In 1883 Fournier, a French venereologist, described 5 patients with unexplained fulminating gangrene of the male genitalia. Fournier emphasized 3 characteristics 1) the abrupt onset in a young, healthy male subjects, 2) the rapid progression to gangrene and 3) the absence of a discernible cause. As currently used by many authors, Fournier's gangrene describes a widely destructive, gangrenous process of the genitalia, with little regard for Fournier's original tenets of patient's age or definable etiology. Early identification and prompt initiation of medical and surgical therapy is imperative. We report two cases of Fournier's gangrene with brief review of the literatures.
Fournier Gangrene* ; Gangrene ; Genitalia ; Genitalia, Male ; Humans ; Male

Intravesical bacillus calmette-guerin( BCG) therapy for superficial bladder carcinoma is believed to exert its antitumor effects through immune mechanisms which have yet to be more clearly defined. Recently, BCG infection is known to induce nitric oxide(NO) production by macrophages through a T cell mediated process. NO is known to be microbicidal and tumoricidal. Therefore, we studied the effects of intravesical BCG instillation on the induction of inducible NO synthase(iNOS) which is responsible for the production of NO in the vesical tissue of rat Forty Sprauge-Dawley female rats were equally divided into 5 groups. In group 1, normal saline( 0.85 ml/kg) was intravesically instilled one time. In group 2 and group 3, BCG of Pasteur strain(2 mg/kg, normal saline 0.85 ml/kg) was instilled one time and 3 times weekly respectively. In group 4, 10-fold dose of the strain( 20 mg/kg, 0.86 ml/kg) and in group 5, 1/10-fold dose of the strain (0.2 mg/kg, 0.85 ml/kg) were instilled one time respectively. We sacrificed two rats to excise the bladders in each group 1, 3, 7, and 14 days after the instillation( after the last instillation in group 3). iNOS mRNA was not detected in the vesical tissues from the rats of group 1, whereas it was strongly detected in all the vesical tissues from the rats in group 2, 3. or 4. More iNOS mRNA was detected 14 days after the instillation in group 3 than group 2 or 4. In group 5, iNOS mRNA was weakly detected 1, 3, and 7 days and not detected 14 days after the instillation. Our results indicate that intravesical BCG instillation of rat induces the expression of iNOS mRNA in the vesical tissue and suggest that the duration and degree of iNOS mRNA expression is dependent on the dose of BCG and the frequency of the instillations. On the basis of these observations, we conclude that adequate dose and frequency are required for effective treatment of superficial bladder carcinoma in the intravesical BCG therapy.
Animals ; Bacillus ; Female ; Humans ; Macrophages ; Mycobacterium bovis* ; Nitric Oxide Synthase Type II* ; Rats* ; RNA, Messenger ; Urinary Bladder

Recently, BCG infection is known to induce nitric oxide(NO) production by macrophages through T cell mediated process and NO is known to be microbicidal and tumoricidal. There are several strains of BCG which are commercially available and vary in the number, pathogenicity, viability, and immunogenicity of organisms. Therefore, we wanted to know if there are any differences between three different strains of BCG(Pasteur, Connaught or Tice strain) on the induction of inducible NO synthase(iNOS) and the histological changes in vesical tissue after intravesical instillation of BCG in rats. Thirty two Sprauge-Dowley female rats were equally divided into 4 groups. In group 1, normal saline(0.85 ml/kg) was intravesically instilled one time. In group 2, 3, and 4, BCG of Pasteur strain(2mg/kg, normal saline 0.85ml/kg), Connaught strain(1.35mg/kg, normal saline 0.85ml/kg), Tice strain(0.21mg/kg, normal saline 0.85ml/kg) was instilled one time, respectively. The bladders were excised from each group on day 1, 3, 7, and 14 after BCG instillation. iNOS mRNA was not detected in the vesical tissues of control group, whereas it was strongly detected in group 2, 3, or 4. Also, iNOS mRNA was more strongly detected on day 1, 3, and 7 after intravesical BCG instillation than day 14 in the vesical tissues of group 2, 3, and 4. Histologic findings were well related with expression of iNOS mRNA. Our results indicate that intravesical BCG instillation of rat induces expression of iNOS mRNA in the vesical tissue accompanying the infiltration of inflammatory cells and suggest that all of the 3 strains of BCG including Pasteur, Connaught, and Tice are good at inducing expression of iNOS mRNA without significant differences between the strains.
Administration, Intravesical* ; Animals ; Female ; Gene Expression* ; Humans ; Macrophages ; Mycobacterium bovis* ; Nitric Oxide Synthase Type II* ; Rats* ; RNA, Messenger ; Urinary Bladder ; Virulence

