PURPOSE: Caliceal diverticular calculi are mostly asymptomatic. In certain cases they may be associated with chronic or recurrent pain, recurrent urinary tract infections, progressive renal damage and hematur ia. The treatment of symptomatic caliceal diverticular calculi has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy (SWL), percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. Percutaneous techniques are frequently used to address the diverticular stone burden, to fulgurate the diverticular wall, to dilated the diverticular neck and improve drainage. For this reason, we reviewed 33 patients with caliceal diverticular calculi to determine whether they could be treated successfully by percutaneous nephrolithotomy (PCNL) as the initial treatment. MATERIALS AND METHODS: A total of 33 patients with caliceal diverticular calculi underwent PCNL between February 1990 and February 2000. The majority of diverticula were located at the upper pole. Access was gained via a direct target puncture. After sequential dilatation of the tract, stones were removed and the diverticular wall was fulgurated. The diverticular neck was dilated with the Amplatz dilator upto 24-30 Fr. and a 20 Fr. nephrostomy catheter was placed. RESULTS: PCNL was performed successfully in 30 patients (90.9%), but puncture was failed in 3. Mean operative time was 105 minutes and mean hospital stay was 4.5 days. All patients who were treated successfully with PCNL became stone-free without any complication. Mean follow-up was 20 months (ranged from 1 to 108 months). Of the 26 patients with symptoms preoperatively, 25 patients were rendered symptom-free (96.2%). Twenty-four patients were assessed with an intravenous urogram at 1 or 3 months and 6, 12 months and there was no stone recurrence. The diverticula were obliterated or had improved drainage in 95.8% (23/24) of assessable cases. CONCLUSIONS: We confirmed that PCNL is a safe, less invasive and effective procedure and should be considered an acceptable form of primary management of patients with caliceal diverticular stone.
Calculi ; Catheters ; Dilatation ; Diverticulum ; Drainage ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lithotripsy ; Neck ; Nephrostomy, Percutaneous ; Operative Time ; Punctures ; Recurrence ; Shock ; Ureteroscopy ; Urinary Tract Infections

No abstract available.
Antibody Formation* ; Heat-Shock Proteins* ; Hot Temperature* ; Mucocutaneous Lymph Node Syndrome*

No abstract available.
Graves Disease* ; Insulin*

In vivo 31P NMR spectroscopic study of forearm wrist flexor muscles was performed in two groups of volunteers composed respectively of 6 sedentaries and 6 canoe athletes. A continuous isometric contraction of endurance exercises was adopted in oder to assess the endurance capacity and recovery potential of skeletal muscles. Differences in high energy phosphorus metabolism between the sedentaries and athletes were evaluated with and emphasis on the intracellular pH and Pi/PCr ratio as indicators of high energy phosphorus metabolism. There were no differences of baseline pH and Pi/PCr ratio between the two groups. The athletes sustained the exercise at more acidic intracellular pH and at a higher Pi/PCr ratio of intracellular conditions for an all-out than did the sedentaries. The recovery rate of pH showed no difference between the two groups. There was a tendency of faster recovery of Pi/PCr in athletes showing half recovery time(T1/2) of 39.0±3.0 seconds as compared to that of sedentaries (55.7±7.5 seconds). The recovery rate of Pi/PCr as a function of Pi/PCr ratio at a given period of time was significantly faster in athletes than in sedentaries (P<0.001). The correlation coefficient of the recovery rate of Pi/PCr against the Pi/PCr ratio was 0.985 and 0.914 respectively for the athletes and sedentaries. The pH and the Pi/PCR ratio at an all-out state can be used as indicators of endurance capacity and the recovery rate of Pi/PCr, as a reovery potential of skeletal muscles.
Athletes* ; Exercise ; Forearm ; Humans ; Hydrogen-Ion Concentration ; In Vitro Techniques* ; Isometric Contraction ; Metabolism ; Muscle, Skeletal* ; Muscles ; Phosphorus ; Volunteers ; Wrist

OBJECTIVE: The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis. MATERIALS AND METHODS: We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1-and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists. RESULT: Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16 (62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy. CONCLUSION: MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.
Adult ; Aged ; Cholangiography/methods ; Clonorchiasis/*diagnosis/radiography ; Female ; Human ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged

Behcets disease is a chronic systemic disease of unknown etiology, which is characterized by the recurrent orogenital ulcers, eye involvement and skin manifestations. In addition to the major symptoms, it includes arthritis, vasculitis, neurologic manifestations and gastrointestinal lesions. We report a case of Behcets disease associated with intestinal ulcers. The patient, a 45-year-old female, who had been treated under the diagnosis of Behcets disease for 4 years, presented with swallowing difficulty, vaginal discharge and persistent right lower abdominal pain. Colonoscopic examination showed multiple ulcers on the ileocecal region which is reported as the most common site of gastrointestinal Behcets disease. Gastrointestinal evaluation can be useful in diagnosis of Behcets disease, especially in a patient with gastrointestinal symptoms.
Abdominal Pain ; Arthritis ; Deglutition ; Diagnosis ; Female ; Humans ; Middle Aged ; Neurologic Manifestations ; Skin Manifestations ; Ulcer* ; Vaginal Discharge ; Vasculitis

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Percutaneous transluminal angioplasty(PTA) were performed in three patients with atherosclerotic stenosis of subclavian arteries. The arteries were successfully dilated without complications during the procedure. All patients were asymptomatic during follow-up periods ranging from eight months to fifteen months after PTA.
Angioplasty* ; Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Subclavian Artery*

Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

The incidence of the cutaneous tuberculosis has shown a steady decline over the past decades. This parallels the decreasing incidence of pulmonary tuberculosis. We experienced 5 cases of cutaneous tuberculosis from January 1990 to February 1991. We present herein 4 cases of cutaneous tuberculosis. They were 3 cases of vulgaris and 1 case of tuberculosis verrucosa cutis. Mantoux tests were done except one case and were reactive in all cases. Culture for Mycobacterium tuberculosis were done but Mycobacterium tuberculosis were not cultivated in the all cases. Histopathological findings showed tuberculoid granulomas in the dermis except one case and no acid fast bacilli were demonstrated on AFB stains.
Coloring Agents ; Dermis ; Granuloma ; Incidence ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Cutaneous* ; Tuberculosis, Pulmonary