An Evaluation of Vesical Urodynamics before and after Renal Transplantation in the Patients of Chronic Renal Failure / 대한비뇨기과학회지

PURPOSE: There are ample experimental and clinical data showing that if the bladder does not receive a significant urine input for a prolonged period it suffers a reduction in capacity and develops hypertonicity. We investigated the urodynamic changes before and after renal transplantation in the patients of chronic renal failure(CRF) under dialysis. MATERIALS AND METHODS: Urodynamic evaluations were performed in 47 CRF patients(25 males and 22 females, average age : 39 years) prior to renal transplantation and 4 weeks after renal transplantation. The clinical notes of each of the patients were reviewed to ascertain the cause of renal failure, duration and type of dialysis. RESULTS: The maximal flow rate , voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were abnormally low in the patients of CRF, and the degree of deterioration was more remarkable in the patients of longer duration of dialysis, but the voiding detrusor pressure was within normal range in the patients of CRF irrespective of duration and type of dialysis. The maximal flow rate, voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were increased significantly after successful renal transplantation, but the change of voiding detrusor pressure was not significant. CONCLUSIONS: The bladder capacity of CRF patients under dialysis is decreased to physiologic disuse state because of decreased urine input into the bladder for a prolonged period, but the contractility is well preserved irrespective of duration of dialysis, and the bladder capacity is recovered in the course of time after successful renal transplantation.

An Experience of Vaginoplasty with Rectos Abdominis Myocutaneous Flap for Testicular Feminization Syndrome / 대한비뇨기과학회지

Testicular feminization syndrome is characterized by 46,XY karyotype, bilateral testes, absent or hypoplastic wolffian duct, female appearing external genitalia, blind vaginal pouch, and absent or rudimentary muillerian derivatives. We experienced vaginoplasty using rictus abdominis myocutaneous flap with modified Burch bladder neck suspension in a 51-year-old patient with testicular feminization syndrome combined with stress urinary incontinence.

Validity on the Activity Index in the Functional Assessment of Stroke Patients

OBJECTIVE: The purpose of this study was to determine the validity and the reliability of the Activity Index to ascertain its value in the functional evaluation of stroke patients. METHOD: The Activity Index consists of sixteen variables divided into three main parts(mental capacity, motor activity, and ADL function) with a total value ranging from 16 to 92 points. A group of 96 stroke patients were included in this study. To determine the validity, kappa statistics between the Functional Independence Measure and the Activity Index were measured. RESULTS: In the validity study, the kappa statistics between the Functional Independence Measure and Activity Index were 0.79 and 0.84 for an initial total score and a discharge total score respectively, indicating a reasonable agreement between the two tests. In the reliability study, the Cronbach's alpha coefficient was 0.97 for the total score indicating a good internal consistency. CONCLUSION: The Activity Index demonstrated an acceptable validity and reliability for the evaluation of functional capacity of stroke patients in clinical practice.

The Time-course of Neurologic Recovery in Traumatic Spinal Cord Injury

Possible mechanisms of neurologic recovery in spinal cord injury were postulated by Ditunno Jr. JF in 1987. The first window encompasses recovery from neurapraxia within 6 to 8 weeks. The second window covers the period from 2 to 8 months after the injury. Recovery during this period might be due to peripheral sprouting of intact nerves to denervated muscle and hypertrophy of functioning muscles. The third window of recovery happens usually beyond 8 to 12 months when axonal regeneration may play a role in further increases in strength. On the basis of these possible mechanisms, we measured the neurological and functional recovery rate according to the periods of these possible mechanisms of motor recovery through 12 months following injury in 21 traumatic spinal cord injury patients. The results were as follows: 1) Neurologically, the most rapid recovery was shown within 6 to 8 weeks after injury, during the phase of recovery from neurapraxia. 2) Most of functional recovery occured in the period between 2 month and 8 month of the compensatory phase. 3) Statistically significant correlation between motor and functional recovery was shown among the incomplete spinal cord injury group. These data would be helpful in planning a timely appropriate rehabilitation program by understanding the time-course of neurologic recovery and prognostication of neurologic and functional recovery in the spinal-cord injured.

Measurement of Intervertebral Foramina on the Plain Radiographs of Patients with Cervical Radiculopathy

In this study, we measured the intervertebral foramina on the plain radiographs of cervical spine of fifty three patients who were over forty-year-old, and with single or multiple unilateral cervical radiculopathies on EMG. In order to determine if the foraminal stenosis on plain radiographs can determine the presense of radiculopathy, four parameters such as vertical diameter, mid-transverse diameter, inferior transverse diameter, and area were measured by a digital caliberator(CD-15C, Mitutoyo, Japan) and an image analyzer(VIDAS 2.0, Kontron, Germany) in 194 foramina of both sides(affected and unaffected groups). Another 80 foramina were also measured as control group in ten age-matched patients who did not show any abnormality on EMG. In control group, C4/5 intervertebral foramen showed maximal values of the parameters among foramina, with vertical diameter of 10.55+/-0.35 mm(mean+/-S.D.), mid-transverse diameter of 6.22+/-0.33 mm, inferior transverse diameter of 5.09+/-0.19 mm and area of 0.77+/-0.05 cm2. The minimal values were noted in C6/7 foramen except those of the vertical diameter which were noted in C4/5 foramen. The mid-transverse diameter and area of C7/T1 intervertebral foramen of affected group were significantly smaller than those of control and unaffected groups(p<0.05). The other values in affected group were also smaller among the groups but they did not reach statistical significance. In conclusion, the mid-transverse diameter and area of intervertebral foramen on plain cervical radiographs are somewhat useful to determine the encroachment of nerve root within the intervertebral foramen, especially in the lower cervical spine, in patients with cervical radiculopathy.