PURPOSE: The aim of the study was to evaluate the clinical outcome and complications of tension free vaginal tape (TVT) procedure for the surgical treatment of female stress urinary incontinence. MATERIALS AND METHODS: Between April 1999 and May 2000, 41 women with stress urinary incontinence underwent TVT procedure. Preoperative evaluation included questionnaires study, physical examination, one hour pad test and urodynamic study. Postoperative clinical outcome, patient's satisfaction and complications were checked after 3-months. RESULTS: The mean age of patients was 51.6 years (range 40-76) and mean hospital stay 2.1 days (range 1-10). The mean follow-up period was 9.9 months (range 3-15). Thirty six patients (87.8%) were cured, 2 patients (4.9%) were improved. Two of 3 patients with failed operation who developed postoperative urge incontinence had grade III cystocele. Five bladder perforations and 1 obturator nerve injury occurred. The abdominal leak point pressure (LPP) increased from 50.6cmH20 to 110.8cmH2O, detrusor pressure of maximal flow rate (Pdet.Qmax) increased from 15.8cmH2O to 28.6cmH2O and maximal flow rate (Qmax) decreased from 32.8ml/s to 22.5ml/s after operation. CONCLUSIONS: The TVT procedure is an effective and feasible surgical treatment for female stress urinary incontinence. However, in patients with grade III cystocele, postoperative urge incontinence may develop after the procedure. Since TVT procedure involves securing the mid-urethra, urinary obstruction may also occur, necessitating the need for continued follow-up as well as a careful comparison with other sling procedure.
Cystocele ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Obturator Nerve ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

Neuroendocrine tumor (NET) of the major duodenal papilla is a rare occurrence. However, that of the minor duodenal papilla is even rarer. To date, only a few cases have been reported. Herein, we present a rare case of NETs detected at the major and minor duodenal papilla synchronously, which were successfully treated with endoscopic papillectomy without procedure-related complication. To the best of our knowledge, this is the first report of this kind in the world. Photomicrograph of the biopsy specimen stained immunohistochemically for synaptophysin showed a positive reaction of tumor cells. All resection margins were negative. Further experience with more cases will be needed to establish the exact indication of endoscopic papillectomy for duodenal papillary NETs.
Ampulla of Vater ; Biopsy ; Neuroendocrine Tumors* ; Pancreatic Ducts* ; Synaptophysin

BACKGROUND: Thromboplastin extracted from human brain has been replaced by other animal sources due to the risk of infection. However, there is a variation in sensitivity according to the animal it was extracted from, making the monitoring of the prothrombin time (PT) in patients on anticoagulant therapy particularly difficult. Standardization of PT is made by comparing each thromboplastin with an international reference preparation, calculating the ISI (International sensitivity index), and expressing the PT in INR (International Normalized Ratio). Thromboplastins that are currently available commercially are from rabbit brain, human placenta, or bovine brain. This study was undertaken to find the best animal source by comparing the precision of thromboplastins derived from different animals, ISI, and the sensitivities to factor VII deficeint plasma. METHODS: The thromboplastin was extracted from the animal's brain with normal saline. The precision of the thromboplastin and the sensitivity to factor VII deficient plasma were measured. Fresh plasmas from 108 healthy individuals and 69 patients on oral anticoagulant therapy were obtained to measure the PT using the thromboplastin from human or animal brain. From the results, the ISI and CV (correlation of variation) were calculated. RESULTS: The average PT for normal individuals using thromboplastins from human (HBT), rabbit (RBT), bovine (OBT), swine (PBT), and canine (DBT) brain were 13.8, 18.3, 26.7, 26.2, and 37.3 seconds, respectively. Thromboplastin from chicken brain failed to induce coagulation. The prolongation of PT with factor VII deficient plasma for HBT, RBT, OBT, PBT, and DBT were 2.96, 2.96, 2.69, 2.47, and 3.08 respectively. The ISI for RBT, OBT, PBT, and DBT were 1.37, 1.39, 1.54, and 1.20 and the CV were 0.9, 0.9, 0.82, and 1.04, respectively. CONCLUSION: The precisions were high for all thromboplastins with the exception ofDBT. The thromboplastins were all sensitive to factor VII depleted plasma. The ISI were less than 1.6 and the CV were all less than 3%. The average PT of healthy individuals was shortest using RBT and the ISI was also low (1.4), indicating that rabbit brain is a suitable source of thromboplastin.
Animals ; Brain ; Chickens ; Factor VII ; Humans ; International Normalized Ratio ; Placenta ; Plasma ; Prothrombin Time ; Swine ; Thromboplastin*

