Volumetric quantification of bone-implant contact using micro-computed tomography analysis based on region-based segmentation

PURPOSE: We have developed a new method of segmenting the areas of absorbable implants and bone using region-based segmentation of micro-computed tomography (micro-CT) images, which allowed us to quantify volumetric bone-implant contact (VBIC) and volumetric absorption (VA). MATERIALS AND METHODS: The simple threshold technique generally used in micro-CT analysis cannot be used to segment the areas of absorbable implants and bone. Instead, a region-based segmentation method, a region-labeling method, and subsequent morphological operations were successively applied to micro-CT images. The three-dimensional VBIC and VA of the absorbable implant were then calculated over the entire volume of the implant. Two-dimensional (2D) bone-implant contact (BIC) and bone area (BA) were also measured based on the conventional histomorphometric method. RESULTS: VA and VBIC increased significantly with as the healing period increased (p<0.05). VBIC values were significantly correlated with VA values (p<0.05) and with 2D BIC values (p<0.05). CONCLUSION: It is possible to quantify VBIC and VA for absorbable implants using micro-CT analysis using a region-based segmentation method.

Comparison of Skills and Knowledge after Basic Life Support Training over a 6 Month Interval on Preclinical Medical Students

PURPOSE: The following study was performed to compare basic life support (BLS) skills and knowledge over a 6 months interval in preclinical medical students. METHODS: Upon initial instruction, 112 first-year medical students at a teaching hospital were given instructions in BLS, their knowledge performance was evaluated by written test and skills test via checklist designed by instructors and PC SkillReporting System(R) (Laerdal, Norway). Their performance was re-evaluated 6 months after initial BLS training in an identical fashion. Evaluation was performed on 103 out of 112 students who had taken initial BLS training. RESULTS: The results of written test showed that the students evaluated right after taking initial BLS training have better knowledge of BLS compared to students evaluated 6 months after taking initial BLS training (p<0.001). Results of skills test evaluated by checklist showed decrease in adequate performance of students evaluated 6 months after BLS education in 12 out of 18 items compared to students who have just received initial BLS training. The decreases were statistically significant in 6 items. Total scores after 6months were also lower compared with initial scores (p<.0.001). The results of the skills test using PC Skill Reporting System(R) demonstrated that the percentage of adequate ventilation volume, compression rate, hands-off time, and hand position were each 18.4%, 46.6%, 47.6%, 84.2% initially and 5.8%, 32.0%, 32.0%, 76.1% at 6 months after initial training. Students performed significantly worse 6 months post training in 4 out of 7 items (p<0.05). CONCLUSION: Knowledge and skills of preclinical medical students decreased significantly after a 6 month period compared to knowledge and skills after initial training. Therefore, retraining of BLS is required within 6 months, but more study is required to determine appropriate intervals and methods of retraining.

Clinical and Radiological Outcomes of Anterior Cervical Interbody Fusion Using Hydroxyapatite Spacer

OBJECTIVE: This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-HA(TM) (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. METHODS: Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. RESULTS: Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. CONCLUSION: HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.

Study of the Length of Needle Thoracostomy Catheter Needed for Patients with Chest Trauma

PURPOSE: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma METHODS: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. RESULTS: As the left and the right mean CWTs were 3.4+/-1.0 cm and 3.4+/-1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p 5 cm. CONCLUSION: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.

Clinical Results of Anterior Cervical Discectomy and Fusion with Prefilled Cage in Patient with Traumatic Cervical Injury

OBJECTIVES: This study is designed to evaluate the fusion rate of anterior cervical discectomy and fusion (ACDF) using prefilled cage, and clinical features in patients with traumatic cervical injury. METHODS: Sixteen trauma patients at a single institute who underwent ACDF with prefilled cage and rigid plate fixation were evaluated for radiographic fusion status postoperatively every 1 month, 3 month, and 6 month after the surgery. ACDFs were done in 9 patients at one level, 3 patients at two levels, 3 patients at three levels, and 1 patient at four levels. Fourteen patients had fracture and instability, and 2 patients had traumatic herniated cervical discs without fracture and instability. Plain radiographs and CT scan were done for evaluation of bone fusion in all patients. RESULTS: Bone fusion was recognized in all patients. Intervertebral disc height was well maintained during follow-up period. There was no patient with graft failure and instability. Even though the patients with fracture and instability, there was no patient who needed posterior stabilization. There was one case of subsidence without clinical symptom which was needed additional surgical treatment. CONCLUSION: In the treatment of the patients with traumatic cervical diseases, prefilled cage is very effective to achieve cervical spinal stability after ACDF, and to maintain intervertebral disc height. We can achieve immediate postoperative stability and prevent graft displacement by reinforcement with cervical plate and screws.

