We experienced one case of renal arteriovenous fistula that was treated with superselective transcatheter arterial embolization of the renal artery. The patient presented with colicky pain, gross hematuria, and acute urinary retention. At that time, we suspected renal stone because of a radio-opaque density on the right renal area of excretory urography. However, an acoustic shadow could not identified by renal ultrasonogram. When gross hematuria reappeared one week later, selective renal angiography was performed, and arteriovenous fistula was found on the right kidney. We used superselective tanscatheter arterial embolization with a Gelfoam fragment on right arterial branch as the treatment modality.
Acoustics ; Angiography ; Arteriovenous Fistula* ; Abdominal Pain ; Gelatin Sponge, Absorbable ; Hematuria ; Humans ; Kidney ; Renal Artery ; Ultrasonography ; Urinary Retention ; Urography

We experienced with 3 cases of penile fractures for recent 2 years, one occurred during masturbation and the others occurred during coitus(one case was associated with urethral injury). While the former was treated with conservative management, the latters were treated with surgical intervention that was immediate removal of hematoma and primary closure of ruptured corpus cavernosum. Penile deformity end decrease in rigidity occurred in conservatively treated case. However, two cases of immediate surgical treatment had a excellent result without complication. Even though we describe only 3 cases and could not compare the degree of injury. our short experiences suggest that immediate surgical intervention is better than conservative management in initial treatment of penile fracture.
Congenital Abnormalities ; Hematoma ; Masturbation

We performed a retrospective analysis of 25 patients presenting with confirmed renal pelvis tumor to examine factors predictive of survival outcome. Follow-up duration was from 11 to 133 months (mean 39 months). The analysis of prognostic factors was performed on 26 cases with available clinical data, testing the following parameters : age, symptom duration, IVP finding, urine cytology, concomitant tumor, histopathological grade, stage, treatment modality and also correlation between each factors was examined. The analysis showed that grade (p <0.001) and stage (p =0.001) were the only two parameters having a statistically significant impact on prognosis, multifocality also had some influence on survival(p<0.05 ). In cases of low-stage, low-grade tumor (stage I-II according to Bennington and Bechkwith classification and grade I - II according to Broder's classification) the probability of survival was 90%. 86% at 5 years, but in high-stage, high-grade tumor, 5 year survival rates were 28 % and 0% respectively. In 20 of total 25 cases nephroureterectomy with bladder cuff excision was performed, simple nephrectomy in 2 cases, radical or palliative nephrectomy in 3 cases, but no survival difference was observed in treatment modality. This finding suggests that early diagnosis and surgical excision of the pelvis tumor will result in excellent outcome but the survival of patients with high stage and high grade tumor probably can not be improved without the development of effective adjuvant therapy.
Classification ; Early Diagnosis ; Follow-Up Studies ; Humans ; Kidney Pelvis* ; Nephrectomy ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder

Noninvasive techniques of antenatal detection of the fetal development and well-being such as biophysical profile, non-stress and stress remain major challenges in modern obstetric practice. To obtain and analyze umbilical artery velocity waveform by pulsed-wave doppler ultrasound, a total of 160 determinations were carried out on 157 normal pregnant women between 16th to 41st week gestation. The ratio of peak systolic to end-diastolic flow velocity (S/D ratio), pulsatility index and resistance index were measured as indices of the resistance in feto-placental circulation. The results were as follows: As gestation advances, the mean values for peak systolic and end-diastolic velocities raised progressively. As gestation advances, the mean values for the S/D ratio declined progressively, exhibiting high diastolic flow velocity caused by low resistance. Pulsatility index, and resistance index were also declined progressively, as gestation advances. The analysis of umbilical artery blood flow velocity waveforms provides a new noninvasive technique to evaluate fetal development and well-being, and may be expected a reliable method for assessment of fetal life.
Blood Flow Velocity* ; Female ; Fetal Development ; Humans ; Methods ; Pregnancy* ; Pregnant Women ; Ultrasonography ; Umbilical Arteries*

PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Operative Time ; Wounds and Injuries

