PURPOSE: Caliceal diverticular calculi are mostly asymptomatic. In certain cases they may be associated with chronic or recurrent pain, recurrent urinary tract infections, progressive renal damage and hematur ia. The treatment of symptomatic caliceal diverticular calculi has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy (SWL), percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. Percutaneous techniques are frequently used to address the diverticular stone burden, to fulgurate the diverticular wall, to dilated the diverticular neck and improve drainage. For this reason, we reviewed 33 patients with caliceal diverticular calculi to determine whether they could be treated successfully by percutaneous nephrolithotomy (PCNL) as the initial treatment. MATERIALS AND METHODS: A total of 33 patients with caliceal diverticular calculi underwent PCNL between February 1990 and February 2000. The majority of diverticula were located at the upper pole. Access was gained via a direct target puncture. After sequential dilatation of the tract, stones were removed and the diverticular wall was fulgurated. The diverticular neck was dilated with the Amplatz dilator upto 24-30 Fr. and a 20 Fr. nephrostomy catheter was placed. RESULTS: PCNL was performed successfully in 30 patients (90.9%), but puncture was failed in 3. Mean operative time was 105 minutes and mean hospital stay was 4.5 days. All patients who were treated successfully with PCNL became stone-free without any complication. Mean follow-up was 20 months (ranged from 1 to 108 months). Of the 26 patients with symptoms preoperatively, 25 patients were rendered symptom-free (96.2%). Twenty-four patients were assessed with an intravenous urogram at 1 or 3 months and 6, 12 months and there was no stone recurrence. The diverticula were obliterated or had improved drainage in 95.8% (23/24) of assessable cases. CONCLUSIONS: We confirmed that PCNL is a safe, less invasive and effective procedure and should be considered an acceptable form of primary management of patients with caliceal diverticular stone.
Calculi ; Catheters ; Dilatation ; Diverticulum ; Drainage ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lithotripsy ; Neck ; Nephrostomy, Percutaneous ; Operative Time ; Punctures ; Recurrence ; Shock ; Ureteroscopy ; Urinary Tract Infections

No abstract available.
Polyps*

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

No abstract available.
Animals ; Linoleic Acid* ; Macrophages, Peritoneal* ; Mice*

PURPOSE: To evaluate MRI findings of malignant ovarian tumors. MATERIALS AND METHODS: MRI findings were retrospectively reviewed in 25 patients with surgically confirmed 30 malignant ovarian tumors(common epithelial tumor;23, sex cord stromal tumor;2, endodermal sinus tumor ; 1, metastatic tumor ;4). The findings evaluated were the lesion size, solid and/or cystic component, wall thickness, septal thickness, necrosis, invasion of adjacent organ, ascites, and adenopathy. RESULTS: MRI findings of the malignant ovarian tumors were as follow:Size of lesion was 5-35cm(mean 14cm) ;solid component was present in 80%(24/30);wall thickness was more than 3ram in 90%(27/30);septal thickness was more than 3ram in 70%(21/30);tumor necrosis was present in 40%(12/30%) ;invasion of adjacent organ was present in 76%(19/25);ascites was present in 56%(14/25);lymphadenopathy was present in 24% (6/25). MRI findings of absence of solid component(6/6), even wall and septal thickness(7/7, 19/19) were found only in epithelial tumors. Uneven septal thickness more than 3mm(7/11) was a predominant MRI findings of non-epithelial tumors. Well-defined cystic lesion within solid component was seen in Krukenberg tumors. CONCLUSION: Evaluation of the lesion size, internal architecture, invasion of adjacent organ, ascites, and lymphadenopathy in MRI would enable diagnosis of malignant ovarian tumors and could lead to possible differential diagnosis of epithelial tumors from non-epithelial tumors.
Ascites ; Diagnosis ; Diagnosis, Differential ; Endodermal Sinus Tumor ; Humans ; Krukenberg Tumor ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies

PURPOSE: To determine the value of Gd-DTPA enhanced fat-suppression(GEFS) MR imaging in the characterization and differentiation of benign from malignant ovarian tumors. MATERIALS AND METHODS: MRI findings of thirty-seven patients with surgically proved 44 ovarian tumors (30 benign, 14 malignant) were studied retrospectively. MR imaging with conventional spin echo (CSE;Tl-weighted image TR/TE 450/20, T2-weighted image TR/TE 3500/30, 90) and GEFS were performed with a 1.5T GE signa. MRI findings of tumors including cystic or solid, wall and septal thickness, necrosis, invasion to adjacent organ, ascites and lymphadenopathy were assessed separately by using CSE and GEFS images, and then tumors were characterized as benign or malignant. RESULTS: Compared with CSE image, GEFS MR image showed better visualization of solid component in 5 malignant lesions, wall thickness in 5 malignant and 1 benign lesions, septal thickness in 3 malignant and 1 benign lesions, necrosis in 1 malignant lesion, and adjacent soft tissue invasion in 5 malignant lesions. Correct characterization of malignant tumors was increased from 71% on CSE image to 93% on GEFS image. However, correct characterization of benign tumors was 93% on both images. CONCLUSION: GEFS MR imaging could be useful for characterization of ovarian tumors, especially in malignant cases, and employed for differentiation of benign from malignant tumors.
Ascites ; Gadolinium DTPA* ; Humans ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies

PURPOSE: To evaluate clinical usefulness of magnetic resonance angiography(MRA) as a diagnostic modality and for treatment planning of intracranial arteriovenous malformations(AVM). METHODS AND MATERIALS: In 14 patients with intracranial AVM which were confirmed by operations, radiologic studies and clinical evaluations, magnetic resonance imaging(MRI), MRA and conventional angiography(CA) were retrospectively reviewed with specific regards to nidus depiction, detectability of feeding arteries and draining veins, and number and anatomic consistency of these vessles. MRA was obtained by 3 D TOF, 2 D PC, and 3 D methods with adequate VENC selection. RESULTS: Nidus of AVM was well demonstrated in MRI and MRA, and no remarkable difference in detection and size estimation of nidus among MRI, MRA and CA except 2 cases of associated intracranial hemorrhage, in which 3 D PC MRA well depicted nidus that were not visualized on MRI because of subacute hemorrhage. Feeding arteries were well demonstrated on 3 D TOF and 3 D PC MRA. Dilated draining veins were well depicted on 3 D PC MRA by scannig with adequate VENC selection, and the results were no remarkable difference compared with the ones on CA. CONCLUSION: MRA of a consecutive scan after MRI is a excellent modality for evaluation and treatment planning of intracranial AVM, and possible substitutive method for CA except for radiotherapy or transarterial embolization.
Arteries ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Intracranial Hemorrhages ; Magnetic Resonance Angiography* ; Magnetic Resonance Imaging ; Radiotherapy ; Retrospective Studies ; Veins

PURPOSE: We assessed the usefulness of magnetic resonance angiography(MRA) and its techniques for differential diagnosis of hemorrhagic causes in patients with non-traumatic intracranial hemorrhagic disease. MATERIALS AND METHODS: We retrospectively reviewed 74 patients with non-traumatic intracranial hemorrhagic diseases, which were confirmed by radiological examinations(36 cases) and operations(38 cases). We compared the usefulness of magnetic resonance imaging(MRI) alone from MRI with MRA in evaluation of hemorrhagic causes. MRA was obtained by Time-of-Flight(TOF) and Phase Contrast(PC) technique. We investigated the usefulness of TOF and PC technique. RESULTS: MRI with MRA for detection of hemorrhagic causes(89%, 66 cases) was better than MRI only (64%, 47 cases). PC was better than TOF for evaluation of arteriovenous malformation and aneurysm due to subtraction of background noise(hemorrhage). CONCLUSION: MRI with MRA in more useful than MRI alone for evaluation of non-traumatic intracranial hemorrhagic causes.
Aneurysm ; Angiography* ; Arteriovenous Malformations ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

Aortoiliac aneurysm is a rare cause of ureteral obstruction. We report a case of perianeurysmal fibrosis(PAF) associated with aortoiliac aneurysm resulting in hydronephrosis. CT and MRI findigns of PAF are presented. In patient with hydronephrosis of unknown cause, PAF should be included among the differential diagnosis. The diagnosis of PAF is easily made with CT and MRI findings.
Aneurysm ; Diagnosis ; Diagnosis, Differential ; Humans ; Hydronephrosis* ; Magnetic Resonance Imaging ; Retroperitoneal Fibrosis* ; Ureteral Obstruction