The majority of hypospadias repairs can now be accomplished in one stage, providing a better result with reduced morbidity. To evaluate the efficacy of one stage repairs of hypospadias, a total of 83 patients treated with various urethroplasty technique was stratified according to 2 different stage repairs of hypospadias and compared to clinical outcome during the period of the last 15 years. The study included the age of the patients, anatomical variants of the hypospadias, accompanying congenital anomaly, the technique used, postoperative complication and management, success rate according to the technique used and the methods of urinary diversion. The method of repair was based on individual patient pathology. Transverse preputial island flap was the most common operation performed (n=24) followed by parameatal-based flap (n=15), meatal advancement and granuloplasty repair (MAGPI) in one stage repairs. Thiersch-Duplay (n=8), Belt-Fuqua (n=3), Byars (n=3), Modified Denis-Brown (n=7) techniques were performed in two stage repairs. Of the 83 cases of hypospadias, one stage repairs were done in 62 cases and two stage repairs in 21 cases and their successful outcome, defined as a controllable urinary stream, an acceptable cosmetic appearance and functional erection, was achieved in 60% and 51% respectively. The postoperative complication were fistula in 25 cases (18 in one stage repairs/7 in two stage repairs), stricture in 6 (4/2), wound dehiscence in 2 (1/1), diverticulum in 1 (1/0), persistent chordee in 1 (1/0). There were no significant difference between one and two stage repairs in success rate (60%/ 51%), so we thought that one stage hypospadias repairs could be applicable in most cases of hypospadias and gave satisfactory cosmetic and functional results with a low incidence of serious complications and low costs.
Constriction, Pathologic ; Diverticulum ; Female ; Fistula ; Humans ; Hypospadias* ; Incidence ; Male ; Pathology ; Postoperative Complications ; Rivers ; Urinary Diversion ; Wounds and Injuries

Microform cleft lip is a mild form of incomplete cleft lip, also known as a minimal occult, abortive, forme fruste cleft lip. However, it has no definition and few methods have been reported for its correction. A microform cleft lip is characterized as the incomplete union of the superficial portion of the orbicularis oris muscle. It is more prominent during facial expression than in a resting state. We confined microform cleft lip in our study to the absence of philtral skin change and a contracted position on the top of cupid's bow. During the past 5 years, 17 patients of microform cleft lip were operated on. We corrected the defect of the upper vermilion border and nostril sill with minimal incision, and repaired the underlying lip musculature in superficial discontinuity. Reduction of the widened alar base was performed. Deformed alar cartilage was dissected via rim incision, and suspended in a medial and upper direction with pull-out sutures. The most important thing is precise repair of the superficial portion of the separated orbicularis oris muscle via minimal incision, and it is best to operate after 1-year of age for accurate repair. The results were satisfactory and the parents were also satisfied. The advantages of this procedure are as follows: 1. Less visible, minimal scar on upper lip 2. Simultaneous correction of vermillion notching, deformed cupid's bow and nasal deformity. 3. Eversion of philtral ridge due to tenting effect of horizontal mattress suture 4. Philtral elongation effect by reduction of alar base and Z-plasty of cupid's bow.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Facial Expression ; Humans ; Lip ; Microfilming* ; Parents ; Skin ; Sutures

BACKGROUND: Recently, according to many studies, variable factors have been known to be associated with physical fitness. The factors such as obesity and inactivity are associated with poor physical fitness, but regular exercise is associated with good physical fitness. In our country, these studies are not yet reported. And so, this study was designed to investigate the factors associat,ed with physical fitness. METHODS: From May 1st, until July 30th 1996, we recruited the 411 subjects who visited the Health Promotion Center at Seoul National University Hospital. Data related to sex, age, exercise, job, cigarette smoking, alcohol consumption were obtained by self-administered Questionnaire. Obesity index was calculated by the percentage of standard body weight. And VO2max were obtained by submaximal bicycle ergometer test. High level exercise group was defined as the persons who had taken exercise more than 3 times a week and 20 minutes per session, and moderate exercise group was defined as the persons who had taken exercise one or two times a week and 20 minutes per session, and sedentary group was defined as the persons who had taken exercise more than 20 minutes less than one time per week. RESULTS: The subjects were 230 males(56%), total numbers were 411. The results were as follows. Compaired to women and nonexercise group, men and exercise group had high VO2max(p<0.005). The relationship between VO2max and age showed negative, and the VO2max of obese group(obesity index>_120) was greater than that of nonobese group. Any significant relationships between VO2max and job, disease were not found. In multiple regression analysis, significant relationships between VO2max and age, sex, exercise type, and obesity index were observed(p<0.01). CONCLUSIONS: We concluded that there were significant relationships between VO2max and obesity index, exercise group.
Alcohol Drinking ; Body Weight ; Female ; Health Promotion ; Humans ; Male ; Obesity ; Physical Fitness* ; Seoul ; Smoking ; Surveys and Questionnaires

No abstract available.
Fetal Death*

PURPOSE: Nitric oxide (NO) has recently been identified as the main neurotransmitter involved in the nonadrenergic-noncholinergic (NANC) pathway and is responsible for penile erection. Nitric oxide synthase (NOS)-containing nerve regeneration can be seen 6 months after unilateral cavernosal nerve neurotomy in rats. However its molecular mechanism is still unknown. It is believe that growth factors are involved in this phenomenon. In this study I investigated the change of NOS containing nerve fibers and the RNA expression of insulin like growth factor (IGF)-I, nerve growth factor (NGF), transforming growth factor (TGF)-alpha, TGF-beta 1, TGF-beta 2, TGF-beta 3, vascular endothelial growth factor(VEGF), nNOS and eNOS on the penis after cavernosal neurotomy in rats. MATERIALS AND METHODS: Male rats were divided into three groups: sham operation (n=12); unilateral neurotomy of a 5-mm segment of the cavernosal nerve (n=18); and bilateral neurotomy (n=18). Electrostimulation of the cavernosal nerve of pelvic ganglion was performed at 1,3 and 6 months. Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was used to identify NOS in the penile nerve fibers. The gene expressions for growth factors, nNOS and eNOS were investigated in corporal tissue by reverse transcriptase-polymerase chain reaction (RT-PCR) using specific oligonucleotide primers. RESULTS: One month after neurotomy, both unilateral and bilateral neurotomy groups showed significant decreases in NOS-containing nerve fibers on the dorsal and intracavernosal nerves on the side of neurotomy and significantly lower mRNA expressions of nNOs, IGF-I and TGF-beta 2, and the unilateral neurotomy group showed higher mRNA expression of eNOS and VEGF189. At 3 months, the number of NOS-containing nerve fibers in the unilateral neurotomy group increased only slightly but at 6 months, those in the intracavernosal nerve increased in a significant amount (p<0.0001),however mRNA expressions of nNOs, IGF-I and TGF-beta . , showed significant increases as early as at 3 months, After bilateral neurotomy, the NOS-positive nerve fibers in the dorsal and intracavernosal nerve were significantly decreased at 1 month and remained so at 6 months; no erectile response could be elicited by pelvic ganglion stimulation. In the unilateral neurotomy group at 6 months, more NOS-positive neurons in the pelvic ganglia were found on the intact side than on the side of the neurotomy (p<0.005), indicating that the regeneration derived from pelvic ganglion neurons on the intact side. Furthermore, electrostimulation in the unilateral neurotomy group revealed a greater maximal intracavernosal pressure and a shorter latency period at 6 months than at 1 month (p<0.001, p<0.001, respectively). CONCLUSION: These data suggest that IGF-I and TGF-beta 2, may play a key role in regeneration of NOS-containing nerve fibers in the dorsal and intracavernosal nerves, and eNOS increases temporarily in the intracavernosum involving VEGF189 after unilateral cavernosal nerve injury.
Animals ; DNA Primers ; Ganglia ; Ganglion Cysts ; Gene Expression ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Intercellular Signaling Peptides and Proteins* ; Latency Period (Psychology) ; Male ; NADP ; Nerve Fibers ; Nerve Growth Factor ; Nerve Regeneration ; Neurons ; Neurotransmitter Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Penile Erection ; Penis ; Rats* ; Regeneration* ; RNA ; RNA, Messenger ; Transforming Growth Factor beta ; Transforming Growth Factors

