No abstract available.
Vasovasostomy*

Varicocele is found in 8-20% of male population and comprises the most common etiology of male infertility. Abnormalities in sperm concentration, motility, and morphology are observed on 65 to 75% of varicocele patients. Improvements of such parameters are seen in 50 - 80% after surgical correction of varicocele, and fertility is achieved in 30 -40% of cases. We evaluated the results of surgical correction of varicocele in both infertile and non-infertile patients. The effects of varicocele and subsequent correction on semen parameters and pregnancy were also reviewed. From September 1987 to December 1995, 254 patients with varicocele were surgically corrected. Semen analysis were performed in 229 patients, revealing abnormalities in 153 (66.8%) patients. Degree of abnormalities was correlated with the grade of varicocele and presence of infertility (79.8%). Improvement of postoperative semen was observed in 112 (73.2%) of 153 patients with abnormal preoperative semen profiles. Improvement was not correlated with grade of varicocele or age, but significantly correlated with fertility status. Postoperative sperm concentration, morphology, and motility were significantly improved in grade II and III varicocele. Sperm motility was improved when correction were performed under 30 years of age. Pregnancy was confirmed in 27 of 88 (30.7%) of infertile patients, and fertility rate was correlated with preoperative sperm concentration and motility, but not correlated with varicocele grade and sperm morphology. Higher pregnancy rate was observed if sperm concentration >=40 X 106/ml, normal morphology >= 60%, and motility >=60% on the postoperative semen. In conclusion, varicocele patients with infertility are affected by grade, age, and surgical correction. Thus early diagnosis and treatment should be offered to all patients with varicocele with infertility.
Birth Rate ; Early Diagnosis ; Fertility ; Humans ; Infertility ; Infertility, Male ; Male ; Pregnancy ; Pregnancy Rate ; Semen Analysis ; Semen* ; Sperm Motility ; Spermatozoa ; Varicocele*

SS-cream is a topical agent for treating the premature ejaculation (PE) which was made up with extracts of 9 oriental herbs (Ginseng Radix alba, Angelicae gigantic Radix, Cistanchis Herba, Zanthoxylli Fructus, Torilidis Semen, Asiasari Radix, Caryophylli Flos, Cinnamoni Cortex and Bufonis Veneum). According to the active compositions, the main mechanism of SS- cream on PE was thought to be the local desensitizing effect. In order to realize the pharmacological action of SS-cream on PE, we performed the corneal sensitivity test with SS- cream and lidocaine in the rabbit (n=80). Both SS-cream and lidocaine inhibited the pin-prick induced corneal reflex dose-dependently (p<0.001). The anesthetic effect of lidocaine was appeared 5 minutes after the application and the duration of action persisted for 10 minutes. The intensities of desensitizing effect of SS- cream were almost same with those of 2% lidocaine, but the time of onset and duration of action was longer than 2% lidocaine. The time of onset was 10 minutes and the duration of action was persisted for more than 30 minutes. There were no local histopathologic changes after the application of SS-cream and lidocaine. With these result, we can conclude that SS-cream has a desensitizing effect on the cornea of rabbit. The believed main pharmacologic mechanism of SS-cream on PE is the desensitization of the Local Surface sensitivity.
Anesthetics ; Angelica ; Cornea* ; Lidocaine ; Premature Ejaculation ; Reflex ; Semen

Traumatic pyriform sinus perforation is a very rare complication of endotracheal intubation. Forced insertion of endotracheal tube can tear pyriform sinus mucosa. Pyriform sinus perforation can result in deep neck infection which may be potentially lethal. We report a case of pyriform sinus perforation secondary to traumatic intubation, which was successfully treated with primary closure.
Intubation ; Intubation, Intratracheal ; Mucous Membrane ; Neck ; Pyriform Sinus

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the clinical efficacy of sentinel node centered selective neck dissection in patients with early stage tongue cancer (T1T2N0). SUBJECTS AND METHOD: Lymphoscintigraphy was performed for 12 patients, subsequently followed by sentinel node centered selective neck dissection. The location of the sentinel node, pathological confirmation of node metastasis, and follow-up recurrence were analyzed. RESULTS: In total, 19 sentinel lymph nodes were identified. Of these, 18 were located in levels I to III, and one in level IV. After surgery, 3 patients (25%) were diagnosed with neck node metastasis: two experienced sentinel node metastasis and one experienced skipped metastasis. During follow-up, 3 of the 12 patients (25%) experienced recurrence. CONCLUSION: The recurrence of lymph node could be covered with supraomohyoid neck dissection, which indicates that it has superiority over sentinel node centered selective neck dissection in preventing recurrence in T1T2N0 tongue cancer patients.
Follow-Up Studies ; Humans ; Lymph Nodes* ; Lymphoscintigraphy ; Methods ; Neck Dissection* ; Neck* ; Neoplasm Metastasis ; Recurrence ; Tongue Neoplasms* ; Tongue* ; Treatment Outcome

