PURPOSE: Visual internal urethrotomy is a standard therapy for incomplete urethral stricture, and may also be a reasonable initial treatment for a short complete urethral stricture. The success rate and final results of the repeated internal urethrotomy were retrospectively assessed to figure out the appropriate indication for visual internal urethrotomy as an initial treatment for incomplete pendulous and bulbous urethral stricture; according to the stricture free month. MATERIALS AND METHODS: Between January 1990 and December 1999, an internal urethrotomy was primarily performed on 166 patients with urethral strictures. The exclusion criteria were complete urethral and posterior urethral stricture. Retrograde urethrography was performed under fluoroscopic control. When the stricture recurred, the urethrotomy was repeated as the primary procedure. RESULTS: With regard to the time to recurrence, the success rate of the group of stricture recurrence at 6 months was significantly lower than that of the stricture free group at 6 months. CONCLUSIONS: With regard to the stricture site and length, the stricture free month might be considered as an important predictor of the outcome of a repeated internal urethrotomy, and visual internal urethrotomy might be considered as an initial treatment method for incomplete urethral stricture under the following conditions; a bulbous stricture, a stricture length under 20mm, and stricture free at 6 months.
Constriction, Pathologic ; Endoscopy ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Urethral Stricture*

Hemifacial spasm consists of irregular, but repetitive clonic twitching of the muscles of one side of the face. Usually it is first involved around the eyes, the repetitive twitching spreads slowly to involve the whole face. It most commonly affects middle aged or elderly women, and usually appears with an aberrant vascular cross-compression near the root entry zone (REZ) of VII nerve. Among numerous approaches to treat facial spasm, only Jannetta's microvascular decompression has confirmed efficacy. However facial nerve block by needle insertion technique seems to be of benefit in patients with mild spasm, the elderly, poor risks and those who refuse the craniotomy. To treat our three patients with hemifacial spasm, we did physical facial nerve block by a direct puncture of the facial nerve trunk just at its exit from the stylomastoid foramen. Satisfactory results were obtained by the treatment employed. This technique is a valuable method in the treatment of hemifacial spasm.
Aged ; Craniotomy ; Facial Nerve* ; Female ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery ; Middle Aged ; Muscles ; Needles ; Punctures ; Spasm

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor. This study was performed to determine alterations in distribution and expression of kainate receptor subunits after 1 hour of moderate hypoxia in the newborn piglet brain, as in a condition of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were ventilated at PaO2 over 80mmHg for 30min. Thereafter, the control group(n=5) was ventilated with 21% oxygen, and hypoxic group(n=5) with 6% oxygen at PaO2 below 25mmHg for 1 hour. Concentrations of protein, ATP and phosphocreatine were determined. The proteins were immunostained with anti-rat GluR6/7 and anti-rat KA2 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). The concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR6/7 subunits were ordered; cerebral cortex>hippocampus, thalamus, hypothalamus>basal ganglia, cerebellum>white matter, and KA2 subunits were ordered : hippocampus, basal ganglia>cerebral cortex>thalamus, cerebellum>hypothalamus, white matter. The distribution of the subunits between the hypoxic group and control group were similar. CONCLUSION: Cerebral cortex, hippocampus and basal ganglia may be the most vulnerable to excitotoxic injury. Kainate receptor subunits did not change after 1 hour of moderate hypoxia.
Adenosine Triphosphate ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebral Cortex ; Ganglia ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Oxygen ; Phosphocreatine ; Receptors, Kainic Acid ; Thalamus

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor. This study was performed to determine alterations in distribution and expression of kainate receptor subunits after 1 hour of moderate hypoxia in the newborn piglet brain, as in a condition of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were ventilated at PaO2 over 80mmHg for 30min. Thereafter, the control group(n=5) was ventilated with 21% oxygen, and hypoxic group(n=5) with 6% oxygen at PaO2 below 25mmHg for 1 hour. Concentrations of protein, ATP and phosphocreatine were determined. The proteins were immunostained with anti-rat GluR6/7 and anti-rat KA2 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). The concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR6/7 subunits were ordered; cerebral cortex>hippocampus, thalamus, hypothalamus>basal ganglia, cerebellum>white matter, and KA2 subunits were ordered : hippocampus, basal ganglia>cerebral cortex>thalamus, cerebellum>hypothalamus, white matter. The distribution of the subunits between the hypoxic group and control group were similar. CONCLUSION: Cerebral cortex, hippocampus and basal ganglia may be the most vulnerable to excitotoxic injury. Kainate receptor subunits did not change after 1 hour of moderate hypoxia.
Adenosine Triphosphate ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebral Cortex ; Ganglia ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Oxygen ; Phosphocreatine ; Receptors, Kainic Acid ; Thalamus

