No abstract available.
Lithotripsy* ; Shock*

A retrospective analysis was done on 68 patients with primary superficial bladder cancer between September 1989 and December 1995. We evaluated the predictive value of urine cytology in the recurrence and the progression of superficial bladder cancer. Positive cytology was shown in 52.9% (36/68) and was significantly associated with tumor grade (p=0.001). The recurrence rate in patients with negative cytology was 28.1% (9/32) compared to 77.8% (28/36) in those with positive cytology (p=0;001). No patients of negative cytology had tumor progression while 4 out of 36 (11.1%) patients of positive cytology had progression to invasive or metastatic disease. In conclusion, urinary cytology appears to be a significant prognostic factor in superficial bladder cancer.
Humans ; Recurrence* ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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

PURPOSE: We analyzed the RESULTS of the GnRH stimulation test to assess its usefulness as a predictor for testicular dysfunction in adolescent varicocele. MATERIALS AND METHODS: We studied 20 adolescents with unilateral varicocele from January 1998 to January 2001. Eight patients were grade II and 12 were grade III. Testicular volume was measured using an orchidometer. The responses of the gonadotropins to GnRH stimulus were compared between grade II and III patients. All patients had varicocelectomy and 7 were followed up. RESULTS: After GnRH stimulus, all patients except one showed excessive response in LH and FSH. LH response(8-fold greater than the baseline) was more exaggerated than that of FSH(1.8-fold greater than the baseline). The 12 patients of grade III varicocele presented greater excessive responses in LH and FSH to GnRH stimulus than those of grade II(p>0.05). After surgical treatment, the exaggerated gonadotropin response to GnRH was not normalized. But the response was less exaggerated, suggesting an improvement of testicular dysfunction. CONCLUSIONS: In this study, the grade of the varicocele was correlated with the excessive responses of the gonadotropins to the GnRH stimulus. Nevertheless, we suggest that the deterioration of the testicular function in adolescents with varicocele was a progressive phenomenon. We think that the GnRH stimulation test could be useful in assessing the testicular dysfunction in adolescent varicocele patients.
Adolescent* ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Varicocele*

PURPOSE: This study was conducted to explore clinical nurses' experience of positive organizational culture in order to provide data for effective strategies of acquisition and retention of competent nurses. METHODS: In this qualitative study, interviews with four focus groups of four to six nurses, 19 in total, were held. Compositional factors in groups included clinical experience, age, work place, and position. Interviews proceeded until data were saturated. RESULTS: Fifteen sub-themes, categorized into six themes, emerged. Positive organizational culture themes included "Helping nurses to be organization members", "Allowing nurses to communicate with one another", "Helping nurses take an initiative to lead organization", "Having competent leader take charge of organization", "Enabling nurses to achieve organizational changes", and "Leading nurses to accomplish organizational performance." CONCLUSION: Results indicate that positive organizational culture is related to increases in occupational satisfaction and decreases in turnover through supportive organizational culture which makes it possible to reinvest expenses required for training new members to promoting quality growth in the organization and the prestige of professional nurses. In order to improve occupational satisfaction and sustained growth in nurses, it is necessary to provide nurses with positive work environments and require members to make active efforts leading to strategic changes.
Focus Groups ; Organizational Culture* ; Workplace

