PURPOSE: In situ ESWL is the most attractive treatment for mid-ureteral stones as it is non-invasive and effective. X-ray fluoroscopy is usually used to localize the mid-ureteral stones for in-situ ESWL, since it is easy to manipulate, although a radiation hazard and high maintenance costs are involved. We report our experience of in-situ ESWL, using an ultrasonographic localization system, for the treatment of mid-ureteral stones. MATERIALS AND METHODS: Between June 1992 and June 2001, the mid-ureteral stones overlying the pelvic bone were treated with a Siemens Lithostar Ultra lithotriptor using a Sonoline SL-1 (Siemens, Germany) ultrasonographic localization system, with no anesthesia nor pain control. The mid-ureteral stones, located at the upper half of the pelvic bone, were treated in the prone position, with the shock waves delivered through the back wall using the kidney, renal pelvis and ureter, as landmarks for targeting. The mid-ureteral stones, located at the lower half of the pelvic bone, were treated in supine position, with the shock waves delivered through the abdominal wall using a filled bladder as the landmark for targeting. The localization success, stone free, ESWL success rates, and complications, were evaluated. RESULTS: Of the 96 patients, with mid-ureteral stones, we failed to localize the stone in only 2 patients. Therefore, the success rate for the stone localization was 97.9% (94/96). The stone free rate at 3 months after completion of the in-situ ESWL was 97.9% (92/94). Therefore, in-situ ESWL success rate was 95.8% (92/96). The mean ESWL sessions needed to be free of stones were 1.3+/-0.8 (126 sessions/92 patients). Some patients had hematuria and colicky pain, but serious complications, such as febrile UTI or severe hematuria requiring a transfusion were not encountered. CONCLUSIONS: In-situ ESWL, using an ultrasonographic localization system, is a non- invasive and effective treatment for mid-ureteral stones.
Abdominal Wall ; Anesthesia ; Abdominal Pain ; Fluoroscopy ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Lithotripsy* ; Pelvic Bones ; Prone Position ; Shock* ; Supine Position ; Ultrasonography ; Ureter ; Urinary Bladder

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rear occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputum, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count without tuberculous inflammatory changes, the and CD4:CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.
Administration, Intravesical* ; Alveolitis, Extrinsic Allergic ; Bacillus ; Biopsy ; Bronchoscopy ; Carcinoma in Situ ; Drug Therapy ; Fibrosis ; Humans ; Lung ; Lung Diseases, Interstitial* ; Lymphocyte Count ; Mycobacterium bovis* ; Recurrence ; Sputum ; Therapeutic Irrigation ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Nocturia is one of the most bothersome of all benign prostatic hyperplasia(BPH) symptoms. Nocturia with BPH is generally thought to be closely associated with change of detrusor receptor and infection secondary to bladder outlet obstruction. However, age-associated physiological changes in bladder function and concurrent disease, for example, congestive heart failure, cause nocturia in elderly. Therefore, in BPH with nocturia, evaluation for etiology of nocturia is important for proper control of nocturia permanently and this study was performed to investigate the underlying etiology of nocturia. MATERIALS AND METHODS: The twenty-seven BPH patients who complained more than three times of nocturia were included in this study. Evaluation included voiding diary for 24 hour, and urodynamic study. Based on diary and urodynamic study, functional bladder capacity was determined and etiology of nocturia was classified into one of three groups : noctural polyuria, hyperactivity nocturia and functional nocturia. Noctural polyuria was defined as overnight urine volume is over than 33% of 24 hour urine volume, hyperactive nocturia as the number of nocturia is more than (overnight urine volume/functional bladder capacity)-1 and functional nocturia as the number of nocturia is equal to (overnight urine volume/functional bladder capacity)-1. RESULTS: Overall 7(26%) had noctural polyruia. 4(15%) hyperactive nocturia and 13(48%) were mixed with noctual polyuria and hyperactive nocturia. The other 3(11%) were classified into functional nocturia. CONCLUSIONS: The cause of nocturia in the patient with BPH was multifactorial and unrelated to bladder outlet obstruction in significant proportion of BPH patients. Therefore in BPH patients with nocturia, we think that sufficient evaluation to find cause of nocturia is needed preoperatively and treatment should be directed to each condition with BPH management.
Aged ; Heart Failure ; Humans ; Nocturia* ; Polyuria ; Prostatic Hyperplasia ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urodynamics

