PURPOSE: To compare extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic removal of stone (URS) on the basis of success rate, cost effectiveness, safeness, cause of failure, complication, and auxiliary procedures in treating ureteral stones larger than 1cm. MATERIALS AND METHODS: From January 2001 to April 2005, 72 cases were treated with URS using 7.5Fr or 9.5Fr rigid ureteroscopy and 110 cases with in situ Direx Compact ESWL. The mean stone sizes of URS and ESWL were 12.8mm and 13.1mm, respectively, and all were larger than 10.0 mm. RESULTS: In the URS, the overall success rate and the mean operative time were 88.9% (64/72 cases) and 68 minutes, respectively. According to stone site, the success rates of upper, mid and lower ureteral stones were 83.3% (15/18 cases), 84.6% (11/13 cases) and 92.6% (38/41 cases), respectively. The first session and total treatment, stone-free rates for ESWL were 34.5% (38/110 cases) and 79.0% (87/110 cases), respectively. The complication rates associated with URS and ESWL were 13.8% (10/72 cases) and 11.8% (13/110 cases), respectively. All complications were managed successfully with conservative treatment. Overall costs were similar for both modalities, but detailed cost analysis (e.g. follow-up loss patient) was not performed. CONCLUSIONS: Both URS and ESWL are effective treatments for stones larger than 1cm, but ureteroscopy with intracorporeal lithotripsy is the more efficient and cost effective method.
Cost-Benefit Analysis ; Costs and Cost Analysis ; Lithotripsy* ; Operative Time ; Shock* ; Ureter* ; Ureteral Calculi ; Ureteroscopy

A case of unilateral pulmonary vein atresia with absent right superior vena cava in 9 years-old boy is described with a discussion. Clinical findings were similar to other reports and consisted of hemoptysis, dyspnea and anemia. A chest X-rary revealed irregular vascular marking on left lung fiedld and increased interstitial marking on right upper lung field. The diagnosis could be confirmed with radionuclide perfusion study, MRI scan of heart and great vessels and angiography which demonstrated a small right pulmonary artery, pruned its peipheral branches, stasis of contrast material and nonvisualization of draining righ pulmonary veins. Pneumonectomy, patch angioplasty of diaphargm excision will be necessary.
Anemia ; Angiography ; Angioplasty ; Child ; Diagnosis ; Dyspnea ; Heart ; Hemoptysis ; Humans ; Lung ; Magnetic Resonance Imaging ; Male ; Perfusion ; Pneumonectomy ; Pulmonary Artery ; Pulmonary Veins* ; Thorax ; Vena Cava, Superior*

Objective: This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns. Methods: This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles. Results: The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height. Conclusions TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

Objective: This study aimed to evaluate the following null hypothesis: there are no differences in the morphology of the temporomandibular joint (TMJ) structures in relation to vertical and sagittal cephalometric patterns. Methods: This retrospective study was performed with 131 participants showing no TMJ symptoms. The participants were divided into Class I, II, and III groups on the basis of their sagittal cephalometric relationships and into hyperdivergent, normodivergent, and hypodivergent groups on the basis of their vertical cephalometric relationships. The following measurements were performed using cone-beam computed tomography images and compared among the groups: condylar volume, condylar size (width, length, and height), fossa size (length and height), and condyle-to-fossa joint spaces at the anterior, superior, and posterior condylar poles. Results: The null hypothesis was rejected. The Class III group showed larger values for condylar width, condylar height, and fossa height than the Class II group (p < 0.05). Condylar volume and superior joint space in the hyperdivergent group were significantly smaller than those in the other two vertical groups (p < 0.001), whereas fossa length and height were significantly larger in the hyperdivergent group than in the other groups (p < 0.01). The hypodivergent group showed a greater condylar width than the hyperdivergent group (p < 0.01). The sagittal and vertical cephalometric patterns showed statistically significant interactions for fossa length and height. Conclusions TMJ morphology differed across diverse skeletal cephalometric patterns. The fossa length and height were affected by the interactions of the vertical and sagittal skeletal patterns.

PURPOSE: Prostate biopsy for diagnosing cancer can be painful. The efficacy and safety of combination perianal-intrarectal lidocaine-prilocaine (PILP) cream and periprostatic nerve block were compared with nerve block alone during transrectal ultrasound guided prostate biopsy (TRUS-Bx). MATERIALS AND METHODS: From October 2007 to August 2009, 74 men undergoing a transrectal prostate biopsy were randomized into two groups. In group 1, 36 patients received a combination of PILP cream and a periprostatic nerve block; and in group 2, 38 patients received lubricant jelly and a periprostatic nerve block. Thirty minutes later, the TRUS-Bx was performed. Pain was evaluated by a 10-point visual analogue scale (VAS) after the biopsy. RESULTS: Patients in group 1 showed a significantly lower VAS score than patients in group 2 (mean score 2.22+/-0.89 vs. 3.02+/-1.15, p<0.001). In addition, there was a difference in the number of patients that had a pain score of three or more, 44% in group 1, and 65% in group 2. The overall complication rate was similar in both groups (p=0.45). CONCLUSIONS: A combination of PILP cream and periprostatic nerve block reduced pain compared to the periprostatic nerve block alone. This safe, simple technique can be considered prior to TRUS-Bx to reduce patient discomfort.
Analgesia ; Biopsy* ; Humans ; Male ; Nerve Block* ; Prostate* ; Ultrasonography*

