PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.
Clitoris* ; Collagen ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Muscle, Smooth ; Neurons ; Nitric Oxide Synthase ; Ovariectomy ; Rabbits ; Relaxation ; Research Personnel ; Vagina

BACKGROUND: To compare flexible ring with rigid ring for annular remodeling and hemodynamic changes of left ventricle (LV) in mitral valve repair (MVR) at short term interval. METHODS: From January 1998 to March 2001, 35 patients with mitral valve prolapse underwent mitral valve repair with ring annuloplasty. The mean age of these patients was 49 years. Eighteen patients underwent mitral annuloplasty with Carpentier-Edwards Classic-ring (Group A). Seventeen patients underwent mitral annuloplasty with Physio-ring (Group B). LV fun-ction and annulus size were assessed by echocardiography on the day before operation and 2 to 3 months later. Mitral annular motion had been examined by means of the extent of mitral annular systolic excursion (MASE) as measured in two longitudinal LV segments (septal and lateral). RESULTS: 1) In valve pathology, anterior leaflet lesion was 14 cases, posterior was 14, combined lesion was 7 cases. 2) At all, left ventricular end-systolic dimension, left ventricular end-diastolic dimension and LV mass decreased postoperatively. But, no differences existed between the groups. 3) Postoperatively (after 2-3 months), echocardiograms in 35 patients demonstrated no mitral regurgitation (MR) in 16 cases, trace to mild MR in 17 cases, moderate MR in 2 patients. In Classic-ring group, MR was demostrated in 11 cases (61%). In Physio-group, MR was demonstrated in 8 cases (47%). 4) Postoperatively, mitral valve area increased significantly only in patients with Physio-ring (1.93+/-0.33 vs 2.38+/-0.92, p<0.05). 5) No differences existed between the groups in MASE. CONCLUSION: There are the significant reduc-tion in cardiac chambers and annulus size and improvement of LV function after both types of ring annuloplasty at short term result. There are no significant differences between Classic-ring and Physio-ring except 2 cases postrepair SAM (systolic anterior motion) of mitral valve in Classic-ring.
Echocardiography ; Follow-Up Studies* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pathology

BACKGROUND AND OBJECTIVES: Although it is well known that mitral valve repair provides a better postoperative outcome than valve replacement for mitral valve prolapse with mitral regurgitation, there haven't been much studied the nature of remnant regurgitation and the change of heart function and structure by remnant regurgitation after mitral valve repair surgery. We tried to research for it. METHODS AND RESULTS: Retrospective analysis of echocardiographic data and medical records was done in patients who underwent repair surgery for mitral valve prolapse with significant mitral regurgitation at the Keimyung University Dong-san Medical Center from February 1996 to February 2000. Patients who underwent echocardiography before and after the surgery were selected for the analysis. Of patients who underwent mitral valve repair surgery for mitral valve prolapse with mitral regurgitation during that period, 30 patients (male 15, female 15) were included in this study. The average age of them was 44.30+/-14.30 year old. After surgery, heart chamber size was decreased significantly in all patients (e. g. LVDd 6.25+/-1.06 cm vs. 5.14+/-0.62 cm, LV mass 272.46+/-107.36 gm vs. 197.30+/-75.16 gm). Remnant mitral regurgitation after repair surgery was found in 22 patients (73.3%). Remnant mitral regurgitation above trivial flow was found in 10 patients. Such case as involving ant. leaflet was found in 5 patients (16.7%), as involving post. leaflet, in 2 patients (6.7%), as involving both leaflet, in 3 patients (10%) among 10 ones. Eccentric flow among remnant regurgitation, was observed in 2 patients who underwent repair surgery for ant. leaflet, 1 patient who underwent repair surgery for both leaflet. CONCLUSION: Mitral valve repair surgery reduce the left ventricular chamber size and left ventricular mass. Postoperatively, patients who involve ant. leaflet were much remnant regurgitation above trivial flow more than others.
Ants ; Echocardiography ; Female ; Heart ; Humans ; Medical Records ; Mitral Valve Insufficiency* ; Mitral Valve Prolapse* ; Mitral Valve* ; Retrospective Studies ; Thoracic Surgery

