Comparing the Certification Criteria for CCHIT-Certified Ambulatory EHR with the SNUBH's EHR Functionalities / 대한의료정보학회지

OBJECTIVES: This study aims to investigate the suitability of electronic health record (EHR) systems in Korea for global certification and to propose functions for future global systems by comparing and analyzing the certification criteria for Certification Commission for Health Information Technology (CCHIT) Certified Ambulatory EHR with BESTCare, which is the EHR system at Seoul National University Bundang hospital. METHODS: Domain expert groups were formed to analyze the inclusion of BESTCare functions and the types of differences for each of the CCHIT Certified 2011 Ambulatory EHR Certification Criteria. The types of differences were divided into differences in functions (F), differences in business processes (B), and differences in government policies (P). RESULTS: Generally, the criteria that showed differences in functions pertained to the connection between the diagnosis/problem list and order, the alert and warning functions for medication-diagnosis interactions, and the reminder/instruction/notification messages related to the patient's immunization status; these absent functions were enhanced clinical decision support system (CDSS) functions related to patient safety and healthcare quality. Differences in government policies were found in the pharmacy's electronic prescription functions, while differences in business processes were found in the functions constrained by the local workflow or internal policy, which require some customization. CONCLUSIONS: Functions that differed between the CCHIT certification criteria and the BESTCare system in this study should be considered when developing a global EHR system. Such a system will need to be easily customizable to adapt to various government policies and local business processes. These functions should be considered when developing a global EHR system certified by CCHIT in the future.

Effects of Preconceptional Sperm Exposure to Female Genital Tract on the Development of Hypertensive Diseases During Pregnancy / 대한산부인과학회잡지

OBJECTIVE: This study was performed to know whether toxemia occurred more frequently in pregnancy which is achieved despite of azoospermia or severe oligospermia. METHODS: We selected 31 women who underwent surgical sperm aspiration and ICSI at Seoul National University Hospital (SNUH) from 1995 to 2001 and pregnancy continued over 20 gestational age as study group. And as a comparison group, 19 women who underwent ICSI at SNUH from 1995 to 2001 with no semen analysis abnormality and pregnancy continued over 20 gestational age were selected. The incidence of toxemia in both groups was observed. RESULTS: There were no differences in the incidence of gestational hypertension and preeclampsia between groups (RR=3.46, 95%CI 0.37-32.18) (RR=0.91, 95%CI 0.14-6.02). CONCLUSION: No association was observed between preconceptional sperm exposure to female genital tract and the incidence of toxemia.

A Case of a M llerian Duct Remnant Leiomyoma Suspected of Ovarian Tumor in a Woman with M llerian Dysgenesis / 대한산부인과학회잡지

In women, leiomyomas are very common diseases and may arise from any organs containing smooth muscle. However, they are extremely rare in M llerian duct remnant. A medline research disclosed only 13 published cases including 3 domestic cases. We report a case of a M llerian duct remnant leiomyoma in a woman of congenital vaginal agenesis with M llerian dysgenesis whose chief complaint was a palpable pelvic mass suspected of an ovarian tumor.

The causes of primary amenorrhea / 대한산부인과학회잡지

OBJECTIVE: To identify the causes of primary amenorrhea in the Korean population. METHODS: We reviewed the available medical records of the 100 patients who had visited the Department of Obstetrics and Gynecology at Seoul National University Hospital with the complaint of primary amenorrhea and examined their karyotypes between January 1989 and December 2000. Review of history, physical examination, laboratory findings, imaging studies, and operative findings was done, when needed. RESULTS: The mean age at diagnosis was 25.1+/-6.1 (mean+/-S.D.) years of age, ranged 14 to 40. Mllerian agenesis was the most common cause (40.0%), followed by primary ovarian failure (33.0%), and then followed by hypothalamic-pituitary failure (12.0%). Androgen insensitivity syndrome and Swyer syndrome were found in four patients (4.0%), respectively. CONCLUSION: This study shows that the common cases of primary amenorrhea in Korean women are Mllerian agenesis, primary ovarian failure and hypothalamic-pituitary failure.

