A vesicovaginal fistula is a distressing complication which may follow hysterectomy and other extensive pelvic operation. Maligntncies of the uterin cervix or bladder may predispose to erosion and vesicovaginal fistula or such fistulas may occur as a result of extensive radiation therapy. Childbirth, particularly involving prolonged labor with potential necrosis of the vesico vaginal septum or complicated delivery with trauma may also induce a vesicovaginal fistula. In this experience the most common cause of vesicovaginal fistula resulting from surgery was total abdominal hysterectomy. Diagnosis of vesicovaginal fistula is usually made when appearance of methylene blue in the vagina after instillation of the dye into the bladder and further confirmed the presence and definitive localization of the fistula with cystoscopic examination. The operative procedures, the authors utilized were suprapubic transvesical closure in 8 cases, vaginal closure in two cases, and transabdominal approach in one case. The bladder was opened at the dome and then stay sutures were made at 1.0cm from the fistula margin. Then, the fistulous tract was excised making a lateral margin wide enough to leave viable tissue for subsequent closure. Vaginal wall and bladder wall closure were carried out in whole layer using interrupted 2 zero chromic suture. In one case of large fistula with high opening, the patient was underwent transabdominal method interposing a peritoneal flap between vagina and bladder wall. A urethral catheter was placed for 10 to 12 days postoperatively. In 5 cases of ureterovaginal fistula, one patient required the nephrectomy because of pyonephrosis, 2 patients refused further medication, one had ureteral reimplantation and another patient had psoas hitch and Boari operation. The following conclusions were obtained. 1. The most common cause of vesicovaginal fistula was the complication of total hysterectomy. 2. The diameter of fistulous tract was ranging from 1 to 10 mm. 3. For the repair of vesicovaginal fistula transvesical approach were 8 out of in 13 case, vaginal route in 2 cases, intraabdominal approach using a peritonal flap in one case. 4. Urethral catheter had been placed postoperatively was removed on the 12th postoperative day in most cases. Ureteral splint catheter was also placed for 8 to 10 days postoperatively. 5. 12 out of 14 cases, urinary vaginal fistulas were successfully closed on the first surgical attempt and one case healed on the second attempt. One case failed because of infection at the area of closure.
Catheters ; Cervix Uteri ; Diagnosis ; Female ; Fistula ; Humans ; Hysterectomy ; Methylene Blue ; Necrosis ; Nephrectomy ; Parturition ; Pyonephrosis ; Replantation ; Splints ; Surgical Procedures, Operative ; Sutures ; Ureter ; Urinary Bladder ; Urinary Catheters ; Vagina ; Vaginal Fistula* ; Vesicovaginal Fistula

A case of intussusception of a ureter due to a ureteral polyp was observed. Ureteral intussusception have been exceedingly rare, and very few reference to this condition can be found in the medical literature. The author have report a 39 years old female of a case of intussusception of the ureter associated with a benign polyp. The author have performed satisfactory conservative treatment. The patient was entirely recovery and has remained in excellent health since.
Adult ; Female ; Humans ; Intussusception* ; Polyps* ; Ureter*

Post-caval or retrocaval ureter is a congenital anomaly of the vascular system. This anomaly almost. always involve the rt. ureter and occurs more frequently in male We have reported a 36 years male of rt. postcaval ureter that was resulted marked hydronephrosis due to compression of rt. ureter by vena cava. Three months after the operation, excretory urogram showed previous caliectasis and pyelectasis were moderately reduced and previous dislocated ureteral course was corrected.
Humans ; Hydronephrosis ; Male ; Pyelectasis ; Retrocaval Ureter ; Ureter*

The number of skin graft operations following the soft tissue injuries has been increasing year after .year, as the number of industrial business is growing fast in Seoul district. We have performed one hundred and two cases of skin graft, mainly for the extremities injury in the orthopedic surgical department alone during last sixteen months (from January. l968 to Apri1, 1969) including two plastic operation for the penile skin which involves, very rarely because of an anatomical .stand point The plastic repair of penile skin was done by means of Goodwin's technic. The pedicle skin wag donated from the scrotum for the completely necrotized penile skin which was developed following the attempt of removal of the penile paraffinoma.
Commerce ; Extremities ; Orthopedics ; Plastics* ; Scrotum ; Seoul ; Skin* ; Soft Tissue Injuries ; Transplants*

