A clinical observation was made on 96 cases of transurethral resection for the benign prostatic hypertrophy, admitted during the period of 3 years from January 1984 to December 1986. Previous to the transurethral resection of prostate, the suprapubic cystostomy was accomplished in 38 cases among them and following advantageous results were obtained. 1. Suprapubic cystostomy before TURP provides better endoscopic vision by continuous flow of irrigating fluid to permit no interrupted resection. 2. By eliminating the time spent for evacuation of the bladder, eye accommodation and reestablishment of surgical land marks, it permits transurethral resection of larger gland, within recognized safety guidelines. 3. It tends to minimize and prevent absorptive complications by lessening intravesical pressure. 4. It decreases operative risk by lessening operative time and the volume of fluid absorbed. 5. It provides an alternative route of irrigation and drainage intraoperatively and postoperatively.
Cystostomy* ; Drainage ; Operative Time ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate ; Urinary Bladder

Fournier's gangrene is a fulminating gangrene of the male genitalia. It is associated with severe systemic toxic effect and a high motality rate, and it requires early diagnosis and intensive care with surgical intervention. We report a case of Fournier's gangrene in 33-year-old man, who showed marked swelling and necrosis of the scrotum, and extending cellulitis on the right flank and chest. With prompt excision of all the gangrenous scrotal skin and drainage incisions made on the flank and chest, the healing was successful.
Adult ; Cellulitis ; Drainage ; Early Diagnosis ; Fournier Gangrene* ; Gangrene ; Genitalia, Male ; Humans ; Critical Care ; Male ; Necrosis ; Scrotum ; Skin ; Thorax

The increasing use and availability of renal transplantation has resulted in a demand for noninvasive methods to study possible complications. One of the most serious adverse reactions is acute rejection, a possibly reversible cause of transplant failure if treated promptly. Sixty-six donors and recipients were evaluated by duplex Doppler examination of intrarenal arteries. A simplified formula, resistive index(RI) ([peak systolic frequency shift-lowest diastolic frequency shift]/[peak systolic frequency shift]), were used to diagnose rejection. All RI values of donors were within normal limit. RI values of recipients were not significantly different according to the number of renal artery and the ischemic time during operation. With a RI greater than 0.90, a 100% positive predictive value was obtained for the diagnosis of acute rejection. A 88% positive predictive value of acute rejection was obtained with a RI greater than 0.80. A value less than 0.70 was unlikely to be rejection(negative predictive value, 95%). The results suggest that the duplex Doppler examination and the resistive index obtained by simple analysis of the wave form would be used as a valuable noninvasive method for the detection of acute renal transplant rejection. The findings of Doppler examination are not necessarily pathognomonic for one specific process, but they can aid the clinician in deciding the kind of treatment necessary and the need for biopsy.
Arteries ; Biopsy ; Diagnosis ; Graft Rejection ; Humans ; Kidney Transplantation* ; Renal Artery ; Tissue Donors

Radiologic chain cystourethrography for stress urinary incontinence (SUI) has several disadvantages including the risk of excessive radiation, the time required for the test, and the discomfort of the patients. Nowadays it is widely accepted that transrectal ultrasonography for evaluating bladder and urethra provides similar information about SUI comparing with the conventional radiographic examination. We evaluated the effectiveness of transrectal ultrasonography in the diagnosis of SUI in 30 women with SUI and in normal 20 women as a control. The results of evaluation were as follows: 1. Mean age was 52.9 in SUI group and 48.5 in control group, and mean parity was 2.8 in SUI group and 3 In control group. 2. According to the symptom grading by Stamey, 8 patients (27%) were Grade I and 22 (73%) were Grade II. 3. The mean value of posterior urethrovesical angle (PUVA) at resting state was 139 +/- 14.7 degrees in control group and 145 +/- 15.2 degrees in SUI group (p>0.05). 4. The mean value of PUVA at strain state was 146 +/- 7.9 degrees in control group and 169 +/- 12.1 degrees in SUI group (p<0.05). 5, Bladder neck descent was 7.3 +/- 2.7 mm (mean+/-SD.) in control group and 13.7+/-6.2 mm in SUI group (p<0.05). 6. Diagnostic criteria of SUI in transrectal ultrasonography are more than 149.5 degrees in PUVA at strain state, and more than 9.1 millimeter in bladder neck descent. 7. Sensitivity and specificity of transrectal ultrasonography in the diagnosis of SUI were 86% and 80% in PUVA at strain state, 80% and 80% in bladder neck descent, respectively. 8. There was significant change of transrectal ultrasonographic finding in pre and post-bladder neck suspension (p<0.05). In conclusion, transrectal ultrasonography is simple, non-invasive, not shameful, and free of radiation, so might be a useful diagnostic method in female SUI.
Diagnosis ; Female* ; Humans ; Neck ; Parity ; Sensitivity and Specificity ; Shame ; Ultrasonography* ; Urethra ; Urinary Bladder ; Urinary Incontinence*

Renal cell carcinoma has been recognized for several years as a relatively common cause of paraneoplastic syndromes. Fever, polycythemia, hypercalcemia, amyloidosis, abnormal liver function, Cushing's syndrome and neuropathy have been ostm frequently reported in association with renal cell carcinoma, but leukemoid reactions have been reported only rarely with this tumor. Recently we experienced a leukemoid reaction in a 64-year old female patient who presented with an advanced case of renal cell carcinoma. According to the literature the mortality is 100% with leukemoid reactions in renal cell carcinoma, and indeed this patient expired. We therefore, consider this reaction as a late manifestation of a bizzare presentation of renal cell carcinoma.
Amyloidosis ; Carcinoma, Renal Cell* ; Cushing Syndrome ; Female ; Fever ; Humans ; Hypercalcemia ; Leukemoid Reaction* ; Liver ; Middle Aged ; Mortality ; Paraneoplastic Syndromes ; Polycythemia