OBJECTIVE: New antidepressant, nefazodone is classified as a serotonin -2 antagonist/reuptake inhibitor like old antidepressant, trazodone. Nefazodone, however, differs from trazodone in that it lacks anti-histaminergic properties and in that it has some norepinephrine reuptake inhibitory properties. These differences may account for the differences between the two drugs in the side effect profiles. This study was conducted to compare the acute effects of nefazodone on the psychomotor performance with those of trazodone. METHODS: The subjects were 12 healthy male volunteers aged between 20-40 years. A single, oral starting dose of nefazodone or trazodone was administered in a double-blind, randomized latin-square design with a 1-week interval between each drug switch. Psychomotor performances were assessed at 1 hour before and at 2 hours after administration of nefazodone 50 mg, nefazodone 100 mg or trazodone 50 mg. The measures of psychomotor performance included Vienna Determination Unit for complex choice reaction time, Critical Flicker Fusion Test, and Grooved Pegboard Test. RESULTS: In the Vienna Determination Unit, when 'within drug effect' (pre- vs. post-medication) was analyzed, nefazodone 100 mg decreased complex choice reaction time in both subtest 2 and subtest 3. Nefazodone 50 mg also decreased the reaction time in subtest 3 but not in subtest 2 which was more difficult and demanding task than subtest 3. On the other hand, no significant changes in the reaction time were observed with trazodone 50 mg in either subtest 2 or subtest 3. When 'between drug effect' was analyzed, however, the differences between drugs were not found to reach statistically significant level. No significant 'between drug effect' or 'within drug effect' was observed in Critical Flicker Fusion Test and Grooved Pegboard Test. CONCLUSION: Although the differences between nefazodone and trazodone did not reach statistically significant level, the results on the complex choice reaction time suggest that al least a single starting dose of nefazodone up to 100 mg does not impair psychomotor performances and it might have a less detrimental effect than trazodone on the psychomotor performance.
Administration, Oral* ; Flicker Fusion ; Hand ; Healthy Volunteers* ; Humans ; Male ; Norepinephrine ; Psychomotor Performance* ; Reaction Time ; Serotonin ; Trazodone* ; Volunteers

No abstract available.
Korea* ; Lung*

BACKGROUND: We evaluated a rapid screening kit for the detection of hepatitis surface antigen (HBsAg) and antibody (anti-HBs) using an immunochromatographic method. MATERIALS AND METHODS: We selected 499 serum specimens for the evaluation. Each specimen was tested by enzyme immunoassay (EIA; Cobas Core, Roche, Switzerland), reverse passive hemagglutination (RPHA; Serodia HBs, Asan, Korea) for HBsAg, passive hemagglutination (PHA; Serodia Anti-HBs, Asan, Korea) for anti-HBs, and with the Genedia HBsAg and Anti-HBs Rapid (Green Cross Corp., Korea) kits. Results of each assay were compared with those of the EIA. RESULTS: The sensitivities and specificities of the Genedia HBsAg Rapid kit were 98.0% and 100%, and those for the Genedia Anti-HBs Rapid kit were 95.3% and 98.0%, respectively. These were higher than those for RPHA (96.0% and 100%), and PHA (83.2% and 96.0%). Concordance rates between EIA and Genedia HBsAg Rapid, Genedia Anti-HBs Rapid, RPHA, and PHA were 98.8%, 96.4%, 97.6%, and 88.4%, respectively. Extending the incubation time from the recommended 30 minutes to 2 hours increased the sensitivities of the Genedia kits. CONCLUSION: The Genedia HBsAg and Anti-HBs Rapid kits are simple, sensitive, and inexpensive assays suitable for screening or use in emergency situations.
Antigens, Surface ; Chungcheongnam-do ; Emergencies ; Hemagglutination ; Hepatitis ; Hepatitis B Surface Antigens* ; Immunoenzyme Techniques ; Mass Screening*

Cervical pregnancy is a life threatening, rare type of ectopic pregnancy. Hysterectomy was considered as the only treatment for cervical pregnancy. In 1982, as a conservative treatment of ectopic pregnancy, local injection of methotrexate was tried by Tanaka et al. We reviewed a case of sucessful treatment of cervical pregnancy after 45 days from direct local injection of methotrexate into gestational sac under the guidance of vaginal ultrasonogram in department of obstetrics and gynecology, Korea university hospital.
Female ; Gestational Sac ; Gynecology ; Hysterectomy ; Korea ; Methotrexate* ; Obstetrics ; Pregnancy* ; Pregnancy, Ectopic ; Ultrasonography