BACKGROUND: A small percentage of patients presenting with acute myocardial infarction are found to have angiographically normal or near normal coronary arteries. Thrombus, coronary spasm or coronary embolism have been thought to cause myocardial infarction in these circumstances. Acetylcholine(Ach) may dilate coronary arteries indirectly by releasing EDRF(endothelium derived relaxing factor), but constrict arterial smooth muscle when endothelium is dysfunctional or denuded. In this study, we observed Ach responses of infarct related arteries with and without stenotic leisions to clarify the possible etiologic role of vasospasm in ischemic heart disease. METHODS: Seven to ten days after acute myocardial infarction. Ach(100ug for left and 50ug for right )responses of infarct-related coronary was studied in 16 patients with angiographically normal coronary arteries(Group 1) and 15 patients with significant stenotic lesions(Group 2). Ach responses was also studied in 27 noninfarct related arteries(NIRA) of group 1 and 29 NIRAs of group2. The positive response was defined as total or subtotal occlusion after Ach injection. In 6 patients of group 1 with Ach(+), intravenous ergonovine(Erg) test was also performed after completion of Ach test. RESULTS: 1) Ach(+) responses of IRAs with or without significant coronary artery disease was more frequent(70%) than that of NIRAs(14%). 2) Ach(+) response of IRAs with angiographically normal coronary artery (87.5%) was more common than that with significant fixed disease(45.4%). 3) ACh and ergonovine induced vasospasm at the same site in 4 of group 1. CONCLUSIONS: In the majority of patients with normal coronary artery and acute myocardial infarction(AMI), Ach induced vasospasm in the IRAs. Ach(+) response occured more frequently in normal coronary arteries. These findings suggest that coronary vasospasm might etiologic role for AMI. especially in thoses patients with normal coronary artery. However our investigation failed clarify whether the those responses of IRAs to Ach was a cause or a result of myocardial infarction due to the post-ischemic injured endothelium. Ach and Erg induced vasospasm at the same site in 4 of group 1 which suggests that local hyperreactivity might be related to coronary spasm.
Acetylcholine* ; Arteries ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Embolism ; Endothelium ; Ergonovine ; Humans ; Muscle, Smooth ; Myocardial Infarction ; Myocardial Ischemia ; Spasm ; Thrombosis

H-reflex is a kind of late respons which can be used for the proximal nerve conduction study. Also it is a useful and widely used nerve conduction technique es to look electrically at the monosynaptic reflex. Although recordable from all muscles theoretically, H-reflexes are most commonly recorded from the calf muscles following stimulation of the tibial nerve in the popliteal fossa. But in this study, We tried to establish the normal data and to evaluate the significance of the H-reflex study in cervical radiculopathy. H-reflexes were recorded from flexor carpi radialis (FCR) muscle, extensor carpi radialis (ECR) muscle, brachioradialis (BR) muscle, and abductor digiti minimi (ADM) muscle in 31 normal adults (62 cases) and 12 patients with cervical radiculopathy. The mean values of H-reflex latency in normal control group were 16.16+/- 1.65 msec in FCR; 15.99+/- 1.25 msec in ECR; 16.47+/- 1.59 msec in BR; 24.46+/- 1.42 msec in ADM. And the mean values of side to side difference of H-reflex latency were 0.47+/- 0.48 msec in FCR; 0.68+/- 0.72 msec in ECR; 0.63+/- 0.43 msec in BR; 22.31+/- 1.24 msec in ADM. Mean values of side to side differences of interlatency time were 0.49+/-0.47 msec in FCR; 0.73+/- 0.62 msec in ECR; 0.79+/- 0.71 msec in BR; 0.69+/- 0.44 msec in ADM. Also, there were no significant differences in H-reflex latency between right and left side. H-reflex tests in patient group with cervical radiculopathy revealed abnormal findings in 11 out of 12 patients. These results suggest that H-reflex in the upper extremity would be helpful in the diagnosis of the cervical radiculopathy.
Adult ; Male ; Female ; Humans

BACKGROUND: Several Studies from western institutes were done on the clinical characteristics and long-term prognosis of patients with variant angina. In these reports, 61-92% of patients had significant coronary artery disease, and survival without myocardial infarction at 1 year was approximately 70-83%. These results differ from our clinical experiences with Korean patients with variant angina;however, no detailed study has been reported in Korea. The purpose of this study was to describe the clinical characteristics and long-term follow-up data of our Korean patients with variant angina. METHODS: Two hundred four consecutive patients with variant angina(M/F;166/38, mean age 53+/-10 year) were included. The diagnosis of variant angina was made by spontaneous spasm in 53, positive intravenous ergonovine(iv Erg) provocation in 52, intracoronary acetylcholine(ic Ach) provocation in 55, simultaneous iv Erg and ic Ach provocation in 48 and bedside intravenous ergonovine with 2-dimensional echocardiography in 33. The clinical and angiographic characteristics were examined in 204 patients and mean 1.5 year(6 month to 3.5 year) follow-up could be done in 165 for the evaluation of long-trem prognosis. RESULTS: The Korean patients with variant angina were characterized by relatively low prevalences of significant coronary stenosis(25%), myocardial infarction and rate of cardiac death. Futhermore, survival and survival without myocardial infarction for the entire group were significantly better in our observation(1 year survival without myocardial infarction, 98%) than in other studies. During the follow-up period, 4(2%) out of 165 patients died, 1 developed myocarddial infarction and ventricular fibrillation occurred in 2. Three of 4 death caused by stopping medication abruptly. Thirteen patients were angina free after discontinued medications during the follow-up. CONCLUSION: The overall prognosis of variant angina may be better in Korean patients. We believe that less severe coronary atherosclerotic disease and a high rate of treatment with calcium blockers may have contributed to the lower rate of cardiac death and myocardial infarction on our patients compared with those in previous studies.
Academies and Institutes ; Calcium ; Coronary Artery Disease ; Death ; Diagnosis ; Echocardiography ; Ergonovine ; Follow-Up Studies* ; Humans ; Infarction ; Korea ; Myocardial Infarction ; Prevalence ; Prognosis ; Spasm ; Ventricular Fibrillation

