We reviewed 26 patients with staghorn calculi to determine whether extracorporeal shock wave lithotripsy (ESWL) monotherapy with Dornier MPL-9000X lithotriptor is a successful alternative to the classical approaches. Of the staghorn calculi 5 cases were complete and 21 cases were incomplete staghorn. Double-J ureteral stents were placed in 24 of 26 patients before the ESWL. Of 15 patients with stone volume less than 20ml, 12(80%) showed stone-free after 5.7 mean session of ESWL. Of 11 patients with stone volume more than 20 ml, 7 (64%) became stone-free after 7.1 mean session of ESWL. The post-ESWL complications were flank pain in 9 patients (35%), gross hematuria in 24 (92%), high fever in 3 (13%) and steinstrasse in 24 (92%). Frank pain and high fever were managed successfully with analgesics and antibiotics. Gross hematuria disappeared spontaneously within 2 days. For the steinstrasse, the stone fragments passed spontaneously in 15 cases (62.5%) and ESWL to the steinstrasse was needed in other 9 cases (37.5%). Though the treatment of choice for the staghorn stones is combination therapy (PNL and ESWL) at the present, we experienced good results by ESWL monotherapy in staghorn calculi with Dornier MPL-9000X.
Analgesics ; Anti-Bacterial Agents ; Calculi* ; Fever ; Flank Pain ; Hematuria ; Humans ; Lithotripsy* ; Shock* ; Stents ; Ureter

A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.
Colon ; Duodenum ; Gastrointestinal Tract ; Hemorrhage ; Jejunum ; Rectum ; Stomach

In spite of today's striking development of radiologic studies, the differential diagnosis of acute scrotal diseases is difficult. We studied 14 cases of appendix testis torsion that had visited our hospital from May 1991 to October 1994 in order to be diagnosed accurately and made appropriate treatment. The torsion of appendix testis occurred during prepubertal ages, and ages of our 14 cases were from 3 to 13, and average age was 9.6 years old. In all of our cases the chief complaint was scrotal pain. The localized pain and palpable tender mass of testicular upper pole were present in only 8 of 14 cases and 5 cases had blue dot sign. These were very helpful in diagnosis of torsion of appendix testis. Doppler ultrasonography was done in 9 cases and radionuclide scrotal imaging was done in 3 cases, but none of these studies were diagnosed as torsion of appendix testis definitely. But in 8 cases that had positive blue dot sign and/or localizing tender mass in upper pole of testis, we could diagnose torsion of appendix testis certainly. We operated 11 of l4 cases( scrotal exploration and excision of torsed appendix testis) and treated conservatively 3 of 14. Most 11 operated cases were revealed that scrotal pains were relieved within 24 hours of postoperative period and secondary complications did not occurred in 3 cases treated conservatively. In summary, the early surgical exploration is necessary to improve maximal testicular salvage when testis torsion cannot be ruled out completely in acute scrotal diseases. But if testis torsion can be ruled out completely, conservative treatment may be considered in torsion of appendix testis.
Appendix* ; Diagnosis ; Diagnosis, Differential ; Postoperative Period ; Strikes, Employee ; Testis* ; Ultrasonography, Doppler

Thyroid nodules are uncommon in children and adolescents compared with adults, but the risk of malignancy is much higher. In adults, fine needle aspiration biopsy (FNAB) has been used extensively to select patients for surgical exploration with a high degree of reliability. The purpose of this study was to assess the utility of FNAB for the management of thyroid nodules in children and adolescents. We reviewed our experience with 60 FNABs of thyroid nodules in 51 children and adolescents. Of the 60 aspirates, 45 aspirates (74%) were diagnosed as "benign", 5 aspirates (8%) as "suspicious for malignancy", and 6 aspirates (10%) as "malignant", and 4 aspirates (7%) as "unsatisfactory". Thyroidectomy was performed in 17 patients, and 5 with a cytological diagnosis of "benign" revealed nodular hyperplasia in three and follicular adenoma in two; 5 with a cytological diagnosis of "suspicious" revealed nodular hyperplasia in one, follicular adenoma in two, and papillary carcinoma in two; and 6 with a cytological diagnosis of "malignant" revealed papillary carcinoma. One patient with a cytological diagnosis of "unsatisfactory" revealed papillary carcinoma. The diagnostic accuracy was 81% with 100% sensitivity and 63% specificity. The positive and negative predictive values of FNAB were 73% and 100%, respectively. We conclude that FNAB is a good screening test for thyroid nodules in children and adolescents because of its high sensitivity.
Thyroid Nodule/*diagnosis/*pathology ; Thyroid Neoplasms/*diagnosis/*pathology ; Sensitivity and Specificity ; Reproducibility of Results ; Predictive Value of Tests ; Male ; Humans ; Female ; Child, Preschool ; Child ; Biopsy, Fine-Needle/*methods ; Adult ; Adolescent

