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JYMS : Journal of Yeungnam Medical Science

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Volume 18(2); December 2001
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Reviews
Pediatric Outpatient Anesthesia.
Il Sook Seo
Yeungnam Univ J Med. 2001;18(2):145-169.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.145
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AbstractAbstract PDF
In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.
Clinical Situations in which Musculoskeletal Ultrasound is Helpful.
Kil Ho Cho
Yeungnam Univ J Med. 2001;18(2):170-186.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.170
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AbstractAbstract PDF
Musculoskeletal ultrasound (MSUS) has newly evolved by the mechanical improvement of the machine over past several years, becoming a part of imaging techniques for the evaluation of variable diseases in the musculoskeletal system. MSUS has proven diagnostic superiority in pathologies including rotator cuff disease of the shoulder, lateral epicondylitis of the elbow, diseases of the peripheral nerve, detection of intra-articular loose bodies and soft tissue foreign bodies, and in evaluating small superficial soft tissue tumors such as ganglion, epidermoid cyst, and glomus tumor. Besides, MSUS is very useful for obtaining tissue or fluid via percutaneous fine needle aspiration and/or biopsy for the histopathologic diagnosis. Combining MSUS with MR would play a great role in the field of the diagnostic imaging of the musculoskeletal system. The MSUS examiner should have the knowledge of cross-sectional anatomy, and of the mechanical and physical properties of ultrasound in order to interpret the ultrasound findings accurately and properly, and to avoid diagnostic errors due to variable artifacts subsequently. The goal of this article is to introduce the capabilities of MSUS in certain kinds of clinical situation and to familiarize the reader with MSUS. For the purpose, author intends to describe this article according not to the disease-, or organ-based, but to the clinical problem-based format.
Original Articles
Operative Treatment of Tibial Plateau Fractures.
Duck Seop Shin, Byeong Yeon Seong, Dong Won Kim
Yeungnam Univ J Med. 2001;18(2):187-198.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.187
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AbstractAbstract PDF
BACKGROUND
The purpose of this study was to evaluate the relationship between variable factors and clinical results following the operative treatment of the tibial plateau fractures. MATERIALS AND METHODS: The clinical and radiological analysis was performed on 29 cases of the tibial plateau fractures who had been treated with operative treatment and followed up for more than 1 year from January 1991 to December 1997. The analysis of clinical results was performed dividing into age, cause of injury, fracture type of Schatzker classification, associated soft tissue injury and method of operative treatment. RESULTS: According to Schatzker classification, 2 cases(6.9%) were type I, 11 cases(37.9%) were type II, 1 case(3.5%) was type III, 5 cases(17.2%) were type IV, 4 cases(13.8%) were type V, and 6 cases(20.7%) were type VI. In all cases, bony unions were obtained. According to Blokker evaluation, 23 cases(79.3%) of 29 cases were acceptable. CONCLUSION: We could expect good clinical results if early knee joint mobilization following minimal invasive open reduction and internal fixation could be obtained. Bad clinical results were related with young age group under 30, more than Schatzker classification type IV of high energy trauma and associated injury of anterior cruciated ligment or meniscus.
Treatment Outcomes of Septoplasty with Turbinate Surgery in Septal Deviation with Chronic Hypertrophic Rhinitis.
Yong Dae Kim, Bo Su Suh, Gil Sung Cho, Si Youn Song, Seok Keun Yoon, Kei Won Song
Yeungnam Univ J Med. 2001;18(2):199-207.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.199
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AbstractAbstract PDF
BACKGROUND
Septoplasty with turbinate surgery is common surgical treatment in patients with septal deviation and chronic hypertrophic rhinitis. The aim of this study was to evaluation objective outcomes of septoplasty with turbinate surgery by analysis of subjective symptom score with objective acoustic rhinometric test before and after surgery, prospectively. MATERIALS AND METHODS: We reviewed 45 adult patients which were done septoplasty with bilateral turbinectomy or turbinoplasty and followed up at least 3 months by one rhinologist from November 1999 to April 2000, prospectively. We analyzed subjective symptom score, minimal cross-sectional area (MCA), C-notch cross-sectional area, and total volume of both nasal cavity before and after surgery. Correlation test was studied between symptom improvement and acoustic rhinometric results. RESULTS: Twenty nine cases were male and sixteen cases female. The average age was 26.9 year-old (range: 17 to 57 years). There was significantly improvement of symptom score in postoperative 3 months (p<0.05). There was significantly increased C-notch cross-sectional area and total volume in postoperative 3 months. Symptoms improvement were associated with acoustic rhinometric profiles, but, there was not significantly correlation. CONCLUSION: Septoplasty with turbinate surgery is considered to be effective for nasal obstruction in patients with septal deviation and turbinate hypertrophy. Acoustic rhinometric test is favorable objective test for evaluation of symptom improvement after septal surgery.
