PURPOSE: Anterior vaginal wall sling operation (by Raz`s method )for the treatment of stress urinary incontinence(SUI) associated with intrinsic sphincter dysfunction(ISD) may produce postoperative suprapubic discomfort and suture related problem such as pull-through and loosening. Stabilization of the bladder neck to the pubic bone decreases the tension placed on the anterior rectus fascia and lessens the possibility of suture-related pain and the risk of entrapment of ilioinguinal neve branches. At present, bone anchoring system is available in Korea but its cost sometimes limit the use of the kit. Therfore, we developed self-made titanium screw which is anchored to pubic bone at the time of anterior vaginal wall sling operation and acquired good short-term results. MATERIALS AND METHODS: Total 16 women who had SUI with ISD were treated by in-situ anterior vaginal wall sling using self-made titanium screw anchored to pubic bone to support the bladder neck and midurethra. Postoperative results were analyzed for 16 patients who has been followed up for more than 3 months after surgery. RESULTS: Overall cure rate was 100% at 3 months of follow-up. Complication included anemia in 2 patients, mild dysuria in 2 patients and osteitis pubis in 1 patient. After resting and antibiotic therapy, complications were subsided. CONCLUSIONS: In short term follow-up, anterior vaginal wall sling using self-made titanium screw was shown to be very effective treatment of SUI with ISD with simple technique and had relatively low cost, low complication rates. Long-term followup will be necessary to define the efficacy of this method.
Anemia ; Dysuria ; Fascia ; Female ; Follow-Up Studies ; Humans ; Korea ; Neck ; Osteitis ; Pubic Bone ; Suture Anchors ; Sutures ; Titanium* ; Urinary Bladder ; Urinary Incontinence*

This paper presents the case of a ruptured hydrogel breast implant, along with its clinical, radiologic, and pathologic findings. Breast asymmetry is typically the most common clinical feature of breast implant rupture. In case of a hydrogel breast implant rupture, hydrogel spreads out after implant leakage and the breast is enlarged with swelling and edema. Intracapsular ruptures showed no significant collapse of the implants despite a collection of fluid surrounding the implant inside the capsule. However, extracapsular ruptures showed implant collapse and extensive inflammation or fibrosis extension to the muscle and chest wall. In this case, a large amount of fluid collection with enlarged implants inside the capsule and extracapsular granulomas were showed simultaneously. Since the use of silicone breast implants has been restricted, hydrogel implants have been used for some time as an alternative option for breast implants. However, hydrogel implants have been restricted because of their unpredictability and unreliability. This case report draws attention to an unusual presentation of complications following the insertion of hydrogel breast implants for augmentation mammoplasty.
Breast ; Breast Implants ; Edema ; Female ; Fibrosis ; Granuloma ; Hydrogel ; Inflammation ; Mammaplasty ; Muscles ; Rupture ; Silicones ; Thoracic Wall

No Abstract Available.
Adipose Tissue* ; Glomus Tumor*

Consideration of the nutritional status of patients with acute respiratory failure and mechanical ventilation is important for effective patient assessment and management. Patients with acute respiratory failure are at a high risk for developing malnutrition. High glucose intakes given during the administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients experiencing compromised pulmonary function. The authors report a case of successful weaning from mechanical ventilation in patient with post-operative ARDS by proper nutritional support and by changing the proportion of calories derived from carbohydrates and fats. Substitution of fat calories for carbohydrate in TNA solutions can reduce CO2 production and help wean patients from mechanical ventilation. Conclusively, the TNA (total nutrients admixture) system is more beneficial to patients with acute respiratory failure due to less CO2 production and surfactant production than TPN. For patients with hypercapnia, providing 25% to 30% of calories as carbohydrate and 50% to 55% of calories from fat may be beneficial.
Carbohydrates ; Fats ; Glucose ; Humans ; Hypercapnia ; Malnutrition ; Nutritional Status ; Nutritional Support* ; Parenteral Nutrition, Total ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilator Weaning* ; Ventilators, Mechanical* ; Weaning

Transcatheter arterial chemoembolization (TACE) improves the survival rate in patients with hepatocellular carcinoma (HCC). Despite the low probability, iatrogenic hepatic arterial dissections during interventional procedure are rarely created by the technical difficulties. Direct trauma from the guidewire, the tip of the catheter, or the jet of contrast injection can contribute to iatrogenic hepatic arterial dissections. We report one case of a female who had HCC necrosis caused by iatrogenic hepatic arterial dissection during TACE. Ischemia resulting from iatrogenic hepatic arterial dissection during TACE was smilar to the result of transarterial embolization for HCC on our case. To our knowledge, none of the similar cases was reported in previously published literatures.

