The erectile response is peripherally mediated by cavernous nerve that contains thoracolubar sympathetic nerve and sacral parasympathetic nerve. It is known that thoracolubar sympathetic nerve involves in detumescence and sacral parasympathetic nerve in tumescence, however there are some opinions that rhoracolubar sympathetic nerve participates in psychogenic erectile mechanism. We previously reported that by the comparison with electrostimulation-induced erection, apomor- phine-induced erection was a vascular event. The aim of our study was to determine the infraspinal neural pathway of APO-induced erection. The sham operated rats remained normal in all measured respects. All rats having undergone neurotomy ot the hypogastric nerves showed APO-induced erection except one. The only 5 rats having undergone neurotomy of the pelvic nerves showed APO-induced erection. Erections could be elicited upon cavernous or pelvic nerves stimulation in all rats having undergone neurolomy of the hypogastric nerves. Among 17 rats having undergone neurotomy of the pelvic nerve erection could be elicited upon cavernous nerves slimulation in 14 rats, however. the intracavernous pressure (47.9+/-16.5 mmHg) was lower than that found in sham-operated rats. Erectile response in these 14 rats appeared to result from stimulation of penile neurons coming from the major pelvic ganglion. In contrast to no response in sham-operated rats, stimulation of the hypogastric nerves also resulted in erections in 7 out of 17 rats. In conclusion, this present study suggests that APO-induced ereclion is primarily mediated via the sacral parasympathetic nerve system and may be mediated by the thoracolumbar sympathetic pathway following injury to the parasympathetic nerve system. Furthermore we can guess the possibility that the neural pathway of psychogenic erection is same that of AP0- induced erection.
Animals ; Apomorphine ; Ganglion Cysts ; Models, Animal* ; Neural Pathways* ; Neurons ; Rats*

PURPOSE: The purpose of this study was to analyze the causes of late death and the long-term survival of patients following abdominal aortic aneurysm (AAA) repair. METHODS: From 1993 to 2005, 146 (98 intact and 48 ruptured) consecutive AAA patients underwent open repair. The perioperative data was supplemented with a retrospective review of the medical records and the use of the database of the National Statistical Office to calculate the survival rates and the causes of death. RESULTS: There was one operative death (1%) in the intact AAA group and 12 (25%) in the ruptured AAA group. After exclusion of the operative deaths, the survival rates of the intact AAA patients were 94.5% at 1 year, 77.0% at 5 years and 33.2% at 10 years; these findings demonstrated a significant longer survival for the intact AAA patients than for patients with ruptured AAA (86.1% at 1 year, 56.7% at 5 years and 0% at 10 years, respectively). The causes of late death included cardiovascular disease in 52.8% (coronary artery disease in 22.6%, cerebrovascular disease in 20.8%, other arterial aneurysms in 5.7% and graft-related death in 3.8%), malignancies in 11.3% and pulmonary disease in 11.3%. The multivariate analysis showed that the long-term survival rates were influenced by the rupture status, the history of cerebrovascular disease and hypertension. CONCLUSION: This study showed that the long-term survival after intact AAA repair was better than that for ruptured AAA repair even if we exclude the operative deaths. The most common cause of late death was cardiovascular disease. Our findings suggest that the patients with preoperative cerebrovascular disease and hypertension require additional care.
Aneurysm ; Aortic Aneurysm, Abdominal ; Arteries ; Cardiovascular Diseases ; Cause of Death ; Humans ; Hypertension ; Lung Diseases ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Rupture ; Survival Rate

A 44 years old woman was admitted to Inha University hospital in semicomatose state. An electrocardiogram (ECG), taken in the emergency room, showed ST segment elevation in the precordial leads. She underwent a urgent echocardiography. It showed that there was akinesia of anteroseptal segment from the mid left ventricle to the apex and inferior segment from the mid left ventrile to the lower mid left ventricle. With the impression of acute myocardial infarction (AMI), she underwent a urgent coronary angiography. There was no significant luminal narrowing of the right or the left coronary arteries but the left ventriculography revealed akinesia of anterolateral and diaphragmatic segments of the left ventricle. Computerized tomography (CT) of the brain, taken shortly after coronary angiography, showed subarachnoid hemorrhage. The abnormal ECG and echocardiography findings, simulating acute myocardial infarction, were assumed to be caused by coronary vasospasm derived from subarachnoid hemorrhage accompanied by massive adrenergic discharge.
Adult ; Brain ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Echocardiography ; Electrocardiography ; Emergency Service, Hospital ; Female ; Heart Ventricles ; Humans ; Intracranial Hemorrhages* ; Myocardial Infarction ; Phenobarbital ; Subarachnoid Hemorrhage

