Purpose: We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). Methods: We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. Results: Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n=299, 19.1%) or salvage (n=58, 3.7%) therapy. Patients in the TUC group were older (mean±standard deviation, 70.6±7.3 years vs. 69.3±7.0 years; P=0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P<0.001), higher serum prostate-specific antigen (PSA) (5.4 ±4.8 ng/mL vs. 3.8 ±4.5 ng/mL, P <0.001), larger total prostate volume (TPV) (89.5 ±44.7 mL vs. 66.0 ±32.6 mL, P<0.001), and larger transitional zone volume (TZV) (57.3±34.9 mL vs. 37.7±24.2 mL, P<0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV<22.3 mL, the OR was 2.42 in 34.1 mL≤TZV<53.5 mL (95% confidence interval [CI], 1.58–3.72; P<0.001), 5.17 in ≥53.5 mL (95% CI, 3.44–7.77; P<0.001). Conclusions The risk of TUC during HoLEP surgery increases in patients with TZV >35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.

PURPOSE: The aim of this study was to evaluate the effect of metal primers on the bonding of dental alloys and veneer resin. Polyvinylpyrrolidone solution's tarnish effect on bonding strength was also investigated. MATERIALS AND METHODS: Disk-shape metal specimens (diameter 8 mm, thickness 1.5 mm) were made from 3 kinds of alloy (Co-Cr, Ti and Au-Ag-Pd alloy) and divided into 4 groups per each alloy. Half specimens (n=12 per group) in tarnished group were immersed into polyvinylpyrrolidone solution for 24 hours. In Co-Cr and Ti-alloy, Alloy Primer (MDP + VBATDT) and MAC-Bond II (MAC-10) were applied, while Alloy Primer and V-Primer (VBATDT) were applied to Au-Ag-Pd alloys. After surface treatment, veneering composite resin were applied and shear bond strength test were conducted. RESULTS: Alloy Primer showed higher shear bond strength than MAC-Bond II in Co-Cr alloys and Au-Ag-Pd alloy (P<.05). However, in Ti alloy, there was no significant difference between Alloy Primer and MAC-Bond II. Tarnished Co-Cr and Au-Ag-Pd alloy surfaces presented significantly decreased shear bond strength. CONCLUSION: Combined use of MDP and VBATDT were effective in bonding of the resin to Co-Cr and Au-Ag-Pd alloy. Tarnish using polyvinylpyrrolidone solution negatively affected on the bonding of veneer resin to Co-Cr and Au-Ag-Pd alloys.
Alloys ; Dental Alloys* ; Povidone

Centric occlusion-maximum intercuspation (CO-MI) discrepancy is one of main causes of evoking premature contact and resultant mandibular shift. These non-physiological conditions can induce temporomandibular disease, periodontitis, and non-carious cervical lesion. Therefore, if CO-MI discrepancy exists in patients who need extensive prosthetic rehabilitation, it must be corrected and then physiological occlusion must be restored. This report describes the treatment procedure of removing CO-MI discrepancy and prosthetic rehabilitation in a patient with 3.5 mm discrepancy, multiple caries and periodontitis. Proper mandibular position and modified opening & closing movement were confirmed by ARCUSdigma II and transcranial radiograph.
Centric Relation ; Humans ; Periodontitis ; Rehabilitation*

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.
Female ; Humans ; Korea ; Prospective Studies ; Psychometrics* ; Surveys and Questionnaires* ; Translations ; Urinary Bladder ; Urinary Incontinence* ; Urination

BACKGROUND: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure, we routinely performed off-pump total arterial coronary revascularization. MATERIAL AND METHOD: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. RESULT: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibbon A or B patency grading. CONCLUSION: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.
Cardiomegaly ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Gastroepiploic Artery ; Hemodynamics ; Hemorrhage ; Humans ; Myocardial Infarction ; Transplants ; Veins

PURPOSE: To assess the prevalence of urinary incontinence (UI) and incontinence-related quality of life in Korean women. MATERIALS AND METHODS: During April 2003, the prevalence of overall, stress, urge and mixed UI, frequency of incontinence symptom and quality of life influenced by UI in Korean women was assessed by telephone survey. RESULTS: Of the 1,303 women with a mean age of 48.1 (+/-12.9, S.D.) years, 537 (41.2%) reported UI, comprising 492 (37.8%) with stress UI, 234 (18.0%) with urge UI, 194 (14.9%) with mixed UI and unclassified 5 (0.4%). The prevalence of UI increased with age significantly (p< 0.05). The frequency of stress UI symptom was as follows: 'always' 3.0%, 'a few times a day' 3.7%, 'about once a day' 3.9%, '2-3 times a week' 7.5%, 'less than 1 in a week' 81.9%. Incontinence-related quality of life was significantly dependent on the type of incontinence: the proportion of women who feel unsatisfactory with their incontinence was significantly higher in urge UI and mixed UI than stress UI (p< 0.01). The need for medical consultation for UI was also variable according to the type of incontinence: 20.0% in urge UI, 19.1% with stress U and 25.8% in mixed UI. However, the proportion of women who do not willing to consult medical help was significantly higher in stress UI than other types of UI. CONCLUSION: The present study revealed that there was a high prevalence of UI in Korean women and the impact of UI on the quality of life was high. Therefore, tailored education to the women about the UI seems to be highly necessary.
Education ; Female ; Humans ; Prevalence* ; Quality of Life* ; Telephone ; Urinary Incontinence*

