OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study is to compare the efficacy of suturing methods of vaginal cuff between laparoscopic and vaginal approach. METHODS: One hundred and sixty one cases of laparoscopic hysterectomy were devided into two groups. In group A(n=67), vaginal cuff was sutured by laparoscopic suture technique and in group B(n=94), vaginal cuff was repaired by vaginal approach. RESULTS: There were no significant differences in uterine weight, hospital stay, pre-and postoperative hemoglobin level and complications including febrile morbidity in two groups. Operation time was significantly shorter in group B(p=0.05). CONCLUSION: Transvaginal repair of vaginal cuff showed shorter duration of operation time than laparoscopic suture technique in total laparoscopichy sterectomy.
Hysterectomy* ; Laparoscopy ; Length of Stay ; Suture Techniques

The femoral fracture, occurred associated with the cemented hip arthroplasty, is well-known cornplication but the proximal femoral fractures of the noncemented hip arthroplasty, were occurred more than those. Among the 290 patients, who were treated by the noncemented hip arthroplasty from Dec. 1987 to April 1992, the 24 cases of the femoral fracture were experienced and the results were as follows: 1) of the 24 cases, the male was nine and the female was fifteen. The age distribution was mostly occurred between 41 and 60 years old and most fracture were developed in 1 1mm stem size. In revision cases, 225mm stem length (Wagner) was common. The locations of fracture were proximal 1/3 (type I: 19 cases), tip (type II; 1 case), distal 1/3 (type III; 1 case) and comminuted (type IV; 3 cases) by Johansson; siclassification. 2) The femoral fracture was mostly developed during the stem insertion and the fracture site in anatomical stem was only proximal femur. 3) 1n cases of revision, most of the fractures were occured on the anterior or lateral side of the femur. It was difficult to manage the fracture because of the severe osteoporosis and comminution. 4) As the problem of the operative technique, the fracture incidence can be decreased by accurate preoperative measurement and it must be cautious in the stem more than 225 mm length, which were used in revision case. 5) The circumferential wiring for proximal and plate & screws in middle and distal were done as the treatment of fracture and the results were all good, but stem tip fracture in osteoporotic patients was troublesome. We think that long plate(>8 holes) & both cortex purchase and bone graft are best methods so far.
Age Distribution ; Arthroplasty ; Female ; Femoral Fractures ; Femur ; Hip ; Humans ; Incidence ; Male ; Osteoporosis ; Transplants

PURPOSE: The aim of this study was to investigate the anti-fibrotic effect of relaxin in subsynovial fibroblasts activated by transforming growth factor beta (TGF-β). MATERIALS AND METHODS: To test the anti-fibrotic effect of an adenovirus-relaxin construct (Ad-RLN) on subsynovial fibroblasts in vitro, cells from subsynovial connective tissue of patients with carpal tunnel syndrome were activated with TGF-β1 and exposed to Ad-RLN (as a therapeutic gene) or adenovirus-lacZ construct (as a marker gene) for four hours. Subsynovial fibroblast cultures without adenoviral exposure served as controls. RESULTS: We observed induction of gene expressions of collagen I, III and IV, as well as the abatement of alpha-smooth muscle actin (a-SMA) synthesis, Smad2 phosphorylation, and fibronectin at the protein level, in comparison to controls. In addition, protein expressions of matrix metalloproteinase (MMP) I was significantly induced, whereas the protein expressions of tissue inhibitor of metalloproteinases (TIMP) I and IV were reduced due to relaxin expression. CONCLUSION: RLN prevents excessive synthesis of extracellular matrix by reducing the expressions of its components, such as fibronectin, a-SMA, and phosphorylated Smad2, by increasing the expression of MMPs; and by decreasing the expression of TIMPs.
Actins ; Carpal Tunnel Syndrome* ; Collagen ; Connective Tissue ; Extracellular Matrix ; Fibroblasts* ; Fibronectins ; Gene Expression ; Humans ; In Vitro Techniques ; Matrix Metalloproteinases* ; Phosphorylation ; Relaxin* ; Tissue Inhibitor of Metalloproteinases ; Transforming Growth Factor beta

Cysts of the spleen are uncommon disease entities and can be classified as either primary (true) or secondary (pseudo-) depending on the presence of a true epithelial lining. True nonparasitic cysts of spleen are very rare, and the majority of the cases are classified as epidermoid cysts. True splenic cysts were found in three children during the last eleven years (1989~1999) in Yeungnam University Hospital. Two of the children were girls and one was boy. The age at diagnosis ranged from 7 to 15 years. Abdominal ultrasonography was utilized to the initial diagnosis, and computerized tomography was done for the detailed studies. Radionuclide scanning was performed in a patient. Surgical resection (one partial splenectomy and two total splenectomies) was performed. The cysts were from 4cm to 9cm in maximum diameter. Pathologic finding was epidermoid cyst of the spleen.
Child ; Diagnosis ; Epidermal Cyst ; Female ; Humans ; Male ; Spleen ; Splenectomy ; Ultrasonography

Objectives: . Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis. Methods: . We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated. Results: . An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement. Conclusion . Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.