The majority of nasal fractures have been managed by using closed reduction, intranasal packing and external splinting. However, in comminuted nasal bone fractures, the conventional closed reduction may be inadequate to reduce the fracture segments accurately, and insufficient to prevent secondary nasal deformity. In these cases, open reduction and interfragment wire fixation was recommended for accurate reduction, and has been mainstay of treatment modality. Furthermore, in nasoethmoid orbital fractures, anatomic reduction of fractured nasal bone, medial and inferior orbital rim segments to reconstruct nasofrontal buttress and transnasal wiring to prevent telecanthus were essential. But, the interfragment wire fixation is difficult and time-consuming procedure. The care must be taken to fix small fracture segments. It is also difficult to obtain bony support due to extensive dissection of periosteum, and to achieve rigid fixation on three- dimensional space, causing depression of bony contour. From April 1998 to August 1999, we used malleable mesh microplates for treatment of 3 comminuted nasal bone fractures and 3 nasoethmoid orbital fractures. During the follow up period of 8 months to 24 months, all of six patients had successful cosmetic result without complications. There was no recurrent depression of bony contour, no secondary nasal deformity, no displacement of microplates and no palpable, externally shown hardwares. The use of mesh microplates is reliable and useful method for the treatment of comminuted nasal fractures because it is relatively simple procedure and achieves rigid fixation on three-dimensional space without postoperative temporary nasal packing which may cause patient's discomfort. Furthermore, in nasoethmoid orbital fractures, correction of telecanthus can be done without application of transnasal wiring.
Congenital Abnormalities ; Depression ; Follow-Up Studies ; Humans ; Nasal Bone* ; Orbit ; Orbital Fractures ; Periosteum ; Splints

The basolateral amygdala (BLA) receives dense projections from cholinergic neurons of the basal forebrain. Acetylcholine can contributes to amygdala-dependent behaviors: formation and extinction of fear memory and appetitive instrumental learning. However, the cholinergic mechanism at the circuit level has not been defined yet. We demonstrated that cholinergic-induced di-synaptic inhibition of BLA pyramidal neurons exhibits a retrograde form of short-term synaptic inhibition, depolarization-induced suppression of inhibition (DSI). Activation of nicotinic receptors was sufficient to evoke action potentials in cholecystokinin (CCK)-positive inhibitory neurons, which strongly inhibit pyramidal neurons through their perisomatic synapses. Our cell type-specific monosynaptic retrograde tracing also revealed that CCK neurons are innervated by basal forebrain cholinergic neurons. Therefore, our data indicated that CCK inhibitory neurons mediate the cholinergic-induced di-synaptic inhibition of BLA pyramidal neurons.
Acetylcholine ; Action Potentials ; Basal Forebrain ; Basolateral Nuclear Complex ; Cholecystokinin ; Cholinergic Neurons ; Conditioning, Operant ; Iontophoresis ; Memory ; Neurons ; Pyramidal Cells ; Receptors, Nicotinic ; Synapses

The purpose of this study was to investigate the factors related to burnout of nurses working at intensive care units. Methods: The subjects of this study included 149 nurses in intensive care units at six general hospitals. The data was analyzed using the SPSS/WIN 23.0 program with descriptive statistics, t-test, ANOVA, Scheffé test, Pearson correlation coefficient, and Stepwise multiple regression analysis were used. Results: The factors significantly affecting burnout included work stress ‘high to very high’ (β=.39, p<.001), communication skill (β=-.24, p=.001), subjective health status ‘normal’ (β=.22, p=.001) and ‘bad to very bad’ (β=.20, p=.002) and problem-driven coping (β=-.19, p=.010) in order, and the explanatory power of these factors to the burnout was 46.3%. Conclusion: Based on the results, effective interventions need to be provided to improve intensive care unit nurses’ health conditions and to relieve their work stress. It is necessary to develop practical strategies to improve nurses’ communication and stress coping skills to reduce their burnout.

Cloacal anomalies are very rare congenital malformations with the incidence of 1/50,000-250,000 births. Hydrocolpos involves the dilatation of the vagina due to obstruction of the genital tract, leading to accumulation of secretions. Because of wide spectrum of abnormal anatomy involving urogenital and gastrointestinal systems, prenatal diagnosis is difficult. As ultrasound becomes more and more reliable, prenatal diagnosis is possible as early as in the second trimester. The presence of prenatally detected hydro (metro) colpos warrants a systematic evaluation of fetal and neonatal anatomy to rule out a large variety of possibly associated malformations or syndromes. We present a case of urogenital sinus maldevelopment which was initially presented as a fetal ascites.
Ascites ; Dilatation ; Female ; Humans ; Hydrocolpos ; Incidence ; Parturition ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; Ultrasonography* ; Vagina

The duodenum ranks second to the colon as the most common site of diverticulosis in the gastrointestinal tract with a prevalence of more than 20%. It is usually asymptomatic, and rarely requires treatments for complications, including diverticulitis, hemorrhage, and luminal obstructions. Unlike diverticulosis, duodenal diverticulitis is extremely rare. Given that the radiological appearance and clinical presentation of duodenal diverticulitis often mimic those of pancreaticobiliary neoplasms or inflammations, it is a challenge for clinicians to diagnose it correctly, which often leads to misdiagnosis and inappropriate management. Here we report a case of a 69 year-old female patient with duodenal diverticulitis, whose clinical symptoms and radiological images were similar to those of acute cholangitis. We also briefly review the literature.
Cholangitis ; Colon ; Diagnostic Errors ; Diverticulitis ; Diverticulum ; Duodenum ; Female ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Hydrazines ; Inflammation ; Phenobarbital ; Prevalence ; Sphincterotomy, Endoscopic

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.
Adenomatous Polyps ; Carcinoma in Situ ; Gastrectomy ; Gastric Bypass ; Gastric Stump* ; Gastroenterostomy ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Polyps ; Prevalence ; Stomach Ulcer

No abstract available.
DNA* ; Immunophenotyping*