With the recent increase in the elderly population, and the Westernization of the diet and increased consumption of meat products, a significant rise in the incidence of prostate cancer has been noted in the Republic of Korea. In cases with localized prostate cancer and sufficiently long life expectancy, the standard treatment is surgical resection of the prostate. Such surgical treatment is so far the only modality demonstrated through randomized prospective studies to be beneficial in terms of disease-specific survival; this procedure involves not only surgical removal of the prostate but also pelvic lymphadenectomy for accurate staging and neurovascular bundle preservation to aid in postoperative functional recovery. Prostatectomy can be carried out either with an open technique, laparoscopically, or under robot assistance. Reviews of the literature and meta-analyses have shown that laparoscopic and robot-assisted procedures offer significant reductions in blood loss and transfusion rates and advantages in terms of recovery from postoperative complications such as incontinence and impotence over open prostatectomy. However, no long-term oncologic outcomes are available for laparoscopic or robot-assisted procedures, and the long-term prevalence of incontinence and impotence for these two methods doesnot differ significantly from those for open prostatectomy, despite the laparoscopic and robot-assisted procedures being far more costly. Therefore, surgical treatment of prostate cancer should be carefully decided on following ample deliberation of various factors including the stage, age, comorbidities, and economic status of the patient and provision of sufficient information to the patient.
Aged ; Comorbidity ; Diet ; Erectile Dysfunction ; Humans ; Incidence ; Life Expectancy ; Lymph Node Excision ; Male ; Meat Products ; Postoperative Complications ; Prevalence ; Prostate ; Prostatectomy ; Prostatic Neoplasms* ; Republic of Korea ; Urologic Surgical Procedures

OBJECTIVE: This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. MATERIAL & METHODS: The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. RESULTS: During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. CONCLUSION: Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.
Blood Transfusion ; Cesarean Section ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Prenatal Care ; Risk Factors ; Urinary Tract ; Uterine Inertia

OBJECTIVES: The objective of this study is to evaluate the expression of vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP), and to correlate them with clinicopathological factors in uterine cervical neoplasia. METHODS: A total 81 cervical biopsy specimens obtained from Jan.1995 to Aug. 1996 at YUMC were evaluated for the expressions of VEGF and TP : 9 were designated as benign, 6 as CIN 1, 11 as CIN 2, 12 as CIN 3, and 43 as invasive squamous cell carcinoma of uterine cervix. We applied the immunohistochemistry using primary antibodies, such as VEGF and TP monoclonal antibody on formalin-fixed, and paraffin-embedded tissues. The results of immunostaining were correlated with various clinicopathological factors of cervical cancer and patient 5-year survival. RESULTS: As the cervical tumorigenesis progressed, there was significant increase of expression of VEGF and TP. VEGF expression was inversely correlated with stage of cervical cancer and showed a significant correlation with the depth of stromal invasion and lymphovascular space invasion. TP expression in cancer cells was significantly high in tumors with advanced stage, large tumor size, pelvic node metastasis. There was an inverse relationship between VEGF and TP expression. VEGF had no significant power to predict patient survival but TP showed statistically significant correlation with poor survival. CONCLUSIONS: Both VEGF and TP play important roles in invasiveness of uterine cerival neoplasia. However, the former is important in early process and the latter in the late process of cervical tumorigenesis and affects the patient's survival in uterine cervical carcinoma, respectively.
Antibodies ; Biopsy ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Thymidine Phosphorylase* ; Thymidine* ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*