PURPOSE: This study aimed to compare the neonatal outcome by quantifying the effect of maternal age on low birth weight (LBW). METHODS: We reviewed the medical records of 12,742 newborn infants born at CHA Bundang Medical Center from January 2009 to December 2013. Infants were compared after being categorized by the following 4 maternal age groups - <25 years (N=343), 25-34 years (N=8,573), 35-39 years (N=3,186), > or =40 years (N=640). Statistical analysis included use of logistic regression models with likelihood ratio tests for interaction effects. RESULTS: Incidence of perinatal complications tended to increase significantly with maternal age - gestational diabetes mellitus (GDM; P<0.001), pregnancy induced hypertension (PIH; P=0.019), placenta previa (P<0.001), and cesarean section (P<0.001). Compared to the age group of 25-34 years (reference group), no significant differences were found in age group of 35-39 year [odds ratio (OR)=0.945, 95% confidence interval (CI) 0.847-1.056, P=0.319] and > or =40 years (OR=0.841, 95% CI 0.671-1.056, P=0.136) for LBW. After adjusted by gestational age, incidence of in vitro fertilization (IVF), and perinatal complications, maternal age was not found to be an independent risk factor for LBW (OR=0.847, 95% CI 0.730-0.982, P=0.028 for 35-39 years, and OR=0.652, 95% CI 0.481-0.884, P=0.006 for > or =40 years). CONCLUSION: Although incidence of perinatal complications tends to increase with age, neonatal outcome of age group of > or =35 years measured by incidence of LBW infants was not unfavorable compared to the reference group. The result suggests that the thorough prenatal care may be more important than the maternal age itself.
Cesarean Section ; Diabetes, Gestational ; Female ; Fertilization in Vitro ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Logistic Models ; Maternal Age* ; Medical Records ; Parturition* ; Placenta Previa ; Pregnancy ; Prenatal Care ; Risk Factors

PURPOSE: We evaluated the clinical characteristics of term infants admitted to the neonatal intensive care unit (NICU) from nursery. METHODS: This is a study of NICU-admitted infants who were born > or =37 weeks of gestation at the Bungdang CHA Hospital between January 2012 and August 2013 (n=161). The infants were divided into 3 groups. The "nursery room (NR) group" (n=97) comprised admissions from the nursery following a late deterioration in condition. The "delivery room (DR) group" (n=64) comprised infants who required admission to the NICU immediately after delivery. In addition, healthy term infants who were selected as the "Term group" (n=95). RESULTS: The NR group had a higher incidence of respiratory distress syndrome than DR group (28.9% vs. 14.1%, P=0.029). Compared with the Term group, the NR group had increased incidence of prolonged (>18 h) premature rupture of membranes (PROM) (6.2% vs. 0.0%, P=0.029). By logistic regression analysis, comparing NR group and Term group, a 1 min Apgar score < or =7 points {odds ratio (OR) and 95% confidence intervals (CI) 3.1 (1.0-9.1)}, a requirement of O2 at birth 2.6 (1.2-5.9) and abnormalities detected on an antenatal sonogram 3.3 (1.4-7.8) were associated with an increased risk of admission to NICU. CONCLUSION: Risk factors for NICU admission from nursery in term infants included prolonged PROM, a 1 min Apgar score of < or =7 points, a requirement of O2 at birth, and abnormalities on antenatal sonograms. Term infants with these risk factors should be carefully observed in the early neonatal period.
Apgar Score ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal* ; Logistic Models ; Membranes ; Nurseries* ; Parturition ; Patient Admission ; Pregnancy ; Risk Factors ; Rupture ; Term Birth

Acute infection increases disease activity in patients with systemic lupus erythematosus(SLE) and causes life threatening complication such as acute renal failure or ischemic bowel disease. We here report a case of acute renal failure and ischemic bowel disease complicated by acute pyelonephritis in a patient with SLE. A 19-year-old woman was admitted for high fever and right flank pain. Urine examination revealed acute pyelonephritis. Thrombocytopenia, proteinuria, positive antinuclear antibody and anti-dsDNA, false positive VDRL confirmed SLE. The pyelonephritis improved with antibiotic treatment, but oliguria and abdominal pain and ascites newly developed. Kidney biopsy and abdominal computed tomography revealed lupus nephritis type IV and ischemic bowel disease, respectively. After methylprednisolone and cyclophosphamide treatment, the patient improved.
Abdominal Pain ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Ascites ; Biopsy ; Cyclophosphamide ; Female ; Fever ; Flank Pain ; Humans ; Kidney ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Oliguria ; Proteinuria ; Pyelonephritis* ; Thrombocytopenia ; Young Adult

