PURPOSE: We describe clinical assessment of visual internal urethrotomy (VIU) as primary treatment modality in 69 men who presented with complete or partial obstructed urethral stricture. MATERIALS AND METHODS: The 63 patients with partial obstructed urethral stricture were treated by typical VIU. The 6 men with complete obstructed urethral stricture were treated by VIU using sound passed through previously placed suprapubic tract as guide. RESULTS: The procedure was completed successfully in 57 of the 63 men with partial obstructed (90.5%) and 3 of 6 patients with complete obstructed urethral stricture (50%). CONCLUSIONS: VIU is a safe and effective as primary treatment plan when urethral stricture is partial obstructed and the impassable urethral segment is shorter than 1.0cm.
Humans ; Male ; Urethral Stricture*

PURPOSE: It is well known that leg amputaions are more common in diabetic than non-diabetic patients with arterial occlusive disease. However, the previous reports comparing the graft patencies following infrainguinal bypasses between diabetic and non-diabetic patients revealed a wide range of variance. We tried to determine whether there is a difference on the graft patency between diabetic and non-diabetic patients with infrainguinal arterial bypasses. METHOD: During the period from March, 1993 to December, 1999, 271 infrainguinal bypass grafts were implanted to the limbs with chronic atherosclerotic arterial occlusive disease at Kyungpook National University Hospital, Taegu, Korea. Among them, 193 limbs with autogenous reversed vein grafts were included in this study, which comprised of 65 limbs (34%) in diabetic and 128 limbs (66%) in non-diabetic patients. To compare the graft patencies between diabetic and non-diabetic patients, we divided them into 3 groups according to the levels of distal anastomosis. We used life table or Kaplan-Meier methods to calculate the cumulative primary patency rates and log-rank test to compare the graft patencies between the groups. RESULT: The sites of distal anastomosis were above-knee popliteal artery in 29.2%, below-knee popliteal artery in 40.0%, and infrapopliteal artery in 30.8% of diabetic patients, whereas above-knee popliteal artery in 21.1%, below-knee popliteal artery in 50.0%, and infrapopliteal artery in 28.9% of non-diabetic patients. Vein grafts used in the bypasses were 185 reversed greater saphenous veins, 5 spliced veins, and 3 arm veins. The cumulative primary patency rates at 1, 3 and 5 years were 86% (SE 5.0%), 74% (SE 7.6%) and 74% (SE 7.6%) respectively, in diabetic patients, while 84% (SE 3.7%), 73% (SE 5.2%) and 56% (SE 9.8%) respectively, in non-diabetic patients group. After comparing the patency rates between 2 groups at 3 different levels of distal anastomosis, there was no statistically significant (p<0.05) difference at any level. CONCLLUSION: We found that diabetes did not affect the primary graft patency following the lower extremity arterial bypasses using reversed vein grafts.
Arm ; Arterial Occlusive Diseases ; Arteries ; Daegu ; Extremities ; Gyeongsangbuk-do ; Humans ; Korea ; Leg ; Life Tables ; Lower Extremity ; Popliteal Artery ; Saphenous Vein ; Transplants* ; Veins

Endoscopic intraluminal implantation of a self expandable stent has been increasing in patients with recurrent urethral strictures because of its simple and relative safe technique. There has been a few reports concerning luminal obstruction after implantation of Wallstent. We have experienced 4 cases of urethral obstruction after variable period of Wallstent implantation in the treatment of traumatic urethral stricture. Herein the methods for treatment of urethral obstruction are discussed. The patients were managed with two different types of treatment. The first one was transurethral resection of granulation tissue inside Wallstent. The other is reinsertion of Wallstent inside the first one after transluminal resection of granulation tissue in patients with urethral obstruction occurring within 5 months after Wallstent implantation. Retrograde urethrography and urethroscopy after 3 months have demonstrated patency of urethra and epithelial covering of the implant. Our experience shows that in all 4 patients with traumatic urethral stricture have developed variable degrees of urethral obstruction after a variable period of wallstent implantation. Therefore, we consider that our method is one of the alternatives to treat urethral obstruction after wallstent implantation in patients with traumatic urethral stricture.
Granulation Tissue ; Humans ; Phenobarbital ; Stents ; Urethra ; Urethral Obstruction* ; Urethral Stricture*

