According to the ophthalmic literature, the lack of epicanthus and termi-nal hairs at the medial side of punctum are unique features in most non-Asian eyelids.We wanted to examine the presence of terminal hairs at the medial side of punctum in Asian.A study was designed to examine 416 eyes of 208 patients who had visited our hospital between March 1999 and Sep-tember 1999.Physical examination included the presence of epicanthus, terminal hairs at the medial side of punctum, upper eyelid crease and pruritus in medial canthal area.The mean age of the patients was 56.5 years.Epi-canthus was seen in 256 eyes of 416 eyes (61.5%).The upper lid creases were detected in 242 eyes of 416 eyes (58.2%)and classified mostly as the medial tapering and lateral flaring type (83.5%).There were 250 eyes of 416 eyes (60.1%)who had terminal hairs at the medial side of punctum.Sixty eyes of 416 eyes (14.4%)complained of itching sensation in medial canthal area and had experienced once or two times per week (70.0%).They com-posed of 44 eyes of 60 eyes (73.3%)with epicanthus and terminal hairs, 10eyes of 60 eyes (16.7%)with only terminal hairs, and 6 eyes of 60eyes (10.0%)with only epicanthus.In our study, we found many patients had terminal hairs at the medial side of punctum in Asian and the presence of epicanthus and terminal hairs caused itching sensation at medial canthal area.
Asian Continental Ancestry Group ; Eyelids ; Hair ; Humans ; Pruritus* ; Sensation

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

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: 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

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

OBJECTIVE: To investigate the risk factors for fall in the elderly population residing in rural areas of Korea and provide useful data for their prevention. METHODS: As part of farmers’ health promotion project, a retrospective study was conducted with a total of 350 elderly people recruited from March 2016 to December 2016. These subjects were divided into two groups: 254 non-fallers and 96 fallers. A person who fell to the floor at least once in the past year was defined as a faller. Participants were asked to visit the hospital once. The demographic characteristics, social environment, and educational levels were surveyed using a questionnaire. Physical examination was performed in the following order: cognitive function, lower leg strength and torque, body composition, and knee image test. RESULTS: Statistically significant factors for falls in univariate analysis were female gender, age, living alone, educational level less than middle school, skeletal muscle mass, Mini-Mental State Exam, knee osteoarthritis, hip torque, hip power mean, knee torque, and knee power mean. Multivariate analysis was performed to identify variables most relevant to falls among statistically significant factors in univariate logistic analysis. It was confirmed that female gender and age of 70–79 years were statistically significant factors related to falls. CONCLUSION: Female gender and elderly status (70–79 years) are important risk factors for falls in rural areas underscoring the need for special attention when considering risk factors for falls among the elderly living in rural areas.
Accidental Falls ; Aged ; Body Composition ; Cognition ; Female ; Health Promotion ; Hip ; Humans ; Knee ; Korea ; Leg ; Multivariate Analysis ; Muscle, Skeletal ; Osteoarthritis, Knee ; Physical Examination ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sociological Factors ; Torque

Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

Purpose: Trastuzumab has markedly improved the survival outcomes of patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer, and dual blockade of HER2 using trastuzumab and pertuzumab in combination with taxanes (THP) has become a standard of care for HER2-positive metastatic breast cancer (MBC) worldwide since the CLEOPATRA trial. We assessed the outcomes of THP as a first-line treatment for Korean HER2-positive MBC patients in the real-world setting. Materials and Methods: Between August 2008 and October 2020, we identified 228 HER2-positive MBC patients who received THP as a first-line palliative chemotherapy. We analyzed survival outcomes, efficacy, and adverse events of THP retrospectively. Results: After a median follow-up duration of 28.7 months, median overall survival and progression-free survival were 58.3 months (95% confidence interval [CI], 36.6 to 80.0) and 19.1 months (95% CI, 16.2 to 21.9), respectively. Better survival outcomes were observed in patient who received docetaxel for more than six cycles. Patients exposed to anti-HER2 directed therapies in a perioperative setting had poor survival outcomes. The overall response rate was 86.8% with a complete response (CR) rate of 17.7%. Among responders, 16.7% of patients sustained THP over 35 months and showed better survivals and higher CR rates. Adverse events were comparable to those reported in previous studies. Conclusion In a real-world context, clinical outcomes of Korean HER2-positive MBC patients treated with THP were similar to those of patients in the CLEOPATRA trial. Much longer follow-up results would be warranted.

Purpose: Hand-foot syndrome (HFS) and hand-foot skin reaction (HFSR) are relatively common toxicities that interfere with the quality of life (QoL) of patients with cancer. Anti-inflammatory tripeptide cream (ATPC) is a complex formulation of anti-inflammatory tripeptides, the CD99-agonist Binterin and the Wnt-antagonist Winhibin. The present study aimed to assess the therapeutic effects of ATPC in HFS/HFSR associated with anticancer drugs. Materials and Methods: This was a single-center, randomized, double-blind, placebo-controlled trial. Patients who developed grade 1 HFS/HFSR after systemic anticancer treatments were enrolled, and randomly assigned to receive either ATPC or placebo cream (PC) and followed up at 3-week intervals for up to 9 weeks. Primary endpoint was the development of grade ≥ 2 HFS/HFSR. Results: Between April 2019 and July 2022, 60 patients (31 in the ATPC and 29 in the PC group) completed the study. The incidence of grade ≥ 2 HFS/HFSR was significantly lower in the ATPC than in the PC group (25.8% vs. 51.7%, p=0.039). The ATPC showed trends towards a better QoL score, assessed by a HFSR and QoL questionnaire at 9 weeks (26.0 vs. 29.9, p=0.574), and a lower frequency of discontinuation, interruption, or dose reduction of anticancer drugs (51.6% vs. 58.6%, p=0.586) than the PC group over 9 weeks, though without statistical significance. Conclusion Our results showed that ATPC significantly decreased the development of grade ≥ 2 HFS/HFSR in patients already with HFS/HFSR. Therefore, ATPC may be an effective treatment for HFS/HFSR associated with anticancer drugs.