PURPOSE: As the number of patients with localized renal cell carcinoma has increased, there are conflicting reports on the nuclear grade as a prognostic factor. The aim of this study was to evaluate the significance of the nuclear grade as a prognostic factor. MATERIALS AND METHODS: We retrospectively enrolled 172 patients with localized renal cell carcinoma and who underwent radical nephrectomy. The patients were staged according to the 1997 TNM stage and the Fuhrman grading. The survival rate was analyzed by the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS: The overall 1- , 5- and 10-year survival rates were 98.1, 72.5 and 68.4%, respectively. The 5-year survival rates for grades I, II, III and IV were 100, 92.6, 85.0 and 60.9%, respectively (p<0.0001). According to the Fuhrman grade in each T stage, 1) for patients with pT1b, the 5-year survival rates were 100, 85.0, 85.71 and 33.3% for patients with grade I, II, III and IV, respectively (p=0.002). 2) for patients with pT2, the 5-year survival rates were 100, 92.3, 60.0 and 25.0% for patients with grade I, II, III and IV, respectively (p<0.0001). A comparison of the survival curves by the Fuhrman grade showed a statistically significant difference. CONCLUSIONS: The Fuhrman grade is an important prognostic factor for patients with localized renal cell carcinoma. A high nuclear grade tends to have metastatic potential and a poor prognosis. This group of patients with a high nuclear grade must be followed up more closely. Determining the pathologic stage along with using the Fuhrman grade-based surveillance protocols are a logical approach to follow-up.
Carcinoma, Renal Cell* ; Cell Nucleus Shape ; Follow-Up Studies ; Humans ; Logic ; Multivariate Analysis ; Nephrectomy ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate

PURPOSE: The objective of this study was to investigate the efficacy of the International Prostate Symptom Score (IPSS) and various parameters obtained from transrectal ultrasonography (TRUS) as predictors of the onset of acute urinary retention in patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: From January 1997 to December 2003, 1,765 patients with symptomatic BPH were enrolled in this study, but not all patients had had previous BPH treatment. Of the 1,765 patients, 323 presented with acute urinary retention. A TRUS examination was performed to calculate the total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI=TZ volume/TP volume) and elongation ratio (ER=maximal anteroposterior diameter/transverse diameter). Statistical comparisons of the retention (n=323) and non-retention groups (n=1,442) were performed using the Mann-Whitney test, and receiver operating characteristic (ROC) curves of the independent risk factor were obtained to compare the usefulness of various indices. RESULTS: There were significant differences in the age, TPV, TZV, TZI and ER between the retention and non-retention groups, but no significant differences in the IPSS. The most effective cutoff value was a 15ml TZV. The area under the curves were 0.887 (TZV), 0.884 (TZI), 0.857 (TPV) and 0.736 (ER). CONCLUSIONS: The TZV is the most useful predictor of the onset of acute urinary retention in patients with symptomatic BPH, with the TZI can also be a useful predictor. The TZV and TZI may be useful parameters when deciding the method of treatment.
Humans ; Prostate ; Prostatic Hyperplasia* ; Risk Factors ; ROC Curve ; Ultrasonography ; Urinary Retention*

PURPOSE: To investigate the ability of serum prostate specific antigen (PSA) as an estimator of the prostate volume in patients with symptomatic benign prostatic hyperplasia (BPH) according to their decade of life. MATERIALS AND METHODS: Between January 1997 and May 2003, 3,192 patients presented at our clinic due to lower urinary tract symptoms. Of these 1,922 were confirmed as BPH and enrolled in this study. Patients with prostate cancer and conditions other than BPH at the baseline were excluded. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic ability of serum PSA to estimate the threshold prostate volume and select the optimal PSA cut-off values. RESULTS: The ROC curve analyses revealed the serum PSA to be a good estimator of the prostate volume, with areas under the ROC curves of 0.785, 0.846 and 0.856 for prostate volume cut-off points of 30, 40 and 50ml, respectively. The optimal serum PSA cut-off values for all age groups, irrespective of age, were 1.5ng/ml for the detection of a prostate volume>30ml and 2.0ng/ml for a prostate volume>40ml. CONCLUSIONS: Serum PSA can be used to estimate the prostate volume. Since the treatment outcome or risk of complications depends on the prostate volume, the estimated prostate volume is useful in therapeutic decision making in the absence of a reliable direct measurement of the prostate volume.
Decision Making ; Humans ; Lower Urinary Tract Symptoms ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; ROC Curve ; Treatment Outcome

