Biomedical subjects
Publications and source records attributed to Jang Hwan Kim.
To overcome the technical difficulties of a third renal transplantation, we developed a refined technique. After native ureteral stenting, the subhepatic retroperitoneum was approached by way of a midline incision. The renal vein was sewn to the vena cava, the artery to the common iliac artery, and the ureter to the native stented ureter.
OBJECTIVES: To evaluate the significance of vesicoureteral reflux (VUR) in adult women with uncomplicated acute pyelonephritis. METHODS: Eighty-six adult women with uncomplicated acute pyelonephritis were studied from April 1998 to October 2003. They showed no structural urinary tract abnormalities. The mean age of patients was 36.2 years (range, 19 to 54 years). We divided these patients into two groups. In group I (31 patients), we performed a voiding cystourethrogram (VCUG) on the third day of treatment to demonstrate possible transient low-grade VUR during the acute infectious phase. In group II (the remaining 55 patients), we performed VCUG after the seventh day of treatment. RESULTS: There were only 2 (2.3%) cases of VUR among 86 patients with uncomplicated acute pyelonephritis. No VUR was found in group I, and grade II reflux was found in 2 patients of group II. CONCLUSIONS: These results indicate that, unlike in children, VUR is not a significant factor causing ascending infection leading to the development of acute pyelonephritis in adult women. Further research is warranted regarding the pathophysiology of ascending infection in the adult population.
OBJECTIVES: To create a model of peripheral neuropathy and explore the potential of using muscle-derived cells (MDCs) to facilitate the regeneration of autonomic nerves and improve bladder function. Damage to the peripheral nerves that innervate the bladder from radical pelvic surgery is refractory to the currently available treatments. METHODS: Rat MDCs were isolated from the gastrocnemius muscle using the preplate technique. The unilateral pelvic nerve was cut in female Sprague-Dawley rats. Three experimental groups were included: control (n = 5); unilateral pelvic nerve transected with sham injection (n = 5); and unilateral pelvic nerve transected with injection of MDC (3 x 10(5) cells/site; n = 5). Two weeks after injection, the intravesical pressures were measured during electrical stimulation of the proximal transected preganglionic nerve. The contralateral major pelvic ganglion was excised to ensure that any observed bladder activity was due exclusively to inputs on the unilateral side. The rats were killed, the experimental side major pelvic ganglion was removed, and enkephalin immunoreactivity was counted. RESULTS: After unilateral pelvic nerve transection, no change occurred in bladder weight or capacity or postvoid residual urine volume. The maximal intravesical pressures for the control, sham, and MDC groups, after the contralateral pelvis had been cut, was 31.7 +/- 10.3, 9.6 +/- 4.5, and 15.2 +/- 7.7 cm H2O, respectively (P <0.05). After transecting the preganglionic pelvic nerve, the intensity of pericellular enkephalin immunoreactivity varicosities was significantly decreased in the sham group but unchanged in the MDC group compared with the control group. CONCLUSIONS: MDCs can promote peripheral autonomic nerve regeneration. The morphologic changes correlated with the functional neurologic recovery effect of MDCs. The underlying neurologic recovery mechanisms of MDCs need to be exploited.
PURPOSE: We observed concomitant improvement in fecal incontinence in children with myelomeningocele undergoing intravesical electrical stimulation (IVES) to decrease uninhibited bladder contractions and increase bladder capacity and/or bladder sensation. We retrospectively reviewed the effect of intravesical electrical stimulation on neurogenic bowel dysfunction in these children. MATERIALS AND METHODS: A total of 9 boys and 15 girls 3.9 to 13.2 years old (mean age 8.1) completed a mean of 30.3 daily sessions (range 10 to 69) of IVES. Evaluation forms were used to record frequency of fecal incontinence, daily bowel movement and diaper use before and after IVES. RESULTS: The mean number of overall fecal incontinence episodes decreased significantly from 7.36 to 4.8 a week after IVES (p <0.05). Greater than 50% decrease in the episodes of fecal incontinence was observed in 75% of the patients. However, there was no significant change in the number of daily bowel movements before (1.8 daily) and after (1.55 daily) IVES. CONCLUSIONS: These results demonstrate the therapeutic effect of IVES in children with neurogenic bowel dysfunction and spina bifida. We believe that IVES is another viable option for controlling fecal incontinence in these children.