A Lateral Cephalometric Study of Maxillofacial Morphologic Features in Class III Malocclusion Children.
Woo Ill Sohn, Ic Jun Chang, Jae Chul Song, Byung Rho Chin
Yeungnam Univ J Med. 2001;18(2):208-214.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.208
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AbstractAbstract PDF
BACKGROUND
When we make treatment plan of class III malocclusion children, it is difficult to determine whether we treat it with orthognathic surgery or without orthognathic surgery. To determine that, we must consider many factors, such as cephalometric analysis, growth pattern, family history, and skeletal age. A Harvold cephalometric analysis is useful in determining the amount of discrepancy by comparing the maxillary unit length with mandibular unit length. We tried this study to help the decision of treatment planning in class III malocclusion children by comparison in class III malocclusion and normal occlusion children using a Harvold analysis. MATERIALS AND METHODS: The materials for this study consisted of 20 class III malocclusion children. Cephalometric tracing and measurements were performed by one investigator. The control group consisted of 18 normal occlusion children and lateral cephalograms were obtained from 8.5 to 14.5 years old children biannually. The relationships between class III malocclusion group and normal occlusion group were evaluated statistically. RESULTS: The lower anterior facial heights between two groups were not significantly different, although the lower anterior facial heights of class III malocclusion group was higher than those of normal occlusion group in all age groups. The Maxillary-mandibular unit length differences of class III malocclusion group were significantly higher than those of normal occlusion group(p < 0.05). CONCLUSION: A Harvold analysis was useful to make treatment planning for class III malocclusion children.
Change of Serum Levels of C-Reactive Protein After Coronary Angioplasty and Its Effects on Clinical Restenosis.
Jong Seon Park, Gu Ru Hong, Chae Hoon Lee, Dong Gu Shin, Young Jo Kim, Bong Sup Shim
Yeungnam Univ J Med. 2001;18(2):215-225.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.215
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AbstractAbstract PDF
BACKGROUND
There are many evidences that inflammation is an important determinant of the development of atherosclerosis and one of the systemic markers of inflammation, C-reactive protein(CRP), is associated with extent of coronary artery disease and risk of coronary events. We assessed the time response of CRP response after coronary angioplasty and it's influence on the clinical restenosis in angina patients. MATERIALS AND METHODS: Patients included 36 angina patients undergoing single vessel angioplasty. Levels of CRP were measured before and 12, 24, 48, and 72 hours after angioplasty. Clinical restenosis was assessed at 6 months after procedure. RESULTS: Baseline CRP level was 0.30+/-0.01 mg/dL in stable and 0.46+/-0.28 mg/dL in unstable angina patients(p<0.05). After angioplasty, CRP level was increased with peak at 24 hour and persisted to 72 hours after angioplasty. At 24 hour after angioplasty, the magnitude of CRP change was 0.32+/-0.31 mg/dL in stable and 0.79+/-0.73 mg/dL in unstable angina patient(p<0.05). The change of CRP level was not associated with troponin-T after angioplasty. In unstable angina patients, clinical restenosis was developed in 8% of patients with low baseline CRP levels and in 50% of those with high baseline CRP levels more than 0.6 mg/dL(p<0.05). CONCLUSION: In unstable angina patients, inflammatory response is more increased than stable angina patients, and increased inflammatory response effects on the restenosis after coronary angioplasty.
A Study for Improvement of Erythropoietin Responsiveness in Hemodialysis Patients.
