PURPOSE: To compare the efficacy of Bimix solution (27.3 mg/ml papaverine and 0.9 mg/ml phentolamine) versus Trimix solution (18.8 mg/ml papaverine, 0.6 mg/ml phentolamine and 6.3ug/ml prostaglandin El) in terms of erectile response and complications. MATERIALS AND METHODS: We comparatively analyzed the erectile response and the incidence of pain, prolonged erection (>4 hours), and corporal fibrosis of either medication in the 155 impotent patients who used Bimix solution for intracavernous pharmacotherapy (mean duration: 15 months) and thereafter used Trimix solution (mean 12 months). RESULTS: Erectile response to Trimix solution was significantly better than Bimix solution (p<0.01). The mean dose of Bimix solution was higher than Trimix solution (0.43 ml. vs. 0.34 ml, p<0.05). The severe pain enough for impediment to ntercourse occurred in 6.5% of the Trimix group, while no patient of the Bimix group experienced (p<0.01). The corporal fibrosis was noted in 8.4% of the Trimix group and 16.1% of the Bimix group. However, there was no significant difference between the two groups (p=0.08). The incidence of prolonged erection was significantly lower (p<0.05) in the Trimix group (2.6%) than in the Bimix group (12.3%). A total of 139 patients (89.7%) finally selected Trimix solution. CONCLUSIONS: The Trimix solution was more effective and safer than Bimix solution for the treatment of erectile dysfunction.
Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Humans ; Incidence ; Male ; Papaverine ; Phentolamine

PURPOSE: To investigate serum level of prostate-specific antigen(PSA) after high energy transurethral microwave thermotherapy(HE-TUMT) for benign prostatic hyperplasia(BPH) could predict and represent efficacy of the treatment. MATERIALS AND METHODS: In patients with BPH who underwent HE-TUMT using Prostatron with Prostasoft 2.5(EDAP-Technomed, France), serum levels of PSA at 7 days(n=37), 3 months(n=40), and 6 months(n=26) after the treatment were compared with Madsen and international prostate symptom score(MSS and IPSS), maximal and average uroflow rate(MFR and AFR), and postvoiding residual urine(PVR) of 6 months after the treatment. RESULTS: The subjective(MSS and IPSS) and objective(PFR, AFR, and PVR) parameters were significantly(p<0.05) improved at 6 months after the treatment. The postoperative serum level of PSA showed a 643.2% increase(0.5-2870%) at 7 days(more than 500% increase in 18 men and less than 500% in 19), a 34.9% increase(79% decrease?303% increase) at 3 months, and a 8.5% decrease(74.7% decrease?53.7% increase). There was no significant difference in the both subjective and objective parameters at 6 months between the two groups; more and less than 500% increase on the 7th day, and among the three groups; more than 20% decrease(n=14), less than 20% decrease or increase(n=13), and more than 20% increase(n=13). However, improvement of MFR and AFR was significantly(p<0.05) higher at 6 months in 20% decrease group(n=9) compared with that of the remainder(n=17) although symptom scores and PVR not significantly different. CONCLUSIONS: Serum level of PSA at 7 days and 3 months after HE-TUMT could not predict efficacy of the treatment at 6 months. However, the extent of decrease in PSA level may represent relieved bladder outlet obstruction resulting from reduction of prostate volume.
Humans ; Male ; Microwaves ; Prostate ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate* ; Urinary Bladder Neck Obstruction

Anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old male patient presenting initially with right chest discomfort and hemoptysis. He was died following precipitous clinical deterioration, 2 months after open thoracotomy. The true malignant nature of this tumor, that there are endodermal sinus tumor and squamous cell carcinoma, was apparent on resection specimen. The former had metastasized to right supraclavicular lymph node. A similar case has not been reported previously on the review of the pertinent literature on malignant mediastinal teratoma.
Male ; Humans

Lipid cell tumors of the ovary are among the rarest of the functional ovarian neoplasms. Recently, authors experienced a case of lipid cell tumor of the left ovary in a 19 year old female, who presented with amenorrhea and hirsutism for 4 years. Grossly, the ovary was well encapsulated, and measured 6.5x6x4.5 cm. Cut surface show homogenous yellowish bulging neoplastic tissue and peritheral displaced normal ovarian tissue. Microscopically, neoplastic cells were composed of rounded and polyhedral cells, arranged in nests seperated by rich vascular networks. On the basis of the author's findings and the evidence available in the literature, we determined this case as ovarian lipid cell tumor.
Female ; Humans

