Outcomes of the Sauve-Kapandji Procedure in Patients with Advanced Rheumatoid Arthritis

PURPOSE: We evaluated the clinical and radiographic outcomes of the Sauve-Kapandji procedure for the treatment of advanced rheumatoid arthritis. METHODS: Twenty-severn wrists in twenty-two patients were treated for advanced rheumatoid arthritis with Sauve-Kapandji procedure. Patients were evaluated in terms of wrist pain, bony union, instability of the ulnar proximal stump, ulnar stump pain, range of motion and other complications. Pain was evaluated using a visual analog scale. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS: The average visual analogue scale score improved from 4+/-1.85 preoperatively to 0.78+/-0.91 at the last follow-up (p=0.003). Bone unions in distal radioulnar joint were obtained in all 22 patients, 27 wrists at mean 10.74 weeks (range, 6-28 weeks) after operation. The supination/pronation range of motion was changed from 55/50 degrees preoperatively to 79/73 degrees at postoperative 6 months follow up (p=0.32). The mean carpal translation index did not change after the operation. CONCLUSION: The Sauve-Kapandji procedure is a reliable methods of relieving pain, preserving range of motion (supination/pronation) and preventing ulnar translation of the carpus in managements of the severely destroyed distal radioulnar joints in rhematoid arthritis.

Role of p16 in the pathogenesis of Langerhans cell histiocytosis

BACKGROUND: It has been hypothesized that genetic alteration at the cellular level may have a significant effect on cellular mechanisms controlling the proliferation and apoptosis of Langerhans cells (LCs). METHODS: We examined whether p16 protein expression can be used to predict the outcome of Langerhans cell histiocytosis (LCH). Archival paraffin blocks from children diagnosed with LCH and followed at the Asan Medical Center and Chungnam National University Hospital between March 1998 and February 2008 were studied. RESULTS: Slides were stained with p16 antibody and evaluated semi-quantitatively using the following scale: negative, no staining; +/-, weakly positive; 1+, staining similar to lymphocytes surrounding the LCs; 2+, stronger staining than lymphocytes; 3+, much stronger staining than lymphocytes. Negative and +/- groups were assigned to a lower expression group (LEG) and the 1+, 2+, and 3+ groups were assigned to a higher expression group (HEG). The median age of the 51 patients (24 girls, 27 boys) was 49 (range, 0.6-178) months, and LCH was diagnosed based on CD1a positivity. p16 protein was expressed to varying degrees in all but one specimen. There was a greater tendency toward multisystem disease, risk organ involvement, and relapse in the HEG than in the LEG. CONCLUSION: The p16 protein may have a significant effect on cellular mechanisms controlling the proliferation and apoptosis of LCs, and thus may influence the clinical outcome and prognosis of LCH.

The Effect of Eradication of Methicillin-resistant Staphylococcus aureus from Neonatal Intensive Care unit by Aggressive Infection Control Measures : Isolation Program and the Use of Chlorhexidine / 대한주산의학회잡지

PURPOSE: The increasing incidence and mortality of Methicillin-resistant Staphylococcus aureus (MRSA) colonization or blood-stream infection is an important problem in neonatal intensive care unit (NICU). The aims of this study are to evaluate the effective eradication of MRSA through the aggressive isolation program with or without the use of 2% chlorhexidine-gluconate (CHG) and to investigate significant risk factors of MRSA colonization in NICU. METHODS: This study is a retrospective collected data among 414 neonates admitted to a NICU from June 1, 2007, through October 31, 2009. We divided the groups into 3 periods according to isolation program or the use of 2% CHG. RESULTS: The aggressive isolation program decreased the incidence of MRSA colonization and the additional use of 2% CHG has reduced much more the incidence of MRSA colonization and bacteremia. Days of hospitalization, use of central line, days of using central line, presence of respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), isolation program, and isolation program + use of CHG were significant factors associated with MRSA colonization or bacteremia in univariate logistic regression analysis. Days of using central line and isolation program + use of CHG were significant after in multivariate logistic regression analysis. CONCLUSION: Hand hygiene, active MRSA surveillance culture, isolation, contact isolation, nursing/doctor cohorts and the use of 2% CHG as skin sterilizer were effective in eradicating to MRSA. The effort of shortening the days of using central line is also necessary.