Acidosis ; Administration, Intravenous ; Anesthesia ; Anesthetics ; Blood Pressure ; Dantrolene ; Diagnosis ; Early Diagnosis ; Emergency Treatment ; Fever ; Humans ; Incidence ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Orthognathic Surgery ; Succinylcholine ; Tachycardia ; Young Adult

Pilomatricomas are rare, usually benign and solitary, asymptomatic, calcifying tumors of the hair matrix cell, which mostly appear in the first and second decade of life. However, they may occur in adulthood. The most prevalent sites of pilomatricomas in children are the head and neck but they may occur anywhere. The typical presentation is a firm, slowly enlarging, freely mobile, well-circumscribed subcutaneous nodule, measuring 0.5 to 3 cm in diameter. The tumors are generally solitary, often adherent to overlying skin. Multiple pilomatricoma is relatively rare. Spontaneous regression is never observed, complete surgical excision is a treatment of choice. We present two cases of pilomatricoma arising from the right posterior auricle and the left posterior neck, which were treated with simple excision.
Child ; Hair ; Head ; Humans ; Neck* ; Pilomatrixoma* ; Skin

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) can present as heart failure or arrhythmias in a child. It is a rare disorder, characterized by prominent trabecular meshwork and deep intertrabecular recesses. We still know little about the diagnosis, symptoms, and clinical outcomes of INVM. METHODS: We included in our study 6 patients who showed ventricular noncompaction on echocardiography. Patients were diagnosed as INVM were excessively prominent trabeculations with deep intertrabecular recesses were found on echocardiography. Patients who had other complex heart lesions such as pulmonary atresia with intact ventricular septum in addition to ventricular noncompaction, were excluded. RESULTS: Age at presentation ranged from 1 day 7 years, with follow up being as long as 6 years. Symptoms at initial presentation were heart murmur, paroxysmal supraventricular tachycardia, cyanosis, feeding intolerance, ventricular tachycardia, and cardiomegaly at fetal screening. Prominent trabeculations and intertrabecular recesses were observed at left ventricular apex in all six patients. All patients were alive at last follow-up. One patient showed WPW syndrome on electrocardiography. Echocardiography revealed decreased systolic function in 4 patients, and decreased systolic and diastolic function in 1 patient. One patient is currently asymptomatic. CONCLUSION: Six patients were diagnosed with INVM with various symptoms at initial presentation. Echocardiography is the most important tool in the diagnosis of INVM due to its morphological characteristics. INVM can rarely be the cause of long term systolic dysfunction, and early detection by echocardiographic screening may be beneficial.
Arrhythmias, Cardiac ; Cardiomegaly ; Child ; Cyanosis ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Murmurs ; Humans ; Isolated Noncompaction of the Ventricular Myocardium* ; Mass Screening ; Pulmonary Atresia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Trabecular Meshwork ; Ventricular Septum ; Wolff-Parkinson-White Syndrome

Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.
Abscess ; Blood Sedimentation ; Drainage ; Female ; Graves Disease ; Humans ; Hypothyroidism ; Neck Pain ; Prednisolone ; Respiratory Tract Infections ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Subacute* ; Young Adult

The Fas (TNF receptor superfamily, member 6) (FAS)/FAS ligand (FASLG) interaction plays a central role in the regulation of programmed cell death. FAS and FASLG polymorphisms in promoter regions affect transcriptional activities. To investigate whether FAS and FASLG polymorphisms are associated with the development and clinical phenotypes of stroke, 2 promoter single nucleotide polymorphisms (SNPs) in FAS (rs1800682, -670C/T) and FASLG (rs763110, -844C/T) were selected and genotyped by direct sequencing in 220 stroke patients [107 ischemic stroke (IS), 77 intracerebral hemorrhage (ICH), and 36 subarachnoid hemorrhage (SAH)] and 369 control subjects. For the analysis of clinical symptoms, all stroke patients were divided into 3 clinical phenotypes according to the respective results of the National Institutes of Health Stroke Survey (NIHSS) and the Modified Barthel Index (MBI) and the presence or absence of complex regional pain syndrome (CRPS). The SNPStats, SNPAnalyzer, and Helixtree programs were used to analyze the genetic data. Multiple logistic regression models (codominant, dominant, and recessive) were used to estimate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. The promoter SNP rs1800682 was associated with stroke in the codominant (OR=0.48, 95% CI=0.25-0.94, p=0.04) and dominant models (OR=0.51, 95% CI=0.30-0.87, p=0.011). However, a FASLG SNP (rs763110) was not in Hardy-Weinberg equilibrium (p<0.05). In the analysis of stroke types, rs1800682 was associated with IS in the codominant (OR=0.30, 95% CI=0.12-0.74, p=0.025), dominant (OR=0.44, 95% CI=0.23-0.88, p=0.018), and recessive models (OR=0.45, 95% CI=0.21-0.99, p=0.042). The genotype frequencies of rs1800682 were different between ICH and controls in the dominant model (OR=0.49, 95% CI=0.26-0.94, p=0.031) but not between SAH and controls. In the analysis of clinical symptoms, however, rs1800682 was not related to the 3 clinical phenotypes (NIHSS, MBI, and CRPS). These results suggest that a promoter SNP (rs1800682, -670C/T) in FAS may be associated with the development of stroke in the Korean population.
Cell Death ; Cerebral Hemorrhage ; Genotype ; Humans ; Logistic Models ; National Institutes of Health (U.S.) ; Odds Ratio ; Phenotype ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Stroke ; Subarachnoid Hemorrhage