A total of 92 men with impotence underwent a trial of intracavernous injection of papaverine 30mg. Underlying causes of impotence were psychogenic (26 Pts.), posterior urethral injury (28 Pts.), spinal cord injury (15 Pts.), pelvic surgery (14 Pts.) and eldly (9 Pts.). The results were as follows 1. The underlying causes of impotence in papaverine responders were psychogenic 23 (88.5%), posterior urethral injury 19 (67.9%), spinal cord injury 13(86.7%), Pelvic surgery 5 (35.7%) and eldly 3 (33.3%). 2. Fourteen patients of the moderate papaverine responders underwent intracavernous injection of papaverine 30mg with phentolamine 1mg and 8 of them attained full erection. 3. After injection, the erection started in an average of 2.6 minutes, rigidity of penis attained in an average of 7.3 minutes, and erection status sustained for an average of 42.6 minutes in 60 patients. 4. Normal nocturnal penile tumescence monitoring (NPTM) or stamp test was found in 19 of 40 patient and 18 of them (94.7%) were papaverine responders, while 21 had an abnormal NPTM or stamp test and 11 of them were papaverine non-respoders. 5. A penile brachial index (PBI) of 0.6 or more was found in 62 of 73 patients and 53 of them(85.5 %) were papaverine responders, while 11 had an index of less then 0.6 and all of them were papaverine non-responders. 6. Thitry patients had sexual intercourse. Twenty-seven of them had a satisfactory result and 23 of them had ejaculation. 7. Papaverine induced prolonged erection occurred as major complicatiun in 4 patients after trial injection. Erection was subsided after intracavernous phenylepinephrine injection. There were minor complications such as ecchymosis at the injected site on the prepuce but subsided spontaneously in a few days. We conclude that intracavernous papaverine injectiun currently is a good screening technique for the differential diagnosis of severe vasculosenic impotence and is a useful chemical prosthesis of non-vasculogenic impotence.
Coitus ; Diagnosis, Differential ; Ecchymosis ; Ejaculation ; Erectile Dysfunction ; Humans ; Male ; Mass Screening ; Papaverine* ; Penile Erection ; Penis ; Phentolamine ; Prostheses and Implants ; Spinal Cord Injuries

PURPOSE: To investigate the timing of colostomy closure and the associated risk factors that affect the development of complication after colostomy closure. METHODS: We have reviewed and analyzed the results of 28 patients with colostomy closure at the Kwangju Christian Hospital from January 1993 to December 1997. We investigated to associated literatures on this subject for timing of colostomy closure, preparing a patient for colostomy closure, suture technique, wound management, underlying disease process related to the incidence of complication and experience of surgeons. RESULT: Wound infection developed in 4 patients (14.4%). Anastomotic leakage occurred in one patient (3.6%). Small bowel obstruction developed in two patients (7.2%). Overall incidence of complication was 25%. The incidence of complications in patients with trauma who underwent colostomy was 44.4% and patients without trauma, 15.8%. Complication rate was 16.6% for loop colostomies and 40% for end colostomies. The morbidity was 40% for colostomies on the left side, 18.7% for transverse colostomies, and 0% for colostomies (2 ileostomies) on the right side. The morbidity rate for closures within 6 weeks for the initial operation was 50%; for those within 6 to 12 weeks, 8.3%; and for those after 12 weeks, 16.6%. CONCLUSION: The optimal timing of closure varies from patient to patient, but closure within 6 weeks of the initial operation significantly increased the morbidity. Colostomies on the left side are associated with a higher morbidity rate than transverse colostomies or colostomies on the right side.
Anastomotic Leak ; Colostomy* ; Gwangju ; Humans ; Incidence ; Risk Factors ; Suture Techniques ; Wound Infection ; Wounds and Injuries

