PURPOSE: To examine the effects on erectile function of concomitant treatment with an alpha-blocker (tamsulosin) and an antimuscarinic agent (solifenacin) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function. In group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in the International Prostate Symptom Score [IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of life (QoL)], prostate-specific antigen, trans-rectal ultrasonography, urine flowmetry, residual urine, and a 5-item version of the International Index of Erectile Function (IIEF-5) were assessed after a 3-month treatment period. In both groups, it was determined whether treatment was associated with changes in LUTS and erectile function and whether improvement in the IPSS was correlated with the IIEF-5. Comparative analysis was also done to examine the linear relationship between improved IPSS scores and IIEF-5 scores. RESULTS: A comparison of the degree of improvement in all the parameters indicated that both groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and IPSS-QoL (p<0.05). A comparison of the degree of improved sexual function associated with improved LUTS in each patient showed significant improvement in the IIEF-5 score associated with the degree of improvement in the IPSS-ST domain in group 1, but no significant associations were found in group 2. In cases in which tamsulosin was administered, the IIEF-5 score significantly improved as the IPSS-ST domain score improved. In the group in which tamsulosin and solifenacin were concomitantly administered, improvement of the IPSS-ST domain score had no significant effect on the IIEF-5 score. CONCLUSIONS: In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective for LUTS, but erectile function was not significantly improved. Therefore, although effective for improving LUTS, combination therapy with an alpha-blocker and an antimuscarinic agent was not effective for improving erectile function.
Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Quality of Life ; Quinuclidines ; Rheology ; Sexual Dysfunction, Physiological ; Sulfonamides ; Tetrahydroisoquinolines ; Urinary Tract ; Solifenacin Succinate

BACKGROUND: Tracheal tubes are different on the flexibility, material and bevel angle according to the manufacturers. These may affect the success rate of blind tracheal intubation through laryngeal mask airway (LMA). In addition, using straight-tip exchanger or curved-tip introducer, we tried to compare the success rate of tracheal tube insertion through LMA. METHODS: After receiving informed consents, 30 patients were enrolled. Blind tracheal intubation was tried with reinforced tracheal tube (M group), or one of two kinds of conventional tracheal tube (P group and B group). Tracheal tube was selected in random order and advanced into the trachea through LMA one by one. If all the three attempts was unsuccessful, we considered the blind tracheal intubation through LMA a failure. We also compared the success rate of blind tracheal insertion through LMA using straight-tip exchanger or curved-tip introducer. The first trial was performed on the neutral head position. The exchanger or introducer was rotated during the second trial. If the second attempt was unsuccessful, the exchanger- or intubator-guided intubation was performed on the sniffing position and, as a last and fourth trial, while mandible was being elevated with hands. RESULTS: Success rate of blind tracheal intubation through LMA was 50% (15/50) in group P and 36.7% (11/30) in group M, 33.3% (10/30) in group B (P=0.05). By using curved-tip introducer, intubation through LMA was successful in 80% (16/20), while it was successful only in 35% (7/20) via straight-tip exchanger. CONCLUSION: Blind tracheal intubation through LMA was dependent on the types of tracheal tube. Also, curved tip introducer may be a more valuable aid in performing blind tracheal intubation through LMA. Its use seems to be better technique than directly inserting tracheal tube through LMA.
Hand ; Head ; Humans ; Intubation* ; Laryngeal Masks* ; Mandible ; Pliability ; Trachea

