PURPOSE: Introduction of shock wave lithotripsy has provided an avenue for dealing with many urinary stones noninvasively. Although shock wave is known to cause pathologic changes in various organ, little is k nown about its effect on the ureter and recovery after shock wave, the target organ in SWL of injury induced by shock wave and the potential protective effect of allopurinol and nifedipine against shock wave. MATERIALS AND METHODS: A total 24 rabbits were assigned to 2 groups. 12 rabbits received allopurinol(10mg.each) and nifedipine (1mg.each) that were given orally 3 times a day for 5 days starting the night before SWL. The other 12 rabbits reseived no medication. The left lower Ureter segments of 24 rabbits were removed ureter. Groups of 8 rabbits(4were medication group and 4, no medication group) were sacrificed 1, 3 and 5 days after shock wave exposure. The histomorphological alterations were examined under light and transmission electron microscopy. RESULTS: The epithelial cells disclosed no change after shock wave application. Histologically the muscular layer was the most affected part of ureter. There was interstitial and intracellular edema on light microscopy and made chromatin and mitochondrial changes at the subcellular level. The adventitial layer wes also edematous. This chanfes were prominent on day 1and 3 and returned to normal on day 5. The medication group showed less severe features of injury, compared with the no medication group. CONCLUSIONS: Electromagnetic shock waves produce reversible morphological changes in rabbit ureteric muscle and allopurinol and nifedipine may have its role in protecting the tissue injury produced by high energy shock waves.
Allopurinol* ; Chromatin ; Edema ; Epithelial Cells ; High-Energy Shock Waves ; Lithotripsy ; Magnets ; Microscopy ; Microscopy, Electron, Transmission ; Nifedipine* ; Rabbits ; Shock* ; Ureter* ; Urinary Calculi

BACKGROUND: Acute emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires the emergent intensive treatment. Diagnosis is usually established by the certain radiologic findings. Mortality rates of patients reportedly vary from 40 to 90% and patients treated conservatively approaches 80% in some series. Traditional therapy for emphysematous pyelonephritis is nephrectomy. Recent advances on endourologic area have been applied to percutaneous drainage, but appropriate care requires aggressive treatment to preserve renal function without increased mortality. I reviewed the clinical feature, radiologic findings and results of different mode of treatments. METHOD AND RESULTS: Seven patients who admitted with the impression of the acute emphysematous pyelonephritis from March 1997 to March 1999 were enrolled in this study. The clinical feature, radiologic findings and results of different treatments were evaluated. All patient presented with diabetes mellitus and complained fever of short duration. Other characteristics and laboratory findings were variable. Escherichia coli was documented organism in 4 cases and Klebsiella in 1 case. Of the 7 patient, 4 were managed by conservative treatment including with intensive antibiotic therapy followed by prolonged oral antibiotics and supportive care. The results of treatment of 3 cases were successful but, 1 patient with multiple predisposing diseases and poor general condition at the initial presentation was deteriorated despite of intensive care. And among the 7 cases, emergent nephrectomy was performed to 2 patients, as the patient had the evidence of progressive course of septic shock and clinically fetal. After operation, 2 patients improved markedly. And remaining 1 patients were improved after the percutaneous drainage of the collection of prominent perirenal abscess. CONCLUSION: Tough definite prognostic factor were not documented, the underlying disease and general condition in initial presentation may have important role. Standard treatment to emphysematous pyelonephritis are known to be emergent nephrectomy, but my cases revealed that conservative treatment including intensive antibiotics therapy and percutaneous drainage may effective to the less critical patients.
Abscess ; Anti-Bacterial Agents ; Bacterial Infections ; Diabetes Mellitus ; Diagnosis ; Drainage ; Escherichia coli ; Fever ; Humans ; Critical Care ; Kidney ; Klebsiella ; Mortality ; Nephrectomy ; Pyelonephritis* ; Shock, Septic

No abstract available.
Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Introduction of the shock wave lithotripsy (SWL) has provided an avenue for dealing with many urinary stones noninvasively. Although SWL has been known to cause pathologic changes in various organ, little is known about its effect on the ureter, the target organ in SWL of ureteral stones in situ. We sought to determine the short-term effects of SWL on the ureter`. MATERIALS AND METHODS: We removed the left lower ureteral segments of 21 rabbits to serve as the control group and 2000 shocks were applied to the right lower ureters. Groups of 7 rabbits were sacrificed at 1, 3 and 5 days after shock wave exposure. The histomorphological alterations were examined under light and transmission electron microscopy. RESULTS: The epithelial cells disclosed no change after shock wave application. Histologically the muscular layer was the most affected part of ureter. There was interstitial and intracellular edema on light microscopy and marked chromatin and mitochondrial changes at the subcellular level. The adventitial layer was also edematous. This changes were prominent on day 1 and 3 and returned to normal on day 5. CONCLUSIONS: We conclude that electromagnetic shock waves produce reversible morphological changes in rabbit ureteric muscle.
Chromatin ; Edema ; Epithelial Cells ; Lithotripsy* ; Magnets ; Microscopy ; Microscopy, Electron, Transmission ; Rabbits ; Shock* ; Ureter* ; Urinary Calculi

