Ninety-six cases of urinary tract fistulas, which were admitted to Severance Hospital during the period from Jan. , 1960 to Dec. 1969, were analyzed clinically and statistically. They were investigated by comparing with previous papers. 1) The rate of urinary tract fistulas accounted for 2.4 per cent of the total admissions to the Urologic Department and 0.057 per cent of Obstetrics and Gynecologic Department during 10 years. Twenty-eight cases of all fistulas were in men and sixty-eight in women. The age distribution was much the same as that found in previous literature. The most common age was from 20~50 years with 91.7 per cent. 2) The most commonly involved site was the bladder with 64.5 per cent and the most common fistula type was vesicovaginal with 42.6 per cent of those involving bladder. 3) About forty-seven per cent of all fistulas occurred after previous pelvic operation, seventeen per cent due to carcinoma of pelvic organs and thirteen per cent due to abnormal delivery. Chemicals, radiation, infection, trauma, foreign body and stone of the urinary tract were listed frequently as an etiologic factors. 4) The incidence of ureteral injury during radical hysterectomy was variable in the literature, but it accounted for 10 per cent generally. Among the 10 per cent of ureteral injury, ureteral fistulas developed in 20 per cent of our cases, but in 12 per cent of Meig's. 5) There are many surgical approaches to repair urinary tract fistulas according to the surgeon's taste, fistula type, location, size or number, previous attempts and adhesion of surrounding tissues. No two fistulas are exactly alike, and surgical approach to any fistula must be well thought before the time of operation. The operation must be fitted to the fistula, not the fistula to the operation. 6) To repair urinary tract fistula is today a somewhat difficult problem, and the operative failure rate in our 41 cases of vesicovaginal fistula was 34.4 per cent.
Age Distribution ; Female ; Fistula* ; Foreign Bodies ; Humans ; Hysterectomy ; Incidence ; Male ; Obstetrics ; Ureter ; Urinary Bladder ; Urinary Tract* ; Vesicovaginal Fistula

Temeliescu first demonstrated that bladder expansion could be evaluated by serial instillations of contrast medium. If bladder capacity is not exceeded, each instillation results in a symmetrical expansion of the normal bladder. When the muscular wall of the bladder is infiltrated by tumor, its capacity to expand is lost at the site of invasion. There are several methods of staging bladder tumors. To standardize the nomenclature and to facilitate the exchange of information, the I.U.C.C. had adopted a clinical stage classification. The value of a standardized classification is obvious. From a prognostic point of view one of the most important features is to determine if the tumor has invaded muscle. Careful bimanual examination under anesthesia will properly stage the tumor in about 80 per cent of cases. However, this degree of accuracy is only achieved by those seeing large numbers of bladder tumors. In certain instances, accurate staging of this disease is still a problem, which has led to the development of additional X-ray technique and non-operative means of more precisely staging the tumors. Angiography, double contrast barium cystography and perivesical gas insufflation have been used to visualized bladder tumors. However, these various techniques are of little assistance in determine the degree of invasion and, consequently, little additional information may be obtained, furthermore, certain techniques are distressing to the patient and are not without serious morbidity. Complications of angiography include hemorrhage, aneurysm formation, impaired vascular supply to the lower limbs and embolism. In addition these techniques require highly skilled personnel and elaborate equipment, thereby restriction their use. Fractionated cystography is a simple method of evaluating muscle invasion by a bladder tumor. It requires no complicated equipment and carries little or no morbidity. The time required for doing the procedure is little more than that for conventional cystograms. 10 cases of bladder tumors done fractionated cystography, which were admitted to our Urologic Department during Jan., 1970 to present, were reported. Utilizing a modification of Temeliescu's technique, we have been studying bladder tumors since Jan. 1970. They were investigated by comparing with previous papers.
Anesthesia ; Aneurysm ; Angiography ; Barium ; Classification ; Embolism ; Hemorrhage ; Humans ; Insufflation ; Lower Extremity ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study was conducted to examine the effects of simulation-based education regarding care in a cardio-pulmonary emergency care as related to knowledge, clinical performance ability, and problem solving process in new nurses. METHODS: An equivalent control group pre-post test experimental design was used. Fifty new nurses were recruited, 26 nurses for the experimental group and 24 nurses for the control group. The simulation-based cardio-pulmonary emergency care education included lecture, skill training, team-based practice, and debriefing, and it was implemented with the experimental group for a week in May, 2009. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability and t-test with the SPSS program. RESULTS: The experimental group who had the simulation-based education showed significantly higher know-ledge (t=5.76, p<.001) and clinical performance ability (t=5.86, p<.001) for cardio-pulmonary emergency care compared with the control group who had traditional education but problem solving process was not included (t=1.11, p=.138). CONCLUSION: The results indicate that a simulation-based education is an effective teaching method to improve knowledge and clinical performance ability in new nurses learning cardio-pulmonary emergency care. Further study is needed to identify the effect of a simulation-based team discussion on cognitive outcome of clinical nurses such as problem solving skills.
Adult ; Cardiopulmonary Resuscitation/*nursing ; *Clinical Competence ; *Competency-Based Education ; Educational Measurement ; Emergency Medical Services ; Female ; Humans ; Male ; *Problem Solving ; Program Evaluation ; Questionnaires ; Young Adult