Reflex ileus in acute abdominal disease were produced frequently due to cholecystitis, cholelithiasis, abscess in pelvic, appendiceal and diaphragmatic etc. But we found that a functional type of paralytic ileus due to ureteral stonetr renal stone was commonly seen on the plain roentgenogram. In these functional type of reflex ileus due to urinary stone, distension of the small intestine withgas may interfere with an accurate detection of the stone. It may lead to confusion in detecting ureteral stone and obstructive ileus. In this report, we analyzed how many cases would show a functional type of reflex ileus in urinary stone cases. 1. In 200 cases of urinary stone, reflex ileus with urinary stone were produced in 49 cases(21. 5%) 2. Many cases of ureteral stone were found on lower third of the ureter. (99 cases) 28 reflex ileus cases in 99 cases were produced (29.2%) 3. In reflex ileus due to urinary stone, we classified them by sex, age, location and stone size. The stone was often masked by nausea, vomiting, abdominal distention and reflex ileus on plain roentgenogram. So it is necessary to perform a complete urological study to detect urinary stone.
Abscess ; Cholecystitis ; Cholelithiasis ; Ileus* ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Masks ; Nausea ; Reflex* ; Ureter ; Urinary Calculi* ; Urolithiasis ; Vomiting

No abstract available.
Animals ; Diuresis* ; Heat-Shock Proteins ; HSP70 Heat-Shock Proteins* ; Rats* ; Urinary Bladder*

Two hundred four patients with urinary tuberculosis who underwent surgical intervention were evaluated during the period from 1970 to 1988. Surgical management included nephrectomy in 171 cases, nephrostomy in 35 cases, partial nephrectomy in 4 cases and reconstruction of ureteral stricture and contracted bladder in 57 cases. Of 267 cases, 3 cases of ureteral reimplantation and 6 cases of operation performed with intestinal segment were failed. For the success of operation performed with intestinal segment, creatinine lower than 2.0mg/dL was inevitable. Direct method of ureteral reimplantation were all successful but 1 case of Boari operation and 2 cases of antireflux method were failure. One case of Boari operation and 2 cases of operation performed with intestinal segment were dead. The causes of death were sepsis and acute renal failure.
Acute Kidney Injury ; Cause of Death ; Constriction, Pathologic ; Creatinine ; Humans ; Nephrectomy ; Replantation ; Sepsis ; Tuberculosis* ; Ureter ; Urinary Bladder

Furosemide acts primarily on the thick ascending limb of the loop of Henle and inhibits the chloride transport in this site, which is the main mechanism of diuretic action of furosemide However, the precise molecular mechanism of diuretic action of furosemide is still unknown. Recent studies have shown that cGMP might be involved in diuretic effect of furosemide. In this study, the effects of furosemide on the renal tissue level of cGMP in vivo and on the renal guanylate cyclase in vitro were investigated. Also, the influence of aspirin on these effects was examined. The results were as follows: 1. The renal tissue level of cGMP was increased after administration of furosemide, but decreased after administration of aspirin. A combined administration of furosemide and aspirin increased the renal tissue level of cGMP, but the degree of elevation was less than those of the furosemide group. 2. The renal guanylate cyclase activity was slightly increased by furosemide, but this increase was not significant. The renal guanylate cyclase activity was significantly increased by arachidonic acid. Furosemide potentiated the effect of arachidonic acid on renal guanylate cyclase activity, which was inhibited by aspirin. These results indicate that effect of furosemide on renal tissue level of cGMP may be indirect effect that furosemide activates guanylate cyclase by means of increasing prostaglandin synthesis.
Animals ; Arachidonic Acid ; Aspirin ; Diuretics ; Extremities ; Furosemide* ; Guanylate Cyclase* ; Loop of Henle ; Rats*