No abstract available.
Humans ; Lung Neoplasms* ; Lung*

PURPOSE: To evaluate the rates of inter- and intraobserver agreement of the BI-RADS US lexicon. MATERIALS AND METHODS: Two radiologists reviewed 60 sonograms of solid breast masses to evaluate interobserver agreement. After four weeks, the radiologists reinterpreted the series to evaluate the intraobserver agreement. The radiologists described shape, orientation, margin, lesion boundary, echo pattern, posterior acoustic features and microcalcifications. Final assessment categories and management plans were suggested for each case. The rates of inter- and intraobserver agreements were measured by the use of kappa statistics. RESULTS: Interobserver agreement ranged from the highest for orientation (k=0.65) and shape (k=0.61) to the lowest for posterior acoustic features (k=0.42). For the final assessment categories (k=0.46) and management (k=0.49), interobserver agreements were moderate. Intraobserver agreement ranged from the highest for microcalcifications in mass (k=0.90, 0.82) and orientation (k=0.87, 0.83) and the lowest for echo patterns (k=0.62, 0.57) and posterior acoustic features (k=0.59, 0.65). In the final assessment category and management, intraobserver agreements were substantial or nearly complete (k=0.65-0.83). CONCLUSION: There were variable ranged inter- and intraobserver agreements in the description of the BI-RADS US lexicon of solid breast masses. Among them, margin and lesion boundary showed lower agreements. A modification of the BI-RADS US lexicon with more detailed guidelines, followed by continuous education, are suggested.
Acoustics ; Breast* ; Education ; Information Systems*

Authors performed horizontal transposition of superior and inferior rectus muscle in 3.0 mm, to eliminate excyclotorsion of the 5 degrees which remained after Harada-Ito procedure in two patients with superior oblique palsy. The medial and lateral edges of the proximal part of tendon were reattached at the temporally and the inferior retus nasally. This operation was performed 3 or 4 months ater Harada-Ito procedure in 2 patients, respectively. The amount of horizontal transposition was made according the degree of excyclotorsion measured by double maddox rod test. The results showed no cyclotorsion at head tilt to the right and double maddox rod test. In conclusion, the horizontal transposition of vertical rectus muscles is effective in the elimination of excyclotorsion remained after Harada-Ito procedure for superior oblique palsy.
Head ; Humans ; Muscles ; Paralysis ; Tendons

The transforaminal epidural injection (TFEI) has been preferred in many cases because it can deliver the injected dose of medication closer to the nerve root and better facilitate ventral epidural flow compared to other methods. However, in patients with deformities not demonstrated on fluoroscopic imaging, the needle may enter unwanted locations. We treated two cases of intradiscal injection of contrast dye, during the TFEI, in patients with lumbar disc herniation.
Congenital Abnormalities ; Discitis ; Humans ; Injections, Epidural ; Needles

BACKGROUND AND PURPOSE: Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea. METHODS: Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator. RESULTS: Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals. CONCLUSIONS: The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.
Ambulatory Care Facilities ; Classification ; Diagnosis ; Epidemiology ; Headache Disorders* ; Headache Disorders, Secondary* ; Headache* ; Humans ; Korea* ; Migraine Disorders ; Neurology ; Prescription Drug Overuse* ; Research Personnel ; Tension-Type Headache ; Tertiary Care Centers

