PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.
Alprostadil ; Education ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Humans ; Male ; Papaverine ; Phentolamine

To determine the optional and objective criteria for choosing the appropriate treatment modality or ureteral calculi. we reviewed 210 patients (215 ureteral calculi) initially treated with expectation (78 calculi), ESWL (82 calculi). ureteroscopic removal (31 calculi). stone basket (7 calculi) and surgery (17 calculi) and the results of each treatment were compared. N 78 calculi treated with expectation 58 (74.4% ) passed spontaneously. The duration of 50% and 75% cumulative spontaneous passage (CSP) of proximal ureteral calculi (<6 mm) were 3 weeks and l3 weeks, whereas the duration of 25% CSP of proximal ureteral calculi (> or =6 mm) were 5 weeks (p=0.0087). The duration of 50% and 75% CSP of distal ureteral calculi (<7 mm) were S weeks and S weeks. whereas the duration of 25% and 50% CSP of distal ureteral calculi (> or =7 mm) were 4 weeks and 11 weeks (p=0.01 75). The overall success rate of ESWL was 88.5% and the success rates of upper. middle and lower ureteral calculi were 92.2%. 70.6% and 94.7%. The duration of passage of calculi fragmented by ESWL was 1 to 16 weeks (mean: 4 wks). The overall success rate of ureteroscopic removal was 87.5% and the rate increased to 93.1% when only lower ureteral calculi were included. Stone basket was successful in 4 calculi out of 7. In conclusion, it is preferable to treat the proximal ureteral calculi smaller than 6mm and distal calculi smaller than 7mm with expectation until 3 months and 5 weeks, respectively. Otherwise ESWL is appropriate for proximal ureteral calculi and ureteroscopic removal for lower ureteral calculi. Although advanced technology for the management of ureteral calculi has been developed, traditional therapy has the proper role in contemporary practice.
Calculi ; Humans ; Ureter* ; Ureteral Calculi*

Pulmonary alveolar proteinosis is a rare disease, which hallmark is a dense accumulation of PAS positive phospholipid material within alveolar sac. Pulmonary alveolar proteinosis is classified as primary form of unknown etiology and secondary form associated with other diseases. We report a case of secondary pulmonary alveolar proteinosis associated with acute erythroleukemia. A C year old male patient complained of nonproductive cough and general weakness, and presented fine inspiratory crackles at both lower lung field. Chest radiographs and high resolution CT scans showd a lobular pattern of ground-grass opacity with interlobular septal thickening in the center field of the both lungs, Bone marrow aspiration and biopsy revealed acute erythroleukemia. Open lung biopsy revealed PAS positive eosinophilic granular material filled in alveoli. He was treated with TAD chemotherapy, but died from multiorgan failure with pneumonia 22days after chemotherapy.
Biopsy ; Bone Marrow ; Cough ; Drug Therapy ; Eosinophils ; Humans ; Leukemia, Erythroblastic, Acute* ; Lung ; Male ; Pneumonia ; Pulmonary Alveolar Proteinosis* ; Radiography, Thoracic ; Rare Diseases ; Respiratory Sounds ; Tomography, X-Ray Computed

PURPOSE: This study aimed to evaluate whether a shorter time from the arrival at a hospital to delivery is related to the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age. METHODS: We studied 142 newborns of less than 34 weeks of gestational age. The time from the arrival at the hospital to delivery was measured. The correlation between the time required for delivery and the occurrence of cerebral palsy was elucidated by diagnosing cerebral palsy in neonates using the Korean Infant Development Screening Test and neurological examination. RESULTS: Preliminary result suggested that a shorter time from hospital arrival to delivery was related to a lower development score for gross motor activity and to a higher frequency of cerebral palsy occurrence. Moreover, it was responsible for a tendency of obtaining lower Apgar scores at 1 and 5 minutes. The shorter delivery time was associated with a higher probability of respiratory distress syndrome (RDS) occurrence when the length of delivery time was less than 6 hours and there was a higher probability of a shorter gestation period. However, the multifactor analysis revealed that there was little impact of delivery time on the occurrence of cerebral palsy. Conclusions: The length of hospital arrival time to delivery did not significantly influence the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age.
Cerebral Palsy ; Child ; Child Development ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Mass Screening ; Motor Activity ; Neurologic Examination ; Pregnancy

