PURPOSE: Abnormalities of the relaxation and contraction of the corpus cavernosum can lead to erectile dysfunction. Therefore, we induced a partial bladder outlet obstruction(PBOO) in male rats, and investigated the mechanisms of penile dysfunction with endothelial nitric oxide synthase(eNOS), vascular endothelial growth factor(VEGF), endothelin-1(ET-1), and apoptosis of peri-vascular smooth muscle and connective tissue cells in the corpus cavernosum. MATERIALS AND METHODS: PBOO was induced in 13 Sprague-Dawley rats by placing a 25 gauge needle sheath around the urethra, then ligating the bladder neck with a 3-0 suture. Three week after surgery, distal penile tissues were dissected for immunohistochemical staining, immunoblotting, and TUNEL staining. RESULTS: The expression of eNOS and VEGF were significantly decreased, whereas the expression of ET-1 and apoptosis of perivascular smooth muscle and connective tissue cells were significantly increased in the corpus cavernosum. CONCLUSIONS: The significant increase of ET-1 and apoptosis along with decreased eNOS and VEGF could mediate erectile dysfunction.
Animals ; Apoptosis ; Connective Tissue Cells ; Contracts ; Endothelin-1 ; Erectile Dysfunction ; Humans ; Immunoblotting ; In Situ Nick-End Labeling ; Male ; Muscle, Smooth ; Neck ; Needles ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Rats ; Rats, Sprague-Dawley ; Relaxation ; Sutures ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Vascular Endothelial Growth Factor A

PURPOSE: The National Institute of Health (NIH) category III chronic nonbacterial prostatitis/chronic pelvic pain syndromes (CPPS) are commonly seen disorders; however, there has been no consensus on how to manage these patients. The purpose of this trial was to compare the efficacy of antibiotic monotherapy and antibiotic plus alpha-blocker combination therapy for the treatment of CPPS patients. MATERIALS AND METHODS: The study was comprised of 54 patients who were randomly placed into two groups: group I was treated with levofloxacin alone (28 patients), and group II was treated with levofloxacin and alfuzosin (26 patients). The levofloxacin, or the levofloxacin and alfuzosin were given to the respective groups for 8 weeks. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) was evaluated both before and after the treatment. RESULTS: Before the treatment, the mean CPSI of the group I patients was 23.1+/-8.1, and after the treatment, it was 15.6+/-5.6. For the group II, the mean CPSI before the treatment was 23.9+/-8.3, and after the treatment, it was 11.0+/-4.5. The difference between the pre-and post-treatment CPSI scores of group II was significantly larger than that of group I (p=0.001). The mean differences of the CPSI from the initial scores to the final scores in both groups were followed: 2.2 in group I and 4.3 in group II for the pain domain, 1.5 in group I and 2.8 in group II for the urinary domain, and 3.8 in group I and 5.7 in group II for the quality of life domain. CONCLUSIONS: Combination therapy of levofloxacin with alfuzosin appeared more effective for treating patients with chronic prostatitis/chronic pelvic pain syndrome than just administering antibiotic alone.
Adrenergic alpha-Antagonists ; Anti-Bacterial Agents ; Chronic Disease ; Consensus ; Humans ; Levofloxacin ; Pelvic Pain* ; Prospective Studies* ; Prostatitis ; Quality of Life

Some aneurysms with peculiar shapes, large sized or in unusual location cannot be obliterated by ordinary methods. We present four cases using two kinds of fenestrated clips. There were 4 aneurysms in the 4 patients:3 saccular and 1 fusiform aneurysm. Two aneurysms were located in anterior communicating artery, one left carotico-opthalmic artery, and one distal middle cerebral artery. All of the aneurysms were successfully obliterated. Our results suggest that the various shape of fenestrated clips may be benefit for clipping difficult aneurysms, which would not be clipped with ordinary one.
Aneurysm ; Arteries ; Intracranial Aneurysm* ; Middle Cerebral Artery

