PURPOSE: To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions. MATERIALS AND METHODS: We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side. RESULTS: The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period. CONCLUSIONS: The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.
Constriction, Pathologic ; Cystoscopy ; Endometriosis ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Humans ; Laparoscopy ; Myoma ; Replantation ; Retrospective Studies ; Stents ; Ureter ; Ureteral Neoplasms ; Urography

OBJECTIVE: The purpose of this study was to review the incidence, types, chemotherapy regimens, operation methods, pregnancy rate and propiosis of the ov#arian malignancy under the age of twenty years old. METHODS: Retrospective reviews of the medical recordings for 22 patients with ovarian malignancy under the age of twenty years old in the Department of Obstetrics and Gynecology, Hanyang University from 1986 to 1997 were done. RESULTS: Gerin cell tumor accounts for the majority of cases (77%), whereas 5 patients(23%) belong to the common epithelial poup which were all mucinous type. Our experiences with 22 cases are as followings: 5 mucinous cystadenocarcinoma, 8 immature teratoma, 4 endodermal sinus tumor, 3 dysgernma and 2 mixed germ cell tumor. The incidence of this group was 8.2% (22/266) in all ovarian malignancy. Fourteen of them are stage I, each one is, stage II and IV, and six patients are stage III. The average age was 14.9 years old in germ cell tumor and 18.4 yems old in mucinous cystadenoearcinoma. Malignant ovarian cancer under the age of twenty can be treated with conservative surgery, followed by adjuvant chemotherapy. Commonly used chemotherapeutic regimens were VAC(Vincristine, Actinomycin-D; Cyclophosphamide), VBP(Vinblastine, Bleomycin, Cisplatin) and BEP(Bleomycin, Etoposide, Cisplatin). Second look operations were done in 11 patienth and histologic positive findings were detected in 4 of them. The length of follow-up ranged ftom 3 months to 137 months and median value was 44 rnonths. CONCLUSIONS: It is concluded that for young women who wish to preserve child-bearing capacity, regardless of the stage of the tumor, fertility preserving surgery with complete surgical staging, if necessary followed by combination chemotherapy is an appropriate treatment.
Bleomycin ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous ; Drug Therapy ; Drug Therapy, Combination ; Endodermal Sinus Tumor ; Etoposide ; Female ; Fertility ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Medical Records ; Mucins ; Neoplasms, Germ Cell and Embryonal ; Obstetrics ; Ovarian Neoplasms ; Pregnancy Rate ; Retrospective Studies ; Teratoma

OBJECTIVE: We aim to statistically analyze the variables affecting FHR using principal component analysis and multiple regression analysis. It is tried to find which variables significantly affect FHR. Thus, it would help further work of building objective decision basis to analyze variables affecting FHR. METHODS: The samples are chosen from pregnant women who took a NST at Hanyang University Hospital. It consists of 5,314 data which have been collected from 1989 to 1997. For collection of data and values of each variable, our own FHR interpretation softwares, HYFM-I (DOS version, since 1989) and HYFM-II (Windows version, since 1998) were used. Then, the principal component analysis is performed to find significant variable and multiple regression analysis is performed using these variables. RESULTS: The mean baseline FHR is not influenced by a specific factor in abnormal group. The gestational week, loss of signal, variability, and 5 minutes Apgar score are chosen as main effects through principal component analysis. From the results of regression analysis, it is noticed that 5 minutes Apgar score which is one of neonate prognosis after birth causes an increase of estimated FHR score (EFS), whereas the loss of signal causes a decrease of EFS. The variability in normal group is more active increasing factor of EFS than abnormal group. CONCLUSIONS: Based on gestational week, 5 minutes Apgar score is highly related with fetal maturity in both normal and abnormal groups. Also, it is found that different patterns of each variable by groups are due to delay of fetal growth that is caused by disease of a pregnant women. Thus, the further studies to build objective decision basis are need.
Apgar Score ; Female ; Fetal Development ; Fetal Heart* ; Heart Rate, Fetal* ; Humans ; Infant, Newborn ; Multivariate Analysis* ; Parturition ; Pregnancy ; Pregnant Women ; Principal Component Analysis ; Prognosis