A 55 year old male complain right shoulder pain and right upper quadrant pain about three months. He was a heavy alcoholism. Highly selective angiography, CT scan and operation findings suggest primary malignant neoplasm of the liver. Right hepatic lobectomy and partial diaphragmectomy was done under impression of heaptocellular carcinoma. The specimen measured 15x11x9 cm and disclose relatively hard and nodular mass devoid of cirrhotic changes. Cut surface show unilobar large mass measuring 11x8x6 cm and bearing brightly yellow discoloration and multifocal hemorrhagic necrosis. Histological characteristics were diffuse proliferation of large neoplastic cells with ample cytoplasm, containing granular materials, erythrophagocytosis, neutrophagocytosis and hemosiderin pigments. Atypical and bizarre mitosis and multinucleated giant cells bearing abundant erythro and neutrophagocytosis were frequently seen. The large or vesicular nuclei were irregular, with occasional deep indentations and revealed sharply defined nuclear membrane, coarse chromatin and conspicious nucleoli. Ultrastructurally the cytoplasm of neoplasltic cells had lysosomal granule, phagolysosome, phagocytized material and residual bodies. Immunohistochemical stains for alpha 1-antitrypsin, alpha 1-antichymotrypsin, vimentin and lysozyme showed positive reactions, but, alpha fetoprotein, cytokeratin, S-100 protein, factor VIII, complement 3 receptor and carcinoembryonic antigen were negative. Alpha-naphtyl acetate esterase activity in paraffin embedded tissue ribbon showed negative reaction. These findings show compatible with primary malignant lymphoma, true histiocytic type, (histiocytic sarcoma, Kupffer cell carcinoma) of the liver.
Male ; Humans

No abstract available.
Child ; Femoral Fractures ; Humans

We have experienced 19 patients of the cerebral arteriovenous malformation with subarachnoid hemorrhage, who were admitted to the Presbyterian Hospital, Daegu from January 1966 to July 1968, and to the Catholic Medical Center, Seoul from August 1968 to August 1971. All of the patients, who have the cerebral arteriovenous malformation, were proved by cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the result of surgery, various analysis of the clinical manifestations and the cerebral angiographic findings were attempted. Of the 19 patients, surgery was performed on 12 patients and its results were analyzed correlating to various types of surgical procedure. Following are the results. 1. From January 1966 to August 1971, there were 100 cases of cerebral vascular anomalies which were proved by cerebral angiography. Among the 100 cases, there were 71 intracranial aneurysms, 19 cerebral arteriovenous malformations, one cavernous angioma, 2 telangiectasis, 5 cerebral rete mirabile, and s Sturge Weber-Dimitris disease. The ratio of arteriovenous malformatons to aneurysms was 1: 3.7. 2. Age distribution of the bleeding arteriovenous malformations was ranged from 8 to 54, and 42 per cent of them were in the third decade. 73 percent of the group had bleeding from the cerebral arteriovenous malformation before the age of 40. The ratio of male to female was 1.9:1. 3. The parietal region was most commonly involved by the malformations. There were 8 parietal lesion, 4 temoroparietal lesions, one temporal lesion, one occipital lesion, and one tela chorioidea lesion. Simultaneous involvement of the both hemispheres occurred in one case. In lesions involving the cerebral hemisphere, there was a predominance of the left side. 4. In the past history, convulsive seizure was recorded in two cases and recurrent hemorrhages were reported in two. One patient was recorded to have suffered fourth hemorrhage and the other have sufferd third hemorrhge. 5. Meningeal irritation signs were most frequently observed in bleeding arteriovenous malformations. The incidence of weakness of extremities was higher in lesions involving the parietal area. Unconsciousness was occurred in 6 patients at the onset of symptom, of which transient loss of consciousness was seen in 3 patients. Transient hypertension at the onset was observed in two patients. 6. The feeding arteries of the malformations were most frequently seen from the middle cerebral artery and the draining veins from the malformations were into the superior sagittal sinus and internal cerebral vein in many cases. It was evident that the carotid artery of the sites of arteriovenous malformations was markedly dilated in 5 patients. 7. Ligation of the vessels feeding the arteriovenous malformations was carried out in 8 patients. One patient had neurologic deficit after the operation. Evacuation of intracerebral hematoma, resection of the anomaly or carotid ligation were carried out in 4 patients. Of the 12 patients who underwent various types of surgery, there was one death after evacuation of a large intracereral hematoma. 8. In our opinion, the ligation of feeding artery a choice of procedure to reduce the incidence of rebleeding, if the resection of the lesion was considered to have operative risk by the location of malformations.
Age Distribution ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Carotid Arteries ; Cerebral Angiography ; Cerebral Veins ; Cerebrum ; Daegu ; Extremities ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations ; Ligation ; Male ; Middle Cerebral Artery ; Neurologic Manifestations ; Protestantism ; Rabeprazole ; Seizures ; Seoul ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Telangiectasis ; Unconsciousness ; Veins