Leiomyomatosis peritonealis disseminata is a rare non-neoplastic proliferation of histologically benign smooth muscle that occurs in the alxlominal cavity of during the reproductive years of life, often giving rise to false choical imprwsion of d.isseminated carcinomatosis grossly, In 1952 Wilson & Peale described a condition which they called "multiple peritoneal leiomyomas". Taubert et al(1965) clearly delinated the features of the lesion and named it leiomyomatosis peritonealis disseminata(LPD). We report a case of leiomyomatosis peritonealis disseminata with a brief review of literatures.
Carcinoma ; Leiomyomatosis* ; Muscle, Smooth

BACKGROUND: The operating room should provide an optimum environment that is safe for the patient and the working personnel. In this point of view, we investigated 8 items of temperature, humidity, air flow, noise, brightness, dust, CO2 and NO2. METHODS: Operating rooms, corridors and recovery rooms were tied as region I, II and III depending on their characteristics. 29 points were measured using appropriate instruments. After that, averaged values were calculated. RESULTS: Indoor climate (temperature, humidity and air flow) in region I were averaged 24.7, 65, 0.18/II were 25.5, 68, 0.18/III were 22.3 (degrees C), 56 (%), 0.22 (m/sec). Physcial condition (noise, brightness and dust) in region I were averaged 63, 295, 63/II were 67, 138, 87/III were 63 (db), 139 (lux), 26 (microgram/m3). Harmful gas (CO2 and NO2) concentration in region I were averaged 1152, 0.008/II were 913, 0.009/III were 1367 (ppm), 0.013 (ppm). CONCLUSIONS: Temperatures were appropriate but humidities were high except partial points. Air flow showed low values in average. Values of noise, dust and CO2 were relatively high. NO2 was low but brightness was variable. These mean that adequate improvement for quiet condition and air ventilation should be considered.
Climate ; Dust ; Humans ; Humidity ; Noise ; Operating Rooms* ; Recovery Room ; Ventilation

