A cumulative clinical investigation was undertaken on subfertile males who were seen in our department during the period from 1955 to 1978. The results obtained were as follows, 1. A total of 2, 117 subfertile males corresponds to 2.8% of total urological out-patients(75,540), and 3.4% of total male out-patients(62,341) for the period of 24 years. 2. A total of 486 subfertile males were hospitalized for corrective surgery. They were 9% of the urological in-patients(5,582) for the same period. 3. Numbers of subfertile male patients are increasing yearly with the ratio from 10 cases(1%) in 1955 to I79 cases(l8%) in 1978(Table 1). 4. Primary infertility was found in 88% of the total subfertile males and the secondary, 12%. 5. Age of subfertile males varied from 22 to 61. the mean being 35, and that of their partners ranged from 24 to 49, the mean being 32(Table 2). 6. Duration of infertile marital life ranged from 1 to 40 years, the mean being 6 years. An average duration of infertile marriage from 1955 to 1959 was 10 years but that of infertile marriage from 1975 to 1978, 4 years(Table 3). 7. Occupation of the subfertile male patients comprised of merchants, farmers, company employees, public officials, engineers, laborers, soldiers, medical doctors, students, and no occupation. Of these, mental workers were 40%, and muscular workers, 60%. 8. An average frequency of sexual intercourse of the subfertile couples revealed 2.2 per week with no significant differences between the infertile group and the normal fertile group(Table 4). 9. According to etiological classification of male infertility, 1) faulty spermatogenesis occupied 22% of total patients; 2) faulty transportation, 35%; 3) faulty seminal composition, 7%; 4) faulty ejaculation, 1%; 5) faulty maturation, 3%; 6) hormonal disturbances, 2%; and idopathic, 30%(Table 5). 10. Suspective etiological factors are listed as follows: Vasectomy reversal was 22%; testicular hypoplasia, 18%; various causes of epididymitis, 12%; pyospermia, 4%; varicocele, 22%; etc(Table 6) 11. Judging from the results of semen analyses, azoospermia was found in 53%, oligospermia, in 29%; and normospermia, in 7% of the 1,876 cases whose semen was examined. In 151 cases, semen analyses revealed normal, but no babies have been born within 1 year of normal marital life even with fertile women. No primary causes were found in 11O cases of azoospermia, and in 410 cases of oligospermia(Table 7) 12. An average value of spermiogramme was as follows: Volume was 2.4ml; count, 93*l000000/ml; motility, 64%; and morphology, 88% in normospermia group, while volume was 2.3ml; count, 24* 10000000/ml; motility, 27%; normal shape, 79% in oligospermia group(Table 8). 13. Findings of testicular biopsies of azoospermias showed that hypospermatogenesis was found in 15% ; peritubular fibrosis, in 26%; germinal arrest, in 15%; germinal aplasia, in 26%; and normospermatogensis with obstructive pattern, in 18% of the 366 azoospermias(Table 9). 14. Single or combined medical therapy with various drugs such as HCG (Puberogen), testosteront ( Miro-depo), liothyronine (Thyronamin), vitamins (Vitamedine), l-arginine, nucleic acid precursor ( AICAMIN). and Korean Ginsen were given to 275 cases out of the 485 idiopathic subfertile patients for the period from 3 to 12 months in order to improve the spermatogenesis. The improved results were obtained from 60 cases out of 141 oligospermias, and from 15 cases out of 134 azoospermias (Tables 10 and 11). The detail results of the medical therapy on the remaining 210 patients will be separately published. 15. Epididymovasostomy was carried out on 124 cases of the bilateral post-inflammatory epididymal obstruction and viable sperm were appeared in 25 cases out of the 82 cases whose semen could be examined but pregnancy occurred only in 11 cases(Table 12). 16. Vasovasostomy was performed on 329 previously vasectomized men and successful results were obtained in 252 cases for patency and in 105 cases for pregnancy out of 300 patients whose semen could repeatedly be tested post-operatively(Table 12).
Arginine ; Azoospermia ; Biopsy ; Classification ; Coitus ; Ejaculation ; Epididymitis ; Family Characteristics ; Female ; Fibrosis ; Humans ; Infertility ; Infertility, Male* ; Male ; Male* ; Marriage ; Military Personnel ; Occupations ; Oligospermia ; Pregnancy ; Semen ; Semen Analysis ; Spermatogenesis ; Spermatozoa ; Transportation ; Triiodothyronine ; Varicocele ; Vasovasostomy ; Vitamins

