In the situations that intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility, there appeared some needs to evaluate the role of microsurgical single tubular epididymovasostomy (EV). The outcome of microsurgical single tubular EV for obstructive azoospermia patients was retrospectively reviewed in 61 patients who had been followed for more than 18 months postoperatively. The overall patency rate followed surgery was 69% (42/61 patients), and live-birth rate was 31% (19/61 patients). Of these 19 men 13 were able to impregnate their partners; 6 of the 19 live-birth were achieved with the assistance of conventional IVF. Previously known prognostic factors-etiology, preoperative testis biopsy findings and intraoperative presence of sperm or motile sperm- all did not affect the patency and pregnancy rate. The live-birth rate of ICSI has been reported about 20~40%. Our results suggest that microsurgical single tubular EV is the preferential method to treat obstructive azoospermia patients concerning the merits of natural pregnancy and high patency rate. ICSI would be applied to the patients with patent anastomoses who have failed to achieve natural pregnancy. We think that microsurgical single tubular EV in obstructive azoospermia patients should be performed more actively by well-trained urologists in more expanded indications.
Azoospermia ; Biopsy ; Humans ; Infertility, Male ; Male ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic* ; Spermatozoa ; Testis

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.
Adult ; Dyspnea ; Female ; Follow-Up Studies ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lung ; Myxoma* ; Perfusion ; Pulmonary Embolism* ; Thorax

Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Blood Platelets ; Blood Transfusion ; Hip ; Humans ; Suction* ; Wounds and Injuries

PURPOSE: The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. MATERIALS AND METHODS: In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. RESULTS: The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the diaphysis in five, and the metadiaphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. A solid mass was present in all cases of malignant bone tumor, and an extraosseous mass in five such cases. Two benign bone tumors took the form of a cystic mass, two were a cystic mass containing an enhanced solid portion, and one was a solid mass. A soft tissue hematoma was seen in three cases. CONCLUSION: Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion.
Diaphyses ; Eosinophilic Granuloma ; Femur ; Fractures, Spontaneous* ; Hematoma ; Humans ; Humerus ; Magnetic Resonance Imaging* ; Osteomyelitis ; Radiography ; Retrospective Studies ; Tibia

Nonpalpable breast abnormalities which require excision and biopsy usually require marker localization. Many of these abnormalities are visible on ultrasound and this imaging technique can be used to guide fine needle aspiration and the placement of a wire marker prior to surgical excision. A non-invasive technique which does not require placement of a wire marker would offer significant advantages, being more pleasant for the patient and less demanding on resources. We attempted to localize 36 nonpalpable breast masses with non-invasive ultrasound marker technique at the department of general surgery, Soon Chun Hyang University Hospital, between January 1994 and February 1995. Cases clearly visible on ultrasound, whether on mammography(15 patients) or not(17 patients), underwent non-invasive ultrasound localization. In all cases the abnormality was easily identified and removed during surgery. The surgical biopsies contained fibroadenoma(19 cases), fibrocystic disease(12 cases), epithelial hyperplasia(1 case), intraductal papilloma(1 case), parasitic disease(1 case) and infiltrating ductal carcinoma(2 cases). The average age was 43 years old.. This non-invasive technique is a simple and accurate method for localizing small ultrasonically visible nonpalpable breast abnormalities, especially in younger female patient with dense breast, though further trials and studies will be attempted.
Adult ; Biopsy* ; Biopsy, Fine-Needle ; Breast* ; Female ; Humans ; Ultrasonography*

Bougie or balloon dilation is a good short-term treatment for caustic esophageal strictures, although recurrence after dilation occurs in approximately 30% of these cases. Therefore, long-term treatment options are required in some cases, and endoscopic incisional therapy has been used for patients with an anastomotic stricture in the gastrointestinal tract. A 58-year-old woman presented with severe swallowing difficulty because of a caustic esophageal stricture, which was caused by accidental exposure to anhydrous acetic acid at infancy. She had undergone several previous bougie and balloon dilations but the stricture did not improve. We performed sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid, which resulted in the patient’s symptoms markedly improving. Thus, we report this case of an intractable caustic esophageal stricture, which was successfully treated using combined endoscopic sequential treatment.
Acetic Acid ; Caustics ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis* ; Female ; Gastrointestinal Tract ; Humans ; Middle Aged ; Recurrence