Historically, digital rectal examination (DRE) had been the only method available to evaluate the prostate gland for malignant tumor. Recently, serum prostate specific antigen (PSA), transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) using endorectal coil have been added to the methods used to detect prostate cancer. But the roles of these tests in detecting cancer are currently undefined. Because of its low specificity, some reports have suggested the routine use of TRUS be discouraged. The present study was undertaken to evaluate the value of TRUS in the detection of prostate cancer. In a retrospective study, 123 BPH patients were examined by TRUS and PSA measurement. All patients were planned for prostatectomy and they had no evidence for prostate cancer at DRE. Of 123 patients with pathologically proven diagnosis, 10 patients had prostate cancer and 113 patients had BPH. Among the patients with prostate cancer, 6 patients had elevated PSA level ( >10ng/mL), while a patient had normal PSA level. Of 66 patients whose PSA levels were between 4 and 10ng/mL, only 3 patients had prostate cancer. Among 10 patients with prostate cancer, one patient had positive finding in TRUS, while 9 patients had negative finding. Among 113 patients with BPH, 17 patients had positive findings in TRUS and 96 patients had negative findings. Over all TRUS sensitivity and specificity for prostate cancer detection was 10% and 84.9% respectively. From our data we conclude; 1. The use of TRUS in BPH patients with negative DRE and PSA less than 10ng/mL seems to be questionable. 2. For the patients with negative DRE and PSA higher than 10ng/mL, sono-guided biopsy should be done regardless of the result of TRUS.
Biopsy ; Diagnosis ; Digital Rectal Examination ; Humans ; Magnetic Resonance Imaging ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: The aim of this study was to evaluate possible predictive variables for the outcome of shock wave lithotripsy (SWL) of renal stones in a single center. MATERIALS AND METHODS: Between March 2008 and March 2010, a retrospective review was performed of 115 patients who underwent SWL for solitary renal stones. The patients' characteristics and stone size, location, skin-to-stone distance (SSD), and Hounsfield units (HU) of stone were reviewed. The impact of the possible predictors on the disintegration of the stones was evaluated by logistic regression analysis. Receiver operator characteristic (ROC) curves were generated to compare the predictive powers of the variables. RESULTS: Seventy-nine patients (68.7%) had successful outcomes, whereas 36 patients (31.3%) had residual stones. Significant differences were found in the mean size and mean HU of the stones (size: 8.34+/-3.58 mm vs. 13.57+/-5.41 mm, p<0.001; HU: 675.29+/-254.34 vs. 1,075.00+/-290.41, p<0.001). In the unadjusted model, age, stone size, and stone density were significant predictors. In the reduced model, stone density and size were significant predictors for the outcome of SWL. The area under the ROC curve (AUC) was significantly higher for stone density and size than for the other parameters, but the AUC between stone density and size did not differ significantly (stone density: 0.874, stone size: 0.827, p=0.388). CONCLUSIONS: Stone density and size were significant predictors of the outcome of SWL for renal stones less than 2.0 cm in diameter. We should consider HU and stone size when making decisions on the treatment of renal stones.
Area Under Curve ; Humans ; Kidney Calculi ; Lithotripsy ; Logistic Models ; Retrospective Studies ; ROC Curve ; Shock ; Tomography, X-Ray Computed

