Objective: : Though the operating microscope (OM) has been the standard optical system in neurosurgery, a new technology called three-dimensional (3D) exoscope has emerged as an alternative. Herein, two types of 3D exoscopes for brain tumor surgery are presented. In addition, the advantages and limitations compared with the OM are discussed. Methods: : In the present study, 3D exoscope VOMS-100 or VITOM 3D was used in 11 patients with brain tumor who underwent surgical resection; the Kinevo 900 OM was used only in emergency. After completion of all surgeries, the participants were surveyed with a questionnaire regarding video image quality on the display monitor, handling of equipment, ergonomics, educational usefulness, 3D glasses, and expectation as a substitute for the OM. Results: : Among 11 patients, nine patients underwent neurosurgical resection with only 3D exoscope; however, two patients required additional aid with the OM due to difficulty in hemostasis. Regarding video image quality, VITOM 3D was mostly equivalent to the OM, but VOMS-100 was not. However, both 3D exoscopes showed advantages in accessibility of instruments in the surgical field and occupied less space in the operating theater. Differences in ergonomics and educational usefulness between the exoscopes were not reported. Respondents did not experience discomfort in wearing 3D glasses and thought the exoscopes could be currently, and in the future, used as a substitute for the OM. Conclusion : Although many neurosurgeons are not familiar with 3D exoscopes, they have advantages compared with the OM and similar image quality. Exoscopes could be a substitute for OM in the future if some limitations are overcome.

Primary sarcomas of the central nervous system are rare. These tumors is rapid growth often produces mass effect on the brain. Diagnosis is rendered pathologically after resection. Surgical resection is the mainstay treatment and need the adjuvant therapy. We report a 44-year-old female with a meningeal sarcoma of frontal meninges. She complained headache for 2 months and palpable forehead mass for 3 weeks. Brain MRI demonstrated a soft tissue mass sized as 5.3×3.7×3.1 cm with well-defined osteolysis on the midline of the frontal bone. The mass attached to anterior falx without infiltration into the brain parenchyme. The tumor had extracranial and extraaxial extension with bone destruction. The tumor was totally removed with craniectomy and she had an adjuvant radiotherapy. However, an isolated subcutaneous metastasis developed at the both preauricular area of the scalp, originating from the scar which was remained the first surgery. After complete removal of this metastasis, she had an adjuvant radiotherapy in other hospital. However, she expired after six months after first surgery. We believe that the occurrence of tumor seeding at the site of incision in the scalp is related to using the fluid for irrigation after tumor resection and the same surgical instruments for the removal of the brain tumor.
Adult ; Brain ; Brain Neoplasms ; Central Nervous System ; Cicatrix ; Diagnosis ; Female ; Forehead ; Frontal Bone ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms ; Meninges ; Neoplasm Metastasis ; Osteolysis ; Radiotherapy, Adjuvant ; Sarcoma* ; Scalp* ; Surgical Instruments

No abstract available.
Eating ; Humans ; Ketosis

PURPOSE: We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. MATERIALS AND METHODS: This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. RESULTS: Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. CONCLUSIONS: This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.
Aged ; Biopsy, Large-Core Needle/methods ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Prostatectomy/*methods ; Prostatic Neoplasms/*pathology/*surgery/ultrasonography ; Retrospective Studies ; Ultrasonography, Interventional/methods

PURPOSE: The objective of the present study was to evaluate the efficacy of a sclerosing solution for inducing epididymal occlusion in male rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into two groups: an injection group (n=20) and control group (n=20). Before injecting the sclerosing agent, seminal vesiculectomy and sperm identification using electrostimulation were performed in all of the rats. In the injection group, 0.2 mL of 0.1% sodium tetradecyl sulfate solution was injected into the epididymis. In the sham group, only the identification of the epididymis was performed. At 4 and 12 weeks after the injection, semen was collected by electrostimulation and evaluated to assess the contraceptive effect. Epididymis was evaluated by hematoxylin and eosin (H&E) staining. RESULTS: After 4 and 12 weeks, semen collection was performed in the two groups. Sperms were not observed in the injection group, while there was no change in the sperms in the sham group. H&E staining showed the obstruction of epididymal tubules and an accumulation of inflammatory cells in the injection group. CONCLUSIONS: This study showed that the sclerosing agent induced sterilization in male rats. This result suggests that the injection method can replace vasectomy as a contraceptive method. However, a further study of large animals and a clinical study are needed. Further, the long-term effectiveness of this method needs to be studied.
Animals ; Contraception* ; Contraceptive Agents ; Eosine Yellowish-(YS) ; Epididymis ; Hematoxylin ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Sclerotherapy* ; Semen ; Sodium Tetradecyl Sulfate ; Spermatozoa ; Sterilization ; Vasectomy

PURPOSE: The objective of the present study was to evaluate the efficacy of a sclerosing solution for inducing epididymal occlusion in male rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into two groups: an injection group (n=20) and control group (n=20). Before injecting the sclerosing agent, seminal vesiculectomy and sperm identification using electrostimulation were performed in all of the rats. In the injection group, 0.2 mL of 0.1% sodium tetradecyl sulfate solution was injected into the epididymis. In the sham group, only the identification of the epididymis was performed. At 4 and 12 weeks after the injection, semen was collected by electrostimulation and evaluated to assess the contraceptive effect. Epididymis was evaluated by hematoxylin and eosin (H&E) staining. RESULTS: After 4 and 12 weeks, semen collection was performed in the two groups. Sperms were not observed in the injection group, while there was no change in the sperms in the sham group. H&E staining showed the obstruction of epididymal tubules and an accumulation of inflammatory cells in the injection group. CONCLUSIONS: This study showed that the sclerosing agent induced sterilization in male rats. This result suggests that the injection method can replace vasectomy as a contraceptive method. However, a further study of large animals and a clinical study are needed. Further, the long-term effectiveness of this method needs to be studied.
Animals ; Contraception* ; Contraceptive Agents ; Eosine Yellowish-(YS) ; Epididymis ; Hematoxylin ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Sclerotherapy* ; Semen ; Sodium Tetradecyl Sulfate ; Spermatozoa ; Sterilization ; Vasectomy

PURPOSE: To evaluate the association of a specific type of lower urinary tract symptom (LUTS) and the depression in community-dwelling elderly Korean men. MATERIALS AND METHODS: A total of 392 men aged 65 years or older, who completed urological and psychiatric evaluations as a participant of the Korean Longitudinal Study on Health and Aging, were included. From each subject, an interview on the demographic characteristics and medical history, IPSS, and psychiatric questionnaire were taken. Subjects were divided into two groups; depression and euthymic. Subjects with IPSS subscore more than 3 points was considered 'high' subscore. IPSS subscores were compared between the two groups, and the relationship between depression and LUTS severity was assessed. RESULTS: The mean age of the subjects was 75, and 6.4% of the subjects were diagnosed to have major depressive disorders. The depression group showed higher IPSS scores than the euthymic group (16.1+/-9.9 vs. 11.6+/-8.6, p=0.01). IPSS subscores of question 1 (incomplete empty), question 3 (intermittency), question 4 (urgency) and question 6 (straining to void) were higher in the depression group compared with the euthymic group. Chi-square test revealed subjects with high IPSS 1, 3, 4, and 6 score were associated with depression, but multivariate analysis identified only high IPSS question 4 as a significant prognostic factor for depression. CONCLUSIONS: Elderly population with depression is more likely to have more severe LUTS than population without depression. Among the urinary symptoms, urgency was strongly associated with depression. Patients with moderate to severe LUTS and especially urgency may need their mental health status evaluation.
Aging ; Depression* ; Depressive Disorder, Major ; Humans ; Longitudinal Studies ; Lower Urinary Tract Symptoms ; Male ; Mental Health ; Multivariate Analysis ; Urinary Tract

PURPOSE: The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases. MATERIALS AND METHODS: Women with SUI who underwent a TVT procedure were studied. "Cure" was defined as no urine leakage at all in any circumstances and "improvement" was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, > or =65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure. RESULTS: A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5+/-5.9 and 72.0+/-5.0 years and the mean follow-up times were 50.5+/-9.4 and 48.8+/-9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7% and 4.7% vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8+/-1.1 vs. 3.3+/-1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6+/-3.3 kg/m2 and 26.6+/-1.0 kg/m2, and body mass index was the only factor that differed significantly between the two subgroups (p=0.028). CONCLUSIONS: Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate.
Aged ; Body Mass Index ; Female ; Follow-Up Studies ; Humans ; Suburethral Slings ; Urinary Incontinence