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.
Comorbidity ; Delivery of Health Care ; Depression ; Female ; Humans ; Korea ; Life Style ; Logistic Models ; Mass Screening ; Mental Health ; Questionnaires ; Risk Factors ; Smoke ; Smoking

The diagnostic significance of ultrasonography, computed tomography and magnetic resonance imaging for predicting the stage of tumors was evaluated by comparing their results with preoperative and histopathologic findings. The 24 patients who were diagnosed as renal cell carcinoma by histopathologic finding have taken preoperative examination such as ultrasonography, computed tomography. Additionally, magnetic resonance imaging was performed in 15 patients among them. The T stage was determined correctly by magnetic resonance imaging in 87% of the cases, by computed tomography in 80%. We suggested that a computed tomography is reliable imaging method for evaluating the T,N category preoperatively, but magnetic resonance imaging is more sensitive than a computed tomography in predicting the stage of renal cell carcinoma and a magnetic resonance imaging can replace the computed tomography.
Carcinoma, Renal Cell* ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

PURPOSE: To determine whether prostate-specific antigen density(PSAD) and transition zone prostate-specific antigen density(TZ-PSAD) can predict the clinical response of patients with benign prostatic hyperplasia(BPH) to alpha-adrenergic blocker(terazosin). MATERIALS AND METHODS: From January 2000 to June 2002, 202 patients with BPH who were treated with alpha-adrenergic blocker(terazosin) were enrolled in this study. The peak flow rate(Qmax) and the International Prostate Symptom Score(IPSS) were compared prior to and 3 months following medication. We analyzed total prostate volume(TPV), transition zone volume(TZV), transition zone index(transition zone volume/total prostate volume, TZI), PSAD(PSA/total prostate volume), and TZ-PSAD (PSA/transition zone volume) as predictors of the response to alpha-adrenergic blocker (terazosin). RESULTS: At 3 months following medication with terazosin, a statistically significant improvement was shown in the IPSS and Qmax. There was no significant correlation between pretreatment TPV, TZV, TZI and the percent change in the IPSS and Qmax. However, there was a significant negative correlation between pretreatment PSAD (r=-0.632, p<0.001), TZ-PSAD (r=-0.599, p<0.001) and the percentage change in Qmax, while there was a positive correlation between pretreatment PSAD (r=0.620, p<0.001), TZ-PSAD(r=0.604, p<0.001) and the percentage change in the IPSS. Using the receiver operating characteristic curves to compare PSAD and TZ-PSAD for IPSS, the areas under the respective curves were 0.867 and 0.874(cut-off values were 0.04 and 0.1), and for the Qmax, the areas under the respective curves were 0.876 and 0.873(cut-off values were 0.04 and 0.1). CONCLUSIONS: Patients with a lower pretreatment PSAD and TZ-PSAD responded better to alpha-adrenergic blocker than those with a higher pretreatment PSAD and TZ-PSAD. PSAD and TZ-PSAD were predictors of the response to alpha-adrenergic blocker (terazosin) in patients with BPH.
Adrenergic alpha-Antagonists ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; ROC Curve

Congenital chylothorax is a rare disorder and can be diagnosed by prenatal ultrasonography recently. Most cases of congenital chylothorax were characterized by different clinical courses of respiratory distress. We describe two female cases with congenital chylothorax observed by ultra- sonography prenatally. In the first case, left-sided pleural effusion was noted by prenatal ultrasonography taken at 34 weeks of gestation, and then pleural fluid was extracted by intrauterine thoracentesis under sonography guidance. After birth, this patient was managed by TPN(total parentral nutrition) and intermittent thoracentesis without surgical treatment. But, pleural fluid was accumulated recurrently and respiratory distress was aggravated. At 15th hospital day, shock state was developed and patient died. In the second case, bilateral pleural effusion and ascites were noted by prenatal ultrasonography, and then patient was delivered immediately without intrauterine thoracentesis. After birth, the second case received conservative therapy including mechanical ventilation, TPN, intermittent thoracentesis and paracentesis. The patient was discharged with complete regression of chylothorax. We report the two cases with brief review of related literatures.
Ascites ; Chylothorax* ; Female ; Humans ; Paracentesis ; Parturition ; Pleural Effusion ; Pregnancy ; Respiration, Artificial ; Shock ; Ultrasonography, Prenatal*

The posterior lumbotomy was a useful approached for removal of a small kidney, for bilateral nephrectomy in patients with chronic renal failure, for pyeloplasty, for pyelolithotomy when a stone was filled the pelvis and was not able to migrated, or for an upper ureterolithotomy when the stone was firmly impacted. During a 32 month interval 19 patients underwent upper ureterolithotomy through the posterior lumbotomy approach. The intraoperative course and postoperative performance were compared to the patients operated upon using the standard flank incision. Our analysis established the superiority of the posterior lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and postoperative hospitalization.
Drainage ; Hospitalization ; Humans ; Kidney ; Kidney Failure, Chronic ; Nephrectomy ; Pelvis