OBJECTIVES: Corticotropin releasing factor (CRF) plays a primary role in coordinating the neuroendocrine, autonomic, immune and behavioral responses to stress. CRF exerts its action through two major receptors, corticotropin-releasing factor 1 Receptor (CRF-R1) and corticotropin-releasing factor 2 receptor (CRF-R2). Using two types of chronic stress models, we investigated the changes of CRF-R1 mRNA and CRF-R2A mRNA expressions and CRF mRNA in the stress related brain circuit areas. METHODS: Male Sprague-Dawley rats were exposed to either immobilization stress or variable intermittent unpredictable stress for 10 days and then in situ hybridization histochemistry was used to quantify CRF expression in the brain. RESULTS: 1) CRF1 receptor mRNA expressions were decreased in bed nucleus stria terminalis (BNST) following stressors. 2) CRF2A receptor mRNA expressions were increased in lateral septum following stressors. 3) CRF mRNA expressions were increased in central nucleus of amygdala (CeA) and BNST. CONCLUSION: The increased CRF mRNA of CeA and BNST may be related with anxiety response in the repeated stress. Down-regulation of CRF-R1 mRNA expression in BNST may represent a compensatory adaptation to chronic stress and may be involved in the anxiety response, whereas up-regulation of CRF-R2A mRNA expression in lateral septum may represent an anxiety response or impaired learning but the functional meaning is uncertain.
Adrenocorticotropic Hormone* ; Amygdala ; Anxiety ; Brain ; Corticotropin-Releasing Hormone* ; Down-Regulation ; Humans ; Immobilization ; In Situ Hybridization ; Learning ; Male ; Rats, Sprague-Dawley ; Receptors, Corticotropin-Releasing Hormone ; RNA, Messenger ; Up-Regulation

BACKGROUND: The cyclin D1 gene is one of the most frequently amplified chromosomal regions(11ql3) in human carcinomas. In laryngeal and head and neck carcinomas, its overexpression has been shown to be associated with advanced local invasion and presence of lymph node metastases. Cyclin D1 may therefore play a key role in cell growth regulation and tumorigenesis. Lung cancer is a worldwide problem and in many contries it is the most lethal malignancy. As relapse is frequent after resection of early stage non-small cell lung cancer, there is an urgent need to define prognostic factors. PURPOSE: This study was undertaken to evaluate the prognostic value of the cyclin D1, that is one the G1 cyclins which control cell cycle progression by allowing G1 to S phase transition, on the patients in radically resected non-small cell lung cancer. METHOD: Total Si cases of formalin-fixed paraffin-embedded blocks from resected primary non-small cell 11mg cancer from January 1., 1983 to July 31, 1995 at Hanyang University Hospital were available for both clinical follow-up and immunohistochemical staining using monoclonal antibodies for cyclin D1. RESULTS: The histologic classification of the tumor was based on WHO criteria, and the specimens included 45 squamous cell carcinomas, 25 adenocarcinomas and 11 large cell carcinomas. Cyclin D1 overexpression was noted in 26 cases of 81 cases tested (30.9%). Cyclin D1 expression was not significantly associated with cell types of the tumor, pathological staging and the size of the tumor. But cyclin D1 overexpression was significantly correlated with positive lymph node metastasis(p=0.035). The mean survival duration was 22.76+/-3.50 months in cyclin D1 positive group and 45.38 +/- 5.64 months in cyclin D1 negative group. There was a nearly significant difference in overall survival Between cyclin D1 positive and negative groups(p=0.0515) in radically resected non-small cell lung cancer. CONCLUISON: Based on this study, cyclin D1 overexpressiom appears at important poor prognostic indicator in non-small cell lung cancer and may have diagnostic and prognostic importance in the treatment of resectable non-small cell lung cancer.
Adenocarcinoma ; Antibodies, Monoclonal ; Carcinogenesis ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cell Cycle ; Classification ; Cyclin D1* ; Cyclins* ; Follow-Up Studies ; Genes, bcl-1 ; Head ; Humans ; Lung Neoplasms ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Recurrence ; S Phase

