The Effectiveness and Satisfaction of Modified Fascial Sling in Patients with Stress Urinary Incontinence: Comparison between Simple and Complex Types / 대한비뇨기과학회지

PURPOSE: Sling operation is applied to all types of the stress urinary incontinence (SUI) nowadays. We evaluated and compared the operation success rate and patient satisfaction between simple and complex types of SUI for patients who had undergone the modified fascial sling. MATERIALS AND METHODS: We reviewed 147 patients who were treated with the modified fascial sling for SUI. Patients were categorized into simple and complex types according to the classification of Chaikin et al. Surgical outcome and patient satisfaction were assessed by questionnaire. RESULTS: Of the 147 patients, 62 were simple type (42%) and 85 complex type (57%). In complex type, there were 76 cases of urge incontinence (89%), and 16 of grade 3 or 4 cystocele (19%). Mean duration of follow-up was 39.5 months (range 12-64). For operation outcome results, in simple type there were 56 cases of cure (90%) and 4 of improvement (6%), and in complex type there were 76 cases of cure (90%) and 6 of improvement (7%). The operation satisfaction rate of patients was 94% in simple type and 86% in complex type. Persistent urge incontinence was seen in 15 cases (20%) of 76 patients with preoperative urge incontinence. Complications were de novo urge incontinence in 5 cases (3%) and urinary retention in 7 cases (5%) of the sling operation. CONCLUSIONS: This study shows that the success rate of modified fascial sling in both simple and complex types of SUI was represented by the high result of 97%. However, the satisfaction rate for the surgery was somewhat different between the 2 types (94% vs. 86%). The main reason for the dissatisfaction was persistent urge incontinence.

The Effect of Capsular Tension Ring on Anterior Capsular Opening and Intraocular Lens in Cataract Surgery

The effect of capsular tension ring[CTR]on prevention of contraction of capsular opening induced by continuous curvilinear capsulorhexis in cataract surgery has been evaluated. In this study, we performed cataract surgery on 15 patients[23 eyes]in Group I[IOL implantation with CTR] and 13 patients[24 eyes]in Group II[IOL implantation without CTR]from September 1998 to November 1998. We compared uncorrected visual acuity[UCVA], spherical equivalent[SE], astigmatism, size of capsular opening, IOL rotation and change of anterior chamber depth between two Groups. We used image analysis system to determine an actual size of capsular opening and measured a depth of anterior chamber than 5 times by using A-scan ultrasound. GroupIand IIshowed a similar pattern of change of UCVA, SE and astigmatism. Contraction rate of capsular opening 2 months after operation was 1.41%in Group Iand 3.95%in Group II. This difference was statistically significant [p<0.001].The anterior chamber depth increased temporarily in both groups, However, it was slightly decreased and maintained in Group I, while steadily decreased in Group II. Rotation of IOL was greater in Group IIthan Group I. However, it was not statistically significant. With these results it would be concluded that CTR might prevent a contraction of capsular opening and enhance a stability of IOL.

The Analysis of Clinical Results Following Vitrectomy for Diabetic Retinopathy

The objective of this research is to examine the visual outcome of diabetic vitrectomy depending on each indication, to examine the factors influential to last visual acuity, to identify the causes for low vision and to learn the frequency of postoperative complications. Risk factors for the development of neovascular glaucoma either preoperative or intraoperative were carefully evaluated. Postoperative visual improvement was achieved in 67 eyes[53.6%]of 97 patients[125 eyes]who had undergone surgery due to diabetic retinopathy. Anatomical success was achieved in 111 eyes[88.8%]and vision better than 5/200 in 54 eyes [43.2%]. Statistically significant improvement of vision was obtained among the patients who had been controlling their blood sugar level successfully. Postoperative complications such as rubeosis iridis or neo-vascular glaucoma proved to be detrimental to visual outcome. Neovascular glaucoma occured in 20 eyes among the total 125 eyes[16%]and more frequently associated in eyes with postoperative retinal detachment[37.5%]than in eyes without retinal detachment[12.8%]. The difference was significant statistically. To summarize :first, thorough control of blood sugar level is indispensible in order to reduce postoperative visual loss and obtain the maximum effect of diabetic vitrectomy, second, postoperative occurrence of retinal detachment is at high risk for developing neovascular glaucoma.