Long-term Maintenance of Smoking Cessation and Related Factors of Relapse / 가정의학회지

BACKGROUND: Long-term maintenance of smoking cessation is important to reduce smoking related diseases. There are few studies that evaluated long-term maintenance and related factors. For effective cessation treatment, we analyzed the relapse pattern after cessation and related factors. METHODS: We selected people who visited a health care center more than two times between January 1995 and December 2006 and who have succeeded in cessation after the first visit. Telephone survey was done and their medical records was analyzed. A total of 308 people whose medical records corresponded to the results of the telephone survey were finally included and analyzed. RESULTS: The mean follow-up duration was 112 months and the mean age of the first visit was 47.9 years. The median maximum duration of abstinence was 5.50 years, and the annual hazard ratio of relapse was about 2.5-4.2% from two to seven years of duration of abstinence. Mean age of smoking onset was 22.9 years, the mean smoking duration was 24.5 years, and the mean smoking amount per a day was 20.0 cigarettes. In single-variate analysis, the total number of cessation success, the age of smoking onset, the mean smoking duration, the mean smoking amount per day, the cessation method, the reason for trying cessation were related with the long-term cessation maintenance. In multivariate analysis, the total number of success for cesstion, the reason for trying cessation, the cessation method, the mean number of cigarettes per day were related. CONCLUSION: The experience of relapse, the motive of cessation and self-willingness were shown to be important for long-term maintenance of smoking cessation.

Neurologic Complications Associated with Respiratory Syncytial Virus Infection in Childhood / 대한소아신경학회지

PURPOSE: Respiratory syncytial virus(RSV) mainly brings about respiratory complication, but it can also be related to neurologic complication. We have studied clinical aspect and incidence of neurologic complication associated with RSV infection. METHODS: We reviewed the medical records of 732 children with RSV infection who were admitted to the department of pediatrics, Hanyang University hospital from November 2002 to June 2007 and studied on existence of neurologic complication, age, sex, clinical symptom, characteristics of seizure, and laboratory findings. RESULTS: Neurologic complications were occurred in 52 patients(7.1%) among 732 patients. Among them, 14 patients(1.9%) had seizure and 38 patients(5.2%) had alteration of mental status such as drowsy, lethargy. Age distribution of patients with neurologic complication was from 1 month to 5 years(mean 16.4 months). There were 30 boys and 22 girls. Among 14 patients who had seizure, 2 patients had convulsion disorder, 3 patients had febrile convulsion, and 9 patients had no seizure before. Their age distribution was from 1 months to 4 years(mean 18.4 months) and there were 8 boys and 6 girls. All of 14 patients showed generalized tonic clonic seizure and durations were from 30sec to 15 min(mean 4.4 min). All of the investigations were normal. None of 52 patients had recurrence and neurologic sequelae. CONCLUSION: It is important to know that RSV can cause CNS complications because we know how many patients infected by RSV. RSV-related seizure can be considered as benign seizure which does not need any long-term antiepileptic medication.

A Radiologic Study of the Reference Line for Measuring Posterior Slope Angle on Lateral View of the Knee / 대한정형외과학회잡지

PURPOSE: This study evaluated the radiological reference line of the posterior slope angle on the lateral view of a plain knee radiograph. MATERIALS AND METHODS: The lateral view of the plain knee and whole tibia radiographs were analyzed from thirty seven patients (fifty-two cases) who had undergone total knee arthroplasty. The posterior slope angle was measured on the lateral view of the tibia. On the lateral view of the knee, the posterior slope angle was measured with reference to the proximal tibial anatomical axis, the proximal tibial anterior cortical line, the proximal tibial posterior cortical line and the proximal fibular anatomical axis. These values were compared with the posterior slope angle measured on the whole tibia lateral view. RESULTS: The posterior slope angle, which was measured by the anterior cortical line as a reference line, was tilted slightly anteriorly to that measured by the whole tibial lateral anatomical axis (0.15 degree in average; anterior slope 3.95- posterior slope 5.57 degree). This difference was smallest among that of the measured angle by the other reference lines (p<0.001). CONCLUSION: The anterior cortical line of the proximal tibia appears to be the most reliable reference line for measuring the posterior slope angle on a knee lateral radiograph after TKA.

