PURPOSE: To determine the incidence of concomitant procedures performed for pelvic organ prolapse or vaginal reconstruction at the time of surgery for stress urinary incontinence in contemporary urologic practice. MATERIALS AND METHODS: We retrospectively examined all concomitant procedures for pelvic organ prolapse or vaginal reconstruction in 279 women who had underwent sling operation for stress urinary incontinence at our institution. The subjects presented with stress urinary incontinence underwent history taking, physical examination and urologic investigations such as standing cystourethrography and urodynamic study including Valsalva leak point pressure. RESULTS: Of 279 women, 64(22.9%) had at least one concomitant procedure performed for pelvic organ prolapse or vaginal reconstruction, including 43(15.4%) cystocele repairs, 24(8.6%) rectocele repairs, 6(2.2%) cystocele and rectocele repairs concurrently, 2(0.7%) vaginal hysterectomy and 1(0.4%) urethral diverticulectomy. CONCLUSION: We found that women who undergo surgery for stress urinary incontinence had a high incidence(22.2%) of associated pelvic organ prolapse requiring surgical repair. These additional maneuvers contributed to the overall success of surgery and should not be overlooked.
Cystocele ; Female ; Humans ; Hysterectomy, Vaginal ; Incidence* ; Pelvic Organ Prolapse* ; Physical Examination ; Rectocele ; Retrospective Studies ; Urinary Incontinence* ; Urodynamics

PURPOSE: To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect. MATERIALS AND METHODS: 36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method. RESULTS: Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015). CONCLUSION: The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.
Free Tissue Flaps ; Tibia

PURPOSE: This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. METHODS: A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. RESULTS: According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. CONCLUSION: The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.
Adult ; Gout/*prevention & control ; Health Knowledge, Attitudes, Practice ; Hospitals, University ; Humans ; *Internet ; Male ; *Medication Adherence ; Middle Aged ; *Program Evaluation ; *Self Care ; User-Computer Interface

PURPOSE: We determined the usefulness of in vitro germ cell culture in nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome, no sperm in testicular sperm extraction. MATERIALS AND METHODS: This study included 44 patients (45 testicular tissues) with nonobstructive azoospermia who were diagnosed with Sertoli cell only syndrome and were found to have no sperm in testicular sperm extraction between January 2006 and July 2008. Among the 45 testicular tissues, 22 tissues were processed for culture. In the in vitro cultures, the testicular tissues were dissociated and plated on gelatin-coated dishes. Patients were divided into 2 groups according to culture success: group I, culture positive (+; n=10); and group II, culture negative (-; n=12). RESULTS: The mean patient ages were 31.73 and 31.68 years for groups I and II, respectively. The mean testicular sizes were 10.19 and 10.42 cc, respectively; the semen volumes were 2.86 and 3.04 cc, respectively; and the mean FSH, LH, and testosterone levels were 18.86 mIU/ml, 5.99 mIU/ml, and 4.46 ng/ml vs. 21.02 mIU/ml, 6.29 mIU/ml, and 4.32 ng/ml for groups I and II, respectively, with no significant differences between the groups (p>0.05). The culture rate of nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome was 45.5% (10/22). Round spermatid injection was done in 2 patients with consent of the patients, but implantation failed. Among the 45 tissues, germ cells were found in 8 tissues after pathologic reexamination. CONCLUSIONS: The in vitro culture of germ cells would be useful in the advanced treatment of nonobstructive azoospermic patients.
Azoospermia ; Germ Cells ; Humans ; Semen ; Sertoli Cell-Only Syndrome ; Spermatids ; Spermatozoa ; Testosterone

BACKGROUND: The evidence for H. pylori as a gastrointestnal pathogen is now very strong, if not overwhelming. Among the pathogenic factors of H. pylori, flagella and urease are considered to be major factors causing the gastrododenal disease. We observed the gene diversity of H. pylori using the PCR-amplified 1.4Kb fla A gene and 0.9Kb ure B gene and examined the relationship between the gene pattern and the gastroduodenal disease. METHOD: Fifty-one cases of isolated strains were cultured at the Helicobacter-selective blood agar plates. To compare the gene diversity among the isolates of gastroduodenal disease genotypes was analyzed by PCR-based RFLP. 1.4Kb fla A gene and 0.9Kb ure B genes from isolates were amplified by PCR and digested with Hae 3 restriction enzymes to observe the restriction fragment length polymophysm. Protein patterns were also compared to examine the antigenic variations. Total cell proteins, and octyl-glucose extracts from isolates were analyzed by SDS-PAGE gel electrophoresis. RESULTS: 41 cases (80.4%) of H. pylori were isolated in the 51 cases of gastroduodenal diseases. We could classify theses isolates 3 types of PCR-RFLP in the fla A gene, 900+500bp, 500+500+400bp, 600+800bp, and 9 types in the ure B gene. PCR-RFLP in the fla A gene and ure B gene of the isolates was different from the standard strain of Australia and the genetic diversity was not related to the types of the gastroduodenal disease. We demonstrated variations in the protein pattern and antigenic profiles among the isolates by SDS-PAGE analysis. These data also did not show any relationship between protein pattern and types of gastroduodenal diseases. CONCLUSION: Tese studies showed many different gene diversity in the flagella and urease gene without any relationship with the types of gastoduodenal disease. And variable protein pattern were noted among the strains of H. pylori. Further studies to demonstrate the pathgenecity of H. pylori should be continued even if there was no relationship between the genomic diversity of the flagella or urease and the types of gastroduodenal disease.
Agar ; Australia ; DNA* ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Flagella ; Genes, vif ; Genetic Variation ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Urease