Papillary cystadenoma of the epididymis is a rare benign tumor that accounts for only 5% of all epididymal tumors. A case of epididymal cystadenoma was presented in a 25 year old man. The patient was hospitalized initially because of infertility and bilateral painless palpable scrotal masses. He had multiple renal cysts and pancreatic cysts. He had no renal, adrenal, cerebellar or retinal lesion as cardinal manifestation of the Von Hippel-Lindau Syndrome (VHL). The VHL gene mutation in this case was not identified. For evaluation and management, we planned left epididymovasostomy and left testicular biopsy. However, due to a cystic change on the left epididymis and left tunica albuginea, we instead performed a left partial epididymectomy for the cystic lesion, excision of the cystic mass from the left tunica albuginea, and diagnostic left testicular biopsy. The pathologic evaluation revealed a papillary cystadenoma of the epididymis and tunica albuginea, but with normal spermatogenesis.
Adult ; Biopsy ; Cystadenoma ; Cystadenoma, Papillary* ; Epididymis* ; Humans ; Infertility ; Male ; Pancreatic Cyst* ; Retinaldehyde ; Spermatogenesis ; von Hippel-Lindau Disease

Primary testicular carcinoid is a rare disease, accounting for less than 1% of all testicular neoplasms, with the potential for distant metastasis. We report a case of primary testicular carcinoid in a 44-year-old-man who presented with a painless, palpable mass in the left testis. Preoperative testicular ultrasound examination revealed a solid mass. Radical orchiectomy was performed, and pathologic examination showed a carcinoid tumor confined to the testis. There was no evidence of carcinoid syndrome, and a 24-hour urinary 5-HIAA assay was normal. Abdominopelvic CT scan and gastrointestinal contrast study showed no evidence of carcinoid in other organ. At 12 months postoperatively, the patient was without evidence of tumor recurrence.
Carcinoid Tumor* ; Humans ; Hydroxyindoleacetic Acid ; Neoplasm Metastasis ; Orchiectomy ; Rare Diseases ; Recurrence ; Testicular Neoplasms ; Testis* ; Tomography, X-Ray Computed ; Ultrasonography

Malignant mesothelioma occurs commonly in the peritonial cavity, pleural and pericardial cavity, also have been reconginzed in numerous other locations. However, it is rarely found in testis arised from tunica vaginalis. Aggressive surgery is necessary soon after diagnosis. Generally the prognosis is very poor and there is no consensus regarding treatment after surgery. We report a case of a 44 years old man with scrotal mass with recurrent pain for 2 years and pathologically diagnosed as a malignant mesothelioma in tunica vaginalis.
Adult ; Consensus ; Diagnosis ; Humans ; Mesothelioma* ; Pleural Cavity ; Prognosis ; Testis

PURPOSE: This study aimed to propose a common scope of practice (SOP) for 13 specialties of Advanced Practice Nurses (APNs) in Korea.METHODS: The first draft of a common SOP was extracted from domestic and international laws with a literature review by 17 experts from the Korean Association of Advanced Practice Nurses (KAAPN). Then, the common SOP was finalized after comparing the activities of APNs in clinical settings.RESULTS: A total of 70 duties were identified and six categories were suggested for the common SOP. The SOP proposed by the KAAPN featured the following: 1) identification of and discrimination between health problems; 2) prescription and implementation of diagnostic tests; 3) treatment of injuries and diseases while implementing measures to prevent exacerbation; 4) prescription of medicinal products in line with 1) to 3); 5) referral and consultation; and 6) education and counseling. It was then confirmed that the proposed six categories in the common SOP reflected all the duties performed by APNs in clinical practice, including all 40 activities.CONCLUSION: The results of this study can be used as evidence for the legalization of a common SOP for APNs. Given the increasing multidisciplinary team approach adopted in Korean hospitals, it may be desirable to establish a broader SOP to reflect the diverse duties of APNs.
Counseling ; Diagnostic Tests, Routine ; Discrimination (Psychology) ; Education ; International Law ; Korea ; Prescriptions ; Professional Practice ; Referral and Consultation