OBJECTIVES: This study was conducted to compare between hallucination group and delusion group in patient with schizophrenia, using Brain (99m)Tc-ECD SPECT. METHODS: Among 16 patients with less than 3 schizophrenic episodes, 8 patients whose initial symptom was hallucination were assigned to the hallucination group, and other 8 patients with initial sumptom of delusion were assinged to the hallucination group. All of the patients clinically evaluated using the PANSS and BPRS. Both groups of patients and 8 healthy subjects underwent (99m)Tc-ECD SPECT. RESULTS: Score of thinking disturbance subscale of BPRS were significantly lower in the hallucination group than the delusion group. In SPECT analysis, the hallucination group showed significantly increased perfusion in some areas of the right temporal lobe, bilateral limbic lobes and left parietal lobe compared to delusion group. Both group had a reduced rCBF in some areas of the frontal lobe. CONCLUSION: The hallucniation group, compared with the delusion group, showed significantly increased regional cerebral blood flow in some regions. Therefore, this data suggests that different neural substrates may affect the process of auditory hallucination and delusion.
Brain ; Delusions ; Frontal Lobe ; Hallucinations ; Humans ; Parietal Lobe ; Perfusion ; Schizophrenia ; Temporal Lobe ; Thinking ; Tomography, Emission-Computed, Single-Photon

Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.
Adenosine/*adverse effects/metabolism ; Aged ; Coronary Vasospasm/*chemically induced/pathology ; Humans ; Male ; Myocardial Perfusion Imaging/*methods ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Vasodilator Agents/*adverse effects/metabolism

The antihistaminic drug diphenhydramine is mainly used as a sedative, hypnotic and antiemetic. In many countries it is available over-the-counter, very common, and generally regarded as a harmless drug. However, diphenhydramine overdose can result in cardiotoxicity due to its ability to block fast sodium channels in a manner analogous to classic Vaughan-Williams type IA antidysrhythmic agents. As such, cardiotoxicity from diphenhydramine resembles that of the tricyclic antidepressant agents. Here we report a case of a 52 year old man who ingested 2,000 mg of diphenhydramine and presented with an altered mental state and an electrocardiographic change. His electrocardiogram showed sinus tachycardia with a rate 145 beat/min, a QRS interval of 88 ms, and a QTc of 556 ms. He had a wide anion gap metabolic acidosis. He was treated with intravenous sodium bicarbonate and supportive therapy. His clinical manifestations waned and he was transferred to another hospital nearby his hometown.
Acid-Base Equilibrium ; Acidosis ; Diphenhydramine ; Electrocardiography ; Humans ; Sodium Bicarbonate ; Sodium Channels ; Tachycardia, Sinus

BACKGROUND: The purpose of this study was to define morphine's effects on resting ventilation and the ventilatory response to hypoxia and hypercarbia. METHODS: Six healthy nonsmoking young adult males were tested for the respiratory effects of intravenous morphine (0.15 mg/kg). Test began with baseline measurement of resting ventilation, isocapnic hypoxic ventilatory response (HVR), and normoxic hypercapnic ventilatory response (HCVR). After baseline measurement, morphine was administered and ventilatory responses were determined 20 and 40 min postinfusion. RESULTS: Morphine significantly decreased resting ventilation, hypoxic ventilatory response, and hypercarbic ventilatory response. Resting hypoventilation manifested as a peak rise in PETCO2 from 38.0+/-1.4 to 42.8+/-1.0 mmHg ( SEM) at 20 min (p<0.05). Hypoxic ventilatory response, measured as the slope of the ventilatory response to hypoxia, decreased from a control of 20.7+/-3.8 to 14.5+/-7.2 at 20 min after morphine (p<0.05). Hypercapnic ventilatory response, measured as the slope of the ventilatory response to hypercarbia, also decreased from 34.9+/-7.5 to 11.1+/-4.9 (p<0.05) 20 min after morphine. CONCLUSION: These decreased responsiveness to the chemical stimuli to breathing may contribute to the ventilatory depression frequently seen after administration of morphine.
Anoxia* ; Humans ; Hyperventilation* ; Hypoventilation ; Male ; Morphine* ; Respiration ; Respiratory Insufficiency ; Ventilation ; Young Adult

PURPOSE: This study was performed to find the adequate number of removed lymph nodes to achieve an acceptable false-negative rate when performing sentinel lymph node biopsy for breast cancer. METHODS: A total of 179 sentinel node biopsies combined with conventional axillary lymph node dissection for breast cancer were performed between November 2003 and June 2007. RESULTS: The overall identification rate of sentinel lymph node and the false negative rate of the biopsy were 95.0% and 8.1%, respectively. Yet the false negative rate of the biopsy was lowered as the number of the removed nodes was increased. Especially, the false negative rate was 0% when more than 4 lymph nodes were removed. CONCLUSION: We recommend that four lymph nodes should be removed to obtain accurate results in sentinel node biopsy for breast cancer.
Biopsy ; Breast ; Breast Neoplasms ; Lymph Node Excision ; Lymph Nodes ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy