PURPOSE: The aim of this study was to demonstrate that the combined systemic administration of apomorphine (APO) and sildenafil have a synergistic effect on the erection in conscious rabbits. MATERIALS AND METHODS: The erections of the male New Zealand White rabbits (2-3kg, n=12) were assessed by measuring the length of the uncovered penile mucosa (LUPM) and duration of the erection, both before and after the intravenous administration of agents. After the injection of APO (0, 0.05, 0.1, 0.4mg/kg), sildenafil was administered intravenously in a dose-response manner (0.5, 1, 5mg/kg), followed by measurements for 0-120 minutes. In additional experiments, the effect of increasing the dosages of sildenafil, combined with APO, on blood pressure were evaluated. RESULTS: The intravenous administration of sildenafil caused a concentration dependent increase in the LUPM. There was a statistically significant increase in the LUPM with the administration of APO compared with no administration. The dosages of sildenafil and APO showing the greatest efficacy of sildenafil potentiation were 1mg/kg and 0.1 mg/kg, respectively. The intravenous administration of APO at a dose of 0.1mg/kg was more effective than those of 0.05 and 0.4mg/kg, with dosages of sildenafil of 0.5 and 1mg/kg. There was no additional increase in the duration of erection on the administration of APO. The intravenous administration of sildenafil caused a concentration dependent decrease in blood pressure, but there was no additional decrease on administration of the APO. CONCLUSIONS: We have shown that apomorphine elicits a stronger response on the erection induced by sildenafil in conscious rabbits, with no additional decrease in blood pressure.
Administration, Intravenous ; Apomorphine* ; Blood Pressure ; Humans ; Male ; Mucous Membrane ; Penile Erection* ; Rabbits* ; Sildenafil Citrate

To evaluate the effects of reflected glare on eyes, authors assessed the periodic health examination(1991-1996) and self-administered questionnaire data of a semiconductor producing company. The 13 lead frame(LF) department workers have been exposed to high reflected glare in the process for examining the silver plating products. We compared the data of connector(14) and clerical(12) workers as the non-exposed ones. Among LF department workers, 100% felt their visual acuity worsened(connector:81.8%, clerical:85.7%), and 70% had worn the glasses or contact lenses(connector :14.3 %, clerical :40%) since working at the company. Major ophthalmic symptoms of the LF workers are asthenopia, tearing, decreased visual acuity, congestion and glare. Decrease of visual acuity by Hahn's line change of the LF workers is significantly high during a 5-year follow-up(p<0.05 by simple regression) compared with connector, clerical workers.
Asthenopia ; Estrogens, Conjugated (USP) ; Eyeglasses ; Female* ; Glare ; Glass ; Humans ; Surveys and Questionnaires ; Semiconductors ; Silver* ; Tears ; Visual Acuity*

PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.
Compliance* ; Counseling ; Education ; Erectile Dysfunction ; Humans ; Male ; Prescriptions ; Sexual Behavior ; Telephone ; Sildenafil Citrate

Catamenial hemoptysis is syndrome characterized by bleeding from the bronchial trees and lungs that occurs synchronously with the female menstrual cycle. Etiologic mechanism of pulmonary endometriosis is still controversial, and the diagnosis is usually made on the basis of the clinical history and exclusion of other causes of recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations have been proved to be a useful confirmatory test. We experienced a 33-year-old female patient who had been previously diagnosed as pelvic endometriosis pathologically, experienced cyclic hemoptysis during menstruations. The diagnosis of pulmonary endometriosis was made based on her history and changes in the character of the lesions as documented on radiologic studies of the chest. She was treated successfully with GnRH analogue and there is no evidence of recurrence.
Female ; Humans

A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo-scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer.
Adenocarcinoma ; Aged ; Biopsy ; Carcinoma, Signet Ring Cell ; Constriction, Pathologic ; Duodenal Neoplasms* ; Duodenum ; Esophagus* ; Gastrectomy ; Humans ; Intestines* ; Laparotomy ; Lymph Node Excision ; Lymph Nodes ; Male ; Mucous Membrane ; Nausea ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Stomach Neoplasms* ; Stomach* ; Ulcer ; Vomiting

Trochlear nerve palsy associated with spontaneous subarachnoid hemorrhage (SAH) is known to be a rare malady. We report here on a patient who suffered with left trochlear nerve palsy following rupture of a right posterior communicating artery aneurysm. A 56-year-woman visited our emergency department with stuporous mental change. Her Hunt-and-Hess grade was 3 and the Fisher grade was 4. Cerebral angiography revealed a ruptured aneurysm of the right posterior communicating artery. The aneurysm was clipped via a right pterional approach on the day of admission. The patient complained of diplopia when she gazed to the left side, and the ophthalmologist found limited left inferolateral side gazing due to left superior oblique muscle palsy on day 3. Elevated intracranial pressure, intraventricular hemorrhage or a dense clot in the basal cisterns might have caused this trochlear nerve palsy.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Cerebral Angiography ; Diplopia ; Emergencies ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Intracranial Hypertension ; Muscles ; Paralysis ; Rupture ; Stupor ; Subarachnoid Hemorrhage ; Trochlear Nerve ; Trochlear Nerve Diseases