White blood cells (WBCs) and storage period are the main factors of transfusion reactions. In the present study, cytokine/chemokine concentrations after leukoreduction (LR) and irradiation (IR) in stored canine whole blood were measured. Red blood cell storage lesion caused by IR and LR were also compared. Blood samples from 10 healthy Beagles were divided into four groups (no treatment, LR-, IR-, and LR + IR-treated). Leukocytes were removed by filtration in the LR group and gamma radiation (25 Gy) was applied in the IR group. Immunologic factors (WBCs, interleukin-6 [IL-6], C-X-C motif chemokine ligand 8 [CXCL-8], and tumor necrosis factor-alpha) and storage lesion factors (blood pH, potassium, and hemolysis) were evaluated on storage days 0, 7, 14, 21, and 28. Compared to the treated groups, IL-6 and CXCL-8 concentrations during storage were significantly higher in the control (no treatment) group. LR did not show changes in cytokine/chemokine concentrations, and storage lesion presence was relatively mild. IR significantly increased CXCL-8 after 14 days of storage, but IR of leukoreduced blood did not increase CXCL-8 during 28 days of storage. Storage lesions such as hemolysis, increased potassium, and low pH were observed 7 days after IR and storage of blood, regardless of LR. IR of leukoreduced blood is beneficial to avoid immune reactions; however, storage lesions should be considered upon storage.
Blood Preservation ; Down-Regulation ; Erythrocytes ; Filtration ; Gamma Rays ; Hemolysis ; Hydrogen-Ion Concentration ; Immunologic Factors ; Interleukin-6 ; Leukocyte Reduction Procedures ; Leukocytes ; Necrosis ; Potassium ; Transfusion Reaction

Purpose: There are increased therapeutic usages of rituximab in kidney transplantation (KT). However, few studies have evaluated the effect of rituximab on cancer development following KT. This study aimed to evaluate the effect of rituximab on the cancer occurrence and mortality rate according to each type of cancer. Methods: Five thousand consecutive recipients who underwent KT at our center were divided into era1 (1990–2007) and era2-rit– (2008–2018), and era2-rit+ (2008–2018) groups. The era2-rit+ group included patients who received single-dose rituximab (200–500 mg) as a desensitization treatment 1–2 weeks before KT. Results: The 5-year incidence rates of malignant tumors after KT were 3.1%, 4.3%, and 3.5% in the era1, era2-rit–, and era2-rit+ group, respectively. The overall incidence rate of cancer after transplantation among the 3 study groups showed no significant difference (P = 0.340). The overall cancer-related mortality rate was 17.1% (53 of 310). Hepatocellular carcinoma (HCC) had the highest mortality rate (61.5%) and relative risk of cancer-related death (hazard ratio, 8.29; 95% confidence interval, 2.40–28.69; P = 0.001). However, we found no significant association between rituximab and the incidence of any malignancy. Conclusion Our results suggest that single-dose rituximab for desensitization may not increase the risk of malignant disease or cancer-related mortality in KT recipients. HCC was associated with the highest risk of cancer-related mortality in an endemic area of HBV infection.

Background: The lack of headforms that accurately reflect the head characteristics of Koreans and the demographic composition of the Korean population can lead to inadequate FFR testing and reduced effectiveness of FFRs.MethodDirect measurements of 5,110 individuals and 3D measurements of 2,044 individuals, aged between 9 and 69 years, were sampled from the data pool of Size Korea surveys based on the age and gender ratios of the Korean resident demographics. Seven head dimensions were selected based on the ISO 16976-2, availability of Size Korea measurements, and their relevance to the fit performance of FFRs. A principal component analysis (PCA) was performed using the direct measurements to extract the main factors explaining the head characteristics and then the main factors were standardized and remapped to 3D measurements, creating five size categories representing Korean head shapes. Lastly, representative 3D headforms were constructed by averaging five head shapes for each size category. Results: The study identified two main factors explaining Korean head characteristics by the PCA procedure specified in ISO 16976-2 and developed five representative headforms reflecting the anthropometric features of Korean heads: medium, small, large, short & wide, and long & narrow. Conclusion This study developed representative headforms tailored to the Korean population for conducting total inward leakage (TIL) tests on filtering facepiece respirators (FFRs). The representative headforms can be used for TIL testing by employing robotic headforms to enhance the performance of FFRs for the Korean target population.