PURPOSE: Due to their high success rate, sling operations have recently been widely performed for stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite the encouraging short-term results of the sling surgery using anterior vaginal wall, the long-term results have been shown not to be as good as those in short-term studies. This study was designed to investigate the long term results of a Raz's anterior vaginal wall sling (AVWS), and to determine factors contributing to patients' satisfaction. MATERIALS AND METHODS: An outcome-based study was conducted on 77 patients who had undergone an AVWS performed by the same surgeon. Patients were preoperatively evaluated for their history, by physical examination, standardized symptom questionnaires and urodynamic studies. Patients with a follow-up of at least 1-year were assessed by the parameters of voiding symptoms and subjective satisfaction from the postoperative questionnaires. RESULTS: Of the 62 patients (81%) available for long term follow-up, 43 (69.4%) were currently satisfied with the urinary status, 35 (56.5%) were dry all the time, 12 (19.4%) were occasionally wet, but the severity had improved, 15 (24.1%) had not improved or had worsened. A review of the charts of the 15 failures revealed all of them were postoperatively urgent. Late complications occurred in 4 patients; 1 had recurrent cystocele and 3 had dyspareunia. De novo urge incontinence occurred in 5 patients. CONCLUSIONS: The stress incontinence was cured, or improved, in 75.8% of the patients after a follow-up of at least 1-year. The satisfaction of patients was closely associated with the presence, or resolution, of postoperative urgency or urge incontinence.
Cystocele ; Dyspareunia ; Female ; Follow-Up Studies ; Humans ; Physical Examination ; Surveys and Questionnaires ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

Tibia fractures are frequently occurred with increased traffic accident and industrial accident recently. And there are controversies in treatment of tibia fractures. From Jan. 1986 to Oct. 1988, tibial fractures of 107 cases in 105 patient, treated at the Department of Orthopedic Surgery of Dae Han Hospital, were analyzed. Results were obtained as follows. l. Of 105 patients, 85 patients were male & 20 patients were female. 2. The most common causes of fracture was traffic accident. 3. The most common level of fracture was middle one-third of tibial shaft. 4. Of 107 cases, conservative treatment was 35 cases and operative treatment in 72 cases. 5. Average union time was 16 weeks in conservative treatment & 18.5 weeks in operative treatment.
Accidents, Occupational ; Accidents, Traffic ; Female ; Humans ; Male ; Orthopedics ; Tibia ; Tibial Fractures

Recently, along with technology development of endoscopic equipment, a stent has been developed for the convenience of operation, shortening of recovery times, and reduction of patient's pain. To this end, optimal factors are simulated for the stent structure and mechanical reaction and verified using finite element analysis. In order to compare to present commercialized product such as Zilver (Cook, Bloomington, Indiana, USA) and S.M.A.R.T (Cordis, Bridgewater Towsnhip, New Jersey, USA), mechanical impact factors were determined through Taguchi factor analysis, and flexibility and expandability of all the products including ours were tested using finite element analysis. Also, important factors were sought that fulfill the optimal condition using central composition method of response surface analysis, and optimal design were carried out based on the important factors. From the centra composition method of Response surface analysis, it is found that importat factors for flexibility is stent thickness (T) and unit area (W) and those for expandability is stent thickness (T). In results, important factors for optimum condition are 0.17 mm for stent thickness (T) and 0.09 mm2 for unit area (W). Determined and verified by finite element analysis in out research institute, a stent was manufactured and tested with the results of better flexibility and expandability in optimal condition compared to other products. Recently, As Finite element analysis stent mechanical property assessment for research much proceed. But time and reduce expenses research rarely stent of optimum coditions. In this research, Important factor as mechanical impact factor stent Taguchi factor analysis arrangement to find flexibility with expansibility as Finite element analysis. Also, Using to Center composition method of Response surface method appropriate optimized condition searching for important factor, these considering had design optimized. Production stent time and reduce expenses was able to do the more coincide with optimum conditions. These kind of things as application plan industry of stent development period of time and reduce expenses etc. be of help to many economic development.
Academies and Institutes ; Finite Element Analysis ; Indiana ; New Jersey ; Pliability ; Stents