PURPOSE: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones and to analyze the predictive factors for stone-free. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent RIRS for renal stones from January 2000 to July 2009. We identified 66 RIRSs (63 patients with 3 bilateral renal stones) and collected data. Stone-free and success were respectively defined as no visible stones and clinically insignificant residual stones less than 3 mm on postoperative imaging; predictive factors for stone-free were evaluated. RESULTS: Of the 66 renal stones, 18 stones (27.3%) were located in the upper pole or midpole or renal pelvis and 48 (72.7%) in the lower pole with or without others, respectively. The mean cumulative stone burden was 168.9+/-392.5 mm2. The immediate postoperative stone-free rate was 69.7%, and it increased to 72.7% at 1 month after surgery. The success rate was 80.3% both immediately after the operation and 1 month later. In the multivariate analysis, stone location except at the lower pole (p=0.049) and small cumulative stone burden (p=0.002) were significantly favorable predictive factors for the immediate postoperative stone-free rate. The overall complication rate was 6%. CONCLUSIONS: RIRS is a safe and effective treatment for renal stones. The stone-free rate of RIRS was particularly high for renal stones with a small burden, except for those located in the lower pole. RIRS could be considered in selective patients with renal stones.
Humans ; Kidney Calculi ; Kidney Pelvis ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Ureteroscopy

Primary malignant melanoma of the vagina is an exceedingly rare entity, accounting for about 3% of all primary vagina1 malignant tumors and 0.3% of all melanoma. The overall 5-year survival in patients with primary vaginal melanoma is notoriously poor, estimated to be between 13% and 19%. A case of primary malignant melanoma of the vagina treated with the wide local excision of vagina and rectum was presented with a brief review of literature.
Humans ; Melanoma* ; Rectum* ; Vagina*

BACKGROUND: A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. METHODS: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. RESULTS: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). CONCLUSION: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.
Analgesia ; Analgesia, Epidural* ; Dizziness ; Early Ambulation ; Female ; Fentanyl* ; Gynecologic Surgical Procedures* ; Humans ; Lower Extremity ; Nausea ; Pruritus ; Urinary Retention ; Vomiting

BACKGROUND: A retrospective study was performed to estimate the frequency of red cell antibodies in blood donors (n=1,620,023) and transfusion candidates (SNUH n=12,111, YUMH n=26,665) for last 2 years (2000~2001). The results of the antibody screening and identification tests, the frequency and specificities of antibodies identified compared with blood centers and two hospitals had been used the different test methods each others. METHOD: Blood centers had been used tube and micro-plate method simultaneously with an in house and commercial panels. SNUH had been used micro-plate method using V plate with an in house and commercial panels. YUMH had been used gel agglutination technique (DiaMed ID System : DiaMed, Murten; Switzerland) since 1998. RESULTS: The frequencies of red blood cell antibodies were 0.26% (4,204 / 1,620,023 donor sera ), 0.11% (135 / 12,111 patient sera in SNUH) and 0.48% (128 / 26,665 patient sera in YUMH). Female donors and old ages showed higher frequency of red cell antibodies than male and young ages. Most of antibodies detected in donors were clinically less relevant antibodies such as Anti-Lea and Leb (38.9%), anti-P1 (18.1%), anti-H(IH) (8.4%), anti-M (6.2%) and so on. Clinically significant antibodies including Rh system antibodies (2.0%) were few, and composed only 12% of all the antibodies detected. In patients, clinically relevant antibodies including Rh antibodies (40.4% in SNUH, 71.9% in YUMH) were more frequently observed comparing with in donors. CONCLUSION: Antibodies found in donors were mostly clinically less relevant. Antibody screening method used in blood centers would be standardized. Blood banks using gel technique showed high detection rate of clinically significant antibodies comparing with facilities using other methods.
Agglutination ; Antibodies* ; Antibody Specificity ; Blood Banks ; Blood Donors* ; Erythrocytes ; Female ; Humans ; Korea* ; Male ; Mass Screening ; Retrospective Studies ; Tissue Donors

