PURPOSE: Radical cystectomy has been a standard method in the treatment for invasive bladder cancer. Recently the orthotopic substitutions have been generally performed for urinary diversion. Ghoneim introduced a new method for orthotopic substitution which has used relatively short segment of ileum, and the method is regarded to have few complications. We performed this method for our study and analyzed the results and complications. MATERIALS AND METHODS: Among total 29 patients underwent ileal W-neobladder with serous-lined extramural tunnel, 27 patients had invasive bladder cancer and the remaining two patients had contracted bladder with vesicoureteral reflux. There were 25 male patients with the mean age of 59.2 years(45-70) and 4 female patients with 61.8 years(51-68). Mean follow-up period for the entire group was 8.4 months(3?17 month). History taking, physical examination, and complete laboratory tests were performed postoperatively and IVP or CT scan was taken at 3 month and 9 month after the operation for the evaluation of recurrence and upper tract change. RESULTS: The average operating time was 8 hours 35 minutes(420-670 min). Paralytic ileus developed in two patients and wound dehisced in 4. In all 29 patients, vesicoureteral reflux was not detected. Stricture of ureteroileal anastomosis was observed in 4 left renal units. We performed percutaneous nephrostomy and antegrade double J stenting on all the patients with stricture primarily, but one patient underwent neoureteroileostomy because of the failure of the primary management. Four patients complained enuresis, but no daytime incontinence was observed. There were no clinical symptoms of complications in all 29 patients and no metabolic acidosis was observed in laboratory tests. CONCLUSIONS: Serous-lined extramural tunnel method of orthotopic substitution showed an acceptable and safe reservoir with a large capacity at low pressure and absence of reflux with relatively short segment of ileum.
Acidosis ; Constriction, Pathologic ; Cystectomy ; Enuresis ; Female ; Follow-Up Studies ; Humans ; Ileum ; Intestinal Pseudo-Obstruction ; Male ; Nephrostomy, Percutaneous ; Physical Examination ; Recurrence ; Stents ; Tomography, X-Ray Computed ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion ; Vesico-Ureteral Reflux ; Wounds and Injuries

The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growth”in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.
Academies and Institutes ; Budgets ; Chungcheongnam-do ; Delivery of Health Care ; Education ; Health Personnel ; Health Policy ; Humans ; Policy Making ; Professionalism

The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growth”in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.

Brachial plexus block is frequently used for surgery on the upper extremity. Unsuccessful brachial plexus block is usually caused either by injection outside the neurovascular sheath or by incomplete blockade inspite of injection within the neurovascular sheath. Studied by Winnie and Collines suggested that the extent of blockade following injection in the sheath surrounding the brachial plexus also should be directly proportional to the volume of local anesthetic injected. We therefore investigated the extent of blockade using different volume of bupivacaine with supraclavicular approach. The results were as follows. 1) Complete analgesia was observed between the group of 15 ml and 30 ml. 2) The interval of complaint of pain after a single injection ranged from 14.3 to 16.4 hours. Insignifi-cant difference was found between the group of 15 ml and 30 ml (p> 0.1) 3) There was no hematoma, shivering, but there was Horner's syndrome in 13, phrenic N.paralysis in 2, pneumothorax in 1 cases. No general seizure or other side effects were observed. Therefore we come to the conclusion that above the volume of 15 ml is sufficient to brachial plexus block with supraclavicular approach.
Analgesia ; Brachial Plexus ; Bupivacaine* ; Hematoma ; Horner Syndrome ; Pneumothorax ; Seizures ; Shivering ; Upper Extremity

PURPOSE: There are many medical treatments for enuresis. However, it is not known the effect of enuresis management according to when medication was started in the clinical field. Therefore, this study was conducted to determine the results of treating enuresis according to different starting points of the medication. MATERIALS AND METHODS: During March 2001 to May 2004, 331 patients among the 412 primary monosymptomatic enuresis patients were studied for over 6 months: they were treated to a combination of medical treatments and then the reduction of medication dose was taped. Patients less than 5 years old were in group A, the 6-7 years old were in group B, and the patients older than 8 years old were in group C. Successful medication was defined as 14 days of no enuresis without relapse, and failure was defined as 2 or more incidence of enuresis in 2 weeks or loss to follow up after 6 months of treatment. RESULTS: Group A included a total of 105 patients; 81(77.1%) patients experienced successful treatment. Group B included a total of 111 patients, and 86 (77.5%) patients had a successful treatment. Group C included a total of 115 patients, and 79 (68.7%) patients had successful treatment. The mean medication period was 6.5+/-5.2 months for group A, 8.5+/-6.8 months for group B and 10.3+/-9.5 months for group C: these results showed statistical significance (p<0.05). CONCLUSIONS: Despite that spontaneous cure does occur, the study results showed that the patients who were medicated earlier had a higher success rate and a shortened medication period. Considering the results of this study, early treatment for enuresis should be suggested.
Child ; Child, Preschool ; Enuresis* ; Follow-Up Studies ; Humans ; Incidence ; Recurrence