Jong Won Park, Jun Yeung Do, Kyung Woo Yoon
Yeungnam Univ J Med. 2001;18(2):226-238.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.226
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AbstractAbstract PDF
BACKGROUND
Anemia in chronic renal failure plays an important rolr in increasing morbidity of dialysis patients. The causes of the anemia are multifactorial. With using of erythropoietin(EPO), most of uremia-induced anemia can be overcome. However, about 10% of renal failure patients shows EPO-resistant anemia. Hyporesponsiveness to EPO has been realted to many factors: iron deficiency, aluminum intoxication, inflammations, malignancies and secondary hyperparathyroidism. So I evailuated the improvement of EPO responsiveness after correction of above several factors. MATERIALS AND METHODS: Seventy-two patients on hemodialysis over 6 months were treated with intravenous ascorbic acid(IVAA, 300 mg t.i.w. for 12 weeks). After administration of IVAA for 12 weeks,patients were classified into several groups according to iron status, serum aluminum levels and i-PTH levels. Indivisualized treatments were performed; increased iron supplement for absolute iron deficiency, active vitamin D3 for secondary hyperparathyroidism and desferrioxamine(DFO, 5 mg/kg t.i.w.) for aluminum intoxication or hyperferritinemia. RESULTS: 1) Results of IVAA therapy for 12 weeks on all patients(n=72) Hemoglobin levels at 2,4,6 week were significantly elevated compared to baseline. but those of hemoglobin at 8, 10, 12 week were not significantly different. 2) Result of IVAA therapy for 20 weeks on patients with 100 microgram/1< or =ferritin<500 microgram/1 and transferrin saturation(Tsat) below 30%(n=30) After treatment of IVAA for 12 weeks, patients were evaluated the response of therapy according to iron status. Patient with 100 microgram/1< or =ferritin?500 microgram/1 and Tsat below 30% showed the most effective response. These patients were treated further for 8 weeks. Hemoglobin levels at 2, 4 week were significantly increased compared to baseline with significantly reduced doses of EPO at 2, 4, 10, 12, 16, 20 week. Concomitantly significantly improvement of Tsat at 2, 6, 16, 20 week compared to baseline were identified. 3) Result of IVAA therapy for 12 weeks followed by DFO therapy for 8 weeks on patients with serume aluminum above 4 microgram/1(n=12) Hemoglobin levels were not significantly increased during IVAA therapy for 12 weeks but dosages of EPO were significantly decreased at 2, 4, 6, 8 week during DFO therapy compared to pre-treatment status. CONCLUSION: IVAA can be helpful for the treatment of the anemia caused by functional iron deficiency and can reduce the dosage of EPO for anemia correction. And administration of low dose DFO, in cases of increased serum aluminum level, can reduce the requirment of EPO.
Indication of Bone Marrow Aspiration in Acute Idiopathic Thrombocytopenic Purpura in Children.
Won Duck Kim, Jeong Ok Hah
Yeungnam Univ J Med. 2001;18(2):239-245.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.239
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AbstractAbstract PDF
BACKGROUND
Acute idiopathic thrombocytopenic purpura(ITP) is one of the common hematologic disorders in children. Bone marrow aspiration(BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITP. MATERIALS AND METHODS: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of 50x109/L or lower was the cutoff level. RESULTS: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. CONCLUSION: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.
Treatment of Henoch-Sch?nlein Purpura with Intravenous Immunoglobulin.
Hyo Seok Chung, Won Duck Kim, Eun Sil Lee, Kwang Hae Choi, Yong Hoon Park, Yong Jin Kim
Yeungnam Univ J Med. 2001;18(2):246-252.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.246
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AbstractAbstract PDF
We report the result of a high-dose intravenous immunoglobulin therapy in a Henoch-Sch?nlein purpura patient with severe abdominal pain and nephrotic syndrom who did not respond to methylprednisolone pulse therapy. Kidney bbiopsy showed diffuse mesangial cell proliferative glomerulonephritis with fibrocellular crescent formation in approximately 50% of glomeruli. Mesangium of all glomeruli were strong positive for IgA and C3 antibodies. High-dose intravenous immunoglobulin treatment was introduced and dramatic improvement of gastrointestinal symptom and proteinuria as well as hematuria was noted. Immunoglobulin administration should be considered in Henoch-Schnlein purpura patients with sterois-resistant intractable dastrointestinal manifestation and renal involvenment.
The Comparison of Intelligence Efficacy According to Methylphenidate Administration in Attention Deficit Hyperactivity Disorder(ADHD) Patients.