Congenital sialo-cutaneous fistula arising from the accessory parotid gland is extremely rare. Although the fistula tract can be successfully excised after making a skin incision along the skin tension line around the fistula opening, a facial scar inevitably remains. We here report a case of sialo-cutaneous fistula that was treated with chemocauterization with trichloroacetic acid (TCA). TCA cauterization is an easy and effective option for the treatment of congenital fistula from an accessory parotid gland, especially from the aesthetic point of view.
Cicatrix ; Fistula ; Parotid Gland ; Skin ; Trichloroacetic Acid

Mandibular metastasis of thyroid carcinoma is extremely rare. We present the case of a 46-year-old woman who had bilateral huge cheek masses that had grown rapidly over several years. Intra-oral mucosal tissue biopsy and imaging work-up including computed tomography scan and magnetic resonance imaging were performed and the initial diagnosis was presumed to be central giant cell granuloma. Incidentally detected thyroid lesions were studied with ultra-sonography guided fine needle aspiration and diagnosed as simple benign nodules. Due to continuous oral bleeding and the locally destructive feature of the lesions, we decided to excise the mass surgically. To avoid functional deficit, a stepwise approach was performed: Firstly, the larger left mass was excised and the mandible was reconstructed with a fibular free flap. The final pathologic diagnosis was follicular thyroid cancer. Postoperative I-131 thyroid scan and whole body positron-emissions-tomography were performed. Right side mass was revealed as a thyroid malignancy. Multiple bony metastases were detected. Since further radioactive iodine therapy was required, additional total thyroidectomy and right side mandibulectomy with fibular free flap reconstruction was performed. The patient also underwent high dose radioactive iodine therapy and palliative extra-beam radiotherapy for the metastatic lumbar lesion. Follicular thyroid carcinoma should be considered as a differential diagnosis for mandibular mass lesions.
Adenocarcinoma, Follicular ; Biopsy ; Biopsy, Fine-Needle ; Cheek ; Diagnosis, Differential ; Female ; Free Tissue Flaps ; Granuloma, Giant Cell ; Hemorrhage ; Humans ; Iodine ; Magnetic Resonance Imaging ; Mandible ; Mucous Membrane ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

THE AIM OF STUDY: The transseptal-transsphenoidal approach (TSA) for pituitary tumors may alter nasal functions, including nasal respiration and olfaction. The aim of this study was to investigate the efficacy of TSA in terms of nasal functions. MATERIALS AND METHODS: Twenty two cases of pituitary tumors, managed at Seoul National University Hospital from May 1997 through March 1998, were included in this prospective study. Nasal functions were evaluated preoperatively and 2 months after the operation through symptom questionnaires, rhinomanometry, acoustic rhinometry and the butanol thres-hold test. RESULTS: The subjective nasal symptoms, including nasal obstruction and olfaction, were not changed following the operation in 72% and 86% of the cases, respectively. In the objective findings, total nasal resistance was not grossly changed after the operation, however, cross-sectional areas at C-notch and 3.3 cm from the anterior nasal spine increased significantly after the operation. Mucosal response to a topical vasoconstrictor after the operation was less effective than before the preoperation. CONCLUSION: TSA for pituitary tumors may be a safe and effective technique in preserving nasal functions subjectively and objectively.
Nasal Obstruction ; Pituitary Neoplasms ; Prospective Studies ; Respiration ; Rhinomanometry ; Rhinometry, Acoustic ; Seoul ; Smell ; Spine ; Surveys and Questionnaires

Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.
Choristoma ; Electrocoagulation ; Female ; Foreign Bodies ; Gastric Mucosa ; Humans ; Oropharynx ; Pharynx ; Sensation

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well. SUBJECTS AND METHOD: Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes. RESULTS: The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%. CONCLUSION: Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.
Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Head ; Humans ; Medical Records ; Neck ; Neoplasm Metastasis ; Physical Examination ; Positron-Emission Tomography ; Prognosis* ; Retrospective Studies