The outcomes of treatment of 31 patients who were managed by single visual internal urethrotomy were compared with those of 25 patients managed by perineal urethroplasty to asses whether the replacement of almost urethroplasty by the simpler urethrotomy was justified. The overall successful results were achieved in 51.6% of visual internal urethrotomy and 76%, of urethroplasty. Patients with anterior urethral strictures more than 1 cm long or completely obliterated strictures had higher failure rates in the visual internal urethrotomy than urethroplasty (p<0.05). The morbidity rates were 9.6% in the visual internal urethrotomy and 24% in the urethroplasty. We recommend that visual internal urethrotomy be reserved for patients with urethral strictures 1 cm or less in length and posterior urethral stricture which is supposed to have a high recurrence rate since the procedure is simple and it does not compromise asecondary urethroplasty.
Constriction, Pathologic ; Equidae ; Humans ; Recurrence ; Urethral Stricture*

METHODS: We investigated and compared the epidemiologic characteristics of the E. cloacae isolation in the period of outbreak (April-June, 1998) with those in the control period (January-March, 1998). To identify the risk factors for E. cloacae sepsis, we retrospectively conducted a chart review for the patients who had E. cloacae sepsis during the period of outbreak. On the basis of these results, environmental culture was performed hospital wide. RESULTS: Ten clinical isolates E. cloacae were recovered from the blood of ten patients from April to June. 1998. Seven out of 10 patients recieved ERCP procedure just before E. cloacae sepsis. Hence, we performed surveillance study in the endoscopy room before and after the procedure. The survey showed that distilled water which was used for washing the endoscopy was contaminated with E. cloacae, which was suspected to be the common source of this outbreak. Therefore, we changed distilled water into sterilized distilled water on washing the endoscopy. After this correction was performed, the incidence of ERCP-associated E. cloacae sepsis declined markedly (P<0.011). CONCLUSION: We investigated an outbreak of ERCP-related E. cloacae sepsis and the outbreak was successfully controlled by removing the source of infection.
Cholangiopancreatography, Endoscopic Retrograde* ; Cloaca ; Endoscopy ; Enterobacter cloacae* ; Enterobacter* ; Humans ; Incidence ; Methods ; Retrospective Studies ; Risk Factors ; Sepsis* ; Water

OBJECTIVES: Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. METHODS: The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. RESULTS: Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. CONCLUSIONS: This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems.
Delivery of Health Care ; Health Care Sector ; Health Information Management ; Health Promotion ; Information Systems ; Medical Informatics

This study was performed to evaluate the relationship between biological markers of lead exposure and thyroid functions among male workers occupationally exposed to inorganic lead. 30 male workers exposed to inorganic lead at smelting and battery factories were investigated, and 30 male control workers who were not exposed to inorganic lead occupationally were chosen for this study. The data were obtained using direct interview and assessment of biological markers of lead exposure and thyroid indices. As biological markers for lead exposure, blood ZPP. blood lead, urine lead and hemoglobin were measured. As thyroid indices. TSH and FT4were determined. The results of the study were summarized as follows 1. Levels of ZPP, blood lead, and urine lead were significantly higher in lead-exposed group than in nonexposed control group(p<0.01 all). Hemoglobin level was significantly lower in lead-exposed group than in nonexposed group(p<0.01). 2. Study subjects had normal values of TSH and FT4 But TSH level was insignificantly lower in lead-exposed group than in nonexposed control group(p=0.11) and FT4 level was significantly lower in lead-exposed group than in nonexposed group(p<0.01). 3. As the result of simple regression analysis in lead-exposed group. FT4 level was negatively correlated with the amount of smoke, blood ZPP, and blood lead(p < 0.05 all). 4. In lead-exposed group, FT4 was used as a independent variable and age, the amount of smoke, blood ZPP, and blood lead were entered as a dependent variables in the model. As the result of multiple regression analysis with stepwise selection method, the amount of smoke and blood ZPP were negative predictors of FT4(p=0. 04, p=0.09, respectively). In conclusion, levels of TSH and FT4were lower in lead-exposed group than in nonexposed control group. In lead-exposed group, FT4 level was negatively correlated with amount of smoke, blood ZPP, and blood lead in simple regression analysis. To clarify this relation, further research between lead exposure and thyroid function may be required for worker with long-term lead exposure or high lead exposure.
Biological Markers ; Humans ; Male* ; Occupations* ; Osmeriformes ; Reference Values ; Smoke ; Thyroid Gland*