OBJECTIVES: To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.
Adult ; Aged ; Female ; Health Expenditures ; Health Services/economics/*utilization ; Humans ; Insurance, Health/*statistics & numerical data ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasms/economics/*therapy ; *Private Sector ; Socioeconomic Factors

PURPOSE: Despite gsstric cancer is one of the most common ma1ignancies, its prognosis has not been improved significantly. Therefore, it is important to know what clinical and pathological factors relate to survival in gastric carcinoma in order to improve survival rate. The aim of this retrospective study was to evaluate treatment results and to analyze the factors that affect the survival of patients with gastric carcinoma. MATERIALS AND METHODS: A total of 1,580 patients with primary gastric adenocarcinoma who had been treated surgically during the period 1983-1996 at the Department of Surgery, Korea University College of Medicine was studied to evaluate the treatment outcome. Prognostic factors were investigated by univariate and multivariate analyses in 1,407 resected patients. RESULTS: The 5-year survival rate was 57.1% in all case, 62.4% in resected cases, and there was no survivor at 2.5 year in unresectable cases. In univariate analysis, gross type, maximum tumor diameter, depth of invasion, lymph node involvement, distant metastasis, histologic type and type of operation were found to correlate significantly with survival. Multivariate analysis indicated that lymph node involvement, depth of invasion and type of cancer were independently conelated with survival. The stage-related survival rates (UICC, 1987) were 95.8% (stage Ia), 87.6% (stage Ib), 76.7% (stage II), 51.3% (stage 1IIa), 25.5% (stage IIlb), 9.4% (stage IV) and the stage-related survival rates (UICC, 1997) 95.8% (stage Ia), 87.6% (stage Ib), 76.4% (stage II), 55.2% (stage IIla), 24.0% (stage IIIb), 13.4% (stage IV). There was no difference between two staging systems. CONCLUSIONS: These results suggest that lymph node involvement, depth of invasion, and gross type were the most important prognostic factors, indicating that they may be helpful as predictors of long-term survival and in planning the treatment.
Adenocarcinoma* ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Survivors ; Treatment Outcome

PURPOSE: Grinding with less stress on 3Y-TZP through proper selection of methods and instruments can lead to a long-term success of prosthesis. The purpose of this study was to compare the phase transformation and physical properties after zirconia surface grinding with 3 different grinding burs. MATERIALS AND METHODS: Forty disc-shaped zirconia specimens were fabricated. Each Ten specimens were ground with AllCeramic SuperMax (NTI, Kahla, Germany), Dura-Green DIA (Shofu Inc., Kyoto, Japan), and Dura-Green (Shofu Inc., Kyoto, Japan). Ten specimens were not ground and used as a control group. After the specimen grinding, XRD analysis, surface roughness test, FE-SEM imaging, and biaxial flexural strength test were performed. RESULTS: After surface grinding, small amount of monoclinic phase in all experimental groups was observed. The phase change was higher in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs. The roughness of surfaces increased in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs than control groups and ground with Dura-Green. All experimental groups showed lower flexural strength than control group, but there was no statistically significant difference between control group and ground with Dura-Green DIA and AllCeramic SuperMax burs. The specimens, which were ground with Dura- Green showed the lowest strength. CONCLUSION: The use of dedicated zirconia-specific grinding burs such as Dura-Green DIA and AllCeramic SuperMax burs decreases the grinding time and did not significantly affect the flexural strength of zirconia, and therefore, they may be recommended. However, a fine polishing process should be accompanied to reduce the surface roughness after grinding.
Prostheses and Implants

BACKGROUND: Dosage influences distribution of a local anesthetic solution in cerebrospinal fluid. The dose of intrathecal local anesthetic was investigated, taking into account the patient's weight and height, to see whether this would stabilize the hemodynamics and provide adequate spinal anesthesia for Cesarean section. METHODS: In this double-blind prospective study, 60 patients undergoing elective Caesarean delivery were randomized to receive either fentanyl 25microgram in hyperbaric 0.5% bupivacaine 2.5 ml (Group 1) or fentanyl 25microgram and 0.9% normal saline in a volume of hyperbaric 0.5% bupivacaine, taking into account the patient's weight and height (Group 2). The patient's hemodynamics, time to sugical incision, supplementary analgesia and conversion to general anesthesia, etc were recorded. RESULTS: The incidence of hypotension and use of ephedrine were decreased, and the administration of fluid and the duration of motor blockade were significantly shorter in Group 2. The time to surgical incision was faster and the peak sensory level was higher in Group 1. Others effects were similar in both groups. CONCLUSIONS: The dose of intrathecal local anesthetic, taking into account the patient's weight and height stabilized the hemodynamics and provided adequate spinal anesthesia for elective Cesarean section.
Analgesia ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cerebrospinal Fluid ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Pregnancy ; Prospective Studies