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여성 요도게실제거술 후 치골질식슬링과 Martius 지방편이식술의 유용성
한거름(Keo Reum Han),이유식(You Sik Lee) 대한임상노인의학회 2002 대한임상노인의학회지 Vol.3 No.4
Purpose: To evaluate the effects of pubovaginal sling (PVS) and Martius labial fat pad interposition (MLFI) upon patients with female urethral diverticulum after diverticulectomy. Materials and methods: Total 23 consecutive cases of urethral diverticulum were reviewed retrospectively. The pre-operative evaluation included a history, physical examination, voiding cystourethrogram, cystoscopy, transperineal ultrasound and urodynamic study to investigate the urethral function and concomitant stress urinary incontinence. Treatment consisted of transvaginal diverticulectomy alone or with PVS only or combined with MLFI. Results: The presenting symptoms were palpable vaginal mass (52.2% of cases), urinary incontinence (52.2%). frequency/urgency (30.4%) and pain (21.7%). All patients were treated with surgical procedure. Transvaginal diverticulectomy alone was performed using a 3-layer closure in nine women (39.1%) and concomitant PVS with diverticulectomy in eight women (34.8%) with stress urinary incontinence. MLFI combined with the above procedure was performed in six women (26.l %) with large defect of urethra after resection of diverticulum. None of the women who underwent diverticulectomy with or without PVS and MLFI had urethrovaginal fistula, recurrent diverticulum or postoperative incontinence. Conclusions: In complicating cases, simultaneous transvaginal diverticulectomy, pubovaginal sling and Martius labial fat pad interposition can be performed safely and effectively.
이재석,한거름,박용석,서주태,Lee, Jae-Seok,Han, Keo-Reum,Park, Young-Seog,Seo, Ju-Tae 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.2
Objective: We investigated whether serum testosterone to estradiol ratio was decreased in infertile men and whether this condition can be corrected with oral aromatase inhibitor. Method: The serum testosterone to estradiol ratio of 26 men with testicular failure were compared with those of normal semen analysis parameter, 89 control reference group. All of 26 testicular failure group were diagnosed with the previous testicular biopsy. Then 46 men with oligospermia and/or asthenospermia were selected and treated with 1 mg of the aromatase inhibitor anastrozole ($Arimidex^{(R)}$) orally once daily for 3 months. Testosterone to estradiol ratio and semen analyses were evaluated during anastrozole therapy. Results: The testosterone level of testicular failure group was significantly lower and the testosterone to estradiol ratio was more decreased than normal semen parameter group. Forty six on-anastrozole group had significantly lower testosterone (4.6 versus 5.7 ng/ml, p<0.01) and higher estradiol (15.9 versus 23.4 pg/ml, p<0.01) than pre-anastrozole group, resulting in a decreased testosterone to estradiol ratio ($0.21{\pm}0.07$ versus $0.39{\pm}0.15$, p<0.01). Semen analyses before and during anastrozole treatment revealed significant increases in sperm count (35.5 versus 52.2 million sperm per ml, p<0.01) and motility (22.9% versus 29.3%, p<0.01). Conclusions: We identified infertile men with testicular failure had hormonal changes characterized by a decreased serum testosterone to estradiol ratio. The ratio can be corrected with aromatase inhibitor, resulting in a significant improvement in semen parameters.