Bladder mucosa has been reported as an excellent tissue for construction of a neourethra. We used bladder mucosa in 3 cases when there was inadequate foreskin to create a neourethra. Two cases were penoscrotal hypospadias with chordee which were repaired in one stage operation and one case was scrotal hypospadias with severe chordee which was repaired in two stage operation. The. sizes of harvested bladder mucosa were 4x 1.5cm, 10 x 3.5cm and 15 x 3cm respectively. Two minor and one major complications occurred. The minor complications were urethral stricture in one case which was managed with urethral dilation and penile swelling after self-voiding in one case which required urinary diversion for several days. In one case severe problem with entire neourethra stricture necessitated internal urethrotomy and intermittent urethral dilatation. In all cases sufficient graft tissue could be obtained and there were no urethrocutaneous fistulas. Thus, the use of bladder mucosal graft in hypospadias repair is feasible in cases in which previous repairs have railed or in which sufficient foreskin for neourethral reconstruction is lacking.
Constriction, Pathologic ; Dilatation ; Female ; Fistula ; Foreskin ; Hypospadias* ; Male ; Mucous Membrane ; Transplants* ; Urethral Stricture ; Urinary Bladder* ; Urinary Diversion

No abstract available.
Humans ; Infant, Newborn*

No abstract available.
HIV* ; Humans*

This study was performed in order to evaluate the sero-epidemiological status of toxoplasmosis in pregnant Korean women. Among 5, 175 sera and 750 amniotic fluid samples obtained from pregnant women, 41 serum samples (0.79%) and 10 (1.33%) amniotic fluid samples tested positive for IgG antibodies by ELISA. Fifty one cases showing a score more than 0.25 on ELISA were tested for PCR reaction against the SAG1 gene. Only one case of the 51 ELISA positive cases exhibited a positive reaction on all tests. This case had a history of acute nephropyelitis during early pregnancy, but fortunately, had delivered a phenotypically healthy baby. In this study, the seroprevalence of toxoplasmosis in pregnant women was found to be comparatively low, consistent with previous reports from Korea. However our trials, performed with a variety of diagnostic tools, were considered to be useful for the precise diagnosis of congenital toxoplasmosis.
Adult ; Animals ; Antibodies, Protozoan/*blood ; Female ; Humans ; Korea/epidemiology ; Pregnancy ; Pregnancy Complications/diet therapy/*epidemiology ; Seroepidemiologic Studies ; Toxoplasma/*immunology ; Toxoplasmosis/*epidemiology

BACKGROUND: Syncope is both one of the most common and one of the most challenging problems seen in medical practice. In spite of intensive medical evaluation, the cause of syncope remains unknown in a significant number of patients. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. This study investigated the clinical utility of this technique in te evaluation of patients with vasovagal syncope. METHODS: Seven patients with unexplained syncope were evaluated with a 60 degree or 80 degree head-up tilt test with or without intravenous infusion of isoproterenol(1-4ug/min) in an attempt to provoke bradycardia, hypotension or both. There were 4 males and 3 females with a mean age of 35+/-8 years. RESULTS: 1) During head-up tilt test, vasovagal responses were provoked in 5 of 7 patients(71.4%) with syncope of unknown origin. During the test, there was no complication associated with the test. 2) During tilt-induced vasovagal reponse, mean systolic blood pressure decreased to 84+/-12mmHg from supine control of 125+/-21mmHg(p<0.01) and mean diastolic blood pressure decreased to 50+/-17mmHG from supine control of 76+/-14mmHg(p<0.01). 3) Five patients with positive results of the tests were followed up for 12months and they had a good outcome free of recurrence. CONCLUSION: Head-up tilt test appeared safely applicable test in patients with suspected vasovagal syncope and good prognosis was expected in the patients.
Blood Pressure ; Bradycardia ; Female ; Follow-Up Studies* ; Humans ; Hypotension ; Infusions, Intravenous ; Male ; Prognosis ; Recurrence ; Syncope ; Syncope, Vasovagal*

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.
Anesthesia, General ; Anoxia ; Catheters ; Cholecystectomy ; Diagnosis ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypotension ; Intensive Care Units ; Lower Extremity ; Lung ; Middle Aged ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Shock ; Syncope

C-erbB-2, one of epidermal growth factor receptor gene family, may have an important role in progression of transitional cell carcinoma (TCC of the urinary bladder. We herein immunohistochemically examined 52 bladder TCC specimens for expression of c-erbB-2 gene product to investigate its prognostic value. Interrelationship between expression of c-erbB-2 and stage, grade, expression of proliferating cell nuclear antigen (PCNA), and clinical outcomes were analyzed. Overexpression of c-erbB-2 was significantly higher in invasive tumors as compared with superficial tumors and in high grade tumors as compared with low grade tumors (p<0.005). However, there were no significant correlations between the degree of expression of c-erbB-2 and progression-free survival in patients with superficial bladder TCC as well as actual-survival in patients with invasive bladder TCC. There also was no significant correlation between the expression of c-erbB-2 and PCNA. These results suggest that c-trbB-2 may be an important marker of malignant potentials and invasiveness of bladder TCC, but immunohistochemical study for its expression in bladder TCC may not provide additional prognostic information to stage and grade of the tumors.
Carcinoma, Transitional Cell ; Disease-Free Survival ; Genes, erbB-2 ; Humans ; Proliferating Cell Nuclear Antigen ; Receptor, Epidermal Growth Factor ; Urinary Bladder Neoplasms* ; Urinary Bladder*

To evaluate the typical appearance and the influence in the image interpretation of the metallic artifact which is known as one of the patient-related field artifacts, we analysed the magnetic resonance (MR) images of 40 patients (the total number of metallic materials were 45) acquired at MR 1.5T unit. All patients were screened for the presence of metal. The metallic implants were surgical wires and clips, orthopedic devices, and the other miscellaneous materials. The artifacts produced by metallic objects can be seen on MRI as the focal loss of signal and/or the local distortion of the image. Regardless of their ferromagnetic properties, metallic implants created regional artifacts in their images. Ferromagnetic materials, such as a lead fragment, showed severe artifacts and nonferromagnetic metals showed mild to moderate artifacts. The conspicuity of artifact was related tot he composition, mass, shape, orientation, and the location of the metallic objects in the body. Under high magnetic field strength, there were no significant differences between the various pulse sequences. Artifacts are particularly prominent on gradient-echo images. Our findings indicate that MR imaging of patients with standard nonferromagnetic metallic materials can be successfully performed and usefully interpretated.
Artifacts* ; Humans ; Magnetic Fields ; Magnetic Resonance Imaging* ; Magnets ; Metals ; Orthopedics

The prognostic significance of vascular (blood and lymphatic vessels) invasion was evaluated in a retrospective review of 27 patients with upper urinary tract transitional cell carcinoma from January 1985 to December 1993, who underwent a nephroureterectomy with bladder cuff resection. Vascular invasion was found in 10 patients (37%). The incidence of vascular invasion was well correlated with tumor grade and stage. The incidence of postoperative metastases was significantly higher in the patients with (70%) than without (17.6%) vascular invasion (p<0.05). The survival rate of the patients with vascular invasion was significantly lower than in those without vascular invasion (p<0.01). In multivariate Cox`s regressional analysis the prognostic value of vascular invasion was independent of tumor grade and stage. These results indicate that vascular invasion should predict a more unfavorable outcome in patients with upper urinary tract transitional cell carcinoma as an independent morphological indicator.
Carcinoma, Transitional Cell* ; Humans ; Incidence ; Lymphatic Vessels* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder ; Urinary Tract*

Recently LHRH analog has been interested in the endocrine management of metastatic prostatic. cancer. But the effect of LHRH analog therapy on the prostate has not been previously documented definitely. And the initial flare phenomenon may be developed after initiation of LHRH analog therapy, but the definite method to block this phenomenon has not been introduced. To assess the effect of LHRH analog administration on the prostate, The author observed the weight and histopathologic changes of rat prostate during the administration of a potent LHRH analog (leuprolide acetate) for 6 weeks. And the author intended to present a possible method to block the initial flare phenomenon by observation of the weight and histopathologic changes of rat prostate after local testicular irradiation with a minimal dose(500 rad) producing Leydig cell dysfunction. The following results were obtained: 1. The prostate weight in control group was progressively increased during experimental periods At 0 day, 3 weeks and 6 weeks of experimental period, the prostate weights were 0.44gm, 0 58gm and 0.64gm respectively. 2. The prostate weight in leuprolide treated group was significantly decreased at 3 weeks(0.40+/-0.02gm) and 6 weeks (0.30+/-0.04gm) of administration in contrast to the age-matched control group (p<0.05). 3. The prostate weight in testicular irradiation group was significantly decreased at 3 weeks(0.44+/-0.04gm) and 6 weeks(0.42+/-0.02gm) after irradiation in contrast to the age-matched control group(p<0.05). But its change was less prominent than leuprolide treated group. 4. The pathologic change of prostate after leuprolide administration was the vacuolization of acinar cells. The vacuolization was noticed at 2 weeks of administration and pro gressively increased to the 6 weeks. 5. The pathologic change of prostate after testicular irradiation was the progressively increased vacuolization of acinar cells during experimental periods, but its change was less significant than leuprolide treated group. These results suggest that LHRH analog develops the progressive vacuolization of acinar cells, causing the regression of acinar cells and prostatic atrophy as well as the possible inhibition of normal prostatic growth and that local testicular irradiation prior to LHRH analog therapy may be a possible method to block the initial flare phenomenon.
Acinar Cells ; Animals ; Atrophy ; Gonadotropin-Releasing Hormone* ; Leuprolide ; Prostate* ; Rats* ; Testis ; Weights and Measures