Comparative Study of the Results of Electromagnetic (EML Dornier Compact Delta(R)) and Electroconductive (ECL, EDAP-Sonolith Praktis) Extracorporeal Shock Wave Lithotriptors / 대한비뇨기과학회지

PURPOSE: We compared the efficacy of two shock wave energy sources; the newer electromagnetic lithotriptor(EML, Dornier Compact Delta(R)) and electroconductive lithotriptor(ECL, EDAP-Sonolith Praktis) that were used for treatment of the urinary calculi. MATERIALS AND METHODS: From January 2004 to October 2006, 614 patients were treated with EML. From January 2000 to October 2006, 936 patients were treated with ECL. Following lithotripsy, a plain abdominal film was taken 1 week after each session to determine if there were residual stones and assessed the need for retreatment. Success was defined as no residual stones. We analyzed the site and size of stones, success rate, mean session, mean treatment time, causes of failure and complications. RESULTS: The success rate was 95.9% for EML compared to 93.6% for ECL (p=0.048). The success rate was decreased for 20mm or larger stones. The treatment mean session wasn't different but the total treatment time was significantly longed for EML(58.5+/-27.1 min) compared for ECL(39.7+/-21.7 min)(p<0.05). No statistically significant difference were found in complications and failure between both groups. Insufficient fragment was most common cause of failure in both groups(1.8% for EML versus 2.4% for ECL). Gross hematuria were noted 26.4% of patient treated with EML and 26.6% of those treated with ECL. CONCLUSIONS: The EML has a little advantages over the ECL in terms of total success rate, but ECL has its advantage in mean and total treatment time. Ultimately, these two contemporary energy sources are acceptable. They are equally efficacious, judging from single center treatment and follow-up criteria.

Surgical Correction of Fixed Kyphosis

STUDY DESIGN: A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. PURPOSE: To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. OVERVIEW OF LITERATURE: Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. METHODS: There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. RESULTS: The average kyphotic angle was 71.8degrees preoperatively, 31.0degrees postoperatively, and the average final angle was 39.2degrees. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. CONCLUSIONS: Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Cervical and Thoracolumbar Epidural Abscess: A Case Report / 대한척추외과학회지

Epidural abscess is a rare disease that can cause severe neurological complications or death if it is not recognized and treated early. Authors report a case of panspinal epidural abscess, which is diagnosed by MRI and treated with surgical drainage and antibiotics.

Reconstruction of Disarticulated Knee Stump by Using Distally Based Anterolateral Thigh Island Flap

PURPOSE: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. METHODS: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the 14x10cm sized flap was transferred to cover the defect. The pedicle measured 14cm in length with pivot point 7cm above the patella. RESULTS: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. CONCLUSION: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

Acquired Dermoid Cysts within Subcutaneous Scar Tissue

PURPOSE: Dermoid cysts are almost always caused by congenital events. The most widely accepted pathogenesis is that the cysts are dysembryogenetic lesions that arise from ectodermic elements entrapped during the midline fusion. We report a rare case of dermoid cyst, which occurred not congenitally but newly in the subcutaneous scar tissue secondary to trauma. METHODS: A 26-year-old man had a deep submental laceration caused by a car accident and got a primary wound closure 16 months ago. There were 18 cm-long submental hypertrophic scar and newly developed palpable masses inside the subcutaneous layer at the center of the scar. Initial impression was an epidermal cyst or a thyroglossal duct cyst. Ultrasonographic finding showed two cystic masses inside the scars at the submental area, but impressed dermoid cysts. The cystic masses were completely removed with W-plasty and histological examination were followed. RESULTS: The histological diagnosis was dermoid cysts which were mainly composed of keratotic squamous epithelium in their inner surface linings and numerous skin appendages such as sebaceous glands, sweat glands, and hair follicles in their cystic lumens histopathologically. During the follow-up period of 25 months, there was no recurrence of any subcutaneous mass in the site of scar. CONCLUSION: We report a very unusual case of dermoid cysts developed by an acquired cause, considering that the accidental inclusion of deep skin elements caused by a trauma can be a critical origin of dermoid cysts.