Thunderclap headache refers to a sudden and severe headache that comes unexpectedly, reminding one of a clap of thunder. The initial description of this type of headache was in association with an unruptured intracranial aneurysm. It is known to be a presenting feature of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous thrombosis, cervical artery dissection, spontaneous intracranial hypotension, pituitary apoplexy, retroclival hematoma, and hypertensive reversible posterior leukoencephalopathy. A formula for diagnostic assessment of thunderclap headache, such as brain computed tomographic scan and spinal tap, should be established. We experienced a case of cerebral infarction presented with thunderclap headache, diagnosed using diffusion weighted magnetic resonance imaging. We suggest that, even when these patients have shown non-specific findings on neurological examination, brain computed tomography, and cerebrospinal fluid analysis, diffusion MRI should be considered for differential diagnosis of thunderclap headache in emergency medical services.
Arteries ; Brain ; Cerebral Infarction ; Diagnosis, Differential ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Emergency Medical Services ; Headache ; Headache Disorders, Primary ; Hematoma ; Humans ; Infarction, Middle Cerebral Artery ; Intracranial Aneurysm ; Intracranial Hypotension ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neurologic Examination ; Pituitary Apoplexy ; Spinal Puncture ; Subarachnoid Hemorrhage ; Venous Thrombosis

PURPOSE: Methylphenidate (MPH) is one of the most commonly prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract function. This study investigated changes in cystometric parameters after intragastric administration of MPH in conscious spontaneously hypertensive rats (SHRs), an animal model of ADHD. METHODS: Fourteen- to 16-week-old male SHRs (n=10), weighing between 280 and 315 g, were used. Three micturition cycles were recorded before administering MPH. One hour after each intragastric MPH injection, three cycles of cystometrogram were obtained in the awake condition. Various cystometric parameters were evaluated, including basal pressure (BP), maximal pressure (MP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), micturition interval (MI), and residual volume (RV). The data were analyzed using paired Student t-tests. RESULTS: Five SHRs were each administered a dose of 3-mg/kg MPH, and the other five received a dose of 6-mg/kg MPH. BP and MP increased significantly in the rats that received the 3-mg/kg MPH injection, but not in those that received the 6-mg/kg injection. BC, MV, and MI significantly increased in the rats that received the 6-mg/kg MPH injection, but not in those that received the 3-mg/kg injection. There were no significant changes in TP after either injection. CONCLUSIONS: Significant increases in BC, MV, and MI after the 6-mg/kg MPH injection suggest that the peripheral and the central nervous systems may play important roles in bladder function in those receiving MPH for ADHD.
Animals ; Attention Deficit Disorder with Hyperactivity ; Central Nervous System ; Humans ; Male ; Methylphenidate* ; Models, Animal ; Rats ; Rats, Inbred SHR* ; Residual Volume ; Urinary Bladder ; Urinary Tract ; Urination ; Urodynamics

Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome that commonly presents with stable hemodynamic status during the acute phase. An 8-year-old boy initially presented with severe hypotension and acute kidney injury. He was placed in the intensive care unit and was diagnosed with KD. Observed clinical features were defined as KD shock syndrome. His coronary artery was dilated during the subacute phase. Furthermore, he was given anti-hypertensive medications, owing to hypertension as an unusual complication of KD. We knew the importance of monitoring for blood pressure considering vasculitis as an aspect of the main pathogenesis of KD.
Acute Kidney Injury* ; Blood Pressure ; Child ; Coronary Vessels ; Hemodynamics ; Humans ; Hypertension* ; Hypotension ; Intensive Care Units ; Male ; Mucocutaneous Lymph Node Syndrome* ; Shock* ; Vasculitis

PURPOSE: Pelvic floor muscle exercise (PFME) is a therapeutic option for urinary incontinence (UI). However, studies of the efficacy of PFME on UI in patients with cognitive impairment (CI) are lacking. Therefore, we evaluated the effect of PFME on UI in elderly women with mild CI. METHODS: A total of 150 women with mild CI or Alzheimer disease and UI were screened using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Cognitive function and behavioral symptoms were evaluated by the Mini-Mental State Examination and Barthel's Activities of Daily Living. The patients were randomly divided into a control group (n=46) and a PFME group (n=52, 6 sessions of PFME for 12 weeks). The primary outcome was the change in UI episodes measured with a frequency volume chart (FVC). The secondary outcomes were other FVC parameters and the ICIQ-SF scores. RESULTS: A total of 82 women (control group: 40 and PFME group: 42) completed the study. After 12 weeks of PFME, the mean number of UI episodes per 24 hours decreased by 1.6 (from 3.3 to 1.7) in the PFME group and by 0.5 (from 3.4 to 2.9) in the control group (P < 0.001 between groups). The mean number of micturition episodes and total ICIQ-SF scores improved in the PFME group to a significantly greater extent than in the control group (P<0.001). CONCLUSIONS: Supervised PFME can be a good therapeutic option for improving UI in elderly women with CI.
Activities of Daily Living ; Aged* ; Alzheimer Disease ; Behavioral Symptoms ; Cognition ; Cognition Disorders* ; Female ; Humans ; Pelvic Floor* ; Urinary Incontinence* ; Urination

