No abstract available.
Nephrectomy*

PURPOSE: To search for a safer and easier approach for laparoscopic donor nephrectomy, hand-assisted laparoscopic techniques have been added to the surgical armamentrium. Hand-assisted live donor nephrectomy (HALDN) for renal transplantation is being performed in increasing numbers with the goal of broadening organ supply while minimizing pain and duration of convalescence for donors. Here, we compared our initial series of HALDN with open donor nephrectomy (ODN). MATERIALS AND METHODS: Between July 2001 and February 2003, a total of 63 patients underwent consecutive live donor nephrectomy in our hospital, which were all performed by a single surgeon. Of these patients 22 underwent HALDN and 41 underwent ODN. Objective data and subjective recovery information was obtained from medical records, telephone interviews, and questionnaires. RESULTS: Twenty-two HALDNs were performed successfully without open conversion. There was a significant reduction in postoperative visual analogue pain scale (p<0.05), and there were characteristics of rapid return to normal activities (p<0.05) in the HALDN group. The mean operative time, estimated blood loss, hospitalization, and complications were similar in both groups. The mean warm ischemic time was significantly longer in the HALDN group (p<0.05). However, warm ischemic time between the latter HALDN and the ODN group was not significant (p=0.46). In terms of allograft function, serum creatinine at 1, 2 days, 1 week, 2 weeks, 1 month, 2 months, delayed graft function, episodes of rejection, and ureteral complication were similar in both groups. Transfusion was required in one patient of the HALDN group. CONCLUSIONS: HALDN is efficacious and reproducible, and it is safe for live donor nephrectomy. Compared with ODN, HALDN significantly lessened the pain for the donor, and it allows a more complete convalescence, while enabling excellent allograft function.
Allografts ; Convalescence ; Creatinine ; Delayed Graft Function ; Hand ; Hospitalization ; Humans ; Interviews as Topic ; Kidney ; Kidney Transplantation ; Laparoscopy ; Medical Records ; Nephrectomy* ; Operative Time ; Pain Measurement ; Surveys and Questionnaires ; Tissue Donors* ; Transplantation ; Ureter ; Warm Ischemia

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.
Abdominal Pain ; Angiography ; Anorexia ; Busan ; Cardiovascular Diseases ; Creatinine ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Flank Pain ; Hematuria ; Heparin ; Humans ; Hypertension ; Infarction* ; Kidney Transplantation ; Male ; Medical Records ; Nausea ; Neoplastic Cells, Circulating ; Oliguria ; Physical Examination ; Renal Insufficiency ; Thromboembolism ; Thrombosis ; Ultrasonography ; Vasculitis ; Vomiting ; Warfarin

PURPOSE: This study was performed to investigate the short-term changes in the morphology and growth factors after the augment of rat bladders with a porcine small intestinal submucosa (SIS). MATERIALS AND METHODS: The experiments were performed in 39 female Sprague- Dawley rats, comprised of 3 controls, 18 sham-operated and 18 SIS-augmented rats. The sham-operated group underwent a primary closure after a longitudinal incision of the bladder. The augmentation cystoplasty was performed using a porcine SIS after a hemi-cystectomy. The rats were postoperatively sacrificed at periods ranging between 12 hours and 14 days, and their bladders procured for histological examination. Reverse transcription-polymerase chain reactions (RT-PCR) were performed to evaluate the expressions of the keratinocyte growth factor (KGF) and the transforming growth factor-alpha (TGF-alpha). RESULTS: Both groups showed an acute inflammatory reaction during the immediate postoperative period, and chronic inflammatory cells appeared 48 hours postoperatively, with new capillaries and fibroblasts appearing 4 days postoperatively. The disrupted urothelial barrier was restored on the 7th postoperative day in the sham group, and epithelialization began to appear on day 4 in the augmented group. New granulation tissue covered the small intestinal submucosa, like a sheet of membrane, by the 4th postoperative day, and its thickness and cellularity increased with time. The mRNA expressions of the KGF and TGF-alpha increased during the initial postoperative period, but tended to derease with time. Their expressions coincided with acute inflammatory reactions. CONCLUSIONS: In conclusion, the short-term morphological changes after the augmentation cystoplasty, with a porcine small intestinal submucosa, were initially composed of acute inflammation, chronic inflammation, fibroblast aggregation, neoangiogenesis, epithelialization and formation of granulation tissue. The mRNA expressions of the KGF and TGF-alpha coincided with acute inflammatory reactions.
Animals ; Capillaries ; Female ; Fibroblast Growth Factor 7 ; Fibroblasts ; Granulation Tissue ; Growth Substances ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Membranes ; Postoperative Period ; Rats* ; RNA, Messenger ; Transforming Growth Factor alpha ; Urinary Bladder*