PURPOSE: We studied the usefullness of intravenous administration of contrast material to facilitate in situ shock wave lithotripsy(SWL) of ureteral stones in cases that stone localization was difficult as radioluscent, less radiodense, small stone, and interference with visualization by bone or intestinal gas. MATERIALS AND METHODS: From March 1992 to June 1997 we treated 831 patients with ureteral stone by in-situ SWL using EDAP-LT02 piezoelectric lithotriptor which utilizes ultrasono and fluroscopy for stone localization. Among 831 patients, intravenous contrast material were used in 53 cases to facilitate stone localization during SWL treatments. To evaluate the effectiveness of stone localization by the assistance of intravenous contrast media we compared success rate, storages, treatment sessions, durations, and side effects of two groups with or without intravenous contrast material, based on the location and the size of stones. RESULTS: Among 53 patients, stone was localized without ureteral catheterization in 5.7%(25/437) of upper ureteral stone, 18.2%(18/99) of mid-ureteral stone, and 3.4%(10/295) of lower ureteral stone after administration of intravenous contrast material. There were no significant differences in success rate, storages, treatment sessions, and durations(p>0.05). There were no significant complications except dye hypersensitivity in two patients, who were managed conservatively. CONCLUSIONS: The administration of intravenous contrast material during SWL allows effective localization of ureteral stones that otherwise could not be imaged adequately without ureteral catheterization. We believe that the use of intravenous contrast material for localization of ureteral stone in SWL have the benefits of inexpensiveness, noninvasiveness, and painlessness.
Administration, Intravenous ; Contrast Media ; Humans ; Hypersensitivity ; Shock ; Ureter* ; Urinary Catheterization ; Urinary Catheters

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Anesthesia, General ; Brachial Plexus ; Forearm ; Hand ; Humans ; Mepivacaine ; Needles

Benign or malignant tumors that arise in a benign cystic teratoma are rare. Malignant transformation in mature cystic teratoma of ovary is reported to occur in 1~3%. Several types of malignancy can occur from any of three germ-cell layers, but the most common malignancy is a squamous cell carcinoma derived from ectoderm. We experienced a papillary carcinoma arising in a struma ovarii of the complex teratoma. 74-year-old female presented with an abdominal discomfort. A pelvic ultrasonograph and computed tomography detected a 7 x 6 cm-sized and well-circumscribed cystic mass at the anterior to the uterus. The inner part of the mass was filled with cystic fluid showing low-density, however, solid portion including fat and soft tissue accompanied by calcification was identified in more than half of the entire tumor volume. The patient underwent a bilateral salpingo-oophorectomy. On histopathologic examination, the lesion was consistent with papillary carcinoma with squamoid features arising in a struma ovarii of the mature cystic teratoma. We herein report a case of the very rare papillary carcinoma arising in a struma ovarii of the complex teratoma and review the available literature.
Aged ; Carcinoma, Papillary* ; Carcinoma, Squamous Cell ; Ectoderm ; Female ; Humans ; Ovary ; Struma Ovarii* ; Teratoma* ; Tumor Burden ; Uterus