We retrospectively analyzed 29 patients with caudate hemorrhage, and evaluated the prognosis and the predictors of short-term and long-term outcomes. P With caudate hemorrhage showed better short-term outcome compared to those with intracerebral hemorrhages in general. However, the ciance re -ing was Rebleedmg, which had interval of less than 1 year in most cases, occurred mainly in patients with previous stroke. And this worsened the patients' outcome. Management of risk factors is critical. The prognostic factor influencing on the short-term outcome was the initial consciousness level and the long-term outcome could be anticipated through the evaluation of the neurologic status on the 30th day; subsequent improvement was expected in patients with mild abnormality, but not in those with moderate to severe disability.
Cerebral Hemorrhage ; Consciousness ; Hemorrhage* ; Humans ; Prognosis* ; Retrospective Studies ; Risk Factors ; Stroke

OBJECT: In order to estimate the frequency and risk factors for adenomyosis. METHOD: The clinical records of 1127 women undergoing hysterectomy were retrieved in the Department of Obstetrics and Gynecology, Incheon Christian Hospital, during 7 years, from Jan. 1st 1991 to Dec. 31st 1997. RESULT: The following results were obtained. 1. Adenomyosis was found in 206 of 1127 patients(18.3%). 2. The highest incidence was 41-50 years of age group, an incidence of 55% and mean age group was 46.9 years. 3. Adenomyosis was more frequently observed in parous woman than non-parous woman, such as 8.3% and 91.7%, respectively. 4. Grossly, the size of uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 62.4%. 5. Pelvic pain, dysmenorrhea and metrorrhagia were common symptom of adenomyosis, an incidence of 26.7%, 25.2% and 19.4%, respectively. 6. Myoma was the most combined disease in adenomyosis, showing the incidence of 53.4%. 7. Combined pelvic endometriosis was not observed in this study. 8. Endometrial findings of adenomyosis showed proliferative phase of normal endometrial cycle in the highest incidence, giving 72.3% of all cases. 9. Preoperative diagnostic accurracy of adenomyosis was 8.2%. CONCLUSION: This results show that deeply understanding of the common symptom and epidemiology of adenomyosis improve the preoperative diagnostic accuracy.
Adenomyosis* ; Dysmenorrhea ; Endometriosis ; Epidemiology ; Female ; Gynecology ; Humans ; Hysterectomy* ; Incheon ; Incidence ; Menstrual Cycle ; Metrorrhagia ; Myoma ; Obstetrics ; Pelvic Pain ; Risk Factors ; Uterus

PURPOSE: There are no clear-cut guidelines of how to treat patients who have failed after a tension-free midurethral sling (MUS) procedure. We describe our experience with repeat MUS procedures and transvaginal shortening of the previously implanted tape for those patients with an initially failed MUS procedure. MATERIALS AND METHODS: We reviewed the medical records of the patients who failed with their initial MUS procedure and then had a second operation. Of the 20 women, 14 patients had repeat MUS and another 6 patients underwent shortening of the implanted tape. Repeated MUS was done by either the retropubic or transobturator pathway. Shortening of the tape was done with a metal hemoclip to shorten the previously implanted tape. The preoperative characteristics and the intraoperative and postoperative data were assessed by reviewing the operative notes, medical records and office notes. RESULTS: The mean interval between the first and repeat procedures was 8.4 months (range: 1-48). The mean follow up time after the second operation was 29.9 months (range: 7-70). Seven patients underwent repeat MUS instead of tape shortening because the implanted tape had migrated or severe adhesions were noted on the intraoperative findings. Ten (71.4%) of 14 patients who underwent repeat MUS achieved full continence, while 4 patients (28.6%) had significant improvement. Of the patients with tape shortening, 4 (66.6%) achieved full continence, one (16.7%) improved and one (16.7%) was failed. CONCLUSIONS: Based on our limited experience, a repeat MUS sling procedure or tension revision of the tape might be an effective treatment for the patients with failed MUS.
Animals ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Mice ; Reoperation ; Suburethral Slings* ; Treatment Failure ; Urinary Incontinence*

