Evaluation of the Nervous and Vascular Systems in Erectile Dysfunction Patients after Electric Injuries / 대한비뇨기과학회지

PURPOSE: There is a high prevalence of erectile dysfunction (ED) after electric injuries, but our medical understanding of ED after electric injuries is scanty at best. Thus, the authors attempted to investigate nocturnal penile tumescence (NPT), bulbocavernosus reflex latency (BCRL) and penile duplex Doppler ultrasonography (PDDU) for the patients who suffer from ED after electric injuries. MATERIALS AND METHODS: Of the patients who visited our Burn Care Center between January 2005 and February 2006, ten male patients (aged 20 or older) who complaining of ED after electric injuries underwent NPT, BCRL and PDDU. RESULTS: The patients' mean age was 38.1 years (age range: 25-54), and the numbers of patients exposed to whole body, upper-lower extremity and upper-upper extremity pathways of the electrical current were 1, 2 and 7, respectively. For the patient exposed to the whole body pathway, abnormal findings were observed on all the tests. For one patient who experienced two upper-lower extremity pathways, normal findings were seen on all the tests, while the other patient showed an abnormal NPT, an normal BCRL and an arteriogenic ED. Three of the patients who experienced the upper-upper extremity pathway showed normal findings on all the tests. The other two in the group showed an abnormal NPT, a normal BCRL and arteriogenic ED; the other one showed a normal vascular function, a abnormal NPT and no reaction to BCRL; the other one showed an abnormal NPT, a delayed BCRL and an arteriogenic ED. CONCLUSIONS: More abnormal findings were seen in NPT, BCRL and PDDU for the cases associated with upper-lower body or whole body electrical current pathways, as compared to patients whose electrical pathways were limited to the upper body.

A Clinical Experience of Direct Extension to Parotid Gland of Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma has a high incidence. However, regional metastasis occurs infrequently because skin cancer is usually recognized and treated early. We report the case of squamous cell carcinoma around the earlobe in a 74-year-old male patient. The cutaneous squamous cell carcinoma invaded ipsilateral parotid gland directly without lymphatic spreading. Wide excision was made with 1.5 cm margin and immediate reconstruction was performed with radial forearm fasciocutaneous free flap. During operation facial nerve was preserved. No recurrence was noted for 5 years and the patient was satisfied with good aesthetic result. Cutaneous squamous cell carcinoma spreads to the parotid gland usually through lymph nodes and there are few reports of invasive organ damage by direct invasion. We experienced a case of direct invasion to parotid gland without lymph node involvement of cutaneous squamous cell carcinoma and treated the cancer adequately with wide excision and free flap coverage.

Erectile Dysfunction in Patients with Electrical Injury / 대한비뇨기과학회지

PURPOSE: The severity of electrical injury depends on the intensity and pathway of the electric current. We hypothesized that erectile dysfunction (ED) may be a sequelae of electrical injury. Therefore, in this study, the prevalence of ED in electrical injury patients was estimated, and the results correlated with the electric voltage and pathway of the electric current at the time of the injury. MATERIALS AND METHODS: Mail and phone surveys were undertaken by 416 electrical injury patients admitted with electrical injury to our burn care center, between November, 1998 and December, 2003. Patients were given a self-administered questionnaire, which included the five item Korean version of the International Index of Erectile Function (IIEF-5). The voltage, pathway of electric current at the time of injury and other diseases, such as hypertension (HTN), diabetes mellitus (DM) and neurological disease, were also reviewed. Of the 416 (66%) subjects, 276 agreed to participate, but 20 (7%) of these were excluded due to HTN, DM and neurological disease. RESULTS: The remaining 256 patients constituted our patient population. The mean age was 39.2 (range 21 to 66) years. 52.7% of the 256 patients had ED. According to age, the prevalence of ED in patients in their third, forth, fifth and sixth decades were 43.8, 54.2, 55.8 and 42.9%, respectively; no patient in their seventh decade showed ED. There was no statistically significant difference among the age groups. 58.4, 21.2 and 33.3% patients with high, low and unknown voltage injuries had ED, which was statistically significant. The prevalence of ED according to the pathway of the electric current were 100, 70.3, 44.4, 31.9, 15.4 and 22.2% for whole body, upper-lower body, lower-lower body, upper-upper body, electrical spark burn and for unknown pathways, respectively. CONCLUSIONS: To our knowledge, this is the first study of ED in electrical injury patients. 52.7% of patients with electrical injury had ED. High voltage injures showed a higher prevalence of ED than low voltage injuries. Whole and upper-lower body pathways of the electric current showed a higher prevalence of ED compared to focal/local involvement (electrical spark burn), lower-lower body and upper-upper body pathways.

Statistical Analysis of the Polydactyly and Syndactyly by National Health Insurance Corporation Data

The feature of congenitial hand anomalies is multiple and complex. Polydactyly and syndactyly is one of the most common congenital anomalies of the upper limb. The statistical analysis of these anomaly is the basic study of congenital hand anomalies. However, the number of reports is small. The purpose of this study is to compare and analyze objective data and make a nation-wide statistical report on polydactyly and syndactyly. We used data from the National Health Insurance Corporation for reviewing polydactyly and syndactyly. We reviewed 3 years of data from 1998 to 2000 focusing on age, the number of operations, male to female ratio, the duration of hospital care and cost. The number of operations for polydactyly was 694 cases and for syndactyly was 574 cases. Therefore we may assume that polydactyly occurs 1:910 births and syndactyly occurs 1:1101 births. The duration of hospital care for polydactyly was 12 days and for syndactyly was 17 days. The full cost for the correction of polydactyly was 770,000 won and syndactyly was 1,220,000 won. The ratio of polydcatyly and syndactyly was 1.12:1. The operation for polydactyly and syndactyly was performed between the age of 1 and 2 in most cases. Male to female ratio of polydactyly was 1.14 :1 and syndactyly was 1.39:1. This study will be helpful to find appropriate treatment for congenital hand anomalies.

