PURPOSE: Feminizing genitoplasty is the surgical management after female gender assignment for intersex patients. The surgical outcome and complications of 20 cases of feminizing genitoplasty were analyzed. MATERIALS AND METHODS: Between January 1988 and December 2003, 20 patients surgically treated by feminizing genitoplasty, were retrospectively reviewed. The mean ages at the time of diagnosis and surgical treatment were 6.25 and 7.35 years, respectively. The preoperative evaluations included history taking, physical examination, and chromosomal, hormonal, and radiological studies. All patients underwent feminizing genitoplasty, including at least one of clitoral reconstruction, vaginoplasty or labial reconstruction. The 20 patients were analyzed according to their karyotype, phenotype, gender of rearing, ages at diagnosis and operation, surgical procedures, complications and follow up. RESULTS: Of the 20 cases, there were 10 female pseudohermaphroditism, 6 male pseudo- hermaphroditism, 3 gonadal dysgenesis, and 1 Mayer- Rokitanski-Kuster syndrome. Within these cases, 14, 10 and 9 clitoral reconstructions, vaginoplasties and labial reconstructions were performed. The streak gonad was removed in all patients with gonadal dysgenesis. Postoperative cosmetic and functional effects were successful, with few complications. CONCLUSIONS: Considering our surgical outcomes, feminizing genitoplasty for intersex patients, who are determined to a female gender assignment, is a good surgical procedure.
46, XX Disorders of Sex Development ; Diagnosis ; Disorders of Sex Development ; Female ; Follow-Up Studies ; Gonadal Dysgenesis ; Gonads ; Humans ; Karyotype ; Male ; Phenotype ; Physical Examination ; Retrospective Studies ; Surgery, Plastic

No abstract available.
Emergencies ; Humans

The optimal approach for a staghorn, large upper calyceal or complex renal stone burden is through the upper pole posterior calyx, which at times is best accomplished by a supracostal puncture. A supracostal posterior calyx puncture is usually of concern due to the potential complications of pneumothorax, hydrothorax and lung injury. A case of right upper calyceal calculi is reported in a 25-year-old male, who was managed by a supracostal transhepatic percutaneous nephrolithotomy.
Adult ; Calculi ; Humans ; Hydrothorax ; Kidney Calculi ; Lung Injury ; Male ; Nephrostomy, Percutaneous* ; Pneumothorax ; Punctures

PURPOSE: We compared recipients' ureteral complications after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). MATERIALS AND METHODS: Between January 1999 and September 2006, a total of 166 transplantaions were underwent via a HALDN or ODN. Kidney transplantation was performed in a standard fashion and ureteroneocystostomy was done by extravesical Lich-Gregoir method. We retrospecitvely compared 2 groups with regard to ureteral complications and functional recovery of transplanted kidney. RESULTS: Twenty-six right kidneys (26/88) were transplanted in HALDN and 20 right kidneys (20/78) were done in ODN. 18 multiple arteries were found in HALDN and 13 in ODN. The mean ischemic time of HALDN and ODN was 270 and 290 seconds. If short length of ureter or anastomosis site swelling was found, ureteral catheter was inserted to ureter of recipient (HALDN: 12, ODN: 3). Four ureteral complications were happened in HALDN group; five in ODN group. In HALDN, two ureteral leakages, one ureteral stricture and one ureteral leakage with anastomosis site narrowing were developed. In ODN, one vesicoureteral reflux, three ureteral leakages and one ureteral stricture were developed. Laterality and multiple renal arteries were not related with ureteral complications. Only ureteral stent insertion reduced ureteral complications (p<0.05). Acute rejection in 1 year were 6 patients in HALDN and 4 patients in ODN. In HALDN, 1-year patient and graft survival was 98.9% (87/88) and 95.5% (84/88); In ODN 100% (78/78) and 98.7% (77/78). CONCLUSIONS: In comparison with ODN, HALDN combined with the extravesical ureteral implantation technique provides similar graft outcomes with low ureteral complication rate. These results suggest that HALDN is safe and effective comparable recipient surgical outcomes.
Arteries ; Constriction, Pathologic ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Nephrectomy ; Rejection (Psychology) ; Renal Artery ; Stents ; Tissue Donors ; Transplants ; Ureter ; Urinary Catheters ; Vesico-Ureteral Reflux

