PURPOSE: Patients with neurogenic bladder ultimately undergo morphometric and functional changes of their bladder and urethra. As a result, voiding symptoms such as frequency, nocturia, urgency and incontinence appear Propiverine hydrochloride(BUP-4) is a benzylic acid derivative with musculotropic antispamodic activity and moderate anticholinergic effect. We evaluated the clinical and urodynamic effects of BUP-4 for patients with neurogenic urinary frequency and incontinence MATERIALS AND METHODS: Twenty six patients with neurogenic bladder suffering from urinary frequency and incontinence(including 5 placebo) were given 20mg of BUP-4 orally a day and its clinical and urodynamic effect were evaluated. RESULTS: In the group treated with BUP-4 for four weeks, 57.9% in 19 patients with frequency, 53.3% in 15 nocturia, 50.0% in 14 weak stream, 55.6% in 9 intermittency, 50.0% in 10 dribbling, 64.3% in 14 urgency, 55.6% in 9 hesitancy, 73.7% in 19 incontinence showed improvement of their symptom. Urodynamic study performed after treatment with BUP-4 for 4 weeks or more revealed greater than 10% increase in bladder capacity compared to pretreatment study in 11 patients out of 21(52.4%) and their maximum bladder capacity increased significantly from 181.7+/-101.3 to 249.4+/- 184.7mL(p=0.012). Maximum detrusor pressure decreased from 52.5+/-35.6 to 50.9+/- 26.8cmH2O(p=0.010). Changes in compliance and volume on the first urge sense were statistically insignificant. In placebo group, no significant symptomatic and urodynamic improvement were reported. Side effects of the drug had appeared in 7 patients(33.3%) out of 21 after 4 weeks of treatment -5 cases of dry mouth and 2 cases of nausea - but they were not severe enough to stop the treatment. CONCLUSIONS: The use of BUP-4 in patients with neurogenic bladder results in improvement of symptoms and urodynamic profile(bladder capacity and maximum detrusor pressure). Thus, BUP-4 could be used as one of the first line drugs in the treatment of patients with neurogenic bladder.
Compliance ; Humans ; Mouth ; Nausea ; Nocturia ; Rivers ; Urethra ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urodynamics*

Actinomycosis is a slowly progressive chronic suppurative infection noted for forming characteristic sulfur granule by an anaerobic gram-positive bateria. Pelvic actinomycosis occurs most commonly in association with IUD and has variable nonspecific symptoms that make an initial diagnosis difficult. Colonization of lower genital tract by Actinomyces occurs most often in IUD users and increases with the duration of IUD use. We experienced a case of actinomycotic pelvic abscess associated with IUD and report it with a brief review of concerned literature.
Abscess ; Actinomyces ; Actinomycosis* ; Colon ; Diagnosis ; Intrauterine Devices* ; Sulfur

PURPOSE: The efficacy of the artificial urinary sphincter(AUS) in treating sphincteric incontinence has been clearly demonstrated. We report on 20 years of experience using artificial sphincter implantation at a single institute. MATERIALS AND METHODS: The follow-up data for 37 patients who received AUS(AMS 800(TM)) implantation between 1987 and 2006 at Yonsei University were available for this study. We investigated various components of the medical records, such as the number of pads used per day, results of pre-operative urodynamic studies, operative and post-operative complications, and revision rate. RESULTS: Mean patient age was 35.6 years(range 15-64 years), and mean follow-up duration was 12.4 years(range 1.4-19.8 years). Of the 37 patients, 21 had neurogenic bladder, and 9 had traumatic injury. Other causes of incontinence included post-operative complications(4 patients) and congenital anomalies(3 patients). The cuffs were placed were in the bladder necks of 21 patients and in the bulbous urethrae of 16 patients. The average number of pads used daily decreased significantly from 6.2 to 1.2 after the operation, and 27 patients(72.9%) were able to maintain 'dry-up status' (number of pads used< or=1). A total of 32 artificial sphincters remained in place(86.4% survival rate), with 8 revisions(21.6%) required secondary to infection, mechanical failure, or urethral stone. CONCLUSIONS: AUS implantation is a safe and durable treatment for urinary incontinence in patients with intrinsic sphincter deficiency from various underlying diseases.
Follow-Up Studies ; Humans ; Medical Records ; Neck ; Urethra ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urinary Sphincter, Artificial ; Urodynamics

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic*

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic*

BACKGROUND: Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuber-culosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the managenent of multidrug-resistant tuberculosis. METHOD: A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findigs : (1) patients who have reasonably localized lesion ( Localized Lesion Group ; LLG) (2) patients who have cavitary lesion after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG). (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multidrug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. RESULTS: Seventy five point six percent were men and 24.4% woment with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients (90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25.7 months. The mean length of postoperative drug therapy off LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. CONCLUSION: Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failture or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all them could not be resected perfectly, you should not open the thorax.
Disease Outbreaks ; Drug Therapy ; Follow-Up Studies ; Humans ; Lung ; Lung Diseases ; Male ; Mortality ; Mycobacterium ; Mycobacterium tuberculosis ; Recurrence ; Retrospective Studies ; Sputum ; Thorax ; Tuberculosis, Multidrug-Resistant*

PURPOSE: Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment. MATERIALS AND METHODS: Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone. RESULTS: Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM. CONCLUSION: Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.