Testosterone therapy in high doses produces male infertility. There are reports that atrophy of the interstitial cells and decrease in testicular size occur in the rat after treatment with testosterone, and the azoospermia which resulted from testosterone therapy could be reversed by simultaneous treatment with HCG. This study was evaluated for 45 days to clarify microscopic changes in the testis. A total of 60 male mice, 30 BALB/C strain, aged 3-4 weeks and with an average body weight of l2 g and 30 BALB/C strain, aged 3 months and with an average body weight of 20 g, were divided into 2 groups; for one group treatment with testosterone propionate only and another group fur treatment with testosterone propionate and HCG. The results of histological structure were as follows: 1. Mature group, treated with testosterone propionate (0.25mg/g B.W.) daily, reduced Leydig cell numbers and showed germinal epithelium atrophy, and inhibited spermatogenesis. 2. Mature group, treated with testosterone propionate (0.25mg/g B.W.) daily and HCG (2.5 I.U./g B.W.) every 3 days, showed normal variation of interstitial cell, germinal epithelium and spermatogenesis. 3. Immature group, treated with testosterone propionate (0.25mg/g B.W.) daily, increased in numbers of Leydig cells slightly and showed tortuous tubules and spermatogenesis. 4. Immature group, treated with testosterone propionate (0.2.mg/g B.W.) daily and HCG (2.5 I.U./g B.W.) every 3 days, showed normal variation of interstitial cell, germinal epithelium and spermatogenesis.
Animals ; Atrophy ; Azoospermia ; Body Weight ; Cell Count ; Epithelium ; Humans ; Infertility, Male ; Leydig Cells ; Male ; Mice* ; Rats ; Spermatogenesis ; Testis* ; Testosterone Propionate ; Testosterone*

It has been postulated that seminal plasma contains a potent immunosuppressive factor(s) which play a critical role h preventing sensitization of females to sperm antigens after insemination. It has been shown that human seminal plasma (HuSePl) inhibited phytohemagglutinin(PHA) and Concanavalin A(ConA) induced blast transformation of normal peripheral blood lymphocytes. To analyze protein fractions of HuSePl and to observe suppression of cell-mediated immune response by each fraction, the authors performed the Sephadex G-100 chromatography and the lymphocyte transformation with parameters of purified PHA(PHA-P) and pokeweed mitogen(PWM) stimulation test. The results were as follows; 1. Sephadex G-100 chromatography of HuSePl yielded five fractions(Fr. 1-5). 2. The molecular weight of each fraction, assessed by sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS.PAGE), was from 14,000 daltons(D) to more than 85,000 D in Fr. 1, 42,000 D and 33,000 D in Fr. 2, 43,000 D in Fr. 3, 20,000 D in Fr. 4 and 19,000 D in Fr. 5. 3. The mean percentages .of suppression in PHA-P stimulation test by fractions isolated from HuSePl in male (n=I3) were 59.8+10.1% in Fr. 1, 59.5+23.0% in Fr. 2, 84.2+9.4% in Fr. 3, 60.9+/-2l.4% in Fr. 4, 49.4+/-23.2% in Fr. S(F=6.=8, P <0.01) and in female (n=13) were 64.6+/-11.7 % in Fr. 1, 65.4+13.1% in Fr. 2, 82.9+9.2% in Fr. 3, .55.4+21.5% in Fr. 4, 59.2+/-26.0% in Fr. 5(F=4.76, P <0.01). 4. The mean percentages of suppression in PWM stimulation test by fractions isolated from HuSePl in male (n=11) were 15.8+/-17.1% in Fr. 1, 45.1+18.6% in Fr. 2, 80.4+2.7% in Fr. 3, 61.7 + 4.2 % in Fr. 4, 63.5+/-12.8% in Fr. 5(F=38.91, P<0.01) and in female (n=11) were 9.5+/-15.3% in Fr. 1,32.9+/-20.5% in Fr. 2, 78.7+4.5% in Fr. 3,59.9+/-10.0% in Fr. 4, 55.3+15.2% in Fr. 5(F =39.65, P <0.01). 5. The sex difference was not significant in PHA and PWM stimulation test with each fraction (P>0.05). The results revealed that the Fr. 3 has the strongest suppressive effect on lymphocyte transformation activity and these observations support the concept that a local immune response against sperm in the female reproductive tract is actively suppressed by a component in seminal plasma.
Chromatography ; Female ; Humans* ; Infertility ; Insemination ; Lymphocyte Activation ; Lymphocytes ; Male ; Molecular Weight ; Phytolacca americana ; Semen* ; Sex Characteristics ; Sodium Dodecyl Sulfate ; Spermatozoa ; T-Lymphocytes*