No abstract available.
Classification* ; Female ; Hydatidiform Mole* ; Pregnancy

PURPOSE: To evaluate the MRI findings of acute facial nerve paralysis in Bell's palsy and herpes zosteroticus, and to correlate these with the clinical findings. MATERIALS AND METHODS: We retrospectively reviewed theMRI findings in six cases of Bell's palsy(BP) and two of herpes zoster oticus(HZO), and compared them with thefindings for 30 normal facial nerves. This nerve was considered abnormal when its signal intensity was greaterthan that of brain parenchyma or the contralateral normal side on Gd-enhanced T1-weighted axial and coronal MRimages. We analysed the location and degree of contrast enhancement, interval change, and clinical progression incorrelation with House-Brackmann(HB) grade and electroneuronography(ENoG) findings. RESULTS: Fifteen of 30 normalfacial nerves(50%) seen on Gd-enhanced MRI were mildly enhanced in the geniculate ganglion, the proximal tympanic,and the proximal mastoid segment of the facial nerve. No enhancement of the internal auditory canal(IAC) orlabyrinthine segment of the facial nerve was noted, however. In BP and HZO, Gd-enhanced MR images revealed fair tomarked enhancement for more than two segments from the internal auditory canal to the mastoid segment of thefacial nerve. During follow-up MRI, enhancement of the facial nerve varied in location and signal intensity,though gradually decreased in intensity approximately eight weeks after the onset of facial nerve palsy. Nocorrelation between clinical HB grade, ENoG, and follow up MRI findings was noted. CONCLUSION: Except in theinternal auditory canal and labyrinthine segment, normal facial neve may show mild and relatively symmetricalenhancement. In BP and HZO, the facial nerve showed diffuse enhancement from the IAC to the mastoid segment.
Bell Palsy* ; Brain ; Facial Nerve ; Follow-Up Studies ; Geniculate Ganglion ; Herpes Zoster Oticus* ; Herpes Zoster* ; Magnetic Resonance Imaging* ; Mastoid ; Paralysis ; Retrospective Studies

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic "bamboo spine" appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.
Arthroplasty* ; Hip* ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Ligaments ; Needles ; Sciatic Nerve* ; Skeleton ; Spine ; Spondylitis, Ankylosing*

OBJECTIVES: A number of investigators have examined the possible pathophysiological mechanisms in patients who died from asthma, but the reasons for the increased incidence of death in patients with asthma are largely unknown. To elucidate the risk factors and possible causes of fatal asthma, we reviewed the clinical data of patients with potentially fatal asthma(PFA). METHODS: We retrospectively studied the clinical and laboratory profiles of 35 PFA patients(43 episodes) who had been admitted at the Kyungpook University Hospital and Taegu Fatima Hospital in recent 5 years(1989. 7-1994. 6). Our criteria of PFA were defined as either respiratory arrest or an arterial carbon dioxide tension(PaCO2) greater than 50 mmHg or an altered state of consciousness, due to acute asthma. RESULTS: 1) Twenty four patients with PFA were female and 11 male. At the time of PFA episode, age distribution was between 16-65 year (42% between 36-49). 2) Seasonal distribution was 13 episodes between March and May, 13 June and August, 6 September and November, 11 December and February. 3) Previous hospitalization history due to asthmatic attack was noted in 81 percent, and 75 percent were relatively compliant to their therapy. 5) At visiting emergency room, 81 percent satisfied the criteria of PFA, whereas 19 percent during hospitalizatoin. 77 percent required mechanical ventilation, and 52 percent of them within 30 minutes after visiting. 6) Initial arterial blood gas analysis at emergency room showed marked hypercapnia(75 +/- 29 mmHg), hypoxemia(50 +/- mmHg) and acidosis(pH 7.14 +/- 0.15). Serum potassium levels were within normal ranges in 75 percent. 7) All, except one, showed no significant cardiac arrthymias. 8) Possible precipitating factors leading to PFA were respiratory tract infection in 31 episodes, ingestion of NSAIDs in 2, emotional upsets in 2, irritant air pollutions in 2, withdrawal of anti-asthma drugs in 1, and unknown causes in 5. 9) Nine of 16 patients were atopic, and majority of them showed positive reaction to Dermatophagoides antigen. CONCLUSIONS: These results may suggest that PFA is mainly due to airway obstruction, and upper respiratory infection is an important precipitating factor leading to PFA. It is necessary to establish an appropriate plan for preventing PFA and related deaths.
Age Distribution ; Air Pollution ; Airway Obstruction ; Anti-Inflammatory Agents, Non-Steroidal ; Asthma* ; Blood Gas Analysis ; Carbon Dioxide ; Consciousness ; Daegu ; Eating ; Emergency Service, Hospital ; Female ; Gyeongsangbuk-do ; Hospitalization ; Humans ; Incidence ; Male ; Potassium ; Precipitating Factors ; Pyroglyphidae ; Reference Values ; Research Personnel ; Respiration, Artificial ; Respiratory Tract Infections ; Retrospective Studies* ; Risk Factors ; Seasons

