BACKGROUND AND OBJECTIVES: The earliest atrial (A)/ventricular (V) activation potential, or accessory pathway (AP) potential are commonly used as ablation targets for atrioventricular (AV) APs. However, these targets are sometimes ambiguous. SUBJECTS AND METHODS: We reviewed 119 catheter ablation cases in 112 patients diagnosed with orthodromic atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Local A/V amplitude potentials with the earliest activation or AP potential were measured shortly before achieving antegrade AP conduction block, ventriculoatrial block during right ventricle (RV) pacing, or AVRT termination with no AP conduction. RESULTS: APs were located in the left lateral (55.5%), left posterior (17.6%), left posteroseptal (10.1%), midseptal (1.7%), right posteroseptal (7.6%), right posterior (1.7%), and right lateral (5.9%) regions. The mean earliest activation time was 16.7±15.5 ms, mean A/V potential was 1.1±0.9/1.0±0.9 mV, and mean A/V ratio was 1.7±2.0. There was no statistically significant difference between the activation methods (antegrade vs. RV pacing vs. orthodromic AVRT) or AP locations (left vs. right atrium). However, when the local A/V ratio was divided into 3 groups (≤0.6, 1.0±0.3, and ≥1.4), the antegrade approach resulted in an A/V ratio greater than 1.0±0.3 (86.7%, p=0.007), and the orthodromic AVRT state resulted in a ratio of less than 1.0±0.3 (87.5%, p<0.001). CONCLUSION: The mean local A/V potential and ratio did not differ by activation method or AP location. However, a different A/V ratio based on activation method (≥1.0±0.3, antegrade approach; and ≤1.0±0.3, orthodromic AVRT state) could be a good adjuvant marker for targeting AV APs.
Catheter Ablation* ; Catheters* ; Electrophysiologic Techniques, Cardiac ; Heart Ventricles ; Humans ; Methods ; Tachycardia ; Tachycardia, Supraventricular

BACKGROUND: Organochloride pesticides are prohibited around the world due to their toxicity and environmental persistence. However, lindane, one organochloride pesticide, is still widely used to treat head lice and scabies in Korea. OBJECTIVE: For evaluation of the effect of lindane usage and blood lindane concentration, we conduct an evaluation of blood lindane concentrations among children who were treated for head lice. METHODS: The total study population of 80 was divided into rural and urban areas. Age, sex, parent's farming, sea food consumption and head lice treatment information were gathered using a structured questionnaire. Blood lindane concentrations were analyzed by a solid phase extraction(SPE) method. Quantitative analysis was done by GC/ECD. Non-parametric analysis was done for comparing blood lindane concentrations between the head lice treated group and the non treatment group. After a log transformation, regression analysis was done for controlling confounding variables. RESULTS: The median age of the study population was 11. The study population involved 38 (47.5%) male and 42 (52.5%) female children. Twenty (25.6%) children were infested by head lice. The blood concentration of lindane was higher in the head licetreatment group [N.D (N.D-78.9)] than in the non-treated group [N.D (N.D-43.4), P < 0.01]. The results were the same after regression analysis controlling for confounding variables. CONCLUSION: Lindane has toxicity to the endocrine system and nervous system and persists in the environment and in the human body. Therefore, careful usage of lindane shampoo is needed to treat head lice.
Child ; Confounding Factors (Epidemiology) ; Endocrine System ; Female ; Head ; Human Body ; Humans ; Lindane ; Male ; Nervous System ; Pediculus ; Pesticides ; Scabies ; Seafood ; Surveys and Questionnaires