To increase retinal blood flow, we attempted to increase blood flow of ophthalmic artery which in the major vascular supply to the eyeball. The authors evaluated changes in blood flow of ophthalmic artery and retinal capillary after compression of superficial temporal artery. In 5 normal healthy subjects, the superficial temporal artery was compressed for 10seconds and the blood flow was measured with color doppler imaging and Heidelberg Retinal Flowmeter(HRF). After compression, the mean volume of ophthalmic artery was increased by 59.3% and the mean change of diastolic velocity was significantly increased by 29.6%. Systolic velocity did not changing significantly. For evaluation of retinal microcirculation, we measured volume, flow, velocity in retina and optic nerve head. The relative ratio in changes of volume, flow, velocity were 87.9%, 91.5%, 92.6%, in retina respectively and 110.1%, 140.7%, 139.5%, respectively in optic nerve head. These significant changes were not statistically(P>0.05). In 5 diabetic patients with damaged autoregulatory mechanism, the relative ratio in changes of volume, flow, velocity were 114.25%, 118.30%, 117.6%, respectively. These changes were not statistically significant(P>0.05). Our results indicate that the increase of blood flow in ophthalmic artery by compressing superficial temporal artery did not increase retinal blood flow.
Capillaries ; Humans ; Microcirculation* ; Ophthalmic Artery ; Optic Disk ; Retina ; Retinaldehyde ; Temporal Arteries*

Background/Aims: This study aimed to assess the association between local and systemic reactogenicity and humoral immunogenicity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Methods: Adverse events were prospectively evaluated using an electronic diary in 135 healthy adults who received a SARS-CoV-2 vaccine (AZD1222, AstraZeneca/Oxford, n = 42; or BNT162b2, Pfizer/BioNTech, n = 93). We semi-quantitatively measured anti-S1 immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay at baseline, 3 weeks after the first dose of AZD1222 or BNT162b2, and 2 weeks after the second dose of BNT162b2. We evaluated the association between the maximum grade of local or systemic adverse events and the anti-S1 IgG optical density using multivariate linear regression with adjustment for age, sex, and use of antipyretics. Results: The median age of the 135 vaccinees was 30 years (36 years in the AZD1222 group and 29 years in the BNT162b2 group) and 25.9% were male (9.5% in the AZD1222 group and 33.3% in the BNT162b2 group). Local and systemic adverse events were generally comparable after the first dose of AZD1222 and the second dose of BNT162b2. The grades of local and systemic adverse events were not significantly associated with anti-S1 IgG levels in the AZD1222 or BNT162b2 group. Conclusions Local and systemic reactogenicity may not be associated with humoral immunogenicity after SARS-CoV-2 vaccination.

Laparoscopic cholecystectomy has now rapidly replaced open cholecystectomy. Rarely a calculus may arise from a metallic surgical clip migrated into the common bile duct (CBD) after this surgical procedure was performed. We report a 50-year-old man with CBD stone formed around a surgical clip, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 14 months before. Abdominal CT revealed a single stone in mildly dilated CBD. A high density core within the CBD stone, was suspected to be a surgical clip. The stone was removed using a retrieval balloon catheter and basket after endoscopic sphincterotomy.
Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects