PURPOSE: The aim of the study was to clarify the anatomy of the male rat urethra, and to establish a more accurate and consistent method for analyzing external urethral sphincter (EUS) contractility based on this clarified anatomy by comparing different muscle strip orientations. MATERIALS AND METHODS: The whole urethra in male rats was investigated histologically using H/E and immunohistochemical staining. The contractility of the spiral (S) orientation of the entire proximal urethral (EUS) was then compared with the transverse (T) and the ring (R) orientations of the optimal portion, via electrical stimulation in an organ bath. RESULTS: In male rats, the urethral tract consisted of following parts: proximal urethra, transient urethra, urethral diverticula, and penile urethra. Throughout the proximal urethra, a layer of striated muscle fibers encircled the smooth muscle layers. The EUS contraction of the S, TM (Transverse, Middle of proximal urethra) and RM (Ring, Middle of proximal urethra) groups were 4.66+/-0.33mN, 2.92+/-0.33mN and 2.47+/-0.38mN, respectively. The strength of the EUS contraction of the S group was significantly higher than that of the TM. Group, but after adjusting the length, there was no statistically significant difference between the two groups. CONCLUSIONS: Unlike previous studies, showing striated muscle fibers limited to the lower half of the proximal urethra, we noted them throughout the whole proximal urethra. From our results, the spiral orientation of the entire urethra was found to be the optimal configuration for evaluating the contractility of the EUS using fast twitch muscle contractile testing.
Animals ; Baths ; Diverticulum ; Electric Stimulation ; Humans ; Male* ; Muscle, Smooth ; Muscle, Striated ; Rats* ; Urethra*

Tuberculosis of parotid gland is extremely rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or as primary involvement. Because of the clinical and radiological similarity, parotid tumor and parotid inflammatory disease take priority over the tuberculosis of parotid when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of tuberculosis of parotid gland in patient with a slowly growing parotid mass. However, its treatment is primarily medical if the positive diagnosis is well established. We have recently experienced a case of tuberculosis of parotid gland that was considered as the benign tumor preoperatively, but which was confirmed as tuberculosis of parotid gland after extracapsular dissection. We report it with a review of literature.

Tuberculosis of parotid gland is extremely rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or as primary involvement. Because of the clinical and radiological similarity, parotid tumor and parotid inflammatory disease take priority over the tuberculosis of parotid when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of tuberculosis of parotid gland in patient with a slowly growing parotid mass. However, its treatment is primarily medical if the positive diagnosis is well established. We have recently experienced a case of tuberculosis of parotid gland that was considered as the benign tumor preoperatively, but which was confirmed as tuberculosis of parotid gland after extracapsular dissection. We report it with a review of literature.

A 24-year-old man visited our hospital with painless scrotal mass 2 weeks in duration. Physical examination revealed about 3cm in diameter, ovoid, hard, movable and painless mass in the left side of the scrotum. He had no history of trauma, voiding difficulty or infection sign. CBC, blood chemistry and tumor marker were normal. Left orchiectomy was done. Tumor was a well encapsulated white-gray ovoid mass filled with yellowish gray material and histogically diagnosed as epidermoid cyst. Benign tumors of testis are rare, acounting for less than 1% of all testicular tumors. Herein we report a case of epidermoid cyst of testis and review the literatures.
Chemistry ; Epidermal Cyst* ; Humans ; Orchiectomy ; Physical Examination ; Scrotum ; Testicular Neoplasms ; Testis* ; Young Adult

Background and Objectives: The study reports on the clinical experience of repairing white-eyed orbital blow out fracture through a retrospective study of various incidences of white-eyed orbital blow out fracture that resulted in different treatment methods and outcomes.Subjects and Method A retrospective study was performed on 22 patients with white-eyed blowout fracture who underwent operation between March 2009 and June 2019 at our clinic. Patients were divided into 2 groups by age: 6 to 12 and 13 to 18. A review of medical records included demographic data, cause of injury, preoperative symptoms, trauma to operation time and surgical outcomes including improvement of postoperative ocular symptoms and complications. Results: The study population included 20 males and 2 female patients ranging from 6 to 18 years (mean, 14.2 years) of age. Fifteen of 21 patients with diplopia or limitation of eyeball movement showed a complete improvement of symptoms after surgery and 6 (28.5%) had remaining symptoms. One patient had no ocular symptom, but had oculocardiac reflex including nausea and vomiting. Two cases were re-operated due to adhesion of graft material. There was one sinus infection related to the implant. Conclusion This study shows that early reconstruction and release of incarcerated muscle within 5 days after trauma for white-eyed blowout fracture gives successful result that does not accompany major complications. All of the 22 patients who were operated for white-eyed blowout fractures had successful results.