Biomechanical Efficacy of Various Anterior Spinal Fixation in Treatment of Thoraco-lumbar Spine Fracture

PURPOSE: To evaluate the biomechanical results according to various anterior spinal fixation methodology in the treatment of thoracolumbar spine fracture. MATERIALS AND METHODS: The comparative analysis of fixation method was evaluated by three dimensional finite element model using the 1 mm reconstruction image of CT. Authors evaluated the flexion, extension, lateral bending, torsional stresses with 12 fixation methods for the compression and burst fracture. RESULTS: In biomechanical analysis, stiffness of body-fixation device was more stable in two-rod system in compression fracture and was stable in one-rod, two-rod system in burst fracture, but two-rod system was showed over-increase of stiffness. CONCLUSION: Authors recommend the usage of two-rod system in anterior fixation only and anterior one-rod system in anterior-posterior fixation.

Usefulness of the Mycofast Test (MYCOFAST(R) Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the usefulness of Mycofast (MYCOFAST(R) Evolution 2, International Microbio, France) for Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) in association with nongonococcal genitourinary infections. MATERIALS AND METHODS: 530 patients visited our department for genitourinary infection symptoms or for the evaluation of sexually transmitted disease. The genital swabs were first vortexed in Mycofast transport broth. A volume of 100mul of liquid sample was innoculated to each well of the Mycofast broths and 0.5mul of liquid sample was innoculated to A7 agar culture media (International Microbio, France). The Mycofast broths were incubated at 35-37 degrees C for 36 hrs, and the A7 agar culture media was incubated for 4 days. We compaired Mycofast with A7 agar culture for the sensitivity, specificity, the positive and negative predictive values and the antibiotic susceptable profiles. RESULTS: Of the 530 samples submitted, 165 samples were positive by the A7 agar culture and 162 samples were positive by Mycofast. 157 samples were positive by both methods. Of the 365 samples that were negative by the A7 agar culture, 360 samples were also negative by the Mycofast. In this study, Mycofast had a sensitivity and specificity of 95% and 98%, respectively, and a positive and negative predictive value of 96% and 97%, respectively. The Mycofast drug susceptibility tests indicate a high susceptibility to doxycyclin as follows: U. urealyticum: 86.3%; M. hominis: 85.0% and both organisms with simultaneous isolation: 75.8%. CONCLUSIONS: Mycofast was an easy test to perform and it proved to be a practical and reliable method for isolating the Mycoplasma and Ureaplasma species for making the diagnosis of nongonococcal genitourinary infections, and it showed the added benefit of determining the limited susceptibilities of the isolated strains.

Therapeutic Efficacy of Extracorporeal Magnetic Therapy on Low Urinary Tract Symptoms and Sexual Function in Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: To find whether extracorporeal magnetic innervation (ExMi) changes the low urinary tract symptoms and sexual function in patients with chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: ExMi treatment was performed in 51 patients, diagnosed as National Institute of Health (NIH) type III prostatitis, with each treatment session composed of 10 min at 40Hz, 2 min rest and 10 min at 50Hz. Both before and after the completion of 8 sessions of ExMi, self-administered NIH-chronic prostatitis symptom index (NIH-CPSI) and International Index of Erectile Function (IIEF) questionnaires were completed to assess the changes in the patient's symptoms. RESULTS: Following the ExMi treatment, 25 of the 40 patients experienced a 30% or greater improvement of low urinary tract symptoms. The total NIH-CPSI scores ranged from 22.4 to 15.6 (p<0.05). Each domain of the NIH-CPSI was as follows: pain, from 9.0 to 6.2; urination, from 6.7 to 4.8 and effect on the quality of life, from 6.6 to 4.5, and 11 of the 26 patients experienced a 15% or greater improvement of their sexual function. The mean total IIEF scores ranged from 44.1+/-13.5 to 51.6+/-11.3 (p<0.05). Each domain of the IIEF was as follows: erectile function, from 19.5 7.0 to 21.7+/-5.6 (p<0.05); intercourse satisfaction, from 7.4+/-2.2 to 9.5+/-2.2 (p<0.05); orgasm function, from 6.5+/-2.2 to 6.6+/-2.6 (p=0.516); sexual desire, from 6.2+/-1.9 to 6.3+/-1.6 (p=0.294) and overall satisfaction from 5.4+/-1.5 to 7.3+/-1.3 (p<0.05). CONCLUSIONS: result, ExMi was shown to reduce the lower urinary tract symptoms, and enhances the sexual function in CPPS, suggesting ExMi is effective and may help in the management of CPPS.

