ObjectiveTo explore the efficacy and indications of three kinds minimally invasive surgery treatment of upper ureteral calculus (UUC) complicating hydronephrosis.MethodsFour hundred and ninety-two patients with UUC complicating hydronephrosis were divided into three groups:minimally percutaneous nephrolithotomy (mPCNL) group (310 patients),ureteroscopy lithotripsy(URSL) group ( 130 patients) and retroperitoneal laparoscopic ureterolithotomy (RLU) group (52 patients).The operation time,blood loss,length of stay,stone-free rate and postoperative complications in three groups were compared.ResultsThe stone-free rate was 91.0％(282/310) in mPCNL group,78.5％(102/130) in URSL group and 100.0％(52/52) in RLU group,mPCNL group and RLU group were significantly higher than URSL group (P ＜0.01 ).URSL group and RLU group had the advantage of less operation time,blood loss,length of stay and postoperative complications compared with mPCNL group [ RLU group:(55.8 ± 20.5 ) min,( 10.8 ± 3.2)ml,(6.3 ± 2.1 ) d,1.9％(1/52) ;URSL group:(56.5 ± 15.2) min,(8.6 ± 1.4) ml,(5.7 ± 1.6) d,1.5％(2/130);mPCNL group:(113.8 ±42.5) min,(132.8 ±40.2) ml,(12.5 ±2.4) d,8.4％(26/310),P＜ 0.01 ].Conclusions Minimally invasive surgery on the treatment of UUC is safe and effective.URSL is preferred to treating the small UUC,RLU can improve the success rate for larger UUC.Contrary to mPCNL,which is best for merger kidney calculus,has higher stone-free rate,can be used as supplement of URSL after treatment failure.

Objective To investigate the effect of repeat transurethral resection for superficial bladder cancer. Methods One hundred and twenty patients who were newly diagnosed superficial bladder cancer were divided randomly in to two groups by mechanical sampling method,60 patients underwent second of prostate TUPKVP 4 weeks after initial transurethral and received adjuvant MMC intravesically (experiment group) and the other 60 patients received adjuvant MMC following the initial TUPKVP(control group). The two groups were followed up by cystoscopy at 3-month intervals,and then compared the recurrences between the two groups. Carcinoma in situ or muscle invasive disease were excluded from the study. Results Mean following up time was 6-24 (12.0 ±6.5) months, within the following up period,recurrence was observed in 13 (21.7%, 13/60) patients in experiment group and in 38 (63.3%,38/60)patients in control group, there was signiticantly statistical difference between the two groups (P＜ 0.01). Of all the recurrences, the recurrence rate of high grade tumor was 26.2% (11/42) in experiment group and 70.0% (35/50) in control group,the recurrence rate in experiment group was obviously less than that in control group (P ＜ 0.01). Conclusions Repeat transurethral resection can lower the recurrence of superficial bladder cancer (especially for the high grade tumor) which with initial resection, it can improve the classification of malignant rumor, and find the residual tumor, so it has value in clinical treatment.

PURPOSE: We conducted a pilot study to investigate the effects of sleep patterns on wellness in interns working in the emergency department (ED). We also looked at various factors interns considered in deciding specialties and aspects of the ED they dislike, to collect the basic data necessary for quality improvement. METHODS: We conducted a prospective observational study of interns who worked a 25 h shifts every other day by evaluating various aspects of their ellness (stress, fatigue, burnout), using questionnaires and vital signs. The questionnaires were completed four times by each subject at each shift. In total, 62 interns were assigned to teams comprised of three interns each. Each team participated in the study four times each day, once every week for 4 weeks, yielding a total of 992 questionnaires to be analyzed. RESULTS: The participating interns were 26 years of age on average. Thirty-six (58%) were male, and twenty-six (41%) were female. Systolic and diastolic blood pressure (BP) both tended to fall as time passed, as demonstrated by relatively higher BP at 8 a.m. and 4 p.m., as compared to BP measured at 3 a.m. and 9 a.m. (systolic BP p=0.003, diastolic BP p<0.0001). Similarly, pulse rate was in the normal range at 8 a.m. and 4 p.m. but tended to fall from 3 a.m. to 9 a.m. (p<0.0001). Sleep at night-time after duty was positively correlated to the degree of stress, fatigue, and burnout, with longer night-time sleep resulting in higher scores for each. Four hours or more of daytime sleep also resulted in a statistically significant increase in stress and fatigue scores. CONCLUSION: More than 4 hours daytime sleep after duty resulted in more stress and fatigue the next day. An increase in night-time sleep as well as total sleeping hours positively correlated with and resulted in increased stress, fatigue, and burnout scores.
Blood Pressure ; Emergencies ; Emergency Medicine ; Fatigue ; Female ; Heart Rate ; Humans ; Male ; Pilot Projects ; Prospective Studies ; Surveys and Questionnaires ; Reference Values ; Sleep Deprivation ; Vital Signs

PURPOSE: The role of a point of care test (POCT) is currently becoming important when treating patients and making decisions in the emergency department. It also plays a role for managing patients presenting with drug intoxication. But the availability of the test has not yet been studied in Korea. Therefore, we investigated the utility and the availability of POCT for drug screening used in the emergency department. METHODS: This was a retrospective study for those patients with drug intoxication between January 2007 and December 2010 in an urban emergency department. RESULTS: Between the study period, 543 patients were examined with a Triage(R)-TOX Drug Screen. Among those, 248 (45.7%) patients showed negative results and 295 (54.3%) patients showed positive results. The sensitivity of the test for benzodiazepine, acetaminophen and tricyclic antidepressants were 85.9%, 100%, 79.2%, respectively. CONCLUSION: POCT of drug screening in emergency department showed good accuracy especially in patient with benzodiazepine, acetaminophen and tricyclic antidepressant intoxication. Therefore, it can be useful diagnostic tool for the management of intoxicated patients.
Acetaminophen ; Antidepressive Agents, Tricyclic ; Benzodiazepines ; Drug Evaluation, Preclinical ; Emergencies ; Humans ; Korea ; Mass Screening ; Retrospective Studies