Between January l986 and June l990. 86 cases with interventional uroradiologic procedure entered into the study. Of 86 cases, 54 procedures were performed via percutaneous route and 32 procedures via intravascular. 54 percutaneous procedures included 24 of puncture and aspiration (13 for renal abcess and 11 for renal cyst). 2 of uric acid stone dissolution and 20 of UPJ and ureteral management (11 for UPJ stricture. 8 for ureteral stricture and 1 for ureteral fistula). 32 intravascular procedures included 24 of transcatheter embolization (10 for kidney. 3 for bladder and 11 for internal spermatic vein) and 8 of transluminal angioplasty (6 for renovascular hypertension and 2 for renal artery stenosis after renal tansplantation). Complications occurred in 10 cases which consisted of severe bleeding in 3, sepsis in 3, chronic urinary tract infection in 2. high fever with flank pain in 1 and paresthesia of gluteal muscle in 1. These complications were managed by conservative treatments with no sequalae. The results of interventional uroradiologic procedures for the 86 cases revealed good in 52. fair in 19 and fail in 15.
Angioplasty ; Constriction, Pathologic ; Endovascular Procedures ; Fever ; Flank Pain ; Hemorrhage ; Hypertension, Renovascular ; Kidney ; Paresthesia ; Punctures ; Renal Artery Obstruction ; Sepsis ; Ureter ; Uric Acid ; Urinary Bladder ; Urinary Tract Infections

No abstract available.
Diagnosis* ; Ultrasonography* ; Varicocele*

No abstract available.
Peripheral Nerves*

PURPOSE: There diagnostic modalities have been commonly used to detect prostate cancer to date: digital rectal examination (DRE), serum prostate specific antigen (PSA) and transrectal ultrasonography(TRUS). We evaluated the diagnostic values of these three modalities in the early detection of prostate cancer. MATERIALS AND METHODS: We analysed 215 patients with low urinary tract symptoms who had pathologic diagnosis for prostatic cancer was possible by biopsy or transurethral resection. Transectal ultrasonography guided sextant biopsies were performed if the PSA level was greater than 4.0 ng/ml or DRE was suspicious, even if TRUS revealed no ateas suspicious for cancer. TURP were performed without TRUS or biopsies if the PSA level was lesser than 4.0 ng/ml and DRE was negative. RESULTS: Of the 215 patients, 36 (16.7%) revealed prostate cancer. Positive predictive value, sensitivity and specificity was 37.0%. 83.3%. 71.5% for DRE, 30.0%, 91.7%, 58.3% for PSA and 27.6% 58.3%. 43.3% for TRUS respectively. Positive findings on serum PSA or DRE or both tests detected significantly more tumors(97.2%, 35of 36 cancers) than only PSA (91.7%, 33 for 36 cancers), DRE (83.3%, 30 of 36 cancers) and TRUS (60.0%, 21 of 35 cancers) alone. CONCLUSIONS: These result shows that DRE is more valuable and cost effective method for detection of prostate cancer than serum PSA and the use of DRE in conjunction with serum PSA enhances prostate cancer detection.
Biopsy ; Diagnosis ; Digital Rectal Examination* ; Humans ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Transurethral Resection of Prostate ; Ultrasonography* ; Urinary Tract

Wilms' tumor is one of the most common abdominal neoplasms in the pediatric age group. The incidence of bilateral involvement is generally estimated to be 5 to 10 per cent. In the past, synchronous bilateral Wilms' tumor was almost always atal but multidisciplinary treatments have resulted in clearly improved prognosis. When the clinical characteristics of patient with bilateral tumors were compared with those of patients with unilateral tumors, several features became evident. Herein the authors report a case of a 7 month old infant with synchronous bilateral Wilms' tumor with congenital anomalies.
Abdominal Neoplasms ; Humans ; Incidence ; Infant ; Prognosis ; Wilms Tumor*

PURPOSE: Our aim is to identify the false negative rate of doppler ultrasonography and to compare color doppler ultrasonography with pathologic findings during testis torsion in animal model. MATERIALS AND METHODS: Seventeen male house rabbits weighted 1.9-2.6kg were examined with doppler ultrasonography as control group and 1 rabbit was orchiectomized as pathologic control group. In 16 rabbits, right spermatic cord was torqued 720o count-clockwise and placed back into the scrotum, and 1, 3, 6, 9, 12, 18, 24, 48 hours after torsion, doppler ultrasonographic and pathologic findings were examined at twisted testicles. RESULTS: In 1 hour and 3 hours group, false negative rate of doppler ultrasonography were 100% and 6 hours after torsion false nagative rate was 63%. Nine hours after torsion false negative rate was 50%, 12 hours after torsion false negative rate was 25%. But after 18 hours group, all had decreased or disappeared blood flow. Before 9 hours after torsion, there was no pathologic changes in seminiferous tubules. In seminiferous tubules, number of spermatid decreased in 12 hours group and spermatid was absent and spermatocyte were markedly degenerated in 18 hours group. In 48 hours group, spermatid and spermatocyte were absent, number of Sertoli cell decreased markedly and diffuse infarction were seen. CONCLUSIONS: As time goes by, false negative rate of doppler ultrasonography was decreased. So if blood flow have been normal when doppler ultrasonography was done before 12 hours after torsion, doppler ultrasonography should be re-examined in suspected testis before 12 hours after torsion because of spermatocytes are degenerated after 12 hours.
Animals* ; Humans ; Infarction ; Male ; Models, Animal* ; Rabbits ; Scrotum ; Seminiferous Tubules ; Spermatic Cord ; Spermatids ; Spermatocytes ; Testis* ; Ultrasonography, Doppler* ; Ultrasonography, Doppler, Color