BACKGROUND: Double lumen endobronchial tube and single lumen tube with bronchial blocker are most frequently used tubes for one lung anesthesia. This study compared the double lumen endobronchial tube with the single lumen tube with bronchial blocker to determine whether there were objective advantages of one over the other during one lung anesthesia. METHODS: Sixty patients were randomly assigned to one of two groups. Thirty patients were intubated with a left-sided double lumen endobronchial tube, and thirty patients were intubated with a single lumen tube with bronchial blocker. Each group was subdivided into two groups with a person intubating (i,e, certified anesthesiologist or resident) to compare the easiness of intubation according to the type of tube. Fiberoptic flexible bronchoscope was used in all patients. The following were studied 1) time required to position each tube until satisfactory placement achieved, 2) frequency of malposition after initial placement with fiberoptic bronchoscopy, 3) surgical exposure ranked by surgeons blinded to type of tube used, 4) easiness of tracheobronchial toilet (TBT). RESULTS: 1) Statistically significant differences were observed in time required to place each tube by resident(double lumen tube 5.73+/- 0.48 min. versus single lumen tube with bronchial blocker 4.18+/-0.70 min (P<0.05) and in easiness of TBT (double lumen tube 18/30 versus single lumen tube with bronchial blocker 27/30) (P<0.05). 2) No differences were observed in time required to position each tube by anesthesiologist, the frequency of malposition and surgical exposure. CONCLUSIONS: Single lumen tube with bronchial blocker is better in easiness of intubation by resident and in easiness of TBT than double lumen endobronchial tube. But the selection of two tubes depends upon type of surgery and familiarity of each tube by the anesthesiologist.
Anesthesia* ; Bronchoscopes ; Bronchoscopy ; Humans ; Intubation ; Lung* ; Recognition (Psychology)

Although dysphagia in patients with acute leukemia is usually related to reflux esophagitis, infectious esophagitis, chemotherapy1) and leukemic infiltration2), acute esophageal stricture resulting from chemotherapy in the patient with leukemia is very rare. A 40-year-old man with acute myelogenous leukemia was admitted for operation of esophageal stricture which was developed within 1 month of chemotherapy. An esophagectomy and esophagogastrostomy with pyloroplasty was carried out. Histology showed mucosal infiltration of mononuclear cells and transmural fibrosis involving submucosa and the muscle layer.
Adult ; Deglutition Disorders ; Drug Therapy ; Esophageal Stenosis* ; Esophagectomy ; Esophagitis ; Esophagitis, Peptic ; Fibrosis ; Humans ; Induction Chemotherapy* ; Leukemia ; Leukemia, Myeloid, Acute

No abstract available.
Nicotine* ; Smoke* ; Smoking Cessation* ; Smoking* ; Tobacco Use Cessation Products*

Rapid induction,complete loss of conciousness,and stability of cardiovascular system are the variables that should be considered in choosing anesthetics and method of induction for patients with cardiovascular diseases. The great attention should be given because elevation of blood pressure and tachycardia during induction of anesthesia can deteriorate patients cardiovascular system. High-dose of fentanyl was used for the induction of open heart surgery since 1978 and showed effectiveness in stabilizing cardiovascular changes. Many authors argued that fentanyl may not induce unconciousness. As endeavor to shorten the oneset time of unconsciousness, commonly used intravenous anesthetics with fentanyl were tried. Among patients scheduled for open heart surgery, 30 patients with ejection fraction higher than 0.5 were randomly selected and divided into three groups. For the induction of anesthesia, group 1 was given fentanyl alone; group 2 fentanyl with diazepam(0.1mg/kg); and group 3 fentanyl with thiopental sodium (0.2mg/kg). Loss of conciousness (oneset time of unconciousness and dosage of fentanyl) and cardiovascular responses(systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and rate pressure product) just before induction,before intubation, and immediately after intubation were compared and results were as followes. l. It took 322 seconds to induce unconciousness in group 1, 213 seconds in group 2,and 87 seconds in group 3. It was shortened significantly in group 2 and group 3 as compared to group 1 and in group 3 as compared to group 2(p<0.05). 2. Dosage of fentanyl was 30 mcg/kg in group 1, 20 mcg/kg in group 2, and 8 mcg/kg in group 3. As compared to group 1 and group 2, it was significantly decreased in group 3 (p<0.05). 3. Systolic blood pressures before tracheal intubation in gmup 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05), 4. Diastolic blood pressure before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction(p<0.05). 5. Mean arterial blood pressure before tracheal intubation in group 2 and group 3 significantly decreased as compared to the level of preinduction(p<0.05). 6. There was no significant change in heart rate. 7. Rate pressure product before tracheal intubation in group 3 significantly decreased as compared to the level of preinduction and rate pressure product after tracheal intubation in group 1 significantly increased as compared to the level of preinduction(p<0.05). Considering above results, it is difficult to choose specific anesthetics and methods for the induction of open heart surgery. It depend on the patients cardiovascular function and physicians experience and their preference. Meticulous observation and continuous monitoring of cardiovascular response are very important when intravenous anesthetics are used with fentanyl.
Anesthesia ; Anesthetics ; Anesthetics, Intravenous ; Arterial Pressure ; Blood Pressure ; Cardiovascular Diseases ; Cardiovascular System ; Fentanyl ; Heart Rate ; Heart* ; Humans ; Intubation ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Unconsciousness*

