PURPOSE: Botulinum toxin (BTX) acts by inhibiting acetylcholine (ACh) release at the presynaptic cholinergic neuromuscular junction, and is applied in various urethral and bladder dysfunctions, including detrusor external sphincter dyssynergia (DESD). We investigated the use of BTX in DESD patients as a reversible chemical sphincterotomy. MATERIALS AND METHODS: A total of 6 patients (male 3, female 3) with DESD were included. Their mean age was 45.5 years. The underlying diseases were multiple sclerosis (1), meningomyelocele (1), spinal cord injury (1), multiple systemic atrophy (1) and transverse myelitis (2). All the patients had severe voiding symptoms and large residual urine, despite anticholinergics and alpha-adrenoceptor antagonists with clean intermittent catheterization (CIC). Urodynamic studies were performed before and 1 month after treatment. A total of 100 units of BTX-A (Botox(R)) were injected at 4 sites, 3, 6, 9 and 12 o'clock relative to the external sphincter, under anesthesia, on an outpatient basis. The alpha-adrenoceptor antagonist medication was discontinued for evaluation after surgery. RESULTS: At 1 month after the injection, the mean maximal flow rate was increased (from 8.4 to 12.2ml/sec) and mean residual urine was decreased (from 258 to 120ml) compared to the baseline values. The external sphincter pressure was decreased. All patients were able to discontinue the CIC. There were no systemic complications, such as respiratory distress or myasthenic crisis. CONCLUSIONS: Transurethral BTX-A injections were safe and effective for releasing or ameliorating a lower urinary tract obstruction due to DESD, and a safe and valuable therapeutic option in DESD patients not desiring surgery or CIC, and who are resistant to medications. (Korean J Urol 2005;46:604-609)
Acetylcholine ; Anesthesia ; Ataxia* ; Atrophy ; Botulinum Toxins* ; Cholinergic Antagonists ; Female ; Humans ; Intermittent Urethral Catheterization ; Meningomyelocele ; Multiple Sclerosis ; Myelitis, Transverse ; Neuromuscular Junction ; Outpatients ; Spinal Cord Injuries ; Urethra* ; Urinary Bladder ; Urinary Tract ; Urodynamics

To investigate the seroprevalence of the Orientia tsutsugamushi infection of Apodemus peninsulae and genomic variations in O. tsutsugamushi isolates, 246 A. peninsulae were trapped in 14 mountainous areas approximately 500 meter above sea level in Korea during the period of 1997 and 2000. Seropositive rate of O. tsutsugamushi among A. peninsulae was 31.8% in Kyunggi, 8.2% in Chunbuk and 7.1% in Kangwon provinces by microimmunofluorescent test. The 56 kDa protein gene was amplified by PCR in the spleens of seropositive A. peninsulae. Two amplicons from seropositive A. peninsulae were sequenced and their phylogeny was analysed on the basis of sequence homology. The 56 kDa genes of A. peninsulae 98-12 strain and A. peninsulae 98-16 strain showed 98.7% nucleotide homology and 96.6% amino acid similarity. A. peninsulae 98-12 and A. peninsulae 98-16 strain were related to Kuroki, Boryong and Karp strains showing 93.3~92.2%, and 87.1~84.6% homologies in nucleotide and amino acids levels, respectively. In the phylogenetic analysis, A. peninsulae 98-12 and A. peninsulae 98-16 strain formed a distinct group with Boryong, Kuroki and Nishino strains and were clearly distinguished from other genetic groups. The results suggest that A. peninsulae might be an important reservoir of O. tsutsugamushi in Korea.
Amino Acids ; Animals ; Chungcheongnam-do ; Gangwon-do ; Gyeonggi-do ; Korea* ; Murinae* ; Orientia tsutsugamushi* ; Phylogeny ; Polymerase Chain Reaction ; Sequence Homology ; Seroepidemiologic Studies* ; Spleen

This study was carried out to determine the seropositivity for Orientia tsutsugamushi infection among wild rodents captured in farms and mountains of Korea. A total 965 wild rodents of 7 species and 48 Crocidura laciura were captured in farms and mountains of 6 province during 1997~2000 in Korea. Serological evidence for O. tsutsugamushi infection was obtained using O. tsutsugamushi antigens by indirect immunofluorescent antibody technique (IFA). Four hundred eighty four Apodemus agrariusus, 246 Apodemus peninsulae, 179 Eothenomys regulus, 44 Microtus fortis, 6 Micromys minutus, 5 Mus musculus, and 1 Cricetula triton were captured in Gyeonggi, Gangwon, Chungnam, Gyeongbuk, Gyeongnam, and Jeonbuk province. Among them, 59 (12.2%) A. agrariusus, 22 (8.9%) A. peninsulae, 12 (6.7%) E. regulus, 5 (11.4%) M. fortis and 1 (16.7%) M. minutus were IF antibody positive against O. tsutsugamushi Gilliam or Karp strain.
Animals ; Arvicolinae ; Chungcheongnam-do ; Gangwon-do ; Gyeonggi-do ; Gyeongsangbuk-do ; Jeollabuk-do ; Korea* ; Mice ; Murinae ; Neptune ; Orientia tsutsugamushi* ; Rodentia*

Cast formation of biliary sludge leading to obstruction and cholangitis have been reported in patients who received orthotopic liver transplantation. The pathogenesis of biliary cast after orthotopic liver transplantation appeared to be multifactorial. Cold ischemic damage, immunologic attack to the bile duct and bile stasis may have played a role. On the other hand, only three cases of biliary cast have been reported in non-transplanted patients. We described the successful endoscopic removal of this complication in a 70-year-old man whose biliary sludge aggregated into firm casts occupying the extrahepatic ducts which has been developed after cholecystectomy and segmentectomy for intrahepatic cholangiocarcinoma. We speculated on the hemolysis and prolonged fasing as the initiating events but the exact pathogenesis of biliary cast remains to be clarified.
Aged ; Bile ; Bile Ducts ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Hand ; Hemolysis ; Humans ; Liver Transplantation ; Mastectomy, Segmental ; Cholangiocarcinoma

Cast formation of biliary sludge leading to obstruction and cholangitis have been reported in patients who received orthotopic liver transplantation. The pathogenesis of biliary cast after orthotopic liver transplantation appeared to be multifactorial. Cold ischemic damage, immunologic attack to the bile duct and bile stasis may have played a role. On the other hand, only three cases of biliary cast have been reported in non-transplanted patients. We described the successful endoscopic removal of this complication in a 70-year-old man whose biliary sludge aggregated into firm casts occupying the extrahepatic ducts which has been developed after cholecystectomy and segmentectomy for intrahepatic cholangiocarcinoma. We speculated on the hemolysis and prolonged fasing as the initiating events but the exact pathogenesis of biliary cast remains to be clarified.
Aged ; Bile ; Bile Ducts ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Hand ; Hemolysis ; Humans ; Liver Transplantation ; Mastectomy, Segmental ; Cholangiocarcinoma

Bcl-2 and p53, two proteins, have implicated in apoptosis and among them p53 is known as adverse prognostic factor in a number of tumors. But it is variable in different tissues whether bcl-2 expression and its role are related in the prognosis. The present study was aimed to find the role of bcl-2 and p53 in prognosis of epithelial ovarian cancer. We examined 32 epithelial ovarian cancer specimens of different histologic types and stages by immunohistochemical staining. Bcl-2 protein expression was found in 11/32 epithelial ovarian cancers and it was related in survival(p=0.0038) and p53 accumulation was found in 17/32 epithelial ovarian cancers but it was not rrelated in survival(p=0.0717). But bcl-2 expression and p53 accumulation were not related to the FIGO stages(p>0.05). The analysis of the postoperative course of 32 patients showed that survival depended on the FIGO stages(p=0.001 2) and the histologic type(p=0.009). However, bcl-2 immunohistochemistry identified a subgroup of patients with p53 and bcl-2 positive carcinomas who had not a statistically better outcome(p=0.082) than patients with p53 positive and bcl-2 negative carcinomas. Thus our observations point to different molecular alterations possibly underlying phenotypic diversity of ovarian carcinomas and provide clues for a better understanding of tumor progression in these neoplasms.
Apoptosis ; Humans ; Immunohistochemistry ; Ovarian Neoplasms ; Prognosis

BACKGROUND: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. MATERIAL AND METHOD: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37+/-12.89years, and the male: female ratio 99:87. RESULT: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78+/-2.35% at 1 year and 39.03+/-9.08% at 5 years, and those of graft fistula were 96.09+/-2.22% at 1 year and 16.45+/-10.15% at 5 years. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. CONCLUSION: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.
Arteriovenous Fistula* ; Dilatation ; Female ; Fistula ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Prognosis ; Renal Dialysis* ; Retrospective Studies ; Thrombectomy ; Transplants

PURPOSE: The purpose of this descriptive study was to identify the nursing needs of patients with chronic illness. METHOD: The subjects of this study were 636 patients with chronic illness, 323 general nurses, and 106 public health nurses. The instruments used for this study were questionnaires including perceived functions of nursing from the center for chronic illness, preference to placement, intention to use, needs to receive services from the center for chronic illness, strategies management for nursing, and nursing needs of chronically ill patients. RESULTS: The mean of perceived functions for nursing from the center were 3.1(0.5) in public health nurses, 2.9 (0.59) in general nurses, and 2.4(1.33) in chronically ill patients. Regards of needs to receive on services of the nursing centers were, the regularly physical examination, for health educational services which was perceived highest request amongst chronically ill patients. We found the means of each specific need as 2.2(0.6), for physical health, 2.1(0.7), for psychosocial health, and 1.8(0.6) for spiritual health. CONCLUSION: From the results of this study, it is suggested that establishing a nursing center for chronically ill patients consider physical, psychosocial, for spiritual health needs of chronically ill patients. It is also a consideration that direct care for symptom management and health education in the nursing center be implemented.
Chronic Disease* ; Health Education ; Humans ; Intention ; Nurses, Public Health ; Nursing* ; Physical Examination ; Surveys and Questionnaires

The spontaneous regression of herniated cervical discs is not a well established phenomenon. However, we encountered the 3 cases of spontaneous regression of severe radiculopathic herniated cervical discs that were treated using a non-surgical method. Each of the patients were treated with a combination of manipulation, dry needling and analgesics. In each case, the symptoms improved within 12 months of treatment and magnetic resonance imaging (MRI) conducted at that time revealed marked regression of the herniated disc in all cases. These cases provide additional examples of spontaneous regression of herniated cervical discs documented by MRI following non-surgical treatment.
Analgesics ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.
Acidosis, Respiratory ; Catheterization ; Catheters ; Cystoscopy ; Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics