PURPOSE: Sacral neuromodulation has become an effective option for controlling intractable symptoms of overactive bladder: urgency and urge incontinence. However, it has its limitations in that an intermittent pulse generator (IPG) is insertable only in patients with symptom improvement of at least 50%. In this study, we aimed to investigate the parameters that predict surgical outcomes. MATERIALS AND METHODS: Data from 31 candidates for sacral neuromodulation were retrospectively analyzed. Twenty patients out of 31 candidates had satisfactory symptom improvement after tinned lead test implantation, which resulted in IPG implantation. Data and neural stimulation parameters were compared and analyzed between successful IPG implants (group 1) and test failures (group 2). RESULTS: The percentage of female patients was higher in the IPG implant group (group 1: 95%, group 2: 64%). There was a significant difference in symptom duration, between the two groups (group 1: 40.5 months, group 2: 91 months). There was a significant difference in the number of episodes of urgency between the two groups (group 1: 6.83/day, group 2: 9.66/day, p=0.012), and severity of urgency showed significant difference between two groups (group 1 Female ; Humans ; Lower Urinary Tract Symptoms ; Operative Time ; Retrospective Studies ; Statistics as Topic ; Tin ; Urinary Incontinence, Urge

PURPOSE: This study aimed to examine the effects of cyclooxgenase-2 inhibitors on patients with nocturia, whose symptoms persisted after the use of first-line drug therapy, such as alpha blockers and/or anticholinergics. MATERIALS AND METHODS: Thirty-three patients whose symptoms persisted after more than three months of first-line drug therapy were chosen to receive additional COX-2 inhibitors or antidiuretic hormones orally. Seven patients (group 1) were given 80mg of zaltoprofen at night, while 15 (group 2) were given 100mg of nimesulide at night. Desmopressin acetate (0.2mg) was administered at night to 11 patients (group 3) as a control group. Median follow up was 35 days (range, 28~90 days). RESULTS: In 25 patients (75.8%), the severity of nocturia was reduced. The median decline of nocturia in the COX-2 inhibitor groups (groups 1 and 2) was once, and it was statistically significant (p<0.001), while the median decline in each of these groups was twice (p=0.026) and once (p=0.002), respectively. The reduction of nocturia in the control group was once (p=0.011). The differences in reduction between the COX-2 inhibitor group and the control group were not statistically significant (p=0.418). CONCLUSIONS: The effects of the COX-2 inhibitors were not significantly different from those of desmopressin. Combination therapy with COX-2 inhibitors can effectively reduce nocturia in patients with refractory nocturia, following first-line drug therapy.
Cholinergic Antagonists ; Cyclooxygenase 2 Inhibitors ; Deamino Arginine Vasopressin ; Drug Therapy ; Follow-Up Studies ; Humans ; Nocturia* ; Vasopressins

It has been established that the graft of cryopreserved dermal fibroblast is able to improve wound healing. Transplantation of mesenchymal stem cells has the ability to undergo site-specific differentiation and participates in wound healing process. The wound healing process requires angiogenesis and the formation of a vascular network throughout the newly formed tissue. In this study we examined the effect of xeno- transplantation of fresh human mesenchymal stem cells and dermal fibroblasts on the angiogenesis. Human mesenchymal stem cells and human fibroblasts were isolated from bone marrow and dermis of the same patients and were grown in culture respectively. We have developed a porous polyethylene disc as an experimental model system for angiogenesis. Single block of polyethylene was cut into discs which were 5 mm in diameter and 3 mm in thickness. Four discs were soaked in a solution containing 4 106 cells and 1 ml thrombin. After porous polyethylene discs were loaded with the cell-thrombin composite, they then were coated with fibrinogen. After the discs were cleaned from surrounding fibrin, they were implanted in the back of Sprague-Dawley rats. In group I, the discs were filled with fibrin alone without cells. In group II and III, the discs were loaded with fibroblasts and mesenchymal stem cells respectively. Eight rats and 16 discs per group(total 48 discs) were used in this study. After creating 6 pockets in the back of a rat, 6 discs(2 discs per group) were implanted. At three different time intervals from 1 to 3 weeks, the implanted discs were harvested and processed for histological study. A longitudinal section was cut with a thickness of 6 micrometers in the very middle of a disc. Histological study was carried out to examine the formation of microvessels in the implants. Microvascular density was measured by counting the number of microvessels in the very middle of a biopsy specimen under 100 magnification field. Only fibrinoid materials and inflammatory cells were detected in most of specimens in the first week under 100 magnification field of the very middle. There was no significant differences in microvascular density among the three groups. In the second week, extracellular matrices including microvessels were detected in all the 3 groups. The microvascular density of group III(17.75/ 100 magnification field) was significantly higher than that of group II(10.50/100 magnification field) and group I (10.25/100 magnification field). The third week specimens showed that most of the pores of the implants contained extracellular matrices. Significantly greater differences were seen in the microvascular density. The microvascular densities averaged 52.88, 26.12, and 17.50 per 100 magnification field for group III, II, and I respectively. The results indicate that transplantation of mesenchymal stem cells and dermal fibroblasts can significantly improve the angiogenesis in the wound healing process and mesenchymal stem cells are superior to dermal fibroblasts.
Animals ; Biopsy ; Bone Marrow ; Dermis ; Extracellular Matrix ; Fibrin ; Fibrinogen ; Fibroblasts* ; Humans* ; Mesenchymal Stromal Cells* ; Microvessels ; Models, Theoretical ; Polyethylene ; Rats* ; Rats, Sprague-Dawley ; Thrombin ; Transplants ; Wound Healing