We investigated the pathobiological course of uranyl nitrate (UN) induced polyuric acute tubular necrosis (ATN) in male Sprague Dawley rats. UN (5mg/kg 15mg/kg and 3Omg/kg) in 5% NaHCO3 induced weight loss, polydipsia, and polyuria 24 hrs after injection when compared to the controls which were treated with 5% NaHCO3 only. Twenty four hours following the injection of UN, serum creatinine and blood urea nitrogen levels had increased. These changes continued for at least 72 hours, although the concentration of uranium had decreased. Light microscopic studies conducted 24 hours after injection, revealed partial degeneration and necrosis of the proximal tubules and many casts m the distal convoluted tubules. These changes progressed for 72 hours. Despite this tubular damage, the glomeruli were relatively intact. 5 days after injection, the epithelial cells lining the proximal tubules displayed regenerative activities; these findings were more prominent after 10 days. Through electron microscopic examination, we observed the destruction of mitochondria in the proximal tubular cells, a possible cause of polyuria. Ten days post injection regenerative activities in the proximal tubular cells showed that the maturation of intracellular organelles followed the proliferation of the premature cells.
Animal ; Kidney Failure, Acute/chemically induced* ; Kidney Function Tests ; Kidney Tubular Necrosis, Acute/chemically induced* ; Male ; Rats ; Rats, Inbred Strains ; Uranium/pharmacology* ; Uranyl Nitrate/pharmacology*

The ventriculoatrial(VA) intervals during supraventricular tachycardia(VAsvt) and during pacing with same cycle length as tachycardia(VApace) were analysed in 48 patients to evaluate the usefullness in determining the mechanism of paroxysmal supraventricular tachycardia(PSVT) and the sites of accessory pathways. The results are as follows : 1)In differenciation AV nodal reentry from AV reentry mechanism, VAsvt(25.6+/-21.5 vs 148.0+/-27.7msec, p<0.01), VApace-VAsvt(135.3+/-15.7 vs 55.0+/-33.5msec,p<0.01), and VAsvt/VApace(0.15+/-0.10 vs 0.75+/-0.14,p<0.05) were useful. Cutoff values were 95msec in VAsvt, 110msec in VApace-VAsvt and 0.5 in VAsvt/VApace. 2) There were no overlaps in VA intervals between the AV nodal reentry group and the AV reentry group with posteroseptal accessory pathway.3) In AV reentry tachycardia, VApace-VAsvt>50msec(sensitivity 81%,specificity 100%) and VAsvt/VAace<0.7(sensitivity 71%, specificity 100%) suggested the high probability of left free wall accessory pathway. In Conclusion, VAsvt, VApace-VAsvt and VAsvt/VApace are useful parameters in determining the mechanism of PSVT and the sites of accessory pathways.
Humans ; Sensitivity and Specificity ; Tachycardia

PURPOSE: To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL. MATERIALS AND METHODS: In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core). RESULTS: The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001). CONCLUSION: MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.
Adenocarcinoma/blood/diagnosis/*pathology ; Aged ; Biopsy/*methods ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods ; Humans ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Middle Aged ; Neoplasm Grading ; Prostate/diagnostic imaging/*pathology ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/blood/diagnosis/*pathology ; Ultrasonography, Interventional/methods

Previous studies have shown that experimental canine coronary or rabbit cardtid qrtery stenosis that is associated with endothelial injury results in a typical pattern of blood flow characterized by gradual decreases in arterial flow followed by restorations of flow to normal values. This pattern of flow, called cyclic flow reduction(CFR), is the consequence of recurrent platelet aggregation at the site of the stenosis and endothelial injury and subsequent dislodgement of the thrombus. This study was designed to test the efficacy of verapamil in ingibiting in vivo platelet aggregation in a rabbit model of cardotid artery stenosis and ecdothelial injury. Carotid blood flow was measured continuously with a electromagnetic flowmeter probe that is positioned proximal to the constrictor. During placement of constrictor and angioplasty balloon, CFR developed in 8 of 20 rabbits with a mean frequency of 10.0+/-2.2 cycles/h. CFRs were observed for 30min, and IV verapamil was administered till declining of blood pressure(up to 100ug/kg). After intravenous verapamil, the mean frequency of CFR insignificantly decreased to 8.7+/-2.1 cycles/h(p=ns). After 20mg/kg of aspirin were given intravenously, the CFR were abolished in 5 rabbits, the mean frequency of CFR decreased in 1 rabbit, and no significant change was observed in 2 rabbits. It is concluded that verapamil is relatively ineffective in inhibiting in vivo platelet aggregation at doses that don't change hemodynamics significantly.
Angioplasty ; Arteries ; Aspirin ; Carotid Stenosis* ; Constriction, Pathologic ; Flowmeters ; Hemodynamics ; Magnets ; Platelet Aggregation ; Rabbits ; Reference Values ; Thrombosis ; Verapamil*