BACKGROUND: The current various case-finding instruments for detecting depression in Korea are too cucumbersome and time-consuming for routine use in primary care or student and soldier groups because of too many questions. We carried out this study in order to investigate the validity of the two-question case-finding instrument for detecting depression easily in the primary care or the mentioned groups. METHODS: We selected one boy high school in Seoul and 155 sophomer students answered the questionnaire by self-report. The questionnaire included two questions about depressed mood and anhedonia: (1) "During the past month, have you often been bothered by feeling down, depressed or hopeless?" (2) "During the past month, have you often been bothered by little interest or pleasure in doing things(e.g., studying, playing or talking with friends) ?". And then a resident of family medicine interviewed them and made a diagnosis for depression using the diagnostic criteria of DSM-IV. Simultaneously we compared the test characteristics of a two-question case-finding instrument with those of a previously validated Beck Depression Inventory as a currently world-wide used screening instrument for depression. RESULTS: The prevalence of major depression as determined by the interview was 6.6%(10 of 151). The two-question case finding instrument had a Cronbach's alpha of 0.663-internal consistency, a sensitivity of 100%, a specificity of 54.6%, a positive likelihood ratio of 2.20 and a negative predictive value of 1.00.(A "yes" answer to either of the two questions was considered a positive test.) And the BDI had a sensitivity of 90%, a specificity of 68.1%, a positive likelihood ratio of 3.63 and a negative predictive value of 0.99(cut-off point=15). Area under the ROC curves of the two-question case-finding instrument was 0.882, greater than that of the BDI, 0.834. CONCLUSIONS: The test characteristics of a two-question case-finding instrument were higher compared to those of BDI for major depression. Therefore, the two-question case-finding instrument is a useful measure for detecting depression and less time-consuming in primary care and certain groups.
Adolescent ; Anhedonia ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Male ; Mass Screening* ; Military Personnel ; Pleasure ; Prevalence ; Primary Health Care ; ROC Curve ; Sensitivity and Specificity ; Seoul ; Surveys and Questionnaires

Purpose: The aims of this study were (1) to investigate the relationship between the characteristics of allogenic bone block and the compressive strength of an allogenic bone block measured by biomechanical experiments, and (2) to compare the maximum pressure load of allogenic bone block with the gap pressure measured at the high tibial opening osteotomy. Materials and Methods: Ten patients who provided informed consent for gap pressure measurements during opening wedge high tibial osteotomy (OWHTO) were included. The gap pressures were measured at 1 mm intervals while opening the osteotomy site from 8 mm to 14 mm. Seventeen U-shaped allogenous wedge bone blocks were made from the femur, tibia, and humerus. The height, width, cross-sectional area, and cortex thickness of the bone blocks were measured, along with the maximum compressive load just before breakage. The relationship between these characteristics and the maximum pressure load of the bone blocks was evaluated. The gap pressures measured in OWHTO were compared with the maximum pressure loads of the allogenous wedge bone blocks to evaluate the possibility of inserting allogenous wedge bone blocks into the osteotomy site without a distractor in OWHTO. Results: The OWHTO gap pressure increased with increasing osteotomy site opening. The mean gap pressure, which occurred at a 14-mm opening, was 282±93 N; the maximum pressure was 427 N. The maximum pressure load of the allografts was 13,379±6,469 N (minimum, 5,868; maximum, 29,130 N) and was correlated significantly with the cortical bone thickness (correlation coefficient=0.693, p=0.002) and cross-sectional area (correlation coefficient=0.826, p<0.001). Depending on the sterilization method, the maximum pressure loads for the bone blocks were 13,406±5,928 N for freeze-dried and 13,348±7,449 N for fresh frozen. The maximum compressive load of the allogenous wedge bone blocks was 13.7-times greater than that in OWHTO opened to 14 mm (5,868 N vs. 427 N). Conclusion The compressive strength of allogenous wedge bone blocks was sufficiently greater than the gap pressure in OWHTO. Therefore, allogenous wedge bone blocks can be inserted safely into the osteotomy site without a distractor.

