No abstract available.
Forehead* ; Methylmethacrylate*

BACKGROUND: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. METHODS: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. RESULTS: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). CONCLUSIONS: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Body Mass Index ; Bone-Patellar Tendon-Bone Grafts ; Female ; Humans ; Knee ; Linear Models ; Male ; Outcome Assessment (Health Care) ; Patellar Ligament ; Retrospective Studies ; Tears ; Transplants*

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure. MATERIALS AND METHODS: A retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed. RESULTS: Mean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p<0.001), morcellation efficiency reached a learning curve at 20 cases (p=0.032), and enucleation ratio had no learning curve in this study. There were several cases of surgery-related complications, including bladder mucosal injury by the morcellator (13%), capsular injury during enucleation (7%), and conversion to a conventional resectoscopy procedure (15%), which showed a reduction in incidence with time. CONCLUSIONS: The learning curve of HoLEP is steep; however, it can be overcome gradually. Further study is necessary with respect to long-term postoperative follow-up.
Follow-Up Studies ; Holmium ; Humans ; Incidence ; Lasers, Solid-State ; Learning ; Learning Curve ; Lower Urinary Tract Symptoms ; Prostate ; Prostatic Hyperplasia ; Retrospective Studies ; Urinary Bladder

PURPOSE: A questionnaire is a mandatory screening tool for the deduction of an androgen deficiency in aging males (ADAM). The aim of this study was to translate the ADAM questionnaire into Korean and validate it linguistically. MATERIALS AND METHODS: Two native Korean speakers, who were also fluent in English, independently translated the original English version of the ADAM questionnaire into written Korean. A panel, consisting of the aforementioned translators and four urologists, reviewed the translations to form a single acceptable forward translation. Another translator, having never seen the original version, back-translated the first draft into English. The discrepancies between the original form and the first draft of the Korean translation were reviewed by the panel. Cognitive debriefing interviews with five impotent males with low serum total testosterone levels (>250 ng/dl) were conducted to test the interpretation of the translation. RESULTS: After the forward translation of the ADAM questionnaire, the cultural, linguistic and emotional aspects were discussed, item-by-item, to arrive at a first version. Another bilingual translator then back- translated the first Korean version into English. The panel discussed every discrepancy and decided to modify questions 6 and 8 (second version). Five ADAM patients gave their opinions on the understandability of the translated questionnaire and clarified the questions on a standard form. Through this cognitive debriefing process, the second version was verified as the final Korean version of the ADAM questionnaire, without modifications. CONCLUSIONS: The linguistic validation of Korean version of the ADAM questionnaire has been completed, which might be a useful and reasonable screening tool for the detection of androgen deficiency in aging Korean males.
Aging* ; Humans ; Linguistics ; Male* ; Mandatory Testing ; Mass Screening ; Surveys and Questionnaires* ; Testosterone ; Translations

We report a case of a 51-year-old woman with Evans syndrome (autoimmune hemolytic anemia and primary immune thrombocytopenia) and hypothyroidism. She was previously diagnosed with Hashimoto's thyroiditis in 1994 (age, 35) and autoimmune hemolytic anemia (AIHA) 3 years ago. She was treated with oral prednisolone. After a period, in which the anemia waxed and waned, there was an abrupt development of thrombocytopenia (nadir 15x10(9)/L) that coincided with the tapering off of prednisolone after 3 years of administration. Because her thrombocytopenia was refractory to prednisolone, we administered rituximab (375 mg/m2 weekly) for 4 weeks. Two weeks after the completion of the rituximab treatment, her platelet count was up to 92x10(9)/L. No intermittent peaking of thyroid stimulating hormone occurred after rituximab treatment was initiated. Evans syndrome and autoimmune thyroiditis might share common pathophysiological mechanisms. This notion supports the use of rituximab in a patient suffering from these disorders.
Anemia ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Antibodies, Monoclonal, Murine-Derived ; Female ; Humans ; Hypothyroidism ; Middle Aged ; Platelet Count ; Prednisolone ; Stress, Psychological ; Thrombocytopenia ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune ; Thyrotropin ; Rituximab