The Regional Anatomy of the Corrugator Supercilii Muscle and Facial Nerve

Glabellar frown lines develop as a result of contraction of the corrugator supercilii muscles. These lines make look angry or aging. The neurotomy of facial nerve supplying corrugator supercilii muscle will prevent complications of the surgical technique and the reversibility of the nonsurgical technique. The regional anatomy of corrugator supercilii muscle is necessary for developing new technique. However, there is little information regarding the motor innervation of this muscle. The purpose of this study is to identify the regional anatomy of corrugator supercilii muscle and facial nerve and help to develop new technique of the neurotomy. We have dissected 6 Korean adult cadavers(12 sides). The motor innervation of this muscle was the temporal branch of facial nerve. The entry point of facial nerve into this muscle was found to be the inferolateral part. It was directly beneath the hair of lateral side of mid one-third of the eyebrow. The average distance between median plane and the entry point was 35.8mm. The measurement was not significantly different between right and left side. This study will be helpful for developing new technique of the neurotomy of motor nerve that supplies to corrugator supercilii muscle.

Mechanism and Type of Dry Ejaculation after Transurethral Microwave Thermotherapy / 대한남성과학회지

PURPOSE: To investigate the mechanism and type of aspermic ejaculatory dysfunction resulting from high-energy transurethral microwave thermotherapy of benign prostatic hyperplasia. MATERIALS AND METHODS: Eleven patients who complained of dry ejaculation longer than 12 months after transurethral microwave thermotherapy were examined. Transrectal ultrasonography as used to assess seminal vesicle or ejaculatory duct dilatation, urethroscopy to identify any ejaculatory duct orifice obstruction, and urinalysis after ejaculation to detect sperm as an indicator of retrograde ejaculation. RESULTS: Four of eight patients with no sperm on urinalysis after ejaculation showed both seminal vesicle dilation and ejaculatory duct orifice obstruction with or without verumontanal scar formation. Another three patients showed either seminal vesicle dilation or ejaculatory duct orifice obstruction, and the final patient with no sperm on urinalysis showed neither seminal vesicle dilation nor ejaculatory duct orifice obstruction. Five patients with no sperm on urinalysis after ejaculation complained of some combination of perineal, scrotal, and urethral discomfort during or immediately after ejaculation. Three patients had sperm in their urine after ejaculation. CONCLUSIONS: In 7 patients (63.6%), dry ejaculation resulted from ejaculatory duct obstruction. Three patients (27.3%) had retrograde ejaculation, and one patient (0.09%) may have had dry ejaculation as a result of failure of spermatogenesis. The main mechanism of dry ejaculation after transurethral microwave thermotherapy seems to be ejaculatory duct obstruction, not failure of bladder neck closure.

Chronic Dissecting Aortic Aneurysm with Right Coronary Artery Perfused Solely by False Lumen of Asceading Aorta / 영남의대학술지

Dissecting aortic aneurysm is relatively rare in those under 40 years of age without high risk factors. After dissecting aortic aneurysm is occurred, the coronary artery is rarely perfused by false lumen. We present a thirty two-year-old man who showed Debakey type 1 dissecting aortic aneurysm with right coronary artery perfused by false lumen of ascending aorta and with congestive heart failure due to aortic insufficiency without discernible risk factor. Medical and surgical treatment (Modified Bentall's operation) were successfully performed. The pathologic report showed combined cystic medial necrosis. Now he is well tolerated and stable only with anticoagulation during follow up 18 months.

Graves' disease Associated with Idiopathic Thrombocytopenic Purpura and Iron Deficiency Anemia / 영남의대학술지

Since 1931, sporadic reports have appeared noting an apparent association between hyperthyroidism and idiopathic thrombocytopenic purpura. Recent various studies suggested that these two diseases may share a similar immunologic background, but the exact mechanism is still a matter of speculation. This 22-year-old female patient visited this hospital because of general weakness and purpura of legs for 2 months. The laboratory findings were compatible with Graves' disease associated with idiopathic thrombocytopenic purpura. The platelet count was 16000/mm³, hemoglobin was 10.9 g/dl and MCV was 60.1fL. T3 was 490.53 ng/dL, T4 was 24 ug/dL and free T4 was 5.66 ng/dL. Antiplatelet antibody and antimicrosomal antibody were positive. The bone marrow findings were compatible with iron deficiency anemia and idiopathic thrombocytopenic purpura. The thyroid biopsy showed adenomatous goiter. She was administered with propylthiouracil, Beta-blocker, iron and prednisolon. On the 10th hospital day, platelet count was 184000/mm³, hemoglobin was 12.0 gm/dL and MCV was 67.5 fL. On the 20th hospital day, T4 was 10.35 ug/dL and free T4 was 2.30 ng/dL. Therefore she was discharged and followed up.