Background/Aims: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. Methods: Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. Results: Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343–37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. Conclusions Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.

Background/Aims: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. Methods: Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. Results: Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343–37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. Conclusions Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.

BACKGROUND: A cream made from mucus secreted by snails contains 80% mucin, as well as glycosaminoglycan, allantoin for skin rejuvenation, glycolic acid for keratin removal, and collagen and elastin, which are components of dermis. OBJECTIVE: The goal of the present study was to evaluate the efficacy of using cream containing mucus secreted by snails to reduce wrinkles, improve skin elasticity, restore dermal density, and lift the skin. METHODS: Cream containing mucus secreted by snails was applied to the lateral epicanthal areas and the left cheek of 10 subjects for 4 weeks twice per day. Wrinkles, skin elasticity, dermal density, and skin tightening were evaluated at baseline and 2 and 4 weeks. A patient survey was conducted at 4 weeks. RESULTS: There were statistically significant differences between baseline and 4 weeks after applying the cream in terms of wrinkles, skin elasticity, dermal density, and skin tightening (p<0.05). CONCLUSION: Use of cream containing mucus secreted by snails seems to be effective for anti-aging of the skin. Long term follow up studies, such as 3 or 6 months, to confirm the efficacy of the cream should be conducted involving a larger number of patients.
Allantoin ; Cheek ; Collagen ; Dermis ; Elasticity ; Elastin ; Humans ; Mucins ; Mucus* ; Rejuvenation ; Skin* ; Snails*

BACKGROUND: Over the last decade, the incidence of ultraviolet B (UVB)-related skin problems has increased. Oxidative stress caused by UVB induces the secretion of melanocyte growth and activating factors from keratinocytes, which results in the formation of cutaneous hyperpigmentation. Therefore, increasing the antioxidant abilities of skin cells is thought to be a beneficial strategy for the development of sunscreen agents. Superoxide dismutase 1 (SOD1) is an antioxidant enzyme that is known to exhibit antioxidant properties. OBJECTIVE: The purpose of this study was to investigate the effect of SOD1 on alpha-melanocyte stimulating hormone (alpha-MSH) and UVB-induced melanogenesis in B16F10 melanoma cells and HRM-2 melanin-possessing hairless mice. METHODS: The inhibitory effect of SOD1 on tyrosinase activity was evaluated in a cell-free system. Additional experiments were performed using B16F10 melanoma cells to demonstrate the effects of SOD1 in vitro, and HRM-2 melanin-possessing hairless mice were used to evaluate the antimelanogenic effects of SOD1 in vivo. RESULTS: We found that SOD1 inhibited melanin production in a dose-dependent manner without causing cytotoxicity in B16F10 melanoma cells. SOD1 did not inhibit tyrosinase activity under cell-free conditions. The results indicate that SOD1 may reduce pigmentation by an indirect, nonenzymatic mechanism. We also found that SOD1 decreased UVB-induced melanogenesis in HRM-2 melanin-possessing hairless mice, as visualized through hematoxylin and eosin staining and Fontana-Masson staining. CONCLUSION: Our results indicate that SOD1 has an inhibitory effect on alpha-MSH and UVB-induced melanogenesis, indicating that SOD1 may be a promising sunscreen agent.
alpha-MSH ; Animals ; Cell-Free System ; Eosine Yellowish-(YS) ; Hematoxylin ; Hyperpigmentation ; Incidence ; Keratinocytes ; Melanins ; Melanocytes ; Melanoma ; Mice ; Mice, Hairless ; Monophenol Monooxygenase ; Oxidative Stress ; Pigmentation ; Skin Pigmentation ; Skin* ; Superoxide Dismutase*