Tuberous sclerosis is an autosomal dominant disease characterised by hamartomas (tubers) in many organ systems and the four major intracranial manifestations including cortical tubers, white matter abnormalities, subependymal nodules and subependymal giant cell astrocytoma. But there is immense variability in the clinical presentation of tuberous sclerosis and many incomplete forms (formes frustes) exist. Almost all patients with tuberous sclerosis have seizures and mental retardation. The authors experienced a 7-year-old boy with medically intractable epilepsy without any skin lesion or mental retardation. In terms of surgical standpoint for determination of extent of resection, corticectomy on the overriding cortex of right premotor and lesionectomy of periventricular calcified lesion were performed according to ictal single photon emission computed tomography(SPECT), which showed hyperperfusion in the subcortical and calcified area. Histopathologic findings showed a few cytologically abnormal neurons with extensive gliosis, containing many Rosenthal fibers, reactive astrocytes and dense calcification, composing of abundant calcospherites which suggested forme fruste tuberous sclerosis. During the follow-up period of eighteen months, seizure was free after surgery.
Astrocytes ; Astrocytoma ; Child ; Epilepsy* ; Follow-Up Studies ; Gliosis ; Hamartoma ; Humans ; Intellectual Disability ; Male ; Neurons ; Seizures ; Skin ; Tuberous Sclerosis*

Adrenal myelolipoma is an uncommon, benign, hormonally non-active lesion that is composed of a mix of hemopoietic elements and mature adipose tissue. Most adrenal myelolipomas are incidentally found by ultrasonogram, computed tomography or magnetic resonance imaging. This tumor is commonly asymptomatic, although patients will occasionally present with nonspecific abdominal pain. We report here on a case of myelolipoma that was treated by Hand-assisted transperitoneal laparoscopic adrenalectomy.
Abdominal Pain ; Adipose Tissue ; Adrenal Glands ; Adrenalectomy* ; Humans ; Laparoscopy ; Magnetic Resonance Imaging ; Myelolipoma* ; Ultrasonography