No abstract available.
Heart Septal Defects, Atrial

A 43-year-old man presented painless protruding mass on left side of penile shaft only during erection. 1 year ago he had a dorsal penile neurectomy for the treatment of premature ejaculation at local clinic. A protruding cavernousal aneurysm about 2 cm in diameter was developed 6 months after surgery and confirmed on penile duplex ultrasonography after PDE5 inhibitor ingestion with visual sexual stimulation. We have observed the lesion every month and found there was slight enlargement for the last 3 months without any other symptoms. We performed cavernosoplasty under the genereal anesthesia. There was a round cavernosal aneurysm on the left side of penile mid-shaft about 4cm in diameter after artificial erection with intracavernosal saline injection. We prevented cavernosal protrusion by covering the aneurismal surface with bovine pericardium patch (Supple Peri-Guard(R)). There was no side effect for 6 months postoperatively. This is an unusual type of complication of dorsal penile neurectomy.
Adult ; Anesthesia ; Aneurysm ; Dilatation ; Eating ; Humans ; Pericardium ; Premature Ejaculation

PURPOSE: 13N-ammonia is a well known radiopharmaceutical for the measurement of a myocardial blood flow (MBF) non-invasively using PET-CT. In this study, we investigated a correlation between MBF obtained from dynamic imaging and myocardial perfusion score (MPS) obtained from static imaging for usefulness of cardiac PET study. METHODS: Twelve patients (11 males, 1 female, 57.9+/-8.6 years old) with suspicious coronary artery disease underwent PET-CT scan. Dynamic scans (6 min: 5 sec X 12, 10 sec X 6, 20 sec X 3, and 30 sec X 6) were initiated simultaneously with bolus injection of 11 MBq/kg 13N-ammonia to acquire rest and stress image. Gating image was acquired during 13 minutes continuously. Nine-segment model (4 basal walls, 4 mid walls, and apex) was used for a measurement of MBF. Time activity curve of input function and myocardium was extracted from ROI methods in 9 regions for quantification. The MPS were evaluated using quantitative analysis software. To compare between 20-segment model and 9-segment model, 6 basal segments were excluded and averaged segmental scores were used. RESULTS: There are weak correlation between MBF (rest, 0.18-2.38 ml/min/g; stress, 0.40-4.95 ml/min/g) and MPS (rest 22-91%, stress, 14-90%), however the correlation coefficient between corrected MBF and MPS in rest state was higher than stress state (rest r=0.59; stress r=0.80). As a thickening increased, correlation between MBF and MPS also showed good correlation at each segments. CONCLUSIONS: Corrected and translated MPS as its characteristics using 13N-ammonia showed good correlation with absolute MBF measured by dynamic image in this study. Therefore, we showed MPS is one of good indices which reflect MBF. We anticipate PET-CT could be used as useful tool for evaluation of myocardial function in nuclear cardiac study.
Coronary Artery Disease ; Female ; Humans ; Male ; Myocardium ; Perfusion*

BACKGROUND AND OBJECTIVES: Particular repositioning maneuver (PRM) have been recommended as a treatment of benign paroxysmal positional vertigo (BPPV). Some patients require multiple treatments for remission, although most of the patients are treated at the first trial of single maneuver. The purpose of this study was to evaluate risk factors for the treatment failure in patients with posterior canal BPPV (p-BPPV) and horizontal canal BPPV (h-BPPV). SUBJECTS AND METHOD: Retrospective review was performed for the 287 patients diagnosed as BPPV visiting the dizziness clinic between February 2011 and August 2012. The diagnostic criteria for BPPV were met by following the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery. Patients were classified into two groups: Group 1 (treatment success) that requires only 1 PRM and Group 2 (treatment failure) that requires more than 2 PRMs. We analyzed the relationship between treatment failure and the clinical characteristics, and studied the etiology of BPPV. RESULTS: The study included 183 patients with p-BPPV, 54 patients with h-BPPV (geotropic type), and 50 patients with h-BPPV (apogeotropic type). The type of BPPV and average numbers of PRM required for remission were significantly related with treatment failure by statistical analysis (p<0.05, respectively). Statistically significant correlation was demonstrated between the history of ipsilateral inner ear viral infection (acute vestibular neuritis, sudden sensorineural hearing loss) and treatment failure (p<0.05). CONCLUSION: Multiple PRMs may be required in patients with h-BPPV (apogeotropic type) or with secondary BPPV caused by ipsilateral inner ear viral disease. Clinically, this information may be used to provide helpful information for clinicians performing PRM to treat BPPV.
Dizziness ; Ear, Inner ; Hearing ; Humans ; Labyrinthitis ; Neck ; Retrospective Studies ; Risk Factors ; Treatment Failure ; Vertigo ; Vestibular Neuronitis ; Virus Diseases