Experience of Extracorporeal Shock Wave Lithotripsy with Electroconductive Lithotriptor (ECL, EDAP- Sonolith Praktis) in 703 Patients with Urinary Calculi / 대한비뇨기과학회지

PURPOSE: We analyzed the therapeutic results of 703 cases of urinary calculi treated using an EDAP-Sonolith Praktis, an electroconductive lithotriptor (ECL). MATERIALS AND METHODS: Between January 2000 and June 2004, 703 patients meeting the study inclusion criteria were treated with an EDAP-Sonolith Praktis. The site and size of the stones, session, auxiliary procedure, success rate, causes of failure, complication, efficiency quotient (EQ) and retreatment were analyzed. RESULTS: The records of 703 patients, in whom urinary calculi were treated by extracorporeal shock wave lithotripsy, using an EDAP-Sonolith Praktis, were retrospectively reviewed. The success rates were 99.3, 92.5, 66.7 and 12.5% for stone sizes or=30mm, respectively, with an overall success rate of 95.3%. The EQ, mean number of session and retreatment rate were 0.71, 1.7 and 30.6%, respectively. As auxiliary procedures, double-J stenting, ureteroscopic stone removal and open surgery were performed in 6, 15 and 1, respectively. The complications were gross hematuria, flank pain, steinstrasse, nausea and fever, which were successfully controlled by conservative treatment. CONCLUSIONS: EDAP-Sonolith Praktis, an ECL, is an efficient and safe outpatient procedure for initial urinary calculi treatment.

A Case of Adenomyoma Causing Jejunal Bleeding / 대한소화기내시경학회지

Adenomyoma, a benign tumor generally considered to be a form of pancreatic heterotopia, is composed of smooth muscle and undifferentiated columnar epithelium. A 62-year-old female was admitted with melena. Small bowel enteroscopy using a pediatric colonoscope revealed a small sized nodular mass with active bleeding in the proximal jejunum. After a endoscopic resection of the tumor, the bleeding ceased. Histologic examination disclosed an adenomyoma. We report a case of the adenom-yoma causing jejunal bleeding with a review of the literature.

Urodynamic Analysis of Men with Lower Urinary Tract Symptoms without Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Purpose: The pathogenesis of lower urinary tract symptoms (LUTS) without benign prostatic hyperplasia (BPH) in men is unclear. In this study, patients with LUTS without BPH were analyzed with a urodynamic study to search for effective treatments. MATERIALS AND METHODS: Ninety nine men with LUTS without BPH were assessed by their medical history, symptom score, uroflowmetry, filling cystometry and a pressure- flow study. The patients were divided into irritating and obstructive symptom groups according to their chief complaints. The urodynamic parameters between the two groups were compared. RESULTS: On urodynamics, 33 (33.3%) patients showed demonstrable evidence of detrusor instability (DI) of whom 10 had a concomitant bladder outlet obstruction (BOO), while 8 had concomitant detrusor underactivity (DU). BOO and DU was identified in 21 (21.2%) and 30 (30.3%) patients, respectively. Of the 61 patients presented with irritating symptoms, DI, BOO and an impaired contractility (IC) was found in 26.3, 13.1, and 13.1% of patients, respectively. Of the 38 patients with obstructive symptoms, DI, BOO and IC was found in 7.1, 8.1, and 17.2%, respectively. There was a significant positive correlation between the irritating symptoms and the presence of DI. CONCLUSIONS: Lower urinary tract symptoms in men are common and often misdiagnosed. This study demonstrated that 84 (84.8%) patients with lower urinary tract symptoms without a benign prostatic hyperplasia had urodynamic abnormalities such as DI, BOO and IC. A urodynamic study may to be useful in establishing a correct diagnosis and launching the appropriate therapy.