PURPOSE: To determine the criteria that can be used to safely reduce unnecessary biopsies for patient found to be lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) negative on digital rectal examination (DRE) and transrectal ultrasound (TRUS), with a prostate specific antigen (PSA) level over 4.0ng/ml. MATERIALS AND METHODS: A retrospective data analysis of 157 patients, with a raised serum PSA level, over 4.0ng/ml, and negative DRE and TRUS findings was performed. The detection rates of prostate cancer according to the prostate volume were also investigated. All patients with one benign biopsy were followed with PSA determination over a 2 year period, and in the cases of men with a persistently elevated PSA, a re-biopsy was suggested. Patients were also classified according to the results of the first biopsy and the follow up PSA level. RESULTS: Of the 157 patients, the rate of prostate cancer was 14.6% (23 of 157), and that for a benign disease, including BPH, was 85.4% (134 of 157). The rates of prostate cancer according to prostate volume (PV) were 20.6 (22 of 107) and 2.0% (1 of 50) in those with a PV80ml, respectively. In the men with one benign biopsy, cancer was not found in 61 (23 with a prostatectomy and 38 with a re-biopsy) and 112/134 (83.6%) had normalized PSA after 1 year. CONCLUSIONS: A statistically significant difference was noted in the profile of a prostate biopsy for cancer according to the prostate volume. We concluded that the majority of LUTS/BPH men with a prostate volume over 80ml have PSA elevation due to BPH or another benign prostate disease, not related to cancer. For patients with negative DRE and TRUS findings, a large prostate (>80ml) and elevated prostate-specific antigen (PSA), over 4ng/ml, watchful waiting, with PSA follow up and BPH treatment, may be a suitable option.
Biopsy* ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatectomy ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Retrospective Studies ; Statistics as Topic ; Ultrasonography ; Watchful Waiting

Purpose: To examine the usefulness of the prostate-specific antigen (PSA) density for selection of biopsy candidates with serum PSA levels between 4-10ng/ml, and determine the optimal PSA density (PSAD) cut off value for use in clinical practice. Materials and Methods: We retrospectively enrolled 705 patients with serum PSA levels between 4-10ng/ml. The patients were divided into the prostate cancer and the non-prostate cancer groups. The PSA level and PSAD in predicting prostate cancer were compared. A receiver operating characteristic (ROC) curve was generated, and utilized to evaluate the optimal PSAD cut off value. Results: One hundred and nineteen and five hundred and eighty six patients had prostate and non-prostate cancers, respectively, on pathological examination. The mean PSA values were not significantly different; 6.9 and 7.0ng/ml, respectively (p>0.05). However, the mean PSAD values were 0.168 and 0.213ng/ml/cc; significantly higher in the prostate cancer group than the BPH group (p<0.05). The ROC curves for the PSA level and PSAD demonstrated superior benefit for the PSAD. The sensitivity, specificity and positive predictive values of a PSAD cut off of 0.15ng/ml/ cc were 73.1, 45.9 and 21.5%, respectively. A PSAD cut off of 0.17ng/ml/cc showed the highest sensitivity and specificity, with sensitivity, specificity and positive predictive values of 63.9, 59.2 and 24.1%, respectively. Conclusions: The PSAD seems to be useful in the selection of biopsy candidates with serum PSA levels between 4-10ng/ml, and a PSAD cut off of 0.17ng/ml/cc would seem to be preferable to 0.15ng/ml/cc.
Biopsy ; Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Parry-Romberg syndrome(Progressive hemifacial atrophy), described in the last century by Parry(1825) and Romberg(1846), is a very rare disorder characterized by a slowly progressive and self-limited unilateral(rarely bilateral) atrophy of the faces affecting variably the skin, subcutaneous fat tissues, musculature, connective tissue, cartilage and bones. And this disorder is usually accompanied by contralateral Jacksonian epilepsy, trigerminal neuralgia, and changes in the eyes and hair. The onset is slow and progressive, starting at 5-15 years of age and lasting from 2-10 years, ending with the face being "burned out". There are a few cases of this disease which presented during the neonatal period. This disorder seems to affect females more than males, and its etiology and incidence has yet to be determined. Trauma, infection with a slow virus, sympathetic dysfunction, immunological abnormality and cranial vascular malformation are proposed causes. No typical or consistent neuropathologic findings occur. No specific treatment for the syndrome exists; however, various reconstructive surgical procedures can have in reasonably good cosmetic effects, as well as antiinflammatory or immunosuppressive treatment. We report a case of Parry-Romberg syndrome, which was presented at 1 month of age, and has progressd to contralateral hemiparesis.
Atrophy ; Cartilage ; Connective Tissue ; Epilepsy ; Facial Hemiatrophy* ; Female ; Hair ; Humans ; Incidence ; Infant, Newborn* ; Male ; Neuralgia ; Paresis ; Reconstructive Surgical Procedures ; Skin ; Subcutaneous Fat ; Vascular Malformations