BACKGROUND: The aim of this study was to compare the antihypertensive effect of S-(-)-amlodipine nicotinate with ramipril in patients with essential hypertension. METHODS: Total 138 patients (54.5 +/- 10.5 years, 69 males) were enrolled in this study between 2008 and 2010. Amlodipine 2.5 mg or ramipril 2.5 mg was treated once in a day for 8 weeks. Epidemiologic analysis was performed in intend-to-treat (ITT) group. Efficacy analysis was performed in the differences of diastolic blood pressure in study groups. Abnormal reactions were divided with severities and drug-relationship. RESULTS: The change of diastolic blood pressures were more prominent with -12.7 +/- 7.02 mm Hg in amlodipine group, and -9.6 +/- 7.38 mm Hg in ramipril group (p = 0.023). The change of systolic blood pressures was higher in amlodipine group with -18.1 +/- 7.91 mm Hg, and -14.3 +/- 11.96 mm Hg in ramipril group (p = 0.047). Blood pressure normalization rates were 81.3% (48 of 59 patients) in amlodipine group, and 61.4% (35 of 57 patients) in ramipril group (p = 0.017). Abnormal reaction occurred in 5.8% (4 of 68 patients) of amlodipine group and 14.2% (10 of 70 patients) of ramipril group (p = 0.102). The most frequent abnormal reaction was respiratory symptom. CONCLUSIONS: S-Amlodipine-Nicotinate was more effective than ramipril in hypertensive patients without significant abnormal reaction.
Amlodipine ; Blood Pressure ; Humans ; Hypertension ; Niacin ; Ramipril

BACKGROUND: Heart failure is a rare condition of thyrotoxicosis. We report a case of thyrotoxicosis-inducing heart failure. CASE REPORT: A 29-year old female had been suffered from thyrotoxicosis for 3 years without proper medication. She complained progressive dyspnea and palpitation with atrial fibrillation with rapid ventricular response. Marked cardiomegaly, and severe right ventricular dysfunction with biatrial enlargements were found on Two-dimensional (2D) echocardiography. We treated her with medications for heart failure and thyrotoxicosis, and the patient's symptoms and objective cardiac functions are improved after two weeks. CONCLUSION: Severe heart failure caused by thyrotoxicosis could be reversible with proper management. Patients who have thyrotoxicosis should be assessed closely, and suitable treatment can markedly improve the patient's prognosis.
Atrial Fibrillation ; Cardiomegaly ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Failure ; Humans ; Hyperthyroidism ; Prognosis ; Thyrotoxicosis ; Ventricular Dysfunction, Right

PURPOSE: The purpose of our study was to compare the outcomes of patients who had undergone a conventional open adrenalectomy (OA) with those who had undergone a laparoscopic adrenalectomy (LA). METHODS: We retrospectively reviewed 66 patients who underwent an adrenalectomy between 1990 and 2005. The study group was comprised of 41 laparoscopic cases with 25 open adrenalectomy cases comprising the control group. The parameters studied included the operating times, transfusion volumes, time to resumption of a soft diet, total frequency of analgesics, time to return to free ambulation and length of hospital stay in both the OA and LA groups. RESULTS: No mortality was observed in either the OA or LA groups. The operating times were, on average, 203.1+/-64.5 and 158.2+/-76.4 minutes in the OA and LA group, respectively (P=0.011). 10 cases in the OA group needed a transfusion (average: 438.52+/-687.57 ml), but two cases including one require conversion to a celiotomy, due to a right renal vein injury, needed a transfusion (average: 23.41+/-110.63 ml)(P=0.004). The patients of the OA and LA groups began soft diets on the 4.8+/-1.1 (3~7 days) and 2.7+/-1.5 postoperative days (1~8 days), respectively (P=0.004). Total frequencies of analgesics were 9.5+/-6.5 and 4.4+/-4.7 in the OA and LA groups, respectively (P=0.001). The times needed to return to free ambulation were 7.6+/-3.8 and 4.3+/-2.3 days in the OA and LA groups, respectively (P= 0.000). Postoperative hospital stays were 16.3+/-7.5 and 7.3+/-2.3 days in the OA and LA groups, respectively (P=0.000). CONCLUSION: An LA appears to be a safe and effective approach for patients with various adrenal pathologies and large sized adrenal lesions. We expect the indications for an LA may be extended to large adrenal tumors as well as primary or metastatic malignant adrenal lesions if the oncologic principles are obeyed.
Adrenal Gland Neoplasms ; Adrenalectomy* ; Analgesics ; Diet ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Pathology ; Renal Veins ; Retrospective Studies ; Walking