AIMS OF STUDY: During reflex micturition, the urethral outlet remains open (relaxed) to promote urinary emptying. The mechanisms involved in the relaxation of urethral outlet is thought to be complex including nitric oxide (NO) pathway and beta-adrenergic activity. The aims of the study focused on these several issues related to the neural control of urethral outlet in vivo. MATERIALS & METHODS: Female rats weighing 200~300 gm were anesthetized wish urethane. Catheters were inserted into femoral artery for drug administration.4 two-way catheter (16 G angiocath) was inserted into the bladder for saline infusion and pressure monitoring. A separate cannula (PE 50) was placed into the urethra via external urethral meatus or proximal urethrat opening to record urethral pressure. The bladder was filled with saline at a rate of 0.1 ml/min to induce reflex micturition. Urethral pressure was recorded via cannula through which saline was infused at a rate of 0.05 ml/min. Isovolumetric bladder contraction and urethral pressure were recorded simultaneously. After an equilibration period of 30 minutes, baseline intravesical and urethral pressure were recorded for 10 minutes prior to drug administration. NG-nitro-L-arginine methylester (L-NAME, 10 to 15 mg/kilrogram, i.v.), L-arginine (150 mg/kilrogram, i.v.), propranolol (1 microM., 0.1 ml/250 mg, i.a.), and phenylephrine (1 0~100 microM, i.a.) were administrated. RESULTS: During isovolumetric bladder contraction, urethral pressure was decreased simultaneously, and then returned to the resting states in conjunction with end of the bladder contraction. After the administration of L-NAME, the magnitude of reflex urethral relaxation was decreased significantly (42.6 +/- 15.1% of the control, p<0.01), and this effect was reversed by addition of L-arginine. Administration of propranolol also inhibited urethral relaxation (66.4% of the control). Administration of L-NAME followed by propranolol almost completely abolished the urethral relaxation. Administration of phenylephrine increased the resting urethral tone (mean; 4 cmH2O) significantly, and the magnitude of urethral relaxation was decreased substantially. CONCLUSION: These RESULTS suggest that urethral relaxation is mediated by several neural factors. NO seems like to a potent mediator in a reflex relaxation of the urethral smooth muscle during micturition. Also, beta-adrenergic stimulation play an important role for urethral relaxation. alpha-adrenergic nerve discharge, contributed to contraction of urethral smooth muscle, shows inhibitory effect against the reflex urethral relaxation.
Animals ; Arginine ; Catheters ; Female ; Femoral Artery ; Humans ; Muscle, Smooth ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Nitroarginine ; Phenylephrine ; Propranolol ; Rats ; Reflex ; Relaxation* ; Urethane ; Urethra ; Urinary Bladder ; Urination

A 40-year-old man attended our hospital with presenting symptoms of an acutely swollen, tender testicle and bulging mass on the inguinal area. Considered it as urgent conditions no demonstrating blood flow to the involved testicle on Color Doppler ultrasonography, we underwent scrotal exploration right away. On operative finding the right testis was so enlarged and engorged secondarily to the irreversible ischemic damage, but torsion of spermatic cord was not found. Another inguinal approach revealed herniated mass protruding from internal inguinal ring and compressing the spermatic cord. For further evaluation abdominal ultrasonography and CT scan was done and huge mass occupying right lower quadrant of abdomen and pelvic cavity was noted. The resected tumor through surgical exploration was proved to be a retroperitoneal liposarcoma pathologically. Herein we report an uncommon case of testicular infarct, mimicking torsion of spermatic cord that is a urological emergency, caused by herniated retroperitoneal mass. So the present report suggest that, when adult men attend with symptoms of acutely swollen painful testicle, we pay a more careful attention to patient,s physical findings and recommend further diagnostic evaluation.
Abdomen ; Adult ; Emergencies ; Humans ; Inguinal Canal* ; Liposarcoma* ; Male ; Spermatic Cord ; Testis ; Tomography, X-Ray Computed ; Ultrasonography ; Ultrasonography, Doppler, Color

