OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

PURPOSE: To investigate whether the preoperative prostatic biopsy values predict the tumor stage in radical retropubic prostatectomy (RRP) specimens. MATERIALS AND METHODS: We reviewed the prostatic needle biopsy findings in 69 patients, diagnosed with clinical organ confined prostate cancer, and who underwent a RRP between December 2003 and November 2004. The biopsy specimens were assessed for the number and maximal tumor length of positive cores and for the Gleason score. The preoperative serum prostate-specific antigen (PSA) level and prostate volume were measured using transrectal ultrasonography (TRUS). TRUS guided biopsies of 13.7 2.2 sites were performed. The preoperative values were compared with the pathological stage of the RRP specimens. RESULTS: Of the 69 patients, 53 (76.8%) had organ confined cancer and 16 (23.2%) had extraprostatic extension (pathologic T2 and T3 or greater, respectively), with mean ages of 65.6 and 65.1 years, respectively. The mean PSA levels were 8.0 and 13.0ng/ml and the prostate volumes were 38.3 and 33.8ml, respectively. The age, prostate volume, biopsy Gleason score and preoperative PSA level were not significant factors for predicting the pathological stage inform a multivariate analysis (p>0.05). The number (p=0.007) and maximal tumor length of positive cores (p=0.046) were significantly higher in those with an extraprostatic stage than in the organ confined cancer group. The optimal maximal tumor length and number of positive cores for the detection of extraprostatic cancer were 7.5mm and 6.5, respectively. CONCLUSIONS: The number and maximal tumor length of positive cores were strong predictors of the pathologic stage in the RRP specimens.
Biopsy* ; Biopsy, Needle ; Humans ; Multivariate Analysis ; Neoplasm Grading ; Pathology ; Prostate ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms ; Ultrasonography

Traditionally, radical hysterectomy is the main surgical method for the treatment of early cervical carcinoma and always results in the loss of fertility. But, large numbers of young women are recently being diagnosed with cervical carcinoma and fertility preservation has become a concern. So, there has been a move towards more conservative approaches for the treatment of cervical carcinoma in recent years. Radical trachelectomy, which allows preservation of uterus but removes the cervix, parametrium and upper one third of the vagina, is a conservative but locally radical procedure. We performed radical abdominal trachelectomy with pelvic lymphadenectomy for two cases of invasive cervical carcinomas, which may be the first report in korea. One patient was 37 years old single women who had stage Ib cervical cancer and was disease free for 17 months after treatment. The other patient was 19 years old student who was also single and had stage IIa cervical cancer and was disease free for 14 months after treatment. We report the first two cases and review the literature on radical trachelectomy.
Adult ; Cervix Uteri ; Female ; Fertility ; Fertility Preservation ; Humans ; Hysterectomy ; Korea ; Lymph Node Excision* ; Uterine Cervical Neoplasms ; Uterus ; Vagina ; Young Adult

PURPOSE: We prospectively evaluated the prostate cancer detection rate and pathologic characteristics of patients with a serum prostate-specific antigen (PSA) level of 3.0 to 4.0ng/ml and we compared this with the patients who had a PSA level in the range of 4.1 to 10.0ng/ml. MATERIALS AND METHODS: We analyzed the data of patients who had PSA levels of 3.0 to 10.0ng/ml, benign findings on digital rectal examination (DRE) and no specific lesion identified on transrectal ultrasound. The clinical characteristics, cancer detection rate and pathologic findings of the biopsy and prostatectomy specimen were compared between the low (3.0 to 4.0ng/ml) and intermediate (4.1 to 10.0ng/ml) PSA groups. RESULTS: A total of 370 patients met our criteria and so they were included in the study. Sixty five and 305 patients had low or intermediate PSA levels, respectively. The mean age and the number of prostate biopsy cores were not different between the two groups. Prostate cancer was diagnosed in 26% of the low PSA group and in 20% of the intermediate PSA group. No significant difference was found between the two groups on the pathologic findings of the biopsy and on the pathology findings of the prostatectomy specimens, including the mean Gleason score, the percentage of patients with a Gleason score 7 or higher, the pathologic stage and the percentage of insignificant prostate cancer. CONCLUSIONS: No statistically significant difference was found in the incidence of prostate cancer or pathological characteristics on comparison between the low and intermediate PSA groups. These results suggest that a lower PSA cutoff should be considered as an indication for a prostate biopsy in the Korean population.
Biopsy ; Digital Rectal Examination ; Humans ; Incidence ; Neoplasm Grading ; Pathology ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Ultrasonography