The changes in extracellular calcium activities during contractures of guinea pig atrial trabecular muscles were measured with Ca2+-selective electrodes. When the tissue was superfused with Na+-free Tyrode solution extracellular Ca2+ activities were decreased and contractures were induced with some delay. When the contracture was relaxed with Na+-containing Tyrode solution, extracellular Ca2+ activities were increased transiently and recovered in a Na+-dependent manner. The magnitude of extracellular Ca2+ activity decreased was proportional to the maximum magnitude of contracture induced by Na+-free solution. Addition of caffeine (10 mM) to Na+-free solution induced transient contracture following slow development of contracture and an increase in extracellular Ca2+ activity. Removal of caffeine from Na+-free solution caused a slow relaxation of contracture and a decrease in extracellular Ca2+ activity. These results confirm that caffeine blocks Ca2+ uptake by the sarcoplasmic reticulum (SR) resulting in an increase in sarcoplasmic Ca2+ activity. Ca2+ activity in the extracellular space, the amount of Ca2+ transported into the cell(Ca2+ depletion in the extracellular space), and the magnitude of contracture are well correlated. Present experiments suggest that extracellular use of Ca2+-selective electrodes provides continuous and quantitative monitoring of Na+-dependent Ca2+ flux across the cardiac cell membrane.

This study aims to ascertain the human saccadic visual tracking characteristics by measuring the eye movement to the double-step stimuli. Responses to simple step and double-step target motions were measured where the target mode and stimulus durations were randomized. To measure the eye movement the Photo-electric Eye Monitor was constructed based on limbus tracking. The results indicate that observers represented two kind of responses (A-or B-type) depending upon the stimulus duration. The percentage of occurrances increased as the stimulus duration increased from 50 to 200 msec. When the subject responded to both target motions, the reaction time of the second saccade was shorter than that of the first. The successive visual information is to change continuously the reaction time or cancel the initial saccade. Our results revealed that parallel data processing characteristics of the visual tracking systems and the saccadic decision-makings are influenced by the temporal relationships.
Eye Movements ; Humans* ; Reaction Time ; Saccades

Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis (M. bovis) that has been used to treat transitional cell carcinoma. Since the initial report by Morales and associates on the use of intravesical BCG for the treatment of recurrent superficial bladder tumors, intravesical therapy with BCG has proved to be more effective for prophylaxis and the treatment of superficial bladder tumors and carcinoma in situ than most of the standard chemotherapeutic agents. While the majority of patients tolerate BCG treatments well, a number of adverse reaction (e.g., fever, hematuria, dysuria, nausea and malaise) have been reported. More serious complications occur on rare occasions and they include pneumonitis/hepatitis, ureteral obstruction, renal abscess and sepsis. We report here on a case of ureteral obstruction that was caused by periureteral tuberculous granuloma after intravesical BCG therapy for superficial bladder tumors, and the condition required distal ureterectomy & ureteroneocystostomy.
Abscess ; Bacillus ; Carcinoma in Situ ; Carcinoma, Transitional Cell ; Dysuria ; Fever ; Granuloma* ; Hematuria ; Humans ; Morale ; Mycobacterium bovis* ; Nausea ; Sepsis ; Ureter* ; Ureteral Obstruction* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Intimal hyperplasia is considered to be a most frequent cause attributing to occlusion of a blood flow after vascular surgeries such as endarterectomy, bypass surgery and angioplasty. Clearly this response is a significant cause of morbidity in patients undergoing vascular procedures and studies to find out the strategy for avoid intimal hyperplasia are of great importance. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been yet clear. The initial event is thought to be damage to the vascular intimal endothelium. Intimal hyperplasia is the characteristic fibromuscular cellular response on intimal injury and some author advocated the "response-to-injury" hypothesis of atherogenesis to be inducing factors of intimal hyperplasia. Endothelial cells release a number of vasoactive substances such as relaxing factor, including nitric oxide(NO). The NO has not only relaxing effect to the smooth muscle cells, but also inhibitory effect to intimal hyperplasia. In this study, we investigated on rat inhibitory effect of NO donor(SNAP, SNP) to intimal hyperplasia on endothelial denudation and reversed by coadministration of the NO synthase inhibitor, L-NAME. Balloon catheter denudation of common carotid artery was performed in 35 rats pharmacologically treated from 3 days before to 14 days after surgery(5 mg/kg/day, intraperitoneally) and divided into 5 groups: control group, without any medical treatment; SNAP group, S-Nitroso-N- acetylpenicillamine; SNP group, sodium nitroprusside; SNAP+L group, both SNAP and N(G)-Nitro-L-arginine methylester; SNP+L group, both sodium nitroprusside and N(G)-Nitro-L-arginine methylester. Animals were killed and left common carotid arteries were perfused and fixed with 10% formalin solution at 14 days after endothelial denudation. Cross sectional intima-to-media area ratios(I-M ratio, intimal area/[intimal area medial area]x100) were calculated by an image analyzer system and serum level of NO was measured directly by electrochemical methods. The results of the this experimental study were as follows: 1) Morphometric analysis of cross sections showed marked intimal thickening in the control group with an mean I-M ratio of 64.71+/-4.96%. In contrast, the I-M ratios in the SNAP group were significantly reduced by 53.14+/-7.86%(P<0.05) and in the SNP group by 43.43+/- 9.32%(P<0.05). The IM ratios of animals treated with L-NAME in group SNAP-L and group SNP-L were 68.43+/-3.91% and 67.71+/-5.50% respectively(P=NS). No significant change was noted when L-NAME was coadministered with SNAP and SNP compared to control group. 2) The serum level of NO in SNAP group(2509.7+/-354.95 nM) and SNP group(3430.4+/-236.70 nM) were significantly increased compare to control group(1339.2+/-101.04 nM)(P<0.05). Coadministration of L-NAME in group SNAP-L(1719.8+/-483.65 nM) and group SNP-L(1415.7+/-219.04 nM)were no significant changed compare to control group(1339.2+/-101.04 nM). These experiments suggest that SNAP and SNP reduced intimal hyperplasia and increased serum level of NO, reversed by coadministration of L-NAME. The relation between the intimal hyperplasia suppression and NO increase should be speculated.
Angioplasty ; Animals ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Endarterectomy ; Endothelial Cells ; Endothelium ; Formaldehyde ; Humans ; Hyperplasia ; Microelectrodes ; Myocytes, Smooth Muscle ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide ; Nitroprusside ; Rats

The successful revascularization and reperfusion of ischemia are still associated with high systemic complication rates and severe local tissue injuries. The morality rates after revascularization have been reported to range from 10% to 20% and the amputation rates from 12% to 22%. It is well recognized that the microvasculature is highly sensitive to ischemia-reperfusion (I/R) and that the initial damage of endothelial cells contributes to I/R-induced tissue injury. In an effort to define the mechanisms responsible for reperfusion-induced vascular injury number of in vitro models have been developed to stimulate the responses of endothelial cells to I/R. Because of its simplicity, many investigators have used monolayers of cultured endothelial cells exposed to anoxia and reoxygenation as a model system to minic I/R-induced vascular changes in vivo. The endothelium serves as an important modulator of vascular homeostases by secreting various levels of both thrombotic and antithrombotic agents. One of the important product of endothelial cells, prostaglandin I2 or prostacyclin (PGI2) helps to maintain hemostasis through its involvement in coagulation, platelet activation, leukocyte migration and adhesion, vascular tone regulation and growth control. PGI2 synthesis is a readily quantifiable index of endothelial cell perturbation and thus serves as a marker for the identification of injurious stimuli. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium plus 20% fetal calf serum. Purity of culture was determined by immunological fluorescent staining of factor VIII related antigen, phase-contrast microscopy. TRK 790 radio-immunoassay kit was used for the measuring of 6-keto-PGF1 alpha released by endothelial cells. The results were as follows: 1) The concentration of PGI(2) released from the cultured endothelial cells was 33.44 +/- 2.26 pg/1 105 cells/mL 2) Incubation of endothelial cells with anoxia and reoxygenation resulted in PGI(2) release of 42.98 +/- 2.29 pg/1x10(5) cells/ml and 62.44 2.11 pg/1 105 cells/ml, respectively. 3) Incubation of endothelial cells with allopurinol (20 mumol/L) decreased the PGI(2) release to 40.68 +/- 2.99 pg/1x10(5) cells/ml. In conclusion, our data showed that the damage of endothelial cells in reoxygenotion group was significantly increased comparing anoxia group (p<0.005) and that allopurinol can inhibit reoxygenation-induced injury of endotheial cells.
6-Ketoprostaglandin F1 alpha ; Allopurinol ; Amputation ; Anoxia ; Endothelial Cells ; Endothelium ; Epoprostenol ; Fibrinolytic Agents ; Hemostasis ; Humans ; Ischemia ; Leukocytes ; Microscopy, Phase-Contrast ; Microvessels ; Morals ; Platelet Activation ; Reperfusion ; Research Personnel ; Umbilical Veins ; Vascular System Injuries ; von Willebrand Factor

The ectopic bone formation is a condition in which mature lamellar bone is formed in tissues that do not normally ossify, which was first described by Riedel in 1883. It has been observed at sites of chronic infection, hemorrhage, fibrous scarring or contracture. The pathophysiology of ectopic bone formation is not clearly identified but has complex and multifaceted causes, which resulted to differentiate the non-circulating pluripotent mesenchymal cells to osteoblastic stem cells. The local environment conditions of trauma, disruption of soft tissues and periostium, bone debris, hematoma, damaged muscle, uncommitted fibroblasts are suspected to be one of the causes of this condition. Comparing to simple soft tissue calcification, the ectopic bone has all the morphologic and biochemical characteristics of orthotopic bone, which is subjected to turnover and even has the ability for bone marrow formation. A case of late occlusion in a femoro-post. tibial PTFE graft about 5 months after vascular reconstruction due to ectotopic bone formation, which is confirmed by pathology around the graft is presented. After excision of the ectopic bone around the inflow vascular anastomosis site with re-vascularization, the patient was free from the ischemic leg symptoms. We reported a case of occlusion of vascular anastomosis site by ectopic bone formation with review of literature.
Bone Marrow ; Cicatrix ; Contracture ; Fibroblasts ; Hematoma ; Hemorrhage ; Humans ; Leg ; Osteoblasts ; Osteogenesis ; Pathology ; Polytetrafluoroethylene ; Stem Cells ; Transplants

The early diagnosis of abdominal aortic aneurysms are difficult, especially when they are not clinically evident. Because of the generalized nature of atherosclerosis, there is reason to believe that there is a high incidence of aneurysms of the abdominal aorta in patients with peripheral vascular disease. But the screening test for hidden abdominal aortic aneurysms in patients with peripheral arterial disease has not been used for routine manner. So we retrospectively reviewed the 9 patients who had asymptomatic abdominal aortic aneurysms with symptomatic peripheral arterial disease during the last four and half-year period: among them three aneurysms were screened preoperatively by physical examination with their diameter more than 5 cm and 6 aneurysms were found intraoperatively with their mean diameter of 3.8 cm. The ages ranged from 66 through 84 years with the mean age 73 years. There were 7 men and 2 women. The sites of the peripheral occlusive disease is as follows: femoral artery only in 1, iliac artery only in 2, both iliac and femoral arteries in 5, and from iliac artery through tibial artery with thrombus formation in 1. We suggest that ultrasonographic screening for the presence of hidden abdominal aortic aneurysm preoperatively in patients with lower extremity occlusive arterial disease is needed, especially when the ages of patients is older than 65 years and the site of arterial disease include iliac segment.
Aneurysm ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal* ; Atherosclerosis ; Early Diagnosis ; Female ; Femoral Artery ; Humans ; Iliac Artery ; Incidence ; Lower Extremity ; Male ; Mass Screening ; Peripheral Arterial Disease* ; Peripheral Vascular Diseases ; Physical Examination ; Retrospective Studies ; Thrombosis ; Tibial Arteries