PURPOSE: To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours. RESULTS: The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C. CONCLUSIONS: BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins.
Catheterization ; Catheters ; Demography ; Humans ; Neck ; Operative Time ; Prostatectomy ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Incontinence

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We analyzed the clinical and radiographic results of surgical treatment for patients with tuberculous spondylitis. MATERIAL AND METHODS: Our study included 18 active tuberculous spondylitis patients (12 males and 6 females) who underwent anterior curettage, strut bone grafting and posterior instrumentation. Their average age was 50.1 years (age range: 24-76 years). The mean follow-up was 43 months. Vertebral bodies from T5 to L5 were involved. The anterior column support was iliac autograft in 10 patients and titanium mesh in 4. All the patients had transpedicular instrumentation with an additional hook in 3 and anterior instrumentation in 1. Except for one paraplegic patient, all the others were able to ambulate wearing TLSO. The mean duration of Anti-Tbc medication was 13.3 months (range: 12 to 18 months). The clinical and radiographic results were analyzed, and they included the segmental kyphotic angle and the complications of instrumentation on the involved vertebrae. RESULT: The subjective satisfaction was greater than good except for 2 patients. These 2 patients' satisfaction was fair due to incomplete neurologic recovery and persistent BG-donor site pain. The three paraplegic patients fully recovered postoperatively. The mean correction of the segmental kyphosis was 13 degrees. The mean correction loss was 0.7 degrees at the final follow-up. Pedicle screws were inserted in the involved vertebrae for 10 patients (n = 30). There was no loosening of instrumentation nor spread or recurrence of infection. One case was complicated by pneumonia. CONCLUSION: For the surgical treatment of active tuberculous spondylitis, anterior column support with strut grafting and posterior instrumentation is mandatory in the destabilized spine after anterior debridement or the correction of kyphosis.
Autografts ; Bone Transplantation ; Curettage ; Debridement* ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Pneumonia ; Recurrence ; Retrospective Studies ; Spine ; Spondylitis* ; Titanium ; Transplants*

PURPOSE: Prolonged urinary incontinence is one of the greatest concerns for patients undergoing radical prostatectomy. One of the possible causes for this urinary incontinence is a postoperative deficiency of the external striated urethral sphincter (EUS) complex and continence nerves. We evaluated the effect of posterior urethral reconstruction (PUR) in the early recovery of urinary continence after robotic-assisted radical prostatectomy. MATERIALS AND METHODS: Between January 2008 and March 2009 we performed robotic-assisted radical prostatectomy with PUR in 30 patients (PUR group) and without PUR in 30 patients (non-PUR group). We compared perioperative parameters and postoperative continence rates between the two groups. Continence was defined as no pads or one diaper per 24 hours and was assessed 1 month, 3 months, and 6 months after the procedure. RESULTS: Patients in the PUR group achieved better continence rates at 1 month (43% vs. 35%) and 3 months of follow-up (89% vs. 64%). At 6 months of follow-up, the continence rate was similar between the two groups (96% vs. 90%). No major complications were observed in the PUR group. However, 2 cases of anastomotic site leakage and 1 case of delayed bleeding were observed in the non-PUR group. CONCLUSIONS: Posterior urethral reconstruction appears to be an easy and reproducible technique in robotic-assisted radical prostatectomy. Our early experience demonstrates that PUR in robotic-assisted radical prostatectomy appears to confer early continence recovery and reduce intraoperative complications.
Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Prostatectomy ; Robotics ; Urethra ; Urinary Incontinence

BACKGROUND: Primary ovarian failure is reportedly increasing in recent years. Environmental factors have been frequently implicated as responsible for this increase, However, only a few of the environmental factors have been proven to cause the ovarian failure in human. METHODS: In June 1995, 24 female laborers, who worked in a factory which used Solvent #5200 (with a main chemical component being 2-bromopropane), developed symptoms of amenorrhea or irregular menstruation. All subjects underwent laboratory tests including measurement of serum LH, FSH, and estradioL Magnetic resonance imaging and ultrasonography of the pelvis were performed in all subjects. Laparoscopic examination was performed in 6 out of 24 patients after obtaining informed consent and 4 of 6 underwent ovarian biopsy. RESULTS: One subject was excluded because she had undergone hysterectomy previously. Among the remaining 23 subjects, 14 and 9 complained of amenorrhea and irregular menstrual periods, respectively. When we defined primary ovarian failure as FSH>30mIU/mL, all of those 14 patients with amenorrhea could be classified as primary ovarian failure. On the other hand, those 9 patients with irregular menstruations had normal FSH levels. Pathologic examination of ovaries showed interstitial fibrosis, loss of primordial follicles, and development arrest of follicles in the group with amenorrhea, similar to what is found in those who received chemotherapy or were exposed to radiation. CONCLUSION: The female laborers who were exposed to the solvent with 2-bromopropane developed primary ovarian failure. This failure was associated with longer duration of exposure. To our knowledge, this is the first report in the world indicating 2-bromopropane as a possible agent for ovarian failure.
Amenorrhea ; Biopsy ; Drug Therapy ; Estradiol ; Female ; Fibrosis ; Hand ; Humans ; Hysterectomy ; Informed Consent ; Magnetic Resonance Imaging ; Menstruation ; Ovary ; Pelvis ; Ultrasonography

No abstract available.

