OBJECTIVE: To analyze the tubal patency in the young-aged women underwent diagnostic laparoscopy with Fitz-High-Curtis Syndrome (FHCS). METHODS: Clinicopathologic results of young-aged women who underwent diagnostic laparoscopy with pelvic inflammatory disease from March 2005 through April 2007 were reviewed. Twenty six patients aged 19-29 years old and preserved their both tubes after diagnostic laparoscopy were included in this study. All were underwent chromopertubation test (CPT) during laparoscopy and postoperative hysterosalpingography (HSG) 3 months later. RESULTS: Of 26 patients, eight patients were diagnosed with FHCS and the others were not. There was no significant difference in mean age, mean hospitalization days, and frequency in past-history of parturition, abortion, chlamydia and gonococci infection between patients with FHCS and with non-FHCS (P>0.05). There was no significant difference in frequency of tubal obstruction in laparoscopic CPT (P>0.05) but not in postoperative outpatient HSG (P<0.05). CONCLUSION: The tubal obstruction may be more frequent in FHCS than non-FHCS and the reliability of laparoscopic CPT for diagnosing the tubal obstruction is supposed to be low. Therefore, as for FHCS patients, HSG should be executed to investigate tubal factor which is helpful to forecast the fertility.
Aged ; Chlamydia ; Fallopian Tube Diseases ; Female ; Fertility ; Hospitalization ; Humans ; Hysterosalpingography ; Laparoscopy ; Outpatients ; Parturition ; Pelvic Inflammatory Disease

OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.
Clomiphene ; Embryonic Structures ; Estrogens ; Gonadotropin-Releasing Hormone* ; Humans ; Pregnancy Rate ; Progesterone ; Superovulation

PURPOSE: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. METHODS: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using removed appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel(R) (Ethicon). We analyzed the success rate. RESULTS: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. CONCLUSION: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.
Appendectomy* ; Appendix* ; Body Mass Index ; Humans ; Laparoscopy ; Recycling ; Surgical Instruments*

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

CATCH 22 is a medical acronym for cardiac defects, abnormal faces, thymic hypoplasia, cleft palate, and hypocalcemia, and a variable deletion on chromosome 22. It includes DiGeorge syndrome, conotruncal anomaly face syndrome, and velo-cardio-facial syndrome. It has a prevalence estimated at 1:3,000-1:6,000. Most deletions occur at de novo, but autosomal dominant inheritance is observed in 6-10% of cases. Hormonal disorders are common in patients with CATCH22 syndrome. While hypoparathyroidism was the predominant endocrine disturbance that has been documented in the DiGeorge syndrome, other hormonal defects, such as growth hormone deficiency, hypothyroidism, and hyperthyroidism have been occurred in patients with CATCH22 syndrome. The spectrum of parathyroid gland dysfunction in this syndrome ranges from severe neonatal hypocalcemia to normal parathyroid function. Most patients are usually diagnosed in young age, but a few patients with mild abnormality are presented later in life. We report a case of CATCH22 syndrome with normal parathyroid hormone and calcium level in an adult. The diagnosis of CATCH22 syndrome was confirmed by fluorescence in situ hybridization analysis.
Adult ; Calcium ; Chromosomes, Human, Pair 22 ; Cleft Palate ; DiGeorge Syndrome ; Fluorescence ; Growth Hormone ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypoparathyroidism ; Hypothyroidism ; In Situ Hybridization ; Parathyroid Glands ; Parathyroid Hormone ; Prevalence ; Wills

OBJECTIVE: It has been suggested that hysterectomy has a disturbing influence on bowel function, mainly constipation. We performed a prospective study to assess the changes of ano-rectal physiology after hysterectomy. METHODS: Fourteen consecutive patients were assessed before and two months after hysterectomy. A detail questionnaire was devised to allow assessment of bowel function and ano-rectal pressure test and balloon expulsion test were performed before and after hysterectomy. The parameters measured in ano-rectal pressure test included the minimal sensible volume, ano-rectal resting pressure, maximal squeezing pressure, recto-anal inhibitory reflex and balloon expulsion test. Data analysis was carried out by paired t-test. Statistical significance was inferred when the p value was<0.05. RESULTS: Among the fourteen patients, the straining in defecation was found in three patients after operation, other defication habits were not significantly changed after hysterectomy(P>0.05). There were no significant changes in ano-rectal pressure test after hysterectomy. The disturbance of balloon expulsion capacity was increased in four patients after hysterectomy(29%). CONCLUSION: Our results demonstrate that hysterectomy does not cause a decrease in ano-rectal pressure and rectal sensitivity, but has an adverse effect on rectal expulsion capacity in a some of patients.
Constipation ; Defecation ; Humans ; Hysterectomy* ; Physiology ; Prospective Studies ; Surveys and Questionnaire ; Reflex ; Statistics as Topic

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

In this paper, the current status of adolescent suicide prevention and intervention are addressed, including areas related to medicine, counseling, mental health nursing, social welfare, and education. Many preventive efforts and intervention programs have been developed and implemented, but the results have been mostly minimal or unfruitful and many problems arose. First, there is a lack of epidemiological research and developmentally appropriate data on adolescent suicide. Thus evidence-based research on adolescent suicide necessary to make important decisions regarding prevention strategies and the allocation of budgets and human resources is not available. Second, there are only a handful of experts with an appropriate level of education and training. Current suicide prevention efforts are performed as a part of crisis intervention, but only a few persons know how to do so effectively. Finally, a good networking and referral system among each area of service is needed. One of the most important issues might be balancing the levels of service available to each subject and to provide a proper, systematized intervention and continuous crisis management services. In order to create an effective networking and referral system among several service providers for adolescent suicide prevention, we need robust support from the Korean government and local communities.
Adolescent ; Budgets ; Counseling ; Crisis Intervention ; Hand ; Humans ; Mental Health ; Referral and Consultation ; Social Welfare ; Suicide