Factors Affecting Quality of Life Among Spinal Cord Injury Patients in Korea / 대한배뇨장애요실금학회지

PURPOSE: Complaints from spinal cord injury (SCI) patients are typically related to physical disability affecting activities of daily life. However, difficulties with voiding and defecation and/or sexual function can also be major concerns. The general population and even physicians are generally unaware of these complaints; therefore, this study focuses on surveying SCI patients regarding challenges that are faced in daily life. METHODS: A questionnaire was administered randomly and anonymously to SCI patients who visited the Korea Spinal Cord Injury Association and several rehabilitation hospitals in the Republic of Korea in 2013. All participants gave their consent prior to filling out the questionnaire. RESULTS: A total of 299 patients answered the questionnaire; the male to female ratio was 5.8:1 and common vectors for injury were motor vehicle accidents, industrial accidents, and falling down. Of the 169 patients who answered the ‘most troublesome’ and ‘wish would improve’ complaints questionnaire properly, urinary problems were most common, specifically incontinence and urinary tract infection. Among all patients, 67% were using clean intermittent catheterization, 63% were taking voiding-related medications, 83% had sexual desires, and among the 122 patients who did not have offspring, 27% had future plans for children. CONCLUSIONS: From this questionnaire, we discovered that SCI patients in the South Korea suffer not only from physical disability but also many other quality-of-life-related problems. When managing SCI patients, physicians should show greater concern and educate patients about problems related to voiding and sexual activity, rather than just physical disability.

What is Neuroaesthetics? : A New Paradigm in Psychiatry / 신경정신의학

Neuroaesthetics is an area of research on the essence of aesthetic experience according to the neurobiological perspective. The purpose of this article is to introduce both the important results from some studies based on neuroaesthetics and some neuroaesthetic reports in specific psychiatric disease. Aesthetic experience is thought to be a series of cognitive and affective processes for pursuing aesthetic judgment and aesthetic emotion. According to the present neuroaesthetic studies, the important domains are reward system, embodiment, aesthetic perspective in contrast with practical perspective, sublime, and so on. The neuroaesthetic approach to specific psychiatric disease is just beginning; however, case studies on the sudden appearance of artistic talents in neuropsychiatric patients have been frequently reported. We expect that neuroaesthetics is likely to continue to contribute new knowledge regarding the ultimate causes of various psychiatric diseases and the creativity of many psychiatric patients.

Low-Dose-Rate Brachytherapy for Low- and Intermediate-Risk Groups of Localized Prostate Cancer

PURPOSE: We applied low-dose-rate brachytherapy for low- and intermediate-risk groups of prostate cancer patients. Our initial experiences were analyzed to assess the result of low-dose-rate brachytherapy for low- and intermediate-risk groups of patients with localized prostate cancer. MATERIALS AND METHODS: A total of 50 consecutive patients have been treated with brachytherapy for 1 year since April 2007. Among them, a total of 24 patients in the low- or intermediate-risk groups were enrolled: 10 of the 24 patients were in the low-risk group (clinical T1a-T2b, Gleason score [GS] of 2-6, PSA<10 ng/ml), and 14 patients were in the intermediate-risk group (clinical T2b-T2c, Gleason score of 7, or PSA 10-20 ng/ml). Implantations were performed by practicing a real-time ultrasound-guided placement including prostatic capsular placement in the intermediate-risk group. All 24 patients were treated with 1 to 3 months of androgen-deprivation therapy. RESULTS: In the low- and intermediate-risk groups, the median patients' ages were 64 and 70 years, respectively. The numbers of patients in the low-risk group according to clinical T stage were 4 cases of T1c and 6 cases of T2a. The intermediate-risk group included 4 patients of stage T2a, 3 patients of stage T2b, and 7 patients of T2c. Five patients with a GS< or =6 and 9 patients with a GS of 7 were classified as being in the intermediate-risk group. Serum PSA levels in the intermediate-risk group were less than 10 ng/ml in 11 patients and 10-20 ng/ml in 3 patients. The median radiation doses delivered to 90% of the prostate in the low-risk and intermediate-risk groups were 257.5 Gy (range, 142.5-357.5 Gy) and 260.0 Gy (range, 147.5-357.5 Gy), respectively. Biochemical failure was not revealed in any case during follow-up. No patients experienced major complications. CONCLUSIONS: We can expect outstanding local control effect with low-dose-rate brachytherapy in low- and intermediate-risk prostate cancer. Our technique of modifying the insertion field in the intermediate-risk group is feasible and tolerable. However, long-term follow-up data are needed for this strategy.

Midureteral Hypoplasia at Congenital Midureteral Stricture / 대한비뇨기과학회지

Hydronephrosis is the most common abnormal finding of genitourinary tract detected by fetal ultrasonography. The causes of majority are attributed to ureteropelvic junction(UPJ) obstruction. The remaining are secondary to vesicoureteral reflux, megaureter, or posterior urethral valves. Congenital midureteral stricture is an unusual cause of hydronephrosis. We report a case in a one month old male baby with hydronephrosis(grade V, 20mm in AP diameter). He was diagnosed as a ureteropelvic junction obstruction. A mid ureteral stricture was identified with intraoperative anterograde pyelography. After removal of severely strictured ureter, the dilated proximal end was anastomosed to the spatulated distal ureter by microscope. Pathologic finding was subepithelial fibrosis and segmental inner smooth muscle attenuation. Ureteral stent was removed 2 months after surgery. Degree of hydronephrosis was markedly reduced on the follow up ultrasonography(14mm in AP diameter) 6 months after surgery.