BACKGROUND: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis of usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged causes of Chronic liver disease is needed. MATERIALS AND METHODS: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. RESULTS: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 50 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol > or =250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. CONCLUSION: In chlestatic hepatitis, durations of abnormal LET are variable regardless of causative drugs. If chlestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.
Anti-Bacterial Agents ; Bile ; Bile Ducts ; Biopsy ; Cholesterol ; Duodenum ; Eosinophilia ; Hepatitis* ; Hepatitis, Autoimmune ; Humans ; Jaundice ; Linear Energy Transfer ; Liver ; Liver Cirrhosis, Biliary ; Liver Diseases ; Medicine, East Asian Traditional ; Prognosis ; Pruritus ; Ticlopidine

BACKGROUND AND OBJECTIVES: The matrix metalloproteinases (MMPs) have been associated with tumor cell invasion and metastasis by mediating the degradation of extracellular matrix components. Cyclooxygenase-2 (COX-2) plays an important role in promotion of carcinogenesis, tumor invasiveness and angiogenesis. Recently, some investigators have reported that COX-2 could promote secretion of MMP-2 and MMP-9. Therefore, an interrelation between MMPs and the associated COX-2 may play a significant role in the invasive phenotype of malignant tumors. In the present study, the authors investigated the correlation between expressions of COX-2 and MMPs. MATERIALS AND METHOD: Immunohistochemical staining of MMP-2, -3 and -9, and COX-2 were performed on paraffin-embedded tissue sections of 51 nasal cavity and paranasal sinuses tumors (27 inverted papillomas, 5 inverted papillomas with malignant transformation, and 19 squamous cell carcinomas). Co-expression of these MMPs and COX-2 was visualized with confocal laser scanning microscope. RESULTS: MMP-2, -3 and -9 were found mainly in malignant lesions in concert with COX-2. However, the co-expressions of MMP-2 and COX-2, MMP-9 and COX-2 were detected with significance. CONCLUSION: These results suggest a potentially important role for COX-2 in the regulation of MMPs, malignant transformation, and progression of squamous cell carcinoma, and it points out the potential use of COX-2 inhibitors, in the prevention and treatment of squamous cell carcinoma of nasal cavity and paranasal sinuses.
Carcinogenesis ; Carcinoma, Squamous Cell ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Extracellular Matrix ; Humans ; Matrix Metalloproteinases* ; Nasal Cavity ; Negotiating ; Neoplasm Metastasis ; Papilloma, Inverted ; Paranasal Sinuses ; Phenotype ; Research Personnel

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. (continue)
Cervix Uteri* ; Conization ; Delivery of Health Care ; Diagnosis* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies

BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.
Cholangiopancreatography, Endoscopic Retrograde* ; Conscious Sedation* ; Dihydroergotamine ; Flumazenil ; Humans ; Meperidine ; Midazolam* ; Multivariate Analysis ; Risk Factors

BACKGROUND: We tested the technical feasibility of fetal cardiac bypass and collected baseline data on the fetal hemodynamics and placental functions related to the cardiopulmonary bypass in the fetal lamb model. MATERIAL AND METHOD: Eleven fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Eight served as a group in which placenta was excluded from the extracorporeal circulation by clamping the umbilical cord during the bypass(the oxygenator group) and in the remaining three, the placenta worked as the only source of oxygen supply(the placenta group). Observations were made every 10 minute during a 30-minute bypass and 30-minute post bypass period. No prostaglandin inhibitors were used both in ewes and in fetuses. RESULT: Weights of the fetuses ranged from 1.9 to 5.2 kg. In the oxygenator group, means of arterial pressure, PaO2, atrial pressure, heart rate, and bypass flow rate ranged 69.8 to 82.6 mmHg, 201.7 to 220.9 mmHg, 4.1 to 4.3 mmHg, 169 to 182/min, and 140.3 to 164.0 ml/kg/min, respectively during bypass, but rapid deterioration of the fetal cardiac functions and the placental gas exchange was observed after the cessation of bypass. In the placenta group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of PaCO2 increased from 61.9 to 129.6 mmHg during bypass. Flow rate was suboptimal(74.3 to 97.0 ml/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. CONCLUSION: In this study, the technical feasibility of fetal cardiopulmonary bypass was confirmed in the fetal lamb model. However, further studies with modifications of the bypass including an addition of prostaglandin inhibitor, an application of the total spinal anesthesia on the fetus, a creation of more concise bypass circuit, and a use of active pump are mandatory to improve the outcome.
Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Arterial Pressure ; Atrial Pressure ; Cardiopulmonary Bypass* ; Catheters ; Constriction ; Extracorporeal Circulation ; Fetus ; Heart ; Heart Rate ; Hemodynamics ; Ketamine ; Models, Theoretical ; Oxygen ; Oxygenators ; Placenta ; Pregnancy ; Prostaglandin Antagonists ; Umbilical Cord ; Weights and Measures