Type 1 Chiari Malformation Presenting With Medullary Infarction and Syncope

No abstract available.

Molecular characterization and genogrouping of VP1 of aquatic birnavirus GC1 isolated from rockfish Sebastes schlegeli in Korea

The cDNA nucleotide sequence of genome segment B encoding the VP1 protein was determined for the aquatic birnavirus GC1 isolated from the rockfish Sebastes schlegeli in Korea. The VP1 protein of GC1 contains a 2,538 bp open reading frame, which encodes a protein comprising 846 amino acid residues that has a predicted MW of 94 kDa. The sequence contains 6 potential Asn-X-Ser/Thr motifs. Eight potential Ser phosphorylation sites and 1 potential Tyr phophorylation site were also identified. GC1 contains the Leu-Lys-Asn (LKN) motif instead of the typical Gly-Asp- Asp (GDD) motif found in other aquatic birnaviruses. We also identified the GLPYIGKT motif, the putative GTPbinding site at amino acid position 248. In total, the VP1 regions of 22 birnavirus strains were compared for analyzing the genetic relationship among the family Birnaviridae. Based on the deduced amino acid sequences, GC1 was observed to be more closely related to the infectious pancreatic necrosis virus (IPNV) from the USA, Japan, and Korea than the IPNV from Europe. Further, aquatic birnaviruses containing GC1 and IPNV have genogroups that are distinct from those in the genus Avibirnaviruses and Entomo-birnaviruses. The birnavirusstrains were clustered into 5 genogroups based on their amino acid sequences. The marine aquatic birnaviruses (MABVs) containing GC1 were included in the MABV genogroup; the IPNV strains isolated from Korea, Japan, and the USA were included in genogroup 1 and the IPNV strains isolated primarily from Europe were included in genogroup 2. Avibirnaviruses and entomobirnaviruses were included in genogroup 3 and 4, respectively.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Morbidity of Vaginal Hysterectomy for Uterine Myoma as Function of Uterine Weight / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal total hysterectomy. METHODS: A retrospective chart review of 549 cases of patients with vaginal totoal hysterectomy was performed. Patients included in this study underwent vaginal total hysterectomy as benign uterine tumors at Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from June 2003 through June 2004. These patients were stratified into four groups; Group I patients with uterine weight of 380 gm (n=79). The groups were compared as regard age, paturity, previous pelvic operations, postoperative discharge day, postoperation hemoglobin change, operation time, postoperative complications. RESULTS: There was no significant difference between the four groups with repect to postoperative discharge day (Mean=9.08 day), concurrent surgical procedure, age (M=45.96 years old), parturity (M=1.88). The overall complication rate was not significantly different (postoperation hemoglobin change (M=1.25), Complication). But the morcellation rate increased 8.33% in group I, 34.18% in group II, 55% in group III, 83.5% in group IV, respectively. The operation time prolonged as uterus weight increased.; 73 minutes in group I, 79 minutes in group II, 85 minutes in group III, 91 minutes in group IV. CONCLUSION: The vaginal total hysterectomy can be performed successfully in case of greatly enlarged uterus. Uterus enlargement is not an absolute contraindication.

Reversible Pontine MRI Lesion in Acute Thalamic Infarct: Reversible Encephalopathy due to Hypertension?

Posterior reversible encephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and is relative sparing of the supratentorial regions. A relative paucity of brainstem signs and symptoms, despite extensive neuroimaging abnormalities therein, support the diagnosis. Although elevation of blood pressure is common in acute cerebral infarction, concomitant brainstem edema has not been reported. We describe here the clinical and neuroimaging features of an unusual brainstem hyperintensity associated with acute ischemic stroke. The neuroimaging abnormalities improved after stabilization of blood pressure, distinguishing this syndrome from brainstem infarction.

Reversible Pontine MRI Lesion in Acute Thalamic Infarct: Reversible Encephalopathy due to Hypertension?

Posterior reversible encephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and is relative sparing of the supratentorial regions. A relative paucity of brainstem signs and symptoms, despite extensive neuroimaging abnormalities therein, support the diagnosis. Although elevation of blood pressure is common in acute cerebral infarction, concomitant brainstem edema has not been reported. We describe here the clinical and neuroimaging features of an unusual brainstem hyperintensity associated with acute ischemic stroke. The neuroimaging abnormalities improved after stabilization of blood pressure, distinguishing this syndrome from brainstem infarction.