BACKGROUND AND OBJECTIVES: We investigated in patients with coronary vasospastic angina whether the exercise ECG test results are influenced by the different modes of exercise load and compared the clinical characteristics including coronary risk factors between patients with positive and negative exercise tests. MATERIALS AND METHODS: This study comprised 34 patients with documented coronary artery spasm without significant stenosis (coronary artery luminal diameter narrowing <70%) and treadmill exercise test. Treadmill exercise ECG test was performed based on Bruce's protocol (graded exercise test, GET) and sudden rapid exercise protocol (non-graded exercise test, NGET) in the morning of the same day. RESULTS: 1) Of 29 patients who underwent both GET and NGET, 19 patients manifested positive result by NGET, whereas only 11 patients did by GET (66 vs. 38%, P=0.04). All patients with positive GET had positive NGET and 8 of 18 patients with negative GET had positive NGET. 2) Of 34 patients who underwent GET, there was no significant difference in frequency of hypertension, diabetes, current smoking, presence of effort chest pain by history, mixed disease (fixed stenosis >50%, <70% of luminal diameter) or total cholesterol level between patients with positive and negative results. In 18 typical variant angina patients by clinical history, 8 of 10 patients with high disease activity (5 times or more attack per week) manifested positive result by GET or NGET, whereas 4 of 8 patients with low disease activity (80 vs. 50%, P=NS). CONCLUSION: In patients with coronary vasospastic angina, sudden rapid exercise could induce more frequently coronary artery spasm than multistage exercise. The result of an exercise test may not be correlated with coronary risk factors, coronary anatomy, effort chest pain, and the disease activity.
Arteries ; Chest Pain ; Cholesterol ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Exercise Test* ; Humans ; Hypertension ; Phenobarbital ; Risk Factors ; Smoke ; Smoking ; Spasm

OBJECTIVE: The authors performed instrumented anterior cervical fusion with either iliac autograft or fibular allograft for various clinical entities. The purposes of the study are to compare the fusion rate and the time to fusion according to graft material, and to identify the factors affecting fusion. METHOD:57 patients underwent instrumented anterior cervical fusion during 3 years between Jan. 1995 and Dec. 1997, among them 31 patients with iliac autograft(autograft group), and 26 patients with freeze-dried fibular allograft (allograft group). The clinical entities were trauma(n=0), soft disc herniation(n=), spondylotic radiculopathy(n=1), spondylotic myelopathy(n=6), and ossified posterior longitudinal ligament(n=). The method of fusion was either interbody fusion confined to disc space or strut fusion after corpectomy. Outcomes were assessed for fusion status and time to fusion, and comparison between autograft group versus allograft group. RESULT: Between autograft and allograft group there were no differences in distribution of perioperative clinical variables such as patients' age and gender, clinical entity, method of fusion, and length of fusion as determined by the number of disc space fused. Mean follow-up period was 19 months(range 10-28 months) in autograft group and 16 months(range 8-22 months) in allograft group. The fusion rate was 90% in autograft group and 85% in allograft group(p=.691). The median time to fusion was 7 months in autograft group and 15 months in allograft group(p<0.001). The perioperative variables affecting fusion, defined as those being significantly associated with the time to fusion, were the graft material(p=.000) and the length of fusion(p=.007). The rate of graft-related complications including donor-site morbidity was 41% in autograft group and 8% in allograft group. CONCLUSION: It is concluded that the use of freeze-dried fibular allograft in instrumented anterior cervical fusion is, though the time to fusion is delayed more than two times, as an effective way as the use of iliac autograft to achieve fusion, and is a better way to ameliorate graft-related complications.
Allografts* ; Autografts* ; Follow-Up Studies ; Humans ; Transplants

BACKGROUND/AIMS: Ulcerative colitis is an inflammatory bowel disease with unknown etiology, which has waxed and waned course. It is diagnosed by colon study, pathology, and especially colonoscopy. It is difficult to differentiate between ulcerative colitis and other infectious colitis, especially amebic colitis, and to confirm of remnant lesion by endoscopic findings. METHODS: Magnifying colonoscopy has 100 time magnifying power compared to 30 time of conventional colonoscopy. By spraying 0.2% indigo carmine dye, we evaluated the magnifying and microscopic findings of 31 colonic mucosa of 23 patients with ulcerative colitis. RESULTS: Initial and magnifying chromoscopic findings in ulcerative colitis were loss of cryptal opening 72% (13/18), loss of submucosal vessel 89% (16/18), mucosal denudation (or microscopic erosion) 83% (15/18), and mucosal unevenness 94% (17/18). Recovery rate of magnifying chromoscopic findings after treatment in ulcerative colitis were in crytal opening 80% (8/10), submucosal vascularity 60% (6/10), mucosal denudation (microscopic erosion) 30% (3/10), and in mucosal unevenness 40% (4/10). CONCLUSIONS: It is suggested that magnifying chromoscopic findings in ulcerative colitis may be useful in initial diagnosis and confirmation of remnant lesion, but, not in prediction of clinical severity.
Colitis ; Colitis, Ulcerative* ; Colon ; Colonoscopy ; Diagnosis ; Dysentery, Amebic ; Humans ; Indigo Carmine ; Inflammatory Bowel Diseases ; Mucous Membrane ; Pathology ; Ulcer*