PURPOSE: We attempted to find out the useful urodynamic parameters for diagnosis of bladder outlet obstruction (BOO) in women, prospectively. MATERIALS AND METHODS: 219 patients were available for analysis, of whom 34 were obstructed by clinical definition, 137 with stress urinary incontinence (SUI) and 34 served as a control. To predict obstruction, comparisons were made; receiver operator characteristic (ROC) curve analysis was used to determine the optimum cut-off values for peak flow rate (Qmax), detrusor pressure at maximum flow (PdetQmax) and maximal urethral closing pressure (MUCP). RESULTS: On the basis of ROC curves between control and BOO groups, using single cut-off value at pressure-flow study, sensitivities and specificities of BOO were 97.1% and 77.9% (Qmax<12ml/s), 85.3% and 86.8% (PdetQmax>30cmH2O), 79.4% and 88.2% (MUCP>80cmH2O). By combined cut-off values, sensitivities and specificities of BOO were 85.3% and 92.6% (Qmax<12ml/s and PdetQmax>30cmH2O), and 73.5% and 94.1% (Qmax<12ml/s, PdetQmax>30cmH2O, and MUCP>80cmH2O). CONCLUSIONS: Our results show that BOO might be diagnosed by the criteria of Qmax<12ml/s, PdetQmax>30cmH2O, and MUCP>80cmH2O.
Diagnosis ; Female* ; Humans ; Prospective Studies* ; ROC Curve ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Incontinence ; Urodynamics

PURPOSE: Numerous operative techniques have been developed to correct proximal hypospadias. Transverse preputial island flap urethroplasty have provided reliable results for the repair of proximal hypospadias, and the versatility of the preputial flap led to its adaptation as an onlay flap that could be sewn onto an intact or preserved urethral plate. Recently, tubularized incised plate urethroplasty(Snodgrass procedure) have been reported with good results. We retrospectively analyzed our experiences with these three techniques to know which procedure is recommendable for repair of proximal hypospadias. MATERIALS AND METHODS: Between January, 1994 and June, 1998, 44 patients underwent repair for the proximal hypospadias by a single surgeon using an transverse preputial island flap(21), onlay flap(16) and tubularized incised plate(7) procedure. We analysed the surgical outcome such as surgical complications according to each procedures. RESULTS: Postoperative complication rate was 57% for transverse preputial island flap, 13% for onlay flap and 14% for tubularized incised plate procedure. The rate of fistula formation were 42%, 13% and 14%, respectively. One diverticulum and two strictures were developed in three patients who underwent transverse preputial island flap procedure, whereas no diverticulum or stricture was developed after onlay or tubularized incised plate procedure. Cosmetic results were excellent in tubularized incised plate urethroplasty. CONCLUSIONS: Onlay or tubularized incised plate urethroplasty using an preserved urethral plate had better outcomes compared to the transverse preputial island flap procedure. The technique using urethral plate could be recommendable as first choice for proximal hypospadias although transverse preputial island flap procedure is worthy to be considered for more complicated cases.
Constriction, Pathologic ; Diverticulum ; Female ; Fistula ; Humans ; Hypospadias* ; Inlays* ; Male ; Postoperative Complications ; Retrospective Studies

Larger animal models, such as porcine, have been validated as appropriate models of the human disc with respect to biomechanics and biochemistry. They are advantageous for research as the models are relatively straightforward to prepare and easily obtainable for research to perform surgical techniques. The intention of this study was to quantitatively analyze gene expression for collagen and proteoglycan components of the extracellular matrix and for collagenase (MMP-1) in porcine discs of varying ages (Newborn; 2-3weeks, Mature; 6-9 month, Older; 2-3 years). In this study, we observed that the cell number and GAG (glycosaminoglycan) formation dramatically decreased with aging. Also, gene expression in the annulus fibrosus (AF) and nucleus pulposus (NP) cells changed with aging. The level of MMP-1 mRNA increased with age and both type I, II collagens decreased with age. The level of aggrecan mRNA was highest in the mature group and decreased significantly with aging. In the mature group, MMP-1 expression was minimal compared to the newborn group. In AF cells, type II collagen was expressed at a high level in the mature group with a higher level of aggrecan, when aged NP showed a decrease in type II collagen. The model of IVD degeneration in the porcine disc shows many changes in gene expression with age that have been previously documented for human and may serve as a model for studying changes in IVD metabolism with age. We concluded that the porcine model is excellent to test hypotheses related to disc degeneration while permitting time-course study in biologically active systems.
Age Factors ; Aggrecans/genetics/metabolism ; Aging/genetics/*metabolism ; Animals ; Animals, Newborn ; Collagen Type I/genetics/metabolism ; Collagen Type II/genetics/metabolism ; Glycosaminoglycans/genetics/metabolism ; Humans ; Intervertebral Disk Degeneration/genetics/*metabolism ; Matrix Metalloproteinase 1/genetics/*metabolism ; *Models, Animal ; Reverse Transcriptase Polymerase Chain Reaction ; Spinal Cord/*metabolism/pathology ; Swine