Ultrasound Detection of Vault Hematoma Following Vaginal Hysterectomy and Their Relation to Morbidity / 대한산부인과학회잡지

OBJECTIVE: To assess whether ultrasound detection of vault hematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. METHODS: Prospective observational study of 418 consecutive cases of vaginal hysterectomy was performed between December 2000 and May 2001. The transvaginal sonographic examination of vaginal vault in the first postoperative week (3rd or 4th day) after vaginal hysterectomy was done. Routine observation and clinical assessments were made by established management protocol: febrile morbidity, hemoglobin drop, need for transfusion, length of stay in hospital. RESULTS: Of the 418 scaned patients, 103 (24.6%) had a vault hematoma. This group was compared with the 315 patients without hematoma. Significant increases in febrile morbidity (22.3% vs 7.6%), postoperative hemoglobin drop (2.39 g/dL vs 1.58 g/dL), need for blood transfusion (10.7% vs 1.3%) and length of hospital stay (8.6 days vs 6.2 days) were seen in the hematoma group. CONCLUSION: Ultrasound detection of vault hematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, hemoglobin drop, need for blood transfusion and longer hospital stay. Transvaginal sonography may facilitate the diagnosis of posthysterectomy vault hematoma, which are not readily detected by pelvic examination.

Prediction of Residual Lesion based on Histopathology and Margin Status of Conization Specimens Related to Post-cone Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The objective of this study is to evaluate predictive factors for residual lesion after conization in patients with cervical neoplasia. METHODS: we performed retrospective study (between January 1996 and June 2002) and reviewed 146 patients who had undergone cervical conization followed by subsequent hysterectomy. The age and the parity of patients, the histopathology and the status of resection margins of cone specimens were analysed as predictive values of residual lesions. RESULTS: The prevalence rate of positive cone margins were 0%, 15%, 43.4%, and 85.7% respectively in patients with low-grade squamous intraepithelial lesion (LSIL) (n=3), high-grade squamous intraepithelial lesion (HSIL) (n=60), Cervical cancer stage I a1 (CC-I a1) (n=76) and Cervical cancer stage I a2 (CC- I a2) (n=7). The prevalence rates of positive residual lesions in post-cone hysterectomy specimens were 0%, 23.3%, 35.5%, and 100% respectively in those with LSIL, HSIL, CC- I a1, and CC- I a2. Residual lesions were significantly more frequently found in patients with positive cone margin (56.3%) than in those with negative margin (21.4%) (P value=0.000026). Positive predictive values of margin status for the presence of residual lesions were 0% (LSIL), 22.2% (HSIL), 57.6% (CC- I a1) and 100% (CC- I a2). Negative predictive values of margin status for the absence of residual lesions were 100% (LSIL), 76.5% (HSIL), 81.4% (CC- I a1) and 0% (CC- I a2). Only 8.3% (4/48) of patients with positive cone margin had more advanced residual lesions. 9.2% (9/98) of patients with negative margins had invasive residual lesion. CONCLUSION: The prevalence rate of positive cone margin and residual lesion increased with high severity of cervical neoplasia. Patients with positive cone margin had significantly higher chances of having residual lesion than those with negative margin. Free cone margin does not ensure the absence of residual lesion in the remaining cervix. Positive cone margin does not invariably indicate the presence and persistence of more severe residual lesion. Subsequent hysterectomy may be reserved for the patients with invasive cone pathology, concomitant morbid uterine condition, or not reliable for continuous follow-up.

Cyclooxygenase-2 Expression and Angiogenesis in Invasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumor growth and angiogenesis of gastrointestinal and other cancers. This was the study to determine the relationship between tumor vascularity and COX-2 expression in invasive cervical cancer. METHODS: We examined the expression of COX-2 and microvessel density (MVD) by immunohis- tochemical staining in 21 specimens collected from invasive cervical cancer patients. RESULTS: All specimens showed weak and strong immunoreactivity, with 52.4% strong reactivity. Microvessel count was higher (median 136) in the strong COX-2 immunoreactivity specimens than the weaks (median 90), and MVD was significantly correlated with the COX-2 immunoreactivity (P=0.002). CONCLUSION: These preliminary data indicate that overexpression of COX-2 may play an important role in carcinogenesis of cervical cancer and this could be partially attributable to modulation of angiogenesis by COX-2. COX-2 maybe a target for future research in the tumorigenesis of the invasive cervical cancer.

