Proper management of childhood and adolescent varicocele remains still controversial. In general, all methods for varicocele ablation for adults are available and include open surgical ligation, laparoscopic ligation, or percutaneous ablation. We evaluated the usefulness of percutaneous embolization of internal spermatic vein in boys with varicocele. Between February 1988 to May 1996, 48 boys of 53 varicoceles underwent percut aneous embolization. In 49 cases, the embolization were technically possible and in the other 4 cases, we could not access the internal spermatic vein because of vasospasm and venous abnormality. The results were successful in 40 cases (81.6%) and failed in 9 cases (18.4%), including 4 (8.2%) of persistent and 5 (10.2%) of recurred cases. There were no major complications except 3 cases of extravasation of contrast material. Percutaneous embolization may be recommended as a primary treatment for childhood and adolescent varicocele.
Adolescent* ; Adult ; Humans ; Ligation ; Varicocele* ; Veins*

In the treatment of maxillofacial injuries, proper intermaxillary fixation is very important in improving bone union and restoration of normal occlusion. The traditional methods of intermaxillary fixation consist of interdental wiring and ligating of arch bars to the teeth of each jaw. These methods have their fixation point within the tooth, which may afflict the tooth itself. The tooth ligation method is also unsatisfactory for partially or totally edentulous patients, necessitating adjunctive circumferential wiring and acrylic splint to effect fixation. Furthermore, because of excessive manipulations (about 14-20 wire) during interdental wiring, it increases the possibility of associated gingival and mucosal injuries, and infections acquired during operation due to skin punctures. The authors have devised an improved method of placing miniscrews into the maxilla and mandibular alveolar bone and using these miniscrews for points of intermaxillary fixation. This procedure has been used in 17 patients with variable mandible fracture. In these cases we obtained better results than those with teeth ligating methods. The advantages of author's method include easy placement and removal with minimal wiring, decreased operation time, decreased patient discomfort, reduced risk of tooth, periodontal tissues, and oral mucosa injuries, and reduced risk of delivering blood transmitted diseases (AIDS, hepatitis) by skin puncture. As far as the stabilization and oral hygiene are concerned, fixation method was found to be superior to tooth ligation methods. Moreover, in patients with multiple dental injuries, author's intermaxillary fixation method proved to be simple and safe. With these advantages, new intermaxillary fixation method without tooth ligation is very useful for mandibular fractures and maxillofacial operations.
Humans ; Jaw ; Ligation* ; Mandible ; Mandibular Fractures ; Maxilla ; Maxillofacial Injuries ; Mouth Mucosa ; Oral Hygiene ; Punctures ; Skin ; Splints ; Tooth*

Shunt infection remains one of the most frequent and disabling neurosurgical complications. We reviewed the medical records of 40 patients who between 1989 and 1997 underwent CSF shunt surgery involving a total of 48 procedures. Infection occured in six of the 40 patients and secondary postoperative infection in two; i.e. in eight of 48 procedures(16.7%); the microorganisms involved were not always isolated, though in all cases, clinical symptoms were detected. Most episodes occured within 6 months of the last shunt operation and patients under one year old are greater risk of infection than those who are older. To prevent such infection careful preoperative surgical planning is mandatory.
Humans ; Hydrocephalus* ; Medical Records

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare injury and reported less frequently in adults than children. The symptoms and prognosis of SCIWORA are associated with injury level of the spinal cord, neurologic impairment, resolution rate, etc. High level injury of the spinal cord can lead to development of quadriplegia, paraplegia, spinal shock, cardiac dysfunction, and respiratory arrest. However initial presenting cardiac arrest is extremely rare in SCIWORA. Therefore we report on a cardiac arrest patient due to SCIWORA after a motorcycle accident. A 50-year-old male was an out of hospital cardiac arrest in a transferred hospital. At the time of local hospital arrival, he was in cardiac arrest state. Therefore he received endotracheal intubation and cardiopulmonary resuscitation for 5 minutes, and spontaneous circulation returned. In our hospital, he underwent whole body computed tomography and echocardiography. He had a fibular fracture and simple multiple rib fractures without pneumothorax and hemothorax. Magnetic resonance imaging showed spinal cord edema from the cervicomedullary junction to C3 level and ossification of the posterior longitudinal ligament at C2-3 level without bony abnormality. In unknown cause of traumatic cardiac arrest, high level spinal cord injury and further evaluation of the cervical spine may be needed.
Adult ; Cardiopulmonary Resuscitation ; Child ; Death, Sudden, Cardiac ; Echocardiography ; Edema ; Heart Arrest* ; Hemothorax ; Humans ; Intubation, Intratracheal ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Motorcycles ; Out-of-Hospital Cardiac Arrest ; Paraplegia ; Pneumothorax ; Prognosis ; Quadriplegia ; Rib Fractures ; Shock ; Spinal Cord ; Spinal Cord Injuries ; Spine

