PURPOSE: The purpose of this study is to evaluate the efficacy of biofeedback 1 treatment and functional electrical stimulation in stress incontinence patients as a physiotherapy and to know which factors affect on the outcome. MATERIALS AND METHOD: A group of 65 patients with stress incontinence were treated with combined alternating biofeedback and intravaginal electrical stimulation during 12 sessions, each 21 minutes in length, during 6 weeks. All patients had type l or ll stress incontinence. RESULTS: At immediate post treatment, subjective cure(complete dryness) rate was 15% and improvement(recovery to avoid other forms of treatment) rate was 60% and failure rate was 25%. Thus, the overall success rate for this treatment was 75%. In 49 patients who had all scheduled sessions and good compliance, subjective cure rate was 14% and improvement rate was 71%, but in 16 patients not to have good compliance, cure rate was 19%, improvement rate was 25%. In compliant patients, the result of 3 months after treatment showed cure rate was 11%, improvement rate was 54%. Compliance with reatment was the most significant parameter predictive of a good outcome(p<0.01) and the degree of stress incontinence was also significant in compliant patients(p<0.05). No clinical correlation with outcome was found in age, type, severity of cystocele, pelvic muscle strength, initial degree of vaginal contraction. Intravaginal pressure increased by an average of 10cmH20. Increased vaginal pressure was found in 93% of the patients and at least 50%improvement was 61%. Urge incontinence and urgency were present in 10(15%) and 19(29%) of the patients and improvement including cure was found 90% in urge incontinence and 89% in urgency. CONCLUSIONS: Biofeedback treatment and functional electrical stimulation is more effective for the patients who have good compliance, low degree stress incontinence and combined bladder irritation symptoms. In order to attain and maintain good results, a well structured biofeedback and functional electrical stimulation program that teaches specific muscle exercise should be used and the patients should be followed by a maintenance program and reinforcement.
Biofeedback, Psychology* ; Compliance ; Cystocele ; Electric Stimulation* ; Humans ; Muscle Strength ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: Some authors have suggested that erectile dysfunction correlates with the level of glycemic control and glycosylated hemoglobin can be used to predict erectile dysfunction in diabetic patients. This study evaluated whether or not glycosylated hemoglobin level can predict the effectiveness of sildenafil citrate, which is a first line therapy for erectile dysfunction. MATERIALS AND METHODS: A consecutive sample of 32 men with type 2 diabetes and erectile dysfunction completed the International Index of Erectile Function (IIEF) and had their glycosylated hemoglobin levels measured. 50mg of sildenafil citrate was prescribed at the first visit, which was then increased to 100mg if the symptom persisted. According to the response, the patients were divided into responders and nonresponders. The pretreatment clinical parameters (age, diabetic duration, erectile dysfunction duration, glycosylated hemoglobin level, body mass index, IIEF, diabetic complications, smoking, alcohol drinking) were recorded. The patients were divided into 3 groups according to the drug dosage (group 1 was 50mg responders, group 2 was 100mg responders, group 3 was nonresponders in any dosage) and the clinical parameters were compared and analyzed. RESULTS: The mean hemoglobin A1c level was 8.68 0.74% and 7.64 1.67% in the nonresponders and responders (p < 0.05), respectively. Diabetic neuropathy and diabetic retinopathy were significantly higher in the nonresponders (p < 0.05). The mean hemoglobin A1c levels of the three groups were 7.36 1.01, 7.78 0.98, and 8.64 0.44%, respectively and group 3 was significantly higher than the other groups (p < 0.05). CONCLUSIONS: High levels of glycosylated hemoglobin suggests a poor response to sildenafil citrate in diabetic patients with erectile dysfunction. Diabetic patients with neuropathy or retinopathy may have a low response for sildenafil citrate.
Body Mass Index ; Citric Acid* ; Diabetes Complications ; Diabetic Neuropathies ; Diabetic Retinopathy ; Erectile Dysfunction* ; Hemoglobin A, Glycosylated* ; Humans ; Male ; Smoke ; Smoking ; Sildenafil Citrate