OBJECTIVES: To investigate whether the new polymorphism at position 2964 (G/A) in the 3' untranslated region of the STAT-6 gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: A polymerase chain reaction of genomic DNA-restriction fragment length polymorphism was used to determine genotypes of the STAT-6 in 90 SLE patients and 148 healthy controls. Clinical and serological manifestations were analyzed in each patient and correlated with the genotypes. RESUTLS: The genotype distribution of the STAT-6 differed significantly between SLE patients and control subjects (AA, AG, GG genotypes 7, 74, 9 vs. 1, 119, 28 controls respectively, p= 0.003). The frequency of AA genotype (7.8%) is significantly increased in SLE patients compared with controls (0.7%)(OR=12.398, 95% CI 1.50~102.5, Fisher's exact test, p=0.005). Clinically in the lupus patients according to the STAT-6 genotypes, there was no significant difference in age at onset, anti-ds-DNA titer, C3, C4 level, SLEDAI, SLICC/ACR Damage Index, or autoantibodies such as RF, anti-Ro, La, RNP, Sm antibodies, except for renal involvement. The frequency of lupus nephritis was significantly higher in the AA genotype in comparison with GG genotype (Fisher's exact test, p=0.019). CONCLUSION: Our data show that the STAT-6 AA genotype may contribute to susceptibility to SLE and may be associated with development of lupus nephritis.
3' Untranslated Regions ; Antibodies ; Autoantibodies ; Genotype ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Polymerase Chain Reaction ; Polymorphism, Genetic

No abstract available.
Seminal Vesicles*

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma ; Consciousness ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal* ; Flumazenil* ; Humans ; Midazolam* ; Premedication* ; Vital Signs

OBJECTIVE: Metabolic syndrome is a constellation of metabolic abnormalities such as obesity, hypertension, glucose intolerance, and hyperlipidemia. The association of metabolic syndrome and hyperuricemia is well known, but not with gout. Therefore, the association of gout and metabolic syndrome is investigated through comparing the prevalence of metabolic syndrome in normal controls and patients with gout. METHODS: This is a case-historical control study of 64 patients with gout recruited from Korea University Anam and Guro Hospital. Clinical factors were checked according to the diagnostic criteria of metabolic syndrome from the ATP III guidelines. Additional waist circumference adjustment was done according to the WHO Asia-Pacific obesity criteria recommendations. The prevalence was compared with historical control studies from the US and Korea. RESULTS: The prevalence of metabolic syndrome in patients with gout was 42.2% according to ATP III criteria and 59.4% with waist circumference adjustment and is significantly higher than control studies (23.7% (US), 6.8% (Korea), ATP III), 10.9% (Korea, WHO Asia-Pacific obesity criteria)(p<0.001 in all cases). Multivariate logistic regression analysis revealed that high BMI and low HDL levels (both ATP III/WHO Asia-Pacific obesity criteria) and the presence of hypertension (ATP III) are the statistically significant risk factors of having metabolic syndrome in gout patients. CONCLUSION: The prevalence of metabolic syndrome in patients with gout is significantly higher than normal control groups. This indicates an association between gout and metabolic syndrome. Especially, being obese or hypertensive, or having low HDL levels are risk factors for the metabolic syndrome in gout patients.
Adenosine Triphosphate ; Glucose Intolerance ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Korea ; Logistic Models ; Obesity ; Prevalence* ; Risk Factors ; Waist Circumference