Percutaneous Endopyelotomy is a natural outgrowth of technique developed for percutaneous ureteral and renal stone removal. In it`s comparison to the Davis ureterotomy technique, a rationale for this procedure and explanation for it`s success is provided. Endopyelotomy, which we performed experimentally to prevent recurrent stone formation, has now matured into a viable procedure under the certain guideline. This procedure has become our first choice for secondary ureteropelvic junction obstruction but primary cases were not experienced. Although classical pyeloplasty must be main surgical means to UPJ obstruction, technical and equipmental advanced could be enabled us to perform 8 endopyelotomy. We incised UPJ obstruction in 8 cases with direct vision nephroscope inserted through a percutaneous nephrostomy tract and ureteroscope. In 6 patients, renal calculi were removed endourologically during same and separate session. There were no immediate complication and nephrostogram showed adequate drainage in all cases.
Drainage ; Humans ; Kidney Calculi ; Nephrostomy, Percutaneous ; Ureter ; Ureteroscopes

We have reviewed 1211 burn patients who had visited our emergency department of Keimyung University Dongsan medical center between April 1995 to March 1997. The following results were obtained; 1) On age and sex distribution, the highest incidence of age group was under 10 year and old in 321 cases(26.5%). Male was affected more frequently than female, the incidence being 847 cases(70.1%) and 364 cases(29.9%). The ratio of male to female was 2.3:1. 2) No monthly and seasonal differences could be recognized. We found winter season having the highest 319 cases(26.3%), followed by autumn, spring and summer. 3) An analysis of causes in burns showed that flame burns were 527 cases(43.1%), scalding burns, 486 cases(40.2%), electrical burns, 96 cases(8.1%) and chemical burns, 48 cases(4.1%). 4) Domestic accidents accounted for 639 cases(52.7%), occupational for 286 cases(23.6%), traffic accidents for 160 cases(13.2%), suicides for 122 cases(10.1%), formentation for 4 cases(0.4%). 5) Most of patients 699 cases(57.7%) were affected with 2nd degree burn in depth, 1st degree for 413 cases(34.1%) and 3rd degree for 99 cases(8.2%). 6) The trunk was the anatomical region most commonly affected followed by upper and lower limbs. 7) 243 cases(20.5%) of all were accompanied by some complications. The main complications were would infection noted in 212 cases(17.5%), pneumonia in 179 cases(14.8%), acute renal failure in 160 cases(13.2), contracture in 155 cases(13.0), urinary tract infection in 24 cases(2.0%), Curling ulcer in 20 cases(1.6%) in order. 8) The over-all mortality rate was 73 cases(6.1%). The mortality rate of the patients with inhalation injury were 33 cases(45.3%). Causes of death were due to sepsis in 54 cases(4.5%), ARDS in 11 cases(0.9%), acute renal failure in 5 cases(0.4%), upper GI bleeding in 2 cases(0.2%), purmonary edema in 1 cases(0.1%).
Accidents, Traffic ; Acute Kidney Injury ; Burns* ; Burns, Chemical ; Cause of Death ; Contracture ; Duodenal Ulcer ; Edema ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Incidence ; Inhalation ; Lower Extremity ; Male ; Mortality ; Pneumonia ; Seasons ; Sepsis ; Sex Distribution ; Suicide ; Urinary Tract Infections

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.
Carotid Artery, External ; Carotid Artery, Internal ; Craniocerebral Trauma ; Fistula* ; Ligation ; Skull Fractures

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.
Carotid Artery, External ; Carotid Artery, Internal ; Craniocerebral Trauma ; Fistula* ; Ligation ; Skull Fractures

BACKGROUND: The currently available ldegrees Cal anesthetics have limitations in action duration. The duration ranges from 3 to 8 hours. Long acting anesthetic agents are particularly desirable to manage postoperative pain, relieve severe pain assdegrees Ciated with terminal cancer, and for nerve bldegrees Cks carried out in pain clinics. In this paper mixture of ldegrees Cal anesthetics was formulated into cylindrical pellet using biodegradable polymer and its efficacy and safety was evaluated. METHODS: Pellets were prepared by modified melting prdegrees Cess with biodegradable polyester 30 wt%, bupivacaine 35 wt%, liddegrees Caine 35 wt% and dexamethasone 0.05 wt% of polymer and drug. In vitro release kinetics of ldegrees Cal anesthetics from pellet were determined in PBS at pH 7.4, 37degrees C, and the released ldegrees Cal anesthetics were analyzed by HPLC. Nine male Sprague Dawley weighing 300~350 gm were implanted with pellets along the sciatic nerve and the sensory bldegrees Ckade was assessed by an analgesiometer. The duration data were analyzed by paired t-test using SAS 6.11. RESULTS: Ldegrees Cal anesthetics were released in a controlled manner in vitro. In general, 40~50% of the drug released for the first day, and thereafter approximately 5% released daily. Sensory bldegrees Ckade lasted to beyond 2 days at the dose of 7 mg/100 g bupivacaine and liddegrees Caine respectively. All of the animals exhibited no systemic toxicity and complete recovery. CONCLUSIONS: The results indicated that the mixture pellet demonstrated efficient and safe in prolongation of sensory bldegrees Ckade for significant period of time. The mechanisms underlying the mixture effect are under investigation.
Anesthetics* ; Animals ; Bupivacaine ; Chromatography, High Pressure Liquid ; Dexamethasone ; Freezing ; Humans ; Hydrogen-Ion Concentration ; Kinetics ; Male ; Pain Clinics ; Pain, Postoperative ; Polyesters ; Polymers* ; Sciatic Nerve