PURPOSE: Various factors are involved in testicular descent, and no single factor is elucidated as the cause of cryptorchidism. We prospectively observed the locations of gubernacular attachments in the cryptorchid testis. MATERIALS AND METHODS: From April 1996 to June 2002, 639 boys underwent surgical correction of cryptorchid testis. Those with complete records of testicular locations and gubernacular attachments were analyzed. RESULTS: A total of 639 boys underwent 732 surgical corrections of inguinal testis (425, 58%), high scrotal testis (165, 23%) and impalpable abdominal testis (142, 19%). Impalpable abdominal testes had gubernacular attachment to either the lateral or upper scrotum in 36 cases (25%) or around the inguinal ring in 83 (58%). The gubernaculum was attached to the bottom of the scrotum in 21 inguinal testes (5%), to the lateral or upper scrotum in 132 (31%) or around the inguinal ring in 268 (63%). In cases of high scrotal testis the gubernaculum was attached usually to the bottom of the scrotum (28, 17%), to the lateral or upper scrotum (109, 66%) or around the inguinal ring (26, 16%). CONCLUSIONS: The locations of distal gubernacular attachments in the cryptorchid testis were usually abnormal (93%). In these cases the possible testicular descent induced by hormonal therapy may either be insufficient or unable to prevent future ascent. Thus, early surgical correction rather than hormonal therapy is warranted in boys with cryptorchid testis.
PURPOSE: Increasing clinical importance is being placed on the role of differential renal function (DRF) in the management of congenital ureteropelvic junction obstruction. Supranormal DRF of the hydronephrotic kidney on renal scan is a puzzling phenomenon and is hypothesized to be due to an increase in single nephron filtration or nephron volume without sound evidence. We studied the histopathological changes of hydronephrotic kidneys to determine whether glomerular hypertrophy underlies supranormal DRF. MATERIALS AND METHODS: We retrospectively evaluated the records of 3 females and 32 males with unilateral congenital hydronephrosis who underwent pyeloplasty. Mean patient age at operation was 12.6 months (range 0.1 to 144). Needle biopsies from 3 different sites at the lower pole of the kidney were performed during surgery. To evaluate the presence of glomerular hypertrophy, the maximal planar area of glomeruli was measured under light microscopy using an image analyzer. Tissue samples obtained from kidneys without a history of urinary tract disease at autopsy were used as controls. The mean glomerular areas of the patient and control groups were evaluated according to DRF and age. RESULTS: The mean glomerular area values of the patient group were smaller than those of the control group, except for 4 patients. The glomerular areas of the hydronephrotic kidneys with supranormal DRF were not significantly different from those of the control group. Instead, the probability of larger renal glomeruli increased with decreasing DRF (p = 0.1155). CONCLUSIONS: Increased nephron volume can be discounted as a cause of supranormal DRF.
OBJECTIVE: Resiniferatoxin (RTX) is an analogue of capsaicin with more than 1,000 times its potency in desensitizing C-fiber bladder afferent neurons. This study investigated the safety and efficacy of intravesical RTX in patients with refractory detrusor hyperreflexia (DH). METHODS: Thirty-six (22 males, 14 females) neurologically impaired patients (20 spinal cord injury, 7 multiple sclerosis, 9 other neurologic diseases) with urodynamically verified DH and intractable urinary symptoms despite previous anticholinergic drug use were treated prospectively with intravesical RTX using dose escalation in a double-blind fashion at 4 centers. Patients received a single instillation of 100 mL of placebo (n = 8 patients) or 0.005, 0.025, 0.05, 0.10, 0.2, 0.5, or 1.0 microM of RTX (n = 4 each group). A visual analog pain scale (VAPS) (0-10; 10 = highest level of pain) was used to quantify discomfort of application. Treatment effect was monitored using a bladder diary and cystometric bladder capacity at weeks 1, 3, 6, and 12 posttreatment. RESULTS: Mean VAPS scores revealed minimal to mild discomfort with values of 2.85 and 2.28 for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. Due to the small sample size, there were no statistically significant changes in mean cystometric capacity (MCC) or incontinence episodes in each treatment dose group. However, at 3 weeks, MCC increased by 53% and 48% for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. Patients in the 0.5-microM and 1.0-microM groups with MCC < 300 mL at baseline showed greater improvements in MCC at 120.5% and 48%, respectively. In some patients, MCC increased up to 500% over baseline, despite a low RTX dose. Incontinence episodes decreased by 51.9% and 52.7% for the 0.5-microM and 1.0-microM RTX treatment groups, respectively. There were no long-term complications. CONCLUSION: Intravesical RTX administration, in general, is a well-tolerated new therapy for DH. This patient group was refractory to all previous oral pharmacologic therapy, yet some patients responded with significant improvement in bladder capacity and continence function shortly after RTX administration. Patients at risk for autonomic dysreflexia require careful monitoring during RTX therapy.
Disorders of the seminal vesicle have been evaluated mainly via imaging techniques. We developed a technique to examine the interior of seminal vesicles endoscopically. In 37 hemospermic patients, transrectal ultrasound (TRUS) or endorectal MRI were performed preoperatively. When the patients had definite abnormalities on the imaging studies and did not improve after medication over a period exceeding 3 months, transutricular seminal vesiculoscopy was performed using a 6F or a 9F rigid ureteroscope. Patients were then followed for at least 3 months. Endoscopic evaluation was also performed in two patients with stage B(1) and D(2) prostate carcinoma. In hemospermic patients, hemorrhage was found in the seminal vesicles or the ejaculatory ducts in 23 (62.2%) and 3 (8.1%), respectively. Calculi were present in the seminal vesicles or ejaculatory ducts in 6 (16.2%) and 2 (5.4%), respectively. In prostate carcinoma patients, seminal vesiculoscopy was similarly informative. Postoperative complications, including epididymitis or retrograde ejaculation, were not observed. Transutricular seminal vesiculoscopy can be performed easily with conventional endoscopic equipment and provides useful information.
