1.Erectile Function and Long-term Oncologic Outcomes of Nerve-Sparing Robot-Assisted Radical Cystectomy: Comparison With Open Radical Cystectomy
Se Yun KWON ; Yun Sok HA ; Tae Hwan KIM ; Tae Gyun KWON
Korean Journal of Urological Oncology 2018;16(1):32-37
PURPOSE: We performed nerve-sparing robot-assisted radical cystectomy (nsRARC) and compared the operative outcomes of nsRARC and open radical cystectomy (ORC). MATERIALS AND METHODS: The data of 38 patients that underwent ORC or nsRARC for bladder cancer between July 2009 and April 2014 (23 ORC and 15 RARC) were retrospectively analyzed. Data were collected on patient demographics, pathologic stages, perioperative outcomes, and oncologic outcomes as well as on erectile function. Five-year overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Erection function recovery was defined as the ability to achieve penetration ≥50% of the time and to maintain an erection sufficient enough for penetration ≥50% of the time at 12 months after surgery. RESULTS: No significant differences were found between the nsRARC and ORC groups in terms of age, sex, body mass index, American Society of Anesthesiologists physical status, or clinical stage. Mean estimated blood loss was significantly less in the nsRARC group (205.3 mL vs. 394 mL, p=0.011), but mean operative time was significantly greater (520.3 minutes vs. 415.0 minutes, p=0.004). Five-year overall survival and cancer-specific survival were 86.7% and 86.7%, respectively, for nsRARC, and 77.7% and 86.7% for ORC. With respect to erectile function, the overall postoperative potency rate at 12 months was 40.0% in the RARC group and 9.5% in the ORC group, and this difference was significant (p=0.021). CONCLUSIONS: Our clinical experiences indicate nsRARC in selected patients is a feasible procedure in terms of oncologic outcome and that it preserves erectile function relatively effectively.
Body Mass Index
;
Cystectomy
;
Demography
;
Humans
;
Methods
;
Operative Time
;
Recovery of Function
;
Retrospective Studies
;
Urinary Bladder Neoplasms
2.Multiple Biliary Papillomatosis: A case report.
Pan Ho YANG ; Byung Jun SO ; Kwon Mook CHAE ; Ki Jung YUN ; Kwon Ha YOON
Journal of the Korean Surgical Society 1999;57(3):446-450
Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract
;
Papilloma*
;
Prognosis
3.A Case of Endovascular Stent-Graft Implantation in Aortic Dissection mimicking Intramural Hematoma in Descending Thoracic Aorta.
Dae Keun SHIM ; Byoung Kwon LEE ; Jong Won HA ; Do Yun LEE ; Byung Chul CHANG ; Won Heum SHIM
Korean Circulation Journal 2001;31(3):347-352
Intramural hematoma(IMH) and penetrating aortic ulcer have been increasingly recognized as causes of acute aortic pathology in addition to aortic dissection. The presence of the intimal tear and a flap traversing the aortic lumen is considered to be a most reliable differential point of aortic dissection and IMH. Transesophageal echocardiography(TEE) has become a valuable modality for the diagnosis, prognosis and management of acute aortic syndrome with the unique advantages of portability and the ability to obtain high-resolution real time images. Endovascular Stent-graft placement over the primary entry tear may be an alternative to open surgery because it can close the intimal tear, which leads to thrombosis of the false lumen, excluding flow through the intimal tear and redirecting aortic flow exclusively into the true lumen. We report 88 year-old male with aortic dissection in descending thoracic aorta, successfully treated with endovascular Stent-graft implantation, which was mimicking intramural hematoma by its appearance and subclinical intimal tear diagnosed exclusively by TEE against other imaging studies.
Aged, 80 and over
;
Aorta, Thoracic*
;
Diagnosis
;
Hematoma*
;
Humans
;
Male
;
Pathology
;
Prognosis
;
Thrombosis
;
Ulcer
4.Pulmonary Embolism in Lupus Anticoagulant Positive Postmenopausal Woman after Estrogen Replacement Therapy.
Bon Kwon KU ; Jong Won HA ; June KWAN ; Dong Woon JUN ; Namsik CHUNG ; Sung Soon KIM ; Do Yun LEE
Korean Circulation Journal 1995;25(1):124-131
Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Dyspnea
;
Echocardiography
;
Estrogen Replacement Therapy*
;
Estrogens*
;
Female
;
Heart Atria
;
Humans
;
Lupus Coagulation Inhibitor*
;
Pulmonary Embolism*
;
Urokinase-Type Plasminogen Activator
5.Immunohistochemical Study for CD44v6 in Hepatocellular Carcinoma and Cholangiocarcinoma.
Ki Jung YUN ; Kwon Ha YOON ; Weon Cheol HAN
Cancer Research and Treatment 2002;34(3):170-174
PURPOSE: CD44 is a multifunctional adhesion molecule in cell-to-cell and cell-to-matrix interactions. This transmembrane glycoprotein exists in either standard or variant form, with the variation originating in alternative splicing. This study was designed to evaluate the role of CD44v6, one of the CD44 isoforms, in hepatocellular carcinoma and cholangiocarcinoma. MATERIALS AND METGODS: Immunohistochemical expression of CD44v6 was studied in 7 normal livers, 14 hepatocellular carcinomas and 16 cholangiocarcinomas, that were formalin fixed and paraffin embedded. RESULTS: CD44v6 was frequently expressed in the normal hepatocytes and hepatocellular carcinomas. Expression was not noted in the normal bile duct within the portal tract. CD44v6 was positively expressed in some of the proliferating bile ducts (43%) and cholangiocarcinomas (69%). CONCLUSION: CD44v6 expression may be more important in the stepwise carcinogenesis of the bile duct than in the normal hepatocyte, but further study is needed.