Various sequences have been developed for MRI to aid in the radiologic diagnosis. Among the various MR sequences, susceptibility-weighted imaging (SWI) is a high-spatial-resolution, threedimensional gradient-echo MR sequence, which is very sensitive in detecting deoxyhemoglobin, ferritin, hemosiderin, and bone minerals through local magnetic field distortion. In this regard, SWI has been used for the diagnosis and treatment of various neurologic disorders, and the improved image quality has enabled to acquire more useful information for radiologists.Here, we explain the principle of various signals on SWI arising in neurological disorders and provide a retrospective review of many cases of clinically or pathologically proven disease or components with distinctive imaging features of various neurological diseases. Additionally, we outline a short and condensed overview of principles of SWI in relation to neurological disorders and describe various cases with characteristic imaging features on SWI. There are many different types diseases involving the brain parenchyma, and they have distinct SWI features.SWI is an effective imaging tool that provides complementary information for the diagnosis of various diseases.

Since coronary arteriovenous fistula(CAVF) was first reported by Krause in 1865, more than 400 cases have been reported. It is relatively rare disease and originates more commonly in the right than in the left coronary artery. We report a case of CAVF between right coronary artery and right ventricular inflow tract with significant left to right shunt in a 34-year old female who was admitted for the cardiomegaly on routine chest X-Ray. It was detected by transthoracic and transesophageal echocardiography, and confirmed by cardiac catheterization and coronary angiography. The opening of the fistula draining into the right ventricle was obliterated with sutures. There was no significant shunt in postoperative cardiac catheterization and coronary angiography.
Adult ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Sutures ; Thorax

PURPOSE: The purpose of this study was to evaluate the overall rate and risk factors for the development of an incisional hernia and a parastomal hernia after colorectal surgery. METHODS: The study cohort consisted of 795 consecutive patients who underwent open colorectal surgery between 2005 and 2007 by a single surgeon. A retrospective analysis of prospectively collected data was performed. RESULTS: The overall incidence of incisional hernias was 2% (14/690). This study revealed that the cumulative incidences of incisional hernia were 1% at 12 months and 3% after 36 months. Eighty-six percent of all incisional hernias developed within 3 years after a colectomy. The overall rate of parastomal hernias in patients with a stoma was 6.7% (7/105). The incidence of parastomal hernias was significantly higher in the colostomy group than in the ileostomy group (11.9% vs. 0%; P = 0.007). Obesity, abdominal aortic aneurysm, American Society of Anesthesiologists score, serum albumin level, emergency surgery and postoperative ileus did not influence the incidence of incisional or parastomal hernias. However, the multivariate analysis revealed that female gender and wound infection were significant risk factors for the development of incisional hernias female: P = 0.009, wound infection: P = 0.041). There were no significant factors related to the development of parastomal hernias. CONCLUSION: Our results indicate that most incisional hernias develop within 3 years after a colectomy. Female gender and wound infection were risk factors for the development of an incisional hernia after colorectal surgery. In contrast, no significant factors were found to be associated with the development of a parastomal hernia.
Aortic Aneurysm ; Cohort Studies ; Colectomy ; Colorectal Surgery ; Colostomy ; Emergencies ; Female ; Hernia ; Hernia, Ventral ; Humans ; Ileostomy ; Ileus ; Incidence ; Multivariate Analysis ; Obesity, Abdominal ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Surgical Stomas ; Wound Infection

Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO2) and outcome. The results were as follows; The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases(61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 29 cases(85%), 17 cases(50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occurred in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5 ml/100 ml in AVDO2 was developed in 32 cases(94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20 mmHg in 15 cases(44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases(15%), prothrombin time(PT) prolongation in 11 cases(32%), activated partial thromboplastin time(APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO2 was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading(NG), GOS IV was developed in 8 cases(NG score 3-6), GOS III in 5 cases(NG score 7-9), GOS II in 2 cases(NG score 10). Total mortality rate was 56%.
Axons* ; Barbiturates ; Blood Platelets ; Cerebral Infarction ; Coma ; Coma, Post-Head Injury ; Diffuse Axonal Injury ; Emergency Service, Hospital ; Female ; Fibrinogen ; Head ; Humans ; Male ; Mortality ; Oxygen ; Prothrombin ; Pupil ; Resuscitation ; Thromboplastin