BACKGROUND: Organochloride pesticides are prohibited around the world due to their toxicity and environmental persistence. However, lindane, one organochloride pesticide, is still widely used to treat head lice and scabies in Korea. OBJECTIVE: For evaluation of the effect of lindane usage and blood lindane concentration, we conduct an evaluation of blood lindane concentrations among children who were treated for head lice. METHODS: The total study population of 80 was divided into rural and urban areas. Age, sex, parent's farming, sea food consumption and head lice treatment information were gathered using a structured questionnaire. Blood lindane concentrations were analyzed by a solid phase extraction(SPE) method. Quantitative analysis was done by GC/ECD. Non-parametric analysis was done for comparing blood lindane concentrations between the head lice treated group and the non treatment group. After a log transformation, regression analysis was done for controlling confounding variables. RESULTS: The median age of the study population was 11. The study population involved 38 (47.5%) male and 42 (52.5%) female children. Twenty (25.6%) children were infested by head lice. The blood concentration of lindane was higher in the head licetreatment group [N.D (N.D-78.9)] than in the non-treated group [N.D (N.D-43.4), P < 0.01]. The results were the same after regression analysis controlling for confounding variables. CONCLUSION: Lindane has toxicity to the endocrine system and nervous system and persists in the environment and in the human body. Therefore, careful usage of lindane shampoo is needed to treat head lice.
Child ; Confounding Factors (Epidemiology) ; Endocrine System ; Female ; Head ; Human Body ; Humans ; Lindane ; Male ; Nervous System ; Pediculus ; Pesticides ; Scabies ; Seafood ; Surveys and Questionnaires

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.
Abdominal Pain ; Adult ; Amenorrhea ; Cervix Uteri ; Choriocarcinoma* ; Chorionic Villi ; Diagnosis ; Drug Therapy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans ; Methotrexate ; Neoplasm Metastasis ; Ovary ; Pregnancy ; Pregnancy Tests ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Rupture ; Salpingectomy ; Teratoma ; Uterine Hemorrhage ; Vagina

PURPOSE: Recently, in assisted reproductive technologies(ART) programs theme Is an increasing Interest in the use of agents for the enhancement of sperm motility for assisted fertilization. In an attempt to improve the motility at the cryopreserved human semen and hence the fertilizing capacity of asthenospermic semen samples, different semen preparation techniques have been attempted and the effects of chemical stimulants as nitric oxide(NO) have been studied extensively. Superoxide anions cause lipid peroxidative damage to cell membrane phospholipids, and sperm are known to be particularly susceptible to lipid peroxidation. Such sperm with damaged membranes are impaired functionally. Recently, peroxynitrite, an anion and a potent oxidant, generated by the interaction of nitric oxide and superoxide anions has been demonstrated In macrophages and other cellular systems. Also this anion cause lipid peroxidative damage to cell membrane phospholiplds. We therefore Investigated whether NO and peroxynitrite have the roles to modulate sperm motility and to affect Its viability. MATERIALS AND METHODS: Normal human semen samples(as per World health Organization (WHO) criteria) were obtained after 3day period of abstinence by donors. The samples(n=5) were incubated with either sodium nitroprusside(SNP; 0.1, 05, 1 or 2mM) or peroxynitrite (10, 50 or 100 micrometer ) and the percent viability and motility were assessed at various time inteval up to 4hr. The human semen samples were treated with N-acetyl-L-cystein(NAC;10mM), SNP (0.5mM), phorbol myristate acetate(PMA; 100nM), of SNF plus PMA. Both superoxide and peroxynitrite release were measured directly by chemiluminometer. Percent viability and motility were assessed at 4hr of Incubation. A sample of each aliquot was placed in a Mauler chamber for videomicrography Percent motility were analyzed by using the sperm analysis imaging system. The sperm vlability was assessed by flow cytometer using LIVE/DEAD sperm viability kIt. The production of superoxide and peroxynitrite were measured by the method of chemiluminescence assay. Result : All results represent a mean +/-SEM, n=5. Treatment of human semen samples for 4hr with SNP, a NO generating agent, significantly decreased sperm motility and viability in high concentration [relative motility(% of control); 38 +/-4 and 30 +/-5, relative viability; 42 +/-4 and 30 +/-3 by 1 and 2mM of SNP]. In the presence of low concentration SNP(0.5mM), the sperm viability was not significantly affected(82 +/-3), whereas the sperm motility was affected(64 2). SNP(0.5mM) also decreased sperm motility(80 +/-2 at 2hr 64 +/-3 at 4hr, 44 +/-3 at 6hr, and 38 +/-4 at 8hr) in a time dependent manner. Since it was demonstrated that superoxide anions are one of the common source of lipid peroxidation, we investigated whether superoxide anions produced by human semens could Interact wlth NO to generate peroxynitrite. Adding N-acetyl-L-cystein(NAC) to the human semen samples partially blocked spontaneous release of superoxide, whereas PMA augmented the release of superoxide from human semen samples (control:0.9 106 0.3, NAC: 0.5 106 +/-0.4, and PMA: 2.5 106 +/-0.4photons/60min). The production of superoxide was corresponded with the production of peroxynltrite(control: 1.0 104CPM, SNP: 3.8 106CPM, SNP plus PMA. 12chi106CPM). In addition, SNP in combination with PMA(65 +/-3) markedly decreased sperm motility than that of SNP alone(77 +/-2.5) at 4hr, implying that nitric oxide might inhibit sperm motility via the formation of peroxynitrite In human semen samples. Exogenous peroxynitrite also decreased sperm motility in a dose dependent manner(10 micrometer : 64 +/-2, 50rM: 53 +/-3, and 1 0 micrometer of peroxynitrite: 23 4). CONCLUSIONS: These results suggest that NO inhibits sperm motility via the formation of peroxynltrite and further demonstrate that NO-induced inhibition of sperm motility is depended on the production of superoxide from human semens because peroxynitrite is generated by the interaction of NO and superoxide.
Cell Membrane ; Fertilization ; Humans ; Lipid Peroxidation ; Luminescence ; Macrophages ; Membranes ; Microscopy, Video ; Myristic Acid ; Nitric Oxide* ; Peroxynitrous Acid* ; Phospholipids ; Semen ; Sodium ; Sperm Motility* ; Spermatozoa* ; Superoxides ; Tissue Donors ; World Health Organization