The development of renal glomerular lesions secondary to severe visceral infection (pulmonary, pleural, retroperitoneal or hepatic abscess) is not generally appreciated. Such patients resemble those with infective endocarditis. The suggested pathogenetic mechanisms by which infection can cause glomerular damage are immunologic interaction, direct toxicity of a bacterial products, and some other triggering factors; However, direct correlation between the infectious and immunologic events has not been demonstrated. The histopathologic findings of infectious glomerulonephritis are variable, and these findings, as well as the clinical abnormalities, may resolve with effective antimicrobial therapy or abscess drainage. We experienced a case of glomerulonephritis and acute renal failure due to staphylococcal retroperitoneal abscess. The patient was a 58-year-old man who presented with abdominal and back pain. We performed an abdominal CT scan which showed a retroperitoneal abscess which was proven to be a staphylococcal infection upon percutaneous abscess drainage. Furthermore, we performed a renal biopsy in order to investigate hematuria, RBC casts, and proteinuria. Pathologic findings revealed postinfectious glomerulonephritis. Abscess drainage and sensitive antibiotics were administered, after which his symptoms and urinary abnormalities disappeared, and the retroperitoneal abscess subsided. Here, we report a case of a staphylococcal retroperitoneal abscess which led to postinfectious glomerulonephritis and acute renal failure along with a brief review of the literatures.
Abscess* ; Acute Kidney Injury ; Anti-Bacterial Agents ; Back Pain ; Biopsy ; Drainage ; Endocarditis ; Glomerulonephritis* ; Hematuria ; Humans ; Middle Aged ; Proteinuria ; Staphylococcal Infections ; Tomography, X-Ray Computed

Purpose: We evaluated the variables that may predict the final Gleason score of a radical prostatectomy in the patients showing more than two different Gleason scores in their positive core biopsy specimens. Materials and Methods: We reviewed the pathological data of patients diagnosed with prostate cancer using extended (12 site or more) needle biopsies who underwent a radical retropubic prostatectomy. A total of 73 patients showed more than two different Gleason scores in their biopsy specimen. The following parameters were assessed: highest Gleason score in the biopsy specimen, the Gleason score of the highest tumor percentage in the core and the highest tumor ratio score (Gleason score of highest total tumor length of same Gleason score/total core length of same Gleason score). Concordance of the Gleason scores between the biopsy specimen and prostatectomy was also examined. Results: The highest tumor ratio score showed the highest (64.4%) concordance rate. The concordance rates of the Gleason scores of the highest tumor percentage in the core and the largest linear cancer length were 59 and 58%, respectively. The concordance rate of the highest Gleason score in the biopsy specimens was only 47%. When stratified by grade: well differentiated (Gleason score=6), moderate (7) and poorly differentiated (8-10), the grade concordance rate of the highest tumor ratio score was 73%. The grade concordance rates of the highest and largest linear cancer length Gleason scores were 64.4 and 64.3%, respectively. Conclusions: If a biopsy specimen shows more than two different Gleason scores in positive cores, the highest tumor ratio score may be the most useful variable for predicting the final Gleason score from radical prostatectomy specimens.
Biopsy* ; Biopsy, Needle ; Humans ; Neoplasm Grading* ; Prostatectomy* ; Prostatic Neoplasms

OBJECTIVE: Cerebrovascular and cardiovacular diseases are the main causes of death in patients with chronic renal failure (CRF) and who are undergoing hemodialysis. We investigated the risk factors for the development of intracerbral hemorrhage (ICH) in this population. METHODS: We retrospectively reviewed a total of 53 patients who underwent hemodialysis for CRF and who developed ICH. The patients' demographics, including gender and age, the duration of the hemodialysis, the initial Glasgow Coma Scale (GCS) score, the underlying causes of CRF, the past medication history, the location and amount of hemorrhage and the therapeutic modality for ICH were analyzed. RESULTS: The development of ICH significantly increased in the old age patients (> or = 65 years), the patients with a prolonged history of hemodialysis (> or = 5 years) and the patients with hypertension (p < 0.05). However, gender, anemia (hemoglobin < or = 8.0 g/dl) and the initial systolic blood pressure (> or = 180 mmHg) were not significantly correlated with the occurrence of intracerebral hemorrhage in the hemodialyzed patients. CONCLUSION: The present study suggests that the development of ICH in patients with CRF is increased in the old age patients, the patients with a prolonged history of hemodialysis and the medically co-morbid patients. To avoid this disastrous complication, we should try to minimize the modifiable risk factors of hemorrhagic stroke in CRF patients.
Anemia ; Blood Pressure ; Cause of Death ; Cerebral Hemorrhage ; Demography ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Hypertension ; Kidney Failure, Chronic ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Stroke

