The ankle is a complex structure supporting the entire musculoskeletal system during standing and walking. The injuries to the ankle joint result in a severe functional disturbance because of complex anatomical characteristics around the ankle joint. 284 patients of the ankle fracture that were treated in orthopedic Dept. Capital Armed Forced General Hospital from march 1985. to march 1988. were analized in clinical and radiological aspects. The following results were obtained: 1. The main cause of the injuries was falling from a height and the other were sports injury and slipping down in order. 2. The most common type by Lauge-Hansen classification was supination-external rotation type(122 case, 42.9%). 3. 211 case(74.3%) were treated with open reduction and internal fixation, and 73 case(25.7%) were treated with closed reduction. Poor outcome seemed closely related to the severity of the injury and degree of fracture displacement. 4. Accurate reduction and rigid internal fixation of the lateral malleolus with shortening was important factor. 5. Classification of Lauge-Hansen was useful in the diagnosis and treatment of the ankle fractures.
Accidental Falls ; Ankle Fractures ; Ankle Joint ; Ankle ; Arm ; Athletic Injuries ; Classification ; Clinical Study ; Diagnosis ; Hospitals, General ; Humans ; Musculoskeletal System ; Orthopedics ; Walking

No abstract available.
Diagnosis* ; Pancreas* ; Ultrasonography*

PURPOSE: We investigated the safety and efficacy of transurethral resection of the prostate(TURP) in benign prostatic hyperplasia(BPH) more than 60cc by single surgeon for the relief of infravesical obstruction. MATERIALS AND METHODS: We evaluated 211 patients treated with TURP in BPH with large prostate by single surgeon. Each group was divided by prostate volume(group 1; 60-69.9, group 2; 70-79.9, group 3; 80-89.9, group 4; 90-99.9, group 5; >100cc of prostate volume). Various parameters such as International Prostate Symptom Score(IPSS), maximal flow rate(Qmax.), postvoid residual volume(PVR), prostate volume, adenoma volume, resection time, resection prostate volume, irrigation fluid volume and complications were evaluated and compared. RESULTS: Age of each group was not significantly different. Prostate volume, adenoma volume, resection time, Resection volume, irrigation volume of each groups were different significantly. But, resection volume/resection time and irrigation volume/resection time were not different significantly. Mean resection volume/resection time was 1.34g/min, and mean irrigation volume/resection time was 315.8ml/min. And intraoperative and postoperative complications of each group were not different. Mean postoperative change of Hb was 2.0+/-1.1g/dl. Postoperative parameters(IPSS, Qmax, PVR) were improved significantly. Only 2 patients needed transfusion in group 5. No urinary incontinence and TUR syndrome in each group was observed. CONCLUSIONS: TURP by experienced surgeon is a safe and effective treatment in BPH patients with large prostates for relief of infravesical obstruction.
Adenoma

PURPOSE: We evaluated the clinical significance of simultaneous transurethral resection of bladder tumor(TURB) and the prostate(TURP) in patients who have superficial bladder cancer with bladder outlet obstruction. MATERIALS AND METHODS: Between April 1997 to April 2006, 213 patients with superficial bladder cancer were included in this study. The patients were treated with TURB only(n=107, Group I) or TURB with TURP (n=106, Group II). Bladder cancer recurrence was observed by performing cystoscopy and urine cytology. Uroflowmetry was performed three months after surgery. RESULTS: There were no significant differences in age, the tumor size or the number of tumors between groups I and II. There was no evidence of cancer implantation where TURP was applied. The recurrence rate of group II was significantly lower than that of group I(p=0.044), and the time to recurrence was longer for group II than for group I(p=0.026). There was no significant difference in the progression rate between the two groups(p=0.788). Three months after surgery, the mean residual urine volume was lower for group II(7.9ml) than that for group I(21.7ml). CONCLUSIONS: For superficial bladder cancer patients with bladder outlet obstruction, simultaneous TURB and TURP may help reduce the bladder cancer recurrence rate and delay the time to recurrence without the risk of cancer implantation at the site where TURP is applied.
Cystoscopy ; Humans ; Prostate ; Recurrence ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder Neoplasms

Premature ejaculation(PE) is the most prevalent male sexual complaint, yet it remains underdiagnosed and undertreated. The sympathetic, parasympathetic, and somatic spinal centers, under the influence of sensory genital and cerebral stimuli integrated and processed at the spinal cord level, act in synergy to command physiologic events occurring during ejaculation. Experimental evidence indicates that serotonin(5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation and pharmacologic manipulation of the serotonergic system has been performed in rats, with the antidepressant selective serotonin reuptake inhibitors(SSRIs) exhibiting the greatest efficacy in delaying ejaculation. Over the last decade, an increasing number of studies of drug treatment of PE have been published. A meta-analysis of those studies demonstrated similar efficacies for daily treatment with the serotonergic antidepressants paroxetine hemihydrate, clomipramine, sertraline and fluoxetine, with paroxetine(hydrochloride) hemihydrate exerting the strongest effect on ejaculation. On the basis of fundamental insights into serotonergic neurotransmission, it has been suggested that on-demand selective serotonin reuptake inhibitor(SSRI) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment. Apart from daily treatment with SSRIs, PE can be delayed by on-demand use of topical anaesthetics. Treatment with phosphodiesterase type 5 inhibitors may be used if PE is accompanied by erectile difficulties.
Animals ; Antidepressive Agents ; Brain ; Clomipramine ; Ejaculation ; Fluoxetine ; Humans ; Male ; Neurophysiology ; Paroxetine ; Phosphodiesterase 5 Inhibitors ; Premature Ejaculation ; Rats ; Serotonin ; Sertraline ; Spinal Cord ; Synaptic Transmission