The clinical reports on Sildenafil sulfate (Viagra) are mainly based on individual observations. However, there is a paucity of objective studies in the literature. In order to objectively examine the effect of Sildenafil, a SS (Sexual Stimulation)-Penogram that is a non-invasive, simple and physiologic method was developed using a radioisotope (RI). One hundred and four SS-penograms were performed on patients who had a documented erectile dysfunction (ED) lasting for more than 6 months. After an intravenous injection of 99mTc-RBC (15 mCi), the first penogram was taken immediately after sexual stimulation, which was done by 30 minutes of erotic videotape viewing. Forty minutes after administering 25 to 100 mg of Sildenafil, a second penogram was taken. The characteristics of each penogram were analyzed according to a previously reported method. The results were graded as follows; Type I(normal function; 5 min or more of peak erectile response with an induction period of 1 to 6 min), Type II-A (impossible function type; i.e., showing less than 2 times the basal radioactivity level), Type II-B (the unstable type; showing less than 5 min of peak erectile response), and Type II-C (the delayed type; which showed a delay of more than 15 min after the start of sexual stimulation). The patients were grouped according to their response after Sildenafil administration, and the effect of Sildenafil was assessed by comparing the radioactivity from between 7 to 22 minutes and the changes in the characteristics of the penogram. The mean age of the patients was 44.9 +/- 10.2 (23 - 68) years. In the first penogram, Type I was found in 12 patients, and Type II-A in 14, Type II-B in 73, Type II-C in 1 and a mixed (II-B + C) type was found in 4 patients. A second penogram after Sildenafil administration, showed Type I in 46 patients, and Type II-A in 10, Type II-B in 46 and a mixed type was found in 2 patients. The responses after Sildenafil were categorized as follows: 1) An excellent response group (consisting of 56 patients-53.9%); Those who showed greater than 50% increase in the RI area after Sildenafil treatment. 2) A good response group consisting of (23 patients-22.1%); i.e., those who showed a less than 50% but greater than a 20% increase in the RI area after Sildenafil administration. 3) A borderline group (consisting of 15 patients-14.4%); showing less than a 20% change in the RI area after Sildenafil treatment. 4) non-response group (consisting of 10 patients-9.6%). The therapeutic efficacy of Sildenafil, as determined by the SS-penograms, revealed that there was an augmentation in the erectile capabilities in 76% of men (79/104) but a non-response was observed in 9.6% (10/104). The efficacy of Sildenafil on the SS-penogram did not correlate with the patient's age (p=0.198). It is believed that the SS-penogram can be used to accurately evaluate the natural erectile status in sexual and pharmacological stimulation, and provides the most objective erectile response in any therapeutic trial. Consequently, the primary challenge for any erectile dysfunction remedy is to be able to demonstrate its efficacy. A further evaluation is warranted in the non-response group, which was not based on any severe organic dysfunction.
The clinical benefits of intravesical electrical stimulation (IVES) in patients with increased residual urine or reduced bladder capacity have been reported. However, studies on the underlying mechanism of IVES has been limited to the Adelta afferent and parasympathetic neurons. This study investigated the changes in the calcitonin gene-related peptide (CGRP), substance P (SP), and nitric oxide synthase (NOS) expression in the thoracolumbar and lumbosacral dorsal root ganglia (DRG) of spinalized rats to determine the effect of IVES on the C fiber afferent nerve. Forty Sprague-Dawley rats were divided into normal controls (n=10); IVES treated normal rats (n=10), spinalized rats (n=10), and IVES treated spinalized rats (n=10). IVES was performed for 2 weeks (5 days a week). IVES was started 3 weeks after spinalization in the spinalized animals. All animals had the DRG removed at the thoracolumbar (T13-L2) and lumbosacral (L5-S1) level. Changes in the CGRP, SP and n-NOS levels at the DRG were measured by western-blot analysis. The relative density of the CGRP and SP following spinalization was significantly higher compared to the controls in both the T13-L2 and L5-S1 DRG. However, IVES in the spinalized rat significantly decreased the relative density of the CGRP and SP compared to the rats with spinalization alone. A significant increase in the relative density of n-NOS was detected in the L5-S1 DRG following spinalization. However, the density of n-NOS was significantly lower after IVES in both the T13-L2 and L5-S1 DRGs. In conclusion, IVES significantly reduced the CGRP, SP and n-NOS levels in the DRG of spinalized rats. CGRP, SP and n-NOS are the main factors that contribute to the hyperexcitability of the micturition reflex after spinal cord injury. These results suggest that the bladder C fiber afferent is also involved in modulating the micturition reflex by IVES.