PURPOSE: Various surgical approaches have been used for stress urinary incontinence. We used a suburethral patch sling operation using fascia lata for all patients with stress urinary incontinence and report our experience. MATERIALS AND METHODS: From November, 1996 to May, 1997, a total of 25 female patients with stress urinary incontinence underwent the sling procedure, and 22 patients were followed up postoperatively. A 1.5- x 3.5- cm rectangle of fascia lata was used with 1-0 prolene sutures attached to allow suspension and the fascia lata patch was fastened at the level of the bladder neck in the anterior vaginal wall. We used the Stamey needle to transfer the suspension sutures in a fashion identical to that used for bladder neck suspension. Median followup was 22 months(range 20 to 26). RESULTS: Mean age was 47.1 years and mean parity was 3.1. According to the symptom grading system by Stamey, grade I was 77.3%(17), grade II 18.2%(4), and grade III 4.5%(1). Valsalva leak point pressure was 60cmH2O or less in 27.3%(6), 61 to 90cmH2O in 27.3%(6), and more than 90cmH2O in 45.4%(10). Mean operation time was 124.0minutes and mean duration of postoperative indwelling catheter was 4.2 days. Among 22 patients, 18 patients(81.8%) were cured, 3(13.6%) improved, and 1(4.5%) failed. No statistically significant relationship existed between either symptom grade or VLPP and success rate, but maybe it would be due to low number of patients to be compared. Two patients(9.1%) with grade I suffered from prolonged voiding difficulty and they catheterized intermittently for 30 days and 64 days respectively before normal voiding. De novo urge incontinence developed in 1 patients(4.5%). Other minor complications were urinay tract infection(4 cases), weak stream(3 cases), bladder irritative symptom(2 cases), deviation of urine stream(2 cases), prolonged suprapubic pain(1 case), prolonged thigh pain(1 case), and dyspareunia(1 case). CONCLUSIONS: The suburethral patch sling operation using fascia lata was considered another useful option for the patients with stress urinary incontinence who want autologous tissue for sling material but can not use rectus fascia due to medical condition or previous abdominal operation or irradiation.
Catheters ; Catheters, Indwelling ; Fascia Lata* ; Fascia* ; Female* ; Follow-Up Studies ; Humans ; Neck ; Needles ; Parity ; Polypropylenes ; Sutures ; Thigh ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.
Cell Differentiation ; Endocrine Cells ; Humans ; Incidence ; Insulinoma ; Islets of Langerhans ; Pancreas* ; Rare Diseases ; Retrospective Studies ; Seoul ; Somatostatinoma ; Stem Cells

Inflammatory mediators, such as oxidants, TNF-alpha, and IL-6, play a major role in the systemic response to bum injury It has been known that a continuing inflammatory response cause a sepsis and subsequent multiple organ failure. Recent studies have shown that burn patients receiving recombinant human growth hormone(rhGH) therapy have an improvement of the general condition, but the mechanism by which rhGH exerts its effects has not been clearly understood. The aim of this study was to evaluate the effect of rhGH on the early bum injury. Female Sprague-Dawley rats were divided into four groups : control group, bum group, burn plus rhGH treated group, and rhGH only treated group. Animals were killed at 30min., 3, 6, 24, and 48 hours after treatment. Histology and biochemical changes including malondialdehyde(MDA) content, tissue reduced glutathione(GSH) and catalase activity in the lung and liver, and plasma TNF-alpha and IL-6 levels were examined. Lung histology in the bum plus rhGH treated group showed decreased inflammtory response such as neutrophil and lymphocyte infiltrations, interstitial thickening, and edema compared with the bum group. Liver histology in the bum group revealed mild neutrophil and lymphocyte infiltrations, vacuolization .of hepatocytes, disrupted lobular structures, and dilated sinusoids. But liver histology of the bum plus rhGH was similar to control group. Lung and liver MDA in the burn plus rhGH and rhGH only treated groups were decreased with time compared with the burn group. Lung and liver GSH and catalase activities in the bum plus rhGH and GH only treated groups remained significantly increased compared with the bum group for the 48-hours period. Plasma TNF-alpha levels in the bum group remained elevated for the 48-hours period compared with the bum plus rhGH and rhGH only treated groups. Plasma IL-6 levels in the burn group were significantly increased only at first compared with the bum plus rhGH and rhGH only treated groups. These results suggested that rhGH showed inhibitory effects on the inflammatory cell infiltration and lipid peroxidation in the lung and liver after bum injury. Increased GSH levels and catalase activities seemed to be associated with the antioxidant effect of rhGH. But the inhibitory effect of rhGH on plasma TNF- and R-6 levels was not clearly demonstrated.
Animals ; Antioxidants ; Burns ; Catalase ; Edema ; Female ; Hepatocytes ; Human Growth Hormone* ; Humans* ; Interleukin-6* ; Lipid Peroxidation* ; Liver ; Lung ; Lymphocytes ; Multiple Organ Failure ; Neutrophils ; Oxidants ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha*

OBJECTIVES: To determine how extended high frequency is affected by noise exposure and other factors that maybe have adverse effects. METHODS: Pure tone audiometry for usual frequencies (250-8000 Hz) and extended high frequencies (1000-16000 Hz) was conducted for 331 workers at a manufacturing company from 2004 to 2005. History of noise exposure, military service, tinnitus, alcohol drinking, smoking, ear diseases, and noisy hobbies were taken by interview. T-test, ANOVA, and multiple regression was conducted according to the frequency to evaluate the factors that could affect extended high frequency hearing. RESULTS: The noise-exposed group had significantly poorer hearing than the noise-unexposed in the frequency range 2000-16000 Hz. The hearing deteriorated with increasing age through all the frequencies. High frequency hearing of 14000 Hz was significantly worse in the noise-exposed group in their 30s. Noise exposure during military service had a bad effect on hearing, especially for the noise-unexposed group. Tinnitus was associated with poorer hearing in both noise-exposed and noise-unexposed groups. Workers with noisy hobbies exhibited better hearing in the noise-unexposed group, contrary to our expectation. Extended high-frequency hearing was affected by aging, ear protection, and noisy hobbies. In extended high frequency, 14000 Hz was especially related with noise exposure history. CONCLUSIONS: Extended high frequency, especially 14000 Hz, could be used as an indicator of noiseinduced hearing loss and should be considered as a screening test for workers in noisy environments.
Aging ; Alcohol Drinking ; Audiometry ; Ear ; Ear Diseases ; Hearing ; Hearing Loss ; Hobbies ; Humans ; Mass Screening ; Military Personnel ; Noise ; Smoke ; Smoking ; Tinnitus

BACKGROUND AND OBJECTIVES: There is evidence which suggests that mammals have functional olfactory systems at birth or shortly before birth. This study was performed to investigate perinatal development of the olfactory mucosa. MATERIALS AND METHODS: Sprague-Dawley rats at the 19th gestational day, and of the 1st, 3rd, 7th, 14th, 21st, and 28th postnatal day were sacrificed. The light microscopic investigation of the olfactory mucosa was conducted with hematoxylineosin stain, immunohistochemical stain for proliferating cell nuclear antigen (PCNA) and protein gene product (PGP) 9.5. RESULTS: Number of the cell layers, epithelial thickness, and density of the olfactory receptor cell peaked at the postnatal 14th day. The cells of the basal layer changed from globose cells to basal cell proper with age. The number of the basal cells to the receptor cells decreased with age. PCNA was positive both in the supporting and basal layers. PCNA positivity decreased with age in the supporting layer but stayed stationary in the basal layer. PGP 9.5 was strongly positive in the olfactory receptor cells, dendrites, and the nerve bundles but negative in the supporting and basal layers. CONCLUSION: The olfactory epithelium proliferated maximally at postnatal 14 day, and afterwards the olfactory mucosa tended to show their characteristic maturation with slowed neurogenesis.
Animals ; Dendrites ; Mammals ; Neurogenesis ; Olfactory Mucosa* ; Parturition ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley

Relapsing polychondritis is an uncommon disease manifested by episodes of progressive inflammation and destruction of cartilage. While the cause remains unknown, an autoimmune pathogenesis appears likely. Characteristic features include auricular chondritis, arthritis, nasal chondritis, ocular inflammation, respiratory tract involvement and audiovestibular damage. The clinical course of patients may vary from a relatively benign illness free of clinically evident visceral involvement, to one of episodic or smoldering activity with variable intensity, to a f ulminant illness and death within months of diagnosis. Dapsone, corticosteroid and immunosuppressive agent remain the effective therapies. We have experienced a case of relapsing polychondritis and active pulmonary tuberculosis in a 69-year-old man. He suffered from arthralgia and swelling of joints for several months on the first admission and initially was diagnosed as pseudogout based on polyarthritis and chondrocalcinosis of right knee joint. During follow-up, chondritis of both auricles and nose, which was proved by the biosy of right auricle, and relapse of polyarthritis were developed. His spu tum smear for acid-fast bacillus was postive on the second admission. Then he was diagnosed as relapsing polychondritis and active pulmonary tuberculosis and has achieved improvement with medication of dapsone and antituberculosis drugs according to susceptability test during followed-up. Thus we report this case with literature review.
Aged ; Arthralgia ; Arthritis ; Bacillus ; Cartilage ; Chondrocalcinosis ; Dapsone ; Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Joints ; Knee Joint ; Nose ; Polychondritis, Relapsing* ; Recurrence ; Respiratory System ; Tuberculosis, Pulmonary

Three cases of cerebrospinal fluid (CSF) rhinorrhea and anterior skull base defects were successfully treated by applying mucoperichondrial free graft through the endonasal endoscopic technique. The causes of the skull base defects were trauma in two cases and endoscopic sinus surgery in one case. The defects were located in the sphenoid sinus in one case and the fovea ethmoidalis in two cases. In these cases, contralateral side septal mucoperichondrial free grafts were used to seal the defects and were supported with fibrin glue and Spongostan(R). Endoscopic repair with mucoperichondrial free graft appeared to be a safe and successful approach to the treatment of the anterior skull base defects.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Fibrin Tissue Adhesive ; Skull Base ; Sphenoid Sinus ; Transplants*

Nevus lipomatosus cutaneous superficialis is a very rare disorder characterized by nevoid fatty growth in the dermis. It usually arises in the pelvic girdle, so is unfamiliar to most otolaryngologists. A case of a 72-year-old male with nevus lipomatosus cutaneous superficialis in the nasal cavity is presented with a brief review of the disease.
Aged ; Dermis ; Humans ; Male ; Nasal Cavity ; Nevus*

PURPOSE: Axillary node involvement is the single most important prognostic variable in patients with breast cancer. If axillary lymph node status of breast cancer patients could be accurately predicted from basic clinical information and from characteristics of their primary tumors, many patients could be spared axillary lymph node dissection. With the availability of numerous histologic prognosticators and new immunochemical prognostic indicators, it is reasonable to reconsider the necessity of axillary node dissection for lesions more advanced than duct carcinoma in situ. MATERIALS AND METHODS: Six hundred fifty-six patients with Tl invasive breast cancer were evaluated. All the patients underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor in this study were age, size, family history, tumor palpability, nuclear and histological grade, hormone receptor status, lymphatic vessel invasion (LVI), and various tumor markers (bc1-2, cathepsinD, c-erbB2, E-cadherin, p53). RESULTS: Approximately 31% of the 656 patients with Tl breast carcinoma had axillary node metastasis. Four factors were identified as significant predictors of node metastasis: age 35 or less (p=0.01), lymphatic vessel invasion (p < 0.01), tumor palpability (p=0.02), and tumor size (p<0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size (p=0.04) and LVI (p=0.03). CONCLUSION: Characteristics of the primary tumor can help assess the risk for axillary lymph node metastases in Tl breast cancer. Selected patients who have 1cm or less without lymphatic vessel invasion are considered to be at minimal risk of axillary node metastasis and might be spared routine axillary dissection.
Breast Neoplasms* ; Breast* ; Cadherins ; Carcinoma in Situ ; Humans ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Neoplasm Metastasis* ; Prognosis ; Biomarkers, Tumor

Kuttner tumor or chronic sclerosing sialadenitis is a benign inflammatory condition of the salivary gland that mimics a malignant neoplasm clinically because of its presentation as a hard mass. The cause of this inflammatory is still unknown. The effects of microliths, infectious agents, secretory dysfunctions, duct abnormalities, and immune processes have been considered. Histologically, it is characterized by progressive periductal sclerosis, acinar atrophy, and dense infiltration of lymphocytes. Kuttner tumor is best diagnosed by open or excisional biopsy. We report one case of Kuttner tumor of right submandibular gland in a 42 year old man.
Adult ; Atrophy ; Biopsy ; Humans ; Lymphocytes ; Salivary Glands ; Sclerosis ; Sialadenitis* ; Submandibular Gland