PURPOSE: To assess the long-term outcomes of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and to identify influencing factors for failure in these cases. METHODS: A total of 136 women who underwent TVT procedures with minimum follow-up duration of 3 years were included in the study. Patients were divided into two groups (non-ISD and ISD groups) based on preoperative urodynamic studies. Patient outcomes were assessed from retrospective chart review and telephone research. Cure was defined as the subjective resolution of SUI in any circumstances. Improvement was defined as the subjective improvement of SUI without complete resolution. Failure was defined as the subjective lack of improvement of SUI. Patients in ISD group were subdivided into two subgroups (cure and non-cure groups) and were compared to identify influencing factors for TVT procedure failure. RESULTS: Eighty-nine patients were in non-ISD group, and 47 in ISD group. The mean follow-up durations were 50.3+/-9.2 and 49.7+/-9.7 months, respectively. Subjective cure rate was 75.3% for non-ISD group, and 76.7% for ISD group (P>0.05). Improvement rate was 6.7% for non-ISD group, and 2.1% for ISD group (P>0.05). Satisfaction scores was 3.8+/-1.2 points in the non-ISD group, and 3.5+/-1.2 points in ISD group (P>0.05). In ISD subgroups, VLPP was 41.9+/-12.0 cmH2O for non-cure group, and 50.5+/-8.6 cmH2O for cure group, and was the only factor that showed significant statistical difference between the two subgroups (P=0.011). CONCLUSIONS: With our long-term results, TVT is an effective treatment even in women with ISD. However, ISD patients with low VLPP should be counseled carefully about TVT outcome.
Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Suburethral Slings ; Telephone ; Urinary Incontinence ; Urodynamics

PURPOSE: To evaluate the diagnostic performance of gray-scale renal sonographic findings for the diagnosis of acute pyelonephritis (APN) by using computed tomography as a reference standard. MATERIALS AND METHODS: We retrospectively reviewed gray-scale renal sonographic findings of 48 patients for the detection of APN. All patients had clinical symptoms such as fever, flank pain, or dysuria and were confirmed as APN by contrast-enhanced CT. The presence of sonographic findings such as renal swelling, alteration of the parenchymal echogenicity, wall thickening of the renal pelvis, loss of the renal sinus fat echogenicity, and loss of the corticomedullary differentiation were evaluated. We also categorized all patients into mild APN or severe APN groups according to the volume of the morbid renal parenchyma on contrast-enhanced CT, and evaluated the aforementioned sonographic findings between the two groups. RESULTS: Overall diagnostic sensitivity, specificity, and accuracy of gray-scale renal ultrasonography (US) for the detection of APN were 32.5%, 72.0%, and 58.5%, respectively. The sensitivity and specificity of each sonographic finding were measured for each group. Renal swelling sensitivity and specificity were 33.8% and 70.8% for the mild APN group, but 45.8% and 66.7% for the severe APN group. Sensitivity and specificity for alteration of the parenchymal echogenicity were 41.7% and 79.2% for the mild APN group, but 58.3% and 66.7% for the severe APN group. The sensitivity and specificity for wall thickening of the renal pelvis was 37.5% and 95.8% for the mild APN group, but 50.0% and 95.8% for the severe APN group. The sensitivity and specificity of loss of the renal sinus fat echogenicity were 12.5% and 83.3% for the mild APN group, but 12.5% and 91.7% for the severe APN group. The sensitivity and specificity of the loss of the corticomedullary differentiation were 12.5% and 95.8% for the mild APN group, but 20.8% and 75.0% for the severe APN group. There was no significant difference of gray-scale renal US diagnostic accuracy for the detection of APN between the mild and severe APN groups (56.3%: 58.3%; p > 0.05). CONCLUSION: Although overall gray-scale renal US has poor sensitivity for the detection of APN, wall thickening of the renal pelvis is the most specific sonographic finding in the both mild and severe APN groups.
Dysuria ; Fever ; Flank Pain ; Humans ; Kidney Pelvis ; Pyelonephritis ; Retrospective Studies ; Sensitivity and Specificity