Hyung Bae Park, Dae Seok Bai, Jeong Sang Ha, Wan Seok Seo, Chang Jin Song
Yeungnam Univ J Med. 2001;18(2):253-266.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.253
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AbstractAbstract PDF
BACKGROUND
The causes of ADHD(attention deficit hyperactivity disorder) are various, it is impossible to understand the whole characteristics of ADHD, only with simple intellignece testing scales. We compared cognitive characteristics of ADHD group with normal controls with Korean Kaufman Assessment Battery for Children(K-ABC), It is well known to evaluate neuropsychological and cognitive aspects of the children. MATERIALS AND METHODS: Age and sex matched 40 ADHD patients and 40 normal controls tested with the K-ABC. Each subscales compared between pre-treatment patients and controls, pre-treatment and post-treatment in patient group, post-treatment patients and controls. RESULTS: Significant differences are ovserved in sequential processing, simultaneous processing, cognitive processing and achievement between pre-treatment patients and controls, and in gestalt closure between pre-treatment and post-treatment patients group. But there are no significant differences between pre-treatment patients and controls in gestalt closure and reading/decoding. CONCLUSIONS: Methylphenidate improved the scores of simultaneous scale, which means improvement of executive functions such as divided attention, analysis and organization. Methylphenidate also reduced distractibility.
P wave dispersion as a predictor of idiopathic paroxysmal atrial fibrillation.
Gue Ru Hong, Woong Kim, Jong Seon Park, Dong Gu Shin, Young Jo Kim, Bong Sup Shim
Yeungnam Univ J Med. 2001;18(2):267-276.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.267
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AbstractAbstract PDF
BACKGROUND
P wave dispersion(PWD) is defined as the difference between the maximum and minimal P wave duration in any of the 12 leads of the surface ECG. The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulse are known electrophysiologic features in patients with paroxysmal atrial fibrillation(PAF). The purpose of this study was to determine the role of P wave dispersion for the prediction of PAF and to evaluate the effectiveness of prophylactic antiarrhythmic therapy. MATERIALS AND METHODS: The study population included 20 patients with a history of idiopathic PAF and 20 age and sex matched healthy control subjects. We measured the maximum P wave duration(P maximum) and P wave dispersion from 12 lead ECG. RESULTS: P maximum and P dispersion in idiopathic PAF were significantly higher than normal control group(97.2+/-12, 48.5+/-9msec vs, 76.5+/-11, 21+/-8msec, respectively p<0.001, <0.001). After 12-month follow up period P maximum and P dispersion were significantly reduced than those of initial state(77.2+/-13, 26.4+/-9msec vs. 97.2+/-12, 48.5+/-9msec, respectively p<0.001,<0.001). CONCLUSION: P dispersion and P maximum were significantly different between patients with idiopathic PAF and healthy control group. Those are easily accessible, non-invasive simple electrocadiographic markers that could be used for the prediction and prognostic factors of idiopathic PAF.
Diagnostic Sensitivity of Several Muscles in Repetitive Nerve Stimulation Test for Myasthenia Gravis.
Hyun Jic Kim, Sung Hwan Lim, Seung Yeop Lee, Jung Sang Hah, Wook Nyeon Kim
Yeungnam Univ J Med. 2001;18(2):277-286.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.277
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AbstractAbstract PDF
BACKGROUND
This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. MATERIALS AND METHODS: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. RESULTS: The significant electrodecremental response of RNST were noted in orbicularis oculi (58.9%), nasalis (51.3%), flexor carpi ulnaris (42%), anconeus (41%) and abductor digiti quinti muscles (27%). Among the 3 muscles of upper extremity (abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles (p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. CONCLUSION: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.
The Clitoral Size of the Korean Female Newborn.
