Acardic twining is a rare congenital anomaly, usually in monozygotic twins. This condition is characterized by the absence or rudimentary development of fetal hear, and associated with various anomaly(especially with anecephalus). The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. We recently experienced a case of acardius acephalus associated with a normal term male infant, so present with a brief review of the literature.
Humans ; Infant ; Male ; Mortality ; Twins* ; Twins, Monozygotic

The pathophysiology of pediatric encopresis has been incomprehensible. The current study was designed to assess its clinical and physiologic findings. Moreover, outcome of treatment was evaluated. METHODS: The clinical and functional findings of 18 patients (13 boys, 5 girls) were analyzed, retrospectively. Physiologic studies for cooperative child included anal manometry (n=12), cinedefecography (n=3), and PNTML (pudendal nerve terminal motor latency, n=1). For exclusion of the organic cause, barium contrast study was carried out in all case. Patients were categorized by leading symptom as constipation or incontinence. Physiologic findings and outcome of treatment were analyzed based on the categorized groups. Biofeedback therapy by using newly-developed anal sphincter control system (KONTINENCE CLINICAL(TM)) in my institute, was underwent a mean 4.1 (range, 2~12) sessions. The outcome was analyzed in the period of 5.4 (range, 1~33) months follow-up. RESULTS: Patients were categorized as having constipation (group I, n=12) or incontinence (group II, n=6) group. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction between group I and II. In the cinedefecography, 3 of group I patients revealed as having the pelvic floor dyssynergia. The findings of PNTML were not specific in group II (n=1). Regarding to the therapeutic outcome, 8 of 10 patients were cured or improved. CONCLUSIONS: There were no differences in the resting and squeeze profiles of manometric parameters between two groups. However, pelvic floor dyssynergia was identified in the cinedefecography of constipated group. Conventional and biofeedback treatment for encopretic children provides acceptable outcome.
Anal Canal ; Ataxia ; Barium ; Biofeedback, Psychology ; Child ; Constipation ; Defecography ; Encopresis* ; Follow-Up Studies ; Humans ; Manometry ; Pelvic Floor ; Retrospective Studies

We describe an 22-yeer-old man with polyorchidism whose both ipsilateral testes were located in the inguinal area and scrotum. Polyorchidism is a rare anomaly with approximately 70 cases reported in the literature. In this report the literature is reviewed and the etiology of this anomaly is discussed briefly.
Scrotum ; Testis

PURPOSE: The aim of this study was to evaluate the correlation among descriptions regarding one's stool, Bristol stool form scale and colon transit time (CTT) in children with gastrointestinal symptoms, along with the clinical significance of Bristol stool form scale. METHODS: 489 patients treated in the pediatric department of Severance hospital with gastrointestinal symptoms between May 2002 to May 2004 were included. We analyzed their age, sex, verbal descriptions of stool, Bristol stool form types, and CTT measured by Metcalf's method. RESULTS: 116 children were under 5 years of age, 202 children between 5.1~10, and 171 children 10 years of age or older. Their mean age was 8.2+/-3.9 years. Stools were described as loose in 65 children (13.3%), normal in 221 (45.2%), hard in 188 (38.4%), and mixed (loose+hard) in 15 (3.1%). According to Bristol stool form scale, 57 children(11.7%) were classified as type 1, 66 (13.5%) as type 2, 203 (41.5%) as type 3, 109 (22.3%) as type 4, 36 (7.4%) as type 5, 18 (3.7%) as type 6, and 1 (0.2%) as type 7. Their mean CTT was checked 35.9+/-19.5 hours. Though no significant relationship was observed between age and CTT (p=0.4), a significant relationship was noted among patient's stool description, Bristol stool form scale and CTT (p<0.001). However, concordance between stool description and Bristol stool form was relatively low in the loose stool group (29%) and normal stool group (37%) while high in the hard stool group (87%). CONCLUSION: Bristol stool form scale could be used in the estimation of CTT in clinical practice.
Child* ; Colon* ; Humans