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.
Cause of Death ; Chungcheongnam-do ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Dialysis ; Hemorrhage ; Humans ; Kidney Failure, Chronic* ; Mediastinitis ; Medical Records ; Mortality ; Peritoneal Dialysis ; Peritonitis ; Pneumonia, Aspiration ; Postoperative Complications ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Sepsis ; Survival Rate

PURPOSE: A finding of only subtle open bladder neck unaccompanied by leakage at resting state, without any other symptoms suggesting overt intrinsic sphincter incompetence, is commonly observed during cystographic evaluation for women with stress urinary incontinence (SUI). We tried to define whether this finding has any clinical significance in aspect of intrinsic sphincter deficiency. MATERIALS AND METHODS: A retrospective study was undertaken in a series of women whose diagnoses were SUI in our hospital. The appearance of contrast medium in the proximal urethra at resting state without overt leakage on cystogram was named as inverted tear-drop (ITD) sign. Quantification of ITD sign was made by measuring vertical and anterior-posterior (AP) distances of this area. Various clinical and urodynamic parameters were compared between the patients who had inverted tear-drop sign (ITD group) and those not (non-ITD group). RESULTS: A total of 453 women underwent fluoroscopic cystography and ITD sign was observed in 273 (60.2%). Analyses were performed in a total of 290 women (ITD group 186, non-ITD group 104). There was a significant difference in mean age between non-ITD (47.0+/-9.4 years) and ITD group (51.7+/-9.5 years). Several clinical factors such as frequency, urgency, urge incontinence, duration of symptoms, parity, previous pelvic surgery, previous anti-incontinence surgery, urine leakage volume by one hour pad test were not significantly different between two groups. However, a ITD sign was significantly more likely to be in groups of patients with menopause and those with a low valsalva leak point pressure (VLPP). VLPP was significantly lower in ITD group (87.1+/-2.7cmH2O) than in non-ITD group (99.0+/-4.1cmH2O). VLPP in ITD group has a negative correlation with vertical (p=0.0001. r=-0.498) and AP length (p=0.0014, r=-0.23) of tear-drop area. Maximal urethral closure pressure was significantly lower in ITD group (48.2+/-1.4cmH2O) than in non-ITD group (56.2+/-2.0cmH2O). ITD group has more advanced types by Blaivas classification than non-ITD group. CONCLUSIONS: Our results suggest that cystographic ITD sign at rest might reflect some loss of intrinsic sphincter function. When surgeons are planning to operate SUI patients, ITD sign could be considered as an additional parameter in choosing operation method.
Classification ; Diagnosis ; Female ; Humans ; Menopause ; Neck ; Parity ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics

As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in measles in our countries. In these situation, it has been reported that measles associated pneumoinia is easily complicated with fatal respiratory failure, especially in immunocompromised patients. Herein we report the case of lethal measles pneumonia after allogenic hematopoietic stem cell transplantation in adults proven by autopsy. Recently, one case of measles was encountered in a 39-year-old female patients after allogenic bone marrow transplanted case (chronic myelogenous leukemia), who progressed into interstitial pneumonia pattern, despite treatment including antibiotics, immunoglobulin. The patient died of giant cell pneumonia compatible with that of measles which was comfirmed in the section of necropsy lung specimen.
Adult ; Anti-Bacterial Agents ; Autopsy ; Bone Marrow ; Bone Marrow Transplantation ; Child ; Female ; Giant Cells ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunocompromised Host ; Immunoglobulins ; Lung ; Lung Diseases, Interstitial ; Measles* ; Pneumonia* ; Respiratory Insufficiency ; Young Adult

BACKGROUND: The development of metastasis in cancer is one of the main problems after primary tumor resection. The identification of metastases is only possible in the follow-up investigation when there is already a solid tumor mass. Subclinical tumor cell dissemination can be detected by immunocytological staining of cells or by other molecular biological methods, like PCR. We investigated 22 peripheral blood isolates from gastric cancer patients with a cytokeratin (CK) 20 specific nested reverse transcriptase PCR (RT-PCR) for the detection of disseminated tumor cells at the time of diagnosis. METHODS: Fresh heparinized peripheral bloods (about 10 mL) were obtained from 22 gastric cancer patients and 10 healthy doctors as controls. Nucleated cells were isolated by a density gradient method. RNA was isolated and then subjected to RT-PCR with CK 20 specific primers. RESULTS: In gastric cancer, 3 of 22 (13.6%) peripheral blood isolates yielded a CK 20 mRNA positive result in a stage undependent manner. CONCLUSION: We detected disseminated tumor cells in the peripheral blood isolated using CK 20 specific nested RT-PCR method. Studies on a larger scale are needed for further investigation on the relationship between positive rates of CK 20 mRNA and survival rates of stomach cancer, according to cancer stages.
Diagnosis ; Follow-Up Studies ; Heparin ; Humans ; Keratin-20* ; Keratins* ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction* ; RNA ; RNA, Messenger ; RNA-Directed DNA Polymerase* ; Stomach Neoplasms* ; Survival Rate