Alternative Splicing
;
Bile Ducts
;
Carcinogenesis
;
Carcinoma, Hepatocellular*
;
Cholangiocarcinoma*
;
Formaldehyde
;
Glycoproteins
;
Hepatocytes
;
Liver
;
Paraffin
;
Protein Isoforms
6.A Neonatal Intussusception induced by Congenital Ileal Polyp in a two-day-old male newborn.
Ha Sung LEE ; Hyuk Chin KWON ; Pyung Kil KIM ; Duk Jin YUN
Yonsei Medical Journal 1970;11(1):54-59
Intussusception is an interesting condition and is one of the most common causes of intestinal obstruction in the infant. We experienced a case of neonatal intussusception in a two-day-old male. The patient developed bloody stool, without a history of vomiting-after passing meconium, on the second day of life. Diagnosis of ileo-cecal type intussusception, which was induced by congenital polyp, was confirmed by exploratory laparatomy performed on the 4th day of life. The polyp was found at the proximal portion of the ileum, 45 cm from the ileo-cecal valve. In Korea a 40 day old patient was the youngest previously reported. We have presented this case with a review of the literature.
Human
;
Ileum*
;
Infant, Newborn
;
Infant, Newborn, Diseases/etiology*
;
Intestinal Polyps/complications
;
Intestinal Polyps/congenital*
;
Intussusception/etiology*
;
Male
7.STA-Distal ACA Bypass Using a Contralateral STA Interposition Graft for Symptomatic ACA Stenosis.
Yoon Ha HWANG ; Young Sub KWON ; Yun Ho LEE
Journal of Cerebrovascular and Endovascular Neurosurgery 2018;20(3):191-197
Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.
Anterior Cerebral Artery
;
Arteries
;
Atherosclerosis
;
Carotid Artery, Internal
;
Cerebral Revascularization
;
Constriction, Pathologic*
;
Dysarthria
;
Humans
;
Infarction
;
Magnetic Resonance Imaging
;
Middle Aged
;
Middle Cerebral Artery
;
Stroke
;
Temporal Arteries
;
Transplants*
8.Quality Assessment of Group Occupational Health Service for Small and Medium Scale Enterprises in Korea.
Sunmean KIM ; Soo Hun CHO ; Chang Yup KIM ; Eun Hee HA ; Yun Chul HONG ; Ho Jang KWON ; Mi Na HA ; Sang Hwan HAN ; Young Su JU
Korean Journal of Occupational and Environmental Medicine 1998;10(1):71-82
Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation
;
Consumer Participation
;
Cooperative Behavior
;
Delivery of Health Care
;
Education
;
Financial Management
;
Health Resources
;
Humans
;
Information Systems
;
Korea*
;
Occupational Health Services*
;
Occupational Health*
;
Primary Health Care
;
Quality Improvement
;
Questionnaires
;
Social Welfare
;
World Health Organization
9.Diabetic Muscle Infarction in a Young Patient with Prader-Willi Syndrome and Type 2 Diabetes Mellitus
Eun-Jeong KWON ; Eun-Ji LEE ; Hak Chul JANG ; Eun Ha KANG ; Yun Jong LEE ; You-Jung HA
Journal of Korean Diabetes 2020;21(4):227-234
Diabetic muscle infarction (DMI), also known as diabetic myonecrosis, is a rare complication of diabetes mellitus (DM); hence, it is often underdiagnosed. Thus, timely diagnosis and treatment are essential for a better prognosis. We describe a 24-year-old woman with Prader-Willi syndrome and an 8-year history of uncontrolled type 2 DM, who presented with a sudden onset of fever and subacute painful swelling of her left thigh. She was finally diagnosed with DMI based on magnetic resonance imaging and muscle biopsy after excluding other infectious and inflammatory diseases of proximal muscles. The patient was treated with bed rest, strict glycemic control, and analgesics, and her symptoms gradually resolved. DMI should be considered in the differential diagnosis of patients with poorly controlled DM, who present with subacute pain and swelling of lower extremity muscles, without a history of trauma.
10.Diabetic Muscle Infarction in a Young Patient with Prader-Willi Syndrome and Type 2 Diabetes Mellitus
Eun-Jeong KWON ; Eun-Ji LEE ; Hak Chul JANG ; Eun Ha KANG ; Yun Jong LEE ; You-Jung HA
Journal of Korean Diabetes 2020;21(4):227-234
Diabetic muscle infarction (DMI), also known as diabetic myonecrosis, is a rare complication of diabetes mellitus (DM); hence, it is often underdiagnosed. Thus, timely diagnosis and treatment are essential for a better prognosis. We describe a 24-year-old woman with Prader-Willi syndrome and an 8-year history of uncontrolled type 2 DM, who presented with a sudden onset of fever and subacute painful swelling of her left thigh. She was finally diagnosed with DMI based on magnetic resonance imaging and muscle biopsy after excluding other infectious and inflammatory diseases of proximal muscles. The patient was treated with bed rest, strict glycemic control, and analgesics, and her symptoms gradually resolved. DMI should be considered in the differential diagnosis of patients with poorly controlled DM, who present with subacute pain and swelling of lower extremity muscles, without a history of trauma.