Bottoming out is the term used to describe the inferior displacement of a breast implant after breast augmentation that results in increased distance between the nipple areolar complex and the inframammary fold. Conventional techniques for correcting bottoming out involve capsulectomy and capsulorrhaphy via an inframammary fold incision that is prone to cause large scar and increases the patient's burden. However, using an endoscopic approach via the axilla, we are able to correct bottoming out, resulting in a smaller scar and shorter recovery time. In this article, we present a novel and simple method to correct bottoming out using endoscopy and electrocauterization.
Axilla ; Breast Implants ; Breast* ; Cicatrix ; Endoscopy ; Nipples

BACKGROUND: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. MATERIAL AND METHOD: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. RESULT: There were 21 male and 6 female patients. Mean birth weight was 2.62+/-.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). CONCLUSION: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.
Birth Weight ; Cause of Death ; Colon ; Constriction, Pathologic ; Empyema ; Esophageal Atresia* ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mortality ; Retrospective Studies ; Tracheoesophageal Fistula

Aneurysms of the coronary arteries are rare. They may be due to atheroselerosis, mucocutaneous lymph node syndrome, mycotic emboli, syphilis or trauma and occasionally they are congenital. The prognosis appears to be poor and death can occur suddenly from rupture of the aneurysm, peripheral coronary embolism or bacterial endocarditis. Recently surgical treatment has been successful. In a 5 year old patient with ventricular septal defect, two aneurysmal sacs located at the cardiac crux and just posterior to it was proved by coronary angiography and MRI, and successfully excised at operation.
Aneurysm* ; Child, Preschool ; Coronary Angiography ; Coronary Vessels* ; Embolism ; Endocarditis, Bacterial ; Heart Septal Defects, Ventricular ; Humans ; Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome ; Prognosis ; Rupture ; Syphilis

The authors reported 100 cases of acute subdural hematomas confirmed by operation from Jan. 1972 to Sept. 1975. We discussed the relationship of the type of operation to mortality in acute subdural hematomas. The types of surgical operations were divided in 4 groups. The surgical mortality rate was 19% for frontotemporoparietal craniotomy, 29% for multiple burr holes technique, 42% for craniectomy and 48% for subtemporal decompression with burr holes and total over-all mortality was 36% in our cases. The authors reviewed the literatures described the surgical operative method and it's mortality and so we thought large frontotemporoparietal craniotomy is more valuable method for operation of the acute subdural hematomas.
Craniotomy ; Decompression ; Hematoma, Subdural, Acute* ; Mortality

No abstract available.
Blinking ; Meningioma* ; Trigeminal Neuralgia*

No abstract available.
Orientia tsutsugamushi* ; Rickettsia* ; Ulsan*

No abstract available.
Heart Septal Defects, Atrial*

Acute motor and sensory axonal neuropathy (AMSAN) are recently described subtypes of Guillain-Barre syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness. In laboratory findings, immunoglobulin M antibodies against hepatitis A were detected in blood and cerebrospinal fluid. The findings of motor nerve conduction studies showed markedly reduced amplitudes of compound muscle action potentials in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. Based on clinical features, laboratory findings, and electrophysiologic investigation, the patient was diagnosed the AMSAN following acute hepatitis A viral infection. The patient was treated with intravenous immunoglobulin and recovered slowly. Clinicians should consider this rare but a serious case of AMSAN following acute hepatitis A infection.
Acute Disease ; Electromyography ; Guillain-Barre Syndrome/*diagnosis/drug therapy/etiology ; Hepatitis A/complications/*diagnosis ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Male ; Young Adult

BACKGROUND: Paradoxical puborectalis syndrome (PPS) is a complex and poorly understood entity characterized by contraction rather than relaxation of the pelvic floor muscles during attempted evacuation. Anal electromyography (EMG) and cinedefecography (CD) are the most commonly used tests for the diagnosis of PPS. Therefore, the aim of this study was to prospectively assess the correlation of EMG and CD in the diagnosis of PPS. METHODS: All patients with symptoms of obstructed evacuation who underwent EMG and CD between September 1998 and February 1999, were evaluated. The clinical criteria for PPS included incomplete or difficult evacuation, straining, tenesmus, and the need for an enema or digitation. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the puborectalis to relax along with incomplete evacuation. RESULTS: Twenty-nine (29) patients had clinical evidence of PPS, 8 males and 21 females with a mean age of 42.6 years (range, 19-75 years), and underwent CD and EMG. The mean duration of symptoms was 7.2 years (range, 3 months-30 years). Nineteen patients (65.5%) had evidence as having PPS on CD and/or EMG. Of these patients, six patients (20.7%) were diagnosed as having PPS on both tests, five patients (17.2%) were only diagnosed on CD, and eight patients (27.6%) were only diagnosed on EMG. The remaining ten patients had normal puborectalis muscle relaxation on CD and EMG. Therefore, the correlation rate between the two tests was 55.2%. If EMG was considered as the ideal test for the diagnosis of PPS, CD had a sensitivity of 42.9% and a specificity of 66.7%. Conversely, if CD was considered as the ideal test, EMG had a sensitivity of 54.5% and a specificity of 55.6%. CONCLUSIONS: The sensitivity and the specificity values of EMG and CD for the diagnosis of PPS are suboptimal, and a low correlation existed between the two tests. This result suggests that the diagnosis of PPS should not be based upon only one test.
Constipation ; Diagnosis* ; Electromyography* ; Enema ; Female ; Humans ; Male ; Muscle Relaxation ; Muscles ; Pelvic Floor ; Prospective Studies ; Relaxation ; Sensitivity and Specificity

Objective The aim of this study was to evaluate the clinicopathologic findings of eight patients with primary cancer of fallopian tube diagnosed and treated in the department of Obstetrics and Gynecology, University of Ulsan, Asan Medical Center for nine years. Methods Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and survival of patients were reviewed retrospectively. Results The patients with primary cancer of fallopian tube constituted 0.4% of all gynecologic malignancies encountered during this period. The age of patients ranged 42 to 70 years(mean+/- S.D.; 53.9+/-9.9) and half of patients were postmenopausal and two patients were nulliparous. Patients were treated by simple or radical hysterectomy and bilateral salpingoophorectomy with or without omentectomy and five patients received postoperative chemotherapy. The FIGO surgical stages of the patients were I(4 cases), II(2 cases), III(1 case) and IV(1 case). There were 3 cases of adenocarcinoma, 3 cases of malignant mixed Mullerian tumor, 1 case of undifferentiated carcinoma and 1 case of serous cystic tumor of low malignancy potential. Serum CA 125 values were followed during treatment and decreased during clinical remission and increased at the time of tumor progression. The mean follow-up duration was 24.3(+28.3) months and 7 patients were alive free of disease and one patients with stage Ic died of the disease. Conclusion Primary fallopian tube cancer is an extremely rare malignancy of the female genitalia and preoperative diagnosis of this disease is difficult. Cytoreductive surgery and postoperative combination chemotherapy seem to be effective treatment and CA 125 value could reflect the disease status during the treatment and follow-up of patients.
Adenocarcinoma ; Carcinoma ; Chungcheongnam-do ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Genitalia, Female ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies ; Ulsan