The Effect of Distension of Distal Colon and Rectum on Micturition Reflex in Rats / 대한비뇨기과학회지

PURPOSE: Bowel distention stimulates neuroreceptors inside bowel wall with resultant effect to the bladder activity via segmental spinal reflex. This work aimed to elucidate the effects of distal colon and rectum distension on the micturition reflex. MATERIALS AND METHODS: The experiments were performed on female Sprague Dawley rats anesthetized with intraperitoneal urethane (1.25g/kg), weighing 250-350g. Intravesical pressure was measured by a conventional pressure transducer. Isovolumetric bladder contractions were recorded during distension of the distal colon and rectum. The frequency of voiding contractions was calculated by counting the number of peaks/10mins. of observation and the mean amplitude of the contractions were recorded from the cystometrogram. During maximal distention of the bowel, changes of the micturition reflex were observed repeatedly after injection of acetylcholine, phenylephrine and adenosine triphosphate (ATP). RESULTS: The frequency and amplitude of micturition reflex decreased significantly compared to baseline during incremental distension of the rectum. whereas, frequency was increased and amplitude was decreased significantly during distension of the distal colon. The micturition reflex inhibited by distension of the rectum was restored by acetylcholine. CONCLUSIONS: The micturition reflex was inhibited by distension of the rectum and restored by acetylcholine. This result indicated that the inhibition of the micturition reflex caused by distension of the rectum is related to parasympathetic nerve activity. With this results, it may be suggested that the constipation or abdominal distension due to intestinal motility disorder are associated with voiding dysfunction clinically.

Implantable Microballoons: An Alternative in the Treatment of Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: All current bulking agents employed for treating intrinsic sphincter deficiency (ISD) have some limitations due to various side effects, technical difficulties and inadequate long-term results. Self-detachable balloon system (SDBS) was tested as a new therapeutic modality for female urinary incontinence. MATERIALS AND METHODS: SDBS which consists of the self-detachable cross-linked silicone balloon, biocompatible filler material and a delivery system was implanted. Fourteen famale patients with ISD were included in the prospective trials. Two to five balloons were implanted per patient. Patients were followed up with incontinence questionnaire, pad tests and determination of Valsalva leak point pressure (VLPP) at 1, 3, 6, 12 and 18 months. RESULTS: The biocompatibility of the microballoons was excellent. With a mean follow-up of 10.1 months, 28.9% (4/14) of the patients were completely dry. 21.1% (3/14) of the patients showed socially dry and 3 patients (21.1%) showed improvement. 28.9% (4/14) of patients were deteriorated during follow-up. Three patients had spontaneous delivery of SDBS. The pad test improved from a preoperative mean of 102.1g to a postoperative mean of 22.4g. The VLPP increased from a preoperative mean of 49.7cmH2O to a postoperative mean 89.8cmH2O. CONCLUSIONS: The implantation of microballoons is a safe, well-tolerated, minimally invasive and clinically effective modality for the treatment of ISD.

A Case of No Residual Cancer in Radical Prostatectomy Specimens Despite Biopsy-proven Prostate Cancer / 대한비뇨기과학회지

In prostate cancer patients without local invasion and metastasis, radical prostatectomy is performed as a rule for the resection of residual cancer. In a few cases, little amount of cancer volume is identified in radical prostatectomy specimens. This finding has been described as 'minimal residual cancer' or 'vanishing cancer phenomenon' and some reports have demonstrated an increase in the incidence of minimal residual prostate cancer. However, only few cases with 'minimal residual cancer' or 'no residual cancer' despite efforts searching for other possibilites have been reported. We report a case of no residual cancer in radical prostatectomy specimens of biopsy-proven prostate cancer.