Hepatoblastoma is a primary embryonic liver tumor usually found in children. It extremely rarely occurs in adults. We report a case of hepatoblastoma in a 56 year old man with chronic hepatitis B of 10years duration. Laboratory investigation of the patient on admission showed a marked elevation of alpha-fetoprotein in serum. Ultrasonography and Computerized tomography scan revealed a primary tumor, 6x7cm in size, in the right lobe. The tumor removed by a right lobectomy. Complete removal of the tumor is the treatment which is potentially curative provided that lesion is confined within the liver capsule. The literature revealed and a case of this tumor reviewed.
Adult* ; alpha-Fetoproteins ; Child ; Hepatitis B, Chronic ; Hepatoblastoma* ; Humans ; Liver ; Middle Aged ; Ultrasonography

Cadmium (Cd)-induced renal damage primarily affects the cellular and functional integrity of the proximal tubules. Cd intoxication is a rare cause of Fanconi syndrome. We report a 31-year-old woman with Fanconi syndrome confirmed by laboratory findings and a renal biopsy that also showed an elevated urinary Cd. Seven months before admission, the patient had a normal urinalysis and renal function. Six and 3 months before admission, the patient ingested Chinese herbal mixtures. On admission, the blood Cd concentration was normal, and the urine Cd concentration was 58 microgram/g of creatinine, 29-times higher than the normal range. A renal biopsy showed degeneration of the proximal tubules with normal glomeruli. The serum creatinine had increased from 1.2 to 3.2 mg/dL over 8 months. This case of Fanconi syndrome and rapidly progressive renal damage over a short period was associated with elevated urinary Cd levels.
Adult ; Asian Continental Ancestry Group ; Biopsy ; Cadmium ; Creatinine ; Fanconi Syndrome ; Female ; Humans ; Reference Values ; Renal Insufficiency ; Urinalysis

BACKGROUND: The postoperative bowel function can affect the number of hospital days and morbidity. This study examined the effect of intravenous lidocaine on the postoperative bowel function. METHODS: Forty patients scheduled to undergo a laparoscopic hysterectomy were randomly allocated to receive intravenous lidocaine or an equal volume of saline. The lidocaine group received a continuous lidocaine infusion of 2 mg/kg/hr intraoperatively and for one hour after surgery. The saline group received an equal volume of saline. The time to the first flatus, defecation and hospital discharge were recorded. The incidence of postoperative nausea and vomiting (PONV) were assessed. The consumption of intravenous patient controlled analgesia (IV-PCA) over a twenty-four hour period and the dose of the rescue drug were measured. The visual analogue scale of pain was assessed at the recovery room and 24 hour after surgery. The side effects of intravenous lidocaine were recorded. RESULTS: The patients' demographics were similar in both groups. The median time to the first flatus was 30 hours in the lidocaine group and 42 hours in the saline group (P < 0.05). The median time to defecation was 65.5 hours in the lidocaine group and 96 hours in the saline group (P < 0.05). The number of hospital days was similar. Intravenous lidocaine significantly decreased the level of IV-PCA consumption (P < 0.05). In the lidocaine group, the incidence of PONV was significantly lower (P < 0.05), and no side effects were observed. CONCLUSIONS: Intravenous lidocaine facilitates the recovery of the bowel function after a laparoscopic hysterectomy by reducing the flatus time and defecation time. In addition, the level of IV-PCA consumption after surgery and the incidence of PONV were also reduced by intravenous lidocaine.
Analgesia, Patient-Controlled ; Defecation ; Demography ; Flatulence ; Humans ; Hysterectomy ; Incidence ; Lidocaine ; Postoperative Nausea and Vomiting ; Recovery Room