PURPOSE: To evaluate effect of modified arthroscopic pull-out suture technique which used number 5-nonabsorbable suture material for tibia intercondylar eminence comminuted fractures. MATERIALS AND METHODS: There were 21 cases of tibia intercondylar emimence fracture which arthroscopic treated at our hospital between 1999 and 2004. However the study population only included 12 cases in which a number 5-nonabsorbable suture material (Ethibond No. 5) was used for tibia intercondylar eminence comminuted fractures and minimum 1-year follow-up has gone. The average follow-up period was 18.5 months (range, 12 to 42 months). Lachman test and KT-2000 athrometer test were evaluated at the pre-and post-operation. Clinical results of all patients were evaluated with the Meyers and Mckeever 's criteria. RESULTS: In all 12 cases, the normal range of motion and sports activities were recovered at the final follow-up. When tested for anterior instability with KT-2000 arthrometer, there were no different between normal knee and operated knee. Clinical results by Meyers and Mckeever's criteria were excellent in 10 patients and good in 2 patients. CONCLUSION: We obtained early mobilization and stable fixation in modified arthroscopic pullout suture technique for tibia intercondylar eminence comminuted fractures. Patients can early return to his job. This technique seems to be one of the effective operative techniques for treatment of tibia intercondylar eminence comminuted fractures.
Arthroscopy ; Early Ambulation ; Follow-Up Studies ; Fractures, Comminuted* ; Humans ; Knee ; Reference Values ; Sports ; Suture Techniques ; Sutures* ; Tibia*

PURPOSE: The extracellular domain (ECD) of the HER-2/neu oncoprotein, whose molecular weight is the range from the 95 kD to 105 kD, is shed into the blood from the cell surface via, proteolysis by a metalloprotease. A monoclonal antibody immunoassay has been developed for measuring the circulating concentrations of serum HER-2/neu ECD (following serum HER-2/neu). Serum HER-2/neu has been reported to be correlated with an increased tumor volume in those patients suffering with breast cancer. We measured the serum CA15-3 level, which is a surrogate marker of the tumor burden, we analyzed the correlation of the serum CA15-3 with the serum HER-2/neu and we analyzed the association of both markers with the clinical outcomes. METHODS: The sera for the analysis of both HER-2/neu and CA15-3 were obtained from 99 healthy Korean women, 66 primary breast cancer patients and 43 metastatic breast caner patients. The serum HER-2/neu level was measured quantitatively with using an ADVIA Centaur(R) automated immunoassay analyzer (Bayer Health Care LLC, Diagnostics Division, Tarrytown, New York, USA) and the CA 15-3 level was measured via radioimmunoassay. RESULTS: The serum HER-2/neu level was increased 23 metastatic cancer patients (53%). On the analysis of the correlation of serum HER-2/neu and CA15-3, the correlation coefficient (r) was 0.8072. Thus a positive serum HER-2/neu test in breast cancer patients was highly associated with the CA15-3 level for assessing whether metastasis was present or not. For the relationship between primary breast cancer and metastatic breast cancer, the former was classified as the control group and the latter as the patient group. The results of the Receiver Operation Characteristic (ROC) curve for serum HER-2/neu and CA15-3 showed no statistically significant differences (p=0.176) but the diagnostic efficacy of the serum HER-2/neu test was measured more exactly than that of CA15-3 and CA15-3 a tool for measuring a tumor marker for the diagnosis of whether metastasis was present or not. CONCLUSION: Serum HER-2/neu is a significant independent predictive prognostic factor for metastatic breast cancer patients. In view of the results we have achieved so far the serum HER-2/neu level in metastatic breast cancer patients may play an important roll as an independent tumor marker.
Biomarkers ; Breast ; Breast Neoplasms ; Delivery of Health Care ; Female ; Humans ; Immunoassay ; Molecular Weight ; Neoplasm Metastasis ; New York ; Proteolysis ; Stress, Psychological ; Tumor Burden