Suk Yong Won, Min Whan Koh, Tae Hyung Lee, Mi Jung Eun, Jung Sook Kim, Ok Kyung Kim
Yeungnam Univ J Med. 2001;18(2):287-292.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.287
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  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
To determine mean clitoral and glans size of Korean female newborn. MATERIALS AND METHODS: The size of glans and clitoris of 68 Korean female newborns born at Yeungnam University Medical Center were measured from May in 1999 to August in 1999. RESULTS: The mean size of the 68 newborns were 2.38+/-1.14 mm in glans length, 2.55+/-1.48 mm in glans width and 4.66+/-1.93 mm in clitoral length. In the premature infants the mean clitoral size was 1.92+/-1.58 mm in glans length, 1.78+/-1.24 mm in glans width and 3.86+/-2.16 mm in clitoral length. In the full term infants 2.53+/-1.12 mm in glans length, 2.75+/-1.58 mm in glans width and 4.94+/-1.89 mm in clitoral length. In low birth weight infants clitoral size was measured 1.55+/-1.10 mm in glans length, 2.04+/-2.03 mm in glans width and 3.29+/-1.87 mm in clitoral length. In normal birth weight infants 2.53+/-1.13 mm in glans length, 2.68+/-1.48 mm in glans width and 4.92+/-1.91 mm in clitoral length. In high birth weight infants 1.54+/-0.50 mm in glans length, 1.63+/-0.53 mm in glans width and 3.18+/-1.04 mm in clitoral length. CONCLUSION: There was no significant correlation between gestational age and clitoral size or glans size, but significant negative correlation was found between birth weight and clitoral size or glans size.

Citations

Citations to this article as recorded by  
  • Reference values for penile and clitoral lengths of healthy term Egyptian newborn infants
    Magda Badawy, Lubna A Fawaz, Hend Abd El Baky, Amr Elkhashab, Ahmed A Hussein, Marwa F Mira
    Journal of Paediatrics and Child Health.2022; 58(1): 157.     CrossRef
  • The role of androgens in clitorophallus development and possible applications to transgender patients
    Frances Grimstad, Elizabeth R. Boskey, Amir Taghinia, Carlos R. Estrada, Oren Ganor
    Andrology.2021; 9(6): 1719.     CrossRef
  • Country‐based reference values and international comparisons of clitoral size in healthy Nigerian newborn infants
    Olumide Olatokunbo Jarrett, Omolola Ouwakemi Ayoola, Björn Jonsson, Kerstin Albertsson‐Wikland, Martin Ritzen
    Acta Paediatrica.2015; 104(12): 1286.     CrossRef
Case Reports
Vaginal removal of mature cystic teratoma in postmenopausal woman.
Ki Mog Jung, Hyun Woo Lee, Ki Wan Kim, Min Whan Koh
Yeungnam Univ J Med. 2001;18(2):293-296.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.293
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AbstractAbstract PDF
Mature cystic teratomas, commonly called dermoid cysts, are the most common benign germ cell tumors of ovary in women of reproductive age. Mature cystic teratoma that constitutes 10-25% of ovarian tumors and 95% of teratoma, is germ cell tumor of the ovary. This occurs frequently in women less than 20 years old, but it can be found upto 10-20% in postmenopausal women. And in women over the age of 50, a mature cystic teratoma is likely to change into malignant form. Traditional surgical methods of mature cystic teratoma treatment include transabdominal cystectomy, oophorectomy, hysterectomy and(or) bilateral salphingooophorectomy. Recently laparoscopic approach replaces transabdominal surgeries in many cases. Vaginal removal of mature cystic teratoma is unique and rare. Compared with laparotomy, transvaginal approach is characterized by shorter hospital stay and lower morbidity rate. Compared with laparoscopic operation, transvaginal approach has advantages of no visible operative scar and lower intra-operative tumor spillage. The decision for surgical methods is related with patients' situations and surgeon's preference. We report 1 case of vaginal removal of mature cystic teratoma as a part of vaginal hysterectomy in old age patient.
A Case of Superior Mesenteric Venous Thrombosis after Endoscopic Sclerotherapy.
Won Duck Kim, Kwang Hae Choi, Jeong Ok Hah
Yeungnam Univ J Med. 2001;18(2):297-301.   Published online December 31, 2001
DOI: https://doi.org/10.12701/yujm.2001.18.2.297
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AbstractAbstract PDF
The efficacy of injection sclerotherapy for treatment of acute esophageal variceal bleeding is well established. But several complications of endoscopic sclerotherapy have been reported. One of the complications is mesenteric venous thrombosis which develops when vasopressin is user for the sclerotherapy. We report a case of superior mesenteric venous thrombosis with developed after endoscopic sclerotherapy for control of esophageal variceal bleeding.

JYMS : Journal of Yeungnam Medical Science