OBJECTIVE: The study was undertaken to evaluate clinical safety and usefulness of laparoscopic myomectomy with analyzing clinical course and postoperative complications of 93 patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital and to introduce operative methods executed in this hospital. METHODS: Total number of patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital from May 2001 to December 2002 was 93. With ward chart and admission recordings, Age, parity, symtom, size of myoma, number of myoma, location operation time and hemoglobin change were recorded. Data were analyzed with Microsoft Excel. RESULTS: The mean age of patients was 42.68 ( +/- 6.05) years. The mean parity was 2.02 ( +/- 0.96). The mean number of myoma was 1.70 ( +/- 1.27). The mean weight of myoma was 71.7 ( +/- 56.4) gm. The most common symtom was hypermenorrhea. The location of myoma was submucosal, intramural, subserosal in large order. The mean operation time was 101.1 ( +/- 30.2) minutes. The mean hemoglobin change after operation was 1.40 ( +/- 0.81) g/dL. Mean hospital stay was 3.90 ( +/- 1.20) days. The operative complication was trocar site bleeding (2 cases), surgical emphysema (2 cases). In 2 cases, Laparoscopic procedure was converted to laparotomic method. CONCLUSION: Indication of operation was extended in almost all age (including reproductive age) and 93 Laparoscopic myomectomy was done safely and effectively without severe complications. However, to obtain more safety and usefulness of laparoscopic myomectomy, adequate laparoscopic instrument and expertized operative technic should be demanded. In near future, laparoscopic myomectomy will be more popular and effective by variable technical development and ordered discipline.
Emphysema ; Female ; Hemorrhage ; Humans ; Jeollanam-do ; Length of Stay ; Menorrhagia ; Myoma ; Parity ; Postoperative Complications ; Surgical Instruments

OBJECTIVE: Although atypical antipsychotics are increasingly being used as monotherapy in acute mania, few Korean studies have investigated on them. This study evaluated the efficacy and tolerability of olanzapine monotherapy in patients with acute mania. METHODS: This multicenter, open-label study evaluated the efficacy of olanzapine to treat mania over 6 weeks. Patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were treated with olanzapine (flexible dosage to a maximum of 30 mg/day). Clinical improvements were rated using the Young Mania Rating Scale (YMRS), Clinical Global Impression-Bipolar Version (CGI-BP), Brief Psychiatric Rating Scale (BPRS), and the Montgomery-Asberg Depression Rating Scale (MADRS). Adverse events were measured using the Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The general functioning of patients was assessed using the Global Assessment Scale (GAS). All assessments were carried out at baseline and at days 7, 14, 21, and 42, with the exception of the GAS. RESULTS: The subjects comprised 76 patients (male=38, female=38), with 55 patients (72.4%) completing the study. The mean initial dose of olanzapine was 11.7+/-5.0 mg/day and mean daily doses at days 7, 14, 21, and 42 were 16.6+/-5.2, 17.2+/-5.0, 18.1+/-5.3, and 17.4+/-4.7 mg/day, respectively. At days 7, 14, 21, and 42, YMRS, CGI-BP, MADRS and BPRS scores had significantly improved from baseline. More improvement in MADRS scores was observed among patients with mixed mania than patients with euphoric mania. Changes in BPRS scores from baseline did not differ between patients with psychotic symptoms and those with euphoric mania. At days 21 and 42, 42 (55.3%) and 57 (75.0%) patients had responded (YMRS scores decreased from baseline by more than 50%). Also 27 (35.5%) and 46 (60.5%) patients had achieved remission (YMRS scores < or =12) at the same assessment points. GAS scores at days 21 and 42 indicated that olanzapine monotherapy improved patients' global functioning compared to baseline. SARS and BARS scores did not differ significantly between pre- and post-drug trial. CONCLUSION: The data indicate that olanzapine monotherapy has favorable effects across a broad range of mood symptoms and yields functional improvement in acute manic patients with minimal adverse events. Therefore, olanzapine monotherapy may be a preferred first-line agent to treat patients with acute mania. These results support the findings from previous studies and guidelines.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Brief Psychiatric Rating Scale ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychomotor Agitation