No abstract available.
Epidermal Growth Factor* ; Estradiol* ; Female ; Follicular Fluid*

PURPOSE: We evaluated the influence of preoperative physical examination (PE) and urodynamic study (UDS) findings on objective postoperative bladder emptying, the subjective development of bladder storage symptoms, and patient-reported success of correction of stress urinary incontinence (SUI). MATERIALS AND METHODS: From January 2007 to August 2008, a total of 159 female patients with SUI underwent transobturator midurethral sling surgery (TOT). The patients were selected for SUI, with no overactive bladder (OAB) symptoms, no detrusor overactivity (DO) on UDS, no pelvic organ prolapse, and no history of prior anti-incontinence surgery. Of these patients, 128 patients (aged 38-74 years; mean age, 51.8+/-7.1 years) with follow-up of at least 12 months were included in the analysis. All patients had PE and UDS findings, including Q-tip testing, free maximal flow rates (Qmax), filling cystometry, Valsalva leak point pressure, detrusor pressure at maximal flow, and maximal urethral closing pressure. The primary outcome was postoperative voiding dysfunction, defined as the subjective feeling of not empting one's bladder completely and a postvoid residual > or =100 ml. A secondary outcome, "cure" of SUI, was defined as "a negative result on the cough stress test and no subjective complaint of urine leakage." We analyzed the preoperative parameters by univariate and multivariate regression for voiding dysfunction, de novo OAB, cure rate, and the patients' satisfaction. RESULTS: Patients with a preoperative Qmax < 15 ml/s (7 patients) had a tendency for postoperative voiding dysfunction compared with those with a Qmax 15 ml/s (15 patients) (35.0% vs. 13.9%, respectively; p=0.046). No other preoperative parameters had a statistically significant influence on postoperative voiding dysfunction. Receiver operating characteristic (ROC) analysis revealed that Qmax was a good predictor because the area under the ROC curve value of Qmax was 0.81 (95% CI: 0.73 to 0.89, p<0.001). The univariate and multivariate analysis of the preoperative PE and UDS parameters demonstrated that no significant differences and no independent risk factors were related to the postoperative de novo OAB, cure rate, or the patients' satisfaction. CONCLUSIONS: These findings suggest that preoperative UDS results, especially Qmax, could be used to predict postoperative voiding dysfunction after the TOT procedure.
Cough ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Pelvic Organ Prolapse ; Physical Examination ; Risk Factors ; ROC Curve ; Suburethral Slings ; Treatment Outcome ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urodynamics

A penile fracture is an injury caused by the rupture of the tunica albuginea. We report an uncommon case of penile fracture with the complete urethral rupture in a 48-year-old man who sustained the injury during the sexual intercourse. He presented with acute penile pain, swelling on the ventral aspect of the penile shaft and the inability to pass urine associated with urethral bleeding. Retrograde urethrography revealed the complete obstruction of the urethra. Exploration and repair of the penile fracture with the urethra rupture were performed. The patient recovered successfully with good erectile and voiding function.
Coitus ; Hemorrhage ; Humans ; Male ; Middle Aged ; Penis ; Rupture ; Urethra

PURPOSE: We evaluated the influence of urinary stone components on the outcomes of ureteroscopic removal of stones (URS) by electrohydraulic lithotripsy (EHL) in patients with distal ureteral stones. MATERIALS AND METHODS: Patients with a single distal ureteral stone with a stone size of 0.5 to 2.0 cm that was completely removed by use of EHL were included in the study. Operating time was defined as the time interval between ureteroscope insertion and complete removal of ureteral stones. Ureteral stones were classified into 5 categories on the basis of their main component (that accounting for 50% or more of the stone content) as follows: calcium oxalate monohydrate (COM), calcium oxalate dihydrate, carbonate apatite (CAP), uric acid (UA), and struvite (ST). RESULTS: A total of 193 patients (131 males and 62 females) underwent EHL. The mean operating time was 25.1+/-8.2 minutes and the mean stone size was 1.15+/-0.44 cm. Calcium oxalate stones accounted for 64.8% of all ureteral stones, followed by UA (19.7%), CAP (8.3%), and ST (7.2%) stones. The mean operating time was significantly longer in the UA group (28.6+/-8.3 minutes) than in the COM group (24.0+/-7.8 minutes, p=0.04). In multivariate analyses, the stone size was negatively associated with the odds ratio (OR) for successful fragmentation. UA as a main component (OR, 0.42; 95% confidence interval, 0.20 to 0.89; p=0.023) was also found to be significantly important as a negative predictive factor of successful fragmentation after adjustment for stone size. CONCLUSIONS: The results of the present study suggest that successful fragmentation by URS with EHL could be associated with the proportion of the UA component.
Accounting ; Apatites ; Calcium Oxalate ; Carbon ; Humans ; Lithotripsy ; Magnesium Compounds ; Male ; Multivariate Analysis ; Odds Ratio ; Phosphates ; Ureter ; Ureteroscopes ; Ureteroscopy ; Uric Acid ; Urinary Calculi

PURPOSE: To evaluate effect of modified arthroscopic pull-out suture technique which used number 5-nonabsorbable suture material for tibia intercondylar eminence comminuted fractures. MATERIALS AND METHODS: There were 21 cases of tibia intercondylar emimence fracture which arthroscopic treated at our hospital between 1999 and 2004. However the study population only included 12 cases in which a number 5-nonabsorbable suture material (Ethibond No. 5) was used for tibia intercondylar eminence comminuted fractures and minimum 1-year follow-up has gone. The average follow-up period was 18.5 months (range, 12 to 42 months). Lachman test and KT-2000 athrometer test were evaluated at the pre-and post-operation. Clinical results of all patients were evaluated with the Meyers and Mckeever 's criteria. RESULTS: In all 12 cases, the normal range of motion and sports activities were recovered at the final follow-up. When tested for anterior instability with KT-2000 arthrometer, there were no different between normal knee and operated knee. Clinical results by Meyers and Mckeever's criteria were excellent in 10 patients and good in 2 patients. CONCLUSION: We obtained early mobilization and stable fixation in modified arthroscopic pullout suture technique for tibia intercondylar eminence comminuted fractures. Patients can early return to his job. This technique seems to be one of the effective operative techniques for treatment of tibia intercondylar eminence comminuted fractures.
Arthroscopy ; Early Ambulation ; Follow-Up Studies ; Fractures, Comminuted* ; Humans ; Knee ; Reference Values ; Sports ; Suture Techniques ; Sutures* ; Tibia*

Purpose: The optimal treatment for patients with stage III non-small cell lung cancer (NSCLC) remains controversial. This study aimed to investigate prognostic factors and clinical outcome in stage III NSCLC using real-world clinical data in the Korean population. Materials and Methods: Among 8,110 patients with lung cancer selected from 52 hospitals in Korea during 2014-2016, only patients with stage III NSCLC were recruited and analyzed. A standardized protocol was used to collect clinical information and cox proportional hazards models were used to identify risk factors for mortality. Results: A total of 1,383 patients (46.5% had squamous cell carcinoma and 40.9% had adenocarcinoma) with stage III NSCLC were enrolled, and their median age was 70 years. Regarding clinical stage, 548 patients (39.6%) had stage IIIA, 517 (37.4%) had stage IIIB, and 318 (23.0%) had stage IIIC. Pertaining to the initial treatment method, the surgery group (median survival period: 36 months) showed better survival outcomes than the non-surgical treatment group (median survival period: 18 months, p=0.001) in patients with stage IIIA. Moreover, among patients with stage IIIB and stage IIIC, those who received concurrent chemotherapy and radiation therapy (CCRT, median survival period: 24 months) showed better survival outcomes than those who received chemotherapy (median survival period: 11 months), or radiation therapy (median survival period: 10 months, p<0.001). Conclusion While surgery might be feasible as the initial treatment option in patients with stage IIIA NSCLC, CCRT showed a beneficial role in patients with stage IIIB and IIIC NSCLC.

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.
Abdomen ; Aged ; Anesthesia, Spinal ; Dysuria ; Female ; Hematuria ; Humans ; Melanoma ; Neoplasm Metastasis ; Physical Examination ; Rivers ; Triacetoneamine-N-Oxyl ; Ulcer ; Urethra

