1) The mean serum levels of 3 tumor markers were significantly higher in lung cancer groups than benign lung disease groups respectively(p=0.001). 2) In squamous cell carcinoma, the SCC Ag was elevated in 67%, in adenocarcinoma CEA was elevated in 77% and in small cell carcinoma NSE was elevated in 77%, but there were no significant differences according to the stage of each cancer cell types. 3) CEA was the most sensitive marker, but nonspecific to cancer types. SCC Ag was less sensitive than other markers, but more specific toward squamous cell carcinoma, and NSE was more specific to primary lung cancer. 4) As the number of positive tumor markers was increased, the relative possibility of lung cancer was also increased. If two markers were positive, it increased to 77%, and if three markers were positive it increased to 90%. CONCLUSION: The simultaneous measurement of serum CEA, SCC Ag and NSE would provide additional information for the diagnosis of lung cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Immunoenzyme Techniques ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Neurons ; Biomarkers, Tumor*

To understand the role of Transglutaminase K(TGase K) in skin diseases, the expression of TGase K protein was studied in hyperkeratotic inflammatory skin diseases, and in several different kinds of benign and malignant skin tumors. Immunohistochemistry was used to detect the TGase K protein with a new anti-human TGase K polyclonal antibody. This antibody showed the same immuno- histochemical staining pattern as in previously published immunofluorescence data with the exception that the immunohistochemical stain showed a slightly weaker stain in the granular layer. However, the staining intensity was decreased in psoriasis, which is opposite for results obtained with the widely used TGase K monoclonal antibody B.C1. In other hyperkeratotic inflammatory skin diseases, like pityriasis rubra pilaria, lichen planus, and pityriasis rosea, the staining patterns were similar while the staining intensity was decreased, compared to normal epidermis. Squamous cell carcinoma showed a diffuse staining pattern in tumor cells with a small intensity increase in well differentiated tumor cells. However, in actinic keratosis and Bowen's disease, which are thought to be precursors of squamous cell carcinoma, the staining intensity was weak. The tumor cells of basal cell carcinoma, malignant melanoma, and seborrheic keratosis showed a weak staining intensity.
Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Epidermis ; External Fixators ; Fluorescent Antibody Technique ; Immunohistochemistry ; Keratosis, Actinic ; Keratosis, Seborrheic ; Lichen Planus ; Melanoma ; Pityriasis ; Pityriasis Rosea ; Psoriasis ; Skin Diseases* ; Skin*