OBJECTIVE: To compare current perception threshold with nerve conduction study, we measured current perception threshold (CPT) in healthy control and patients with carpal tunnel syndrome (CTS). METHOD: Twenty control subjects and twenty patients with CTS were included. Latency and amplitude of median and ulnar motor and sensory nerves were measured. The sensory current perception threshold was measured at the distal interphalangeal joint of third and fifth fingers and the palm with electrical current of 5 Hz, 250 Hz, and 2,000 Hz in frequency. We compared the results of the nerve conduction study with the data of the CPT. RESULTS: We found that measuring of the sensory threshold might detect carpal tunnel syndrome, especially with 2,000 Hz and 250 Hz stimulation and that CPT data correlated to sensory latency and amplitude of the median nerve. CONCLUSION: The sensory threshold test might be useful for diagnosis and follow up test in carpal tunnel syndrome.
Carpal Tunnel Syndrome* ; Diagnosis ; Fingers ; Humans ; Joints ; Median Nerve ; Neural Conduction ; Sensory Thresholds

OBJECTIVE: To compare the efficacy of epidural injection in accordance the distribution of dye in the epidural space for low back pain patient. METHOD: Twenty nine patients with herniated nucleus pulposus or spinal stenosis confirmed by the radiologic studies were treated with epidural injection of steroid. The patients were divided into two groups: 1) patients whose distribution of dye was in the posterior part of epidural space and 2) patients whose distribution of dye was in the anterior and posterior parts of epidural space. RESULTS: The efficacy of epidural injection was assessed using the visual analog scale (VAS) and straight leg raising test (SLR) on pre-treatment and post-treatment. The VAS and SLR change of pre-treatment and post-treatment in the first group was from 7.81 +/- 1.54 and 50.00 +/- 18.97 degrees to 4.45 +/- 2.16 and 75.00 +/- 17.61 degrees (p<0.05), respectively. The VAS and SLR change of pre- and post-treatment in the second group was from 7.72 +/- 1.56 and 43.33 +/- 15.28 degrees to 3.72 +/- 1.64 and 60.00 +/- 10.00 degrees (p<0.05), respectively. The VAS and SLR change between groups has no statistically significant difference (p>0.05). CONCLUSION: The different distribution of dye in epidural space had no significant difference in treating patients with low back pain.
Epidural Space* ; Humans ; Injections, Epidural* ; Leg ; Low Back Pain ; Spinal Stenosis ; Visual Analog Scale

OBJECTIVE: To investigate the effect of repetitive magnetic stimulation (rMS) of the spinal cord on limb angiogenesis in healthy rats and explore its implication for the treatment of lymphedema. METHOD: Twelve adult male Sprague-Dawley rats were divided into four groups as follows: sham rMS followed by tissue harvest 5 minutes later (group 1, n=2), 1 Hz rMS and tissue harvest 5 minutes later (group 2, n=3), 20 Hz rMS and tissue harvest 5 minutes later (group 3, n=3), 20 Hz rMS and tissue harvest 30 minutes later (group 4, n=4). Animals were treated with 20-minute rMS with 120% of the motor threshold on their left side of upper lumbar spinal cord. Expression of angiogenic factors, that is, Akt, phospho-Akt (pAkt), endothelial nitric oxide synthase (eNOS), phospho-eNOS (p-eNOS) were measured by western blot. Bilateral hindlimb muscles (quadriceps and gastrocnemius) were harvested. RESULTS: Expression of Akt in left quadriceps increased in group 4 compared with group 2 and 3 (3.4 and 5.3-fold each, p=0.026). Expression of eNOS in left plus right quadriceps markedly increased in group 3 and 4 compared with group 1 and 2 (p=0.007). Expressions of eNOS, Akt and p-eNOS, pAkt in gastrocnemius were not comparable between four groups (p>0.05). CONCLUSION: Repetitive magnetic stimulation of the spinal cord may exert an angiogenic effect closely linked to lymphangiogenesis. It has clinical implication for the possible therapy of lymphedema caused by breast, cervical or endometrial cancer operation. Future studies with the specific lymphatic endothelial cell markers are required to confirm the effect of rMS on lymphangiogenesis.
Adult ; Angiogenesis Inducing Agents ; Animals ; Blotting, Western ; Breast ; Endometrial Neoplasms ; Endothelial Cells ; Extremities ; Female ; Hindlimb ; Humans ; Lymphangiogenesis ; Lymphedema ; Magnetics ; Magnets ; Male ; Muscles ; Nitric Oxide Synthase Type III ; Pilot Projects ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spinal Cord