PURPOSE: To evaluate the effects of Ginseng alkaloid on the tension regulation of corpus cavernosum, changes of tension of rabbit corpus cavernosum in vitro were studied after administration of Adaptagen(R) that is extract of Ginseng alkaloid. And changes of tension of rat aorta in vitro and rat blood pressure and heart rate in vivo were studied after administration of the same agent to evaluate systemic cardiovascular side effects. MATERIALS AND METHODS: Rabbit corpus cavernosal strips and rat aorta rings were prepared. Strips and rings were mounted in an organ bath and isometric tensions were recorded after administration of agents contracting or relaxing vascular smooth muscle and Adaptagen(R). RESULTS: Adaptagen(R) relaxed rabbit corpus cavernosal strip and rat aorta ring contracted by phenylephrine in a dose-dependent manner. Pretreatment of L-nitroarginine inhibited the relaxing effect of Adaptagen(R) on phenylephrine-induced contraction of these tissues. In vivo, intraperitonealy administered Adaptagen(R) transiently decreased systemic blood pressure and heart rate of rat. CONCLUSIONS: According to above RESULTS, Ginseng alkaloid relaxes corpus cavernosum in a dose-dependent manner without significant systemic side effects. Therefore, it is suggested that Ginseng alkaloid could enhance erectile function but further studies are required for clinical application.
Animals ; Aorta ; Baths ; Blood Pressure ; Heart Rate ; Muscle, Smooth, Vascular ; Panax* ; Phenylephrine ; Rats

PURPOSE: To evaluate the effectiveness of superselective arterial embolization in symptomatic renal angiomyolipoma by assessing tumoral changes and clinical symptoms in long term follow up after embolization. MATERIALS AND METHODS: For the treatment of their condition, nine patients with symptomatic renal angiomyolipoma underwent ten superselective arterial embolization procedures. In all patients, angiomyolipoma had been diagnosed by computed tomography (CT), and in two, had been confirmed by ultrasonography-guided aspiration biopsy. The embolic materials used were absolute alcohol in four sessions, absolute alcohol mixed with lipiodol in three, and Giantruco coils in three. In all patients, follow-up after embolization lasted for between 12 and 54 months, and involved the use of CT. We reviewed retrospectively patients' clinical symptoms, and changes in the size and internal components of tumors, as seen on preembolization and postembolization CT scans. RESULTS: On postembolization angiography, devascularization of the tumor was seen in all patients; the initial symptoms disappeared and tumor size decreased during the follow up period. In nine patients, tumor size decreased after embolization by between 26 and 92%. During the long term (over 12 months) follow up of all patients, seven tumors with a considerable angiomyogenic component markedly decreased in size, but tumors in which the mature fatty component was substantial became only slightly smaller. Reembolization was performed in one patient. CONCLUSION: Superselective arterial embolization is effective in the management of symptomatic renal AML; during long-term follow-up, tumors became smaller and clinical symptoms improved. Embolization is more effective in tumors in which the angiomyogenic components is large.
Angiography ; Angiomyolipoma* ; Biopsy, Needle ; Ethanol ; Ethiodized Oil ; Follow-Up Studies* ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: The aim of the study was to determine the prognostic factors influencing the survival rate in patients with renal cell carcinomas treated by radical nephrectomy. MATERIALS AND METHODS: 90 patients, with a renal cell carcinoma, who underwent a radical nephrectomy between January 1992 and December 2001, were retrospectively reviewed. The survival rate according to the prognostic factors, such as the 1997 TNM stage, tumor size, cell type and nuclear grade of the tumor, age and gender, tumor location and erythrocyte sedimentation rate (ESR), were analyzed using the Kaplan-Meier method. A univariate analysis, using log rank tests, was performed to evaluate the prognostic factors. A multivariate analysis was performed to determine which factors had an independent impact on the survival of patients with a renal cell carcinoma. RESULTS: The overall 1- and 5-year cancer survival rates were 93.6 and 74.7%, respectively. The 1- and 5-year cancer survival rates by stage were 100 and 93.8% in stage I, 100 and 80.0% in stage II, 87.4 and 57.4% in stage III and 66.7 and 27.8% in stage IV (p<0.0001). The univariate analysis showed significant differences in the TNM stage and nuclear grade and the tumor size and the ESR. The multivariate analysis revealed that the TNM stage and nuclear grade of the tumor were the best prognostic indicators for a renal cell carcinoma. CONCLUSIONS: The TNM stage, nuclear grade, size of tumor and enhanced ESR are important prognostic factors in renal cell carcinomas. The TNM stage and nuclear grade of the tumor are independent prognostic factors.
Blood Sedimentation ; Carcinoma, Renal Cell* ; Cell Size ; Humans ; Multivariate Analysis ; Nephrectomy* ; Prognosis* ; Retrospective Studies ; Survival Rate