BACKGROUND: Amlodipine ; 2-<(2-aminoepoxi)methyl>-4-(2-chlorophenyl)-3-ethoxycarbonyl-5-methoxycarbonyl-6-methyl-1,2, dihydropyridine) is a novel calcium channel antagonist of long half-life and steady state blood levels. However, its blood pressure lowering effect throughout the day has not been well documented especially in Korean patients with essectial hypertension. Therefore, antihypertensive effect of amlodipine in Korean patients with mild to moderate hypertension was evaluated with using 24 hour ambulatory blood pressure measurement(ABPM) as well as office blood pressure measurement. METHODS: Total 25 subjects(M;F=13:12, mean age;53.4+/-7.3 yrs) with mild-to-moderate essectial hypertension had completed the study. After 2 weeks of placebo, amlodipine was mediciated for 12 weeks. Initially, amlodipine was given as 5mg once a day and the daily dose was increased to 10mg/day if diastolic blood pressure in over 90mmHg at the 8th week of medication. The blood pressure level was measured every 4weeks during medication in sitting position('office blood pressure level') and 24 hour ambulatory blood pressure monitoring(ABPM) was done at the placebo run-in phase and at the 8th week of medication. RESULTS: In the view of' office blood pressure lever', the blood pressure lowering effect of amlodipine was already impressive at 4 weeks after medication. The systolic(placebo; 165.3+/-16.9mmHg, arter 4 wk of medication; 136.1+/-16.0mmHg, 8 wk; 136.0+/-12.9mmHg, 12wk; 133.2+/-10.7mmHg) and diastolic blood pressure(placebo; 104.1+/-11.0mmHg,after 4 wk of medication; 87.4+/-6.8mmHg, 8 wk; 86.0+/-6.5mmHg, 12 wk; 84.7+/-5.4mmHg)fell significantly, and most patients had both satisfactory systolic(<160mmHg) and diastolic(<90mmHg) blood pressure levels. And such antihypertensive effects were main tained throughout study period. In contrast, the heart rate did not change significantly. The blood pressure lowering effects assessed by 24 hour AVPM were slightly milder, but absolute systolic and diastolic blood pressures by ABPM after 8 weeks of meddication were as low as those of office measurement. The blood pressure lowering effect was maintained throughout the day including morning periods without either rebound blood pressure elevation or reflex tachycardia. The percent reduction of systolc and diastolic vlood pressure with amlodipine were 17% in office blood pressure measurement and 10% in ABPM. During medication, neither significant side effects nor discomforts that lead to discontinuation of the drug has not been observed. Mild edmatous feeling in 3 subjects, flushing in one and palpitation in one were reported. CONCLUSION: Amlodipine is an effective antihypertensive drug that can control the elevated blood pressure in most patients with mild-to-moderate essential hypertension by monotherapy of once a day regimen without serious side effects.
Amlodipine* ; Blood Pressure* ; Calcium Channels ; Flushing ; Half-Life ; Heart Rate ; Humans ; Hypertension* ; Reflex ; Tachycardia

OBJECTIVE: We aimed to assess disturbances in postural and gait balance and functional connectivity within the brain regions controlling balance in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Thirteen children with ADHD and 13 age- and sex-matched controls were recruited. Gait balance was assessed by the difference in the center of pressure (COP) between the left and right foot, as well as the difference in plantar pressure between the left and right foot during gait. Neuroimaging data were acquired using a 3.0 Tesla MRI scanner. Functional connectivity between the vermis of the cerebellum and all other brain regionswas assessed. RESULTS: The difference in plantar pressure between the left foot and right foot in the ADHD group was greater than that observed in the control group. The average COP jerk score of the right foot in the ADHD group was higher than that observed in the control group. A higher functional connectivity between the cerebellum and the right middle frontal gyrus (premotor cortex) and medial frontal gyrus (cingulate gyrus) was observed in the control group relative to the ADHD group. In the ADHD group, the difference in plantar pressure between the left and right foot was also negatively correlated with the beta-value within the middle frontal gyrus. CONCLUSION: Children with ADHD had disturbance of balance as assessed by plantar pressure. Decreased brain connectivity from the cerebellum to the premotor cortex and anterior cingulate was associated with disturbances of posture and balance in children with ADHD.
Brain* ; Cerebellum ; Child* ; Foot ; Gait ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Motor Cortex ; Neuroimaging ; Posture ; Prefrontal Cortex

Six strains of Sparassis crispa such as S. crispa DUM-01, DUM-02, DUM-03, DUM-04, DUM-05, and DUM-06 were tested for their mycelial growth on 6 different kinds of sawdust media and primordial formation on 10 different compositions of larch sawdust media. The highest mycelial growth was recorded on the larch sawdust. Of the 6 strains of S. crispa, S. crispa DUM-04 recorded the favorable formation of primordia. The primordial formation of S. crispa DUM-04 was more favorable on L-3 medium than 9 kinds of larch sawdust media. When S. crispa DUM-04 was cultured on the media of larch sawdust+pine sawdust, the formation of its fruiting bodies was more outstanding on the media of larch sawdust+pine sawdust than those of larch sawdust.
Fruit* ; Larix