Mutations of the Human Androgen Receptor Gene in Men Infertile from Testicular Causes / 대한남성과학회지

PURPOSE: Many men with a normal phenotype but decreased or absent production may have abnormalities of the androgen receptor (AR). Here, we investigated men with severe oligospermia and azoospermia to ascertain wether mutations of the AR gene are associated with male infertility having testicular causes. PATIENTS AND METHODS: A total of 43 infertile men with a normal phenotype and severe oligospermia or azoospermia and three normally fertile men entered this study. Included was one man with known incomplete androgen insensitivity syndrome (AIS). Deoxyribonucleic acid was isolated from peripheral blood samples of the subjects, and polymerase chain reaction (PCR) was carried out using sets of primers designed to amplify sequences of eight exons of the AR gene. For convenience and repidity of analyses, the multiplex PCR method was employed. RESULTS: PCR resulted in amplification of all eight exons. In all samples, amplified products were shown to be appropriate-sized bands on agarose gels. No gross abnormalities were found in most of the infertile patients. However, an increased number of CAG repeat in exon 1 of the AR gene and point mutations (T to C, nt 3897; A to T, nt 3903) in exon 7 were found in the AIS subject. CONCLUSIONS: Our results showed no gross deletions of the AR gene in most infertile subjects. However, point mutations may have been overlooked by the techniques used, as demonstrated in the AIS subject. Further study will be required to clarify expression and localization of AR I the testis and consequently to understand the precise roles of the AR in regulating the normal spermatogenesis.

Effects of Denervation on Erectile Dysfunction: Reduced Erectile Activity Associated with Apoptosis of Smooth Muscle Cells in Rat Corpus Carvernosum / 대한남성과학회지

PURPOSE: Although many clinical observations support the idea that denervation may cause erectile dysfunction, there has been suggested as an underlying cause, resulting in decreased penile tissue and consequently impotence. This study was initiated to investigate whether apoptosis follows denervation of the rat penis. MATERIALS AND METHODS: A total of 40 male Sprague-Dawley rats (10 weeks old) underwent abdominal exploration and unilateral or bilateral cavernous neurotomy. The penises were collected following sacrifice of animals at postoperation day 1, 2, 3, 6, or 10. Sham-operated animals served as controls. Tissues were embedded in paraffin and 3-?3 sections obtained. Deoxyribonucleic acid (DNA) fragmentation was analyzed by an in situ end-labeling method and by gel electrophoresis. Immunohistochemical study was carried out using monoclonal antibodies to p53. RESULTS: DNA fragmentation was evident in the tissues. In situ labeling revealed that the number of apoptotic bodies increased in tandem with the length of denervation. This finding was confirmed by electrophoretic analysis of DNA. However, there was no difference between the unilaterally and bilaterally treated groups. Immunohistochemical localization showed that p53 expression was increased in tissue sections of denervated animals, whereas little or no expression was shown in normal controls. CONCLUSIONS: Our results demonstrate that denervation causes apoptotic cell death in the rat penis. It is also suggested that unilateral nerve injury may be sufficient to affect normal erectile function. Further study will elucidate the molecular mechanisms of impotence caused by nerve-damaging operations such as prostatectomy.

