PURPOSE: The Remeex (Mechanical External Regulation) sling is a mid-urethral sling that allows adjustment of the sling tension in the postoperative period. We evaluated the early outcomes of the procedure in patients in whom the success rate of tension-free slings is low, such as with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: We included 17 women with urodynamically proven stress urinary incontinence (SUI) who underwent the Remeex procedure and were followed for at least 12 months. The patients were considered to have ISD on the basis of a Valsalva leak point pressure (VLPP) <60 cmH2O or a maximum urethral closure pressure (MUCP) <20 cmH2O. We analyzed parameters including history taking, urodynamic study (UDS), and postoperative clinical outcomes. Patient's success and satisfaction rates were evaluated after the procedure. Also, we asked about lower urinary tract symptoms (LUTSs) with a questionnaire, and the severity of LUTSs was assessed with the Visual Analog Scale (VAS) before and 12 months after the operation. RESULTS: The patients' mean age was 55.6+/-9.58 years. Four (23.5%) patients had mixed incontinence. Five patients (29.4%) had undergone previous surgery for SUI. At a mean follow-up of 13.3 months (range, 12-16 months), 14 patients (82.3%) were cured and 3 patients (17.6%) were improved. Four patients (23.5%) answered very satisfied and 13 patients (76.4%) answered satisfied on the satisfaction questionnaire. Also, LUTSs were improved except voiding pain (p<0.05). CONCLUSIONS: This procedure provides high cure and satisfaction rates. Our results demonstrate that the Remeex procedure is suitable for women with SUI with ISD.
Female ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Postoperative Period ; Suburethral Slings ; Urinary Incontinence ; Urodynamics

PURPOSE: Prognosis of primary gastric cancer invading neighboring organs is very poor. However, with en bloc resection, a relatively favorable prognosis can be expected even in patients with such advanced cancer. But there has been controversy on the effectiveness of gastrectomy combined with en bloc resection of the invaded organs, and we conducted this study to evaluate the prognostic effects as well as the outcome of the combined resection. MATERIALS AND METHODS: Among 2,603 who underwent gastrectomy due to gastric carcinoma from January 1987 to December 1994 at the Department of Surgery, Yonsei University College of Medicine, 157 patients (6.0%) in whom curative combined resections of grossly invaded adjacent organs (cT4) were perfonned entered this study. Any case with distant metastasis was excluded. Comparisons and multivariate analysis between the invasion (pT3) group and the non-invasion (pT4) group were made for age, sex, tumor size, location, Borrmann type, depth of invasion, lymph node metastasis, histologic type and 5-year survival rate. RESULTS: One-organ combined resection was done in 60 (38.2%) patients; Two-organ, in 80 (51.0%) patients; and three-organ, in 17 (10.8%) patients. Most commonly combined organ was distal pancreas and transverse colon was the next. Histologic confirmation of invasion was made in 40.9%. 157 patients with T4 were divided into pT3 or pT4. Significant differences were found in type of operation, location of tumor, and TNM staging. Postoperative complications of combined resection were observed in 48 cases (30.6%) and the wound infection was the most frequent one. There were only 2 cases (1.3%) of immediate postoperative mortality in the combined group, and the causes of death were pulmonary complication and acute renal failure. Five-year survival rate (5-YSR) of pT3 group was 43.0% and that of pT4 was 26.2%. In comparison of 5-YSR according to TNM stages, no significant difference was found between pT3 and pT4 (45.0% vs. 66.7% in IIIa; 25.4% vs. 18.4% in IV). No difference of 5-YSR was observed in the groups categorized according to the number of resected organs. The comparison of 5-YSR between the 157 curatively-combined cases and the 63 palliatively-combined cases showed a significant difference (35.6% vs. 4.2%, p=0.000). Multivariate analysis showed that lymph node metastasis and microscopic tumor invasion served as significant parametets. CONCLUSION: En bloc combined resection of adjacent invaded organs along with systematic lymph node dissection would be beneficial to gastric cancer patients with neighboring organ invasion.
Acute Kidney Injury ; Cause of Death ; Colon, Transverse ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreas ; Postoperative Complications ; Prognosis ; Stomach Neoplasms* ; Survival Rate ; Wound Infection