Most of the congenital diaphragmatic hernia (CDH) cases are diagnosed at prenatal period or immediately after birth with severe respiratory symptom. The classic triad, which is respiratory distress, apparent dextrocardia and a scaphoid abdomen, is usually seen in this period. Several case reports have described older infants and children with a wide spectrum of symptoms of CDH, whereas extremely few cases were reported in neonatal period except classic triad such as straungulation of the bowel. These atypical manifestations can lead physician to delayed diagnosis. We report two cases of CDH newborns. First case was diagnosed with pneumoperitoneum following tension pneumothorax, transient diaphragm eventration on 5 days after birth. The other case was diagnosed with failure to thrive and mediastinal mass on 30 days after birth. These cases suggest physicians to consider CDH in late newborn period with pneumoperitoneum following tension pneumothorax, transient diaphragm eventration, failure to thrive, and mediastinal mass.
Abdomen ; Child ; Delayed Diagnosis ; Dextrocardia ; Diaphragmatic Eventration ; Failure to Thrive ; Hernia, Diaphragmatic* ; Humans ; Infant ; Infant, Newborn* ; Parturition ; Pneumoperitoneum ; Pneumothorax

Univentricular heart, or single ventricle, is characterized by the entire flow from the two atria being carried directly through the left and right AV valves into the single ventricular chamber. According to the morphologic structure of the ventricle, univentricular heart is classified as left ventricular type, right ventricular type and rarely intermediate type. Natural survival depends primarily on factors that limit pulmonary blood flow, such as an increase in pulmonary vascular resistance or the presence of pulmonic stenosis. Other variables of survival include the morphologic type of single ventricle, the great artery anatomy and the adequacy of the atrioventricular connection. To our knowledge, this is first report in our country of a patient with single ventricle of left ventricular morphology who naturally survived into the second decade of life.
Arteries ; Heart* ; Humans ; Pulmonary Valve Stenosis ; Vascular Resistance

PURPOSE: Kidney transplantation (KT) is an ideal treatment for pediatric patients with end-stage renal disease (ESRD). We report the clinical outcomes of pediatric ESRD patients who underwent KT in a single regional center. METHODS: We retrospectively investigated the medical records of 60 pediatric patients who were diagnosed with ESRD and underwent KT in our hospital between January 1985 and June 2016. RESULTS: A total of 60 children and adolescents (40 male, 20 female; mean age, 13.86±4.26 years) were included in this study. Six patients (10.0%) underwent KT immediately after receiving the diagnosis of ESRD, while the others underwent KT after dialysis treatment (mean period of dialysis, 368.7±4,41.8 days). The mean donor age (50 living-related [83.3%], 10 deceased [16.7%]) was 40.0±12.85 years and the male:female ratio was 1.07:1. The most common cause of ESRD was chronic glomerulonephritis. The overall survival rates at 1, 3, and 5 years after KT were 98%, 98%, and 96%, respectively, while the graft survival rates at 1, 3, and 5 years were 93%, 86%, and 68%, respectively. Children who underwent KT before 10 years of age had better monthly growth rates than those who underwent KT later than 10 years of age. CONCLUSIONS: KT is performed less frequently in children than in adults, but causes of ESRD vary and clinical outcomes after KT greatly affect the growth and development of pediatric patients. Therefore, further analysis and monitoring of clinical progression after KT in pediatric ESRD patients are necessary.
Adolescent ; Adult ; Child ; Diagnosis ; Dialysis ; Female ; Glomerulonephritis ; Graft Survival ; Growth and Development ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Medical Records ; Retrospective Studies ; Survival Rate ; Tissue Donors

PURPOSE: Kidney transplantation (KT) is an ideal treatment for pediatric patients with end-stage renal disease (ESRD). We report the clinical outcomes of pediatric ESRD patients who underwent KT in a single regional center. METHODS: We retrospectively investigated the medical records of 60 pediatric patients who were diagnosed with ESRD and underwent KT in our hospital between January 1985 and June 2016. RESULTS: A total of 60 children and adolescents (40 male, 20 female; mean age, 13.86±4.26 years) were included in this study. Six patients (10.0%) underwent KT immediately after receiving the diagnosis of ESRD, while the others underwent KT after dialysis treatment (mean period of dialysis, 368.7±4,41.8 days). The mean donor age (50 living-related [83.3%], 10 deceased [16.7%]) was 40.0±12.85 years and the male:female ratio was 1.07:1. The most common cause of ESRD was chronic glomerulonephritis. The overall survival rates at 1, 3, and 5 years after KT were 98%, 98%, and 96%, respectively, while the graft survival rates at 1, 3, and 5 years were 93%, 86%, and 68%, respectively. Children who underwent KT before 10 years of age had better monthly growth rates than those who underwent KT later than 10 years of age. CONCLUSIONS: KT is performed less frequently in children than in adults, but causes of ESRD vary and clinical outcomes after KT greatly affect the growth and development of pediatric patients. Therefore, further analysis and monitoring of clinical progression after KT in pediatric ESRD patients are necessary.
Adolescent ; Adult ; Child ; Diagnosis ; Dialysis ; Female ; Glomerulonephritis ; Graft Survival ; Growth and Development ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Medical Records ; Retrospective Studies ; Survival Rate ; Tissue Donors