PURPOSE: To evaluate the eligibility of laparoscopic surgery for the treatment of renal cysts, we analysed our clinical results of laparoscopic renal cyst marsupialization in 9 patients. MATERIALS AND METHODS: Between January 1994 and February 1997, a total of 9 patients with renal cyst underwent laparoscopic surgery. They were 2 men and 7 women 42 to 67 years old. Mean cyst size of the patient was 7.3cm(5-10cm). Presenting symptoms were flank pain in 8 and palpable mass in 1. One patient had previously undergone ultrasonography guided percutaueous aspiration and ablation. One patient had bilateral renal cyst. Initially the procedures had been performed via the transperitoneal approach in 4 patients after that we attempted retroperitoneal access for laparoscopy in 5 patients(6 renal units). During the operation cyst fluid was obtained for cytologic examination and cyst walls were excised and sent for pathological examination. RESULTS: Mean operation time was 2 hours and 14 minutes. Mean hospital stay was 5.9 days. Perioperative complications were pain(20%), bleeding(10%), subcutaneous emphysema(20%) and pneumothorax(10%). Bleeding was minimal but 2 units of packed red cell were needed in 1 patient. Conversion to open surgery from laparoscopic procedure was needed in 1 patient. Biopsy results were negative for carcinoma. All patients were asymptomatic at a mean follow up of 12.5 months. CONCLUSIONS: Laparoscopic renal cyst marsupialization for symptomatic renal cysts seems to be a safe and effective alternative to open surgery.
Aged ; Biopsy ; Conversion to Open Surgery ; Cyst Fluid ; Female ; Flank Pain ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Male ; Ultrasonography

PURPOSE: Split renal function on diuretic renography has been considered to be a good tool for evaluating renal function, selecting treatment modalities and assessing efficacy of surgery in hydronephrosis, especially in ureteropelvic junction(UPJ) obstruction. However, contradictory supranormal function on renography has provided controversy with urologists. Is the phenomenon the result of fact or artifact? The authers thought that contradictory supranormal renal function measured with 99mTc-DTPA Is fundamentally related with a question. How accurately does the split renal function test represent the real renal function, namely, glomerular filtration rate(GFR)? To know relation of split renal function with real renal function(GFR) and to disclose clinical significance of contradictory supranormal renal function on diuretic renal scan, a prospective study was performed. MATERIALS AND METHODS: Diuretic renography was done in 14patients with upper urinary tract obstruction including UPJ obstruction, ureteral stone and lower urethral obstruction. Afer the first diuretic renography using 99mTc-DTPA percutaneous nephrostomy was performed on affected kidney, which was followed by the second diuretic renography. Endogenous creatinine clearance tests were done on the patients. Urine was collected through the nephrostomy tube, self voiding or indwelling Foley catheter, respectively So the endogenous creatinine clearance was determined respectively on both the renal unit. Also the endogenous creatinine clearance ratio of affected kidney was determined to compare with split renal function on renography. RESULTS: In 7patients, ratio of endogenous creatinine clearance on affected kidney was less than 40%. In the other 7patients, the ratio was more than 48%. In patients with less than 40% of endogenous creatinine clearance ratio on affected kidney, split renal function was overestimated by 10.3% to 27.5%(19.5+/-4.9%) comparing to endogenous creatinine clearance ratio. In the other 7patients split renal function had a little difference from endogenous creatinine clearance ratio (4.5+/-2.5%). The endogenous creatinine clearance ratio was not closely related with split renal function(correlation coefficients: 0.65). Split renal function of the first renography was closely related with that of the second renography(correlation coefficients: 0.88). Contradictory supranormal function occurred in 4cases. In 2cases it was real finding, in the other it was not. CONCLUSIONS: It appears that split renal function is overestimated in poor renal function and split renal function is closely related with real renal function in good renal function slate. Supranormal renal function is real finding in part, not in part. Clinical significance of split renal function should be cautiously and basically reevaluated through further study.
Artifacts ; Catheters ; Creatinine* ; Filtration ; Humans ; Hydronephrosis ; Kidney ; Nephrostomy, Percutaneous ; Pentetic Acid* ; Prospective Studies ; Radioisotope Renography ; Ureteral Obstruction ; Urethral Obstruction ; Urinary Tract*