PURPOSE: We compared neovascularity with needle biopsies and definitive prostatectomy specimens to examine whether the measurement of microvessel density(MVD) has an ability to predict extracapsular extension with limited tissue sample. MATERIALS AND METHODS: We evaluated total 11 pathologically proven stage T3 lesions. The paraffin embedded tissues from needle biopsies and definitive prostatectomy specimens were sectioned serially. Of the serial sections obtained from prostatectomy specimens 2 showing a relatively uniform histology grade; one identical grade with biopsy sample, another the worst grade within the tumor or different grade from biopsy, and 2 from specific sites of the tumor; center and periphery, selected for examination. MVD determinations were performed immunohistochemically using monoclonal antibodies directed at the CD34 antigens. RESULTS: MVD of total 11 needle biopsies with grade 2-5 (score 4-8) ranged from 73.7 to 170.8 (median 106.7 +/- 10.6). The grade (score 5-9) distributions of prostatectomy specimens were different from those of needle biopsies and the MVD obtained from definitive prostatectomy specimens exhibited a heterogeneity within the individual tumor. The variation in densities between different grade group proved statistically different (p< 0.01, paired t-test). Also, the MVD count in the center of the tumor was higher than that in the periphery of the tumor and the difference between two group of the specific sites was statistically significant (p = 0.015, paired t-test). Finally, although MVD of biopsy sample did not correlated exclusively to that of definitive prostatectomy specimen, there would be a significant correlation of MVD between two groups if their distribution of histological grade were identical (p< 0.01, r2 = 0.889). CONCLUSIONS: Prior to surgical extirpation in the patients of clinically localized prostatic carcinomas, MVD determination of needle biopsies of the prostate would not correlate with that of definitive prostatectomy specimen. Given the limited tissue sampling from a biopsy, understanding of the site specificity of vasculature and analyzing the relationship of angiogenesis and other biologic factors of which histologic grade seems to be involved most importantly, are critical to developing a consistent and effective methodology of microvessel quantification.
Antibodies, Monoclonal ; Antigens, CD34 ; Biological Factors ; Biopsy ; Biopsy, Needle* ; Humans ; Microvessels* ; Needles* ; Paraffin ; Population Characteristics ; Prostate* ; Prostatectomy* ; Sensitivity and Specificity

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs of the transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.
Facial Paralysis ; Humans ; Motor Vehicles ; Petrous Bone* ; Prognosis ; Retrospective Studies ; Skull Fractures

In this article, the sixth author's affiliation was misprinted unintentionally.

BACKGROUND: Ventricular function is one of the important prognostic factors in patients with coronary artery disease. Among noninvasive approaches for the evaluation of ventricular performance, radionuclide ventriculo-graphy has shown to be of particular values in the patients with myocardial infarction. We have evaluated ven-tricular function with ECG-gated blood pool scan (GBPS) in patients with myocardial infarction of different locations and compared right and left ventricular functions. METHOD: Left and right ventricular function was assessed with multigated blood pool scan in 49 patients at 2-3 weeks after acute myocardial infarction (anterior infarction=23, inferior infarction=19, and lateral infarction=7). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), maximal emptying rate, maximal filling rate, phase angle and full width at half maximum (FWHM) of phase angles were measured during rest. RESULTS: 1) LVEF was signifi-cantly lower in the patients with anterior myocardial infarction (32.2%) than that of inferior (46.5%, p<0.001) or lateral infarction (45.5%, p<0.05), but not different between inferior and lateral infarction. 2) RVEF was significantly lower in the patients with inferior myocardial infarction (24.6%) than that of anterior (30.5%, p<0.05) or lateral infarction (36.1%, p<0.001), and RVEF of anterior infarction was significantly lower than that of lateral infarction (p<0.05). 3) Phase angle and FWHM of left ventricle and right ventricle phase histogram were not significantly different among the patients groups with different infarct sites. CONCLUSIONS: Ventricular function was differently affected by different infarct sites. Inferior infarction resulted in a greater reduction in right ventricular ejection fraction. In contrast, LVEF was greatly depressed in anterior infarction than in inferior infarction.
Coronary Artery Disease ; Heart Ventricles ; Humans ; Infarction ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Stroke Volume ; Ventricular Function ; Ventricular Function, Left ; Ventricular Function, Right*