No abstract available.
Anesthesia* ; Humans ; Outpatients*

No abstract available.
Fournier Gangrene* ; Scrotum* ; Sparganosis*

Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

PURPOSE: While numerous methods have been introduced to repair hypospadias, no single method is effective for repairing all hypospadias. We reviewed our experience of hypospadias repair to determine the best surgical method and the efficacy of the treatment modality. MATERIALS AND METHODS: We reviewed the hospital charts of 32 patients who had undergone hypospadias surgery from January 1993 to January 2002. Group 1 included patients who were operated on before 1998 and group 2 had those who had operations after 1998 with only the TIP(tubularized incised plate) method. The surgical procedures that were performed on the patients were onlay island flap(6), Mathieu(2), Hodgson's type III(2), Mustard(2), TIP(14), Transverse island flap(5), and Thiersch-Duplay(1). The mean operative time, mean hospital days, mean duration of catheter drainge, and complication rates of the two groups were compared. RESULTS: In group 2, operation time was reduced(142.9+/-69.4 versus 172.5+/-93.4 min)(p<0.05), but the two groups showed no significant differences in mean hospital days(11.9+/-2.8 days. versus 12.3+/-1.6 days) and mean duration of catheter drainge (9.8+/-24 versus 10.5+/-3.6 days). In group 1 and group 2, complication rates were 67% (12 of 18) and 14%(2 of 14), respectively(p<0.05). CONCLUSIONS: Our data show shorter operative time and lower complication rates using the TIP method for various types of hypospadias. Therefore, the TIP method seems to be a safe method of surgery for any type of hypospadias.
Catheters ; Female ; Humans ; Hypospadias* ; Inlays ; Male ; Operative Time ; Urethra

PURPOSE: During transrectal ultrasound guided prostate biopsy, 65% to 90% of patients reportedly have discomfort. We compared the anesthetic effects of a periprostatic injection of lidocaine under ultrasound guidance with the effects of a rectal instillation of lidocaine gel before the transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: A prospective randomized double-blind study was performed in 72 patients requiring a systematic biopsy of the prostate. Patients were randomized into two groups according to the method of anesthetic delivery that was used. Group 1 consisted of 37 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before biopsy, and 5 ml of normal saline was injected into the periprostatic nerve plexus just before biopsy under ultrasound guidance using an 18 gauge 16 cm needle on each side. Group 2 consisted of 35 patients who received 10 ml of sterile gel without lidocaine and a 5 ml 1% lidocaine injection using the same method as group 1. The pain score was assessed using a visual analogue scale immediately after biopsy. RESULTS: There was a statistical difference in the mean pain score between the two groups (5.1+/-1.7 in group 1 versus 3.3+/-1.5 in group 2) (p<0.001), but The complication rates were not significantly different. CONCLUSIONS: We believe that performing the transrectal ultrasound guided prostatic nerve blockade before biopsy significantly diminishes the discomfort associated with the procedure, which, in turn, improves patient tolerance more so than rectal instillation of lidocaine gel. In addition, this procedure is a safe, simple, and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.
Administration, Rectal* ; Anesthetics ; Biopsy* ; Double-Blind Method ; Humans ; Lidocaine* ; Needles ; Nerve Block ; Prospective Studies ; Prostate* ; Ultrasonography*

BACKGROUND: To predict the therapeutic efficacy of osteoporosis, one or two years is needed to evaluate the therapeutic effect by the measurement of bone mineral density(BMD), whereas three to six months is sufficient with bone markers. Using this information, we can change therapeutic plan or modulate drug dosage if necessary. This approach would provide appropriate therapy for osteoporosis. The purpose of this study is to evaluate the association between the percentage change of BMD which was measured by peripheral quantitative computed tomography(pQCT), and bone markers after 1 year of hormone replacement therapy(HRT) in healthy postmenopausal women. METHODS: Bone mineral density of nondominant distal forearm in 89 postmenopausal women was measured by pQCT. We measured serum alkaline phosphatase(ALP) and intact osteocalcin(iOC, Novocalcin) as bone formation markers, urinary deoxypyridinoline(dPyr, PyriLinks-D(TM)) as bone resorption marker by using enzyme immunoassay. After 1 year of HRT, 54 subjects dropped out and 33 subjects were reevaluated. RESULTS: After 1 year of HRT, the drop-out rate was 61%. There was no significant difference in age, age of menopause, years since menopause, initial BMD, initial bone markers between remained and drop out groups. But osteocalcin level was significantly high in remained group(p=0.02). ALP(-27.6 %), iOC(-29.9%), dPyr(-25.2%) were significantly decreased after 1 year of HRT(p<0.001). Trabecular BMD was increased by 2.4%(p=0.003), but the percentage change of total and cortical BMD was not significant(p>0.05). The levels of BMD and bone markers between before and after was significantly correlated, demonstrating the homogeneity of response to HRT. The percentage change of trabecular BMD was negatively correhted with the percentage change of dPyr after HRT(r=-0.45, p=0.01). The variance of the percentage change of dPyr contributed to the percentage change of trabecular BMD by 20%. There was no correlation between the percentage change of total BMD or cortical BMD and the change of ALP, iOC, or dPyr after HRT. CONCLUSIONS: After 1 year of HRT in postmenopausal women, all biochemical bone markers were decreased significantly, whereas only trabecular BMD measured by pQCT was increased significantly. This result suggests that bone markers was more sensitive than BMD to monitor the therapeutic efficacy of HRT. The percentage change of trabecular BMD was correlated with the change of dPyr after HRT only. dPyr might be the most sensitive marker among bone markers tested. Therefore, we can predict the change of BMD after HRT through monitoring the levels of dPyr.
Bone Density* ; Bone Resorption ; Female ; Forearm ; Hormone Replacement Therapy* ; Humans ; Immunoenzyme Techniques ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis

PURPOSE: The ability of preoperative findings, to identify patients where an overactive bladder syndrome failed to resolve postoperatively, was assessed. The clinical outcome of a pubovaginal sling was also evaluated to determine the correlation between the postoperative success rate (subjective, objective) and satisfaction in overactive bladder syndrome. MATERIALS AND METHODS: Thirty three women, with stress urinary incontinence, received a pubovaginal sling procedure using polypropylene mesh. All the preoperative factors that affect the presence of preoperative overactive bladder syndrome, and the postoperative changes in overactive bladder syndrome, were analyzed and evaluated. The correlation between the changes in overactive bladder syndrome and the success rate (subjective, objective) and satisfaction were also analyzed. RESULTS: The presence of preoperative overactive bladder syndrome was significantly related to a decrease in the Valsalva leak point pressure (p=0.05) and an increase of the Stamey grade (p<0.05), and was closely related to the Valsalva type (p=0.07) and the open bladder neck at rest, with the patient erect (p=0.07). The differences in the Blaivas type, Q tip angle, posterior urethrovesical angle and bladder neck descending in the strain lateral view of a cystourethrogram, between the resolved and persistent patients of overactive bladder syndrome postoperatively, were statistically significant (p<0.05). Preoperative urgency, urge incontinence and persistence of postoperative overactive bladder syndrome, are significant factors contributing to decreases in the subjective success rate and patient satisfaction (p<0.05). CONCLUSIONS: Preoperative overactive bladder syndrome was closely associated with the variables related to incompetence of the urethra, and the postoperative persistence of overactive bladder syndrome was associated with the variables related not only to incompetence of the urethra, but also to the urethral hypermobility.
Female* ; Humans ; Neck ; Patient Satisfaction ; Polypropylenes ; Urethra ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence* ; Urinary Incontinence, Urge

We report a case of cystic adenocarcinoma of the prostate in a 67-year-old man who showed severe obstructive voiding symptoms. In this case, the mechanism of the cyst formation from the prostate cancer is thought to be related to the secondary cystic formation, which was due to either the central necrosis of the cancer tissue or intracancerous tissue hemorrhage. Prostate cystic adenocarcinoma is a rare disease, and there are only a few cases reported in the literature. A cyst of the prostate may be either congenital or acquired. A congenital cyst arises from the mesonephric (Wolffian) or paramesonephric (Mullerian) duct system, while an acquired cyst is subdivided into the retention, malignant, and parasitic cyst. A huge prostatic cyst was found in a 67-year-old man. The lesion was presumed to be a prostate cystic adenocarcinoma.
Adenocarcinoma* ; Aged ; Hemorrhage ; Humans ; Necrosis ; Prostate* ; Prostatic Neoplasms ; Rare Diseases

Chordomas are congenital tumor which develop from remnant of the notochord. Most of them arise at the clivus Blumenbachii, at the junction of the sphenoidal and occipital bones or sacrococcygeal region. Rarely chordomas arise at the thoracic spine, which compress the spinal cord epidurally and sometimes invade the substance of the spinal cord. The authors report a case of chordoma at T9-T10 vertebral level in which the characteristic "physaliferous" cells were found in the slides of operative specimen. The tumor was compressing the spinal cord and extending into body and lamine of the vertebra, which resulted the patient, 52 year-old Korean male, in paraplegia.
Chordoma* ; Cranial Fossa, Posterior ; Humans ; Male ; Middle Aged ; Notochord ; Occipital Bone ; Paraplegia ; Sacrococcygeal Region ; Spinal Cord ; Spine*

PURPOSE: Most patients who undergo a curative resection of a pancreatic ductal adenocarcinoma (PDAC) develop recurrence, usually at the tumor bed or in the liver, which has been associated with the poor prognosis of a PDAC. In this study, the clinical characteristics of the recurrences following curative resection of a PDAC were analyzed to discover the surgical and adjuvant treatment strategies. METHODS: Between May 1990 and December 2002, 156 patients diagnosed with a recurrence after curative resection of a PDAC were analyzed for the pattern of recurrence, time of recurrence, associations with stage and adjuvant therapy, and survival using a retrospective review of their medical records. RESULTS: Local and systemic recurrences were found in 41.0 and 25.7%, respectively. About half of the recurrences occurred within 6 months of the operation. A local recurrence was found more frequently in the body and tail than in the head, which occurred earlier than a systemic recurrence at an advanced stage. A local recurrence occurred in 40% of patients treated with surgery alone, and in 29.4% of those treated with surgery plus radiotherapy, whereas a systemic recurrence occurred in 25.5% of patients treated with surgery alone, and in 17.4% of those treated with surgery plus chemotherapy. The patients with a local recurrence had a significantly prolonged median disease free survival time (7.8 months) than those with a systemic recurrence (5.8 months). The two-year survival rate for the locally recurred patients was greater than that for those with a systemic recurrence (23.4% vs. 17.5%). CONCLUSION: Our study showed a high rate and early occurrence of local recurrence, with a poor survival rate within 1 year, even after curative resection of the PDAC. There is still a great need for advances in meticulous surgical techniques for the control of local recurrence, especially in body and tail lesion or an advanced stage, and new adjuvant therapeutic modalities following curative resection to improve the survival rate of patients with a PDAC.
Adenocarcinoma* ; Carcinoma, Pancreatic Ductal ; Disease-Free Survival ; Drug Therapy ; Head ; Humans ; Liver ; Medical Records ; Pancreas* ; Pancreatic Ducts ; Prognosis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Survival Rate