PURPOSE: This study aimed to evaluate whether a shorter time from the arrival at a hospital to delivery is related to the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age. METHODS: We studied 142 newborns of less than 34 weeks of gestational age. The time from the arrival at the hospital to delivery was measured. The correlation between the time required for delivery and the occurrence of cerebral palsy was elucidated by diagnosing cerebral palsy in neonates using the Korean Infant Development Screening Test and neurological examination. RESULTS: Preliminary result suggested that a shorter time from hospital arrival to delivery was related to a lower development score for gross motor activity and to a higher frequency of cerebral palsy occurrence. Moreover, it was responsible for a tendency of obtaining lower Apgar scores at 1 and 5 minutes. The shorter delivery time was associated with a higher probability of respiratory distress syndrome (RDS) occurrence when the length of delivery time was less than 6 hours and there was a higher probability of a shorter gestation period. However, the multifactor analysis revealed that there was little impact of delivery time on the occurrence of cerebral palsy. Conclusions: The length of hospital arrival time to delivery did not significantly influence the occurrence of cerebral palsy in premature infants of less than 34 weeks of gestational age.
Cerebral Palsy ; Child ; Child Development ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Mass Screening ; Motor Activity ; Neurologic Examination ; Pregnancy

PURPOSE: The definition of normal penile length is of considerable importance to urologist who is asked to perform penile augmentation surgery, because such knowledge will lead to better counseling about the relation between penile size in the flaccid and erect states and to develop guidelines for penile augmentation. SUBJECTS AND METHODS: Tape measurements of the flaccid and erect penis were obtained to the nearest 0.5 cm in 309 Korean men by a single examiner. Measurements were made of flaccid length and circumference, depth of the prepubic fat pad, and stretched penile length. After full erection had been obtained by self-stimulation or injection of prostaglandin E, penile length and circumference were measured again. RESULTS: The mean flaccid and erectile length were 7.78+/-1.19 cm and 11.88+/-1.32 cm, respectively. The stretched length demonstrated a more predictable relation to erectile length than flaccid length than flaccid length (Pearson correlation coefficient, R=0.648:0.549). Subjects were grouped by age ad over and under 40 years to study the effect of age on fat pad depth, flaccid length, stretched length, and erectile length increase. Only erectile length increase differed significantly, being greater in younger subjects(ANOVA, p=0.03). When the subjects were grouped by flaccid length as short(< OR =6.5cm), medium (6.5~9 cm), and long (> OR =9 cm), we discovered that a penis that was long in the flaccid state remained long in the erect state. However, there were no statistical differences in erect length among three groups. In other words, we cannot predict the erect length on the bais of the flaccid value. CONCLUSIONS: To define guidelines for penile augmentation, we can choose the cut-off value of 5 cm(flaccid) and 9 cm (erect) based on statistical considerations. Only 1.1% of the patients in our series were below this cut-off value. Thus, it is concluded that only a small number of Korea men should be candidates for penile augmentation.
Adipose Tissue ; Counseling ; Genitalia ; Humans ; Korea ; Male* ; Nomograms* ; Penis

Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis. When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Diagnosis ; Fibrosis ; Gallstones* ; Humans ; Inflammation ; Jaundice, Obstructive ; Middle Aged ; Pancreaticoduodenectomy ; Pancreatitis

In off-pump coronary artery bypass grafting (CABG), multiple proximal anastomosis may increase the risk of cerebral embolism (air, debris) and aortic injury (dissection, pseudoaneurysm). Radial artery (RA) has no intraluminal valve such as saphenous vein. We applied Cabrol technique using aortic root replacement for proximal anastomosis in off-pump CABG. Cabrol technique using RA graft can reduce numbers of proximal anastomosis and reduce number of aortic manipulation in off-pump CABG. We report a Cabrol technique for proximal anastomosis in off-pump CABG with RA graft.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Intracranial Embolism ; Radial Artery* ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Transplants*

At least 88 percents of ventricular aneurysms result from anterior infarction, while the remainder follow inferior infarction. Posterior infarction that produce a distinct left ventricular aneurysm is unusual. We report two operative cases of postinfarction posterobasal left ventricular aneurysms, one with a true aneurysm and the other with a false one.
Aneurysm* ; Infarction ; Myocardial Infarction

BACKGROUND: We analysed the surgical outcomes of immediate reoperations after mitral valve repair. MATERIAL AND METHOD: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. RESULT: There was no early death. After mean follow-up of 33 months, there was one late death. Echocardiography revealed no or grade I of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78.6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. CONCLUSION: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.
Constriction, Pathologic ; Echocardiography ; Endocarditis ; Female ; Follow-Up Studies ; Freedom ; Heart Ventricles ; Humans ; Mitral Valve* ; Reoperation* ; Retrospective Studies ; Rupture