Fit of Implant Frameworks Fabricated by One-Piece Casting, Laser Welding, Soldering, and Electric Discharge Machining / 대한치과보철학회지

The purpose of this study was to measure and compare the strains produced by screw-tightening implant frameworks fabricated by five different fabrication methods;(1)one-piece cast using plastic sleeve,(2)one-piece cast using gold cylinder,(3)laser welding,(4)soldering,and (5)electrical discharge machining,and also to measure and compare the strains produced when the order of screw tightening was changed. A research model incorporating eighteen strain gages was made to measure the fit of implant frameworks in three dimensions.Three implants aligned in an arc were fixed on the top ends of the L-shape aluminum bars of the research model,and standard abutments were joined to the implants with abutment screws.Five types of implant framework were placed on the abutments and screwed by a torque wrench using 10 Ncm. Under the conditions of this study,the following conclusions were drawn: 1.The electrical discharge machining group showed the smallest magnitude of strain,followed by the soldering group,the laser welding group,the one-piece cast group using gold cylinder,and the one-piece cast group using plastic sleeve.However,among the magnitude of strain for the remaining groups except the electrical discharge machining group,there were not significant differences. 2.When the order of screw tightening was changed,there were not significant differences in the magnitude of strain. 3.In comparison with the electrical discharge machining group,the laser welding group and the one-piece cast groups showed greater horizontal distortion and the soldering group showed greater horizontal and vertical distortion.

Treatment of Advanced-Stage Sertoli-Leydig Cell Tumor (SLCT): A Clinicopathologic Study of 1 Case / 대한산부인과학회잡지

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.

Treatment of Advanced-Stage Sertoli-Leydig Cell Tumor (SLCT): A Clinicopathologic Study of 1 Case / 대한산부인과학회잡지

Sertoli-Leydig cell tumors belong to the group of sex-cord stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumor. They occur predominantly at premenopausal women and rarely at postmenopausal and prepubertal. Most common symptom is menstrual disorder including vaginal bleeding. This symptom is the results of excessive testosterone production of Leydig cell. Masculinization is occasionally accompanied by this symptom. but approximately 50% of patients with SLCT have no endocrine manifestations. Prognosis prove generally favorable with 5-year survival rate of 70-90%. Recurrence is rare.The majority of these tumors are benign and are unilaterally (97-98%) localized. Surgery varies with patient age, tumor stage, and differentiation from unilateral salpingo-oophorectomy to bilateral salpingo-oophorectomy and total hysterectomy concomitant with pelvic lymph node dissection. Herewith, we experienced a case of treatment advanced-stage Sertoli-Leydig cell tumor with poorly differentiation in that is ascitic and metastatic in a 53 years old menopause woman who has no virilizing symptom. After all the tumor has resulted in fatal outcome despite of surgery and aggressive chemotherapy. Therefore we present it with review of literature.

Changing Trends in Surgical Approaches of the Hysterectomy: 3408 cases Vaginal Hysterectomy-The University of Hallym Hospital's Experience in Korea / 대한산부인과학회잡지

OBJECTIVE: The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. METHODS: Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. RESULT: 1. In 1990 yrs~1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy [below VH]: 268 / total abdominal hysterectomy [below TAH]: 258; 1990), 55%(VH: 254/TAH: 212; 1991), 60%(VH: 346/TAH: 227; 1992), 64%(VH: 341/TAH: 190; 1993), 72%(VH: 434/TAH: 168; 1994), 75%(VH: 489/TAH: 156; 1995), 76.%(VH: 632/TAH: 196; 1996), 78%(VH: 657/TAH: 190;1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9+/- 8.18(26~84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74+/-0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3+/- 14.2 min(40~230). 5. The average weight of uterus was 166.5+/- 111.4 gm(60~1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280+/- 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4~20) CONCLUSION: In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.

Prenatal Cytogenetic Studies in 937 Cases of Midtrimester Amniocentesis / 대한주산의학회잡지

No abstract available.

A Case of Paget's Disease of the Vulva / 대한부인종양콜포스코피학회잡지

Extramammary Pagets disease(EMPD) of the vulva is an uncommon neoplasm which accounting for 2.5% of all vulvar malignancies and 0.02% of all female cancer. Several hundred cases have been reported worldwide since the first description by sir James Paget in 1874, It generally affects postrnenopausal age poup and presents high rate of recurrence but the precise incidence remines unclear, Although Paget's disease of the breast and the vulva are histologically similar, their histogenesis and biological behavior are considered to be significantly different and EMPD has gcnerally perceived rnore benign compared to that of the breast. Four histologic forms of vulvar EMPD have been recognized and treated vulvar EMPD in according to the 4 histologic classification. The high rate of recurtence disease remains a challenge for optimal management. Recently we experienced a case of Paget's disease of the vulva, diagnosed as an intraepithelial Pagets disease preoperatively and underwent radical vulvectomy and superiomedial thigh(SMT) flap, and present with a brief review of literature.