The outcomes of treatment of 31 patients who were managed by single visual internal urethrotomy were compared with those of 25 patients managed by perineal urethroplasty to asses whether the replacement of almost urethroplasty by the simpler urethrotomy was justified. The overall successful results were achieved in 51.6% of visual internal urethrotomy and 76%, of urethroplasty. Patients with anterior urethral strictures more than 1 cm long or completely obliterated strictures had higher failure rates in the visual internal urethrotomy than urethroplasty (p<0.05). The morbidity rates were 9.6% in the visual internal urethrotomy and 24% in the urethroplasty. We recommend that visual internal urethrotomy be reserved for patients with urethral strictures 1 cm or less in length and posterior urethral stricture which is supposed to have a high recurrence rate since the procedure is simple and it does not compromise asecondary urethroplasty.
Constriction, Pathologic ; Equidae ; Humans ; Recurrence ; Urethral Stricture*

In order to investigate the efficacy and safety of oral fosinopril, a new phosphorus containing angiotensin converting enzyme inhibitor, a single dose of 10 to 20mg was administered in 23 hypertensive patients with diastotic blood pressure above 95mmHg and all other anti-hypertensive agents were not administered during 4 weeks of study. Blood pressure and heart rate were measured on the 2nd and 4th week of therapy. The complete blood count with platelet count, blood chemistry by SMA-12 and serum electrolytes were performed at the begining and 4th week of therapy. The urinalysis and electrocardiography were performed at the beginning and 4th week of therapy. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) At the beginning and 4th weeks of therapy, the average systolic and diastolic pressure were 170.0+/-17.6/101.6+/-6.1mmHg, 142.7+/-15.1/87.3+/-6.7mmHg respectively. The systolic and diastolic blood pressure were declined statistically significantly(p<0.05) throughout the period of treatment and diastolic blood pressure of all subjects except 3 patients(86%) was maintained below 90mmHg after 4th week of treatment. 2) There was no significant change in the pulse rate before and after therapy. 3) There were no significant changes in blood chemistry, serum electrolytes, hematologic findings, urinalysis and electrocardiographic findigns. 4) side effect were developed in 5 patients(23%) with dry cough, 3 patients(13%) with headache and 2 patients with facial edema but side effects were mostly mild in nature without potenitally serious episodes. These results suggested that antihypertensive therapy with onec-daily fosinopril was effective and well tolerated in essential hypertensive patients.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Cough ; Edema ; Electrocardiography ; Electrolytes ; Fosinopril* ; Headache ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A ; Phosphorus ; Platelet Count ; Urinalysis

Purpose: To report a case of arteritic anterior ischemic optic neuropathy diagnosed with brain magnetic resonance imaging (MRI) for temporal arteritis instead of temporal artery biopsy.Case summary: An eighty-three years old female visited our clinic for right blurred vision for 2 weeks ago with occipital headache for 4 months and mastication problems. Initial best corrected visual acuity was 0.1 in right eye. She had right inferior altitudinal visual field defect and superior pale optic disc swelling with few cotton wool spots were checked. In serologic tests, erythrocyte sedimentation rate, C reactive peptide, and rheumatoid factor were increased, and fluorescent antinuclear antibody was positive. We performed high resolution brain MRI which could find superficial temporal artery’s luminal signal. In MRI image, we could find loss of intraluminal signal intensity void with total luminal obstruction. We assumed as arteritic anterior ischemic optic neuropathy and high dose intravenous steroid was done. Visual acuity of right eye was 0.9 and central scotoma was improved 1 week after intravenous steroid. We changed to oral steroid with tapering and added oral azathioprine. After 11 months of oral steroid use, her visual acuity was 0.9 in right eye and inferior altitudinal visual field defect was much improved. Conclusions A patient suspected anterior ischemic optic neuropathy was diagnosed by brain MRI with abnormalities in superficial temporal artery. Visual acuity and visual field defect were improved by steroid and immunosuppressive treatment for arteritic anterior ischemic optic neuropathy.