The primary melanoma of spinal cord was rarely reported in the literatures. The authors report a case of primary spinal maligmant melanoma in the cervical spinal cord. A 41-year-old man presented several months history of right shoulder pain and right hemiparesis. Plain X-ray of the cervical spine, myelography, computerized tomography and magnetic resonance imaging showed intradural mass from third to fifth cervical spine level. The operation was performed, and intradural intra-and extramedullary brownish black tumor, which focally infiltrated to the dura and inner surface of lamina, was removed and the histological diagnosis was maligmant melanoma. And then chemotherapy with vincristine, bleomycin, cisplatine, followed by whole central nervous system radiation therapy was performed. The patient was discharged and followed up with no neurological interval change. The pertinent literature of spinal cord melanoma is reviewed and its rareness is discussed.
Adult ; Bleomycin ; Central Nervous System ; Cisplatin ; Diagnosis ; Drug Therapy ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Myelography ; Paresis ; Shoulder Pain ; Spinal Cord* ; Spine ; Vincristine

OBJECTIVE: Psychiatric disorders such as depression, anxiety and alcohol dependence are associated with serotonin metabolism. We assessed the methylation level of the serotonin transporter (5-HTT) promoter region in control and alcohol dependent patients. METHODS: Twenty seven male patients who met the Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV) criteria for alcohol dependence were compared with fifteen controls. Polymerase chain reaction (PCR) assays of bisulfate-modified DNA were designed to amplify a part of the CpG island in the 5HTT gene. Pyrosequencing was performed and the methylation level at seven CpG island sites was measured. RESULTS: We found no differences in the methylation patterns of the serotonin transporter linked promoter region (5-HTTLPR) between alcohol-dependent and control subjects. CONCLUSION: Our negative finding may be because 5-HTT epigenetic variation may not affect the expression for 5-HTT or there may be other methylation site critical for its expression. To find out more conclusive result, repeating the study in more methylation sites with a larger number of samples in a well-controlled setting is needed.
Alcoholism ; Anxiety ; CpG Islands ; Depression ; DNA ; Epigenomics ; Humans ; Male ; Mental Disorders ; Methylation ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

BACKGROUND: The studies on prediction equations of pulmonary function parameters for adults in Korea have been performed in a reference population mainly consisted of young and middle ages. So they included a relatively few elderly who conducted pulmonary function test frequently in clinic. We established prediction equations of pulmonary function parameters for healthy adults over 50 years old in rural area and compared this results with those of other studies. Therefore we attempted to consider normative values of pulmonary function tests for elderly in Korea. METHOD: Five hundred thirty-three women and men over 50 years old in rural area were participated. A "healthy" subgroup of 110 women and 32 men were identified by excluding those who had conditions that negatively influenced pulmonary function. We derived prediction equations for FVC, FEV1, and FEV1% by multiple linear regression method from their age, heights and weights in each sex. RESULTS: Prediction equations for FVC and FEV1 in each sex were derived as follows Male; FVC (L) = 0.02488Height(cm) - 0.0269Age(years) + 0.493 FEV1(L) = 0.01874Weight(kg) - 0.0282Age(years) + 2.906 Female; FVC(L) = 0.02160Height(cm) - 0.0192Age(years) - 0.0125 FEV1 (L) = 0.01720Height(cm) - 0.0194Age(years) + 0.3890 Prediction equations for FEV1 % were not derived because FEV1 % didn't have statistically significant terms. Comparing Predicted values that were calculated by substitution into the equations of various studies of mean values of age, heights and weights from this study, FVC and FEV1 values in men of this study were lower than those of other studies. In women, FVC and VEV1 values of this study were as similar as or lower than those of the study conducted for healthy elderly blacks in U.S.A respectively. CONCLUSION: We have got prediction equations of pulmonary function parameters which were driven from forced expiratory spirogram in adults over 50 years old in rural area. Predicted values of this study were lower than those of other studies which were conducted in Korea. So we consider that the study for spirometry reference values for elderly Korean using the method compatible with ATS recommendation need to be conducted more frequently forward.
Adult* ; African Continental Ancestry Group ; Aged ; Female ; Humans ; Korea ; Linear Models ; Male ; Middle Aged* ; Reference Values ; Respiratory Function Tests ; Spirometry ; Weights and Measures

No Abstract available.
Heart Septal Defects, Atrial* ; Parturition*

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated. The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits. Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution. It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.
Adult ; Aged ; Alcohol Drinking ; Cognition ; Dementia ; Drinking ; Humans ; Neuroimaging ; Neuroprotective Agents