BACKGROUND: In survivors of acute myocardial infarction(ANI), reduced heart rate variability(HRV) has been demonstrated to be an independent predictor of sudden cardiac death and mortality. The heart rate variability can be examined and analyzed non-invasively and quantitated with 24-hour ambulatory ECG monitoring. In general, the patency of infarct-related artery appears to be one of the most important prognostic factor after AMI. Therefor, the correlation between infarct artery patency and HRV was examined in survivors of AMI. METHODS: The 24-Hour ambulatory electrocardiogram was performed in 23 patients with AMI and 20 normal controls, and analyzed for frequency & time domain HRV. HRV was recorded dwithin 7 days after AMI, and coronary angiogram was performed at 7th day after AMI. The AMI patients were divided into two groups, depending upon patency of infarct-related artery and correlated to clinical manifestations. Thirteen patients had patent vessel(Group 1) and ten patients had non-patent vessel(Group 2). Parameters of frequency domain HRV include LF, HF & LF/HF ratio and time domain HRV include SDNN, SDANN, SD, rMSSD and pNN50. RESULTS: All parameters of HRV was depressed in patients of AMI than in normal control(p<0.05). The mean left ventricular ejection fraction(LVEF) was 54.1+/-10.6% in group 1 and 42.6+/-12.2% in group 2(p<0.05). The mean values of LF, SDNN, SDANN, and SD in group 1 and group 2 were 5.09+/-0.83msec2/Hz & 4.09+/-0.53msec2/Hz, 84.5+/-24.2msec & 59.0+/-11.8msec, 73.2+/-22.8msec & 50.5+/-12.6msec, and 37.8+/-13.1msec & 27.2+/-4.4msec(p<0.05), respectively. There was no difference between two groups in HF,rMSSD and pNN50. The location of infarction and thrombolytic therapy itself did not influence of HRV. The mean values of HF, SDANN, rMSSD and pNN50 in patients with LVEF<40% were reduced significantly than in patients with LVEF> or =40%. There was a significant correlation between LVEF and LF, between LVEF and HF and between LVEF and LF/HF ratio(r:0.55, p<0.05;r:0.67, p<0.05;r:-0.56, p<0.05). CONCLUSION: HRV was depressed due to reduced vagal activity in patients with AMI. The values of LF, SDNN, SDANN, and SD in group of patent infarct-related artery were reduced significantly than in non-patent group.
Arteries* ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Infarction ; Mortality ; Myocardial Infarction* ; Survivors ; Thrombolytic Therapy

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the lacrimal and salivary glands, leading to dryness of eyes (kerato-conjunctivitis sicca) and mouth (xerostomia). The skin lesions in Sjogren's syndrome are usually manifested as xeroderma, but sometimes appear as annular erythema or vasculitis. Central nervous system symptoms may be presented as one of extraglandular manifestations, though rare in incidence, and need differential diagnosis from multiple sclerosis. We report a case of a 45-year-old woman diagnosed as multiple sclerosis at first but later as neurologic manifestation of primary Sjogren's syndrome, showing signs of multiple sclerosis and cutaneous erythematous lesions.
Case Report ; Diagnosis, Differential ; Erythema/pathology ; Erythema/diagnosis* ; Female ; Human ; Middle Age ; Multiple Sclerosis/pathology ; Multiple Sclerosis/diagnosis* ; Sjogren's Syndrome/pathology ; Sjogren's Syndrome/diagnosis*

Myelography has been generally regarded as a safe procedure. However, epidural hematoma and some allergic reactions have been reported, although rarely, as complications of myelography. Herein, we report a patient who experienced seizure and rhabdomyolysis after iopamidol injection with a review of the pertinent literature. A 75-year-old man with no medical history of seizure underwent lumbar spine myelography for the evaluation of the lumbar spine stenosis. After several hours following injection with water-soluble nonionic contrast medium(Iopamidol), he had a generalized tonic-clonic seizure, which progressed into a complex partial. In spite of the efforts of injecting anti-seizure medications, intermittent short-lasting seizure activity continued for hours and brain computed tomographic scan showed a large amount of hyperdense iopamidol in the subarachnoid space. As a consequence, he suffered from rhabdomyolysis-induced acute renal failure. The patient recovered from the contrast-induced acute renal failure after several days of treatment in the intensive care unit and hemodialysis. Fatal complications, such as seizure and rhabdomyolysis, can occur after myelography. Prompt diagnosis and treatment are needed.
Acute Kidney Injury ; Aged ; Brain ; Constriction, Pathologic ; Hematoma ; Humans ; Hypersensitivity ; Intensive Care Units ; Iopamidol ; Myelography ; Renal Dialysis ; Rhabdomyolysis ; Seizures ; Spine ; Subarachnoid Space