BACKGROUND: Atherosclerosis obliterans affecting lower extremities may involve the abdominal aorta and its major branches to the lower extremities, especially the common iliac arteries. It may affect focal segment or multiple segments. MATERIAL AND METHOD: A retrosp ective study was performed on 23 cases of aortoiliac arterial atherosclerotic pa tients who were treated with bypass graft surgery at Eulji University Hospital f rom January, 1995 through December, 1999. RESULT: All the patients were male and the mean age was 60.15+/-8.7. All had history of smoking and the associa ted diseases were diabetes mellitus in 8, hypertension in 7, ischemic heart dise ase in 6, and valvular heart disease in 1. Operative methods of aortoiliac athro sclerotic disease were aortobifemoral bypass graft only(7), aortobifemoral bypas s graft and concomitant femoropopliteal bypass graft(8), aortofemoral bypass gra ft(2), axillofemoral and femorofemoral bypass graft(3), and femorofemoral bypass graft(3). Postoperative complications were retroperitoneal hematoma or bleeding (3), paralytic ileus(3), pneumonia(3), cerebrovascular accident(1), acute renal failure(2), wound infection(2). Three perioperative mortality occurred among ana tomical bypass patients. CONCLUSION: We concluded that anatomical bypass treament has been a standard procedure for treatment of aortoi liac occlusive disease, but extraanatomical bypass surgery colud be a good alter natives for compromised patients with lower morbidity and mortality.
Aorta, Abdominal ; Arterial Occlusive Diseases ; Arteries* ; Atherosclerosis* ; Diabetes Mellitus ; Heart ; Heart Valve Diseases ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Iliac Artery ; Lower Extremity ; Male ; Mortality ; Population Groups ; Postoperative Complications ; Smoke ; Smoking ; Transplants ; Wounds and Injuries

PURPOSE: The H. pylori cagA gene, vacA gene and iceA gene are considered to be important virurence factors that have been implicated in the development of gastric adenocarcinoma. It was reported that the presence of IS605 elements may be responsible for rearrangements and lead to partial or total deletions of the cag pathogenicity island (PAI) and the virulence of cag PAI may be changed. However, different results regarding the association between these virulence factors and clinical disease have been reported from different geographic regions. This study evaluated the relationship between H. pylori virulence factors such as cagA, vacA, iceA, IS605 and gastric adenocarcinoma. MATERIALS AND METHODS: H. pylori isolates were obtained from 54 infected patients (24 cases of gastric adenocarcinoma, 30 cases of control). H. pylori isolates were identified by PCR with ureC gene and 16S rRNA. PCR was performed to examine cagA, vacA, iceA and IS605 genotypes. RESULTS: Significant difference was found in the negative rates of cagA between gastric adenocarcinoma group and control (62.5% vs. 33.3% P=0.033). No significant difference was found in the prevalence of iceA, vacA between gastric adenocar cinoma and control. The genotype of cagA+ vacA s1-m1 iceA1 was predominant in H. pylori isolates irrespective of the clinical outcome. IS605 in PAI was not found in gastric adenocarcinoma gruop and control. The positive rates of IS605 in genome were 33.3% in gastric adenocarcinoma group and 36.7% in control (P>0.05). In gastric carcinoma, the positive rate of cagA+/IS605- was lower than in control (12.5% vs. 40.0%, P=0.025) and the positive rate of cagA-/IS605- was higher than in control (54.2% vs. 23.3%, P=0.02). CONCLUSION: H. pylori virulence factors had not related significantly with gastric adenocarcinoma. Further study is needed to examine the specificity of H. pylori strains.
Adenocarcinoma* ; Genome ; Genomic Islands ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Prevalence ; Sensitivity and Specificity ; Virulence Factors ; Virulence*

Coronary artery embolization is an extremely rare and potentially lethal complication of atrial myxomas. We observed of a case of left atrial myxoma associated with acute anteroseptal and inferior myocardial infarction. A transthoracic echocardiographic study revealed the presence of an echogenic, mobile mass, compatible with myxoma in the left atrium. Coronary angiography disclosed abrupt occlusions of the distal left anterior descending artery and the right coronary artery. The tumor was successfully removed surgically after medical treatment and the patient was doing well post operatively at 6-month follow-up.
Arteries ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Embolism ; Follow-Up Studies ; Heart Atria ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myxoma*