AIMS: This study was done to develop an ethical guideline for organ transplatation, a life-saving treatment which helps improve the quality of life. METHODS: This study begins with a survey of the Korean current state of affairs concerning organ transplantation. This study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. After this survey, followed by a discussion of ethical considerations in arranging organ transplants. Before proposing an ethical guideline, this study discusses a series of interesting ethical issues in transplanting(both living and cadaveric)organs including ethical foundations of organ transplantation, distributive justice and matters of donor's consent in organ transplatation. RESULTS: The foremost research for this study boils down to a survey paper titled, "An Analysis of the Current State of Affairs Concerning Organ Transplantation and Ethical Considerations in Domestic and International Hospitals." Based upon data collected from various hospitals, this work analyzes items, such as the frequency and types of organs transplanted in a hospital, the existence of organ transplant coordinator, the performance of the hospital ethics committee, and ethical considerations in obtaining consents from the living donor. Although thousands of organs are annually transplanted in domestic hospitals, virtually none of them are found to meet ethically proper standards. The paper points out the need to institutionalize a nationwide cadaveric organ distribution organization like UNOS(United Network for Organ Sharing) in the U.S., and proposes to stretch out the national health insurance to extensively cover transplanting expenses. "The Ethical Foundation of Organ Transplantation", the author counts three key ethical principles in organ transplantation: the principle of respect for autonomy; the principle of beneficence; and the principle of justice. He argues that in cases of living donor no principle should take precedence over the principle of respect for autonomy and thus it is very important for a hospital to obtain the donor's consent. As for cadaveric organ transplantation, he holds reservation because he is worried that serious shortage of organs for transplantation in conjunction with pure utilitarian considerations could change the definition of death so that the brain death gains more popularity than ever. In addition, the author claims that the proponent of organ transplantation must distinguish the moral dimension of the discussion from the legal one because otherwise she would hardly be able to defend herself from the slippery slope argument against organ transplantation. This paper concludes with a note that we must implement restrictions to avoid undesired effects if organ transplantation could ever be justified. "A Discussion of Distributive Justice in Organ Transplantation" comprises two parts. The first half delineates above mentioned ethical principles in the context of organ transplantation, while the second half goes generally over the UNOS Point System. This work is focused entirely upon cadaveric organ transplants, because the vast majority of organs available for transplants comes from cadavers and the number is still increasing. The UNOS allocates cadaveric organs based upon both medical and justice criteria. Following are summaries of the UNOS policy on organ distribution. Every potential recipient of organ transplants must be listed on the UNOS computer system waiting list. Allocation of cadaveric kidneys consider factors such as waiting time, six antigen match, panel reactive antibody, blood group and age. The UNOS Point System allocates livers to the local patients first, followed by regional and national patients respectively, in order to limit ischemic time. A recipient of liver transplant belongs to one of five(0~4) medical status levels where status 4 is the most medically urgent. At the regional and national levels pancreas are allocated first to patients with excellent HLA matches, while at the local level waiting time is the sole factor. The intestinal organ allocation system is based on two(1~2) patient status codes, ABO blood type identity and time waiting. In heart or lung tranplants ischemic time seriously matters. "A Biomedical Study of Informed Consent from the Organ Donor" investigates several topics: the relevance of the principle of respect for autonomy as the basic principle of informed consent; how the autonomy of the organ donor to be respected; and the role of the hospital ethics committee in obtaining informed consent from the donor. The author finds the principle of respect for patient's autonomy not sufficient for the basic principle of the living donor's informed consent because there is some danger in which the patient may be left uncared-for, and thus she suggests that the principle of nonmaleficence and the principle of care also be considered. That the principle of respect for autonomy turns out not sufficient even for cadaveric organ donation, and so judgment based upon the best interest of the deceased may seem appropriate for people from some special groups. A medical team must make efforts to identify the donor's competence and voluntariness, i.e., preconditions of informed consent. All the relevant medical information should be disclosed to the living donor. Once the donor makes a judgment, medical experts should respect the donor's decision. This article puts an emphasis on the role of the hospital ethics committee in such activities as identifying donor's voluntariness, confirming the disclosure, and evaluating the minority's benefit. The last work in this paper, "A Moral Theological Investigation of the Presumed Consent in Organ Transplantation" talk about Principium Riflexum(the principle of reflection) in an attempt to explain the possibility that we may harvest cadaveric organs from the deceased who while alive had never expressed their wishes concerning organ donation. To apply the principle in the context of presumed consent, the author, a Catholic priest, introduces two elements of the principle. Probabilismus allows us to feel free to choose when we face dubious matters(in dubio libetas), and by the rule of selection we are justified in choosing whatever our consciousness mandates. He takes both elements to support the presumed consent of the deceased because he believes the good that people may contribute to their neighbors by donating organs would obviously override opposing reasons. Although the author argues for the presumed consent from the deceased, he does not overlook the family grief in donating the cadaveric organs. He concludes with a suggestion that we should work to keep the public aware of cadaveric organ donation and to form public opinions education should play a key role. CONCLUSION: Researcher suggest an Ethical Guideline for Organ Transplantation as our study conclusion. 1) Body organs may be transplanted to protect the health and well-being of the patient, but not for the medical or scientific research. 2) Body organs may be taken for transplantation, only with the consent from the donor. In cases of cadaveric donors who have left no formal consent in the lifetime, they are to be presumed to refuse to donate body organs. 3) In principle, cadaveric transplantation is preferred. Living donors are limited to competent adults who have blood ties with the patient, e.g., parents, children, or siblings of the patient. However, reversible tissue like bone marrows donation may be an exception to this limitation. In particular, no living donors may be put under inappropriate pressure or influences. Body organs may be taken from the living donor only if based upon sufficient and easy-to-understand information provided, the donor voluntarily consents after (s)he deliberately balances benefits against harm. 4) Under no circumstances human bodies, organs, or tissues may be sold or purchased for transplantation. A physician should not participate in any transplanting operations if (s)he becomes to know that the transplant has been obtained through a transaction. 5) Recipients of organs for transplantation should be determined in accordance with the principle of justice on the allocation of limited medical resources. 6) When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient's physician. 7) Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with adequate facilities. 8) All decision procedures in transplanting body organs should be objective, open to parties involved, kept accurately on record, and maintained for a given period of time.
Adult ; Beneficence ; Bioethics* ; Bone Marrow ; Brain Death ; Cadaver ; Child ; Computer Systems ; Consciousness ; Disclosure ; Education ; Ethics ; Ethics Committees, Clinical ; Foundations ; Furunculosis ; Grief ; Heart ; Human Body ; Humans ; Informed Consent ; Judgment ; Kidney ; Liver ; Living Donors ; Lung ; Mental Competency ; National Health Programs ; Organ Transplantation* ; Pancreas ; Parents ; Presumed Consent ; Public Opinion ; Quality of Life ; Surveys and Questionnaires ; Siblings ; Social Justice ; Tissue and Organ Procurement ; Tissue Donors ; Transplants* ; Waiting Lists ; Wedge Argument