PURPOSE: We aimed to define supine static and dynamic magnetic resonance imaging (MRI) appearance of changes in bladder neck and levator ani muscle and find out clinical significance of this method from comparing with valsalva leak point pressure (VLPP) in patients with stress urinary incontinence. MATERIALS AND METHODS: Sixty patients were studied with supine static MR imaging through volumetric axial and sagittal pelvic imaging in the first and second procedures and then were examined with dynamic MR imaging through resting/straining midline sagittal imaging in the third procedure. We evaluated the changes in bladder neck and levator ani muscle of stress urinary incontinence patients from these MR imaging. Patients were divided into two groups according to their responses to VLPP; the group 1 (n=20) with VLPP below 60cmH2O and the group 2 (n=40) with VLPP over 60cmH2O. We analyzed the data taken from comparing MR imaging results with VLPP results. RESULTS: Regarding the degree of changes in bladder neck compared with the results of supine static and dynamic MRI, there were beak shaped changes in the bladder neck in 15 patients from group 1 (75.0%) and especially, in the rest 5 patients excluding 3 patients who had severe cystocele, we could observe 88.2% of beak shaped changes. Beak shaped changes were seen in 5 patients (12.5%) and funnel shaped change or non-specific changes in the rest cases from group 2 (p<0.0001). We could observe the degenerative changes of levator ani muscle in 41 patients from overall (68.3%), which means 13 patients from group 1 (65.0%) and 28 patients from group 2 (70.0%), respectively. CONCLUSIONS: Supine static MRI enables to observe degenerative changes in pelvic floor muscle of stress urinary incontinence while dynamic MRI is deemed to be a relatively comfortable and non-invasive diagnostic method for stress urinary incontinence especially complementing VLLP.
Animals ; Beak ; Complement System Proteins ; Cystocele ; Diagnosis* ; Humans ; Magnetic Resonance Imaging* ; Neck ; Pelvic Floor ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics

Multiple primary malignant neoplasms (MPMN) are defined by the presence of multiple primary cancers of multicentric origin and/or different tissues. The incidence of MPMN is less than 1% in Korea and recently seems to be increased due to early detection of cancer and prolonged survival of cancer patients. Previous investigations suggest that non-Hodgkin's lymphoma (NHL) may be associated with chronic liver disease and hepatocellular carcinoma (HCC). The pathogenesis of this association is thought to be due to chronic antigenic stimulation, the presence of HBsAg, and immunosuppressive therapy. We report a case of synchronous NHL and HCC in a 54-year-old man which is thought to be associated with hepatitis B virus infection. Pathological examination and immunohistochemical study of neck lymph node and liver mass biopsies showed diffuse large cell lymphoma and HCC, respectively. He was treated initially with EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide and prednisolone) chemotherapy for NHL and transarterial chemoembolization with doxorubicin, mitomycin-c, lipiodol, and gelfoam for HCC.
Biopsy ; Carcinoma, Hepatocellular* ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Early Detection of Cancer ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Incidence ; Korea ; Liver ; Liver Diseases ; Lymph Nodes ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Mitomycin ; Neck ; Vincristine

BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
Brain Death ; Humans ; Korea* ; Medical Staff, Hospital ; Retrospective Studies ; Statistics as Topic* ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation

Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain. Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis. Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.

BACKGROUND: Ventilator-associated pneumonia (VAP) requires prompt and appropriate treatment. Since methicillin-resistant Staphylococcus aureus (MRSA) is a frequent pathogen in VAP, rapid identification of it, is pivotal. Our aim was to evaluate the utility of quantitative polymerase chain reaction (qPCR) as a useful method for etiologic diagnoses of MRSA pneumonia. METHODS: We performed qPCR for mecA, S. aureus-specific femA-SA, and S. epidermidis-specific femA-SE genes from bronchoalveolar lavage or bronchial washing samples obtained from clinically-suspected VAP. Molecular identification of MRSA was based on the presence of the mecA and femA-SA gene, with the absence of the femA-SE gene. To compensate for the experimental and clinical conditions, we spiked an internal control in the course of DNA extraction. We estimated number of colony-forming units per mL (CFU/mL) of MRSA samples through a standard curve of a serially-diluted reference MRSA strain. We compared the threshold cycle (Ct) value with the microbiologic results of MRSA. RESULTS: We obtained the mecA gene standard curve, which showed the detection limit of the mecA gene to be 100 fg, which corresponds to a copy number of 30. We chose cut-off Ct values of 27.94 (equivalent to 1x10(4) CFU/mL) and 21.78 (equivalent to 1x10(5) CFU/mL). The sensitivity and specificity of our assay were 88.9% and 88.9% respectively, when compared with quantitative cultures. CONCLUSION: Our results were valuable for diagnosing and identifying pathogens involved in VAP. We believe our modified qPCR is an appropriate tool for the rapid diagnosis of clinical pathogens regarding patients in the intensive care unit.
Adenosine ; Bronchoalveolar Lavage ; Coat Protein Complex I ; DNA ; Humans ; Critical Care ; Intensive Care Units ; Limit of Detection ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Ventilator-Associated ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Sprains and Strains ; Stem Cells