PURPOSE: There are many prognostic factors in the recurrence and the progression of T1 superficial bladder cancer. Among these factors, microstaging evaluation in T1 bladder cancer may be of important value in patients with T1 superficial bladder cancer. To evaluate the usefulness of microstaging evaluation, we analyzed the microstage in T1 superficial bladder cancer and analyzed the recurrence rate and the progression rate of each microstage. MATERIALS AND METHODS: A retrospective analysis was done on 87 patients with T1 primary superficial bladder cancer managed in our hospital between January 1992 and April 1998. Microstages were assigned according to the following system: pT1a, invasion of lamina propria: pT1b, invasion to the level of the muscularis mucosa; pT1c, invasion through the muscularis mucosa but superficial to the muscularis propria. We analyzed the relationship between the microstage and the grade, the relationship between the recurrence or the progression of diseases and the grade of the tumor, the relationship between the grade or the microstage and the recurrence of diseases. All specimens were obtained from transurethral resection. RESULTS: The recurrence rates of pT1a, pT1b and pT1c were 9.1%(3/33), 40%(8/33) and 64.7%(22/33) respectively(p<0.001). The progression rates of pT1a, pT1b and pT1c were 0%(0/33), 10%(2/20) and 20.6%(7/34) respectively(p=0.005). The recurrence rates of grade I, grade II and grade III were 23.1%(3/13), 26.7%(12/45) and 62.1%(18/29) respectively(p=0.002). The progression rates of grade I, grade II and grade III were 7.7%(1/13), 4.4%(2/45) and 20.7%(6/29) respectively(p=0.062). pT1a, pT1b and pT1c were 21.2%(7/33), 20%(4/40) and 5.9%(2/34) in the patients of the grade I. pT1a, pT1b and pT1c were 69.7%(23/33), 50%(10/20) and 35.3%(12/34) in the grade II. pT1a, pT1b and pT1c were 9.1%(3/33), 30%(6/20) and 58.8%(20/34) in the grade III. Thus the relationship between the grade and the microstage was statistically significant(p=0.001). The recurrece rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 14.3%(1/7), 0%(0/4) and 100%(2/2). The recurrence rates of pT1a in the grade II , pT1b in the grade II and pT1c in the grade II were 8.7%(2/23), 40%(4/10) and 50%(6/12). The recurrence rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 66.7%(4/6) and 77.8%(14/20)(p=0.176). The progression rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 0%(0/7), 0%(0/4) and 50%(1/2). The progression rates of pT1a in the grade II, pT1b in the grade II and pT1c in the grade II were 0%(0/23), 10%(1/10) and 8.3%(1/12). The progression rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 16.7%(1/6) and 25%(5/20)(p=0.526). CONCLUSIONS: Microstaging in T1 superficial bladder cancer appears to be a significant prognostic factor in the recurrence and the progression of the diseases.
Humans ; Mucous Membrane ; Recurrence* ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We compared the prophylatic effects and complications of intravesical instillation of the epirubicin and Bacillus Calmette-Guerin (BCG) in patients with stage T1 bladder cancer. MATERIALS AND METHODS: A total 87 patients with stage T1 bladder cancer were treated with transurethral resection (TUR) between January 1992 and April 1998. Of them, 51 patients received BCG (Connaught strain, 81mg), 16 patients received 50mg epirubicin and 20 patients underwent TUR alone. The patients were followed for 18-78 months (mean 40 months). Recurrence rates, progression rates, mean months to tumor recurrence, recurrence free survival rate using Kaplan-Meier curve and complications were compared among three groups. RESULTS: The overall recurrence rate was 27.5% in BCG group, 37.5% in epirubicin group and 65% in control group. Mean months to tumor recurrence and recurrence free survival rate showed that both drugs were superior to TUR alone. The incidence of complications was 94% in BCG group and 12.5% in epirubicin group. CONCLUSIONS: BCG and epirubicin were superior to TUR alone in the prophylaxis of recurrence in stage T1 bladder cancer. Although the prophylactic efficacy of BCG was a little higher than that of the epirubicin, the toxicity rate of epirubicin was much lower than that of BCG. Therefore, epirubicin may be regarded as an alternative treatment of the BCG, especially for the patients who cannot tolerate the side effects of BCG.
Administration, Intravesical ; Bacillus* ; Epirubicin* ; Humans ; Incidence ; Mycobacterium bovis ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Purpose: The purposes of this study were to compare the magnitude and phase between the RR interval and QT interval variability in the frequency domain. METHODS: Twenty four, 12-13 year old healthy males were randomly selected. At resting state and for 5 minutes, ECGs were obtained, and they were digitized to 1000Hz. After measurement of RR interval, QT interval variability was measured using template matching strategy. After normalization of the RR and QT interval time series, power spectral and cross spectral analysis were performed. From each of the time series, low- (0.04-0.15 hertz) and high- (0.15-0.4 hertz) frequency power were measured. From the phase spectrum, the phases and time lags between the two time series at each of the two frequency range were calculated. RESULTS: The average of RR interval and QT interval was 616.0+/-71.0, 364.0+/-47.0 msec, respectively. Their normalized low- and high- frequency power was 4.4+/-7.9 NU(normalized unit), 0.1+/-0.1 NU(p<0.005), and 11.0+/-30.0 NU, 0.3+/-0.3(NU, p<0.005), respectively. The phase differences and resulting time lags between the two interval were -0.5+/-0.4 pi radian(-0.9 seconds) and -0.2+/-0.3 pi radian(-0.4 seconds) in the low- and high-frequency range, respectively. CONCLUSION: During resting state, when compared to RR interval, QT interval oscillates in significantly lower amplitude in both low- and high- frequency ranges. However, the oscillations precede those of the RR interval 0.9 seconds and 0.4 seconds, respectively.
Electrocardiography ; Humans ; Male