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: 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.

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*

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

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

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

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: It is well known that treatment with quetiapine can easily cause somnolence and daytime sleepiness in patients with bipolar disorder. Such sedation may be the discomfort to the drug in terms of patient's perspectives and results in drug noncompliance. This study was aimed to investigate the effect of 6-week quetiapine monotherapy on subjective aspects of sleep in patients with acute bipolar disorder. METHODS: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine. The dose of quetiapine initially started at 200 mg/day and rapid titrated up to 800 mg/day within day 7 according to the clinical judgements. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGI-BP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Subjective sleep questionnaire modified from Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of sleep, which included the aspects covering the ease of getting to sleep (GTS), quality of sleep (QOS) and hangover behavior next day (HOV). All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with quetiapine. Analyses were focused to compare the differences between pre-drug baseline and post-treatment with quetiapine. RESULTS: Total 78 (male=30, female=48) patients were included and most of them were inpatients (N=59, 74.7%). Fifty-nine (75.9%) patients were completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. There were no significant differences from baseline in SARS and BARS at any assessment points. The common subjectively reported adverse events were somnolence, dizziness and dry mouth. While mean changes of 5 items measuring nighttime sleep (GTS and QOS) from baseline were significantly improved at days 7, 14, 21 and 42, those of HOV were not differed between baseline and post-treatment assessments. CONCLUSION: Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.
Bipolar Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dizziness ; Humans ; Inpatients ; Mouth ; Psychomotor Agitation ; Surveys and Questionnaires ; Quetiapine Fumarate