PURPOSE: Helicobacter pylori (H. pylori) is recognized as the cause of primary or unexplained gastrointestinal diseases in children as well as in adults. However, it is unclear whether H. pylori causes specific clinical symptoms or diseases. Therefore, we studied the clinical manifestations associated with H. pylori infection in consecutive symptomatic children undergoing diagnostic endoscopy. METHODS: This study included 42 patients with H. pylori infection, confirmed by ELISA test, CLO test, or Warthin Starry stain of a gastric mucosa biopsy specimen. The presenting symptoms, associated disease, endoscopic findings, and hematologic features were studied in the patients retrospectively. RESULTS: The positivity of H. pylori was 15%, and increased with age. The average age of infected children was 11 years. The presenting symptoms of H. pylori infection were chronic abdominal pain (57.1%), acute abdominal pain (14.3%), pallor (11.9%), hematemesis (9.5%), and nausea/ vomiting (7.1%). The endoscopic findings were nodular gastritis (54.8%), nodular duodenitis (35.7%), duodenal ulcer (14.3%), hemorrhagic erosive duodenitis (2.4%), and normal finding (19%). The associated diseases were chronic recurrent abdominal pain (57.1%), acute gastritis (16.7%), duodenal ulcer (14.3%), and iron deficiency anemia (9.5%). CONCLUSION: H. pylori infection was associated with recurrent chronic abdominal pain, acute gastritis, duodenal ulcer, and iron deficiency anemia in children. Therefore, in patients with several gastrointestinal symptoms and iron deficiency anemia, the diagnostic and therapeutic approach of H. pylori infection is warranted.
Abdominal Pain ; Adult ; Anemia, Iron-Deficiency ; Biopsy ; Child* ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Enzyme-Linked Immunosorbent Assay ; Gastric Mucosa ; Gastritis ; Gastrointestinal Diseases ; Helicobacter pylori* ; Helicobacter* ; Hematemesis ; Humans ; Pallor ; Retrospective Studies ; Vomiting

Rigid ureteroscopy is now an established technique for the management of ureteral stones and the diagnostic procedure of ureteral lesions. The results of ureteroscopic stone removal were reviewed in 153 patients (1 patient ; bilateral). From October 1989 to August 1990, 163 patients underwent ureteroscopic removal of ureter stones. There were 53 female and 100 male patients between 17 and 72 years old. In all patients with ureteral stones surgical intervention was indicated for the obstruction with deteriorating kidney function, infection or severe and prolonged pain. All procedures were performed under epidural anesthesia. Stones were extracted, using grasping forceps or stone baskets with or without electrohydraulic lithotriptor (EHL) under direct visual control. Success of ureteroscopic removal was related to the location of the calculus : 98.2% in the distal, 88.2% in mid and 79.2% in the proximal ureter (overall success rate was 94.2% ). The associated number of complications was low, with most patients being treated conservatively. We conclude that ureteroscopic removal of ureteral stone under direct vision can be done safely and be the first choice of management for the ureteral calculi.
Aged ; Anesthesia, Epidural ; Calculi ; Female ; Hand Strength ; Humans ; Kidney ; Male ; Surgical Instruments ; Ureter* ; Ureteral Calculi ; Ureteroscopy

No abstract availble.
Anticarcinogenic Agents/*therapeutic use ; Aspirin/*therapeutic use ; Colonic Neoplasms/*prevention & control ; Humans

The aim of this study was to investigate behavioral and psychological symptoms of dementia (BPSD) measured by caregiver-administered neuropsychiatric inventory (CGA-NPI) as a function of dementia severity in early onset (EOAD) versus late onset Alzheimer's disease (LOAD). A total of 113 patients with AD consisting of 49 patients with EOAD and 64 patients with LOAD were enrolled consecutively. General cognitive function and severity of dementia were assessed by the Korean version of mini-mental status examination and clinical dementia rating (CDR), respectively. In the mild stage (CDR 0.5-1), LOAD patients had a significantly higher total CGA-NPI score than EOAD patients. Subgroup analysis demonstrated that disinhibition and night-time behavior were more common and severe in the LOAD group than the EOAD group. However, in the moderate to severe stage (CDR 2-3), EOAD patients had a significantly higher total CGA-NPI score with higher subscores in hallucination, agitation/aggression, irritability/lability, aberrant motor behavior, and appetite/eating change. This study suggested that the heterogeneity of BPSD in AD might be accounted for by dementia severity as well as age at symptoms onset.
Alzheimer Disease* ; Dementia* ; Hallucinations ; Humans ; Population Characteristics

Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occur in the setting of pancreatic disease. The most common pancreatic disorders associated with pancreatic panniculitis are acute and chronic pancreatitis, especially the alcohol-related types and pancreatic carcinoma. We now report a case of pancreatic panniculitis in which skin eruptions, not abdominal symptoms, were the presenting symptom. A 45-year-old man presented with multiple erythematous tender subcutaneous nodules on the shins, arthralgia of both ankles and swelling of the left foot. He was diagnosed as having pancreatitis 15 months ago. Histopathologic findings of a skin biopsy showed focal fat necrosis with anucleated "ghost-like" fat cells with a thick shadowy wall. Laboratory evaluation revealed an increase in serum amylase and lipase. We diagnosed this patient's problem as pancreatic panniculitis associated with a relapse of pancreatitis.
Adipocytes ; Amylases ; Animals ; Ankle ; Arthralgia ; Biopsy ; Fat Necrosis ; Foot ; Humans ; Lipase ; Middle Aged ; Necrosis ; Pancreas ; Pancreatic Diseases ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Panniculitis ; Rare Diseases ; Recurrence ; Skin

PURPOSE: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study. RESULTS: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%. CONCLUSION: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.
Diagnosis ; Female ; Hepatic Veins ; Humans ; Liver Neoplasms ; Male ; Portal Vein ; Ultrasonography, Doppler, Color*