PURPOSE: Prostate biopsy for diagnosing cancer can be painful. The efficacy and safety of combination perianal-intrarectal lidocaine-prilocaine (PILP) cream and periprostatic nerve block were compared with nerve block alone during transrectal ultrasound guided prostate biopsy (TRUS-Bx). MATERIALS AND METHODS: From October 2007 to August 2009, 74 men undergoing a transrectal prostate biopsy were randomized into two groups. In group 1, 36 patients received a combination of PILP cream and a periprostatic nerve block; and in group 2, 38 patients received lubricant jelly and a periprostatic nerve block. Thirty minutes later, the TRUS-Bx was performed. Pain was evaluated by a 10-point visual analogue scale (VAS) after the biopsy. RESULTS: Patients in group 1 showed a significantly lower VAS score than patients in group 2 (mean score 2.22+/-0.89 vs. 3.02+/-1.15, p<0.001). In addition, there was a difference in the number of patients that had a pain score of three or more, 44% in group 1, and 65% in group 2. The overall complication rate was similar in both groups (p=0.45). CONCLUSIONS: A combination of PILP cream and periprostatic nerve block reduced pain compared to the periprostatic nerve block alone. This safe, simple technique can be considered prior to TRUS-Bx to reduce patient discomfort.
Analgesia ; Biopsy* ; Humans ; Male ; Nerve Block* ; Prostate* ; Ultrasonography*

BACKGROUND: Diet and Nutrition are important modulators of bone health in men and women. We investigated the associations between frequency of food intake among certain food groups and bone mineral density (BMD) in a large population of Korean adults. METHODS: We used the data from Korea National Health and Nutrition Examination Survey during 2008 to 2009. Participants were aged 20 years and over. BMDs were measured at lumbar spine and femoral neck with dual-energy X-ray absorptiometry. Dietary and supplement intakes were assessed by food-frequency questionnaire. We used multiple linear regression analysis to evaluate the relationships between annual food-frequency of each food group and BMD. RESULTS: After adjustment of multiple covariates, femoral neck and lumbar BMD significantly increased as the frequency of fruit consumption increased in both men and women. Frequency of other carbohydrates consumption was significantly associated with greater femoral neck and lumbar BMD for women. Frequency of milk and dairy product consumption was significantly associated with greater femoral neck BMD in men. Other food groups, however, had no significant associations with BMDs. CONCLUSION: Frequent consumption of fruit has a positive association with BMDs in men and women. Milk and dairy products and other carbohydrates also had positive effects on BMD for men and women, respectively.
Absorptiometry, Photon ; Aged ; Bone Density ; Carbohydrates ; Dairy Products ; Diet ; Eating ; Female ; Femur Neck ; Fishes ; Fruit ; Humans ; Korea ; Linear Models ; Male ; Milk ; Nutrition Surveys ; Spine ; Surveys and Questionnaires

PURPOSE: Although neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate. MATERIALS AND METHODS: Seventy-four gastric cancer patients who underwent gastrectomy after neoadjuvant treatment were divided into two groups according to the pathologic response: favorable (ypT0) and others (ypT1-4). The clinicopathologic characteristics, predictive factors for pathologic response, and oncologic outcome were evaluated. RESULTS: Eleven patients (14.8%) demonstrated ypT0 and the remaining 63 patients (85.2%) were ypT1-4. Chemoradiotherapy (CCRTx) rather than chemotherapy (CTx) was the only predictive factor for a favorable pathologic response. Chemotherapeutic factors and tumor marker levels did not predict pathologic response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery. CONCLUSION: CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after neoadjuvant treatment, the survival benefit remains controversial.
Aged ; Chemoradiotherapy/*methods ; Disease-Free Survival ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/pathology ; Stomach Neoplasms/*drug therapy/mortality/pathology/*radiotherapy/surgery ; Treatment Outcome ; Tumor Markers, Biological

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.
Adolescent ; Bone Cysts ; Femur ; Hepatolenticular Degeneration ; Hospitalization ; Humans ; Knee Joint ; Knee ; Magnetic Resonance Imaging ; Osteochondritis Dissecans ; Osteochondritis ; Radiography

Purpose: Bone age (BA) is needed to assess developmental status and growth disorders. We evaluated the clinical performance of a deep-learning-based BA software to estimate the chronological age (CA) of healthy Korean children. Methods: This retrospective study included 371 healthy children (217 boys, 154 girls), aged between 4 and 17 years, who visited the Department of Pediatrics for health check-ups between January 2017 and December 2018. A total of 553 left-hand radiographs from 371 healthy Korean children were evaluated using a commercial deep-learning-based BA software (BoneAge, Vuno, Seoul, Korea). The clinical performance of the deep learning (DL) software was determined using the concordance rate and Bland-Altman analysis via comparison with the CA. Results: A 2-sample t-test (P<0.001) and Fisher exact test (P=0.011) showed a significant difference between the normal CA and the BA estimated by the DL software. There was good correlation between the 2 variables (r=0.96, P<0.001); however, the root mean square error was 15.4 months. With a 12-month cutoff, the concordance rate was 58.8%. The Bland-Altman plot showed that the DL software tended to underestimate the BA compared with the CA, especially in children under the age of 8.3 years. Conclusion The DL-based BA software showed a low concordance rate and a tendency to underestimate the BA in healthy Korean children.