Purpose: To report a case of arteritic anterior ischemic optic neuropathy diagnosed with brain magnetic resonance imaging (MRI) for temporal arteritis instead of temporal artery biopsy.Case summary: An eighty-three years old female visited our clinic for right blurred vision for 2 weeks ago with occipital headache for 4 months and mastication problems. Initial best corrected visual acuity was 0.1 in right eye. She had right inferior altitudinal visual field defect and superior pale optic disc swelling with few cotton wool spots were checked. In serologic tests, erythrocyte sedimentation rate, C reactive peptide, and rheumatoid factor were increased, and fluorescent antinuclear antibody was positive. We performed high resolution brain MRI which could find superficial temporal artery’s luminal signal. In MRI image, we could find loss of intraluminal signal intensity void with total luminal obstruction. We assumed as arteritic anterior ischemic optic neuropathy and high dose intravenous steroid was done. Visual acuity of right eye was 0.9 and central scotoma was improved 1 week after intravenous steroid. We changed to oral steroid with tapering and added oral azathioprine. After 11 months of oral steroid use, her visual acuity was 0.9 in right eye and inferior altitudinal visual field defect was much improved. Conclusions A patient suspected anterior ischemic optic neuropathy was diagnosed by brain MRI with abnormalities in superficial temporal artery. Visual acuity and visual field defect were improved by steroid and immunosuppressive treatment for arteritic anterior ischemic optic neuropathy.

Objectives: . To determine the appropriate anatomical borders of implantation on the temporal bone in a cadaver study, and to develop a simplified surgical technique for Baha Attract implantation through a small incision along the hairline using anatomical evidence and a navigation system. Methods: . In a cadaver study, 20 human adult dry skulls were used to find flat areas of the temporal bone for Baha Attract magnet implantation. Four borders of the “optimal surgical site” were defined: Asterion line, occipitomastoid suture line, sigmoid sinus line, and digastric groove line. In three patients, we implanted the Baha Attract according to the newly developed surgical procedure and validated the feasibility of this technique with a navigation system. Results: . We identified the appropriate position of the implant on the temporal bone, suggesting a simplified surgical technique for Baha Attract with a small incision. We determined the spot of implantation, and the implants were inserted through a small surgical incision (<2.5 cm) under local anesthesia; the procedure lasted approximately 30 minutes. Conclusion . The optimal surgical site of the temporal bone is a safe and easily accessible location for implantation of the Baha Attract.

No abstract available.
Cleft Palate ; Humans ; Mass Screening

The authors report two cases of epidermoid cyst in the cerebellopontine angle which presented as trigeminal neuralgia. The tumors were surgically removed by suboccipital craniectomy. The cysts were densely adherent to multiple cranial nerves, including the trigeminal nerve, and the tumors occupied adjacent cisterns. After removal of the cystic content, it was sometimes difficult to differentiate the tumor capsule from the arachnoid membrane. In one patient, trigeminal neuralgia was resolved immediately after the operation, while for two weeks postoperatively, the other suffered severe headache and facial dysesthesia due to aseptic meningitis. To avoid surgical complications, it is resonable to leave a minute capsule attached to cranial nerves or blood vessels.
Arachnoid ; Blood Vessels ; Cerebellopontine Angle* ; Cranial Nerves ; Epidermal Cyst* ; Headache ; Humans ; Membranes ; Meningitis, Aseptic ; Paresthesia ; Trigeminal Nerve ; Trigeminal Neuralgia*