We experienced a case of MRKH syndrome in a 24-year-old female which was combined with sacral agenesis, neurogenic bladder, and duplicated ureter associated with vesicoureteral reflux in the right side.
Female ; Humans ; Ureter ; Urinary Bladder, Neurogenic* ; Vesico-Ureteral Reflux ; Young Adult

A 41-year-old man with a 12-year history of urinary incontinence and frequency was presented our hospital. He had a spinal cord injury after fell down from a utility pole. Spastic neurogennic bladder and detrusor external sphincter dyssynergia was diagnosed and augmentation cystoplasty was performed. And we performed additional external sphincterotomy to avoid intrmittent self catheterization. He can retain as much as 800m1 of urine without urinary incontinence and voids with abdominal pressure and retains little residual urine. We report the good result of additional external urethral sphincterotomy after augmentation cystoplasty.
Adult ; Ataxia ; Catheterization ; Catheters ; Humans ; Muscle Spasticity* ; Spinal Cord Injuries ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence

PURPOSE: To determine optimal scan time for the early phase of two-phase spiral CT and to evaluate its usefulness in the detection and assessment of extension of urinary bladder lesions. MATERIALS AND METHODS: In four normal adults, we performed dynamic scanning and obtained time-density curves for internal and external iliac arteries and veins, and the wall of the urinary bladder. Sixty patients with 68 lesions of the urinary bladder or prostate underwent precontrast and two-phase spiral CT scanning. After injection of 100ml of noninonic contrast material, images for the early and delayed phases were obtained at 60 seconds and 5 minutes, respectively. We measured CT H.U. of the wall, the lesion, and lumen of urinary bladder as seen on axial scanning, in each image in which the lesion was best shown. For the detection of bladder lesions and assessment of their extension, precontrast, early-, and delayed phase images were compared. RESULTS: Dynamic study of normal adults showed maximum enhancement of bladder wall between 60 and 100 seconds. The difference of CT H.U. between bladder wall and the lesion was greatest in the early phase. The best detection rate (98.5%) was seen during this phase, and for the detection of bladder lesion, this same phase was superior or equal (66/68,97.1%) to the delayed phase. The precontrast image was also superior or equal (31/68,45.6%) to that of the delayed phase. For the assessment of extension of bladder lesion, the early phase was superior (36/68,52.9%) to the delayed phase, and precontrast image was superior (1/68, 1.5%) to that of the delayed phase. For determining the stage of bladder cancer, the early phase was most accurate if the stages was below B2 or D, while for stage C, the delayed phase was most accurate. CONCLUSION: In two-phase spiral CT scanning, we consider the optimal time for the early phase to be between 60 and 100 seconds after injection of contrast material. For the detection and assessment of extension of urinary bladder lesion, the early phase was superior to the late phase, and for evaluation of the ureter, the delayed phase was useful. The precontrast image was inferior to that of the delayed phase. We suggest that for the detection and assessment of extension of urinary bladder lesion without scanning of the precontrast image, two-phase spiral CT is reliable.
Adult ; Humans ; Iliac Artery ; Prostate ; Tomography, Spiral Computed* ; Ureter ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Veins