Chul Moon

Sexual Function and Quality of Life in Korean Women with Chronic Renal Failure on Hemodialysis: Case-Control Study

OBJECTIVE To assess sexual function and quality of life (QOL) in Korean women with chronic renal failure (CRF) receiving hemodialysis. METHODS Between March 2006 and February 2007, we enrolled 38 consecutive patients between 30 and 64 years old (mean age, 46.1 years old). We enrolled 37 age-matched individuals who visited health promotion center in the study as controls. All were evaluated for estradiol, testosterone, prolactin, and follicle-stimulating hormone (FSH) levels. To obtain sexual function and QOL assessments, the patients and controls were asked to fill out the Female Sexual Function Index (FSFI) and the Medical Outcomes Study Short Form (SF-36). RESULTS The rate of menopause was significantly different between groups (78.9% in the patient group and 27.0% in the control group, P <0.001). The patient group had lower levels of estradiol and testosterone and higher levels of prolactin and FSH than the control groups (all P <0.05). Of the six domains in the FSFI questionnaire, scores of all domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain were significantly lower in the patient group than in the control group (all P <0.05). Regarding the SF-36, the patient group had lower scores on physical functioning, role-physical functioning, role-emotional functioning, vitality, and general health perception (all P <0.05). CONCLUSIONS Hormone disturbances and early menopause are common in Korean women with CRF receiving hemodialysis. In addition, our findings suggest that these patients have higher disturbances in sexual function and QOL than the normal population.

Prediction of post-operative pancreatic fistula in pancreaticoduodenectomy patients using pre-operative MRI: a pilot study.

BACKGROUND Post-operative pancreatic fistula (POPF) is one of the most fearful complications which may occur after pancreaticoduodenectomy (PD). The methods used to predict POPF pre-operatively have not been studied in great detail. We analyzed correlation between various parameters related to PD including pre-operative magnetic resonance imaging (MRI) signal intensity (SI), pathology of pancreatic fibrosis and occurrence rates of POPF, and verified that MRI SI results could be the determining values for pre-operative prediction of POPF. METHODS From January 2005 to August 2006, we retrospectively examined 43 cases of PDs by reviewing abdominal MRI findings, degree of fibrosis of remnant pancreatic stump, and other surgery-related parameters. RESULTS POPF encountered in PD were 11 cases (25.6%). Operation time and degree of fibrosis of remnant pancreatic cut surface were related to POPF (P= 0.030, P= 0.010). The pancreas-liver SI ratio (PLSI) between fistula group and no fistula group was -0.0009 +/- 0.2 and -0.1297 +/- 0.2, respectively (P= 0.0004). The pancreas-spleen SI ratio (PSSI) in each group was 0.423 +/- 0.25 and 0.288 +/- 0.32, respectively (P= 0.014). Using quantitative analysis, the SI ratios were 1.27 and 0.66 in each group (P= 0.013). CONCLUSIONS When analyzing the results of POPF in 43 patients who underwent PD, PLSI, PSSI and qualitative analysis, fistula group differed significantly from no fistula group. Using these results, it will be helpful for us to predict the occurrence of POPF pre-operatively using MRI in PD patients.

Fogarty balloon application technique in dislodging residual thrombus on the single sheath entry point at the apex of thrombosed loop grafts.

PURPOSE We aimed to evaluate the effectiveness of the Fogarty balloon application in dislodging residual thrombus at the sheath entry point in a graft by using single apex puncture to declot thrombosed hemodialysis loop grafts. MATERIALS AND METHODS The apex puncture technique was used in 520 cases to declot 376 hemodialysis loop grafts (male/female, 150/226; mean age, 58 years). The Fogarty balloon application technique, which uses the Fogarty balloon to the apex, was used to compress or displace the sheath entry point residual thrombus that did not wash away spontaneously by arterial . The frequency of the use of the technique, technical success, complications, and primary patency were evaluated. RESULTS Sheath entry point thrombi were washed away spontaneously in 281 of 520 procedures (54%), and 184 procedures (35.4%) underwent a Fogarty balloon application. For a variety of reasons, the Fogarty balloon application technique was not performed in the remaining 55 procedures (10.6%). The technique was successful in 171 of 184 procedures (92.9%), and failed in 13 procedures, which required additional sheath insertion for the removal of sheath entry point thrombus. Complications included sheath dislodgment from the apex during Fogarty ballooning in one procedure and puncture site bleeding in one procedure. Primary patency was 60%, 35.2%, and 15.3% at 3, 6, and 12 months postprocedure, respectively. CONCLUSION The Fogarty balloon application technique is safe and useful for the removal of residual thrombus at the apical, peri-sheath zone when declotting occluded hemodialysis loop grafts.