The distinction between benign and malignant thyroid tumors is critical for the management of patients with thyroid nodules. We applied immunohistochemical staining for galectin-3, HBME-1, cytokeratin 19 (CK19), high molecular weight cytokeratin (HMWCK), cyclin D1 and p27(kip1) in 295 thyroid lesions to determine their diagnostic accuracy. The expression of all markers was significantly associated with differentiated thyroid carcinoma (DTC).The sensitivity for the diagnosis of DTC was 94.7% with galectin-3, 91.3% with HBME-1, and 90.3% with CK19. The specificities of these markers were 95.5%, 69.7%, and 83.1%, respectively. Combining these markers, co-expression of galectin-3 and CK19 or galectin-3 and HBME-1 was seen in 93.2% of carcinomas but in none of the benign nodules. Comparing follicular variant of papillary carcinoma (FVPC) with follicular carcinoma (FC), the expression of galectin-3, CK19, and HMWCK was significantly higher in FVPC. When comparing FC with FA, the expression of galectin-3 and HBME-1 was significantly higher in FC. These results suggest that 1) galectin-3 is a useful marker in the distinction between benign and malignant thyroid tumors, 2) the combined use of HBME-1 and CK19 can increase the diagnostic accuracy, and 3) the use of CK19 and HMWCK can aid in the differential diagnosis between PC and FC.
Adenocarcinoma, Follicular/diagnosis/metabolism ; Carcinoma, Papillary, Follicular/diagnosis/metabolism ; Cyclin D1/analysis ; Cyclin-Dependent Kinase Inhibitor p27/analysis ; Diagnosis, Differential ; Galectin 3/analysis ; Humans ; Immunohistochemistry ; Intracellular Signaling Peptides and Proteins/analysis ; Keratin-19/analysis ; Keratins/analysis ; Sensitivity and Specificity ; Thyroid Gland/chemistry/*pathology ; Thyroid Nodule/*diagnosis/metabolism ; Tumor Markers, Biological/*analysis

No abstract available.
Aged ; Antigens, Tumor-Associated, Carbohydrate/blood ; Carcinoma, Hepatocellular/radiography ; Humans ; Liver Abscess/*complications/pathology/*radiography ; Liver Diseases, Alcoholic/*complications/*pathology ; Liver Neoplasms/radiography ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

PURPOSE: The current study investigates the feasibility of a platform for a nationwide dose monitoring system for dental radiography. The essential elements for an unerring system are also assessed. MATERIALS AND METHODS: An intraoral radiographic machine with 14 X-ray generators and five sensors, 45 panoramic radiographic machines, and 23 cone-beam computed tomography (CBCT) models used in Korean dental clinics were surveyed to investigate the type of dose report. A main server for storing the dose data from each radiographic machine was prepared. The dose report transfer pathways from the radiographic machine to the main sever were constructed. An effective dose calculation method was created based on the machine specifications and the exposure parameters of three intraoral radiographic machines, five panoramic radiographic machines, and four CBCTs. A viewing system was developed for both dentists and patients to view the calculated effective dose. Each procedure and the main server were integrated into one system. RESULTS: The dose data from each type of radiographic machine was successfully transferred to the main server and converted into an effective dose. The effective dose stored in the main server is automatically connected to a viewing program for dentist and patient access. CONCLUSION: A patient radiation dose monitoring system is feasible for dental clinics. Future research in cooperation with clinicians, industry, and radiologists is needed to ensure format convertibility for an efficient dose monitoring system to monitor unexpected radiation dose.
Cone-Beam Computed Tomography ; Dental Clinics ; Dentists ; Humans ; Methods ; Radiation Dosage ; Radiation Monitoring ; Radiography ; Radiography, Dental*

Purpose: The objective of this study was to propose a deep-learning model for the detection of the mandibular canal on dental panoramic radiographs. Materials and Methods: A total of 2,100 panoramic radiographs (PANs) were collected from 3 different machines: RAYSCAN Alpha (n=700, PAN A), OP-100 (n=700, PAN B), and CS8100 (n=700, PAN C). Initially, an oral and maxillofacial radiologist coarsely annotated the mandibular canals. For deep learning analysis, convolutional neural networks (CNNs) utilizing U-Net architecture were employed for automated canal segmentation. Seven independent networks were trained using training sets representing all possible combinations of the 3 groups. These networks were then assessed using a hold-out test dataset. Results: Among the 7 networks evaluated, the network trained with all 3 available groups achieved an average precision of 90.6%, a recall of 87.4%, and a Dice similarity coefficient (DSC) of 88.9%. The 3 networks trained using each of the 3 possible 2-group combinations also demonstrated reliable performance for mandibular canal segmentation, as follows: 1) PAN A and B exhibited a mean DSC of 87.9%, 2) PAN A and C displayed a mean DSC of 87.8%, and 3) PAN B and C demonstrated a mean DSC of 88.4%. Conclusion This multi-device study indicated that the examined CNN-based deep learning approach can achieve excellent canal segmentation performance, with a DSC exceeding 88%. Furthermore, the study highlighted the importance of considering the characteristics of panoramic radiographs when developing a robust deep-learning network, rather than depending solely on the size of the dataset.