The pattern of periodic sharp wave complexes (PSWC) was widely accepted as the most characteristic electroencepalographic(EEG) abnormality in Creutzfeldt-Jakob disease (CJD) although it may be lacking in prodromal and terminal stages. The EEG abnormalities are often asymmetric. We compared PSWC with 18F-FDG PET and brain MRI finding to know the signifcance of PSWC. All the patients had typical clinical courses and symptoms of CJD. Three patients were pathologically verified. Three patients were in full stage and two in terminal stage of CJD. We analysed PSWC in digital EEG and compared the regions of maximal PSWC amplitudes with 18F-FDG PET and brain-MRI finding in regard to lateralization and localization. Regarding lateralization, the maximal amplitudes of PSWC were observed over left frontal area in two patients and over right frontal region in three. Three patients in full stage had PET hypometabolism in the same hemisphere as PSWC were lateralized. Their brain MRI showed abnormal basal ganglia intensities but no sever brain atrophy. Two patients in terminal stage had PSWC lateralized in right frontal region but in PET one had left frontoparietal and the other bilateral global hypometabolism. Their brain-MRI showed severe cortical atrophy in the same hemisphere as PET hypometabolism was observed. Regarding all patients in full or terminal stage had maximal PSWC in frontal region, which were not consistent with PET and MRI findings. Cortical lesions in MRI were well corresponding with PET hypometabolism but not with PSWC. These results suggest that PSWC could reflect the hemisphere with more CJD activities in full stage, but could not localize the region where PET and MRI showed abnormalities, suggesting that the generation of PSWC could be related with the involvement of subcortical structures in CJD.
Atrophy ; Basal Ganglia ; Brain ; Creutzfeldt-Jakob Syndrome* ; Electroencephalography ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging

OBJECTIVE: To evaluate quality of life (QOL), upper extremity function and the effect of lymphedema treatment in patients with breast cancer related lymphedema. METHOD: The basic data comprised medical records (detailing age, sex, dominant side, location of tumor, cancer stage, operation record, cancer treatment and limb circumferences) and questionnaires (lymphedema duration, satisfaction, self-massage). Further to this, we measured upper extremity function and QOL, administered the DASH (Disabilities of Arm Shoulder and Hand outcome measure) and used the EORTC (European Organization for Research and Treatment of Cancer)-QLQ-C30 and the EORTC-QLQ-Br23. Results of these were calculated as main outcome variables. RESULTS: The questionnaire responses and arm circumferences of 59 patients with breast cancer related lymphedema were analyzed. In the DASH questionnaire, it was found that the older the lymphedema patient was, the lower their upper extremity function. On the EORTC-QLQ, patients with metastasis had significantly lower scores in physical functioning and role functioning. In terms of upper extremity circumference, there was a significant upper extremity size reduction after lymphedema treatment. CONCLUSION: There were several dissociations between some subscales of quality of life questionnaires and those of upper extremity functions. Upper extremity function was correlated with the age of breast cancer patients and QOL was influenced by M-stage. Lymphedema treatment was found to be effective in reducing edema in patients with breast cancer related lymphedema.
Arm ; Breast ; Breast Neoplasms ; Edema ; Extremities ; Hand ; Humans ; Lymphedema ; Medical Records ; Neoplasm Metastasis ; Quality of Life ; Shoulder ; Upper Extremity ; Surveys and Questionnaires