Among 7,500 patients whom we have performed gastrofiberoscopy from July 1979 to June 1,982, 226 cases of stomach cancer were diagnosed. The frequency was 3. 0%. The ratio of male to female was 2: 1, the peak incidence, 69 cases(30.5%) was in 5th decade. 1) The frequency of stomach cancer among the age were 0. 5% in 1st decade, 0.4% in 2nd decade, 1.2% in 3rd decade, 2.5% in 4th decade, 5.9% in 5th decade, 12.6% in 6th decade 16.8% in 7th decade. (continue...)
Female ; Humans ; Incidence ; Male ; Stomach Neoplasms* ; Stomach*

OBJECTIVE: To explore the clinical value of postoperative follow-up examination of F-wave and H-reflex in patients with lumbosacral radiculopathy and to clarify optimal timing of follow-up examination. METHOD: The subjects were 17 patients with unilateral lumbosacral radiculopathy caused by disc herniation. In patients with the L5 radiculopathy, F-waves were obtained from extensor digitorum brevis and six parameters including minimal latency per height were used. In patients with the S1 radiculopathy, H-reflexes were obtained from gastrocnemius and amplitude and minimal latency were used as parameters. These parameters were evaluated preoperatively and postoperatively at week 1, 3, 6. These changes of the parameters and clinical findings were related. RESULTS: The parameters of peroneal F-wave and tibial H-reflex showed significant improvement at 3 weeks and 6 weeks after surgery. The improvements of these parameters were not related with clinical improvement at 1 week after operation, but these were significantly related with improvement of pain and muscle weakness at 3 weeks after operation. CONCLUSION: These findings suggested that follow-up examination of F-wave and H-reflex were valuable for objective assessment of lumbosacral radiculopathy after operation and the optimal timing for follow-up study was 3 weeks after operation.
Follow-Up Studies* ; H-Reflex* ; Humans ; Muscle Weakness ; Radiculopathy*

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

Surgical treatment of post-traumatic enophthalmos is one of the most challenging procedures following facial injury. The purpose of this study is to evaluate the advantage of transconjunctival approach and/or medial and lateral extension in reconstruction of orbit in patient with severe post-traumatic enophthalmos. This study includes 7 patients. All operative procedures were performed through preseptal transconjunctival approach and/or medial and lateral extension. After release of scar tissues around orbital contents, reconstruction of orbit was performed using titanium dynamic mesh and silastic sheet. In 5 patients, repositioning of the malunited zygoma was done as concomitant surgery. The aesthetic and functional results were satisfactory. The results were good in 5 patients(72%) and fair in 2 patients(28%). Postoperative improvement of enophthalmos and ocular dystopia were statistically significant by paired t-test(p-value<0.05). No patients complained of postoperative lower lid ectropion. Finally, this approach is much advantageous in patient with severe post-traumatic enophthalmos as wide exposure of lesion and no visible scar on lower lid.
Cicatrix ; Ectropion ; Enophthalmos* ; Facial Injuries ; Humans ; Orbit ; Surgical Procedures, Operative ; Titanium ; Zygoma

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.
Arthritis, Infectious ; Debridement ; Dislocations ; Hallux ; Intra-Articular Fractures ; Joints ; Metatarsophalangeal Joint ; Osteoarthritis ; Osteomyelitis ; Sepsis ; Transplants

Superficial peroneal nerve entrapment is an uncommon compression neuropathy, and is frequently associated with a fascial defect and a muscle hernia. The standard treatment of that was the nerve decompression by complete or limited fasciotomy. But, we experienced a case of superficial peroneal nerve entrapment had satisfactory surgical outcome by fascial repair of peroneus muscle.
Decompression ; Hernia ; Muscles ; Peroneal Nerve