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

Mitochondrial DNA (mtDNA) genome analysis has been a potent tool in forensic practice as well as in the understanding of human phylogeny in the maternal lineage. The traditional mtDNA analysis is focused on the control region, but the introduction of massive parallel sequencing (MPS) has made the typing of the entire mtDNA genome (mtGenome) more accessible for routine analysis. The complete mtDNA information can provide large amounts of novel genetic data for diverse populations as well as improved discrimination power for identification. The genetic diversity of the mtDNA sequence in different ethnic populations has been revealed through MPS analysis, but the Korean population not only has limited MPS data for the entire mtGenome, the existing data is mainly focused on the control region. In this study, the complete mtGenome data for 186 Koreans, obtained using Ion Torrent Personal Genome Machine (PGM) technology and retrieved from rather common mtDNA haplogroups based on the control region sequence, are described. The results showed that 24 haplogroups, determined with hypervariable regions only, branched into 47 subhaplogroups, and point heteroplasmy was more frequent in the coding regions. In addition, sequence variations in the coding regions observed in this study were compared with those presented in other reports on different populations, and there were similar features observed in the sequence variants for the predominant haplogroups among East Asian populations, such as Haplogroup D and macrohaplogroups M9, G, and D. This study is expected to be the trigger for the development of Korean specific mtGenome data followed by numerous future studies.

PURPOSE: We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones. MATERIALS AND METHODS: Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis(R), Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated. RESULTS: The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection. CONCLUSIONS: Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones.
Cosmetics ; Gloves, Surgical ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus ; Ureter ; Ureterolithiasis ; Urinary Tract Infections

BACKGROUND: Evidence-based clinical practice guidelines (CPGs) are defined as “statements that are scientifically reviewed about evidence and systematically developed to assist in the doctors' and patients' decision making in certain clinical situations.” This recommendation aims to promote good clinical practice for the provision of safe and effective practices of conscious sedation in dentistry. METHODS: The development of this clinical practice guideline was conducted by performing a systematic search of the literature for evidence-based CPGs. Existing guidelines, relevant systematic reviews, policy documents, legislation, or other recommendations were reviewed and appraised. To supplement this information, key questions were formulated by the Guideline Development Group and used as the basis for designing systematic literature search strategies to identify literature that may address these questions. Guideline documents were evaluated through a review of domestic and international databases for the development of a renewing of existing conscious sedation guidelines for dentistry. Clinical practice guidelines were critically appraised for their methodologies using Appraisal of guidelines for research and evaluation (AGREE) II. RESULTS: A total of 12 existing CPGs were included and 13 recommendations were made in a range of general, adult, and pediatric areas. CONCLUSION: The clinical practice guidelines for conscious sedation will be reviewed in 5 years' time for further updates to reflect significant changes in the field.
Adult ; Conscious Sedation* ; Decision Making ; Dentistry* ; Evidence-Based Medicine ; Humans

Recently, it has been reported that transfused patients can generate admixture-like genetic profiles. As genetic material of the donor can survive for a reasonable time after transfusion, the recipient's genomic DNA is likely to have a mixture pattern. An autopsy case of a man transfused perimortem generated a mixture patterned short tandem repeat profile. Notably, the patient was transfused mostly with nuclear-deficient cells, limiting the donor genetic material available for the recipient. As a result, mixture-like patterns were observed consistently, regardless of change in input DNA content; the sample DNA content, which was serially diluted, ranged from 1 ng to 0.0625 ng. The distributions of foreign peaks appeared to be irreproducible, showing stochastic behaviors throughout the genotyped results. This study suggests that a cautious approach is required when genotyping of a patient who has undergone recent transfusion. One must consider the possibility of obtaining a mixture patterned profile in such patients, and therefore, choose parenchymal organs or tissues for reliable results.
Autopsy ; Blood Transfusion ; DNA ; DNA Fingerprinting ; Humans ; Microsatellite Repeats* ; Tissue Donors

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

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

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*