BACKGROUND: The heart transplantation is now accepted as a definite therapeutic modality in patients with terminal heart failure. With use of immunosuppressive agent, the incident of rejection deceased but risk of infection increased. Infection has been the most common cause of death in heart transplant patient, especially during the first year. The purpose of this study is to evaluate the infection of 91 patients who had heart transplantation at our hospital. METHODS: Of the total 91 patients, there were 75 males and 16 females, and the mean age was 39.8+/-14.1 years ranged from 14 to 62 years. All patients were in NYHA functional class III or IV preoperatively. The most common underlying heart diseases were dilated cardiomyopathy(72/91). The mean follow-up duration was 36.4 months (range; 0.6 ~ 103 months) and 10 patients died during this period. RESULT: There were 35 patients with infections (early infections in 4 and late infections in 32). The most common infection was skin infection of herpes virus (15 cases). Pneumonia occurred in 8 patients and responded well to antibiotics. But multiple empyema developed in one patient with bacterial pneumonia despite of antibiotics, chest tube insertion was needed. There were 4 patients with tuberculosis, 2 with tuberculous pericardial effusion, 1 with pulmonary tuberculosis and 1 with miliary tuberculosis. Sepsis was noted in 3 patients, 2 with bacterial sepsis and 1 with candidial sepsis. They all died despite of antibiotic treatment. There were 2 cases with wound infections and 1 with perianal abscess, and 1 with aortitis with paraaortic abscess due to Aerococcus viridans. Two patients with cryptococcal meningitis were successfully treated with liposomal amphotericin B and oral fluconazole, one of them also had invasive aspergillosis. There were 6 cases with cytomegalovirus (CMV) disease. Three of them had CMV viremia , 2 had CMV disease ( retinitis and colitis) and 1 had viremia and disease. CONCLUSION: There were 35 patients (38.5%) with infections and among then, 21 patients (23%) had one or more episodes of major infection. Infection was a major cause of death (30%) after heart transplantation. Careful control of infection is vital in the care of transplant recipients because infections result in increased morbidity and mortality.
Abscess ; Aerococcus ; Amphotericin B ; Anti-Bacterial Agents ; Aortitis ; Aspergillosis ; Cause of Death ; Chest Tubes ; Cytomegalovirus ; Empyema ; Female ; Fluconazole ; Follow-Up Studies ; Heart ; Heart Diseases ; Heart Failure ; Heart Transplantation* ; Humans ; Male ; Meningitis, Cryptococcal ; Mortality ; Pericardial Effusion ; Pneumonia ; Pneumonia, Bacterial ; Retinitis ; Sepsis ; Skin ; Transplantation ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Pulmonary ; Viremia ; Wound Infection

BACKGROUND: The relation between pressure-derived fractional collateral flow (PDCF) and coronary arterial remodeling remains uncertain in acute myocardial infarction. METHODS: We evaluated the effect of arterial remodeling on the development of PDCF in 72 patients with first acute myocardial infarction (pain onset <12 h) treated with primary angioplasty. Intravascular ultrasound study was performed before intervention. The remodeling index (RI) was defined as a ratio of (lesion/proximal reference) external elastic membrane area. Positive remodeling was defined as a RI >1.0 and nonpositive remodeling as a RI < or =1.0. Using a 0.014-in. fiber optic pressure monitoring guide wire, the PDCF index was measured by simultaneous measurement of mean aorta pressure (Pao), distal coronary pressure during the balloon occlusion (Pocc), and central venous pressure (CVP):PDCF index=100x(Pocc-CVP)/(Pao-CVP). Sufficient collateral was defined as PDCF index >24% and insufficient collateral as PDCF index < or =24%. RESULTS: The RI was 1.04+/-0.15 in the lesions with sufficient collateral and 1.03+/-0.16 in the lesions with insufficient collateral (p=0.812). There was no significant difference in the frequency of positive remodeling between the 2 groups (55% vs. 54%, respectively, p=0.966). The PDCF index was 20+/-11% and 20+/-9% in positive and nonpositive remodeling, respectively (p=0.891). There was no significant correlation between RI and PDCF index (r=0.027, p=0.823). CONCLUSION: The pattern of coronary arterial remodeling might not influence the development of collateral blood flow in patients with acute myocardial infarction treated with primary angioplasty.
Angioplasty* ; Aorta ; Balloon Occlusion ; Central Venous Pressure ; Collateral Circulation ; Coronary Vessels* ; Humans ; Membranes ; Myocardial Infarction* ; Ultrasonography ; Ultrasonography, Interventional

Lung transplantation is the only treatment for end-stage lung disease, but the problem of donor shortage is unresolved issue. Herein, we report the first case of living-donor lobar lung transplantation (LDLLT) in Korea. A 19-year-old woman patient with idiopathic pulmonary artery hypertension received her father's right lower lobe and her mother's left lower lobe after pneumonectomy of both lungs in 2017. The patient has recovered well and is enjoying normal social activity. We think that LDLLT could be an alternative approach to deceased donor lung transplantation to overcome the shortage of lung donors.
Female ; Humans ; Hypertension ; Korea* ; Living Donors ; Lung Diseases ; Lung Transplantation* ; Lung* ; Pneumonectomy ; Pulmonary Artery ; Tissue Donors ; Young Adult