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*

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

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: 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

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

BACKGROUND: Pulmonary artery banding (PAB)in the functional univentricular heart (UVH)is a palliative procedure for staging toward the Fontan procedure;however,it is known to be a risk factor. MATERIALS AND METHOD: The records of all 37 patients with functional UVHs who underwent surgical palliation using PAB between September 1989 and August 1999 were reviewed retrospectively.We investigated the aortic arch obstruction,the development and progression of subaortic stenosis after PAB,and risk factor of mortality according to surgical method. RESULT: In 37 neonates and infants with single ventricular physiology,aortic arch obstruction was combined in 7.There were 6 early deaths (16.2%)after PAB and 3 late deaths (8.1%)after Fontan operation.The actuarial overall survival including early mortality at 3 and 5 years were 8 0 .7+/-6.6%,72.2 +/-8.2% respectively. Among 31 patients who survived PAB,27 patients (87.1%)could become candidates for Fontan operation;22 patients(71.0%)completed Fontan operation with 3 deaths and 5 were waiting bidirectional cavopulmonary shunt(BCPS)or Fontan operation (follow-up mean 4.5 year,minimal 2 year). Subaortic stenosis developed in 8 patients after PAB (8/29,27.6%);3 cases in the patients without arch anomaly (3/22,13.6%)and 5 in those with arch anomal y (5/7,71.4%).The subaortic stenosis was managed with Damus-Kaye-Stansel procedure (DKS)in 6 patients without operative mortality and conal septum resection in 2 without long-term survivor. Analysis of risk factors established that aortic arch obstruction was strongly associated with subaortic stenosis (p<0.001).The only risk factor of late mortality was Fontan procedure without staged palliation by BCPS (p=0.001). CONCLUSION: PAB is effective as an initial palliative step in functional UVH.And the high risk group of patients with aortic obstruction can undergo effective short-term PAB as an initial palliative step,with subsequent DKS for subaortic stenosis.This strategy,initial PAB and careful surveillance,and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later Fontan procedures.
Aorta, Thoracic ; Constriction, Pathologic ; Fontan Procedure ; Heart* ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Mortality ; Pulmonary Artery* ; Risk Factors ; Survivors

Left ventricular thrombosis is a frequent and potentially dangerous complication in acute myocardiac infarction, but its occurrence and adequate therapy has not been known in patients with Dor procedure for the ischemic cardiomyopathy. We report a patient, 45 year-old male, who had a new left ventricular thrombus developed after coronary arterial bypass graft, Dor procedure, and removal of the left ventricular thrombus for ischemic cardiomyopathy. Left ventricular thrombus was disappeared on the follow-up cardiac MRI following intravenous heparin injection and oral coumadin therapy. This case suggest that anticoagulation therapy may prevent patients with the severe left ventricular dysfunction and apical aneurysm and dyskinesia from developing the left ventricular thrombus, and that thrombi will resolve without clinical evidence of systemic embolism.
Aneurysm ; Cardiomyopathies ; Dyskinesias ; Embolism ; Follow-Up Studies ; Heart Aneurysm ; Heparin ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Thrombosis* ; Transplants ; Ventricular Dysfunction, Left ; Warfarin

Annuloaortic ectasia, aortic regurgitation (AR), and ventricular septal defect (VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hypoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.
Aortic Valve Insufficiency* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Dilatation, Pathologic* ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Male ; Replantation ; Transplants ; Tricuspid Valve ; Weaning ; Young Adult

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