PURPOSE: The need for efficient and optimal training through a structured laparoscopic training program has become increasingly evident. Virtual reality simulation may provide a safe and efficient means of acquiring laparoscopic skills. The LAP Mentor(TM) is a high-fidelity virtual reality simulator with haptic feedback that allows a trainee to practice 9 basic laparoscopic tasks including laparoscopic suturing. The purpose of this study was to evaluate the predictive validity of performance on the LAP Mentor before surgical simulators are incorporated into training programs. MATERIALS AND METHODS: Eleven participants (6 medical students and 5 residents) underwent laparoscopic skills training on the virtual reality simulator LAP Mentor. Each participant was tested on 5 sets of 4 LAP Mentor basic laparoscopic tasks (grasping, cutting, clipping, and suturing) in a 3-week period. Total time and accuracy were measured for each task. RESULTS: There was a significant difference between the initial session and the final session for total time and accuracy in both groups. Among the medical students, as they progressed through the training step by step, total time decreased for the grasping task, the cutting task, the clipping task, and the suturing task. At the same time, accuracy improved for the grasping task, the cutting task, the clipping task, and the suturing task, respectively. The residents group showed a similar progression. CONCLUSIONS: Basic skills straining on a LAP Mentor virtual reality simulator improves learning of the basic skills for laparoscopy. Education with virtual reality simulators, therefore, may provide an effective teaching method and lead to improved operating performance.
Hand Strength ; Humans ; Laparoscopy ; Learning ; Mentors ; Sprains and Strains ; Students, Medical ; Teaching

PURPOSE: The aim of the present study was to investigate if a lateral retinacular peeling helped decrease the amount of lateral patellar tilt in total knee arthroplasty (TKA). MATERIALS AND METHODS: The lateral tilt angles were measured in tangential radiographs made preoperatively and postoperatively, with the knee in 100 degrees of flexion, in an earlier series of 38 TKAs(Group 1) and a series of 53 TKAs (Group 2) that included lateral retinacular peel and partial facetectomy. RESULTS: The mean preoperative patellar tilt angle was 9.1+/-4.5 degrees in the group 1 and 9.5+/-5.2 degrees in the group 2. The mean postoperative patellar tilt angle was 12.8 +/-6.2 and 11.0+/-7.1 degrees, respectively. The implant tilt angle was 6.3+/-7.3 and 5.5+/-6.1 degrees, respectively. The differences between two groups were not statistically significant. CONCLUSION: The patella would tilt laterally following total knee arthroplasty. A lateral retinacular peeling had no discernible effect on the postoperative lateral tilt of the resurfaced patella.
Arthroplasty* ; Knee* ; Patella

PURPOSE: To analyze the results of a minimum of three-year follow-up in patients with a severely deformed sequelae pyogenic hip, who had undergone total hip arthroplasty with a simultaneous limb length correction. MATERIALS AND METHODS: The postoperative complication, clinical and the radiographic results were analyzed in 74 out of 102 patients, who were followed for a minimum of three years between December 1987 and May 2003. The average age was 42.8 years. The average follow-up duration was 4 years and 11 months. There were 50 tuberculosis infections, 24 pyogenic infections, and 23 fused hip cases. The average leg length shortening was 4.1 cm (range, 1.0-10.0 cm). RESULTS: Preoperative Harris hip score improved to 90.2 postoperatively from 65.0 (range, 25-92.5) preoperatively. Leg length shortening was corrected by 0.4 cm (0.0-3.0 cm). Radiographically, excluding the 3 revisions, no case met the criteria of definite loosening. The postoperative complications included the recurrence of tuberculosis (2 cases), and variable nerve palsies, including femoral nerve (3 cases), and a sciatic nerve (3 cases). These patients completely recovered from nerve palsy. B-K amputation, after the postoperative exacerbation of circulation to the affected limb, was needed in one case with a preoperatively undetected femoral artery occlusion. CONCLUSION: Although, restoring the normal limb length in the severely deformed pyogenic hip sequelae patients requires highly demanding surgical techniques, with a relatively higher incidence of postoperative complications, it is possible to achieve a higher level of patient satisfaction and definite gait improvement.
Amputation ; Arthroplasty, Replacement, Hip* ; Extremities ; Femoral Artery ; Femoral Nerve ; Follow-Up Studies ; Gait ; Hip* ; Humans ; Incidence ; Leg ; Paralysis ; Patient Satisfaction ; Postoperative Complications ; Recurrence ; Sciatic Nerve ; Tuberculosis

BACKGROUND: Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. METHODS: The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. RESULTS: The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1+/-1.9 g/dL, mean corpuscular volume was 93.4+/-11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). CONCLUSION: The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.
Anemia ; Anemia, Diamond-Blackfan ; Aortic Coarctation ; Bone Marrow ; Congenital Abnormalities ; Diamond ; Erythrocyte Indices ; Heart Septal Defects, Ventricular ; Hemoglobins ; Hospitals, University ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Registries ; Reticulocytes ; Retrospective Studies ; Steroids ; Strabismus ; Thumb ; Transplants

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires