PURPOSE: The outcome of a tubularized incised plate (TIP) urethroplasty for hypospadias was reviewed retrospectively, and compared with other procedures with respected to the success rate, complications and satisfaction. MATERIALS AND METHODS: Between April, 1994 and July, 2001, 51 patients underwent a repair for hypospadias, by the same operator, using a transverse preputial island flap (TPIF; 7), an onlay island flap (OIF; 3), Mathieu (7) and tubularized incised plate (34) procedures. The operation time, period of catheterization, postoperative hospital days and complication rates for each procedure were also compared. RESULTS: The mean operation time in the TIP group was 140 minutes, compared to 230 220 and 160 minutes in the TPIF, OIF and Mathieu groups, respectively. The mean admission periods in the TPIF, OIF, Mathieu and TIP group, were 14, 17, 11 and 10 days, respectively. The mean operation time and admission period was shorter in the TIP group than those of the other procedures. The incidence rate of an urethrocutaneous fistula was lower in the TIP group (23%: 8/34) than in the TPIF (43%: 3/7), OIF (66%: 2/3) and Mathieu groups (57%: 4/7). Postoperative satisfaction for the penis and meatus shapes was highest in the TIP group. CONCLUSIONS: The TIP urethroplasty had better outcomes than the TPIF, OIF and Mathieu procedures with regard to the operation time, catheterization period, admission period and complication rates following the operations. TIP urethroplasty is thought to be the most economic method for the repair of hypospadias, and can be recommended as the first choice for its repair.
Catheterization ; Catheters ; Female ; Fistula ; Humans ; Hypospadias* ; Incidence ; Inlays ; Male ; Penis ; Retrospective Studies ; Urethra

No abstract available.
Edema* ; Hydrops Fetalis*

OBJECTIVE: To develop a population pharmacokinetics (PK)/pharmacodynamics (PD) model for alcohol in healthy volunteers and to elucidate individual characteristics to affects alcohol's PK or PD including dissolved oxygen. METHODS: Following multiple intakes of total 540 mL alcohol (19.42 v/v%) to healthy volunteer, blood alcohol concentration was measured using a Breathe alcohol analyser (Lion SD-400 Alcolmeter®). A sequential population PK/PD modeling was performed using NONMEM (ver 7.3). RESULTS: Eighteen healthy volunteer were included in the study. PK model of alcohol was well explained by one-compartment model with first-order absorption and Michaelis-Menten elimination kinetics. K(a), V/F, V(max), K(m) is 8.1 hr⁻¹, 73.7 L, 9.65 g/hr, 0.041 g/L, respectively. Covariate analysis revealed that gender significantly influenced V(max) (Male vs Female, 9.65 g/hr vs 7.38 g/hr). PD model of temporary systolic blood pressure decreasing effect of alcohol was explained by biophase model with inhibitory E(max) model. K(e0), I(max), E(0), IC(50) were 0.23 hr⁻¹, 44.9 mmHg, 138 mmHg, 0.693 g/L, respectively. CONCLUSION: Model evaluation results suggested that this PK/PD model was robust and has good precision.

OBJECTIVE: Plasma homocysteine (Hcy) is considered to be a marker of endothelial dysfunction and a predictor of cardiovascular disease (CVD). Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) is not only a marker of vascular damage but a significant predictor of CVD. Previous studies about the effect of high plasma Hcy levels on arterial stiffness have yielded inconsistent results. We therefore assessed the association between Hcy and baPWV in a relatively large number of subjects with type 2 diabetes mellitus (DM). METHODS: We retrospectively assessed plasma Hcy concentration and arterial stiffness in 1,477 Korean type 2 diabetic patients. Participants were also evaluated for plasma glucose, hemoglobin A1c (HbA1c), duration of DM, microvascular complications, lipid profile, and high sensitivity C-reactive protein (hsCRP). Arterial stiffness was measured noninvasively by baPWV. RESULTS: Correlation analysis indicated a significant positive association between serum Hcy levels and baPWV (r=0.245, p<0.001). In a multiple linear regression analysis, the association between serum Hcy levels and baPWV was independent of traditional cardiovascular risk factors (standardized beta=3.8, p=0.01). CONCLUSION: The results support the hypothesis that plasma Hcy levels are associated with arterial stiffness in patients with type 2 DM. Prospective studies are warranted to determine whether lowering serum Hcy level could reduce arterial stiffness and cardiovascular morbidity in type 2 DM.
C-Reactive Protein ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Glucose ; Hemoglobins ; Homocysteine ; Humans ; Linear Models ; Plasma ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

OBJECTIVES: The purpose of this study was to investigate the clinical utility of the Korean Wechsler Intelligence Scale for Children-Fourth Edition (K-WISC-IV) and General Ability Index (GAI) in children with attention-deficit hyperactivity disorder (ADHD). METHODS: The GAI and Full Scale IQ (FSIQ) in K-WISC-IV were compared for a group of 79 children with ADHD and 234 normal children. The mean differences within each group were testified by the t-test and Cohen's d. The Wechsler's descriptive classifications for each GAI and FSIQ score were analyzed in the children with ADHD. Additionally, the critical value for the difference between the means of the FSIQ and GAI was calculated in the normal children. RESULTS: The score on the GAI was higher than that on the FSIQ in the children with ADHD, with a mean difference of 2.19 points. The implications of these findings are discussed regarding the cognitive characteristics of the children with ADHD. According to Wechsler's descriptive classification, the application of the GAI showed a lower (7.59%), equal (61.65%) or higher (60.76%) prevalence of ADHD compared to the application of FSIQ. CONCLUSION: The implications of these findings are discussed regarding the cognitive characteristics of the children with ADHD. The GAI reflecting the attention and behavioral problems in children with ADHD could be utilized as an alternative global intelligence estimate that considers their potential for development.
Child ; Classification ; Humans ; Intelligence* ; Prevalence ; Problem Behavior

BACKGROUND: Ideal Body Weight(IBW) is commonly used to determine obesity levels because of its usefulness as target weight. This study was attempted to evaluate the comparative consistency between standards of determining obesity levels using the BMI and IBW. And the authors here provide a definition of IBW and attempt to suggest a new classification of obesity by IBW. METHODS: The test subjects for the research were 24,816 patients who received treatment at the SNUH Health Promotion Center between May 1, 1996 and December 31, 1999. The comparative consistency between standards of determining obesity levels using the BMI and IBW were analyzed calculating the kappa value. RESULTS: The IBW from the Broca method produced a kappa value of 0.668(p<0.001), while the calculation method for IBW recommended by the Japan Obesity Institute produced a kappa value of 0.664(p<0.001). On the other hand, an IBW calculated as 21(kg/m2)X[height(m)]2 (kg) produced the highest value of consistency at a kappa value of 0.911(p<0.001). After calculating IBW as 21(kg/m2)X[height(m)]2 (kg) and comparing the kappa values while adjusting the boundary zone standards, it was found that defining underweight as below 88% of IBW and obesity as above 145% produced the highest value of concurrence at a kappa value of 0.935(p<0.001). CONCLUSION: The validity and confidence with respect to the definition of IBW and the determination method for obesity as proposed by the authors may be confirmed through the methods high level of consistency [kappa value=0.935(p<0.001)] with determination methods using the BMI.
Body Mass Index* ; Classification ; Hand ; Health Promotion ; Humans ; Ideal Body Weight* ; Japan ; Obesity* ; Thinness

The pulsatile tinnitus is characterized by a rhythmic sound that is synchronous with the patient's heart beat. Accurate diagnosis is imperative, because in many patients, a treatable underlying etiology can be identified. Sigmoid sinus diverticulum is known to be one of the treatable causes of venous pulsatile tinnitus, but rarely reported in the literature. We experienced a case of sigmoid sinus diverticulum in a 58-year-old female presenting a pulsatile tinnitus. So we report this case with a review of literature.
Colon, Sigmoid ; Diverticulum ; Female ; Heart ; Humans ; Middle Aged ; Tinnitus

BACKGROUND: Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. METHODS: From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. RESULTS: There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. CONCLUSIONS: Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.
Adult ; Arthroscopy/*methods ; Female ; Hip/*physiopathology/radiography/*surgery ; Hip Dislocation/*surgery ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis ; Pain/physiopathology/*surgery ; Pain Measurement ; Range of Motion, Articular ; Retrospective Studies ; Young Adult

Necrosis of the upper extremity occurs rarely in type 2 diabetic patients compared to lower extremity necrosis. We report a 69-year-old woman with type 2 diabetes mellitus who presented with necrosis of the left 5th finger tip. The patient had primary biliary cirrhosis accompanied by necrosis of the fingertip due to severe Raynaud's phenomenon. Primary biliary cirrhosis (PBC) is a typical autoimmune disease, which can in rare cases be accompanied by autoimmune symptoms including sicca symptom and Raynaud's phenomenon. Furthermore, autoimmune diseases, such as systemic sclerosis, rheumatoid arthritis and undifferentiated connective tissue disease (UCTD) can be associated. Although every type of vascular etiology should be considered as a cause of digital necrosis, Raynaud's phenomenon is usually not considered in diabetes. We report this case of finger tip necrosis due to severe Raynaud's phenomenon accompanied by PBC and UCTD in a diabetic patient.
Aged ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Connective Tissue Diseases ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Female ; Fingers ; Humans ; Liver Cirrhosis, Biliary ; Lower Extremity ; Necrosis ; Raynaud Disease ; Scleroderma, Systemic ; Upper Extremity

Spinal epidural emphysema is rare, and only a few cases have ever been reported. A 18 year-old man was admitted for neck and chest pain for 3 days. Before admission he experienced rhinorrhea and severe cough. Physical examination revealed wheezing on whole lung field and subcutaneous emphysema over the upper portion of the chest and neck. Chest radiograph showed pneumomediastinum ajdn subcutaneous emphysema in the neck and chest CT images demonstrate a free air in the prevertebral fascia. With coservative management, the patient's condition and the pneumomediastinum improved. The patient was discharged to home on the fourteenth day.
Asthma* ; Chest Pain ; Cough ; Emphysema* ; Fascia ; Humans ; Lung ; Mediastinal Emphysema ; Neck ; Physical Examination ; Radiography, Thoracic ; Respiratory Sounds ; Subcutaneous Emphysema ; Thorax ; Tomography, X-Ray Computed