OBJECTIVES: A growing body of evidence has suggested that morphologic changes in cerebellum may be implicated with pathophysiology of major depressive disorder (MDD). The aim of this study is to investigate a difference in the volume and cortical thickness of the specific region of cerebellum between patients with MDD and healthy controls (HC). METHODS: A total of 127 patients with MDD and 105 HC participated in this study and underwent T1-weighted structural magnetic resonance imaging. We analyzed volume and cortical thickness of each twelve cerebellum regions divided by left and right and the volume and cortical thickness of the whole cerebellum from T1-weigted image of participants. One-way analysis of covariance was used to investigate the volume and cortical thickness difference of total and specific regions between two groups adjusting for age, gender, medication, and total intracranial cavity volume. RESULTS: We found that the patients with MDD had significantly greater volume in the left cerebellum lobule III region [false discovery rate (FDR)-corrected p = 0.034] compared to HC. Also, our findings indicate that cortical thickness of left lobule VIIB (FDR-corrected p = 0.032) and lobule VIIIB (FDR-corrected p = 0.032) are significantly thinner in the patients with MDD compared with the HC. No significant volume and cortical thickness differences were observed in other sub-regions of the cerebellum. The volumes and cortical thickness of whole cerebellum between patients with MDD and HC did not differ significantly. CONCLUSIONS: We observed the region-specific volume and cortical thickness difference in cerebellum between the patients with MDD and HC. The results of our study implicate that the information about structural alterations in cerebellum with further replicative studies might provide a stepping stone toward a specific marker to diagnose MDD.
Cerebellum* ; Depressive Disorder, Major* ; Humans ; Magnetic Resonance Imaging

BACKGROUND: Acute lower respiratory tract infections are common causes of hospitalization in children and viruses are major causative agents. The causative viruses are known to be variable by age, region, or year. We investigated the recent 5-year epidemics of respiratory viruses for pediatric patients in two university hospitals in Korea. MATERIALS AND METHODS: From July 1996 through June 2001, viral agents were detected for the 2,317 pediatric patients who were hospitalized with acute respiratory tract infection in Hanyang University Hospital and Hanyang University Guri Hospital. We obtained nasopharyngeal aspirates on the day of admission and detected the viruses by indirect immunofluorescent staining method (Respiratory panel I viral Screening & Identification Kit, Light Diagnostics, Chemicon, Temecula, CA, USA). RESULTS: The causative viral agents were detected in 737(31.76%) patients. They were respiratory syncytial virus of 53.6%, influenza A virus 38.6%, adenovirus 5.5%, influenza B virus 1.9%, and parainfluenzavirus 0.4%. The epidemics of RSV were found during winter, but the epidemics of influenza A were found more frequently in spring, which had tendency of following the epidemic of RSV. Adenovirus was detected sporadically throughout year. RSV was found more frequently in patient with bronchiolitis and pneumonia and also found more frequently in patient less than 6 month of age. Influenza A and adenovirus were in patients of pneumonia and in more frequently in patient one to two year of age. CONCLUSION: Viruses were the leading causative agents of acute lower respiratory tract infections in pediatric patients. RSV was the most important causative agent. Influenza A virus was the second frequent viral agent and detection rate was higher than other reports. The detection rate of parainfluenza virus was lower than other reports from Korea or from abroad.
Adenoviridae ; Bronchiolitis ; Child ; Hospitalization ; Hospitals, University ; Humans ; Influenza A virus ; Influenza B virus ; Influenza, Human ; Korea ; Mass Screening ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

BACKGROUND: The aim of this study was to compare the accuracy of measured cardiac output using the newly developed esophageal doppler device with that of the thermodilution method using a pulmonary artery catheter. METHODS: In 15 patients undergoing off-pump coronary artery bypass surgery, cardiac outputs were measured at four episodes of surgery; (1) after induction of anesthesia, (2) during dissection of the internal mammary artery, (3) during anastomosis of the left anterior descending artery, and (4) after closure of the pericardium. RESULTS: The bias between the two methods was 0.52 +/- 1.09 L/min. Analysis of the changes in cardiac output from sample episode 1 to 2, from sample episode 2 to 3 and from sample episode 3 to 4, expressed as percent change values, shows no significant differences between the two methods (P > 0.05). CONCLUSIONS: The esophageal doppler accurately reflects changes in cardiac output with time when compared with that of the thermodilution.
Anesthesia ; Arteries ; Bias (Epidemiology) ; Cardiac Output* ; Catheters ; Coronary Artery Bypass, Off-Pump* ; Humans ; Mammary Arteries ; Pericardium ; Pulmonary Artery ; Thermodilution* ; Thoracic Surgery