PURPOSE: The purpose of this study was to investigate the validity of in vivo experimental models to evaluate the therapeutic potentials of drugs for the treatment of premature ejaculation. MATERIALS AND METHODS: Male Sprague-Dawley rats (250-300gm) were divided into 8 groups based on the experimental agent administered: serotonergic agents (serotonin, clomipramine, fluoxetine, sertraline, paroxetine) and alpha-adrenergic blockers (prazosin, terazosin, tamsulosin). Various concentrations of the agents were intravenously injected 20 minutes prior to the electrical stimulation of the hypogastric nerve. Intraluminal pressures of seminal vesicle and vas deferens were measured on each side in the same animal. The concentration-response curves for each drug were obtained, and the inhibitory effects of the drugs on the contractile response of the seminal vesicles and vasa deferentia to the electrical stimulation of the hypogastric nerve were compared. RESULTS: All the serotonergic agents resulted in dose-dependent inhibition of the intraluminal pressure of the seminal vesicle to electrical stimulation (clomipramine>serotonin>fluoxetine>sertraline>paroxetine). The vasal pressure responses were also effectively inhibited by serotonin, clomipramine and sertraline, in that order. Fluoxetine and paroxetine showed no inhibitory effects on the vasal pressure. The pressure responses of both the seminal vesicles and the vasa deferentia were inhibited in a dose-dependent manner by all the alpha-adrenergic blockers. CONCLUSIONS: This in vivo model was not able to demonstrate the established clinical effects of various serotonergic agents widely used in the treatment of premature ejaculation. Conversely, the alpha-adrenergic blockers showed marked dose-dependent inhibition of the seminal tract pressure responses. Therefore, this in vivo model has limitations for the proper evaluation of therapeutic potentials of drugs for the treatment of premature ejaculation.
Adrenergic alpha-Antagonists ; Animals ; Clomipramine ; Electric Stimulation ; Fluoxetine ; Humans ; Male ; Models, Theoretical* ; Paroxetine ; Premature Ejaculation* ; Rats, Sprague-Dawley ; Seminal Vesicles ; Serotonin ; Serotonin Agents ; Sertraline ; Vas Deferens

PURPOSE: We report a case of chronic myelogenous leukemia(CML) involving the retina and optic nerve, in which visual acuity had been improved after radiation therapy combined with steroid pulse therapy. METHODS: In a 44-year-old CML patient with central nervous system involvement who presented with retinal infiltration, initial uncorrected visual acuity was 1.0 in the right eye, 0.9 in the left eye. The patient was given 1% prednisolone acetate eye drops 4 times a day and 40mg of oral prednisolone a day. One month later, papilledema and exudative retinal detachment was developed in the left eye and we raised oral prednisolone dosage to 90mg a day. In spite of those kinds of treatment, papilledema in left eye and retinal infiltration in both eyes were much more aggravated at two months. So we used high-dose steroid(solumedrol 125mg qid) parenterally for initial 3 days followed by tapered oral dosage(prednisolone 60mg/day for 11 days, tapered with 10mg/day and maintain with 10mg/day) and performed simultaneously radiation therapy (total 2340 rads, 13 times) on both eyes through 2 weeks. RESULTS: Uncorrected visual acuity was decreased to 0.3 in the left eye at one month and to 0.6 in the right eye and 0.08 in the left eye at two months, and improved to 1.0 in the right eye and 0.5 in the left eye. Gradual resolution was noted in retinal and optic disc abnormalities at one month after high-dose steroid therapy combined with radiation therapy. CONCLUSIONS: This case suggests that visual acuity in CML patient with the retinal and optic nerve involvement can be improved by using radiation therapy combined with steroid pulse therapy.
Adult ; Central Nervous System ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Ophthalmic Solutions ; Optic Nerve* ; Papilledema ; Prednisolone ; Retina* ; Retinal Detachment ; Retinaldehyde ; Visual Acuity

Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

41 cases of complicated cataract in leprosy patients were operated on from May 1989 to March 1990 at National Sorok Island Hospital. In all cases, extracapsular cataract extraction was attempted and sector or peripheral iridectomy was performed. Inferior sphincterotomy was not done in any of the cases. The postoperative results were very satisfactory in most of the operating cases. The results are as follows; 1) Corrected vision above 0.1 was obtained in 29 eyes(70.7%). 2) Corrected vision from F.C. to 0.09 was obtained in 8 eyes(19.5%). 3) Corrected vision below H.M. was obtained in 4 eyes(9.8%). 4) 37 eyes(90.2%) among the total 41 showed an improvement of corrected vision.
Cataract Extraction ; Cataract* ; Humans ; Iridectomy ; Leprosy*