We report an unusual case of 9.5-cm-sized embryonal rhabdomyosarcoma arose from a mediastinal mature teratoma in a 46-yr-old man. A man presented with chest trauma as a result of an accident at 10 September 2011. On chest X-ray, an anterior mediastinal mass was detected. To obtain further information, chest computed tomography (CT) with contrast enhancement was performed, revealing an anterior mediastinal mass. Complete surgical excision was performed and entire specimen was evaluated. Pathologic diagnosis was embryonal rhabdomyosarcoma arising in mature cystic teratoma. After surgical excision, two cycles of dactinomycin-based chemotherapy were performed. Lung metastasis was detected on follow up CT in September 2012, and wedge resection was performed. Pathological finding of the lung lesion showed same feature with that of primary rhabdomyosarcoma.
Antibiotics, Antineoplastic/therapeutic use ; Dactinomycin/therapeutic use ; Desmin/metabolism ; Humans ; Immunohistochemistry ; Lung Neoplasms/radiography/secondary/surgery ; Male ; Mediastinal Neoplasms/*diagnosis/pathology ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/drug therapy/*radiography/surgery ; Rhabdomyosarcoma, Embryonal/drug therapy/*radiography/surgery ; Teratoma/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVE: This study was aimed to investigate endometrial histology and to find predictable clinical factors for endometrial disease (hyperplasia or cancer) in women with polycystic ovary syndrome (PCOS). METHODS: We investigated the endometrial histology and analyzed the relationship between endometrial histology and clinical parameters, such as LH, FSH, estradiol, testosterone, fasting and 2 hours postprandial glucose and insulin, insulin resistance, body mass index, endometrial thickness, menstrual status from 117 women with PCOS. Statistical analysis was performed with chi square and t-test, p-value<0.05 was considered as statistically significant. And receiver operating characteristic curve was used to find predictable clinical factors for endometrial disease and to decide the cuff off values. RESULTS: In 117 women with PCOS, endometrial histologic profiles are as follows: proliferative phase in 90 women (76.9%), endometrial hyperplasia in 25 women (21.4%), and endometrial cancer in 2 women (1.7%). Of 25 women with endometrial hyperplasia, simple hyperplasia without atypia, complex hyperplasia without atypia and complex hyperplasia with atypia were diagnosed in 15 (12.8%), 6 (5.1%), 4 (3.4%) women, respectively. Age and endometrial thickness were significantly related with endometrial disease, p=0.013 and p=0.001, respectively. At the cut off level of 25.5 years in age, sensitivity and specificity predicting for endometrial disease were 70.4% and 55.6%, respectively (p=0.023). At the cut off level of 8.5 mm in endometrial thickness, sensitivity and specificity were 77.8% and 56.7%, respectively (p=0.000). CONCLUSION: In women with PCOS, the incidence of endometrial hyperplasia and cancer were 21.4% and 1.7%. The age and endometrial thickness may be used as clinical determining factors for endometrial biopsy.
Biopsy ; Body Mass Index ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Estradiol ; Fasting ; Female ; Glucose ; Humans ; Hyperplasia ; Incidence ; Insulin ; Insulin Resistance ; Polycystic Ovary Syndrome ; ROC Curve ; Sensitivity and Specificity ; Testosterone ; Uterine Diseases

OBJECTIVE: This study was aimed to investigate endometrial histology and to find predictable clinical factors for endometrial disease (hyperplasia or cancer) in women with polycystic ovary syndrome (PCOS). METHODS: We investigated the endometrial histology and analyzed the relationship between endometrial histology and clinical parameters, such as LH, FSH, estradiol, testosterone, fasting and 2 hours postprandial glucose and insulin, insulin resistance, body mass index, endometrial thickness, menstrual status from 117 women with PCOS. Statistical analysis was performed with chi square and t-test, p-value<0.05 was considered as statistically significant. And receiver operating characteristic curve was used to find predictable clinical factors for endometrial disease and to decide the cuff off values. RESULTS: In 117 women with PCOS, endometrial histologic profiles are as follows: proliferative phase in 90 women (76.9%), endometrial hyperplasia in 25 women (21.4%), and endometrial cancer in 2 women (1.7%). Of 25 women with endometrial hyperplasia, simple hyperplasia without atypia, complex hyperplasia without atypia and complex hyperplasia with atypia were diagnosed in 15 (12.8%), 6 (5.1%), 4 (3.4%) women, respectively. Age and endometrial thickness were significantly related with endometrial disease, p=0.013 and p=0.001, respectively. At the cut off level of 25.5 years in age, sensitivity and specificity predicting for endometrial disease were 70.4% and 55.6%, respectively (p=0.023). At the cut off level of 8.5 mm in endometrial thickness, sensitivity and specificity were 77.8% and 56.7%, respectively (p=0.000). CONCLUSION: In women with PCOS, the incidence of endometrial hyperplasia and cancer were 21.4% and 1.7%. The age and endometrial thickness may be used as clinical determining factors for endometrial biopsy.
Biopsy ; Body Mass Index ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Estradiol ; Fasting ; Female ; Glucose ; Humans ; Hyperplasia ; Incidence ; Insulin ; Insulin Resistance ; Polycystic Ovary Syndrome ; ROC Curve ; Sensitivity and Specificity ; Testosterone ; Uterine Diseases