PURPOSE: The ureteric length is the most important factor in determining the ideal length of a ureteral stent. In most literature, the ureteric length has been estimated according to the patient height. The ureteric length and reliability of the patient's height were both investigated. MATERIALS AND METHODS: The actual ureteral trace(AUT) and linear distance(LD) from the ureterorenal junction to the ureterovesical junction were measured on the 15 minute intravenous pyelography(IVP) view. A total of 203 patients(100 men, 103 women and 406 ureters), with normal findings, were studied. The AUT, LD and height were all measured. RESULTS: The mean+/-SD height and AUT of the right and left ureters of the patients were 164.3+/-8.3, 23.4+/-1.9 and 24.4+/-2.0cm, respectively. Mean LD of right and left ureters were 22.1+/-1.9 and 22.9+/-2.0cm, respectively. The patient's height showed significant correlations with both the AUT and LD, but these correlations were not linear (R2=0.024 [Rt], 0.059 [Lt]). However, the AUT and LD had a linear correlation (R2=0.879 [Rt], 0.884 [Lt]). Two formulae for estimating the AUT from measurement of the LD were suggested: Right AUT=0.94xright LD+2.6. Left AUT=0.96xleft LD+2.4. CONCLUSIONS: Our results have demonstrated that a patient's height was not reliable for estimating the ureteric length. The LD on IVP is preferable to the patient's height in estimating the ureteric length.
Body Height ; Female ; Humans ; Male ; Stents ; Ureter* ; Urography*

PURPOSE: Prognostic factors of coronary aneurysms in Kawasaki disease have been investigated in many studies. The aim of this study was to identify risk factors associated with early and late coronary artery outcomes in treated patients with Kawasaki disease. METHODS: A total of 392 patients diagnosed with Kawasaki disease from January 2012 to December 2015 in Pusan National University Children’s Hospital were retrospectively selected as subjects of the present study to determine risk factors for coronary aneurysms and persistence of coronary aneurysms after a 1-year follow-up. RESULTS: Coronary aneurysms were detected in 30 of 392 patients within 1 month after the occurrence of Kawasaki disease. Coronary aneurysms persisted in 5 of 30 patients after a 1-year follow-up. A long duration of fever (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.06–2.02; P=0.018) and high platelet count (adjusted OR, 1.00; 95% CI, 1.00–1.01; P=0.009) were found to be independent factors to predict the development of coronary aneurysms in the early phase. Initial coronary severity (adjusted OR, 46.0; 95% CI, 2.01–1047.80; P=0.016) and a high white blood cell count (adjusted OR, 1.17; 95% CI, 1.01–1.36; P=0.028) were found to be significant factors for the persistence of late coronary aneurysms in univariate analysis. However, no significant factors were found in multivariate analysis. CONCLUSION: These data are from early and late follow-up of coronary aneurysms in our unit. Further studies are needed to determine the mechanisms involved in the disappearance of coronary aneurysms and related factors.
Busan ; Coronary Aneurysm ; Coronary Vessels ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Mucocutaneous Lymph Node Syndrome ; Multivariate Analysis ; Odds Ratio ; Platelet Count ; Prognosis ; Retrospective Studies ; Risk Factors

Objective: This study examined whether the changes in reimbursement coverage of brain magnetic resonance image (MRI) affected practice for patients who visited the emergency department with dizziness as the chief complaint. Methods: Among the 5,423 patients who visited the emergency department for dizziness in 2017, 2019, and 2021, 4,497 patients were included in the study retrospectively and investigated by brain diffusion-weighted MRI and the presence of cerebral infarction on brain diffusion-weighted MRI. This study examined whether there was a significant difference before and after the change. Results: In 2017, 2019, and 2021, 1,489, 1,570, and 1,438 patients with dizziness visited the emergency department, respectively. The number of patients who underwent a brain MRI scan gradually increased from 237 (15.9%) in 2017 to 628 (40.0%) in 2019 and 948 (65.9%) in 2021 (P<0.001). The number of positive findings on brain MRI scan increased gradually from 30 patients (2.0%) in 2017 to 47 patients (3.0%) in 2019 and 53 patients (3.7%) in 2021 (P=0.025). The ratio of positive findings of brain MRI scans to the number of patients who underwent brain MRI scans decreased gradually to 12.7% in 2017, 7.5% in 2019, and 5.6% in 2021 (P=0.001). Conclusion The changes in the reimbursement coverage of brain MRI affect the number of brain MRI scans and the detection of cerebral infarction.