Resveratrol (trans-3,4'-trihydroxystillbene), a naturally occurring polyphenolic antioxidant found in grapes and red wine, elicits diverse biochemical responses and demonstrates anti-aging, anti-inflammatory, and anti-proliferative effects in several cell types. Previously, resveratrol was shown to regulate differentiation and inflammation in rabbit articular chondrocytes, while the direct production of nitric oxide (NO) in these cells by treatment with the NO donor sodium nitroprusside (SNP) led to apoptosis. In this study, the effect of resveratrol on NO-induced apoptosis in rabbit articular chondrocytes was investigated. Resveratrol dramatically reduced NO-induced apoptosis in chondrocytes, as determined by phase-contrast microscopy, the MTT assay, FACS analysis, and DAPI staining. Treatment with resveratrol inhibited the SNP-induced expression of p53 and p21 and reduced the expression of procaspase-3 in chondrocytes, as detected by western blot analysis. SNP-induced degradation of I-kappa B alpha (IkappaB-alpha) was rescued by resveratrol treatment, and the SN50 peptide-mediated inhibition of NF-kappa B (NF-kappaB) activity potently blocked SNP-induced caspase-3 activation and apoptosis. Our results suggest that resveratrol inhibits NO-induced apoptosis through the NF-kappaB pathway in articular chondrocytes.
Apoptosis* ; Blotting, Western ; Caspase 3 ; Chondrocytes* ; Humans ; I-kappa B Proteins ; Inflammation ; Microscopy, Phase-Contrast ; NF-kappa B* ; Nitric Oxide ; Nitroprusside ; Tissue Donors ; Vitis ; Wine

PURPOSE: The interest has been growing in the investigation and management of lower urinary tract symptoms, but their prevalence in the general population has so far been based on the estimates made in selected groups of women in Korea. The object of this study was to determine the prevalence of stress urinary incontinence and bladder irritative symptoms of women in rural region in Korea through a community based survey. Also, we investigated the relationship between age, parity, oral contraception, smoking, menopause and obesity and the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A questionnaire survey was performed in a sample of randomly selected 1162 women aged 30 years and over, in 31 villages in the town of Jeong-Eup, Korea. From February 4th to February 22nd, 1997, trained field workers visited every home and interviewed every eligible individual with the questionnaires, which included data on stress urinary incontinence, bladder irritative symptoms, quality of life, reproductive and menstrual history, and use of oral contraceptives. Among 1162 women, 857 responded to questionnaires, and 827 questionnaires were available for analysis. The response rate was 73.5%. The prevalence of stress urinary incontinence was defined as the proportion of the women in the population surveyed who experienced stress urinary incontinence at least twice a week. We defined diurnal frequency as the episodes of voiding again within 2 hours after initial voiding in the series of 5 consecutive voidings during one month period. The urgency was defined as she found it difficult to hold urination, once or more in the series of 5 consecutive voidings and nocturia twice or more per night. RESULTS: The prevalence of stress urinary incontinence was 20.4%. Only seven(4.1%) women carried a sanitary towel or diaper as protection against urinary leakage. The prevalence of stress incontinence among age groups revealed no significant difference. Statistically significant correlation was noted between obesity and the prevalence of stress incontinence. Diurnal frequency was recorded by 375 women(45.3%); 171(20.6%) experienced this symptom more than three times. Urgency was reported by 268 women(32.4%) and 63(7.6%) were always troubled by this symptom. Nocturia 3 times or more every night was recorded by 341 women(42.2%) and 83(10.0%) had nocturia 5 times or more. The severity of nocturia increased significantly with age. CONCLUSIONS: The prevalence of stress urinary incontinence and irritative symptoms in this study is similar to previous studies performed in other countries while the rate of nocturia is much higher in this study. Although stress urinary incontinence and bladder irritative symptoms are relatively common in this community, only few people are seeking for care of these symptoms. Therefore, it is very important to educate the public and promote awareness of this medical problem in this community.
Contraception ; Contraceptives, Oral ; Female ; Health Personnel ; Humans ; Jeollabuk-do ; Korea ; Lower Urinary Tract Symptoms ; Menopause ; Nocturia ; Obesity ; Parity ; Prevalence* ; Quality of Life ; Surveys and Questionnaires ; Smoke ; Smoking ; Urinary Bladder* ; Urinary Incontinence* ; Urination