Effects of Denervation on Erectile Dysfunction: Reduced Erectile Activity Associated with Apoptosis of Smooth Muscle Cells in Rat Corpus Carvernosum / 대한남성과학회지

PURPOSE: Although many clinical observations support the idea that denervation may cause erectile dysfunction, there has been suggested as an underlying cause, resulting in decreased penile tissue and consequently impotence. This study was initiated to investigate whether apoptosis follows denervation of the rat penis. MATERIALS AND METHODS: A total of 40 male Sprague-Dawley rats (10 weeks old) underwent abdominal exploration and unilateral or bilateral cavernous neurotomy. The penises were collected following sacrifice of animals at postoperation day 1, 2, 3, 6, or 10. Sham-operated animals served as controls. Tissues were embedded in paraffin and 3-?3 sections obtained. Deoxyribonucleic acid (DNA) fragmentation was analyzed by an in situ end-labeling method and by gel electrophoresis. Immunohistochemical study was carried out using monoclonal antibodies to p53. RESULTS: DNA fragmentation was evident in the tissues. In situ labeling revealed that the number of apoptotic bodies increased in tandem with the length of denervation. This finding was confirmed by electrophoretic analysis of DNA. However, there was no difference between the unilaterally and bilaterally treated groups. Immunohistochemical localization showed that p53 expression was increased in tissue sections of denervated animals, whereas little or no expression was shown in normal controls. CONCLUSIONS: Our results demonstrate that denervation causes apoptotic cell death in the rat penis. It is also suggested that unilateral nerve injury may be sufficient to affect normal erectile function. Further study will elucidate the molecular mechanisms of impotence caused by nerve-damaging operations such as prostatectomy.

Microdeletions in the Azoospermia Factor Region on the Y Chromosome Long Arm of Males with Idiopathic Azoospermia / 대한비뇨기과학회지

PURPOSE: Idiopathic azoospermia is the most common cause of male infertility Recently, much efforts have been focused on possible genetic etiologies. Mutations in the region of the Y chromosome long arm(Yq), known as the azoospermia factor(AZF) region, have been suggested. In the present study, we analysed Korean azoospermic men with cytologically normal Y chromosomes to examine possible genetic variations In regions of Yq, known to be associated with impaired spermatogenesis. MATERIALS AND METHODS: A total of 63 idiopathic azoospermic subiects were examined. Other cases Included in this study are as follows; 13 subjects with oligospermia, 12 subjects with chromosomal anomalies(eleven 47XXY patients, one 46xx male) and 2 normal subjects. Genomic DNAs were isolated from peripheral blood samples. Each sample was examined for the presence or absence of a total of 28 Y-DNA landmarks in the Yq including DAZ and RBM. To facilitate the analysis, we adopted multiplex PCR where simultaneous amplification of several targets is possible in a single reaction. RESULTS: We detected deletions of small, interstitial portions of the Yq In a total of 14 azoospermia patients(22.2%). Deletion incidence were 14.3% for DAZ and 17.5% for other loci(sy157, sy153, sy127, sy109). But deletion of RBM was not detected. Multiple deletions were found in 4 subjects. One patient with 47XXY and one patient with 46xx male also showed multiple deletions. However, testis biopsies revealed diverse histologic appearances in these subjects. CONCLUSIONS: As other deletions than DAZ were also found within AZF region, it is possible that normal spermatogenesis may be regulated by more than one locus in the Y chromosome; thus, it has yet to be waited to correlate genetic causatives and testicular phenotypes.

A case of multilocular cystic nephroma with sarcoma / 대한비뇨기과학회지

Multilocular cystic nephroma of the kidney is an infrequent lesion and has been reported in the literature under several names. These various denominations reflect the controversy about its nature. Some authors include the lesion among renal dysplasia, while others consider it to be a benign neoplasm that might be related to nephrtblastoms(Wilms` tumor). We present a case of 52 year old male with multilocular cystic nephroma of the left kidney which was composed of highly cellular spindle shaped stromal cells and locally recurred as sarcoma after nephrectomy.