Lichenoid drug eruption can arise as a result of exogenous compound exoposures and closely mimic idiopathic lichen planus. A 45-year-old man who had taken antituberculosis drugs (isoniazid, rifampin, ethambutol, pyrazinamide) for 2 months developed pruritic violaceous papules and plaques with silvery scales on the whole body. On close inspection, he had superficial erosions on the lips and reticulate white papules on the buccal mucosa. Histopathologic findings were hyperkeratosis, parakeratosis, and hypergranulosis in the epidermis and band-like lymphohistiocytic infiltration, numerous eosinophils, and perivascular lymphohistiocytic infiltration in the dermis. The skin lesions improved leaving hyperpigmentation after cessation of the antituberculosis drugs and application of topical corticosteroid.
Dermis ; Drug Eruptions ; Eosinophils ; Epidermis ; Ethambutol ; Humans ; Hydrazines ; Hyperpigmentation ; Lichen Planus ; Lip ; Middle Aged ; Mouth Mucosa ; Parakeratosis ; Rifampin ; Skin ; Weights and Measures

The declining tendency of signal joint T-cell receptor excision circles (sjTRECs) in peripheral blood is known to be age-dependent, and their quantification in blood or bloodstains has recently been introduced as a tool for age estimation. Lymphoid tissues such as the thymus and spleen represent potential candidates for age estimation because they undergo age-related structural and functional changes. In the present study, the correlation between age and sjTREC levels in human lymphoid tissues, namely the thymus, spleen, and blood, obtained from autopsy cases were investigated, with the goal of establishing a reliable age estimation model. Results showed negative regression curves with coefficient values of r=-0.410, r=-0.611, and r=-0.584 for thymus, spleen, and blood, respectively. In addition, this model was testing using thymus samples from the torsos of dismembered bodies from two real forensic cases, and results showed the predicted ages to be close to the actual ages of the victims. Further study will be required to improve accuracy and reduce estimation error, particularly within the lower age range. Nonetheless, these results suggest that quantification of sjTRECs in not only blood but also in other lymphoid tissues could be a useful tool for age estimation in forensic cases.
Autopsy ; Humans* ; Joints* ; Lymphoid Tissue* ; Receptors, Antigen, T-Cell* ; Spleen ; T-Lymphocytes* ; Thymus Gland ; Torso

Juvenile xanthogranuloma (JXG) is a fibrohistiocytic proliferative disorder predominant in infancy and childhood. It is a benign and transient skin lesion that usually appears in the cephalic area. Recently, the concurrent finding of neurofibromatosis (NF), juvenile chronic myelogenous leukemia (JCML), and JXG has been repeatedly reported. Especially, the family history of NF may represent a risk factor for the development of JCML in patients with NF and in patients with NF and JXG. So, a finding of JXG and NF in infants should alert the physician to a possible development of JCML. We report a case of JXG developed in a neurofibromatosis child with family history.
Child ; Humans ; Infant ; Leukemia, Myelomonocytic, Juvenile ; Neurofibromatoses ; Risk Factors ; Skin ; Xanthogranuloma, Juvenile

This study aims to investigate the factors related to the adoption of clinical practice guidelines in clinical settings in Korea; it also aims to determine how these factors differ depending on the specific situation of health care system and professional climate. The research sample comprised physicians who are board members of academic societies with experiences in development of clinical practice guidelines using a convenient sampling. We analyzed 324 physicians with pooling two-year sample of 2007 and 2008. From all the respondents, 48.8% stated that they followed Clinical Practice Guidelines, and 93.4% agreed with the content in the Clinical Practice Guidelines. With regard to the item on the self-efficacy of practicing guidelines, 90.3% of the respondents selected 'low level'. In the regression analysis, the factors associated with implementation were level of recognition, agreement and self-efficacy and positive attitude towards practice guidelines. Although the health care system in Korea differs from those in Western countries, our results revealed that the factors related to the adoption of practice guidelines were similar to the research results of Western countries. These results suggest that professionals' attitudes towards clinical practice guidelines are universal, and implementation strategies should be developed globally.
Adult ; Attitude of Health Personnel ; Awareness ; Female ; Guideline Adherence ; Humans ; Male ; Middle Aged ; *Models, Theoretical ; Physicians/psychology ; *Practice Guidelines as Topic ; Questionnaires ; Regression Analysis ; Republic of Korea ; Self Efficacy