PURPOSE: Detrusor instability (DI) is a main cause of persistent voiding difficulty after TURP in patients with benign prostatic hyperplasia (BPH). So we retrospectively estimated the effect of TURP in BPH patients with DI. MATERIALS AND METHODS: Of the 81 patients who had undergone TURP due to prostatism, 35 patients with BPH were followed at 3 weeks and 6 months postoperatively (21 without DI cases vs. 14 with DI; 6 persistent DI, 7 resolved DI, 1 missing case at 3 weeks and 4 persistent DI, 7 resolved DI, 2 missing cases at 6 months). We compared each group using symptom score (IPSS) and urodynamic parameters. RESULTS: Each irritative and obstructive symptoms were significantly improved in both group (p<0.05). The maximal flow rate (from 12.2 to 25.4ml/sec), average flow rate (from 8.9 to 15.2ml/ sec), residual urine volume (from 135.9 to 39.1ml) in patients without DI and maximal bladder volume (from 150.0 to 203.7ml), maximal flow rate (from 12.5 to 18.6ml/sec), residual urine volume (from 65.7 to 26.0ml) in patients with DI were improved significantly (p<0.05) after TURP, but other parameters were not improved (p>0.05). There were no significant differences in all parameters between 3 weeks and 6 months postoperative period (p>0.05). The amplitude of improvement had no significant difference between two group. There were no significant differences in IPSS and urodynamic parameters between persistent and resolved DI group. CONCLUSION: We suggest that TURP is good therapeutic option even in BPH patients with DI at short term postoperative period, but attempt to predict which patients would have persistent DI following TURP was failed.
Humans ; Postoperative Period ; Prostatic Hyperplasia ; Prostatism ; Retrospective Studies ; Transurethral Resection of Prostate* ; Urinary Bladder ; Urodynamics*

In order to define PSA levels by age decade in men without clinical evidence of prostatic adenocarcinoma, so called non-cancer, Tandem-R assay for PSA was performed in male patients older than 40 years who had visited to our department. We defined the non-cancer population as men with a normal PSA value( 4.0ng/ml or less) and negative digital rectal examination findings. Furthermore, patients with an abnormality in either PSA value or suspicious digital rectal examination underwent transrectal ultrasound and pathologically excluded prostatic cancer from the population by transrectal prostate biopsies or transurethral resection. A total of 203 men entered the protocol, of whom 192 satisfied our criteria of non-cancer population. New mean, standard deviation and cutoff serum PSA values by age proposed as mean + 2 standard deviations were derived as follows, 0.84 0.68ng/ml( 2.2ng/ml) in the 40 to 49-year group, 2.03 + 1.36ng/ml( 4.8ng/ml) in the 50 to 59-year group. 2.02 + 1.7lng/ml( 5.4ng/ ml) in the 60 to 69-year group, 3.16 + 1.91ng/ml( 7.0ng/ml) in the 70 to 79-year group and 4.52 + 4.03ng/ml(12.6ng/ml) in the 80 to 89-year group.
Adenocarcinoma ; Biopsy ; Digital Rectal Examination ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Ultrasonography

We report the case of a 24-year-old man suffering from a pituitary diabetes insipidus associated with massive urinary tract dilatation with infravesical obstruction. The patient had been admitted and diagnosed to bulbous urethral stricture in our department. Endoscopic internal urethrotomy had been performed for his urethral stricture, but his abdominal distention had not been improved. About 1 year later, he was revisited to emergency room due to painful gross total hematuria and abdominal distention after trivial abdominal blunt trauma. On the abdominal CT finding, the right renal pelvis was collapsed, from which the contrast media was extravasated. The right pyeloplasty, nephrostomy, ureteral stent indwelling and suprapubic cystostomy were performed. During immediate postoperative management, extreme fluid and electrolyte imbalances were occurred. However, we overcame these troubles using hypotonic saline and hormonal replacement. So we reported this case with literatures.
Contrast Media ; Cystostomy ; Diabetes Insipidus, Neurogenic* ; Dilatation ; Emergency Service, Hospital ; Hematuria ; Humans ; Hydronephrosis* ; Kidney Pelvis ; Stents ; Tomography, X-Ray Computed ; Ureter ; Urethral Stricture ; Urinary Tract ; Young Adult