Clinical significance in incidentally detected renal cell carcinoma / 대한비뇨기과학회지

Between January 1980 and December 1989. 76 cases of renal cell carcinoma were treated by radical nephrectomy at Department of Urology. Hanyang University Hospital. Among them 65 cases were followed up at least 12 months and 16 cases (24.6%) were diagnosed incidentally. The ratio or incidentally detected renal cell carcinoma has been increasing steadily in the past decade. Two of 24 patients (8%) were discovered incidentally between 1980 and 1984 compared with 14 of 41(34%) between 1985 and 1989. Eleven of these cases(68.7%) were detected by ultrasound. three by computerized tomography. and two by excretory urography. Nine of these cases were unexpectedly found by chance during examination for health check up. while others were found during examination for other diseases. The stage and grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma. respectively (p<0.01. p<0.05). Primary tumor size was also significantly smaller in the incidental carcinoma(p<0.05). The S-year survival rates for the incidental and symptomatic carcinomas after radical nephrectomy were 93.7% and 53.6%. respectively (p<0.001). These data have shown an increase in the proportion of incidentally diagnosed cases. Ultrasonography is a useful tool to detect low stage asymptomatic renal cell carcinoma and has led to earlier diagnosis, lower stage and possible longer survival in patients with incidentally discovered renal cell carcinomas compared with patients where the diagnosis was suspected. These results supported the rationale for the efforts to detect renal cell carcinoma at health check-up or the attention to renal lesions on examination for unrelated diseases.

Diagnostic Efficacy of the Combination of Urine Cytology, Urinalysis and History in the Follow-up of Bladder Tumor / 대한비뇨기과학회지

We studied a retrospective analysis of the diagnostic value of the non-invasive modalities in 6O patients with primary superficial bladder tumors (pTa, pT1) who underwent treated at the Han. yang University Hospital From March 1980 to February 1990. In this study, using empirical cystoscopy follow-up scheme. 17 cystoscopies had to be done to detect each new recurrence. Because of this excessive number of cystosoopies. the diagnostic value of the combination of the following tests were calculated and the sensitivity of the following tests (singly and combined) has been assessed ; (l) urine cytology, (2) red blood cell count in urine sediment and (3) history of symptoms or irritative bladder and hematuria. This study indicated that a combination of non-invasive tests may produce a more rational approach to the follow-up of patients with low stage. low grade transitional cell carcinoma by minimizing the number of cystoscopies. The result indicated that over all recurrence rate was 36.7% (22,60) and 19 cases (86%) were recurred within 2 years and these patients had poor prognosis than patients after 2 years. There were significant increase of recurrence in initial high stage, high grade. high class tumors and the recurrence rate was decreased in patient with instilled adriamycin more than 10 times. The combination of these non-invasive diagnostic tests may constitute a sensitive procedure for the follow-up of bladder tumors. In the case of grade III and muscle-invasive recurrences (>T1), the sensitivity rate was 100%.

Seminoma in abdominal cryptorchid testis associated with torsion / 대한비뇨기과학회지

Seminoma is the most common tumor to occur in abdominal ectopic testes. Intraabdominal seminomas usually presents with secondary signs and symptoms due to the anatomical position of the tumor. We report a case of seminoma developed in abdominal cryptorchid testis associated with torsion. The patient was a 38 year-old male who had complained of left lower abdominal pain radiating to left scrotum. Abdominal ultrasonograph showed a well defined round mass with mixed internal echo in the left lower abdomen. Exploraton revealed that the mass was about 7.5 x 5.5 x 3.5 cm in size and twisted in 180' clockwise and herniated intestine was also seen. We carried out radical orchiectomy. The histopathologic diagnosis was pure seminoma confined to the testis. Postoperative irradiation was performed under the diagnosis of seminoma of stage I.

Five cases of webbed penis / 대한비뇨기과학회지

Webbed penis without chordee or hypospadias is uncommon malformation of the genital integument which is repaired easily once the condition is recognized. Examination reveals a web of skin extending between the median scrotal raphe and the ventral aspect of penis. The web was incised transversely and sutured vertically in two patients. In other three patients the redundant skin was excised and sutured with interrupted 4-0 vicryl. We report five cases of webbed penis which are good functional and cosmetic results.