The only effective treatment for subfoveal neovascular membrane in age-related macular degeneration is laser photocoagulation, which is associated with decreased visual acuity following treatment in most patients. Radiation treatment for subfoveal neovascular membrane has been tried, but its effectiveness and necessary dose are not determined yet. Twelve eyes with subfoveal neovascular membranes received X-ray radiation with the dose of 1980cGy or 1440cGy. After a minimum 6 month follow-up, 4 eyes had improved, 6 eyes had stable and 2 eyes had worsened visual acuity. To date no negative side effects have been observed. We could not find difference in visual outcome between two dose groups due to the small sample size. Regarding the poor natural course of age-related macular degeneration, these results suggest a possible beneficial effect of radiation treatment with total dose of 1980 or 1440cGy and justify the further treatments and evaluations of the radiotherapy.
Follow-Up Studies ; Humans ; Light Coagulation ; Macular Degeneration* ; Membranes* ; Radiotherapy* ; Sample Size ; Visual Acuity

The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.
Adolescence ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use* ; Antineoplastic Agents, Combined/adverse effects ; Bleomycin/administration & dosage ; Central Nervous System Neoplasms/therapy* ; Central Nervous System Neoplasms/mortality ; Cyclophosphamide/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Human ; Lymphoma/therapy* ; Lymphoma/mortality ; Male ; Mechlorethamine/administration & dosage ; Methotrexate/administration & dosage ; Middle Age ; Neoplasm Recurrence, Local ; Prednisolone/administration & dosage ; Procarbazine/administration & dosage ; Radiotherapy Dosage ; Radiotherapy, Adjuvant/adverse effects ; Survival Rate ; Treatment Failure ; Vincristine/administration & dosage

Superficial angiomyxoma (SA) is a rare, benign, cutaneous soft tissue tumor. It is composed of myxoid matrix and blood vessels. Herein, we report a case of a solitary SA on the posterior neck of a 6-year-old boy. An analysis of the biopsied specimen showed a prominent myxoid stroma with thin-walled, branching blood vessels, revealing the presence of an SA. SA especially that originating in the posterior neck, is rarely seen and should be considered as a differential diagnosis for a solitary mass in the posterior neck.

Ichthyosiform eruption as a specific manifestation of mycosis fungoides is very rare and only a few such cases have currently been reported in the medical literature. A 63- year-old Korean man presented with a 4-year history of a pruritic ichthyotic eruption. There was no personal or family history of ichthyosis or atopy. The ichthyosiform skin changes involved the abdomen, arms, thighs and shins. The face, palms and soles were spared. There was no peripheral lymphadenopathy or organomegaly. The typical lesions of mycosis fungoides were not present. The results of the routine investigations were normal or negative. A skin biopsy specimen revealed the findings of early mycosis fungoides. He was successfully treated with photochemotherapy.
Abdomen ; Arm ; Biopsy ; Humans ; Ichthyosis ; Lymphatic Diseases ; Mycosis Fungoides ; Skin ; Thigh

PURPOSE: We undertook this study to evaluate the significance of differences in computed tomography (CT) findings between septic and non-septic acute cholangitis patients. METHODS: One hundred seventy two patients were enrolled in our study. Inclusion criteria for patients were a final diagnosis of acute calculous cholangitis. Patients were divided into two groups: those who had sepsis and those that did not. The two patient groups were compared in order to investigate clinically important CT findings in acute cholangitis with and without sepsis. We also compared signs, symptoms, and laboratory findings between the groups. A p-value <0.05 was considered to be statistically significant. RESULTS: Of the CT findings in acute cholangitis, the presence of intrahepatic duct dilatation (p<0.05), pancreatic duct dilatation (p<0.05), and pancreatitis (p<0.05) were more frequently found in the septic patient group. Septic patients showed fever (p<0.05) and chill (p<0.05) more often as presenting symptoms. Platelet count (p<0.05), segmented neutrophil portion (p<0.001), creatinine (p<0.05), and bicarbonate level (p<0.005) were significantly different in laboratory tests. CONCLUSION: Acute cholangitis patients with sepsis have more clinically important findings on CT, such as the presence of intrahepatic duct dilatation, pancreatic duct dilatation, and pancreatitis. Emergency physicians should focus on these findings and manage patients more urgently when these findings are present in acute cholangitis.
Cholangitis ; Common Bile Duct ; Creatinine ; Dilatation ; Emergencies ; Fever ; Humans ; Neutrophils ; Pancreatic Ducts ; Pancreatitis ; Platelet Count ; Sepsis

BACKGROUND: Anti-apoptotic proteins may be involved in tumor development, progression and the response to treatment. Bcl-2 is by far the most studied anti-apoptotic protein. A novel infibitor of apoptosis, designat ed survivin, and the heat shock proteins (HSPs) have recently been found in many human cancers. Immunohistochemical methods were used to determine the expression level of survivin, HSP 70 and bcl-2 in non-small cell lung cancer (NSCLC) to evaluate their clinical significance. METHODS: Tissue array slides were obtained from 99 surgically resected NSCLCs. Immunohistochemical staining was performed by an immuno-peroxidase technique using an avidin-biotinylated horseradish peroxidase complex. Anti-survivin rabbit polyclonal antibodies, anti-HSP70 mouse monoclonal antibodies and anti-bcl-2 mouse monoclonal antibodies were used as the primary antibodies. RESULTS: Positive ataining of survivin was detected in 33.3% of the cases. Survivin positivity is associated with to females and recurrence. A nonstatistically significant trend toward increased survivin expression was observed in non-smokers, and its expression inversely correlated with the number of cigarettes smoked in smokers. HSP70 was detected in 84.8% but this did not correlate with the clinicopathologic characteristics. Bcl-2 was detected in 18.2% and its and its expression correlated to tumor recurrence. No significant difference in the median survival time was noted in a comparison of al cases with survivin expression and those without. There was no association betwwen HSP70 or bcl-2 expression and survival. CONCLUSIONS: Survivin expression was significantly associated with females and tumor recurrence. In addition its expression was inversely associated with the number of cigarettes smoked. However, HSP70 and bcl-2 expression were not associated with the clinical parameters or survival. This suggests that measuring the survivin levels may be useful in identifying patients at high risk for disease recurrence. Therefore, survivin might be a new diagnostic/therapeutic target in cancer.
Animals ; Antibodies ; Antibodies, Monoclonal ; Apoptosis ; Apoptosis Regulatory Proteins ; Carcinoma, Non-Small-Cell Lung ; Female ; Heat-Shock Proteins ; Horseradish Peroxidase ; Humans ; Immunohistochemistry ; Lung* ; Mice ; Recurrence ; Smoke ; Tobacco Products

In this study, we evaluated feasibility of applying MTV (Metabolic Target Volume) to respiratory gated radiotherapy for more accurate treatment using various SUV (Standard Uptake Value) from PET images. We compared VOI (Volume of Interest) images from 50%, 30% and 5% SUV (standard uptake volume) from PET scan of an artificial target with GTV (Gross Tumor Volume) images defined by percentage of respiratory phase from 4D-CT scan for respiratory gated radiotherapy. It is found that the difference of VOI of 30% SUV is reduced noticeably comparing with that of 50% SUV in longitudinal direction with respect to total GTV of 4D-CT image. Difference of VOI of 30% SUV from 4D-PET image defined by respiratory phase from 25% inhalation to 25% exhalation, and GTV from 4D-CT with the same phase is shown below 0.6 cm in maximum. Thus, it is better to use 4D-PET images than conventional PET images for applying MTV to gated RT. From the result that VOI of 5% SUV from 4D-PET agrees well with reference image of 4D-CT in all direction, and the recommendation from department of nuclear medicine that 30% SUV be advised for defining tumor range, it is found that using less than 30% SUV will be more accurate and practical to apply MTV for respiratory gated radiotherapy.
Exhalation ; Inhalation ; Nuclear Medicine ; Positron-Emission Tomography