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

PURPOSE: To report on the changes in the patterns of care and survival over time for esthesioneuroblastoma. MATERIALS AND METHODS: We retrospectively analyzed 42 previously untreated and histologically confirmed esthesioneuroblastoma patients seen between March 1989 and June 2007. According to Kadish's classification, 3 patients (7%) were stage A, 6 (14%) at stage B, and 33 (79%) at stage C. Of the 33 Kadish C patients, 19 and 14 patients were treated from 1989 through 2000 and from 2001 through 2007, respectively. Treatment included surgical resection, radiotherapy, chemotherapy, or a combination of these methods. Chemotherapy was administered to 8 of 19 patients (42%) seen from 1989 through 2000, whereas all of the 14 patients seen from 2001 through 2007 received chemotherapy (p<0.001). No patient was treated by three-dimensional conformal radiotherapy (3D-CRT) from 1989 through 2000, however 8 of 14 patients (67%) seen from 2001 through 2007 underwent 3D-CRT (p<0.001). The median follow-up time for surviving patients was 6.5 years (range, 2.2~15.8 years). RESULTS: The 5-year overall survival (OS) and progression-free survival (PFS) rates for the entire cohort were 53% and 39%, respectively. The 5-year OS was 100% for Kadish stages A or B and 39% for stage C (p=0.007). For patients with stage C disease who were treated from 1989 to 2000 and from 2001 to 2007, the 5-year OS rate was 26% and 59% (p=0.029), respectively and the corresponding 5-year PFS rate was 16% and 46% (p=0.001), respectively. Intraorbital extension and treatment era (1989~2000 vs. 2001~2007) were found as independent factors for OS and PFS in a multivariate analyses. CONCLUSION: The results of this study suggest that treatment era, which features a distinction in treatment modality and technique with the introduction of 3D-CRT, may be the cause of improved OS and PFS in Kadish stage C patients. To achieve better outcomes for patients with Kadish stage C, combined chemoradiotherapy, especially 3D-CRT, is recommended in addition to surgery.
Chemoradiotherapy ; Cohort Studies ; Disease-Free Survival ; Esthesioneuroblastoma, Olfactory ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis ; Radiotherapy, Conformal ; Retrospective Studies

PURPOSE: Emergency department (ED) and Outpatient department (OPD) are similar to some extent, but there are differences. The difference is complaints that can be encountered during practice. The aim of this study was to investigate complaints of OPD and ED and factors associated with Re-visits. METHODS: We retrospectively investigated 431 official complaints of visitors and 426 re-visitors in one tertiary university hospital OPD and ED between January 1, 2011 and December 31, 2014. RESULTS: ED complaints were 18 times more common than OPD. The two groups differed in chronic disease, follow up duration and frequency, transportation, visiting day of the week, visiting time, relation between patient and claimant, claimant age, related department, medical department, method of expression, major reason for complaints, treatment result, and re-visit. The factors associated with ED re-visits were chronic disease, follow up duration and frequency, treatment result, and expression method. CONCLUSION: Doctors, particularly emergency physicians in the ED, were the subject of the most common complaints. Patients had more complaints about the subjective time delay than the ED retention time. Emergency physicians should be more alert for first visit patients.
Chronic Disease ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Follow-Up Studies ; Humans ; Office Visits ; Outpatients ; Personal Satisfaction ; Retrospective Studies ; Tertiary Care Centers* ; Transportation

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gastroenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal 2(nd) portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.
Acute Kidney Injury* ; Adult ; Caustics ; Dilatation ; Drug Overdose ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophageal Stenosis ; Esophagus ; Follow-Up Studies ; Gastric Lavage ; Gastrointestinal Hemorrhage ; Hand ; Humans ; Kidney ; Kidney Failure, Chronic ; Mucous Membrane ; Pharyngitis ; Proton Pump Inhibitors ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Silicates ; Silicon Dioxide ; Stomach ; Suicide ; Tolnaftate ; Ulcer

Objective: Appropriate triage in emergency rooms is fundamental. This study assessed the appropriateness of the triage results using the Korean Triage and Acuity Scale (KTAS) by emergency medical technicians (EMT) by comparing an emergency physician and a KTAS instructor. Methods: The medical records of patients who presented to a local emergency room for a month were analyzed retrospectively. This study compared the triage results using KTAS among EMTs, an emergency physician, and a KTAS instructor. Results: Among 2,248 patients, consistent KTAS codes of 1,453 patients (64.6%) were obtained between the EMTs and emergency physicians. In addition, a KTAS instructor had agreed with the results of EMT for 1,686 patients (75%). The Kappa value to evaluate the agreement between an emergency physician and a KTAS instructor was 0.72 (95% confidence interval, 0.55-0.89). Conclusion The results of triage using KTAS by EMT was appropriate because substantial agreement existed between an emergency physician and KTAS instructor. On the other hand, there were some inappropriate results of triage, and it is proposed that the results would be reflected in KTAS provider education programs aimed at EMTs. It is expected that qualified KTAS providers will be produced, and the quality of triage can be controlled and improved.

Gossypiboma, an infrequent surgical complication, describes a mass of cotton material inadvertently left in the body cavity after an operation. It is an extremely rare iatrogenic complication of nasal surgery, with only a few cases reported in literature to date. Here we present a case of gossypiboma in the nasal septum of a 35-year-old male patient who previously underwent septorhinoplasty fourteen years prior. He was treated by endoscopic endonasal surgery to remove the lesion. Pathologic findings showed a foreign body (gauze filament) with a giant cell reaction. This report will be helpful for treating patients with similar histories in the future.