No abstract available.
Adult* ; Humans

Korea is a region abundant in foods containing iodine such as seaweed and fish. An adequate amount of iodine consumption is extremely important as both a deficiency and excess of iodine can result in health problems. This study was undertaken to assess the iodine nutritional status of normal Korean adults who consume seaweed and fish, and to determine the relationship between the dietary iodine intake and the urinary excretion of iodine. The dietary assessment of iodine using a food frequency questionnaire and a urinary iodine excretion examination were carried out in 278 healthy adults. The iodide selective electrode (ISE) method was used to determine urinary iodine excretion. The average usual iodine intake of Korean adults was 479 micrograms per day (ranging from 61 micrograms to 4086 micrograms). There was no significant difference in sex or age. The major food sources of dietary iodine included seaweed (66%), milk and dairy products (11%), and fish (9%). The contribution of seaweed to the total iodine intake tended to increase with age while the contribution of milk decreased. The average urinary excretion of iodine was 674 micrograms/g creatinine and there was no significant difference in sex or age. The dietary iodine intake was positively correlated with the urinary excretion of iodine (gamma = 0.60, p < 0.01). The study data indicated that the iodine intake and excretion of Koreans depends mostly on the amount of seaweed consumption like sea tangle and sea mustard. As well, the current iodine intake and urinary iodine excretion by Koreans seems to be higher than in other countries.
Adult ; Dietary Supplements ; Female ; Human ; Iodine/urine* ; Iodine/administration & dosage* ; Korea ; Male

PURPOSE: The factors for predicting persistent urge symptom and urge incontinence following a tension-free vaginal tape (TVT) procedure were investigated in patients with mixed urinary incontinence. MATERIALS AND METHODS: Two hundred and seventy-four women, with a mean age of 55 years, ranging from 28 to 80, with female urinary incontinence (stress urinary incontinence; 201, mixed urinary incontinence; 73) were the subjects of this study. After a TVT procedure, the patients were followed up at 1, 6 and 12 months and every 1 year thereafter. Cure of incontinence after the procedure was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, with all other cases considered as failures. RESULTS: There was no significant difference in the cure rates for stress urinary incontinence in patients with stress and mixed urinary incontinence. However, of 73 patients with mixed urinary incontinence, 20 (27.4%) ans 12 (16.4%) had persistent urgency and continued urge incontinence, respectively. In a multivariate analysis, a low maximal urethral closure pressure (MUCP) was found to be associated with an increased likelihood of persistent urgency (odds ratio, 0.94; 95% confidence interval, 0.38-0.99; p=0.029) and the persistent urge incontinence (odds ratio, 0.94; 95% confidence interval, 0.88-0.99; p=0.030) after a TVT procedure in patients with mixed urinary incontinence. CONCLUSIONS: Our findings suggest that a low MUCP may be associated with the persistent urgency and urge incontinence after a TVT procedure in patients with mixed urinary incontinence.
Exercise Test ; Female ; Humans ; Multivariate Analysis ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Urge*

OBJECTIVE: We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium. STUDY DESIGN: Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ~ 8 days after ovulation (POD 7 ~ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. RESULTS: PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. CONCLUSIONS: In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.
Biopsy ; Cyclooxygenase 2* ; Discrimination (Psychology) ; Endometriosis ; Endometrium* ; Epithelial Cells ; Female ; Gynatresia ; Humans* ; Ovulation ; Progesterone* ; Receptors, Progesterone* ; Stromal Cells

PURPOSE: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lower urinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in this study. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physicians and the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR) analysis. RESULTS: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2 (+/-7.3, standard deviation) years and 47.3 (+/-25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated by physician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589 (53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladder outlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question 3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume (R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to the LR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised (0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820, P=0.063) to the LR model. CONCLUSIONS: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenced decision-making in physicians treating patients with LUTS/BPH.
Bayes Theorem ; Decision Making, Computer-Assisted ; Decision Support Techniques ; Humans ; Linear Models ; Lower Urinary Tract Symptoms* ; Prostate ; Prostatic Hyperplasia* ; ROC Curve ; Urinary Bladder Neck Obstruction ; Urodynamics