No abstract available.
Gastric Stump*

PURPOSE: Adenosquamous carcinoma, a rare malignant tumor of the stomach, is characterized by two different cell components, one adenomatous and the other squamous component. Its clinicopathologic feature and prognosis are quite different from the ordinary adenocarcinomas. We report our experience of 9 such cases. MATERIALS AND METHODS: Clinical and pathologic features were reviewed for the 9 patients who undenwent gastrectomies and were confirmed as adenosquamous carcinoma by pathologists during the 10-year period of from 1987 to 1998. Postoperative adjuvant therapy and prognosis were also reviewed. RESULTS: The ages of 6 male and 3 female patients ranged from 30 to 59, with the median age of 48. Total gastrectomy was done in 4 cases, while other underwent subtotal gastrectomy. Curative resection was done in four cases. Fourteeen additional organs were resected concomitantly due to suspicious tumor invasion and among them 9 organs were histologically confirmed for tumor invasion. The mean tumor size was 7.4 cm (2.5-27 cm) and all cases were pathologically advanced. One case showed peritoneal seeding and 3 cases showed hepatic metastases. There were 7 cases of stage IV disease by the UICC TNM classification (5th ed.) and the other two were stage II and stage IIlb respectively. Eight cases received postoperative adjuvant chemotherapy comprising S-FU, DDP, adriamycin, picibanil or VP-16. Of 9 patients, 6 died and the overall 5-year survival rate was 15.3%. CONCLUSION: Adenosquamous cancer of stomach is regarded as a disease of unfavorable prognosis, which was confirmed by this study. The treatments were not quite different from those for other stomach cancers. Although more cases and further investigations are essential for complete understanding of the clinical prognosis and proper treatment of the gastric adenosquamous cancer, early diagnosis, curative resection and close postoperative follow-ups are currently available options for better outcome of this disease.
Adenocarcinoma ; Carcinoma, Adenosquamous* ; Cellular Structures ; Chemotherapy, Adjuvant ; Classification ; Doxorubicin ; Early Diagnosis ; Etoposide ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Neoplasm Metastasis ; Picibanil ; Prognosis ; Stomach ; Stomach Neoplasms ; Survival Rate

Primary cricopharyngeal dysfunction is a rare, idiopathic, functional disorder of the upper esophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and functional narrowing at the level of UES. It is caused by failure or partial relaxation of the sphincter, lack of pharyngoesophageal coordination, or reduced compliance of the muscular of the UES. We saw a 62-year-old man who presented with dysphagia and UES narrowing on videofluoroscopy swallowing study (VFSS). Physical, neurologic, and laboratory evaluations revealed no abnormal findings. Radiologic evaluation looking for any abnormalities that might provoke dysphagia was within normal limits. VFSS showed laryngeal aspiration, residue in vallecular and pyriform sinuses, and cricopharyngeal narrowing. Balloon catheter dilatation under endoscopic guidance was performed twice, after which, the dysphagia improved. Here, we describe the results of treatment with balloon dilatation in a patient with primary cricopharyngeal dysfunction.
Catheters ; Compliance ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Sphincter, Upper ; Humans ; Middle Aged ; Pyriform Sinus ; Relaxation

There has been considerable controversy over the prognosis of mucinous gastric enocarcinoma (MGC). In this study we analyzed the clinicopathologic fferences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, e relationship between mucin content and other clinicopathologic variables, cluding prognosis in MGC, was also investigated. We reviewed 2118 patients th pathologically-confirmed gastric cancer who underwent gastrectomy at the partment of Surgery, Yonsei University College of Medicine, during the period tween Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma th extracellular mucin (MGC) and 1988 patients had gastric carcinoma without tracellular mucin (NMGC). We placed the MGC patients into two groups according mucin content: mucin content involving over 50% of the tumor (dominant type, = 94) and mucin content involving less than 50% of the tumor area (partial pe, n = 36). The results were as follows: MGC was more common in males than GC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC ean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV GC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: .6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal tastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with C were more advanced in stage at the time of diagnosis and had a worse overall -year survival rate (44.9%) than patients with NMGC (54.7%). However, the -year survival rate according to the stage of MGC was similar to that of NMGC. ere were no significant differences between the mucin content and other thologic variables, including prognosis, i.e. similar biologic behavior tween dominant type MGC and partial type MGC. In conclusion, we suggest that C was more frequently diagnosed in advanced stage than NMGC with a poorer ognosis and that it is reasonable to consider the carcinoma with mucin content volving more than 30% of the tumor area as MGC.
Adenocarcinoma/pathology ; Adenocarcinoma/metabolism ; Adenocarcinoma, Mucinous/pathology* ; Adenocarcinoma, Mucinous/metabolism* ; Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Mucins/metabolism ; Neoplasm Staging ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/metabolism*

Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.
Adenocarcinoma, Papillary/pathology* ; Adult ; Case Report ; Fallopian Tube Neoplasms/pathology* ; Female ; Human ; Neoplasms, Multiple Primary/pathology* ; Ovarian Neoplasms/pathology* ; Teratoma/pathology*

The purpose of this study was to compare the sealing abilities of four endodontic temporary restorative materials using a methylene blue dye penetration test under dynamic loading. Standardized access cavities were prepared in forty-four intact human permanent molar teeth, and the cavities were restored with Caviton, MD-Temp, IRM, or ZOE. After thermocycling, an intermittent load of 98 N at 1 Hz was applied for 1,000 cycles to the long axis of the functional cusp of each of the teeth, which were immersed in a 1% methylene blue solution. The teeth were split in half, and the linear depth of dye penetration was evaluated according to the criteria. The results were analyzed using one-way ANOVA (p = 0.05) and Duncan's multiple range test. The results demonstrated that Caviton and MD-Temp showed significantly lower microleakage than IRM and ZOE. It was concluded that Caviton and MD-Temp exhibited better sealing ability than IRM and ZOE under dynamic loading.
Axis, Cervical Vertebra ; Calcium Sulfate ; Dental Cements ; Humans ; Methylene Blue ; Molar ; Root Canal Filling Materials ; Tooth ; Vinyl Compounds ; Zinc Oxide

OBJECTIVES: The purpose of this study was to examine the occupational risk factors associated with musculoskeletal symptoms in public workers. METHODS: In November 2010, 544 participants anwered a survey that included questions on the participants' general characteristics, job-related factors, health-related behaviors, and psychosocial stress. We measured the relationship of risk factors to musculoskeletal symptoms using a logistic regression analysis. RESULTS: After adjusting for general characteristics, factors associated with occupational musculoskeletal symptoms were gender (OR=2.858, 95% CI=1.701~4.801), unnatural posture (OR=2.386, 95% CI=1.308~4.354), psychosocial stress (OR=4.051, 95% CI=1.336~12.282) and sleep quality (OR=1.672, 95% CI=1.052~2.660). CONCLUSIONS: These findings suggest that psychosocial stress levels and physical environment (especially in professions requiring an unnatural posture) are related to musculoskeletal symptoms in public workers.
Logistic Models ; Posture ; Risk Factors

PURPOSE: Prostate biopsy for diagnosing cancer can be painful. The efficacy and safety of combination perianal-intrarectal lidocaine-prilocaine (PILP) cream and periprostatic nerve block were compared with nerve block alone during transrectal ultrasound guided prostate biopsy (TRUS-Bx). MATERIALS AND METHODS: From October 2007 to August 2009, 74 men undergoing a transrectal prostate biopsy were randomized into two groups. In group 1, 36 patients received a combination of PILP cream and a periprostatic nerve block; and in group 2, 38 patients received lubricant jelly and a periprostatic nerve block. Thirty minutes later, the TRUS-Bx was performed. Pain was evaluated by a 10-point visual analogue scale (VAS) after the biopsy. RESULTS: Patients in group 1 showed a significantly lower VAS score than patients in group 2 (mean score 2.22+/-0.89 vs. 3.02+/-1.15, p<0.001). In addition, there was a difference in the number of patients that had a pain score of three or more, 44% in group 1, and 65% in group 2. The overall complication rate was similar in both groups (p=0.45). CONCLUSIONS: A combination of PILP cream and periprostatic nerve block reduced pain compared to the periprostatic nerve block alone. This safe, simple technique can be considered prior to TRUS-Bx to reduce patient discomfort.
Analgesia ; Biopsy* ; Humans ; Male ; Nerve Block* ; Prostate* ; Ultrasonography*