Emergent abdominal surgery in cirrhotic patients with ascites can result in dismal postoperative outcomes such as sepsis and hepatic failure. In the present case, small bowel resection followed by anastomosis by the hand-sewn method was performed for small bowel strangulation caused by an umbilical hernia; deceased donor liver transplantation was performed one week after the bowel resection because of deterioration of hepatic function. To the best of our knowledge, this is the first case of liver transplantation performed at only one week after small bowel resection; and although we obtained a good result, the optimal time to perform liver transplantation in this situation requires further evaluation.
Ascites ; Hernia, Umbilical* ; Humans ; Liver Failure ; Liver Transplantation* ; Sepsis ; Tissue Donors*

PURPOSE: Although renal transplantation is the most effective treatment for end stage renal disease (ESRD), the incidence of malignant tumors due to long-term immunosuppression has been increasing. We experienced 9 cases of Kaposi's sarcoma (KS) after renal transplantation in our institution out of 2250 renal transplant recipients. KS is a rare mesenchymal tumor involving blood and lymphatic vessels. The oncogenesis by human herpesvirus 8 (HHV8) represent important condition for this tumor to develop. METHODS: Clinicopathologic features, treatment results, and prognosis of the 9 patients diagnosed with KS after renal transplantation were analyzed retrospectively. RESULTS: There were 6 male and 3 female patients. The mean age was 41.1 years. The average period until diagnosis of KS after renal transplantation was 60 months (range: 6 months~8 years). Clinical features were variable, but mostly presenting several red- purple papular and nodular tumors. Lesions were found in the lower extremities in 6 patients. Three patients presented with palpable lymph nodes in the neck and inguinal area without any skin lesions. Computed tomography showed diffusely enlarged showed an aggressive course. lymphnodes. Systemic involvement was found in 2 patients. Diagnosis was confirmed by histopathologic studies. Immunohistochemical stains for HHV8 were positive in all patients. Five patients showed regression of lesions after drastic reduction of immunosuppression, local resection and/or radiotherapy. But other 4 patients resistant to therapy. CONCLUSION: KS is a rare tumor and appears to be caused primarily by HHV8 in Korea as well. Reduction or cessation of immunosuppression potentially improves symptoms, but it also increases the risk of chronic graft rejection or graft failure. A large-scale study, accumulating data from transplantation cases in Korea, to understand the relationship between the various types of immunosuppression and KS, and to set guidelines for treatment appears to be necessary in the future.
Carcinogenesis ; Coloring Agents ; Diagnosis ; Female ; Graft Rejection ; Herpesvirus 8, Human ; Humans ; Immunosuppression ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Korea ; Lower Extremity ; Lymph Nodes ; Lymphatic Vessels ; Male ; Neck ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma, Kaposi* ; Skin ; Transplantation ; Transplants

BACKGROUND: Malignant fibrous/fibrohistiocytic tumors are uncommon soft tissue tumors which gives dermatologists special attention on differential diagnosis. However, there has not yet been a multicenter study on these tumors in Korea. OBJECTIVE: The aim of this study was to investigate the epidemiology and clinical features of malignant fibrous/ fiborhistiocytic tumors. METHODS: A total of 62 patients from 11 training hospitals who had been confirmed with malignant fibrous/ fibrohistiocytic tumor were studied. A retrospective analysis of hospital records served as the data source for this study. RESULTS: Among patients with malignant fibrous/fibrohistiocytic tumors, the most common tumor type was dermatofibrosarcoma protuberance followed by malignant fibrohistiocytic. The male to female ratio among subjects was 1.38 to 1 and the mean age was 44 years old. Of the common complaints recorded, asymptomatic mass was the most frequent. The mean size of the subjects' tumors was 2.9 cm in the long axis and 2.3 cm in the short axis with a mean tumor thickness of 2.1 mm. The most common site for tumors was the back followed by the thigh. The recurrence rate after primary treatment was 14.5% and metastasis developed in 5 of 62 patients. CONCLUSION: This study is expected to be helpful for understanding the clinical and pathological characteristics of malignant fibrous/fibrohistiocytic tumors.
Axis, Cervical Vertebra ; Information Storage and Retrieval ; Dermatofibrosarcoma ; Diagnosis, Differential ; Female ; Hospital Records ; Humans ; Korea ; Male ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thigh

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*