A Randomized Prospective Trial Comparing a New Polyethylene Glycol Based Lavage Solution with the Standard Polyethylene Glycol Solution in the Preparation of Patients Undergoing Colonoscopy (Clinical trial of new PEG solution in bowel preparation) / 대한소화기내시경학회지

BACKGROUND/AIMS: Adequate preparation of the bowel is essential for accurate colonoscopic examination. Standard polyethylene glycol solution had been used as a bowel cleansing premedication. But many patients dislike the taste and saltiness of the polyethylene glycol solution. Comparison has made between colonic preparation with a new polyethylene glycol based solution that reduced the salt content and added flavoring in attempt to improve the palatability and to encourage patient compliance with the standard polyethylene glycol solution. METHODS: One hundred patients were randomized to receive either the new polyethylene glycol solution or the standard polyethylene glycol solution for their bowel cleansing preparation. Two gastroenterologists performing the colonoscopies were made unaware of the type of the preparation. The cleansing score and amount of residual fluids in each colonic segment was then evaluated. RESULTS: There was no significant difference in the colonic cleansing score and amount of residual fluids between two groups. Patients' compliance was higher for the new polyethylene glycol solution group than for the standard polyethylene glycol group. There was no difference in side effects of bowel cleansing solutions. CONCLUSION: The new polyethylene glycol solution as a bowel cleansing method has a higher patient compliance rate and is as effective as the standard polyethylene glycol solution.

Comparison of Clinical Results between Sulcus Insertion and Transscleral Fixation of Intraocular Lenses

To compare clinical results between sulcus insertion of intraocular lens(IOL)(Group I) and transscleral fixation of IOL(Group II), visual acuity, spherical equivalent, astigmatism, corneal thickness and intraocular pressure were evaluated, retrospectively. This study was performed on 37patients(43 eyes), who could have been followed up more than 12 months from September 1994 to August 1997. Six mm scleral incision at 12 o'clock position and sulcus insertion of IOL were used with 2 interrupted sutures in cases of aphakia either with some remained anterior capsule or with continuous curvilinear capsulorhexis(Group I, 12 eyes). The same incision and suture method with transscleral fixation of IOL were used in case of aphakia with little remained anterior capsule(Group II, 31 eyes). In Group II, 10-0 polyprolene sutures were buried beneath the scleral flaps at both three and nine o'clock meridians following transscleral fixation of IOL. Uncorrected visual acuity(UCVA) was improved in both Group I and Group II, except for 4 cases of Group II. Lack of improvement of UCVA did not seem to be related to the operative methods. The changes of UCVA, astigmatism, corneal thickness and intraocular pressure were not statistically significant between the two groups. In conclusion, transscleral fixation of posterior chamber-intraocular lens turned out to be safe and effective in certain cases of insecure zonule or posterior capsule, although its surgical procedure is more complicated than that of posterior chamber-intraocular lens implantation into the sulcus without fixation.

Three Cases of Stevens-Johnson Syndrome Associated with Methazolamide Treatment

There have been recent reports on the increasing number of Stevens-Johnson syndrome cases resulting from methazolamide and its relatively higher incidence in Japanese and Korean than any other people. The objective of this study is to examine its developement potential in Korean people.We observed three patients as the subjects of this research, who had been suffering from skin eruption during glaucoma treatment in the Department of Ophthalmology Catholic University, College of Medicine. All of them, for lowering IOP, took methazolamide 50mg a day for more than two weeks, but they had no history of systemic disease but glaucoma or hypersensitivity induced by other medications. With regard to their skin, vesicular eruption came out in their whole body and particularly oral mucosa severely. Also, systemic symptom such as slight fever and general malaise was accompained . However, by quitting the use of methazolamide and medicating corticosteriods instead, they recovered with no serious complication.It can be concluded, therefore, that they had Stevens-Johnson syndrome mainly by methazolamide based on the condition of their skin eruptionand the fact that they got well again by stopping the use of methazolamide on which they chiefly relied. However, a further systematic research on more cases os required with a view to elucidating confirmatory diagnosis and ethnic pecularity of the syndrome.

A Prospective Clinical Trial of the Newly Designed Esophageal Covered Metal Stent for Prevention of Stent Migration / 대한소화기내시경학회지

BACKGROUND AND AIMS: Palliation of malignant esophageal obstructions consists mainly of symptomatic treatment of dysphagia. For this purpose, variable self expandable esophageal stents have recently been used. Of these stents, membrane covered self expandable metal stents (SEMS) are effective to prevent tumor ingrowth and stent obstruction. But migration is the main problem of covered SEMS. So we made a newly designed covered SEMS for the prevention of stent migration and studied prospectively to define its palliative ability and whether this stent is effective for prevention of migration problems. METHODS: From January to December 1998, 27 patients [23 men, 4 women; mean age 60 years, range 20 to 80] were inserted with newly designed esophageal stents and studied. Data analysis included the location and length of malignant strictures, the length of the inserted esophageal stents, the time for fixation of the stents after insertion, complications related to stent insertion, and the effectiveness of the newly designed stent for prevention of the stent migration. RESULTS: 1) The location of esophageal strictures were 4 in the mid- esophagus (three tracheo-esophageal fistula due to two lung and one esophageal cancer, one esophageal cancer), 7 in the distal esophagus (all esophageal cancer), and 16 in the esophagogastric junction (6 cases of esophageal cancer, 9 with gastric cardiac cancer, and 1 with gastric lymphoma). 2) The mean length of the strictures was 5.2 (3 to 12) cm. 3) The mean length of the stents was 11 (8 to 16) cm. 4) Time for fixation of the stents was 7.2 (5 to 13) days after the stent insertion. 5) Stent placement was successful in all patients without any serious stent-related complications such as esophageal perforation or hemorrhage. During the mean follow-up period of 6 (1 to 12) months, there was no stent migration. CONCLUSIONS: The newly designed covered SEMS was very effective in preventing stent migration without any serious stent-related complications, especially in malignant strictures of the esophagogastric junction, short segment strictures, and T-E fistulas without tumor shoulder.

Long-term Changes of Corneal Endothelial Cells Following Keratoplasty

The purpose of this study was to find out an effect of preoperative causative disease and rejection episodes on the survival rate of donor grafts by analyzing the changes of transplanted corneal endothelial cell density and central corneal thickness after keratoplasty through the long-term observation.We measured corneal thickness,corneal endothelial cells of forty seven patients(and their fifty seven eyes), all of whom were operated from June 1985 to February 1988.We divided those largely into three groups-inflammatory group, noninflammatory group, rejection group-depending on the preoperative corneal status. Without any exception there had been a drop of corneal endothelial cell density for the first one year and came stability at a slow pace after that: 2040cells/mm2 in the third month, 1339cells/mm2 in first year,1013.7cells/mm2 in fifth year and 786.1 cells/mm2 in tenth year.The inflammatory and noninflammatory group showed a dull reduction rate from a year after the surgery and then showed increasing stability later on. A further decrease in corneal endothelial cell density was observed in the rejection group compared to the other ones.It could be concluded that an ever cautious selection of patients who seem to obtain the desired result after the surgery is all important because causative diseases in most cases have a decidedly significant impact on postoperative rejection episodes and survival rates.Also,a more attentive observation on corneal thickness, endothelial cell density is needed at least until a year after the corneal transplantation.

The Role of Helicobacter pylori and NSAID in Patients with Benign Gastric Ulcer / 대한내과학회지

OBJECTIVES: H. pylori infection and NSAID are very important risk factors for peptic ulcer. This study was conducted to investigate the H. pylori positivity rate and the rate of NSAID ingestion in the patients with benign gastric ulcer(BGU), to investigate which test and which site are the most adequate to reduce the false positivity rate of H. pylori, and finally to investigate the role of H. pylori and NSAID in BGU bleeding. METHODS: This study was conducted for the 180 patients with BGU, and H. pylori was diagnosed by any of CLO test, Gram stain of touch print and H&E stain in the antrum and body. In addition, age, sex, ingestion history of NSAID within 4 weeks before gastroscopy, past BGU history, smoking, alcohol and BGU bleeding were investigated. RESULTS: 1) The H. pylori infection rate of patients with BGU in Korea was 82.8%, and the rate of NSAID history was 26.1%. The patients with BGU who have only NSAID history were 8.3%, and the 91.1% of the patients had either H. pylori infection or NSAID history. 2) The most sensitive test for H. pylori infection among CLO test, Gram stain of touch print and H&E stain in the antrum or body was CLO test in the body. 3) Depending on H. pylori positivity, the rate of NSAID history in the H. pylori negative group was 48.4%, which was higher than that of H. pylori positive, 21.5%(p=0.002). In addition, the rate of past BGU history in the H. pylori positive group was 47.0%, which was higher than that of H. pylori negative, 12.9%(p<0.001). 4) Depending on the history of NSAID, the H. pylori positivity rate in NSAID positive group was 68.1%, which was lower than that of NSAID negative, 88.0%(p=0.002). The female percentage of NSAID positive was 40.4%, which was higher than that of NSAID negative, 16.5% (p<0.001). The rate of BGU bleeding in the NSAID positive was 27.7%, which was higher than that of NSAID negative, 14.3%(p=0.039). 5) The rate of NSAID history of bleeding group was 40.6%, which was higher than that of non-bleeding group, 23.0%(p=0.039). However, there was no signifi cance in the correlation of H. pylori positivity rate to the bleeding. 6) The H. pylori positivity and NSAID history showed no correlation with bleeding in the group below age sixty. While in the age over or equal to sixty the H. pylori positivity had no correlation with bleeding, but the rate of NSAID history was 72.7% for the patients with bleeding, which is in contrast with the 25.5% for the patients without bleeding(p=0.003). CONCLUSION: From these results, the H. pylori infection rate of the patients with BGU in Korea was 82.8%, and the best method for H. pylori detection was CLO test in the body. H. pylori infection had no corre lation with the bleeding, but NSAID ingestion increased bleeding tendency, particularly in the group of the age over or equal to sixty.

A Case of Toxic Epidermal Necrolysis Concomittantly Presented with GI Bleeding and Its Gastrofiberscopic Findings / 대한소화기내시경학회지

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.