PURPOSE: Premature ejaculation is the most common male sexual disorder, affecting perhaps as many as 75% of men, but its cause has not been well established. The objective of this study is to evaluate whether alcohol injection on the dorsal aspect of the penis can induce a desensitization of penile sensory nerve fiber in rats. MATERIALS AND METHODS: Forty-four male Sprague-Dawley rats were divided into 4 groups. Group I of 4 rats, the control group, did not undergo any procedure. Group II of 8 rats, received only an alcohol injection without electrical stimulation. In group III of 4 rats, only electrical stimulation was performed without alcohol injection. In group IV of 28 rats, all rats received an alcohol injection on the dorsal aspect of the penis, and groups of four rats were sacrificed after electrical stimulation on the glans penis at 1, 2, 4, 7, 10, 14, and 21 days after alcohol injection. Spinal cords were sectioned and processed for immunohistochemical staining for c-Fos protein. RESULTS: No c-Fos protein was detected in the normal control group, and either none or few c-Fos protein positive neurons were seen in the alcohol injection only group. The number of c-Fos protein positive neurons in the electrical stimulation only group was 30.25+/-3.53 cells/section. Four days after alcohol injection, the level of c-Fos protein positive neurons was reduced significantly compared with the control group (p<0.05), and was very close to the control group at 10 days after alcohol injection. CONCLUSIONS: Our study demonstrates that alcohol injection in the dorsal aspect of the penis reduces c-Fos protein positive neurons in the spinal cord segment through desensitization of penile sensory nerve fibers.
Animals ; Electric Stimulation ; Humans ; Male ; Nerve Fibers ; Neural Conduction* ; Neurons ; Penis ; Premature Ejaculation ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord

We report a case of the accidental intravenous administration of a large dose of magnesium sulfate during cesarean section. A 41-year-old woman, at 33 weeks gestation, with pregnancy-aggravated hypertension, headache and generalized edema presented in acute labor and showed fetal bradycardia on a nonstress test. Laboratory tests demonstrated an increased level of magnesium (5.4 mg/dl). A cesarean section was performed under general anesthesia with O2-N2O-enflurane and vecuronium. After delivery 2,000 mg of magnesium sulfate was mixed with the lactated Ringer's solution 1,000 ml and 550 ml administered to the patient. After noticing the accidental infusion of the magnesium sulfate, we replaced the lactated Ringer's solution with normal saline 1,000 ml and performed arterial blood gas analysis, checked serum electrolyte, including Mg2+ and Ca2+, and had monitored depth of muscle relaxation and vital signs. The level of magnesium had increased to 8.9 mg/dl after the accidental magnesium infusion. For about one and half hours after emergence from general anesthesia, she complained of dyspnea and paraparesis of extremities. To treat the hypermagnesemia, 3% calcium gluconate 1,000 mg and furocemide were given intravenously to antagonize magnesium and to increase the urine output. The depth of neuromuscular block was frequently monitored using a nerve stimulator. After conservative treatment, she recovered from the effect of the hypermagnesemia and was discharged on the fifth postoperative day. Anesthesiologists must to keep in mind the preoperative patients' pathophysiologic conditions, check co-administered drugs and the contents of intravenously connected solutions.
Administration, Intravenous* ; Adult ; Anesthesia, General ; Blood Gas Analysis ; Bradycardia ; Calcium Gluconate ; Cesarean Section* ; Dyspnea ; Edema ; Extremities ; Female ; Headache ; Humans ; Hypertension ; Magnesium Sulfate* ; Magnesium* ; Muscle Relaxation ; Neuromuscular Blockade ; Paraparesis ; Pre-Eclampsia ; Pregnancy ; Vecuronium Bromide ; Vital Signs