BACKGROUND: Pharmacological ACTH test provide information only about the ability of the adrenal gland to respond to unusual stimuli and may not reflect the daily cortisol secretion. There were some controversies in the diagnosis of mild adrenal insufficiency by using a pharmacological dose of ACTH. The purpose of the present study was to assess and compare the effect of low dose 1 pg ACTH and high dose 249 pg ACTH in the evaluation of adrenal function. The intravenous injection of a pharmacological dose(250 pg) of ACTH has been used as a standard test in the initial assessment of adrenal function. So we low dose ACTH to evaluate the adrenal function and compare the result of high dose ACTH. METHOD: Basal serum cortisol sampling was done at 2:00 p.m.. And after 1 pg ACTH iv bolus injection, cortisol sampling was done at 20, 30, 45 and 60 min respectively. On the next day same procedure was repeated at same time, but 249 mg ACTH was given instead of the low dose. Normal adrenal function was diagnosed with the criteria of stimulated serum cortisol concentration over 20 mg/dL. Total 65 patients took part in this study. Three hypopituitarism patients and one Addisons disease were included. Sixty-one patients had the history of glucocorticoid ingestion or had physical findings of cushingoid features with symptoms suggest the adrenal insufficiency. RESULTS: Sixteen patients showed normal response to both low dose and high dose ACTH. Thirty-six patients were not stimulated to both low dose and high dose ACTH. The remaining thirteen patients revealed normal response to high dose ACTH, but not to low dose ACTH. CONCLUSION: It appears that low dose ACTH stimulation test is more sensitive and specific than high dose ACTH and is capable of revealing mild adrenal insufficiency.
Addison Disease ; Adrenal Glands ; Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Diagnosis ; Eating ; Humans ; Hydrocortisone ; Hypopituitarism ; Injections, Intravenous

There remains controversy regarding the appropriate surgical treatment for coarctation of the aorta because of relatively high rate of recoartation and high mortality in the cases associated with complex anomalies. We evaluated 31 consecutive patients who underwent surgical repair of coarctation of the aorta from May 1992 through June 1996. Nineteen patients(61.3%) were neonates and 26(83.9%) were under three months. Nine patients did not have major associated anomalies(Group I), 15 patients had ventricular septal defect(Group II), and 7 patients had major complex anomalies(Group III). 35.5% of the patients had arch hypoplasia. Surgical procedures performed were as follows: extended end-to-end anastomosis in 17 patients, combined resection-flap procedure in 7 patients, and subclavian flap aortoplasty in 7 patients. Residual coarctation occurred in 7(25%) of 28 patients; 2 after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%)), and 5 after extended end-to-end anastomosis(5/15, 33.3%). Higher incidence of residual coarctation was noticed in the group with arch hypoplasia. The incidence of postoperative coarctation at a mean follow-up of 20.5 months in survivals was 12.0%(3/25); 2 cases after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%), and one after end-to-end anastomosis(1/12, 8.3%). The mortality rate related to coarctation repair was 9.7%(3 patients, all in Group III). This study revealed that isolated coarctation of aorta and coarctation with ventricular septal defect(groups I and II) can be repaired with low mortality, but repair of coarctation with complex anomaly had a high operative mortality. Also the patients with arch hypoplasia had higher incidence of post-operative residual coarctation.
Aortic Coarctation* ; Follow-Up Studies ; Humans ; Incidence ; Infant, Newborn ; Mortality