A few cases of laparoscopic surgery for urachal remnant in children has been reported in English literature. With recent developments in minimal invasive surgery, laparoscopic approach for urachal remnant in adulthood is recommended by some laparoscopic surgeons because of its technical feasibility and safety as well as cosmesis. Recently we experienced a case of complicated urachal remnant in a 14-month-old girl, who was managed by laparoscopic approach. At presentation, she complained of high fever and lower urinary tract symptoms. After 6 weeks of antibiotics therapy, laparoscopic surgery was performed transperitoneally via 3 ports. Our experience suggests that laparoscopic excision of urachal remnant can be performed easily and safely in children.
Urachus/*abnormalities/pathology/*surgery ; Staphylococcus aureus ; Staphylococcal Infections/complications ; Laparoscopy/*methods ; Infant ; Humans ; Female

Current study was designed to assess the functional etiology of patients with pelvic outlet obstruction. Moreover, physiologic characteristics and theirs clinical significances were evaluated in the patients with ramified diagnosis. METHODS: 172 patients with pelvic outlet obstruction were performed 328 numbers of physiologic studies. These included cinedefecography (n=172), anal manometry (n=87), colonic transit time study (n=38), and anal EMG/PNTML (n=31). On the basis of physiologic findings, patient groups were categorized as rectocele (group I), nonrelaxing puborectalis syndrome (group II), anal dyschezia (group III), and rectoanal intussusception (group IV). The physiologic findings were compared between subgroup patients. RESULTS: Incidence of categorized patients was 51.7% (group I, n=89), 22.7% (group II, n=39), 12.2% (group III, n=21), and 8.7% (group IV, n=15), respectively. The mean age of patients with group III were lower (p<0.05) than that of overall patients. The incidence of female patients was higher in group I and the incidence of male patients was higher in group II (p<0.0001). In cinedefecography, patients with group II showed smaller anorectal angle at strain (p<0.001), at dynamic change between rest and strain (p=0.002). In anal manometry, patients with group III showed higher mean resting pressures (p=0.001), higher maximum resting pressures (p<0.001), higher mean squeeze pressures, and higher maximal voluntary contraction (p=0.003) than those of patients with other group. In neurologic study, mean value of PNTML was 2.32 +/- 0.34 (range, 1.60~3.66) msec in overall patients. The size of rectocele was increased in proportion to patient's age (r=0.229, p<0.05), number of delivery (r=0.393, p=0.001), and degree of perineal descent (r=0.231, p<0.05). The degree of perineal descent was increased in proportion to patient's age (r=0.249, p<0.05). CONCLUSIONS: Present series provided the diagnostic ramification of pelvic outlet obstruction by using the anorectal physiologic investigations. In addition to the function of puborectalis muscle, evacuation dynamics of anorectum should be emphasized. These findings could provide the fundamental information for guideline of future therapy in the patients with obstructed defecation.
Colon ; Constipation ; Defecation ; Diagnosis ; Female ; Humans ; Incidence ; Intussusception ; Male ; Manometry ; Rectocele ; Time and Motion Studies

PURPOSE: The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection. MATERIALS AND METHODS: total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables. RESULTS: In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%. CONCLUSIONS: The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.
Anti-Bacterial Agents ; beta-Lactamases ; Cefaclor ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Female ; Hospitalization ; Humans ; Inpatients ; Multivariate Analysis ; Outpatients ; Prevalence* ; Risk Factors* ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections*